Patient Rights Notice

PATIENT RIGHTS NOTICE Texas Health & Safety Code, Section 181.105 (HB 4224)

1. HOW TO REQUEST YOUR HEALTH CARE RECORDS You have the right to request copies of your health care records. To do so:

• Step 1: Submit a written request to our front desk or through our website contact form.
• Step 2: Include your full name, date of birth, and the dates of service for the records you need.
• Step 3: Complete a Records Release Authorization form (available at the front desk).
• Step 4: Records will be provided within the time required by law. A reasonable fee may apply.

2. HOW TO CONTACT OUR LICENSING AUTHORITY Addison Auto Accident Injury Chiropractic is licensed and regulated by the Texas Board of Chiropractic Examiners (TBCE).

• Online: https://db.tbce.texas.gov/fmi/webd/TBCE_Complaint_Portal
• Phone: (512) 305-6700
• Email: tbce@tbce.texas.gov
• Mail: TBCE Compliance & Investigations, 1801 Congress Ave., Ste. 10.500, Austin, TX 78701

3. HOW TO FILE A CONSUMER COMPLAINT To file a consumer complaint regarding health care privacy or records access:

• Texas Attorney General: www.texasattorneygeneral.gov/consumer-protection/health-care
• Phone: 1-800-252-8011
• Online complaint form: www.texasattorneygeneral.gov/consumer-protection/file-consumer-complaint