Your Health Records and How to File a Complaint

1. How to request your health records

Ask in writing. You can email info@calmapsychwell.com, mail your request to 8376 Davis Blvd, Suite 218, North Richland Hills, TX 76182, or hand it to me at the office. Please include your full name, a phone number where I can reach you, the dates of service you want, and how you would like to receive the copy (paper, or an electronic copy). To protect your privacy, I may ask you to confirm who you are before I release any records.

I will respond within 15 days of your written request. If you ask for an electronic copy, you will receive it within 15 business days. If I ever need to hold back part of a record, I will tell you why in writing, and you can ask another qualified professional to review that decision. A reasonable, cost-based fee may apply for copies; I will tell you the amount before I make them.

If you are a Headway client, you can also ask me directly; you do not need to go through Headway.

2. How to contact my licensing board

I am a Licensed Professional Counselor (Texas LPC #91969), licensed by the Texas Behavioral Health Executive Council.

Texas Behavioral Health Executive Council
1801 Congress Ave., Ste. 7.300, Austin, Texas 78701
Phone: (512) 305-7700 · 24-hour toll-free complaint line: 1-800-821-3205
Website: bhec.texas.gov

3. How to file a consumer complaint

You can file a complaint about my professional conduct with the Texas Behavioral Health Executive Council, using the contact details above or its online form at bhec.texas.gov.

For a concern about your health records or privacy, you can also contact the Texas Attorney General, Consumer Protection Division. Its patient privacy page explains your rights, lists the state agencies that handle complaints, and links to its online complaint form: texasattorneygeneral.gov/consumer-protection/health-care/patient-privacy

You can also file a privacy complaint with the U.S. Department of Health and Human Services, Office for Civil Rights: hhs.gov/hipaa/filing-a-complaint or 1-800-368-1019.

I hope you will bring any concern to me first, but you never have to. Filing a complaint will never affect your care.