Patient Notice: Your Health Records and Your Rights

Posted in accordance with Texas House Bill 4224 (Health and Safety Code Section 181.105)

Texas law requires us to post clear instructions for requesting your health care records, contacting our licensing authority, and filing a consumer complaint. We are glad to help with any of these at any time. Just ask.

A. How to Request Your Health Care Records

You have the right to access and receive copies of your health care records from this practice.

1.       Submit your request through our secure patient portal (log in at evolveholisticcenter.com and send us a message requesting your records), by email to jason@evolveholisticcenter.com, by mail to 5801 Curzon Ave, Suite 213, Fort Worth, TX 76107, or in person at our office. If you prefer, call 817-313-8026 and we will help you start your request.

2.       Include your full name, date of birth, the specific records or dates of service you need, and the person to whom the records should be sent. Written requests must be signed by you or your legally authorized representative.

3.       We will verify your identity before releasing records. A parent, legal guardian, or authorized legal representative may request records on a patient's behalf with appropriate documentation.

4.       Records are provided within 15 business days from the date of your request, after any applicable fees are received, as required by TBCE Rule §76.2. Fees, if any, are reasonable and cost-based, and you will be notified of any fee before records are prepared. Records are never withheld because of an outstanding balance.

B. How to Contact Our Licensing Authority

Dr. Jason Dixon, DC (License #12971) is licensed and regulated by the Texas Board of Chiropractic Examiners (TBCE).

1.       Website: www.tbce.texas.gov

2.       Phone: 512-305-6700 or toll-free 800-821-3205

3.       Mail: Texas Board of Chiropractic Examiners, 1801 Congress Avenue, Suite 10.500, Austin, TX 78701

C. How to File a Consumer Complaint

If you have a concern about your care or the handling of your health information, you may file a complaint with either of the following:

Texas Board of Chiropractic Examiners: visit tbce.texas.gov and select Complaint Information to submit the complaint form online, or download it and submit by mail, email, or fax. Include dates, names, and a description of your concern.

Office of the Texas Attorney General (for complaints regarding the privacy of your health information, as described by Texas Health and Safety Code Section 181.103): file online at texasattorneygeneral.gov/consumer-protection/file-consumer-complaint.