You have a right to have your complaints heard and resolved in a timely manner. If we
cannot work things out to your satisfaction, you may file a complaint with our licensing
board:

Texas Behavioral Health Executive Council
1801 Congress Avenue, Suite 7.300
Austin, TX 78701
Telephone: 1-800-821-3205
Link to Complaint Form: http://www.bhec.texas.gov/wp-content/uploads/2020/07/BHEC-Complaint-Form.pdf.

If you have a complaint concerning the HIPAA Privacy Regulations, you may contact the U. S. Department of Health and Human Services, Office for Civil Rights, at: OCRMail@hhs.gov.

If you believe that you have a Consumer Complaint regarding the privacy and security of your health information, you may contact the Texas Office of the Attorney General and file a consumer complaint by clicking this link:
https://www.texasattorneygeneral.gov/consumer-protection/health-care/patient-privacy

Texas law requires that requests for mental health records be made in writing.

To obtain your records, or your child’s records, please follow the steps below:

Submit a written request

Choose one of the following options:

• Via Patient Portal Complete our HIPAA-compliant Authorization form and submit it through the patient portal of Just Mind Counseling our electronic health records system.

  • Subject line: “REQUEST FOR RECORDS”

  • Include:

    • The specific records you are requesting

    • The name, address, and/or email address of the intended recipient

• Via Email (if you do not have portal access) Email your written request and completed Authorization form to: scheduling@justmind.org

  • Subject line: “REQUEST FOR RECORDS”

Additional requirements (if applicable):

• Litigation-related records If records are requested for use in litigation, please include:

  • Cause number

  • Case title

  • Court where the case is pending

• Business Records Affidavit

  • If you require a Business Records Affidavit, indicate this in your request

  • Fee: $15

  • Affidavits will not be provided until payment is received

• Records fee

  • Fee for providing records: $25 for electronic records

  • Accepted payment methods: credit cards, or cash.

  • Texas law does not require records to be released until fees are paid

• Couples, family, or third-party records If you are requesting:

  • Couples counseling records

  • Family counseling records

  • Records for anyone other than yourself or your child

• State and federal law require either:

  • A valid Court Order, or

  • An Authorization signed by the individual (or parent/legal guardian)

• Relevant law: 45 C.F.R. §164.512(e); Texas Health & Safety Code §§611.004, 611.0045, 611.008

Instructions for Attorneys and Document Companies

A subpoena alone is not sufficient to compel disclosure of confidential counseling or billing records, or other Protected Health Information (PHI), under HIPAA (45 C.F.R. Chapter 164).

For mental health or medical records requested or subpoenaed in litigation (including testimony), HIPAA permits disclosure only under the following circumstances:

1. In response to a valid court or administrative tribunal order, or

2. When the individual (or parent/legal guardian):

   • Is a party to the proceeding

   • Has notice that the PHI has been requested

   • Does not object to the disclosure

3. An Authorization from the individual or parent satisfies this requirement.

Relevant law: 45 C.F.R. §164.512(e)

Important Note

If the client or parent has indicated that they do not consent to release of records:

• A “Statement of Assurance” will not be accepted

A valid Authorization or Court Order will be required

You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost

 Under the law, health care providers need to give patients who don't have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises