Your rights as a client

Notice to clients

All Fair Winds providers are Licensed Marriage and Family Therapists regulated by the Texas Behavioral Health Executive Council. You can verify any provider's license using the “Verify a License” search at bhec.texas.gov.

Requesting your records

You have the right to request a copy of your health care records from Fair Winds, including evaluation reports.

1. Make your request in writing. Send a message through our secure patient portal, or bring or mail a signed request to our office at 6551 Harris Parkway, Suite 240, Fort Worth, TX 76132.
2. Include the client's full name and date of birth, which records you want and the dates they cover, whether you'd like paper or electronic copies, and where they should be sent. If you are requesting records for a child or another person, tell us your relationship to them.
3. We'll verify your identity before releasing records, to protect your privacy.
4. We'll respond within the time limits set by Texas and federal law. A reasonable, cost-based fee for copies may apply where the law allows.

Questions about a records request? Call 817-735-4165. Our Notice of Privacy Practices explains your other rights regarding your health information.

Filing a consumer complaint

If you have a concern about access to your health records, the privacy of your health information, billing or other consumer protection matters, you may file a consumer complaint with the Texas Office of the Attorney General, Consumer Protection Division:

• Online: texasattorneygeneral.gov/consumer-protection/file-consumer-complaint
• Phone: (800) 621-0508

For concerns about a provider's professional conduct, contact the Texas Behavioral Health Executive Council as described above. You're also always welcome to talk with us directly.

Your right to receive a Good Faith Estimate of expected charges

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 or call 1-800-985-3059.

How this works at Fair Winds: testing is self-pay, and the tests you need aren't known until your provider completes the diagnostic interview. You can ask for a Good Faith Estimate at any time. We'll give you one for the diagnostic interview, and a new written estimate for testing once your provider has set your testing plan, before testing begins.

Nondiscrimination and language assistance

Fair Winds Assessment and Counseling Center complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We do not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

We provide, free of charge and in a timely manner:

• Reasonable modifications and appropriate aids and services to people with disabilities so they can communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, accessible electronic formats).
• Language assistance services to people whose primary language is not English, such as qualified interpreters and information written in other languages.

If you need these services, call 817-735-4165.

If you believe we have failed to provide these services or discriminated in another way, you can file a grievance with our office by phone or in writing at the address above. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, online at ocrportal.hhs.gov, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at hhs.gov/ocr/complaints.

Free language assistance

These notices follow the HHS Office for Civil Rights sample tagline and the top 15 languages spoken in Texas. TTY users can call through 711, the free Telecommunications Relay Service. If you need a language not listed here, call us and we will arrange an interpreter.