Pacific University

Student Health Center

2043 College Way, Forest Grove, OR 97116






  This statement describes how medical information about you may be used and disclosed and how you can get access to this information.  PLEASE REVIEW IT CAREFULLY.



Our Uses and Disclosure—How do we typically use or share your health information?



We can use your health information and share it with other professionals who are treating you.  For example, a doctor treating you for an injury asks another doctor about your overall health condition.


Healthcare Operations:

We may use and disclose your health information in order to run the necessary administrative, educational, quality assurance and business functions.  For example, we may use your health information to evaluate the performance of our staff in caring for you.  We may use and disclose your health information to contact you as a reminder that you have an appointment for treatment or services. For example, we may use your health information to manage your treatment and services.


Billing Purposes:

We can use and share your information to bill and get payment from health plans or other entities.  For example, we give information about you to your health insurance plan so it will pay for your services.   


Other permitted uses and disclosures of your health information

We may use or disclose your health information without your permission in the following circumstances, subject to all applicable legal requirements and limitations:


When Written Authorization is Required.

We will not use or disclose your PHI for any purpose other than the purposes described in this Notice without your written authorization. For example, Pacific University will not supply PHI to another company for its marketing purposes, we will not sell your PHI, and we will not disclose any psychotherapy notes. If you give us authorization, you can withdraw this written Authorization at any time. To remove your authorization, deliver a written revocation—address is at end of this statement.  If you revoke your Authorization, we will no longer use or disclose your health information as allowed by your written Authorization, except to the extent that we have already relied on your Authorization.


Your Rights


When it comes to your health information, you have certain rights.  This section explains your rights and some of our responsibilities to help you.


Our Responsibilities


Notice of Privacy and Confidentiality

We reserve the right to change this statement at any time.  If we change this statement, the new statement will apply to your health information that we already have as well as to such information that we may generate in the future.  If we change this statement, we will post the new notice in our offices and have copies available for you.



Questions or Concerns

If you want more information about our privacy practices, have questions or concerns, please contact: 


Director:                  Kathryn Eisenbarth

Clinic:                        Pacific University Student Health Center

Telephone:              503-352-2705


Address:                  2043 College Way, Forest Grove, OR  97116                  

Rev. 9/23/13