Pacific University Healthcare Clinic workforce members are committed to quality, honesty and integrity in our handling of billing and coding activities within the healthcare clinics.  We are committed to operate within the laws, rules, regulations, and policies set by the federal and state governments, insurance programs and Medicare/Medicaid carriers, fiscal intermediaries, and others. All clinical billing and coding will be done in compliance with all applicable state and federal laws and regulations.  Pacific University follows the standards set forth by the Office of Inspector General (OIG) to identify areas of billing and coding at risk for non-compliance.  Pacific University workforce members will ensure their billing and coding is compliant with these standards. 

Policy last updated in September 2025. 
PUNID required to view policy.

Forms: 

• Assignment of Benefits and Financial Responsibility
• Assignment of Benefits and Financial Responsibility_Spanish
• General Consent for Treatment & Right to Refuse Care
• General Consent for Treatment & Right to Refuse Care_Spanish
• Informed Consent
• Informed Consent_Spanish
• Patient Rights and Responsibilities Receipt
• Patient Rights and Responsibilities Receipt_Spanish
• Patient Rights and Responsibilities
• Patient Rights and Responsibilities_Spanish
• Self Declaration of Income Form
• Self Declaration of Income Spanish
• Self Pay Agreement Form
• Self Pay Agreement Form Spanish