This is the agreement and form to request a cell phone stipend for an employee.  For more information see the Cell Phone Service Guidelines and Policy.

The Code of Conduct outlines principles, policies and some of the laws that govern the activities of the University and to which our employees who represent the University must adhere. The Code of Conduct provides guidance for professional conduct. The success and reputation of the university in fulfilling its mission depends on the ethical behavior, honesty, integrity and good judgment of each member of the community. Those acting on behalf of the University have a general duty to conduct themselves in a manner that will maintain and strengthen the public’s trust and confidence in the integrity of the University and take no actions incompatible with their obligations to the University.  This Code of Conduct supersedes and replaces all prior Code of Conduct, Confidentiality of Records Agreement & Acknowledgement of Pacific University Policies and Procedures.

The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act or Clery Act requires all colleges and universities that participate in federal financial aid programs to keep and disclose information about crime on and near their respective campuses. The following Crime Statistics are provided in compliance with the provisions of this act.

Request an advance on your pay.

This document describes the College of Arts & Sciences administrative structure and policies. The college faculty may recommend alterations to its administrative structure by vote of a majority of faculty members eligible to vote at Faculty Meeting. Major changes require approval by the Provost and the President. All votes described below are by the college’s full-time faculty.

Please submit this form for each new external consulting arrangement to the college dean or to the Provost for non-college faculty members.
Please note that if you have paid external consulting work you also need to fill out the Conflict of Interest Disclosure Form.

This policy establishes a process and guidance for the development, review, approval, and maintenance of University policies and procedures. By implementing this process, the University seeks to enhance operational efficiencies and compliance with applicable laws throughout University operations and activities. Policymaking may be used as a tool for providing guidance and establishing requirements for the areas of the University community covered by the policy or procedure.

Policy template

Procedure template  

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International travel significantly increases the risks of theft or loss of IT equipment and of malware infection that can compromise accounts.  This policy helps to manage these risks and thus manage the risk to university protected data and records. There are also potential legal issues surrounding traveling with encryption and this policy helps manage risk of legal action to the university or its employees.

The Equal Opportunity Policy provides the framework for upholding inclusion, diversity and equity at Pacific University in all academic and employment practices.

To establish guidance regarding students or visitors bringing service or companion animals on University property and, if applicable, the process for appealing a decision relating to a qualifying animal.  This policy does not apply to animals utilized for research or other scholarly activities. 

To establish a process whereby Pacific University faculty, staff, and students may request, and implement, the temporary installation of a public exhibit in or adjacent to a university building or facility. The primary purpose of exhibits on the Pacific University campuses is to promote interest and use of the university’s cultural resources (Archives, Museum, and Art collections); exhibits may also be used to promote diverse scholarly and cultural perspectives or improve access to collections of resources that connect to community or global issues.

SUP - U1003A External Exhibit Agreement

The Code of Conduct provides guidance for professional conduct. The success and reputation of the university in fulfilling its mission depends on the ethical behavior, honesty, integrity and good judgment of each member of the community.

The Code of Conduct outlines principles, policies and some of the laws that govern the activities of the University and to which our employees who represent the University must adhere. Those acting on behalf of Pacific University Healthcare Clinic Operations have a general duty to conduct themselves in a manner that will maintain and strengthen the public’s trust and confidence in the integrity of the University and take no actions incompatible with their obligations to the University.

Those acting on behalf of the University in a capacity related to Health Care Clinics must practice and annually attest to and sign the Code of Conduct, Confidentiality of Records Agreement and Acknowledgement of Pacific University Healthcare Clinic Policies and Procedures.

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Healthcare Code of Conduct Form for Signature (9/2021)

The purpose of this policy is to describe patients’ rights to request an accounting of disclosures of their protected health information.

One of the rights granted to patients under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is the right of the patient to request and receive an accounting of the disclosures of the patient’s PHI. The patient’s right to request and receive an Accounting of Disclosures is described within the Notice of Privacy Practices. This policy describes how Pacific University must to be able to provide the patient with an accurate Accounting of Disclosures.

The scope of this policy is all workforce members of Pacific University’s health care component. Pacific University is a hybrid entity. Only the health care component (i.e., the covered functions) of Pacific University must comply with this policy. All references in this policy to “Pacific University” shall be construed to refer only to the health care component of Pacific University.

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Form - Request for Accounting of Disclosures of Protected Health Information

The purpose of this Policy is to set forth the University’s process for the use and disclosure of PHI pursuant to a written authorization.

This policy describes the uses and disclosures of protected health information (PHI) that require written authorization prior to use or disclosure. This policy establishes guidelines for obtaining and properly documenting an individual’s authorization for any use and/or disclosure of PHI that requires prior authorization. This policy also identifies the elements of a valid authorization and verification for release of PHI upon receipt of an authorization.

The scope of this policy is all workforce members of Pacific University’s health care component. Pacific University is a hybrid entity. Only the health care component (i.e., the covered functions) of Pacific University must comply with this policy. All references in this policy to “Pacific University” shall be construed to refer only to the health care component of Pacific University.

Authorization to Disclose FORM - English

Authorization to Disclose FORM - Spanish

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Policy Updated May 2023; Forms Updated December 2023

The purpose of this policy is to ensure patients the right to request Confidential Communications as required by HIPAA.

HIPAA permits a patient to request that the covered entity communicates by alternative means or to alternative locations.

The scope of this policy is all workforce members of Pacific University’s health care component. Pacific University is a hybrid entity. Only the health care component (i.e., the covered functions) of Pacific University must comply with this policy. All references in this policy to “Pacific University” shall be construed to refer only to the health care component of Pacific University.

Request for Confidential Communications Form

Confidential Communications Revocation Form

The purpose of this Policy is to set forth Pacific University’s process for determining what patient information can be used and disclosed if information that can identify a person has been removed.

Pacific University has a duty to protect the confidentiality and integrity of protected health information (PHI) as required by law, professional ethics, and accreditation requirements therefore this policy outlines the standards that workforce members at Pacific will follow when de-identifying PHI.

This policy applies to the workforce members of Pacific University’s Healthcare Clinics.  Pacific University is a hybrid entity. Only the health care component (i.e., the covered functions) of Pacific University must comply with this policy. All references in this policy to “Pacific University” shall be construed to refer only to the health care components of Pacific University.

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Updated April 2023