Privacy Notice

This notice describes how medical information about you may be used and disclosed, and how you can obtain access to this information. Please review it carefully.

Pacific ClearVision Institute
1125 Darlene Lane Suite 100
Eugene, Oregon 97401
541-344-9478 (Fax)

General Rule

We respect our legal obligation to keep information, that identifies you, private. The law obligates us to give you notice of our privacy practices.

Generally, we can only use your health information in our office, or disclose it outside of our office without your written permission, for purposes of treatment, payment or healthcare operations. In most other situations, we will not use or disclose your health information unless you sign a written authorization form. In some limited situations, the law allows us to disclose your health information without written authorization.

Confidentiality and Security of Client Information

We restrict access to nonpublic Patient information to those persons who need to know that information. We maintain physical, electronic and procedural safeguards to protect your Patient information. We will not sell your Patient information to anyone.

Uses or Disclosures of Health Information

Examples of how we use information for treatment purposes:

We may disclose your health information outside of our office for treatment purposes, for example:

Sometimes we may ask for copies of your health information from another professional that you may have seen before.

We may use your health information within our office or disclose your health information outside of our office for payment purposes. Some examples are:

We use and disclose your health information for healthcare operations in a number of ways. Health care operations mean those administrative and managerial functions that we have to do in order to run our office. We may use or disclose your health information, for example, for financial or billing audits, for internal quality assurance, for personnel decisions, to enable our doctors to participate in managed care plans, for the defense of legal matters, to develop business plans, and for outside storage of our records.

Appointment Reminders

We may call to remind you of scheduled appointments. We may also call to notify you of other treatments or services available at our office that might help you.

Uses & Disclosures with an Authorization

In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never happen at our office at all. Such uses or disclosures are:

Other Disclosures

We will not make any other uses of disclosures of your health information unless you sign a written authorization form. You do not have to sign such a form. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it.

Your Rights Regarding Your Health Information

The Law gives you many rights regarding your health information:

Our Notice of Privacy Practice

By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time in compliance with, and as allowed by law. If we change this notice, the new privacy practices 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 our Notice of Privacy Practices, we will post the new notice in our office, having copies available in our office and at


If you think that we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office of Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to Pacific ClearVision, at the address shown at the beginning of this notice. If you prefer, you can discuss your complaint in person or by phone.

For More Information

If you want more information about our privacy practices, call or visit Pacific ClearVision, at the address or phone number shown at the beginning of this notice.

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