The purpose of this policy is to describe the patient right to request a restriction of use and disclosure of protected health information (PHI). HIPAA permits a patient to request that the covered entity restrict uses or disclosures of protected health information (PHI) about the patient to carry out treatment, payment, or health care operations.
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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Updated March 2023
Form - Request for Restriction Not to Bill Health Plan or Insurance (Updated August 2023)
Form - Request for Restrictions of Use and Disclosure of Protected Health Information (Updated September 2023)