Patient Rights Forms

Below are the forms referenced in The Oregon Clinic Notice of Privacy Practices.

Section 1

Click to Download:

Request for Restriction on Use or Disclosure of Health Information

Request for Restriction on Use or Disclosure of Health Information to a Health Plan

Request for Specified Method of Communication and Release of Information Agreement

Section 2

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Request for Amendment of Health Information

Section 3

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Request for Accounting of Disclosures of Health Information

Our Promise: It’s important we treat you fairly

The Oregon Clinic provides interpreters for our patients free of charge. Click the image below to view our promise to our patients.