Bay Area Eye Center - HIPAA Patient Disclosure Information Logo
  • Bay Area Eye Center
    Bruce Cline OD | Shannon LeBus OD

    Patient Disclosure Instructions

    In general, the HIPAA privacy rule gives individuals the right to request a restriction on uses and disclosures of their protected health information (PHI). The individual is also provided the right to request confidential communications or that a communication of PHI be made by alternative means, such as sending correspondence to the individual's office instead of the individual's home.

  •  - -
  • I wish to be contacted in the following manner (check all that apply)

  •  -
  •  -
  •  -
  • I allow Bay Area Eye Center to give my clinical information to or answer question(s) from.

  • I acknowledge that I have been provided the opportunity to read a copy of
    Bay Area Eye Centers Notice of Privacy Practices.

  • Clear
  • Should be Empty: