patient forms

MEDICAL HISTORY
MEDICAL RECORDS
HIPAA Form
PATIENT PORTAL PROXY FORM
MEDICAL HISTORY

All new patients and patients we haven’t seen within two years must fill out a medical history form. Click the link below to view and download the form. You can call our Health Information department at 541-322-2353 to give your medical history by phone, email to him@thecenteroregon.com, or fax to 541-322-2381. 

NOTICE OF PRIVACY PRACTICES

This policy describes how medical information about you may be used and disclosed and how you can get access to this information.

MEDICAL RECORDS

To receive a copy and/or inspect your medical and billing records, please fill out this Release of Information Form and mail, email, or fax it to the Health Information Department at The Center.

Mailing Address:
The Center
Attention: Health Information Dept.
2200 NE Neff Road, Suite 200
Bend, Oregon 97701

Phone: 541-322-2350
Fax: 541-322-2381
Email: himreleaseofinfo@thecenteroregon.com

Office hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.

PRIVACY AND SECURITY

Your personal health information is absolutely secure – even more than a paper chart. Electronic records are protected by HIPAA compliant safety measures including system security, strict user permissions, and passwords. An electronic health record makes sharing information easier, but only with those who are authorized to receive the information. This provides continuity of care to patients and the system, and includes safety features that ensures only those participants in your care have access to your information. If you have questions please contact the Privacy Officer at 541-322-2329.

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

This federal law addresses the right of patients to have their medical information kept private and confidential. HIPAA applies to all clinics, providers, and staff affiliated with The Center. Under HIPAA, any electronic, written, or oral health information that can identify a specific patient is considered Protected Health Information (PHI). Your health care information is a personal matter and we are committed to protecting its confidentiality.

NOTICE OF PRIVACY PRACTICES

As a requirement of HIPAA, you will receive a complete copy of our Notice of Privacy Practices at your first appointment with the clinic. This document provides detailed information about your rights regarding your personal and health information and how that information may be used and disclosed by The Center.

HIPAA Form

The Center may need to communicate with your family or caregivers. By law, your authorization is required for us to do so.

PATIENT PORTAL PROXY FORM

To enroll a child or an adult you make health decisions for, please fill out this form and bring it to your next appointment. Click here to request a connection for yourself.

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