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 from (check all apply)