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Our Practice

Serving Patients Since 2010

At Pine Forest Functional Medicine, we provide our patients with state-of-the-art facilities and the most experienced and dedicated healthcare professionals in San Francisco. Since we opened our doors to our very first patients, our mission has been to provide quality care in a safe environment—earning us a reputation as the best Medical Clinic in the area.

We believe in being available when others aren’t. We minimize wait times and do our best to offer on-call providers and same-day appointments, when possible. Contact us to find out more.

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Privacy Policy

 

Commitment to Privacy

The appropriate collection, use and disclosure of patients’ personal health information is

fundamental to our day-to-day operations and to patient care.

Protecting the privacy and the confidentiality of patient personal information is important to the

physicians and staff at Pine Forest Functional Medicine.

We strive to provide our patients with excellent medical care and service. Every member of Pine

forest Functional Medicine must abide by our commitment to privacy in the handling of personal

information. This policy was last modified on the 1st day of February, 2020.

Applicability of This Privacy Policy

Our Privacy Policy attests to our commitment to privacy and demonstrates the ways we ensure

that patient privacy is protected. Our Privacy Policy applies to the personal health information of

all our patients that is in our possession and control.

What is Personal Health Information?

Personal health information means identifying information about an individual relating to their

physical or mental health (including medical history), the providing of health care to the

individual, payments or eligibility for health care, organ and tissue donation and health number.

The 10 Principles of Privacy

Our Privacy Policy reflects our compliance with fair information practices, applicable laws and

standards of practice.

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1. Accountability

We take our commitment to securing patient privacy very seriously. Each physician and

employee associated with the Practice is responsible for the personal information under his/her

control. Our employees are informed about the importance of privacy and receive information

periodically to update them about our Privacy Policy and related issues.

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2. Identifying Purposes: Why We Collect Information

We ask you for information to establish a relationship and serve your medical needs. We obtain

most of our information about you directly from you, or from other health practitioners whom

you have seen and authorized to disclose to us. You are entitled to know how we use your

information and this is described in the Privacy Statement posted at The Centre for Family

Medicine. We will limit the information we collect to what we need for those purposes, and we

will use it only for those purposes. We will obtain your consent if we wish to use your

information for any other purpose.

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3. Consent

You have the right to determine how your personal health information is used and disclosed. For

most health care purposes, your consent is implied as a result of your consent to treatment,

however, in all circumstances express consent must be written.

Your written Consent will be forwarded to the Privacy Officer who will document the request in

patient’s medical records and notify appropriate Health care providers and their supporting staff.

Patients who have withdrawn consent to disclose PHI must sign and date the Consent to

Withdrawal Form. It is understood that the consent directive applies only to the PHI which the

patient has already provided, and not to PHI which the patient might provide in the future:

PHIPA permits certain collections, uses, and disclosures of the PHI, despite the consent

directive; healthcare providers may override the consent directive in certain circumstances, such

as emergencies; and the consent directive may result in delays in receiving health care, reduced

quality of care due to healthcare provider’s lacking complete information about the patient, and

healthcare provider’s refusal to offer non-emergency care. Your written Consent to Withdrawal

Form will be forwarded to the Privacy Officer who will document the request in patient’s

medical records and notify appropriate Health care providers and their supporting staff.

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4. Limiting Collection

We collect information by fair and lawful means and collect only that information which may be

necessary for purposes related to the provision of your medical care.

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5. Limiting Use, Disclosure and Retention

The information we request from you is used for the purposes defined. We will seek your

consent before using the information for purposes beyond the scope of the posted Privacy

Statement.

Under no circumstances do we sell patient lists or other personal information to third parties.

There are some types of disclosure of your personal health information that may occur as part of

this Practice fulfilling its routine obligations and/or practice management. This includes

consultants and suppliers to the Practice, on the understanding that they abide by our Privacy

Policy, and only to the extent necessary to allow them to provide business services or support to

this Practice.

We will retain your information only for the time it is required for the purposes we describe and

once your personal information is no longer required, it will be destroyed. However, due to our

on-going exposure to potential claims, some information is kept for a longer period.

Patients may be required to sign and date a Consent to Disclose PHI Form and pay a fee based

on current OMA rates prior to release of information.

 

6. Accuracy

We endeavour to ensure that all decisions involving your personal information are based upon

accurate and timely information. While we will do our best to base our decisions on accurate

information, we rely on you to disclose all material information and to inform us of any relevant

changes.

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7. Safeguards: Protecting Your Information

We protect your information with appropriate safeguards and security measures. The Practice

maintains personal information in a combination of paper and electronic files. Recent paper

records concerning individuals’ personal information are stored in files kept onsite at our office.

Older records may be stored securely offsite.

Access to personal information will be authorized only for the physicians and employees

associated with the Practice, and other agents who require access in the performance of their

duties, and to those otherwise authorized by law.

We provide information to health care providers acting on your behalf, on the understanding that

they are also bound by law and ethics to safeguard your privacy. Other organizations and agents

must agree to abide by our Privacy Policy and may be asked to sign contracts to that effect. We

will give them only the information necessary to perform the services for which they are

engaged, and will require that they not store, use or disclose the information for purposes other

than to carry out those services.

Our computer systems are password-secured and constructed in such a way that only authorized

individuals can access secure systems and databases.

If you send us an e-mail message that includes personal information, such as your name included

in the "address", we will use that information to respond to your inquiry. Please remember that

e-mail is not necessarily secure against interception. If your communication is very sensitive,

you should not send it electronically unless the e-mail is encrypted or your browser indicates that

the access is secure.

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8. Openness: Keeping You Informed

The Practice has prepared this plain-language Privacy Policy to keep you informed. You may

view a copy by visiting us and will hand you PDFcopy and will in due time add it to our website .

If you have any additional questions or concerns about privacy, we invite you to contact us by

phone and we will address your concerns to the best of our ability.

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9. Access and Correction

With limited exceptions, we will give you access to the information we retain about you within a

reasonable time, upon presentation of a written request and satisfactory identification.

We may charge you a fee for this service and if so, we will give you notice in advance of

processing your request.

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If you find errors of fact in your personal health information, please notify us as soon as possible

and we will make the appropriate corrections. We are not required to correct information

relating to clinical observations or opinions made in good faith. You have a right to append a

short statement of disagreement to your record if we refuse to make a requested change.

If we deny your request for access to your personal information, we will advise you in writing of

the reason for the refusal and you may then challenge our decision.

10. Challenging Compliance

We encourage you to contact us with any questions or concerns you might have about your

privacy or our Privacy Policy. We will investigate and respond to your concerns about any

aspect of our handling of your information.

In most cases, an issue is resolved simply by telling us about it and discussing it. You can reach

us at:

Rubin Marioni, Privacy Officer

Pine Forest Functional Medicine

25312 Interstate 45

Spring,Texas

Office phone: 346-418-9642

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