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.
​
​
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.
​
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.
​
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.
​
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.
​
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.
​
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.
​
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.
​
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.
​
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.
​
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
​