Privacy Policy

 

Commitment to Privacy

 

The appropriate collection, use and disclosure of patients’ personal health information isfundamental to our day-to-day operations and to patient care.Protecting the privacy and the confidentiality of patient personal information is important to thephysicians and staff at Pine Forest Functional Medicine.We strive to provide our patients with excellent medical care and service. Every member of Pineforest 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 PolicyOur Privacy Policy attests to our commitment to privacy and demonstrates the ways we ensurethat 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 andemployee associated with the Practice is responsible for the personal information under his/hercontrol. Our employees are informed about the importance of privacy and receive informationperiodically to update them about our Privacy Policy and related issues.​

   2. Identifying Purposes:

Why We Collect InformationWe ask you for information to establish a relationship and serve your medical needs. We obtainmost of our information about you directly from you, or from other health practitioners whomyou have seen and authorized to disclose to us. You are entitled to know how we use yourinformation and this is described in the Privacy Statement posted at The Centre for FamilyMedicine. We will limit the information we collect to what we need for those purposes, and wewill 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 inpatient’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 toWithdrawal 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 consentdirective; healthcare providers may override the consent directive in certain circumstances, suchas 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 WithdrawalForm will be forwarded to the Privacy Officer who will document the request in patient’smedical records and notify appropriate Health care providers and their supporting staff.​

   4. Limiting

CollectionWe 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 RetentionThe information we request from you is used for the purposes defined. We will seek yourconsent before using the information for purposes beyond the scope of the posted PrivacyStatement.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 ofthis 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 ouron-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 basedon current OMA rates prior to release of information.

   6. Accuracy

We endeavour to ensure that all decisions involving your personal information are based uponaccurate 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 InformationWe protect your information with appropriate safeguards and security measures. The Practicemaintains personal information in a combination of paper and electronic files. Recent paperrecords 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 employeesassociated with the Practice, and other agents who require access in the performance of theirduties, and to those otherwise authorized by law.We provide information to health care providers acting on your behalf, on the understanding thatthey are also bound by law and ethics to safeguard your privacy. Other organizations and agentsmust agree to abide by our Privacy Policy and may be asked to sign contracts to that effect. Wewill give them only the information necessary to perform the services for which they areengaged, and will require that they not store, use or disclose the information for purposes otherthan to carry out those services.Our computer systems are password-secured and constructed in such a way that only authorizedindividuals can access secure systems and databases.If you send us an e-mail message that includes personal information, such as your name includedin the "address", we will use that information to respond to your inquiry. Please remember thate-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 thatthe access is secure.​

   8. Openness:

Keeping You InformedThe Practice has prepared this plain-language Privacy Policy to keep you informed. You mayview 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 byphone 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 areasonable 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 ofprocessing your request.​If you find errors of fact in your personal health information, please notify us as soon as possibleand we will make the appropriate corrections. We are not required to correct informationrelating to clinical observations or opinions made in good faith. You have a right to append ashort 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 ofthe 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 anyaspect of our handling of your information.In most cases, an issue is resolved simply by telling us about it and discussing it. You can reachus at:

 

Rubin Marioni, Privacy Officer

Pine Forest Functional Medicine

25312 Interstate 45  Spring,Texas

Office phone: 346-418-9642