Notice of Privacy Practices
Guarneri Integrative Health, Inc.
Pacific Pearl La Jolla |6919 La Jolla Blvd. La Jolla, CA 92037
858-459-6919
858-459-6933 fax
As required by the privacy regulations created as a result of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA). This notice describes how health information about you (as a
patient of this practice) may be used and disclosed and how you can get access to your individually
identifiable health information. Please review this notice carefully; a copy will be provided to you if you
wish.
Our practice is dedicated to maintaining the privacy of your individually identifiable health information
(also called protected health information, or PHI). In conducting our business, we will create records
regarding you and the treatment and services we provide to you. We are required by law to maintain
the confidentiality of health information that identifies you. We also are required by law to provide you
with this notice of our legal duties and the privacy practices that we maintain in our practice concerning
your PHI. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we
have in effect at the time.
We realize that these laws are complicated, but we must provide you with the following important
information:
The terms of this notice apply to all records containing your PHI that are created or retained by our
practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or
amendment to this notice will be effective for all of your records that our practice has created or
maintained in the past, and for any of your records that we may create or maintain in the future. Our
practice will post a copy of our current Notice in our offices in a visible location at all times, and you
may request a copy of our most current Notice at any time.
Rauni Prittinen King, RN
Executive Director
Guarneri Integrative Health Inc.
6919 La Jolla Blvd, La Jolla, CA 92037
858-459-6919 phone, 858-459-6933 fax
The following categories describe the different ways in which we may use and disclose your PHI.
laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis.
We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a
pharmacy when we order a prescription for you. Many of the people who work for our practice –
including, but not limited to, our doctors and nurses – may use or disclose your PHI in order to treat you
or to assist others in your treatment. Additionally, we may disclose your PHI to others who may assist in
your care, such as your spouse, children or parents. Finally, we may also disclose your PHI to other
health care providers for purposes related to your treatment.
services and items you may receive from us. For example, we may contact your health insurer to certify
that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with
details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We
also may use and disclose your PHI to obtain payment from third parties that may be responsible for
such costs, such as family members. Also, we may use your PHI to bill you directly for services and items.
We may disclose your PHI to other health care providers and entities to assist in their billing and
collection efforts.
examples of the ways in which we may use and disclose your information for our operations, our
practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-
management and business planning activities for our practice. We may disclose your PHI to other health
care providers and entities to assist in their health care operations.
of an appointment.
options or alternatives.
health-related benefits or services that may be of interest to you.
member that is involved in your care, or who assists in taking care of you. For example, a parent or
guardian may ask that a baby sitter take their child to the pediatrician’s office for treatment of a cold. In
this example, the baby sitter may have access to this child’s medical information.
provide you with a way to opt out of receiving future fundraising requests.
so by federal, state or local law.
The following categories describe unique scenarios in which we may use or disclose your identifiable
health information:
by law to collect information for the purpose of:
or neglect of an adult patient (including domestic violence); however, we will only disclose this
information if the patient agrees or we are required or authorized by law to disclose this information,
illness or medical surveillance.
activities authorized by law. Oversight activities can include, for example, investigations, inspections,
audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or
actions; or other activities necessary for the government to monitor government programs, compliance
with civil rights laws and the health care system in general.
or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your
PHI in response to a discovery request, subpoena or other lawful process by another party involved in
the dispute, but only if we have made an effort to inform you of the request or to obtain an order
protecting the information the party has requested.
agreement,
description, identity or location of the perpetrator).
identify the cause of death. If necessary, we also may release information in order for funeral directors
to perform their jobs.
transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and
transplantation if you are an organ donor.
circumstances. We will obtain your written authorization to use your PHI for research purposes except
when an Internal Review Board or Privacy Board has determined that the waiver of your authorization
satisfies all of the following conditions:
(A) The use or disclosure involves no more than a minimal risk to your privacy based on the
following: (i) an adequate plan to protect the identifiers from improper use and disclosure; (ii) an
adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless
there is a health or research justification for retaining the identifiers or such retention is otherwise
required by law); and (iii) adequate written assurances that the PHI will not be re-used or disclosed to
any other person or entity (except as required by law) for authorized oversight of the research study, or
for other research for which the use or disclosure would otherwise be permitted;
(B) The research could not practicably be conducted without the waiver,
(C) The research could not practicably be conducted without access to and use of the PHI.
reduce or prevent a serious threat to your health and safety or the health and safety of another
individual or the public. Under these circumstances, we will only make disclosures to a person or
organization able to help prevent the threat.
(including veterans) and if required by the appropriate authorities.
security activities authorized by law. We also may disclose your PHI to federal and national security
activities authorized by law. We also may disclose your PHI to federal officials in order to protect the
president, other officials or foreign heads of state, or to conduct investigations.
if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes
would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and
security of the institution, and/or (c) to protect your health and safety or the health and safety of other
individuals.
programs.
You have the following rights regarding the PHI that we maintain about you:
about your health and related issues in a particular manner or at a certain location. For instance, you
may ask that we contact you at home, rather than work. In order to request a type of confidential
communication, you must make a written request to Rauni Prittinen King, Executive Director, 858-459-
6919 specifying the requested method of contact, or the location where you wish to be contacted. Our
practice will accommodate reasonable requests. You do not need to give a reason for your request.
for treatment, payment or health care operations. Additionally, you have the right to request that we
restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for
your care, such as family members and friends. We are not required to agree to your request; however,
if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies
or when the information is necessary to treat you. In order to request a restriction in our use or
disclosure of your PHI, you must make your request in writing to Rauni Prittinen King, Executive
Director. Your request must describe in a clear and concise fashion:
make decisions about you, including patient medical records and billing records, but not including
psychotherapy notes. You must submit your request in writing to Rauni King, Executive Director in
order to inspect and/or obtain a copy of your PHI. Our practice may charge a fee for the costs of
copying, mailing, labor and supplies associated with your request. Our practice may deny your request
to inspect and/or copy in certain limited circumstances; however, you may request a review of our
denial. Another licensed health care professional chosen by us will conduct reviews.
incomplete, and you may request an amendment for as long as the information is kept by or for our
practice. To request an amendment, your request must be made in writing and submitted to Rauni
Prittinen King, Executive Director. You must provide us with a reason that supports your request for
amendment. Our practice will deny your request if you fail to submit your request (and the reason
supporting your request) in writing. Also, we may deny your request if you ask us to amend information
that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c)
not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our
practice, unless the individual or entity that created the information is not available to amend the
information.
An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your
PHI for purposes not related to treatment, payment or operations. Use of your PHI as part of the routine
patient care in our practice is not required to be documented – for example, the doctor sharing information with the nurse;
or the billing department using your information to file your insurance
claim. In order to obtain an accounting of disclosures, you must submit your request in writing to Rauni
Prittinen King, Executive Director. All requests for an “accounting of disclosures” must state a time
period, which may not be longer than six (6) years from the date of disclosure and may not include dates
before January 1, 2014. The first list you request within a 12-month period is free of charge, but our
practice may charge you for additional lists within the same 12-month period. Our practice will notify
you of the costs involved with additional requests, and you may withdraw your request before you incur
any costs.
practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this
notice, contact Rauni Prittinen King, Executive Director, 858-459-6919.
complaint with our practice or with the Secretary of the Department of Health and Human Services. To
file a complaint with our practice, contact Rauni Prittinen King, Executive Director, 858-459-6919. All
complaints must be submitted in writing. You will not be penalized for filing a complaint.
written authorization for uses and disclosures that are not identified by this notice or permitted by
applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be
revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose
your PHI for the reasons described in the authorization. Please note: we are required to retain records of your care.
Again, if you have any questions regarding this notice or our health information privacy policies,
please contact Rauni Prittinen King, Executive Director, 858-459-6919.
This notice is effective as of January 1, 2014.