Patience. understanding. hope.

That’s our promise to you.

To schedule your initial consultation, call us (858) 794-9192 or send us an e-mail at

The initial consultation is focused on getting to know a new patient. It includes a face-to-face patient-to-physician conversation regarding your complaints, medical and family history, previous therapies and diagnostic test results.

Please bring the following to your appointment:

  • Your available medical records
  • Laboratory test results
  • Original radiographic images
  • Current medications (or list) with doses and frequency

The next step of the initial consultation is a comprehensive physical examination oriented on your problems. In addition to the traditional hands-on physical examination, we analyze joints and soft tissues with high-resolution ultrasound which, allows us to gain valuable diagnostic information while in the office. If necessary, an extended physical examination may include thermography, EKG, an instrumental assessment of autonomic nervous system.

Based on results of the initial assessment, we select appropriate diagnostic tests which are performed within several days or weeks following the consultation. These may include customized outsourced (LabCorp & Quest) biochemical, genetic and immunologic tests, radiographic imaging procedures, stool and saliva testing, food intolerance testing, etc.

Typically, the first follow up appointment is scheduled three – four weeks after your initial consultation. The standard length of the initial consultation is one hour.

Please download and bring the new patient paperwork to your first appointment.

New Patient Packet

Follow-up appointments are focused on discussion of the diagnostic test results, administration of additional diagnostic tests, if necessary, and selection of initial therapy. Based on results of the initial consultation and diagnostic findings, we offer patients several highly individualized therapeutic choices, which include traditional therapy, alternative therapy, when appropriate, or the integrative approach combining both therapies under one umbrella.

Further follow-up appointments are focused on assessment of the treatment efficacy and medical maintenance issues. Based on the selected therapeutic protocols, during follow-up appointments we perform all the necessary procedures and additional diagnostic tests.

Depending on the complexity of the problem, the length of the follow-up appointment varies from 15 to 20 minutes.

The Institute for Specialized Medicine participates with Medicare (not accepting new Medicare patients), Tricare and most PPO insurance plans. Participation varies as changes occur within the insurance industry. Please check with our receptionists to find out if we participate with your insurance plan.

For your convenience, we will file your primary insurance claims if you provide us with the correct billing information. We ask you to pay the deductible, co-insurance, or co-payment at the time of service. We accept cash, Visa, Mastercard, American Express and Discover cards.

Certain services provided by the Institute for Specialized Medicine are fee-for-service only. They include (but are not limited to): acupuncture, shock-wave therapy, laser therapy, prolotherapy, focused dietary consultations, and optimization of exercises.

HIPAA is an abbreviation for Health Insurance Portability and Accountability Act. The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the US Congress in 1996.

According to the Centers for Medicare and Medicaid Services (CMS) website, Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs.

Title II of HIPAA, the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. The AS provisions also address the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the nation’s health care system by encouraging the widespread use of electronic data interchange in the US health care system.

The Institute for Specialized Medicine respects and complies with the federal regulation known as “HIPAA Privacy Rule”. We do everything possible to protect our patients’ privacy. All charts, records and phone messages are kept confidential. If we have to notify you by phone, we will follow your precise instructions about where to call, who to talk to and to leave a message should you not answer the phone yourself.

The “HIPAA Privacy Rule” is set up to assure that patient related information is kept strictly confidential. We ask each patient to assist in our compliance of this regulation by reading and signing the following document which outlines the HIPAA stipulations. This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Click here for our notice of privacy practices

FAQs regarding HIPAA

Should pharmaceutical reps have access to the patient care area?
They should not be allowed to have access to PHI either verbal or written unless the patient agrees. If the physician is not in the facility where the services are being provided then they cannot be billed by the nurse, unless the service is considered to be “general supervision only”.

If pharmaceutical reps come to the office for a preceptorship (to spend the day following the physicians), is verbal consent sufficient from each patient, or is it necessary to get written consent?
To be safe, get written agreement, as the patient may feel pressured and forget verbal consent with a pharmaceutical rep.

How much structural modification to reduce voice transmission is necessary in the office setting?
Technically HIPAA should not require major modification of office physical structure. However, procedural structure should be changed to accommodate privacy.

Should family members be present in the exam room, even after the agreement of the patient?
If patient agrees it is ok, then document agreement.

Is it helpful to have a sign at the checkout window asking whether a private area for scheduling tests is preferred?
If possible the scheduling should be done in a separate area. If not, a sign-in should suffice or alternatively a buffer zone should be created so that others cannot overhear.

What about two MDs with different specialties and practices who share a common office? How does one establish a HIPAA agreement between two groups?
Policy should indicate that records are not shared more than necessary, and precautions should be taken to make certain that information is only provided to those who need it.

An elderly patient comes with her family member (daughter/son), who came with her once before. Will it be ok to release medical info (e.g., lab results) or conduct treatment with the daughter or son present if the patient agrees?

If relatives or friends are present in the examining room, is there an implicit permit to release info to that person in the future? How do we document that?
If another person is present with the patient during a visit it should be documented that the person was there with patient consent.

A false positive on a syphilis tests is sent by the lab to state public health agency. Is this a HIPAA violation?
HIPAA provides protection for reporting of communicable diseases.

Does a list of problems count as chief complaint? For example, a patient returns for follow-up of the following problems listed: RA and osteoporosis.