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Privacy Policy

What is Protected?

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), a new federal law, requires that Dr. Nicholson & Associates have a special policy for safeguarding a category of health information related to you called “ protected health information,” or “PHI,” received or created in the course of providing services to you through Dr. Nicholson & Associates. PHI is health information that related to:

· your physical or mental health condition,

· the provision of health care to you, or

· payment for your health care that can be used to identify you.

Your prescriptions, vision test results and audiogram results, as well as the information you provide on any Dr. Nicholson & Associates health history form, are all examples of PHI.

The remainder of this Notice generally describes our rules with respect to PHI received or created by Dr. Nicholson & Associates.


Uses and Disclosures of PHI

To protect the privacy of PHI, Dr. Nicholson & Associates not only guard the physical security of PHI, but we also limit the way PHI is used or disclosed to others. We may use or disclose PHI in certain permissible ways, such as those described below.

· To provide you with health care services and products. Dr. Nicholson & Associates use and disclose PHI in order to provide you with health care services and products. Our pharmacists ask you questions regarding drug allergies or review your prescription history in order to ensure that we do not provide you prescription drugs to which you may be allergic or which may interact with other prescriptions. Dr. Nicholson & Associates use your prescription from you ophthalmologist to provide you with the appropriate corrective eye glasses or contact lenses.

· To another health care provider if needed for your treatment. For example, we may discuss your prescription information with your primary care physician if a drug interaction concern or question regarding your prescription presents itself.

· To bill you for health care services or products. Dr. Nicholson & Associates use and disclose PHI to bill you and to accept payment for prescription drugs, glasses, or contact lenses which you may purchase.

· To seek reimbursement or to calculate rewards for health care products or services you receive at Dr. Nicholson & Associates. For example, Dr. Nicholson & Associates use and disclose PHI to receive payments from your health plan for covered prescription drugs purchased from a pharmacy.

· For the administration and operation of Dr. Nicholson & Associates. We use and disclose PHI for numerous administrative and quality control functions necessary for Dr. Nicholson & Associates’ proper operation. For example, we may use your pharmacy prescription drug purchase information for fraud and abuse detection activities or to conduct data analyses for planning related purposes.

· To inform you about treatment alternatives or other health-related benefits that may be offered by Dr. Nicholson & Associates. For example, we may use you prescription data to alert you to a generic drug available as a substitute for the prescription drug you are currently using.

· To another health care provider or health plan for administration and operations purposes. We may share PHI with another health care provider or a health plan who has a relationship with you for quality assessment and improvement activities, to review the qualifications of health care professionals who provide care to you, or for fraud and abuse detection and prevention purposes.

· To a family member, friend, or other person involved in your health care if you are present and you do not object to the sharing of PHI or in the event of emergency. Dr. Nicholson & Associates also may allow a family member, friend or other person to pick up your purchases if, in the exercise of professional judgment and experience, we determine it is in your best interests.

· To comply with an applicable federal, state, or local law, including, for example, workers’ compensation programs established by law.

· For public health reasons, including to a public health authority for the prevention or control of disease, injury or disability; to a proper government or health authority to report child abuse or neglect; to report reactions to medications or problems with products regulated by the Food and Drug Administration; to notify individuals of recalls of medication or products they may be using; or to notify a person who may have been exposed to a communicable disease or who may be at risk for contracting or spreading a disease or condition.

· To report a suspected case of abuse, neglect or domestic violence, as permitted or required by applicable law.

· To comply with health oversight activities, such as audits, investigations, inspections, licensure actions, and other government monitoring and activities related to health care provision or public benefits or services. Inspectors or other government officials may view or receive PHI as a result of a government inspection or other request.

· To The U.S. Department of Health and Human Services to demonstrate our compliance with HIPAA.

· To respond to a subpoena, warrant, summons or other legal request if sufficient safeguards, such as a protective order in the case of a private lawsuit, are in place to maintain PHI privacy.

· To a law enforcement official for a law enforcement purpose as requires by law.

· For purpose of public safety or national security.

· To allow a coroner or medical examiner to identify you or determine your cause of death.

· To allow a funeral director to carry out his or her duties.

· To respond to a request by military command authorities if your are or were a member of the armed forces.

To the extent required under law, we use the minimum amount of PHI necessary to perform these tasks.

If an applicable state law provides greater health information privacy protections than the federal law, we will comply with the stricter state law.

Other Uses and Disclosures of PHI

Before we use or disclose PHI for any other purpose than as described above, we must obtain your written authorization. You may revoke your authorization, in writing, at any time. If you revoke your authorization, Dr. Nicholson & Associates will no longer use or disclose PHI except as described above ( or as permitted by any other authorizations that have not been revoked). However, please understand that we cannot retrieve any PHI disclose to a third party in reliance on your prior authorization.

Your Rights

Federal law provides you with certain rights regarding PHI that pertains to you. Parents of minor children and other individuals with legal authority to make health decisions for customers of Dr. Nicholson & Associates may exercise these rights on behalf of such customer, consistent with state law.

Right to request restrictions: You have the right to request a restriction or limitation on Dr. Nicholson & Associates’ use or disclosure of PHI. The law does not require Dr. Nicholson & Associates to agree to your request for restriction and, depending upon your request, we may not be able to grant it because it may affect our ability to provide care services or products to you. However, if we do agree to your requested restriction or limitation , we will honor the restriction until you agree to terminate the restriction or until we notify you that we are terminating the restriction on a going-forward basis.

You may submit a written request for restriction on the use and disclosure of PHI to our privacy Officer. Your request must specify: (I) the PHI your want to limit; (ii) how you want Dr. Nicholson & Associates to limit the use, disclosure, or both of that PHI; and (iii) to whom you want the restrictions to apply.

Right to receive confidential communications: You have the right to request that Dr. Nicholson & Associates communicate with you about PHI at a new address or by different means if you believe that communication through normal business practices could endanger you. You may submit a written request for confidential communications to your local Health Center.

Right to obtain a copy of PHI: You have the right to review and obtain a copy of PHI that is contained in medical or billing records that Dr. Nicholson & Associates maintain or other records that Dr. Nicholson & Associates use to make decisions about you.

However, we will not give you access to PHI records created in anticipation of a civil, criminal or administrative action or proceeding. We also will deny you request to inspect and copy PHI if a licensed health care professional hired by Dr. Nicholson & Associates has determined that giving you the requested access if reasonably likely to endanger the life or physical safety of you or another individual or to cause substantial harm to you or another individual, or that the record makes references to another person (other than a health care provider), and that the request access would likely cause substantial harm to the other person.


If your request to access PHI is denied, you may have that decision reviewed. A different licensed health care professional chosen by Dr. Nicholson & Associates will review the request and denial, and we will comply with the health care professional’s decision.

You may make a request to review or obtain a copy of PHI at Dr. Nicholson & Associates office. We may charge you a fee to cover the costs of copying, mailing or other supplies directly associated with your request. You will be notifies of any costs before you incur any expenses.

Right to amend PHI: You have the right to request an amendment of PHI if you believe the information Dr. Nicholson & Associates have about you is incorrect or incomplete. You have this right as long as PHI is maintained by Dr. Nicholson & Associates. We will correct any mistakes if we created the PHI or if the person or entity that originally created the PHI is no longer available to make the amendment.

Amendments involving the addition of information to Dr. Nicholson & Associates records may generally be made at Dr. Nicholson & Associates office. However, for other types of changes, or we are unable to accommodate your request, you must submit a written request to amen PHI by filling out a Request for Amendment form available from the Privacy Officer and submitting the form back to our Privacy officer. You should include evidence to support your request because we cannot amend the PHI that we believe to be accurate and complete.

Right to receive an accounting of disclosures of PHI: You have the right to request a list of certain disclosures of PHI by Dr. Nicholson & Associates. The accounting will not include (I) disclosures necessary to provide treatment, to determine proper payment or to operate Dr. Nicholson & Associates, (ii) disclosure we make to you, (iii) disclosure permitted by your authorization, (iv) disclosures to friends or family members as discussed in the Notice, or made in your presence or because of an emergency, or (v) disclosure for national security purposes. Your first request for an accounting with in a 12-month period will be free. We may charge you for costs associated with providing you additional accountings. We will notify you of costs involved, and you may choose to withdraw or modify your request before you incur any expenses.

You may submit a written request for an accounting of disclosures of PHI by filling out a Request for Accounting of Disclosures form available from the Privacy Office and submitting the form back to the Privacy Officer. Your request must include (I) the time period for the accounting, which may not ne longer than six (6) years and may not include dates prior to April 14, 2003; and (ii) the form (e.g., electronic, paper) in which you would like the accounting.

Right to file a complaint: If you believe your rights have been violated, you should let us know immediately. We will take steps to remedy any violations of Dr. Nicholson & Associates’ privacy policy or of this Notice.

You may file a formal complaint with our Privacy Officer and/or with the United States Department of Health and Human Services at the address below. You should attach any document or evidence that support your belief that your privacy rights have been violated .We take your complaints very seriously. Dr Nicholson & Associates policy and federal law prohibit retaliation against any person for filing such a complaint.

Complaints should be sent to:

Dr. Philip L. Nicholson, O.D.

17904 Georgia Avenue

Suite 203

Olney, MD 20832


U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue S.W.,
Washington, DC 20201

Additional Information About This Notice

Changes to this Notice: We reserve the right to change the privacy practices as described in this Notice. Any change may affect the use and disclosure of PHI already maintained by Dr. Nicholson as well as any of PHI that the Doctor may receive or create in the future. If there is a material change to the terms of this Notice, revised Notices will be made available his Web Site at .

Acknowledgement: When first delivering this Notice to you, we will ask you to sign an acknowledgement that you were provided a copy of this Notice.

How to obtain an additional copy of this Notice: You can obtain a copy of the current notice by writing our Privacy Officer at the address or e-mail address set out in this Notice or by logging on to Costco’s Web Site at under the Costco Health Centers section.