HIPPA Information

Dr. Stephen Lobaugh
1304 G St. NW
Washington, DC 20005

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.

OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your health information. We
are also required to give you this Notice about our privacy practices, our legal duties, and your rights
concerning your health information. We must follow the privacy practices that are described in this Notice
while it is in effect. This Notice takes effect April 14, 2003, and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such
changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices
and the new terms of our Notice effective for all health information that we maintain, including health
information we created or received before we made the changes. In the event we make a material change in
our privacy practices, we will change this Notice and provide it to you.

You may request a copy of our Notice at any time. For more information about our privacy practices, or for
additional copies of this Notice, please contact us using the information listed at the end of this Notice.

USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and healthcare operations. For
example:

Treatment: We may use or disclose your health information to an optician, ophthalmologist or other
healthcare provider providing treatment to you for: a) the provision, coordination, or management of health
care and related services by health care providers; (b) consultation between health care providers relating to
a patient; (c) the referral of a patient for health care from one health care provider to another; or (d) recall
information.

Payment: We may use and disclose your health information to obtain payment for services we provide to you.
This may include: (a) billing and collection activities and related data processing; (b) actions by a health plan
or insurer to obtain premiums or to determine or fulfill its responsibilities for coverage and provision of
benefits under its health plan or insurance agreement, determinations of eligibility or coverage, adjudication
or subrogation of health benefit claims; (c) medical necessity and appropriateness of care reviews, utilization
review activities; and (d) disclosure to consumer reporting agencies of information relating to collection of
premiums or reimbursement.

Healthcare Operations: We may use and disclose your health information in connection with our healthcare
operations. Healthcare operations include things such as quality assessment and improvement activities,
reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider
performance, conducting training programs, accreditation, certification, licensing or credentialing activities.

Your Authorization: In addition to our use of your health information for treatment, payment or healthcare
operations, you may give us written authorization to use your health information or to disclose it to anyone for
any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will
not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a
written authorization, we cannot use or disclose your health information for any reason except those
described in this Notice.

Marketing Health Products or Services: We will not use your health information for marketing communications
without your prior written authorization. We may provide you with information regarding products or services
that we offer related to your health care needs. We will never sell your health information without your prior
authorization.

To You, Your Family and Friends: We must disclose your health information to you, as described in the Patient
Rights section of this Notice. We may disclose your health information to a family member, friend or other
person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if
you agree that we may do so or, if you are not able to agree, if it is necessary in our professional judgment.

Persons Involved in Care: We may use or disclose health information to notify, or assist in the notification of
(including identifying or locating) a family member, your personal representative or another person
responsible for your care, of your location, your general condition, or death. If you are present, then prior to
use or disclosure of your health information, we will provide you with an opportunity to object to such uses or
disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information
based on a determination using our professional judgment disclosing only health information that is directly
relevant to the person's involvement in your healthcare. We will also use our professional judgment and our
experience with common practice to make reasonable inferences of your best interest in allowing a person to
pick up filled prescriptions, medical supplies, x rays, or other similar forms of health information.

Required by Law: We may use or disclose your health information when we are required to do so by law,
including judicial and administrative proceedings.

Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe
that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.
We may disclose your health information to the extent necessary to avert a serious threat to your health or
safety or the health or safety of others.

National Security: We may disclose to military authorities the health information of Armed Forces personnel
under certain circumstances. We may disclose to authorized federal officials health information required for
lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional
institution or law enforcement official having lawful custody of protected health information of inmate or
patient under certain circumstances.

Appointment Reminders and Treatment Alternatives: We may use or disclose your health information to
provide you with appointment reminders (such as voicemail messages, postcards, or letters) or information
about treatment alternatives or other health-related benefits and services that may be of interest to you.

PATIENT RIGHTS
Access: You have the right to review or get copies of your health information, with limited exceptions. You
may request that we provide copies in a format other than photocopies. We will use the format you request
unless we cannot practicably do so. You must make a request in writing to obtain access to your health
information. You may obtain a form to request access by using the contact information listed at the end of this
Notice. We will charge you a reasonable cost based fee for expenses such as copies and staff time. You may
also request access by sending us a letter to the address at the end of this Notice. If you request an
alternative format, we will charge a cost-based fee for providing your health information in that format. If you
prefer, we will prepare a summary or an explanation of your health information for a fee. Contact us using
the information listed at the end of this Notice for a full explanation of our fee structure.

Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates
disclosed your health information for purposes, other than treatment, payment, healthcare operations, where
you have provided an authorization and certain other activities, for the last 6 years, but not for disclosure
made prior to April14, 2003. If you request this accounting more than once in a 12 month period, we may
charge you a reasonable, cost based fee for responding to these additional requests.

Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your
health information. We are not required to agree to these additional restrictions, but if we do, we will abide by
our agreement (except in an emergency).

Alternative Communication: You have the right to request in writing that we communicate with you about your
health information by alternative means or to alternative locations. Your request must specify the alternative
means or location, and provide satisfactory explanation how payments will be handled under the alternative
means or location you request.

Amendment: You have the right to request that we amend your health information. Your request must be in
writing, and it must explain why the information should be amended. We may deny your request under certain
circumstances.

Electronic Notice: If you receive this Notice on our a Web site or by electronic mail (e mail), you are entitled
to receive this Notice in written form.

QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact us.

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made
about access to your health information or in response to a request you made to amend or restrict the use or
disclosure of your health information or to have us communicate with you by alternative means or at
alternative locations, you may complain to us using the contact information listed at the end of this Notice. You
also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide
you with the address to file your complaint with the U.S. Department of Health and Human Services upon
request.

We support your right to the privacy of your health information. We will not retaliate in any way if you choose
to file a complaint with us or with the U.S. Department of Health and Human Services.

Contact Person: Dr. Stephen Lobaugh
Telephone: 202-737-2262 Fax: 202-628-1842
E-mail: stchlo@covad.net
Address: 1304 G St. NW, Washington, DC 20005