HIPPA Statement

April 17, 2003

RE: HIPPA Privacy Standards

As on this date of April 14, 2003, Hearing Systems will not provide or dissimilate any information that has been entered into your personal audiological file to any person, agency or entity not affiliated with Hearing Systems Inc. without written approval from you on the specific records and/or information needed. A copy of this signatory form will be provided to you, the intended entity and to your file for proof of approval of the request of said information.

Sincerely,

David "Max" McCarthy, M.A., CCC-A

Audiologist/ President

Hearing Systems Inc.

ANY COMPLAINTS MAY BE FILED IN WRITING TO:

State Board of Examiners for Speech Pathology and Audiology

Complaints Management & Investigative Section

PO Box 141369

Austin, Texas 78714-1369

(800) 942-5540