Provider Registration

HIPAA COMPLIANT AGREEMENT This Agreement (“Agreement”) is entered into as of [Effective Date], by and between Uclear Direct Aligners, hereinafter referred to as “Company”, and [Client Name], hereinafter referred to as “Client”. Background: The Company provides orthodontic treatment services, including the provision of clear aligners, through its online platform. In the course of providing these services, the Company may have access to Protected Health Information (PHI) as defined by the Health Insurance Portability and Accountability Act (HIPAA). Client Responsibilities:

1. Authorization for Treatment: By reading and submitting this Agreement, the Client acknowledges and accepts the terms herein and authorizes the Company to use and disclose the Client’s PHI for the purposes of providing orthodontic treatment services, including but not limited to the creation and adjustment of clear aligners.
2. Accuracy of Information: The Client acknowledges that it is their responsibility to provide accurate and complete information to the Company to facilitate the provision of orthodontic treatment services. The Client agrees to promptly inform the Company of any changes to their PHI.
3. Consent for Communication: The Client consents to receive communications from the Company regarding their treatment, including appointment reminders, treatment updates, and other relevant information, via email, phone, or other means of communication provided by the Client.

Company Responsibilities:

1. Protection of PHI: The Company agrees to comply with all applicable HIPAA regulations and to implement appropriate safeguards to protect the confidentiality, integrity, and availability of the Client’s PHI.
2. Limited Use and Disclosure: The Company agrees to use and disclose the Client’s PHI only as necessary to provide orthodontic treatment services and as permitted by law. The Company will not disclose PHI to any third party without the Client’s written authorization, except as required by law.
3. Breach Notification: In the event of a breach of unsecured PHI, the Company will comply with HIPAA breach notification requirements, including notifying the Client of the breach promptly.

Miscellaneous:

1. Term and Termination: This Agreement shall remain in effect for the duration of the Client’s treatment with the Company. Either party may terminate this Agreement upon written notice to the other party if the other party breaches any material term of this Agreement.
2. Governing Law: This Agreement shall be governed by and construed under the laws of Miami, FL US, without regard to its conflict of laws principles.
3. Entire Agreement: This Agreement constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether written or oral, relating to such subject matter.

IN WITNESS WHEREOF, the parties have executed this Agreement as of the Effective Date first written above.