Business Associate Agreement

Please read this Business Associate Agreement (this "BAA") governing the use and disclosure of Protected Health Information that you (the “Covered Entity”) may provide, as a Covered Entity under HIPAA, to MOD Restorative Studio (“MOD” or “Business Associate”). By clicking on the Accept button, you expressly indicate your acceptance of this BA Agreement and agreement to be bound by this BA Agreement. If you do not agree to this BA Agreement, please do not use or access the related services provided by MOD Restorative Studio. Please contact MOD Restorative Studio at info@modrestorativestudio.com if you have any questions or concerns about this BA Agreement.

BACKGROUND

I. Covered Entity is either a “covered entity” or “business associate” of a covered entity as each are defined under the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as amended by the HITECH Act (as defined below) and the related regulations promulgated by HHS (as defined below) (collectively, “HIPAA”) and, as such, is required to comply with HIPAA’s provisions regarding the confidentiality and privacy of Protected Health Information (as defined below);

II. The Parties have entered into or will enter into one or more agreements under which MOD Restorative Studio provides or will provide certain specified services to Covered Entity (collectively, the “Agreement”);

III. In providing services pursuant to the Agreement, MOD Restorative Studio will have access to Protected Health Information;

IV. By providing the services pursuant to the Agreement, MOD Restorative Studio will become a “business associate” of the Covered Entity as such term is defined under HIPAA;

V. Both Parties are committed to complying with all federal and state laws governing the confidentiality and privacy of health information, including, but not limited to, the Standards for Privacy of Individually Identifiable Health Information found at 45 CFR Part 160 and Part 164, Subparts A and E (collectively, the “Privacy Rule”); and

VI. Both Parties intend to protect the privacy and provide for the security of Protected Health Information disclosed to MOD Restorative Studio pursuant to the terms of this Agreement, HIPAA and other applicable laws.

Contact Information

If you have any questions or comments about MOD or this Agreement, you may contact MOD at:

MOD Restorative Studio

320 Broad St. #201

Charleston, SC 29401

info@modrestorativestudio.com