Doctor Submission Form

1 Disclaimer
2 Doctor Information
3 Patient Information
4 File Upload
5 Payment
  • Privacy and Terms of Agreement

    By checking this box you acknowledge that you have read this entire Privacy and Terms of Agreement and agree with its terms and conditions.

    OB1 Dental Solutions operates this Website to provide online access to educational and coaching resources relating to prosthodontics. This Privacy and Terms of Agreement is intended to supplement any other written agreements governing the use of any information accessed via the Website (as defined below) and is not a replacement for such agreements. This Privacy and Terms of Agreement is binding on all Users of the Website. This Privacy and Terms of Agreement may be updated at the sole discretion of OB1 Dental Solutions and the User (as defined below) hereby agrees to be bound by all subsequent updates of such acknowledgment upon receipt of notice of such updates.

    The term OB1 Dental Solutions refers to the managing team that operates this website. The term “you” or “User” refers to you as a user or viewer of this Website, which shall include both clients subscribing to the Website and coaches providing educational and coaching services through the Website.

    The term “Privacy Laws” refers to any domestic or foreign statute, law (including the common and civil law and equity), constitution, code, ordinance, rule, regulation, restriction, regulatory policy or guideline having the force of law relating to the protection of personal information imposed by any governmental body or regulatory body having jurisdiction over the User including, but not limited to, the Health Insurance Portability and Accountability Act, the American Recovery and Reinvestment Act and the Personal Health Information Protection Act and the regulations promulgated under such laws, including, without limitation, the standards for privacy of individually identifiable health information, the standards for security of electronic protected health information, the breach notification provisions and the enforcement and penalties provisions as amended from time to time.

    Any reference to “personal information” includes any and all information protected under any relevant Privacy Laws. For greater clarity, personal information shall be deemed to include a patient’s Medical Records. The term “Medical Records” is a general term for many types of health data and includes without limitation, a patient’s progress notes (hand-written or computer generated), appointment books, accounts, consultant reports, hospital discharge summaries, pathology reports, medical imaging reports such as x-rays, videos, photographs and medicolegal reports.

    The information contained on this Website does not contain privileged and confidential information identifying any particular patient, including patient information, protected by Privacy Laws. It is intended only for the use of registered account holders. If you are not a registered account holder with the Website, you are hereby notified that any review, dissemination, distribution, or duplication of any information contained on the Website is strictly prohibited.

    Acknowledgement

    By checking the box above and using or visiting the OB1 Dental Solutions website (http://www.ob1dentalsolutions.com/) (the “Website”), you acknowledge and agree to the following terms of use:

    • The information contained on this Website is only to be used for educational and coaching services. The information contained on this Website is not intended, nor shall it be construed, as medical or dental advice. The information contained on this Website is intended to assist, licensed dental practitioners in creating treatment plans for their patients. Any other use of any information contained on this Website is strictly prohibited. Use of the information contained on this Website is not intended to, nor shall it create a doctor-patient relationship.
    • By using this website you agree to strictly adhere to our policy of uploading de-identified photos, xrays, models (digital or otherwise), periodontal probing, notes or any other pertinent information that will help treatment planning.
    • By using this Website you will have access to confidential personal information, including patient information, the use, and disclosure of which is strictly governed by Privacy Laws which you agree to strictly adhere to.
    • You have educated yourself and are familiar with the relevant Privacy Laws governing your use and disclosure of personal information and have satisfied yourself with respect to the same. In the event that you are unsatisfied with your understanding of such Privacy Laws, you have sought the opinion or advice of legal counsel regarding your duties and obligations under such Privacy Laws.
    • You agree to comply with the appropriate safeguards as prescribed by applicable Privacy Laws, to prevent use or disclosure of personal information other than as provided by this Privacy and Terms of Agreement or applicable Privacy Laws.
    • You agree to immediately report any breaches or potential breaches of use of personal information to OB1 Dental Solutions, the individual whose personal information was, or is reasonably believed to have been, accessed, acquired or disclosed and the appropriate governing body under any Privacy Laws, if applicable.
    • Subject to the terms herein, in the event that any of your agents, subcontractors or employees have been provided with authorized access to any personal information or this Website, you will implement reasonable and appropriate safeguards and breach notifications provisions to protect the personal information and the same restrictions and conditions shall apply to any such agents, subcontractors or employees.
    • That all personal information provided by you or posted on this Website was obtained with informed consent and disclosure on this Website is not prohibited under any Privacy Laws or by virtue of any third party rights.
    • That all personal information obtained by you or posted by others on this Website will not be disclosed by you to any third party unless such disclosure is permitted under all applicable Privacy Laws. In the event that any personal information is disclosed to you, you shall document all disclosures in accordance with applicable Privacy Laws.
    • That you will periodically review this Privacy and Terms of Agreement and applicable Privacy Laws for any updates and to ensure continued compliance with the same.

    Indemnity

    You agree to defend, indemnify and hold harmless OB1 Dental Solutions, its employees, agents, officers and directors from and against any and all claims, damages, obligations, judgments, losses, liabilities, costs or debts, legal fees and other expenses arising from: (i) your use of and access to the Website; or (ii) your violation of any third-party right, including without limitation any violation of any privacy right or Privacy Laws. This indemnification obligation will survive the terms of use, the term of your subscription, the term of any consulting agreement, and your use of the Website.

    Third Party Access

    You are responsible for maintaining the confidentiality of your account and password and for restricting access to your computer, and you agree to accept responsibility for all activities that occur under your account or password. OCEC is not under any obligation to verify the actual identity or authority of any person using your account to access the Website. OCEC reserves the right to refuse service, terminate accounts, remove or edit content, or cancel orders in its sole discretion.

    Governing Jurisdiction

    This Privacy and Terms of Agreement shall be governed by the laws Massachusetts and any claim or dispute shall be valued in Massachusetts. By checking the box above and agreeing to the terms of this Privacy and Terms of Agreement you hereby waive any claims that may arise from any other jurisdictions and irrevocably consent to the exclusive jurisdiction of courts located in Massachusetts, USA.

    Entire Agreement

    This Privacy and Terms of Agreement and any supplemental terms governed by any other consulting agreement between you and OB1 Dental Solutions shall constitute the entire agreement between you and OB1 Dental Solutions regarding the subject matter of the Privacy and Terms of Agreement. In the event of any inconsistencies between this Privacy and Terms of Agreement and any other consulting agreement between you and OB1 Dental Solutinos, the provisions of this Privacy and Terms of Agreement shall prevail.

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