Notice of Privacy Practices

Range Dental is a dental referral and patient-matching service. This Notice applies to any individually identifiable health information that we create, receive, or maintain when providing our services to you.

In order to match you with an appropriate clinic partner, we collect the following categories of protected health information:

• Your name
• Phone number
• Email address
• Your location (city, state, or ZIP code)
• The dental service or treatment you are interested in

We use and disclose your PHI solely to match you with vetted clinic partners in our network who can provide the dental services you have requested. We do not use your PHI for any other purpose, and we do not use it for marketing without your explicit written authorization.

Before any PHI is shared with a clinic partner, Range Dental requires that partner to execute a signed Business Associate Agreement (BAA). This agreement obligates the clinic partner to implement the administrative, physical, and technical safeguards required by the HIPAA Security Rule and to use or disclose PHI only as permitted by the HIPAA Privacy Rule. No PHI is transmitted to any clinic partner that has not signed a current BAA.

You have the following rights with respect to your PHI:

• Right to Access: You may request access to the PHI we maintain about you.
• Right to Amend: You may request that we amend your PHI if you believe it is incorrect or incomplete.
• Right to Request Restrictions: You may request that we restrict how we use or disclose your PHI. We are not required to agree to all requested restrictions, but we will comply with any restrictions to which we agree.
• Right to an Accounting of Disclosures: You may request a list of certain disclosures of your PHI that we have made.

To exercise any of these rights, please contact our Privacy Officer using the information below.

Range Dental does not and will not sell your protected health information. We do not receive direct or indirect remuneration in exchange for your PHI.

If you believe your privacy rights have been violated, you may file a complaint with Range Dental and/or with the U.S. Department of Health and Human Services Office for Civil Rights (OCR). There will be no retaliation for filing a complaint.

Range Dental reserves the right to change this Notice and to make the revised Notice effective for all PHI we already have as well as any information we receive in the future. We will post a copy of the current Notice on our website with the effective date.

For privacy-related questions, to exercise your rights, or to obtain a paper copy of this Notice, contact our Privacy Officer: