Effective Date: June 24, 2025

What is HealthForms?

Datavant’s HealthForms is a secure online service that helps you request completion of health-related forms from your healthcare provider. Whether you need immunization verification, medical leave forms, or other paperwork completed, HealthForms streamlines the process by allowing you to submit your request and receive completed forms digitally, whenever possible. Datavant works directly with your healthcare provider to complete your forms using information in your medical records. These Terms of Use explain your rights and responsibilities when using our service, including payment policies, privacy protections, and what you can expect from the form completion process.

Acceptance of these Terms

These Terms of Use (“Terms”) are entered into by and between you and Datavant, LLC ("Company," "we," or "us"). These Terms govern your access to and use of the HealthForms website (the "Website" or “HealthForms”), including any content, functionality, and services offered via the Website.

By using HealthForms or clicking to accept the Terms of Use, you accept and agree to be bound by these Terms. If you do not agree, do not use HealthForms.

While Datavant powers HealthForms, healthcare organizations may customize how the service appears with their own branding or web address.

You must be 18 years or older and reside in the United States to use HealthForms. By using HealthForms, you’re confirming you meet these requirements.

---

Purpose of the Website

The Website is intended solely for individuals to submit requests to their healthcare providers to complete medical verification forms, including but not limited to disability forms, family and medical leave documentation, workers’ compensation claims, and school or childcare-related health forms. HealthForms is an administrative service. Datavant assists healthcare providers in completing your forms, but does not provide clinical care, certification of a medical condition, or medical opinions.

---

Security

You agree to provide accurate, current, and complete information when using the Website. If you believe that any unauthorized or inappropriate use of the Website has occurred, please contact us immediately. We reserve the right to restrict or discontinue access to the Website for any reason, including violation of these Terms.

---

Payment for Services

By submitting a request, you agree to pay any applicable fees as displayed at the time of submission. Payment must be made through the Website using an approved payment method before your request will be processed. All fees are non-refundable once the request has been submitted, regardless of the outcome or your provider’s response, unless otherwise required by law.

---

Privacy and Use of Personal Information

All personal information submitted through the Website is subject to our Privacy Policy. By using the Website, you consent to our use of your information as described in the Privacy Policy.

---

User Responsibilities

You agree to use the Website only for lawful purposes and in accordance with these Terms. Specifically, you agree not to:

• Submit false, incomplete, or misleading information.
• Request that a form be completed for anyone other than yourself or an individual you are legally authorized to act on behalf of.
• Interfere with or disrupt the operation of the Website.
• Introduce any viruses, trojan horses, worms, logic bombs, or other material that is malicious or technologically harmful.
• Attempt unauthorized access to any part of the Website.
• Use the Website for commercial purposes or on behalf of third parties.

You understand that the completion, accuracy, and timing of any requested medical form is solely the responsibility of your healthcare provider. The Company does not guarantee that any healthcare provider will accept or complete your request.

You affirm that you are authorized to upload relevant information to the Website and obtain any and all medical information that may be included in or attached to the completed health form.

Before submitting a HealthForms request, please ensure that you have recent medical records with your provider related to your form and are requesting forms for yourself or someone you're legally authorized to represent.

---

Intellectual Property Rights

All content on the Website, including text, graphics, logos, and software, is the property of the Company or its licensors and is protected by copyright and other laws. You may use the Website for personal, non-commercial purposes only.

---

Third-Party Services and Links

The Website may contain links to third-party websites or services. The Company is not responsible for the content or practices of any third party and your use of such services is at your own risk.

---

Disclaimers

• Datavant is not a healthcare provider, does not provide medical advice, and does not participate in clinical decision-making or judgments about your health or ability to perform work or other activities.
• Datavant does not guarantee that your form request will be approved, completed within a specific time, or accepted by any employer, school, insurer, or government agency.
• Datavant does not assume responsibility or any liability whatsoever for the completeness, accuracy, or availability of the information supplied in the form. The completeness and availability of your medical records are the responsibility of your healthcare provider.
• Form rejections or benefit denials are outside our control and responsibility.
• The Website and services are provided "as is" without warranties of any kind. While we strive for reliability, temporary service interruptions may occur.

---

Limitation of Liability

To the fullest extent allowed by law, the Company shall not be liable for any damages resulting from:

• Delays or failures by providers to complete forms.
• Rejection of completed forms by third parties.
• Errors or omissions in form content.
• Unauthorized access to your information despite our safeguards.

In no event shall the Company’s total liability exceed $100. Any cause of action or claim you may have relating to these Terms or the Website must be initiated within one (1) year after the cause of action occurs; otherwise, such cause of action or claim is permanently barred.

---

Indemnification

You agree to indemnify and hold harmless the Company and its affiliates from any claims or losses resulting from your use of the Website, violation of these Terms, or infringement of any third-party rights.

---

Governing Law and Jurisdiction

These Terms are governed by the laws of the State of Delaware. All disputes shall be resolved exclusively in the courts located in Delaware unless otherwise required by law.

---

Arbitration

At the Company’s sole discretion, disputes may be resolved by binding arbitration in accordance with the rules of the American Arbitration Association.

---

Modifications and Termination

The Company reserves the right to modify or discontinue the Website at any time without notice. We may also revise these Terms periodically. Changes are effective immediately when we post them, and apply to all subsequent access to and use of the Website (except changes to the arbitration clause, which will not apply to disputes that the Company has been notified of prior to making the change). Continued use of the Website after changes means you accept the new Terms.

---

Entire Agreement

These Terms, along with our Privacy Policy, constitute the entire agreement between you and the Company. These Terms do not create a provider-patient relationship. All clinical decisions are made solely by your healthcare provider.

---

Getting Help

For website issues, payment problems, or submission questions, please contact:
If you have questions about your medical information or clinical recommendations made in a health-related form, please reach out to your healthcare provider directly.

For questions regarding these Terms, please contact: