Healthcare EULA

HEALTHCARE END-USER LICENSE AGREEMENT

This Healthcare End-User License Agreement (Agreement) governs the access to and use of the licensed healthcare software, patient portal, telehealth services, or related digital health services (Licensed Product) provided by the entity identified below (Provider). Patient Name: Provider Name:

Patient Information

Emergency Contact

Insurance Information

Medical History (for clinical use)

License Grant; Purpose and Use

Subject to the terms and conditions of this Agreement, Provider grants Patient a nonexclusive, nontransferable, revocable limited license to access and use the Licensed Product solely for the purpose of receiving health care services, accessing personal health information, scheduling appointments, and communicating with Provider's care team (Permitted Purpose). Patient shall not copy, distribute, modify, reverse engineer, decompile, or create derivative works of the Licensed Product.

Permitted and Prohibited Conduct

Permitted uses include activities reasonably necessary to receive clinical care and to manage patient health records. Prohibited conduct includes unauthorized access to other users' accounts, attempting to defeat security controls, using the Licensed Product for commercial resale, or transmitting material that is unlawful, defamatory, or harassing. Provider may suspend access for violations.

Privacy, Data Use, and HIPAA Acknowledgment

Patient acknowledges that the Licensed Product will collect, store, and display protected health information (PHI). Provider is obligated to maintain the privacy and security of PHI in accordance with applicable health information privacy laws. Patient expressly authorizes Provider to access, use, and disclose PHI as reasonably necessary to provide clinical care, perform billing and insurance processing, and for operational purposes described in Provider's privacy practices.

Authorization Expiration Date:

I acknowledge that I have received and reviewed Provider's Notice of Privacy Practices and understand my rights to request restrictions, access my health records, and request amendment. I understand that certain disclosures made for public health, legal, or emergency purposes may occur without my prior authorization as required by law.

Electronic Communications and E-Signature Consent

Patient consents to receive electronic notifications, telehealth services, and communications through the Licensed Product and related channels. Patient consents that this Agreement, acknowledgments, and any clinical consents provided electronically shall have the same force and effect as handwritten signatures.

Security; Data Retention; Audit

Provider maintains industry-standard administrative, technical, and physical safeguards to protect PHI. Provider may retain transaction records, audit logs, and clinical data as required for clinical continuity and regulatory compliance. Patient agrees that Provider may monitor and audit use of the Licensed Product to detect misuse and to protect security.

Warranties; Limitation of Liability

Provider warrants that it will use reasonable efforts to maintain the Licensed Product but makes no warranty that services will be uninterrupted or error-free. TO THE MAXIMUM EXTENT PERMITTED BY LAW, PROVIDER DISCLAIMS ALL IMPLIED WARRANTIES, INCLUDING MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT. IN NO EVENT SHALL PROVIDER'S AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THIS AGREEMENT EXCEED ONE HUNDRED DOLLARS ($100.00), EXCEPT WHERE PROHIBITED BY APPLICABLE LAW.

Indemnification

Patient agrees to indemnify and hold harmless Provider and its affiliates from and against any third-party claims, liabilities, damages, losses and expenses (including reasonable attorneys' fees) arising from Patient's misuse of the Licensed Product or breach of this Agreement, except to the extent such claims arise from Provider's gross negligence or willful misconduct.

Termination; Suspension

Provider may suspend or terminate Patient's access immediately for breach of this Agreement or for suspected security incidents. Upon termination, Patient's access to the Licensed Product will cease; Provider may retain a copy of Patient records as required by law. Notice period for non-emergency termination:

Governing Law; Dispute Resolution

This Agreement shall be governed by the laws of the state specified below without regard to conflict of law rules. The parties agree to attempt resolution of disputes through good-faith negotiation and, if unsuccessful, through binding arbitration in the governing state unless prohibited by law. Governing State:

Modifications

Provider may modify terms of this Agreement, feature sets, or practices. Provider will provide notice of material changes through the Licensed Product or electronic communication. Continued use of the Licensed Product after notice of changes constitutes acceptance of the modified terms.

Patient Rights; Revocation

Patient may request to restrict disclosures of PHI or revoke authorizations to the extent permitted by law. Revocation may not be effective to the extent Provider has relied upon the authorization or to the extent disclosure was necessary for treatment, payment, or healthcare operations. Revocation instructions (optional):

Acknowledgment and Certifications

By checking the boxes below and signing this Agreement, Patient certifies that the information provided is true and complete to the best of their knowledge, that they have authority to consent to the uses described, and that they accept the terms and conditions herein.

If Patient is signing as a legal guardian or personal representative, indicate relationship: . Legal authority to sign on behalf of Patient must be provided upon request.

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