Terms and Conditions

Effective Date: 28 October 2026

1. USER CONTENT SUBMISSION GUIDELINES
2. GENERAL TERMS AND CONDITIONS
3. COPYRIGHT INFRINGEMENT NOTIFICATION

Thank you for visiting MDCalc. The terms “we”, “us”, “our”, and “MDCalc” refer to MDCalc Ltd, Inc., and any of its direct and indirect subsidiaries. MDCalc provides online point-of-care clinical decision-support tools, including medical calculators and clinical practice guidelines, which may include artificial intelligence query support connected to third party artificial intelligence solutions and authoritative sources (collectively referred to herein as the “Services”), for use by healthcare professionals. “You”, “your” refers to any person accessing and/or using any of the Services. The decision-support tools are based on published clinical research, and MDCalc’s content is written by physician authors. The Services are not intended for use by laypersons.

Please read these Terms and Conditions (“Terms”) carefully since any use of this Website and all Services constitutes your acceptance of these Terms and our Privacy Policy. These Terms apply to all users except those who are operating in an MDCalc customer’s organization.

IF YOU USE THE SERVICES IN THE COURSE OF YOUR WORK FOR ONE OF MDCALC’S CUSTOMER ORGANIZATIONS THAT HAS EXECUTED A SERVICE AGREEMENT OR LETTER OF INTENT WITH MDCALC THAT IS CURRENTLY IN EFFECT, THESE TERMS DO NOT APPLY TO YOU.

The “Website” refers to MDCalc.com, the MDCalc app, and crosscover.ai. In addition, MDCalc publishes an online journal of peer-reviewed articles entitled “Evidence to Action: Official Journal of MDCalc” (the “Journal.”) Neither the Service nor the Journal is intended for use by laypersons.

If you do not agree to these Terms, please do not use these Websites or any of the Services.

In consideration of your use of the Services, you agree to provide accurate, and complete registration information, and to maintain and promptly update such information to keep it current, and complete. You must be at least 18 years of age to accept these Terms and to use the Services.

Product-Specific Terms; Incorporation of Schedules

Certain Services are governed by additional, product-specific terms set forth in the schedules to these Terms (each, a “Schedule”), which are incorporated herein by reference and form part of these Terms:

• Schedule A: Quality Rating System (QRS) Terms of Service Addendum;
• Schedule B: Collections Terms of Service Addendum;
• Schedule C: CrossCover Terms of Service Addendum; and
• Schedule D: Evidence to Action Journal

Your use of the Quality Rating System, Collections, or CrossCover constitutes your acceptance of the applicable Schedule(s) above, in addition to these Terms. If a Schedule directly conflicts with the General Terms and Conditions set forth above with respect to the specific Service to which that Schedule applies, the Schedule shall govern solely as to that conflict.

1. USER CONTENT SUBMISSION GUIDELINES

We may allow you to comment on and participate in interactive features on our Website. We may also allow you to submit content and materials for use on our Website via our online submission form or email. For example, through use of a calculator, formula, or equation creator, you may be able to submit text, photographs, messages, or videos. The information you post or submit for use on our Website are collectively referred to as “User Content”. You agree to the submission guidelines outlined below (“Submission Guidelines”) when submitting User Content.

Submission Guidelines

A) User Content:

You agree that your User Content is accurate and complete.

You also agree that:

• Your User Content is created exclusively by you. This means that you did not copy it from any other source. If you did not create your User Content, anyone that created it or helped create it must give you permission to submit your User Content to us. By submitting or uploading User Content, you authorize MDCalc to use, publish, and otherwise reproduce, modify, and distribute such User Content with or without attribution to you in perpetuity, worldwide in any and all MDCalc media for any lawful purpose. These uses may include, but are not limited to, information, education, promotion, or advertising of MDCalc or its products via the Internet, websites, mobile apps, and social media. If individuals other than you appear in a photo or video that you submit, you must advise any person (or the legal guardians of any persons) depicted in your User Content that we may exploit User Content in any manner whatsoever and obtain a written consent and release from such persons before you submit the associated User Content.
• Your User Content must not threaten or disparage others. This includes not harassing or intimidating other users. It also includes not defaming or libeling anyone. Your User Content must not contain hateful language. This includes not making negative comments connected to race, national origin, religion or other protected classes.
• Your User Content must not disclose confidential or personal information about other individuals or companies without such person’s / company’s written consent.
• You agree that any material you submit to our Services by upload, or otherwise, including any data, questions, comments, ideas, suggestions or the like are, and will be treated as, non-confidential and non-proprietary.
• You grant us an unrestricted, unconditional, unlimited, worldwide, irrevocable, perpetual, and royalty-free right and license to all or any portion of your User Content. We may use your User Content in any lawful manner and for any lawful purpose without compensation to you. This might include hosting, caching, or storing your User Content. We might also copy, distribute, or sell your User Content. We might also display, perform, publish, broadcast, or transmit User Content. You also understand that we may modify, edit, reformat, or translate your User Content. We may use also your User Content to develop, manufacture, and market products. We may use your User Content to train algorithms and may share your User Content with third parties to test the quality of the Website Content and our user experience. We may sub-license our rights hereunder to third parties who may benefit from the rights and licenses granted to us under these Submission Guidelines and our Terms. Your User Content may be searched and accessed by others.
• You represent and warrant that you own your User Content and have the right to grant the license described above. You further represent and warrant that our use of your User Content will not violate anyone’s intellectual property rights or other rights of any person or entity or otherwise place us in breach of any applicable laws.
• MDCalc has no obligation to use the information submitted. You understand that MDCalc employs both internal and external resources that may have developed or may in the future develop ideas identical or similar to your User Content and that MDCalc is only willing to consider the submissions of User Content on these Submission Guidelines.

B) Website Content and Limitations on Use

All clinical tools and content contained on or accessed from the Website, including text, graphics, user interfaces, visual interfaces, photographs, trademarks, logos, videos, images, applications, programs, computer code and other information (collectively, the “Website Content”), including, but not limited to, the design, layout, MDCalc green background color, and “look and feel” and arrangement of such Website Content, is owned by MDCalc or its licensors and is protected by copyright, trademark, and other intellectual property and unfair competition laws.

Website Content also includes any output, response, recommendation, summary, or other content generated by or through any artificial-intelligence-assisted feature of the Services, including any chatbot-style query interface and any automated cross-check or validation function (collectively, “AI Outputs”), and the underlying retrieval, ranking, matching, scoring, or other methodology, models, rules, or algorithms used to generate Website Content or AI Outputs (collectively, “Methodology”). AI Outputs and Methodology are owned by MDCalc or its licensors.

You may view the Website Content from the Services, solely for your clinical or academic use, to generate individual results, or download a single copy of the individual result, provided you keep intact all copyright and other proprietary notices. Any use of Website Content or AI Outputs that MDCalc otherwise permits under these Terms or a Schedule must include clear and conspicuous attribution to MDCalc or in another form as specified by MDCalc. Attribution does not, by itself, authorize any use not otherwise expressly permitted under these Terms.

You may not copy, display, distribute, modify, publish, reproduce, store, transmit, post, translate, or create other derivative works from, or sell, rent or license all or any part of the Website Content, products, or services obtained from the Services in any medium to anyone, except as otherwise expressly permitted under these Terms and Conditions. Without limiting the foregoing, You may not use the Services to generate results in bulk, or download any aggregated results or content. You may not use the content provided through the Services to train any artificial intelligence (AI) or machine learning (ML) models. This restriction applies equally to any AI Output, and to any dataset, training corpus, fine-tuning set, retrieval index, or embedding store, regardless of whether the underlying content is obtained by automated scraping, manual transcription, bulk export, API access, or any other method. You may not use the Services, Website Content, or any AI Output to benchmark, evaluate, or compare the performance, accuracy, or output of any other product or service, including a competing artificial intelligence or clinical decision-support system, without MDCalc’s prior written consent.

You may not reverse engineer, disassemble, decompile, or translate any software used to deliver the Website Content, or otherwise attempt to derive the source code of such software, except to the extent expressly permitted under applicable law, without our prior written permission. You may not engage in systematic retrieval of Website Content from the Services to create or compile, directly or indirectly, a collection, compilation, database, or directory of Website Content without our prior written permission. You may not reverse engineer, decompile, or otherwise attempt to derive any Methodology, in whole or in part, whether by systematic querying, prompt-based probing, statistical analysis, or any other method.

You may provide suggestions, comments or other feedback (collectively, “Feedback”) to MDCalc with respect to the Services. Feedback is voluntary. MDCalc may use Feedback for any purpose without obligation of any kind. To the extent a license is required under your intellectual property rights to make use of the Feedback, you grant MDCalc an irrevocable, non-exclusive, perpetual, fully-paid-up, royalty-free license to use the Feedback in connection with MDCalc business, including the enhancement of the Services.

C) Prohibition on Inputting Protected Health Information

MDCalc is neither a Covered Entity nor a Business Associate as defined under the Health Insurance Portability and Accountability Act of 1996, as amended, and its implementing regulations, including the HIPAA Privacy Rule (45 C.F.R. Parts 160 and 164) (“HIPAA”).

You will not use the Services to create, receive, maintain, transmit, or otherwise process any information that includes or constitutes Protected Health Information (“PHI”), as defined under HIPAA. Specifically, you will not input, upload, or transmit PHI through the Services.

If you submit PHI to the Services in violation of these Terms— whether inadvertently or otherwise — such submission shall not, in itself, cause us to become subject to obligations under HIPAA. We will have no obligation to treat any such information as PHI, to provide HIPAA-required safeguards in respect of such information, or to notify any individual of a potential breach arising from your unauthorized submission. You shall bear sole responsibility for any HIPAA violation, regulatory penalty, enforcement action, or third-party claim arising from any unauthorized PHI submission.

We make no representation, warranty, or covenant that the Services, as generally provided, comply with HIPAA or are suitable for use in a HIPAA-regulated environment. Nothing in these Terms, our marketing materials, documentation, or public statements shall be construed as a representation that we have implemented the administrative, technical, or physical safeguards required by HIPAA with respect to PHI.

2. GENERAL TERMS AND CONDITIONS

A) Changes

We reserve the right to modify these Terms at any time, and you agree (including by virtue of your continued use of our Services) to be bound by any such changes. Unless explicitly stated otherwise, any new features or functionality (including, without limitation, video and related projects) that augment or enhance our Services shall be subject to these Terms. Please check these Terms for any modifications. The “Effective Date” at the beginning of these Terms reflects the date of the most recent update.

B) Website Links

From Our Website: The Services may contain links to or otherwise provided access to third-party sites or resources. MDCalc is not responsible for the availability of external sites or resources linked or otherwise accessible from the Website, and does not endorse and is not responsible or liable for the performance of any such third party sites or resources or any content, advertising, products, or other materials on or available from such third-party sites or resources. Transactions that occur between you and any third-party are strictly between you and the third-party and are not the responsibility of MDCalc. You should review the applicable terms and conditions and privacy policies of such third party sites or resources, as their policies govern use of such sites or resources and may differ from ours.

From Your Website to Our Website: If you wish to incorporate a link to our Website within your website, you may do so, provided that you do not state or imply any sponsorship or endorsement of your website by MDCalc. Nor shall the materials on your website imply any association with or relation to MDCalc or imply in any way that any materials from the MDCalc Website are maintained within your website. We grant you a nonexclusive, limited license to display MDCalc’s trademarks, domain names, brand names, and logos (collectively, “Marks”) on your website when establishing a link to our Website. Links to our Website other than the one using the Marks are not permitted.

You may not alter in any way the MDCalc Marks. Use of the MDCalc Marks for purposes other than linking to the MDCalc Website from your website is expressly prohibited. The Marks may not be used or associated with any obscene, scandalous, inflammatory, pornographic, indecent, profane, defamatory, or unlawful website or materials in any way, or in any manner that would adversely affect the name, reputation, and goodwill of MDCalc and/or its products or services.

We retain and reserve all rights in and to MDCalc’s Marks MDCalc reserves the right to terminate the license granted herein at any time and for any reason. Upon receipt of notification of termination, your use of the Marks must cease and the link between the MDCalc’s Website and your website must be removed. Use of MDCalc’s Marks for any purpose not expressly granted herein is prohibited. For MDCalc’s other intellectual property rights, including in the Feedback, AI Outputs, Methodology, and other outputs generated by the Services, see Section 2(L) below.

C) Legally-Compelled Disclosure of User Information

You agree that in the event MDCalc receives a subpoena or other legal process issued by a court, law enforcement or government agency requiring disclosure of information regarding you, your use of the Services, or otherwise, we shall comply with such subpoenas without prior notice to you.

D) Systems Operations

MDCalc aims to keep Services available twenty-four (24) hours a day, seven (7) days a week, and to maintain saved information. However, we shall not be liable for lost, altered, or corrupted information or non-availability of the Services.

MDCalc reserves complete and sole discretion with respect to the operation of the Services. We may withdraw, suspend, or discontinue any functionality or feature of the Services at any time. We are not responsible for transmission errors, corruption, or compromise of information carried over local or interchange telecommunications carrier. We are not responsible for maintaining information with respect to the Services. We reserve the right to maintain, delete, or destroy all User Content, communications or information posted or uploaded to the Services in accordance with our internal record retention and/or destruction policies.

E) Beta Features

“Beta Feature” means any feature, functionality, tool, calculator, content, or Service (including any artificial intelligence–assisted feature) that MDCalc designates as “beta,” “preview,” “pilot,” “early access,” “experimental,” or with a similar label, or that MDCalc otherwise makes available for evaluation, testing, or feedback before general release.

MDCalc may, in its sole discretion, make Beta Features available to some or all users. Beta Features may contain errors or inaccuracies, may not have completed MDCalc’s full clinical content review or validation process, and may be changed, suspended, or discontinued at any time without notice, as further described in Section 2(D). MDCalc has no obligation to release any Beta Feature as a generally available Service.

Without limiting Section 2(G), you should not rely on a Beta Feature as the sole basis for any clinical decision and are responsible for independently verifying any output of a Beta Feature before acting on it. BETA FEATURES ARE PROVIDED “AS IS” AND “AS AVAILABLE,” AND THE DISCLAIMERS AND LIMITATIONS OF LIABILITY IN SECTION 2(G) APPLY TO BETA FEATURES TO THE FULLEST EXTENT PERMITTED BY LAW.

Any Feedback you provide regarding a Beta Feature is subject to Section 1(B). Except as stated in this Section, Beta Features are subject to all other provisions of these Terms, including any applicable Schedule.

F) Prohibited Activities

Any use of the Services beyond that permitted by these Terms is prohibited. Without limiting the foregoing, you are prohibited from using the Services in any of the following ways:

• to encourage or assist others in harming the Services or using the Services to harm others;
• to damage, disable, overburden, or impair the Services (or any network connected to the Services);
• to upload files that contain viruses that may cause damage to the property of MDCalc or the property of other individuals;
• to modify, edit, copy, reproduce, create derivative works of, reverse engineer, alter, enhance or in any way exploit any of the Services;
• Unless expressly authorized by us, you may not use any robots, spiders, crawlers, or other automated downloading programs, algorithms or devices, or any similar or equivalent manual process, to: (i) automatically search, scrape, extract, deep link, or index any content; (ii) harvest contact information from the Services for purposes of sending unsolicited or unauthorized material; or (iii) cause disruption to the Services or any other person’s use of the Services. If the Services contain robot exclusion files or robot exclusion headers, you agree to honor them and not use any device, software, or routine to bypass them;
• to gain unauthorized access to any portion or feature of the Services, any other systems or networks connected to the Services or to any MDCalc server, or any of the products or services provided on, accessed from or distributed through the Services;
• to probe, scan, or test the vulnerability of the Services or any network connected to the Website or breach the security or authentication measures on the Services or any network connected to the Website;
• to impersonate any person or entity or otherwise misrepresent your affiliation with a person or entity;
• to modify, publicly display, publicly perform, reproduce or distribute any of this Website;
• to violate any local, state, national, foreign, or international statute, regulation, rule, order, treaty, or other law;
• to cause MDCalc to violate any law or distribute any malware or malicious content;
• to violate or infringe upon the intellectual property rights or the privacy or publicity rights of any person or entity;
• to post or transmit to the Services any unauthorized material including, but not limited to, material that is, in our opinion, likely to cause annoyance, detrimental to or in violation of MDCalc’s or any third party’s systems or network security, libelous, defamatory, racist, obscene, threatening, pornographic, profane, or is otherwise unlawful;.
• to defame or libel MDCalc, its employees, or other individuals or acting in such a way that brings into disrepute the good name of MDCalc; or
• Otherwise attempt to interfere with the proper working of the Website and the Services.

You also agree to pay any damages that we are required to pay as a result of your violation. You alone are responsible for any violation of these Terms by you. We reserve the right to assume the exclusive defense and control of any matter otherwise subject to indemnification by you and, in such case, you agree to cooperate with our defense of such claim.

MDCalc reserves the right to monitor your use of the Website and the Services, and may suspend or terminate your access to and use of the Website and the Services in our sole discretion.

G) Disclaimer of Warranties and Liability

Neither MDCalc nor its suppliers or licensors makes any warranty whatsoever, including without limitation, that the operation of the Services will be uninterrupted or error-free; that any defects will be corrected; that the Services are free of viruses or other harmful components; or as to the accuracy, completeness, reliability, availability, suitability, quality, non-infringement, operation or result obtained from the use of any content, product or service provided on, accessible from or distributed through the Services.

THE SERVICES, INCLUDING ALL CONTENT AND PRODUCTS, INCLUDED IN OR ACCESSIBLE FROM THE SERVICES, ARE PROVIDED “AS IS” AND WITHOUT WARRANTIES OR REPRESENTATIONS OF ANY KIND (EXPRESS, IMPLIED AND STATUTORY, INCLUDING, BUT NOT LIMITED TO, THE WARRANTIES OF TITLE AND NONINFRINGEMENT AND THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE), ALL OF WHICH MDCALC DISCLAIMS TO THE FULLEST EXTENT PERMITTED BY LAW. YOUR USE OF THE SERVICES AND THEIR CONTENT AND PRODUCTS IS AT YOUR SOLE RISK.

To the extent permitted under applicable law, no responsibility is assumed for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any ideas, instructions, methods, products, or procedures contained in the Services. MDCalc is not a medical provider. The Service and Website Content are Clinical Decision Support tools intended for use by qualified healthcare professionals. It is provided for informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is designed to complement, not replace, the independent professional clinical judgment of a healthcare provider. The user retains sole responsibility for verifying all patient-specific data, clinical guidelines, and underlying medical rationale before making any clinical decisions or treatment plans. Medical and health care providers should exercise their own independent clinical judgment. No suggested test or procedure should be carried out unless, in the provider’s judgment, its use is justified. Because of rapid advances in the medical sciences, you must make independent verification of diagnoses, indications, and drug dosages. Discussions, views, and recommendations as to medical or health care procedures, methods, products, choice of drugs, and drug dosages are the responsibility of the authors and must be checked with current medical guidelines, hospital procedures, and pharmaceutical manufacturers.

TO THE EXTENT PERMITTED UNDER APPLICABLE LAW, IN NO EVENT SHALL MDCALC OR ITS SUPPLIERS OR LICENSORS BE LIABLE FOR ANY DAMAGES (INCLUDING, WITHOUT LIMITATION, CONSEQUENTIAL, SPECIAL, INCIDENTAL, INDIRECT, OR SIMILAR DAMAGES, PERSONAL INJURY (INCLUDING DEATH), LOSS OF PROFITS, CORRUPTION OR LOSS OF DATA, BUSINESS INTERRUPTION, OR ANY OTHER COMMERCIAL DAMAGES OR LOSSES) ARISING OUT OF OR IN CONNECTION WITH THE USE OR PERFORMANCE OF THE SERVICES OR ITS CONTENT, PRODUCTS OR SERVICES, NOR SHALL THE LIABILITY OF MDCALC OR ITS SUPPLIERS AND LICENSORS EXCEED USD $100 IN THE AGGREGATE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

IN COUNTRIES WHERE THE ABOVE EXCLUSIONS AND LIMITATIONS ARE NOT PERMITTED, MDCALC SHALL BE RESPONSIBLE TO YOU ONLY FOR LOSSES AND DAMAGES THAT ARE A REASONABLY FORESEEABLE RESULT OF OUR FAILURE TO USE REASONABLE SKILL AND CARE OR OUR BREACH OF OUR CONTRACT WITH YOU.

MDCalc does not claim ownership, endorse, or take responsibility for any third-party products, information, guidelines, materials, or services that may be offered, advertised, provided, or displayed on the Services or incorporated in the content, products or services contained on, accessible from or distributed throughout the Services.

MDCalc may, at our discretion, implement technical safeguards within the Services designed to detect and filter PHI inputs. The existence or operation of any such technical safeguards shall not: (a) expand our obligations under these Terms; (b) constitute a representation that the Services are capable of detecting all PHI inputs; (c) relieve you of your obligations under these Terms; or (d) create any Business Associate relationship or HIPAA obligation between MDCalc and you. You shall not attempt to circumvent, disable, or interfere with any technical safeguards implemented by MDCalc.

H) Export Restrictions

The software supporting these Services may be subject to United States Export laws, rules and regulations, as amended from time to time. No software or property (including, but not limited to, code, images, or screenshots) from these Services may be downloaded or exported (i) into (or to a national or resident of) Cuba, Iraq, Libya, North Korea, Iran, Syria, Sudan, or any other country to which the United States has embargoed goods; or (ii) to anyone on the United States Treasury Department’s list of Specially Designated Nationals or the U.S. Commerce Department’s Table of Deny Orders. By downloading or using the software, you represent and warrant that you are not located in, under the control of, or a national or resident of any such country or on any such list.

I) Mobile Services

If MDCalc permits or makes available to you the ability to: (a) upload content to the Services via your mobile telephone and/or tablet (“Mobile Device”), (b) receive and reply to messages, or to access or make posts using text messaging, (c) browse the Services from your Mobile Device or (d) to access features through a mobile application you have downloaded and installed on your Mobile Device (collectively “Mobile Services”), your mobile carrier’s standard data, Internet, messaging, and other service fees and charges apply to your use of, and access to, the Mobile Services, and you are solely responsible for all such fees and charges. The Mobile Services may not be compatible with all mobile devices, carriers, and services, and MDCalc does not make any representations or warranties regarding such compatibility. You are solely responsible for ensuring that your Mobile Device is compatible with the type of content being provided through the Mobile Services. You understand that content delivered as part of the Mobile Services may be delivered to your Mobile Device through premium mobile services and acknowledge that you are solely and exclusively responsible for any charges for such services, including, but not limited to, any roaming charges.

You may be given the option to register to receive commercial messages from MDCalc via your Mobile Device. You understand that you may be charged by your wireless service provider in connection with the receipt of such messages. You may “opt out” of receiving future messages by following the instructions provided (i) in the wireless messages or (ii) on the website where you registered to receive such messages.

J) Indemnification

To the extent not prohibited by law, you hereby agree to indemnify and hold MDCalc, its directors, officers, shareholders, predecessors, successors in interest, employees, agents, suppliers, and licensors harmless from and against any and all claims of liability, losses, damages, and costs, including, without limitation, reasonable attorneys’ fees, arising from any violation by you of these Terms or in connection with your use of or inability to use the Services or its content, products, or services. We reserve the right to assume the defense of any claim for which we are entitled to indemnification under this clause. In such event, you shall provide us with such cooperation as is reasonably requested by us. MDCalc will reasonably notify you of any such claim or demand that is subject to your indemnification obligation and of which MDCalc becomes aware.

K) Jurisdiction and Governing Law

You agree that any controversy or claim arising from or pertaining to the use of this Website shall be governed by the laws of the State of Delaware, USA, without giving effect to its choice of law provisions, and shall be submitted to the exclusive jurisdiction of the courts of the State of Delaware, USA.

L) Intellectual Property Rights

MDCalc and its licensors retain all right, title, and interest in and to the Services, the Website Content, all AI Outputs, all Methodology, the Marks, the Feedback, and all other intellectual property owned or licensed by MDCalc (collectively, “MDCalc IP”), including all worldwide patent, copyright, trademark, trade secret, and other intellectual property rights therein. Except for the limited rights expressly granted to you under these Terms, no right, title, or interest in any MDCalc IP is transferred or licensed to you, and all rights not expressly granted are reserved by MDCalc. Nothing in these Terms shall be construed to grant you any right or license under any patent, trademark, copyright, or other intellectual property right of MDCalc or any third party by implication, estoppel, or otherwise. Certain Services are subject to additional intellectual-property-specific terms set forth in the Schedules to these Terms, which are incorporated herein by reference.

You acknowledge and agree that a breach or threatened breach of these Terms, including any restriction on use, reproduction, incorporation, reverse engineering, benchmarking, or attribution of Website Content, AI Outputs, Methodology, or any product-specific content or output governed by a Schedule, would cause MDCalc irreparable harm for which money damages alone would not be an adequate remedy. Accordingly, MDCalc shall be entitled to seek temporary, preliminary, and permanent injunctive relief to prevent or restrain any such breach or threatened breach, without the necessity of posting a bond and without proof of actual damages, in addition to any other remedy available at law or in equity under these Terms.

3. COPYRIGHT INFRINGEMENT NOTIFICATION

MDCalc is committed to complying with U.S. copyright law and to responding to claims of copyright infringement. MDCalc will promptly process and investigate notices of alleged infringement and will take appropriate actions under the Digital Millennium Copyright Act, Title 17, United States Code, Section 512(c) (“DMCA”).

Pursuant to the DMCA, notifications of claimed copyright infringement should be sent to following Designated Agent for these Services in the manner described below.

By Mail:

MDCalc Ltd, Inc.
ATTN: Legal Department, DMCA Copyright Notices
93 4th Ave #19 New York, NY 10003
Email: copyright@mdcalc.com

For your complaint to be valid under the DMCA, you must provide all of the following information when providing notice of the claimed copyright infringement:

1. A physical or electronic signature of a person authorized to act on behalf of the copyright owner;
2. Identification of the copyrighted work or other intellectual property alleged to have been infringed;
3. Identification of the material that is claimed to be infringing or to be the subject of the infringing activity, and that is to be removed or access to which is to be disabled, in a sufficiently precise manner to permit MDCalc to locate the material;
4. Information reasonably sufficient to permit MDCalc to contact the copyright owner, such as an address, telephone number, and, if available, an electronic mail address;
5. A statement that you have a good faith belief that use of the material in the manner complained of is not authorized by the copyright owner, its agent, or law; and
6. A statement that the information in the notification is accurate, and under penalty of perjury, that you are authorized to act on behalf of the copyright owner.

For more details on the information required for valid notification, see 17 U.S.C. 512(c)(3).

Unless a notice pertains to copyright or other intellectual property infringement, the Agent will be unable to address the listed concern. We will notify you if we remove or disable access to copyright-protected material that you provided, if such removal is pursuant to a validly received DMCA take-down notice.

We reserve the right, in our sole discretion, to terminate the account or access of any user of this Website or the Services who is the subject of repeated DMCA or other infringement notifications.

You should be aware that, under the DMCA, claimants who make misrepresentations concerning copyright infringement may be liable for damages incurred as a result of the removal or blocking of the material, court costs, and attorneys’ fees.

Schedule A: Quality Rating System (QRS)

1. Definitions

“Quality Rating System” or “QRS” means the proprietary scoring system developed by or on behalf of MDCalc, including all overall scores, subscores, rating categories, rubrics, weighting methodologies, and any explanatory content associated with such scores, as published on the MDCalc platform.

“QRS Content” means any score, subscore, numerical rating, ranking, or associated explanatory text generated through the Quality Rating System, in any form, whether displayed on the MDCalc platform or extracted, copied, transcribed, summarized, or reproduced by any other means.

“Licensed Use” means any use of QRS Content other than an individual healthcare professional or consumer viewing QRS Content on the MDCalc platform for their own personal, non-commercial clinical or educational reference.

2. Ownership

The Quality Rating System, all QRS Content, and the underlying rubric and methodology used to generate it are the exclusive proprietary property of MDCalc. No provision of these Terms, and no display of QRS Content on the MDCalc platform, shall be construed as transferring, licensing, or waiving any ownership or intellectual property right in the Quality Rating System except as expressly set forth in a separate written license agreement signed by MDCalc.

3. Restrictions on Use, Reproduction, and Incorporation

You agree that you will not, without MDCalc’s prior written consent:

• Copy, extract, republish, redistribute, or publicly display any QRS Content, in whole or in part, outside the MDCalc platform;
• Use, incorporate, or reference QRS Content in any other product, service, publication, dataset, database, or tool, whether offered for free or for a fee;
• Use, ingest, or incorporate QRS Content into any dataset, training corpus, fine-tuning set, retrieval index, embedding store, or other input used to train, fine-tune, ground, evaluate, or otherwise inform any artificial intelligence or machine learning model, whether by automated scraping, manual transcription, bulk export, API access, or any other method;
• Cause, permit, or knowingly allow any artificial intelligence system, chatbot, or automated tool to reproduce, paraphrase, summarize, or otherwise output QRS Content, in whole or in substantial part, in response to a user query or otherwise;
• Reverse engineer, decompile, disassemble, or otherwise attempt to derive the rubric, weighting, or scoring methodology underlying the Quality Rating System, whether by systematic querying, statistical analysis, prompt-based probing, or any other method; or
• Use QRS Content, in whole or in part, to benchmark, evaluate, or compare the performance, accuracy, or output of any other product or service, including a competing scoring, rating, or clinical decision-support system.

The restrictions in this Section apply regardless of whether the QRS Content is reproduced verbatim, in summarized or paraphrased form, or as a derivative compilation, and regardless of whether attribution to MDCalc is provided.

4. Attribution Does Not Constitute Authorization

Providing attribution or citation to MDCalc or to the Quality Rating System does not satisfy, substitute for, or cure the licensing requirements set forth in this Addendum. A Licensed Use undertaken with attribution but without a written license from MDCalc remains an unauthorized and unlicensed use in breach of these Terms. Conversely, where a Licensed Use is authorized under a written license, that license shall require clear and conspicuous attribution to MDCalc and the Quality Rating System, in the form MDCalc specifies, as a condition of the license.

5. Mandatory Licensing for Third-Party and Commercial Use

Any Licensed Use of QRS Content requires a separate written license agreement with MDCalc. MDCalc retains sole and absolute discretion to approve, decline, condition, or set fees for any such license. Categories of Licensed Use include, without limitation:

• Integration of QRS Content into a third-party clinical, educational, or commercial platform;
• Redistribution or resale of QRS Content, in whole or in part, in any format;
• Use of QRS Content in connection with the training, fine-tuning, evaluation, or grounding of any artificial intelligence or machine learning model.

6. Audit and Monitoring Rights

MDCalc reserves the right to monitor public sources, including third-party platforms, publications, datasets, and outputs of artificial intelligence systems, for unauthorized reproduction of QRS Content. Any party entering into a license agreement for Licensed Use of QRS Content agrees to cooperate with reasonable requests from MDCalc to confirm compliance with the terms of such license, including, where applicable, permitting reasonable technical audits upon no less than thirty (30) days’ notice.

7. Scope of “Use”- Artificial Intelligence Systems

For the avoidance of doubt, “use” of QRS Content under these Terms includes, without limitation: (a) ingestion of QRS Content for the purpose of training, fine-tuning, retrieval-augmentation, or grounding of any machine learning or artificial intelligence model; and (b) the reproduction, restatement, paraphrase, or summarization of QRS Content, in whole or in substantial part, in any output generated by an artificial intelligence system, whether or not such system is operated by MDCalc, a licensee, or an unaffiliated third party.

8. Remedies

In addition to any remedy set forth above, MDCalc reserves all rights and remedies available at law or in equity for any breach of this Addendum, including injunctive relief, actual damages, disgorgement of profits attributable to unauthorized use, and reasonable attorneys’ fees and costs incurred in enforcement, to the extent permitted by applicable law.

Schedule B: Collections

1. Definitions

“Collection” means a curated grouping of clinical decision support (CDS) tools organized by MDCalc around a disease, condition, clinical scenario, specialty, or other clinical grouping, together with any Comparative Analysis, explanatory content, sequencing, categorization scheme, or visual presentation created by or on behalf of MDCalc in connection with that grouping.

“Collection Content” means the selection and arrangement of CDS tools within a Collection, any Comparative Analysis, any explanatory or educational text, any categorization or tagging scheme, and any visual layout, iconography, or interaction design used to present a Collection.

“Comparative Analysis” means the original text, explanation, or narrative created by or on behalf of MDCalc that compares, contrasts, or explains the differences, relative strengths, appropriate use cases, or clinical context among two or more CDS tools within a Collection.

“Licensed Use” means any use of Collection Content other than an individual healthcare professional or consumer viewing a Collection on the MDCalc platform for their own personal, non-commercial clinical or educational reference.

2. Ownership

The selection, coordination, and arrangement of CDS tools within each Collection, together with all Comparative Analysis, explanatory text, categorization schemes, and visual presentation associated with each Collection, constitute original works of authorship and/or protectable compilations owned exclusively by MDCalc. No provision of these Terms, and no display of a Collection on the MDCalc platform, shall be construed as transferring, licensing, or waiving any ownership or intellectual property right in any Collection Content except as expressly set forth in a separate written license agreement signed by MDCalc.

3. Restrictions on Use, Reproduction, and Incorporation

You agree that you will not, without MDCalc’s prior written consent:

• Copy, extract, republish, redistribute, or publicly display any Collection Content, in whole or in part, outside the MDCalc platform;
• Recreate, in another product or service, the same or a substantially similar grouping, sequencing, or categorization of CDS tools as any MDCalc Collection, where such grouping was derived from or informed by MDCalc’s Collection Content;
• Copy, paraphrase, or closely track the Comparative Analysis or explanatory text associated with any Collection;
• Use, ingest, or incorporate Collection Content into any dataset, training corpus, fine-tuning set, retrieval index, embedding store, or other input used to train, fine-tune, ground, evaluate, or otherwise inform any artificial intelligence or machine learning model, whether by automated scraping, manual transcription, bulk export, API access, or any other method;
• Cause, permit, or knowingly allow any artificial intelligence system, chatbot, or automated tool to reproduce, paraphrase, summarize, or otherwise output Collection Content, in whole or in substantial part, in response to a user query or otherwise, including a query asking the system to compare or differentiate CDS tools in a manner substantially similar to a Collection’s Comparative Analysis;
• Reverse engineer, decompile, disassemble, or otherwise attempt to derive the selection, sequencing, or categorization logic underlying any Collection, whether by systematic querying, statistical analysis, prompt-based probing, or any other method; or
• Use Collection Content, in whole or in part, to benchmark, evaluate, or compare the performance, accuracy, or output of any other product or service, including a competing clinical decision-support system.

The restrictions in this Section apply regardless of whether Collection Content is reproduced verbatim, in summarized or paraphrased form, or as a derivative compilation, and regardless of whether attribution to MDCalc is provided.

4. Attribution Does Not Constitute Authorization

Providing attribution or citation to MDCalc or to a Collection does not satisfy, substitute for, or cure the licensing requirements set forth in this Addendum. A Licensed Use undertaken with attribution but without a written license from MDCalc remains an unauthorized and unlicensed use in breach of these Terms. Conversely, where a Licensed Use is authorized under a written license, that license shall require clear and conspicuous attribution to MDCalc and to the applicable Collection, in the form MDCalc specifies, as a condition of the license.

5. Mandatory Licensing for Third-Party and Commercial Use

Any Licensed Use of Collection Content requires a separate written license agreement with MDCalc. MDCalc retains sole and absolute discretion to approve, decline, condition, or set fees for any such license. Categories of Licensed Use include, without limitation:

• Integration of a Collection or Collection Content into a third-party clinical, educational, or commercial platform;
• Redistribution or resale of a Collection or Collection Content, in whole or in part, in any format;
• Use of Collection Content in connection with the training, fine-tuning, evaluation, or grounding of any artificial intelligence or machine learning model.

6. Visual Design and Presentation

The distinctive visual layout, interaction design, iconography, color coding, and overall look and feel used to present Collections on the MDCalc platform (“Collection Design Elements”) are proprietary to MDCalc and may be protected as trade dress and/or under applicable design patent or copyright law, independent of the protections afforded to Collection Content. You agree not to copy, imitate, or adopt Collection Design Elements, or any confusingly similar visual scheme, in any other product or service without MDCalc’s prior written consent.

7. Audit and Monitoring Rights

MDCalc reserves the right to monitor public sources, including third-party platforms, publications, datasets, and outputs of artificial intelligence systems, for unauthorized reproduction of Collection Content. Any party entering into a license agreement for Licensed Use of Collection Content agrees to cooperate with reasonable requests from MDCalc to confirm compliance with the terms of such license, including, where applicable, permitting reasonable technical audits upon no less than thirty (30) days’ notice.

8. Scope of “Use”: Artificial Intelligence Systems

For the avoidance of doubt, “use” of Collection Content under these Terms includes, without limitation: (a) ingestion of Collection Content for the purpose of training, fine-tuning, retrieval-augmentation, or grounding of any machine learning or artificial intelligence model; and (b) the reproduction, restatement, paraphrase, or summarization of Collection Content, in whole or in substantial part, in any output generated by an artificial intelligence system, whether or not such system is operated by MDCalc, a licensee, or an unaffiliated third party, including outputs that compare or differentiate CDS tools in a manner substantially similar to a Collection’s Comparative Analysis.

9. Remedies

In addition to any remedy set forth above, MDCalc reserves all rights and remedies available at law or in equity for any breach of this Addendum, including injunctive relief, actual damages, disgorgement of profits attributable to unauthorized use, and reasonable attorneys’ fees and costs incurred in enforcement, to the extent permitted by applicable law.

Schedule C: CrossCover

1. Definitions

“CrossCover” means MDCalc’s AI-output safety service, which provides multiple safety features for clinicians to interact with LLMs, including “CrossCheck,” which provides an analysis of outputs generated by artificial intelligence or machine learning systems (whether operated by MDCalc, a customer, or an unaffiliated third party) and identifies potential clinical, factual, or safety-related concerns in such outputs (each, a “Flag”).

“Upstream System” means any artificial intelligence, machine learning, or large language model system whose outputs are submitted to or reviewed by CrossCover, regardless of whether that system is operated by MDCalc or a third party.

“Institutional Customer” means an organization that has entered into a separate written agreement with MDCalc governing its use of CrossCover.

2. Nature and Scope of the Service

CrossCover provides multiple safety features, including CrossCheck. CrossCover does not guarantee that it will identify all, or any, errors, omissions, or safety concerns present in an Upstream System’s output, and the absence of a Flag does not indicate that an output is accurate, complete, or safe for clinical use.

3. No Substitute for Clinical Judgment

Use of CrossCover, and the presence or absence of any Flag, does not relieve any healthcare professional of the obligation to exercise independent clinical judgment and to independently verify any diagnosis, treatment recommendation, drug dosage, or other clinical output before acting on it. CrossCover is a supplementary review tool, not a clinical decision-maker, and is not a substitute for the clinical judgment of a qualified healthcare professional.

4. Disclaimer

MDCalc does not develop, control, or operate any Upstream System reviewed by CrossCover unless otherwise stated, and disclaims all responsibility for the accuracy, safety, or output of any Upstream System. Changes to an Upstream System made by its operator may affect the performance, accuracy, or coverage of CrossCover without notice to MDCalc or to you, and MDCalc has no obligation to detect or correct for such changes.

Beta features within CrossCheck have no guarantees on performance. Users use them at their own risk with no liability to MDCalc or the Upstream System.

5. Ownership

CrossCover, including its underlying detection methodology, models, rules, and Flags, together with all outputs generated by CrossCover, is proprietary to MDCalc. No provision of these Terms, and no use of CrossCover, shall be construed as transferring, licensing, or waiving any ownership or intellectual property right in CrossCover except as expressly set forth in a separate written license agreement signed by MDCalc.

6. Indemnification for Institutional Use

Where an Institutional Customer integrates CrossCover into its clinical workflow, the indemnification obligations set forth in Section 2(J) of these Terms extend to claims arising from that Institutional Customer’s reliance on, or failure to act on, a Flag (or the absence of a Flag), except to the extent such claim arises from MDCalc’s gross negligence or willful misconduct.

7. Restrictions on Use, Reproduction, and Incorporation

You agree that you will not, without MDCalc’s prior written consent:

• Copy, extract, republish, redistribute, or publicly display any Flag or other CrossCover output, in whole or in part, outside the platform or workflow in which it was generated for you other than for purposes of medical evaluation or benchmarking;
• Use, ingest, or incorporate any Flag, CrossCover output, or CrossCover’s underlying detection methodology, rules, or models into any dataset, training corpus, fine-tuning set, retrieval index, embedding store, or other input used to train, fine-tune, ground, evaluate, or otherwise inform any artificial intelligence or machine learning model, whether by automated scraping, manual transcription, bulk export, API access, or any other method;
• Reverse engineer, decompile, disassemble, or otherwise attempt to derive CrossCover’s underlying detection methodology, rules, models, or criteria, whether by systematic querying, statistical analysis, prompt-based probing, or any other method;
• Use any Flag or other CrossCover output to benchmark, evaluate, or compare the performance of any other AI-output review service or competing product; or
• Cause, permit, or knowingly allow any artificial intelligence system, chatbot, or automated tool to reproduce, paraphrase, summarize, or otherwise output a Flag or other CrossCover output, in whole or in substantial part, in response to a user query or otherwise.

The restrictions in this Section apply regardless of whether a Flag or CrossCover output is reproduced verbatim, in summarized or paraphrased form, or as a derivative compilation, and regardless of whether attribution to MDCalc is provided.

8. Attribution Required for Permitted Use

Where an Institutional Customer’s written agreement with MDCalc permits display of a Flag or other CrossCover output within that Institutional Customer’s clinical workflow or elsewhere, such display must include clear and conspicuous attribution identifying MDCalc as the source of the Flag, in a form and placement approved by MDCalc, and the Institutional Customer may not remove, obscure, or alter any MDCalc attribution, trademark, or proprietary notice.

9. Attribution Does Not Constitute Authorization

Providing attribution or citation to MDCalc or to CrossCover does not satisfy, substitute for, or cure any licensing or authorization requirement set forth in this Addendum. A use of CrossCover output undertaken with attribution but without the authorization required under this Addendum remains an unauthorized and unlicensed use in breach of these Terms.

10. Mandatory Licensing for Third-Party and Commercial Use

Any use of a Flag or other CrossCover output beyond an Institutional Customer’s use within its own clinical workflow under a written agreement with MDCalc requires a separate written license agreement with MDCalc. MDCalc retains sole and absolute discretion to approve, decline, condition, or set fees for any such license. Categories of licensed use include, without limitation:

• Integration of a Flag or other CrossCover output into a third-party clinical, educational, or commercial platform other than the Institutional Customer’s own workflow;
• Redistribution or resale of a Flag or other CrossCover output, in whole or in part, in any format; and
• Use of a Flag, CrossCover output, or CrossCover’s underlying detection methodology in connection with the training, fine-tuning, evaluation, or grounding of any artificial intelligence or machine learning model.

11. Audit and Monitoring Rights

MDCalc reserves the right to monitor public sources, including third-party platforms, publications, datasets, and outputs of artificial intelligence systems, for unauthorized reproduction of Flags or other CrossCover output. Any party entering into a license agreement for use of CrossCover output agrees to cooperate with reasonable requests from MDCalc to confirm compliance with the terms of such license, including, where applicable, permitting reasonable technical audits upon no less than thirty (30) days’ notice.

12. Remedies

In addition to any remedy set forth above, MDCalc reserves all rights and remedies available at law or in equity for any breach of this Schedule, including injunctive relief, actual damages, disgorgement of profits attributable to unauthorized use, and reasonable attorneys’ fees and costs incurred in enforcement, to the extent permitted by applicable law.

Schedule D: Evidence to Action Journal

1. Definitions

“MDCalc platform” incorporates MDCalc services as listed above as well as third-party services uses to host or manage the Journal, currently Scholastica whose Terms govern how people use its platform, and Schedule D governs rights in Articles between Authors and MDCalc.

“Journal” means MDCalc’s peer-reviewed online publication, Evidence to Action: Official Journal of MDCalc, as defined in MDCalc’s Privacy Policy.

“Article” means any manuscript, case report, review, commentary, letter, or other written work submitted to and/or published in the Journal.

“Authors” means the individuals who contribute to or edit content for the Journal, as defined in MDCalc’s Privacy Policy.

“Editors” means individuals designated by MDCalc to make or participate in acceptance, rejection, and revision decisions regarding Articles submitted to the Journal.

“Readers” means individuals who view, download, or access Articles or other Journal content, as defined in MDCalc’s Privacy Policy.

“Journal Content” means all Articles published in the Journal, together with any editorial commentary, formatting, typesetting, indexing, and any compilation or arrangement of Articles created by or on behalf of MDCalc.

“Licensed Use” means any use of Journal Content other than an individual Reader viewing or downloading a single Article on the MDCalc platform for their own personal, non-commercial clinical or educational reference.

2. Author Submission and Representations

By submitting an Article to the Journal, each Author represents and warrants that: (a) the Article is the Author’s own original work and has not been previously published, in whole or in substantial part, except as disclosed to MDCalc at the time of submission; (b) the Article does not infringe the copyright, privacy, or other rights of any third party; (c) all individuals named as authors (i) have made a substantive contribution to the Article and have consented to be listed as an author, and no person who made a substantive contribution has been omitted (ii) participated in drafting the Article or revising it critically for important intellectual content; (iii) gave final approval of the version submitted for publication; and (iv) agree to be accountable for all aspects of the Article, including ensuring that questions related to its accuracy or integrity are appropriately investigated and resolved; each such individual has consented to be listed as an author, and no individual meeting these criteria has been omitted; (d) any research involving human subjects described in the Article was conducted with appropriate institutional review board or ethics committee approval and informed consent, and the Author will provide documentation of such approval upon request, and the Author will retain the underlying research data and materials sufficient to respond to questions about the Article’s accuracy or integrity for at least ten (10) years following publication; (e) the Author has disclosed all financial and other conflicts of interest relevant to the subject matter of the Article, including any relationship with a pharmaceutical, device, or other commercial entity referenced in or related to the Article; (f) if the Article includes a case report, image, or other information reasonably capable of identifying a patient, the Author has obtained the patient’s (or the patient’s legal representative’s) written informed consent to publication, including to the potential availability of identifying material on the Internet, and will provide such consent to MDCalc upon request, unless the identifying information has been removed or the patient cannot reasonably be identified; (g) the Author has disclosed to MDCalc, in the manner MDCalc’s submission process requires, any use of artificial intelligence (AI)-assisted technology, including large language models, chatbots, or image-generation tools, in the preparation of the Article; no such technology is named or implied as an author or co-author of the Article; and the Author remains solely responsible for the accuracy, integrity, and originality of any AI-assisted content, including that it is free of plagiarism and that all quoted or reproduced material is properly attributed; and (h) the Authors have designated one Author as the corresponding Author for the Article, authorized to act on the Authors’ behalf in communications with MDCalc regarding the Article, and any request to add, remove, or reorder Authors after submission will be accompanied by a signed statement of agreement from all listed Authors and from any Author to be added or removed.

3. Peer Review and Editorial Discretion

All Articles are subject to MDCalc’s peer review process. MDCalc and its Editors retain sole and absolute discretion to accept, reject, condition acceptance upon revision, or decline to publish any Article, and no submission fee or prior communication with an Editor obligates MDCalc to publish an Article. MDCalc may remove or decline to further distribute a previously published Article at any time, including in connection with a correction, retraction, or expression of concern under Section 6.

4. License Grant from Authors to MDCalc

Open-Access Model: The Author retains copyright and grants the public a Creative Commons Attribution (CC BY) license (or another Creative Commons license selected by MDCalc) to reproduce, distribute, and adapt the Article, provided that MDCalc retains an exclusive license to first publication and to any Journal-specific formatting, typesetting, and compilation.

Regardless of which model is selected, the license framework used for Articles submitted to the Journal is distinct from, and shall not be construed as being subject to, the User Content license set forth in Section 1(A) of the General Terms and Conditions, which is designed for informal submissions (e.g., calculator feedback) rather than peer-reviewed academic manuscripts.

Regardless of which model above is selected, each Author agrees, at MDCalc’s request and expense, to (i) cooperate with MDCalc in any action to enforce rights in the Article against unauthorized use, including by executing any documents reasonably necessary to establish MDCalc’s standing to pursue such action in its own name or jointly with the Author, and (ii) refrain from granting any subsequent license, or taking any other action, inconsistent with the rights granted to MDCalc.

5. Editorial Independence; No Sponsor Influence

MDCalc maintains a defined separation between any advertising, sponsorship, or other commercial relationship (including with pharmaceutical or device companies, as disclosed in MDCalc’s Privacy Policy) and the Journal’s peer review, editorial acceptance, and content decisions. No commercial relationship shall influence, or be represented as influencing, the selection, review, or editorial treatment of any Article.

6. Retraction, Correction, and Research Integrity

MDCalc may issue a correction, retraction, or expression of concern regarding a published Article, consistent with prevailing research integrity standards (e.g., those published by the Committee on Publication Ethics (“COPE”)), including in response to evidence of plagiarism, data fabrication or falsification, undisclosed conflicts of interest, or other research misconduct. Authors agree to cooperate with any MDCalc inquiry into the integrity of a published Article. Where an Article is retracted, MDCalc will label it as retracted and, consistent with prevailing indexing and research-integrity practice, retain it in the Journal’s archive in retracted form rather than remove it, except where availability is limited by technical platforms MDCalc uses or removal is independently required (e.g., by law, by a valid third-party rights claim, or where continued availability would itself cause harm).

7. Ownership of Journal Content

Subject to the license granted by Authors under Section 4, the compilation, arrangement, and selection of Articles within the Journal, together with all editorial commentary, formatting, typesetting, and indexing created by or on behalf of MDCalc, constitute original works of authorship and/or protectable compilations owned exclusively by MDCalc. No provision of these Terms, and no display of Journal Content on the MDCalc platform, shall be construed as transferring, licensing, or waiving any ownership or intellectual property right in the Journal except as expressly set forth in a separate written license agreement signed by MDCalc, or as set forth in the license granted by an Author under Section 4.

8. Restrictions on Use, Reproduction, and Incorporation

You agree that you will not, without MDCalc’s prior written consent:

• Copy, extract, republish, redistribute, or publicly display any Journal Content, in whole or in part, outside the MDCalc platform, except as expressly permitted by the license under which an Article was published;
• Use, incorporate, or reference Journal Content in any other product, service, publication, dataset, database, or tool, whether offered for free or for a fee, other than customary scholarly citation or quotation of a published Article (with attribution) for purposes of comment, criticism, or scholarship consistent with ordinary academic practice and applicable copyright law;
• Use, ingest, or incorporate Journal Content into any dataset, training corpus, fine-tuning set, retrieval index, embedding store, or other input used to train, fine-tune, ground, evaluate, or otherwise inform any artificial intelligence or machine learning model, whether by automated scraping, manual transcription, bulk export, API access, or any other method;
• Cause, permit, or knowingly allow any artificial intelligence system, chatbot, or automated tool to reproduce, paraphrase, summarize, or otherwise output Journal Content, in whole or in substantial part, in response to a user query or otherwise.

9. Attribution Does Not Constitute Authorization

Providing attribution or citation to MDCalc, the Journal, or an Article’s Author(s) does not satisfy, substitute for, or cure the licensing requirements set forth in this Schedule, except to the extent an Article’s applicable open-access license expressly permits attribution-only reuse. A Licensed Use undertaken with attribution but without a written license from MDCalc (where required) remains an unauthorized and unlicensed use in breach of these Terms.

10. Mandatory Licensing for Third-Party and Commercial Use

Any Licensed Use of Journal Content requires a separate written license agreement with MDCalc. MDCalc retains sole and absolute discretion to approve, decline, condition, or set fees for any such license. Categories of Licensed Use include, without limitation:

• Integration of Journal Content into a third-party clinical, educational, or commercial platform;
• Redistribution or resale of Journal Content, in whole or in part, in any format;
• Use of Journal Content in connection with the training, fine-tuning, evaluation, or grounding of any artificial intelligence or machine learning model.

A party’s unauthorized Licensed Use of Journal Content, where a licensing pathway was available and not pursued, shall be treated as evidence of willful and knowing breach for purposes of any enforcement action, damages calculation, or claim for unjust enrichment.

11. Audit and Monitoring Rights

MDCalc reserves the right to monitor public sources, including third-party platforms, publications, datasets, and outputs of artificial intelligence systems, for unauthorized reproduction of Journal Content. Any party entering into a license agreement for Licensed Use of Journal Content agrees to cooperate with reasonable requests from MDCalc to confirm compliance with the terms of such license, including, where applicable, permitting reasonable technical audits upon no less than thirty (30) days’ notice.

12. Indemnification.

Each Author shall indemnify, defend, and hold harmless MDCalc, its officers, directors, employees, and agents from and against any and all claims, damages, losses, liabilities, costs, and expenses (including reasonable attorneys’ fees) arising out of or relating to any breach of the representations and warranties in Section 2, including without limitation claims of plagiarism, copyright or other intellectual property infringement, defamation, breach of patient privacy or informed consent, undisclosed conflicts of interest, or research misconduct.

13. Scope of “Use”: Artificial Intelligence Systems

For the avoidance of doubt, “use” of Journal Content under these Terms includes, without limitation: (a) ingestion of Journal Content for the purpose of training, fine-tuning, retrieval-augmentation, or grounding of any machine learning or artificial intelligence model; and (b) the reproduction, restatement, paraphrase, or summarization of Journal Content, in whole or in substantial part, in any output generated by an artificial intelligence system, whether or not such system is operated by MDCalc, a licensee, or an unaffiliated third party.

14. Remedies

In addition to any remedy set forth above, MDCalc reserves all rights and remedies available at law or in equity for any breach of this Schedule, including injunctive relief, actual damages, disgorgement of profits attributable to unauthorized use, and reasonable attorneys’ fees and costs incurred in enforcement, to the extent permitted by applicable law.