AFFIRMATION G SIGNATURE. By signing below and submitting this Claim Form, I affirm under penalty of perjury under the laws of the United States that I am, or was, a patient of DaVita treated at one of DaVita’s U.S. clinics and I visited a website, patient portal, and/or mobile application owned, operated, or managed directly or indirectly by DaVita or its subsidiaries or affiliates at least once between November 20, 2017 and up to and including September 21, 2023. I further affirm that the information provided in this Claim Form is true and correct to the best of my knowledge. Signature: Printed Name: Date: A proposed class action Settlement has been reached with DaVita Inc. (“DaVita” or “Defendant”) arising out of DaVita’s alleged implementation and use of third-party web tracking and analytics tools on DaVita’s websites, patient portals, and mobile applications owned, operated, or managed by DaVita or its subsidiaries or affiliates. Plaintiffs allege that DaVita’s use of these tools disclosed their web usage data, containing personally identifiable information and protected health information, to Facebook, Google, and other third-parties. DaVita denies these allegations, and the Court has not determined that XxXxxx did anything wrong. The case is known as Xxxxxxx Xxxxxxxx, Xxxxxxxx Xxxxxxxx, and Xxxxxx Xxxxxx v. DaVita, Inc., Case No. , in the Seventeenth Judicial District in and for Broward County, Florida. Who is Included? All U.S. persons who are, or have been, patients of Defendant who were treated at Defendant’s U.S. clinics and who visited any websites, patient portals, and/or mobile applications owned, operated, or managed directly or indirectly by Defendant or its subsidiaries or affiliates at least once between November 20, 2017 and up to and including September 21, 2023. You are receiving this notice because you have been identified as a Settlement Class Member according to XxXxxx’s records.
