Research note · November 2026
PDF validation on community health center websites
What we tested, what we found, and what it does and doesn’t mean.
What we did
We took the U.S. HRSA list of health center organizations and selected nonprofit Health Center Program awardees in North Carolina, South Carolina and Virginia with three or more sites (75 organizations). We followed a limited number of links from each homepage, downloaded up to three linked PDFs per organization, and ran the open-source veraPDF validator with the PDF/UA-1 (ISO 14289-1) profile.
What we found
We tested 110 PDFs from 42 organizations. All 110 failed at least one PDF/UA-1 check.
What this does and doesn’t mean. A failed validator check is not the same as a document that patients can’t use. Some findings are technical conformance issues. Others are potential problems that need hands-on testing to confirm their impact. And some, like form fields with no accessible names, are functional problems we can demonstrate. This sample was also selected, not random: we chose documents most likely to be patient-facing forms.
Why we publish this
It explains why we report each finding in plain language and test every file we fix, instead of relying on a single pass/fail result.