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Patient Informed Consent — BaseHealth, Inc.

This Patient Informed Consent is effective as of October 5, 2014.

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Patient Informed Consent

BY CLICKING THE “SUBMIT” BUTTON DISPLAYED EITHER AT THE END OF THE BASEHEALTH ENROLLMENT FORM, YOU ACKNOWLEDGE AND AGREE TO THIS YOUR INFORMED CONSENT (“CONSENT”) AND ACKNOWLEDGE THAT YOU ARE ELECTRONICALLY SIGNING THIS CONSENT AND AGREEING TO BE LEGALLY BOUND BY ALL OF THE TERMS, CONDITIONS AND NOTICES CONTAINED OR REFERENCED HEREIN. FURTHER, YOU REPRESENT THAT YOU ARE OVER THE AGE OF 18 AND ABLE TO FORM A LEGALLY BINDING CONTRACT.

In this Consent, the words, “you” or “your” mean the person who will receive Services (defined below) from the referring physician or Physician Group indicated on the Enrollment Form (“Physician”) and who use Genophen™, BaseHealth’s integrated health management platform. Genophen integrates genomic and clinical data with behavioral analysis to engage patients with their physicians and help physicians create a detailed action plan uniquely suited to the patient.

This Consent is made among Patient, Physician, and BaseHealth, each a “Party” and together, the “Parties.” The “Effective Date” will be the date on which Patient first agrees to the terms and conditions of this Consent by clicking the SUBMIT button.

Services

BY CLICKING THE “SUBMIT” BUTTON DISPLAYED EITHER AT THE END OF THE BASEHEALTH ENROLLMENT FORM, YOU ACKNOWLEDGE AND AGREE TO THIS YOUR INFORMED CONSENT (“CONSENT”) AND ACKNOWLEDGE THAT YOU ARE ELECTRONICALLY SIGNING THIS CONSENT AND AGREEING TO BE LEGALLY BOUND BY ALL OF THE TERMS, CONDITIONS AND NOTICES CONTAINED OR REFERENCED HEREIN. FURTHER, YOU REPRESENT THAT YOU ARE OVER THE AGE OF 18 AND ABLE TO FORM A LEGALLY BINDING CONTRACT.

In this Consent, the words, “you” or “your” mean the person who will receive Services (defined below) from the referring physician or Physician Group indicated on the Enrollment Form (“Physician”) and who use Genophen™, BaseHealth’s integrated health management platform. Genophen integrates genomic and clinical data with behavioral analysis to engage patients with their physicians and help physicians create a detailed action plan uniquely suited to the patient.

This Consent is made among Patient, Physician, and BaseHealth, each a “Party” and together, the “Parties.” The “Effective Date” will be the date on which Patient first agrees to the terms and conditions of this Consent by clicking the SUBMIT button.

1.1 General Services. You wish for your Physician to perform a personalized disease risk assessment and to provide personalized recommendations using Genophen in an effort to improve your health (“Services”). Recommendations will be generated by Genophen and reviewed by your Physician with You based on procedures described in this Consent.

1.2 Procedures. Services consist of several steps, as follows:

a. An invitation will be sent to you by your Physician asking you to be a part of the Genophen integrated health management platform. At the time this invitation is sent to you, your Physician is providing a prescription for genetic testing to your account. You will complete the Enrollment Form to create your account, will review carefully the posted Terms of Use and Privacy Policy and, then, agree to the posted Terms of Use and Privacy Policy to proceed to use Genophen.

b. Information Collection. To enroll, you will provide your name, date of birth, gender, email address, other addresses, and telephone number(s) to BaseHealth and your credit card information to our third party payment processor (“Enrollment Information”). You will also create a unique user name, password, answer 3 security questions and create a PIN to complete your enrollment and to create your account. You need to input detailed information regarding your lifestyle, your medical history and your family history (“Personal Information”). By way of example, Lifestyle includes information about your nutrition, activities, sleep, stress, smoking/alcohol, relationship, confidential history and environmental factors. Medical includes information about your biometrics, medications, procedures, lab work and health records. Family history includes information about you, your parents, grandparents, other relatives, siblings, uncles or children. You may be asked to provide copies of medical records from other health care providers, as available.

c. Sample Collection. In consultation with your Physician, you will elect and, your Physician will prescribe for you, Genotyping or Whole Genome Sequencing. When you log-in to your account for the first time, you will be prompted to a screen to choose genotyping or whole genome sequencing. After you have selected the test, you will be prompted through the payment process provided through BaseHealth’s third party payment processor.

i. Saliva Sample. For Genotyping, You will provide a saliva sample using a saliva sampling kit that will be provided to you and mail your saliva sample kit to the CLIA certified, independent, licensed laboratory (“Laboratory”) to be analyzed for genetic testing. Your saliva sample will be disposed by the Laboratory following completion of such testing. See, Privacy Policy for more detailed information regarding the submission and analysis of your sample.

ii. Blood Sample. For Whole Genome Sequencing, your Physician will write the required prescription for your blood draw and arrangements will be made with you to have a sample of your blood drawn and submitted to the Laboratory for analysis. The Laboratory may require additional written consent form to be completed before analysis. Your blood sample will be analyzed for multiple parameters, including genetic testing. Your blood sample will be disposed by the Laboratory following completion of such testing and the analysis will be sent to BaseHealth or your Physician to be uploaded to your Genophen account. See, Privacy Policy for more detailed information regarding the submission and analysis of your sample.

d. Analyses and Recommendations. Physician will analyze the genetic testing results from your saliva sample or blood sample, together with the information you provide in accordance with subsection 1.2b above. Recommendations will be generated by Genophen, will be released initially to your Physician and then reviewed by your Physician with You.

Patient Understandings

2.1 Patient May Seek Independent Medical Advice. You specifically understand that you may seek and obtain independent health care advice from another appropriately qualified health care practitioner in relation to any assessment provided by Physician, including obtaining an independent assessment of the testing provided by the independent laboratory. You further acknowledge that any analyses provided in connection with the Services will be largely dependent upon the accuracy and completeness of the information provided by you pursuant to subsection 1.2b.

2.2 Patient Will Provide Complete and Accurate Information to Physician. You agree that all health care information and medical care records provided by you to Physician and/or the providers is true, accurate and complete to the best of your knowledge. Further, you understand that Physician and other health care providers will be relying upon the truth, accuracy and completeness of such health care information and medical records in exercising their own judgment in the performance of the Services.

2.3 Use of Your Genetic Data, Enrollment Information and Personal Information. Your genetic data, Enrollment Information and Personal Information will be compiled, saved and used within the scope of BaseHealth’s business activities for your Physician to provide to you personalized recommendations. In the future, your Personal Information may be used for recommendations made available through Genophen in an aggregate, non-personally identifiable form to minimize the possibility of exposing individual-level information.

2.4 General Risks. You understand and acknowledge that any advice, procedure or other service that Physician provides or arranges for you may carry some risk to you. For example, during the blood draw you may feel the stick of the needle in your arm and may experience bruising in the area of the draw. The blood draw may cause other injuries or side effects. In the case of injury or side effects, you are advised to immediately seek independent medical treatment. In addition, as the assessment of a person’s risk of disease is a complex and inexact science, the analyses provided by Physician may not be reflective of all health risks to which you may be subject. There is risk of unauthorized disclosure or use of your genetic data, Enrollment Information and/or Personal Information from a security breach which may result in public disclosure of your identity or a negative effect on your ability to obtain insurance coverage or employment. As with any online service, if you disclose your account password to others, they may be able to access your account and your genetic information, Personal Information and/or Enrollment Information. There may be additional risks to participation that are currently unforeseeable.

2.5 Genetic Testing Risks. Genetic testing and the interpretation of its results is a complex and uncertain process. Because of this, the accuracy of the test results cannot be guaranteed. The results from your genetic testing will be provided to Physician, who will review the report and explain the findings to you. Physician may recommend genetic counseling before or after completion of genetic testing or if the results are abnormal. Your receipt of the results of the genetic testing and the related analyses may cause anxiety or distress. There is also a risk of harm to you if you disclose results to third parties, such as your employer or insurer. Physician and BaseHealth will use commercially reasonable efforts not disclose such information to unauthorized third parties except as required by law and as described in the Terms of Use or Privacy Policy and this Consent.

General Terms

3.1 Governing Law. This Consent shall be governed by and construed in accordance with the laws of the State of California, excluding only its conflicts of laws principles.

3.2 Severability. If any provision of this Consent, or the application thereof to any person or circumstance, shall be held to any extent to be invalid or unenforceable, the remainder of this Consent, or the application of such provision to other persons or circumstances, shall not be affected thereby, and each provision of this Consent shall be valid and enforceable to the fullest extent permitted by law.

3.3 Attorney’s Fees. In the event of any legal proceeding arising out of or relating to this Consent, the prevailing Party in such arbitration or litigation shall be entitled to recover its costs of prosecuting and/or defending the same, including, without limitation, reasonable attorney’s fees at trial and all appellate levels.

3.4 No Amendment/Complete Agreement. This Consent may not be amended by either Party without the written consent of both Parties. This Consent constitutes the Parties’ entire agreement with respect to the subject matter hereof and supersedes any prior or contemporaneous agreement.

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