Family Link Cord Blood Storage Program

Cord Blood Dear Physiian; Norton Healthare began the program, a private storage faility, in 1998 for storage of umbilial ord blood from a newborn infant. This program allows hematopoieti stem ells from umbilial ord blood to be ryopreserved in the vapor phase of liquid nitrogen and stored in the event that it is needed at a later time by the hild or by his/her siblings (who have a 25% hane of being a math with the newborn). The olletion proess is generally painless with no known risks to the mother or hild. The olletion does not interfere with the birth proess or the bonding between mother and hild afterwards. The ord blood harvest is a simple proedure. One the hild is delivered, the umbilial vein is annulated with a needle from a FDA approved ord blood olletion bag. The umbilial ord blood is olleted by gravity drainage and by the fore of uterine ontrations on the plaenta. These umbilial ord blood ells may provide a soure of hematopoieti stem ells for a hild or adult in the event that a bone marrow transplant is required. When no other family member mathes, the proess of finding an unrelated bone marrow donor an be very diffiult, expensive and frustrating. At any given time, there is an average of 3,000 patients searhing for a ompatible bone marrow donor in the National Marrow Donor Program Registry. In addition, there is a risk of graft vs. host disease, a reation in whih the transplanted ells attak the reipient. With stem ells olleted from ord blood, the likelihood of this adverse reation is dereased when ompared to bone marrow or peripheral blood stem ells. Umbilial ord blood transplantation researh ontinues with goals to further identify ellular harateristis of umbilial ord blood and its potential medial usefulness. The deision to store umbilial ord blood is a personal one for eah family. Considerations should inlude a family history of aner and/or other diseases treatable by stem ell transplantation. There is a one time ost for proessing a ord blood and an annual fee for storage. I have enlosed some information for your review. Additional information an be found on our website at www.nortonhealthare.om/familylink. I am ready to answer any speifi questions for you at any time. Sinerely, Alexandra Cheerva, MD, MS Norton Healthare Medial Diretor Blood & Marrow Transplant BMTL-FL-400 Form2 In Effet: 10/98 Revised: 07/03/13

Cord Blood Step 1 Maternal Blood Colletion 1. Verify mother s identifiation (Mother s Name, Mother s SS#, Donor/Kit #, this an be found on label on biohazard bag ontaining the maternal draw tubes.) 2. Collet mother s blood post-delivery. Use IV line or perform venous stik. 3. Fill the six blood tubes provided in the labeled biohazard bag for maternal blood draw. (4 red top gel tubes, 2 purple top tubes) 4. Label all tubes with the Mother s Name, Mother s SS#, Colletion Date/Time, and Phlebotomist s initials. 5. Plae olleted blood tubes in slots of absorbent pouh and then in biohazard bag provided. 6. Ensure patient label is attahed to label on the provided biohazard bag ontaining the maternal blood draw tubes. Step 2 Set-up Cord Blood Colletion Unit 1. Use appropriate asepti tehnique to open external foil pouh and remove the peel pouh outside of the sterile surgial field. 2. Open the peel pouh to release the unit and set into the sterile surgial field. 3. Disard both the external foil bag and peel pouh. 4. Inspet the set to ensure that the needle guard is between the lamp and the donor needle, ensure the ap is seurely plaed on the air vent, and lose the pinh lamp on the unit s tubing. (see diagram) Step 3 Prepare the Umbilial Cord for Venipunture 1. Clamp and ut the umbilial ord while mother remains in delivery position. 2. At the distal end of the ord, sterilize the punture site (4-8 inhes) by first using providone iodine swabs provided in kit. (srub 30 seonds, allow to dry). 3. Use the sterile alohol pads to wash the site. Step 4 Aess Umbilial Cord and Start Colletion 1. Remove the needle over by twisting to break the seal and then remove in a smooth, straight motion. 2. Insert the needle (with needle bevel down) into the umbilial vein and open the lamp on the tubing. 3. Lower the bag and by gravity flow, ollet as muh ord blood as possible. Note: Lowering the bag to full extension will inrease the flow rate. 4. Rotate the olletion bag periodially to mix and prevent lotting. The olletion should take approximately 3-7 minutes. 5. Collet as muh ord blood as possible from this site. 6. Close the pinh lamp when blood flow has stopped. INSTRUCTIONS FOR CORD BLOOD COLLECTION BMTL-FL-400 Form 3 In effet: 10/01/98 Norton Healthare Blood and Marrow Transplant Laboratory Revised: 07/03/13

Cord Blood 7. Withdraw the needle from the umbilial ord and align the finger ontours of the needle hub so that they are parallel to the opening of the needle guard. 8. Slide the needle guard midway over the needle hub. 9. While holding the sides of the needle guard, grasp the tubing and pull smoothly to draw the needle in the needle guard and lok into plae. Confirm that the needle is loked by listening for the seond lik as the needle is drawn into the needle guard. Ensure that the tubing annot be pulled through the needle guard. 10. Plae the olletion bag on a work surfae and fully extend the tubing above the bag. 11. Remove the tethered ap from the air vent. Allow the blood within the tubing to drain into the bag. 12. Fold vented tubing above the spike port and seal using the provided Hollister Cord Clamp and two metal rimps (folded tubing through above the ord lamp and press eah metal rimp together to hold the tubing). 13. Cut tubing above the seals and disard the needles in a sharps ontainer. Note: Use the seond donor needle/unit only if the blood flow eases before the plaenta appears empty, proeeding to step 2. INSTRUCTIONS FOR CORD BLOOD COLLECTION EX UTERO OPTION: If unable to ollet ord blood before the plaental delivery: 1. Plae plaenta in a sterile basin with the plaental fetal side up. 2. Drape umbilial ord over the side to allow gravity flow. 3. Follow IN UTERO instrutions, proeeding to Step 2. Step 5 Required Labeling/Doumentation and Preparing for Shipment 1. Complete all highlighted areas on the produt label and apply to the olleted ord blood unit. Also tie the labeled tie tag to the ord blood unit. (inluded in olletion supplies) 2. Complete all setions of the Data Colletion Reord. 3. Attah a opy of the hospital labor and delivery reord. 4. Plae both in the poket of the biohazard bag ontaining the ord blood unit and a temperature stabilizing gel pak. 5. Plae biohazard bag with ord blood unit and douments, maternal blood speimens, and any unused/unopened supplies from the ord blood kit into the shipping ontainer. 6. Parents or designee are responsible for preparing the shipping ontainer and for following the transport/shipping instrutions. CORD BLOOD COLLECTION GUIDELINES: 1. The volume of the ord blood is greater than or equal to 30 mls, preferably between 75 mls and 150 mls. 2. Stored produt meets linially useful ellular levels. 3. No visible lots were present in the ord blood produt and had no growth after 14 days. BMTL-FL-400 Form 3 In effet: 10/01/98 Norton Healthare Blood and Marrow Transplant Laboratory Revised: 07/03/13

Cord Blood PARTICIPATING PHYSICIAN/MIDWIFE COMPETENCY CERTIFICATION My signature below indiates understanding of the following statements: I have had the opportunity to read and understand the Storage Agreement and Informed Consent and the OB/Midwife Instrutions for Cord Blood Colletion. I understand that if the ord blood I ollet falls outside s ord blood olletion guidelines, the Instrutions for Cord Blood Colletion and this training and annual ompeteny assessment will be sent to me for ompletion to doument and assure understanding of ord blood olletion. The Competeny Certifiation form should then be returned to so that my understanding of the proess an be doumented. Doing so will assure that I remain part of the Program olletion staff (partiipating OB/midwife) and help stay ompliant with all required areditations. I understand that if I have any questions about the proedure, this form, or the program, I an ontat s tehnial staff 24 hours per day/7 days per week by beeper at (502) 421-0800. Obstetriian/Midwife Signature Date Obstetriian/Midwife Printed Name For Use Only Reviewed By/Date Medial Diretor Approval/Date BMTL-FL-400 Form4 In Effet: 10/05/09 Norton Healthare Blood and Marrow Transplant Laboratory Revised: 07/03/13

Cord Blood Expeted Due Date NOTIFICATION OF CORD BLOOD COLLECTION OB/Midwife Birthing Faility City/State/Zip Additional Comments: Mother s Name Mother s SS# Mother s DOB AUTHORIZATION TO COLLECT CORD BLOOD AND RELEASE FROM LIABILTY My patient has requested that I, or one of the partners in my pratie, ollet her baby s umbilial ord and plaental blood, ord blood. As the attending physiian/midwife, I have reviewed the prenatal physial assessment and testing and agree to ollet the ord blood. I or one of the partners in my pratie will ollet the ord blood from the lamped and ut umbilial ord immediately following delivery. While olletion is a relatively simple proedure, ompliations may our during delivery, whih ould prelude the olletion of ord blood. My patient, as evidened by the signature below, agrees that my judgement shall be absolute and final and releases me, my pratie, the hospital/birthing enter, its Board of Diretors and Offiers, its medial staff, and its anillary staff of any and all liabilities surrounding the olletion and handling of the ord blood. Signature of Obstetriian/Midwife Signature of Mother Name of Obstetriian/Midwife Name of Mother Date Date AUTHORIZATION OF THE RELEASE OF MEDICAL RECORDS/INFORMATION I agree to allow information or opies of my and my newborn s medial reord to be provided to the staff of the. I authorize the release of any information or medial reord that is related to my pre-natal are, delivery, and post partum are as well as any information or medial reord that is related to my baby s newborn are and pediatriian are. I hereby affirm that I have read and fully understand the above statements and onsent to the dislosure of any medial reords and/or information for the purpose and extent stated above. This authorization will ontinue until revoked or aneled by me in writing. Signature of Mother Name of Mother Date This Setion To Be Filled Out By Staff Only CORD BLOOD HARVEST/WORKUP ORDERS As the medial diretor of the Cord Blood Colletion Servie, I request that one olleted, the ord blood unit and mother s blood draw along with ompleted paperwork be pakaged for transportation to the laboratory listed below for proessing and storage. Transport to: (CHECK ALL THAT APPLY) NORTON HOSPITAL (Downtown) Routine Cryopreservation/Storage/Testing TRANSFUSION SERVICES-Blood Bank 200 EAST CHESTNUT STREET Additional Modifiation/Testing, Speify: LOWER LEVEL, LABORATORY LOUISVILLE, KY 40202 Donor/Kit # Contat Person: Teh On Call Phone #: (502) 629-7771 Fax #: (502) 629-7798 Signature of Requesting Physiian Digital Beeper #: (502) 421-0800 BMTL # ALEXANDRA CHEERVA, MD, MS Printed Name of Requesting Physiian Date BMTL-FL-400 Form5 In Effet: 10/98 Norton Healthare Blood and Marrow Transplant Laboratory Revised: 07/03/2013

Cord Blood Dear Expetant Family, Thank you for inquiring about the. We are exited to be able to offer this servie to families in our region. Planning your ord blood olletion is key to a suessful outome. You should disuss with your physiian/midwife your desire to store your newborn s ord blood. Enlosed with your paket is a letter to give to your physiian, along with instrutions on harvesting ord blood. You need to give this information to your physiian as early as possible in your pregnany to ensure that they are familiar with the details of the proedure. If you have any questions please all at 1-502-629-7771. If you have medial questions onerning any aspet of the ord blood olletion and storage whih annot be answered by our tehnial staff, we an diret you to our linial staff that would be happy to help. Step I: Completion of Forms The enrollment paket onsists of the following forms. To partiipate in the Program, you and your physiian need to omplete and return those that are shaded in the first olumn: Contents of Enrollment Paket Partiipating Physiian/Midwife Forms to Review or Complete Expetant Family Forms to Complete Required Signatures OB/ Midwife Expetant Family Return to Program (Envelope provided) Brohure X No-Review Only Physiian/Midwife Letter X No-Review Only Physiian/Midwife Instrutions X No-Review Only Physiian/Midwife Competeny Certifiation (every 12 months) X-if appliable X- if appliable Yes- if appliable Notifiation of Cord Blood Colletion Form Expetant Family Letter X X X X Yes No-Review Only Storage Agreement X X X X Yes Shedule A-Enrollment Form Shedule B- Finane Form X X Yes X X Yes Informed Consent X X X X Yes Health History Form X X Yes Family Instrutions Instrutions for Transporting Cord Blood No-Review Only No-Review Only BMTL-FL-400 Form6 Page 1 of 2 In Effet: 10/98 Norton Healthare Blood and Marrow Transplant Laboratory Revised: 07/03/13

STEP II: Return Completed Forms & Appliation Fee The ompleted forms, along with your nonrefundable appliation fee of $150, should be sent to in the return envelope provided in this paket. You will be billed for the remaining balane of $1450 after the ord blood is reeived and proessed. The hek should be made out to. STEP III: Cord Blood Colletion Kit Delivery One we have reeived your ompleted forms and fee, you will be onsidered enrolled. We will shedule a pikup/ourier servie within 2 months timeframe prior to your due date for the insulated Cord Blood Colletion Kit ( Colletion Kit ) used for the ord blood olletion. Someone must be available to reeive the Colletion Kit or you may also make arrangements to pik up the Colletion Kit during routine business hours. Your Colletion Kit, harvested ord blood produt and ompleted forms will arry unique Donor/Colletion Kit identifying numbers that will allow for auray and traking during ritial points of the proess to ensure your family s ord blood produt is linked speifially to you and your newborn. For your reords, a opy of the Storage Agreement and the Informed Consent along with the rest of the signed enrollment papers and instrutions will be inluded in the Colletion Kit. You should review the douments before the delivery of your baby. Copies of the Notifiation of Cord Blood Colletion and Instrutions on Harvesting Cord Blood will be sent to the physiian offie and birthing faility to inlude with your Medial Reord. STEP IV: Cord Blood Colletion Kit & Birthing Faility You will need to bring the Colletion Kit with you to the birthing faility. The Colletion Kit ontains detailed instrutions for handling, labeling, pakaging and ompleting doumentation required before transport. You should designate a family member that will monitor your ord blood ompletion of paperwork, pakaging, transport and will ensure the proper transport (via Beeline Courier or personal transport) of the Colletion Kit bak to Norton Downtown Transfusion servies for 24 hour monitoring. Any identified issues should be resolved with the olletion staff prior to initiating transport. The Colletion Kit should be transported as soon as possible after olletion to allow tehnial proessing to begin within 24 hours of birth. STEP V: Cord Blood Colletion Kit Proessing The tehnial staff will ontat you by phone after proessing is ompleted to update the Health History Form, ondut identifiation verifiation and disuss initial proessing. You will be ontated promptly by by phone if any issues are identified that would potentially affet the transplant quality of your submitted ord blood. Otherwise, after reeipt of your newborn s sreening test results, you will reeive a notifiation letter indiating the final evaluation of your stored ord blood regarding stem ell transplant suitability and linially useful ellular levels. We look forward to working with your family to meet this very speial need in your life. Sinerely, Tehnial Staff Norton Healthare Blood and Marrow Transplant Laboratory BMTL-FL-400 Form6 Page 2 of 2 In Effet: 10/98 Norton Healthare Blood and Marrow Transplant Laboratory Revised: 07/03/13

Cord Blood Kit Unique Identifiation No. #: CORD BLOOD STORAGE AGREEMENT This Cord Blood Storage Agreement ( Agreement ) is entered into as of the date of exeution by and between the undersigned Parents and Norton Healthare, In. d/b/a Cord Blood Storage Program ( Norton ). Introdution A. Norton provides ord blood storage servies. B. Parents desire to partiipate in Norton s pursuant to the terms and onditions of this Agreement. Terms & Conditions 1. Cord Blood Storage Fees. Parents will omplete Shedule A, Enrollment Form, to register for the. Parents agree to remit payment of the Cord Blood Storage Fees as set forth on the Finane Form, attahed hereto and inorporated herein as Shedule B. Norton reserves the right to hange its fees upon 60 days notie at any time. Any inrease in the storage fees will be reasonable, based upon market fators. 2. Term and Termination of Agreement. This Agreement shall be onsidered effetive upon reeipt by Norton of the following ompleted douments: Exeuted Cord Blood Storage Agreement Enrollment Form (Shedule A) with non-refundable enrollment fee Finane Form (Shedule B) Informed Consent Comprehensive Health History OB/Midwife Competeny Certifiation Doument In aordane with the terms of this Agreement, Norton will maintain the ord blood for a maximum of 20 years or until otherwise direted by Parents, appointed guardian, or the hild upon reahing the age of majority. This Agreement may be terminated by: (i) Norton, upon 90 days prior written notie to the Parents, of its intent to disontinue the Cord Blood Program and dispose of the ord blood in aordane with Norton poliy for disposal of human tissue. Notwithstanding the foregoing, if Parents exeute and remit an Authorization (as defined below) within 90 days after the mailing of the notie, Norton will omply with suh Authorization. In the event the Parents fail to exeute and remit an Authorization, within 90 days, Norton may onsider the ord blood to have been donated to Norton or dispose of the ord blood in aordane with Norton poliy for disposal of human tissue. (ii) In the event that any Cord Blood Storage Fee beomes more than ninety (90) days past due, this Agreement shall automatially terminate and the ownership of ord blood shall automatially revert to Norton, whih shall thereupon be entitled to dispose of the ord blood in its sole disretion. Page 1 of 4 BMTL-FL-400 Form7 In Effet: 10/98 Revised: 07/03/13 Norton Blood and Marrow Transplant Laboratory

Cord Blood Kit Unique Identifiation No. #: (iii) Request from Parents to thaw and dispose of the ord blood in aordane with Norton poliy for disposal of human tissue; (iv) Request from Parents to make the ord blood available for use by (a) the hild; (b) a sibling, if an aeptable geneti math; () one of the Parents of the hild, if an aeptable geneti math; (d) another individual speifially designated by the family, if an aeptable geneti math. Exept if to be used by the hild, Norton will not thaw the ord blood and will not otherwise failitate its use until Norton reeives ertifiation by a qualified hematologist on the Norton medial staff that the potential reipient is an aeptable geneti math for the ord blood based on generally reognized standards of aeptability. Norton will ause the delivery of the ord blood for utilization within Norton Hospital, but all use at other loations will be governed by this Agreement; (v) Request from Parents to donate the ord blood to Norton whih shall then have sole disretion to determine to (a) use the ord blood for researh, or (b) dispose of the ord blood of in aordane with the Norton poliy for disposal of human tissue. The parties aknowledge and agree that Parents may exerise their rights under this Setion only in writing by exeuting an Authorization and Request for Release of Cord Blood Produt ( Authorization ) or suessor form designated by Norton. 3. Child Age of Majority. Parents expressly agree that the rights and duties of Parents set forth in this Agreement shall beome those of the hild upon the hild reahing majority, unless the hild has been determined to be inompetent or the hild agrees in writing to allow Parents to retain suh authority. The hild must exeute a Agreement upon the age of majority or exerise 1 of the above termination rights. 4. Ownership Dispute. If a dispute arises at any time regarding the ord blood, the Parents or other lawful owner shall seek a ourt order resolving the dispute at their sole expense. If any ourt of ompetent jurisdition shall award to either Parent all rights with respet to the ord blood to the exlusion of the other Parent, by an order whih is final and binding as to them, Norton shall have the right thereafter, whether or not a party in the ourt proeedings, to deal exlusively with him or her to whom suh rights were awarded ( the prevailing party ) without liability or other aountability to the other. Additionally, if the hild, either before or after reahing majority, obtains rights with respet to the ord blood (either by proper grant from Parents, final and binding ourt order or operation of law, Norton also shall have the right thereafter to deal exlusively with the hild without liability or other aountability to Parents or any other third party regardless of whether Norton was a party to any proeeding giving rise to the hild s rights. 5. Cord Blood Transport. Parents aknowledge that Norton reommends against transporting the Cord Blood to any other faility or loation (exept if Norton disontinues the Cord Blood Program or transfers the donated ord blood in its disretion pursuant to an Authorization. Other than as expressly provided in the previous sentene, Norton will only transfer when the Parents (i) assume all risks and expenses; (ii) agree in writing to indemnify Norton for all expense and liability assoiated therewith; (iii) pay a reasonable fee for administrative and other osts inluding but not limited to the ost of transport; and (iv) omply with all suh other onditions as Norton may in its reasonable disretion impose. BMTL-FL-400 Form7 In Effet: 10/98 Revised: 07/03/13 Page 2 of 4 Norton Blood and Marrow Transplant Laboratory

Cord Blood Kit Unique Identifiation No. #: 6. Dislaimer of Liability. In onsideration of being aepted into the Cord Blood Program, Parents affirmatively waive, to the maximum extent permitted by law, any and all laims whih they or either of them may hereafter be entitled to assert against Norton, or any personnel thereof, for mental suffering, emotional distress, or any similar or related ause of ation or basis for liability. Parents expressly aknowledge that Norton gives no assurane that the ord blood will be usable when thawed or will be an effetive treatment agent. If either Parent shall make Norton or any of its offiers, board, or employees a party to any litigation arising from any disagreement between Parents, or with the hild or others, as to the rights of any of them under this Agreement, as to eah other or as to Norton, Parents shall be liable for reasonable attorney s fees and other osts of Norton in suh litigation unless Norton is determined by final, non-appealable order to have breahed this Agreement. 7. Current Information. Parents agree to keep their most urrent mailing address on file with the all times during their partiipation in the Program and for 1 year thereafter, and to advise Norton promptly in writing upon eah hange of address or prolonged absene from the last address on file. Unless and until superseded in writing, their urrent mailing address is the address shown on Shedule A. 8. Severability. If any provision of this Agreement shall be found to be unenforeable or illegal for any reason, this Agreement shall remain in full fore and effet, exept for the unenforeable or illegal provision. 9. Assignment. Neither this Agreement nor any rights or duties under this Agreement may be assigned by either party, exept upon written agreement signed by both parties. 10. Amendments. Exept as otherwise provided in this Agreement, this Agreement may not be amended exept upon written agreement signed by both parties. 11. Waiver. A failure by any party to insist upon the strit performane of any ovenant, agreement, term, or ondition of this Agreement or to exerise a right or remedy shall not onstitute a waiver of that ovenant, agreement, term, ondition, right, or remedy. No waiver of any breah shall affet or alter this Agreement, but eah and every ovenant, ondition, agreement, and term of this Agreement shall ontinue in full fore and effet with respet to any other existing or subsequent breah. 12. Entire Agreement. This Agreement and the Exhibits hereto onstitute the entire agreement of the parties with respet to the subjet of this Agreement and supersede any prior written agreements of the parties regarding the subjet matter of this Agreement. 13. Counterparts. This Agreement may be exeuted and delivered (inluding by fasimile transmission or e-mail) in one or more ounterparts, and by eah of the parties in separate ounterparts, eah of whih shall be an original when exeuted and delivered, but all of whih together shall onstitute one instrument. BMTL-FL-400 Form7 In Effet: 10/98 Revised: 07/03/13 Page 3 of 4 Norton Blood and Marrow Transplant Laboratory

Cord Blood Kit Unique Identifiation No. #: 14. Governing Law and Submission to Jurisdition. THIS AGREEMENT SHALL BE GOVERNED BY, AND CONSTRUED AND ENFORCED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF KENTUCKY. This provision shall survive termination of this Agreement. 15. Waiver of Trial by Jury. EACH PARTY IRREVOCABLY WAIVES ALL RIGHT TO TRIAL BY JURY IN ANY PROCEEDING (WHETHER BASED IN CONTRACT, TORT, OR OTHERWISE) ARISING FROM OR RELATING TO THIS AGREEMENT. This provision shall survive termination of this Agreement. IN WITNESS WHEREOF, the parties have exeuted this Agreement to be effetive as set forth in the Agreement. Print Mother Name Signature of Mother Date Print Father Name (optional) Signature of Father (optional) Date Print Mother s Legal Guardian Name (if appliable) Signature of Mother s Legal Guardian (if appliable) Date BMTL-FL-400 Form7 In Effet: 10/98 Revised: 07/03/13 Page 4 of 4 Norton Blood and Marrow Transplant Laboratory

Father s Information Mother s Information Cord Blood Kit Unique Identifiation No. #: Shedule A - Enrollment Form Expeted Delivery Date: Indiate below whether biologial or adoptive parent Mother Last Name Mother First Name Mother Middle Name Mother SSN Mother Address Mother City/State/Zip Mother Email Mother Home Phone Mother Cell Phone Mother s Marital Status (irle) Mother Plae of Employment Married Divored Single Address City/State/Zip Work Phone Father Last Name Father First Name Father SSN Father Plae of Employment Address City/State/Zip Work Phone Page 1 of 2 BMTL-FL-400 Form 8 In Effet: 10/98 Revised: 07/03/13 Norton Blood and Marrow Transplant Laboratory

Family Physiian Contat Information Antiipated Pediatriian Contat Information Physiian/Midwife Contat Information Delivering Hospital Information Cord Blood Shedule A - Enrollment Form Name of Hospital for Expeted Delivery Hospital Labor & Delivery Department Phone Hospital Address Hospital City/State/Zip Physiian/Midwife Name Physiian/Midwife Group/Offie Name Physiian/Midwife Address Physiian/Midwife City/State/Zip Physiian/Midwife Phone Number Physiian/Midwife Fax Number Name of Infant s antiipated Physiian Infant Physiian Address Infant Physiian City/State/Zip Infant Physiian Phone Family Physiian Name Family Physiian Address Family Physiian City/State/Zip Family Physiian Phone Page 2 of 2 BMTL-FL-400 Form 8 In Effet: 10/98 Revised: 07/03/13 Norton Blood and Marrow Transplant Laboratory

Cord Blood Shedule B - Finane Form I agree to the timely payment of the Cord Blood Storage Fees desribed below: The total ost of enrollment, whih inludes olletion supplies, harvesting, proessing, and the first year of storage is $1,650. The non refundable enrollment/kit fee, due upon exeution of this Agreement, (inluding the informed onsent) is $150, and inludes all olletion supplies and shipping materials. The remaining balane is $1,500 and inludes all proessing fees and the storage fee for the first year. If the harvested produt requires shipping to Norton Healthare for proessing, this is also inluded in the fee. If the ord blood produt should not be suitable for storage, for any reason, the $1,500 payment will be refunded. The annual storage fee is $125. This fee is due every year on the anniversary of the birth of the hild whose blood is being stored. The family may hoose to ontinue storage for a maximum of twenty years. If the delivering physiian would invoke a speimen olletion fee, suh a fee would be the responsibility of Parents. Parents are enouraged to disuss this possibility with the physiian prior to delivery. In the event of a multiple birth, a nonrefundable appliation fee of $150 is required for eah hild. The enrollment fee for the first hild is $1500. The enrollment fee for eah additional hild during this pregnany is $1200. PAYMENTS: Nonrefundable Appliation Fee of $150 is paid aording to the method indiated below and I hereby authorize Norton to initiate the finanial transation indiated below upon Norton s reeipt of this Shedule B and full exeution of the Agreement to whih this Shedule B is attahed. Type of Payment: Personal Chek Money Order (Do not send urreny) VISA MasterCard Disover Aount Number of Credit Card: 3-Digit Seurity Code on Bak of Card: Expiration Date of Credit Card: Name of Cardholder: Signature of Cardholder: Please hoose one payment plan below for the balane of enrollment fee of $1450 and sign below verifying your intentions. Pay in full ($1500) due 30 days after birth of your hild. (A statement will be sent 15 days after the birth) Pay ten payments of $150 due at the monthly anniversary of the birth of your hild. Mother Signature: Date Father Signature: Date (optional) BMTL-FL-400 Form9A In Effet: 10/98 Revised: 12/31/13 Norton Healthare Blood and Marrow Transplant Laboratory

Donor/Kit#: 4. Have you ever had a misarriage? If yes, how many? 5. Have you ever had a stillborn? If yes, how many? 16. Had White Blood Cell Diseases? (i.e. Chroni Granulomatous Disease or Wiskott-Aldrih) If yes, list type: 17. Had Immune Defiienies? (i.e.hiv or Severe Combined Immunodefiieny) If yes, list type: 18. Had Platelet Diseases (i.e. hereditary thromboytopenia) If yes, list type: 19. Had Metaboli/Storage Diseases? (i.e. Tay Sah's, Leukodystrophies) If yes, list type: 20. Had Neurologial Disorders? A. Creutzfeldt-Jakob Disease B. Other Neurologi Disorder: 21. Had other geneti disorders/diseases If yes, list types: 22. Have you for any reason been deferred or refused as a blood or ord blood donor, or been told not to donate blood or ord blood? If yes, why? Yes BMTL#: Instrutions: Read eah question as written and answer to the best of your knowledge. If you have any questions, please disuss them with the staff. COMPREHENSIVE HEALTH/HISTORY RECORD Mother's Name: Mother's S.S. #: Date Completed: / / Calulated Due Date: Mother's Rae / / Cauasian/White Hispani Planned Cesarean Date: Afrian/Amerian Native Amerian / / No Asian Other: Speify: Mother's Health History Questions 1. Is this your first pregnany? (If yes, skip to question 6) 2. How many other pregnanies have you had? 6. Have you had any hildren who died within the first 10 years of life? 7. Have you ever donated or privately stored another infant's ord blood before? If yes, indiate: Other 8. Have you had any ompliations with the pregnany? 9. Did this pregnany use either a donor egg or donor sperm? A. If yes, is a family medial history questionnaire available for the egg or sperm donor? 10. Were you and/or the baby's father adopted at early hildhood? A. If yes, is a family medial history available for you and/or the baby's father? 11. Are you taking an antibioti or any other mediation for an infetion? 12. Have you been exposed to at fees during this pregnany? 13. Have you ever been referred to or advised to donate ord blood to this program? If yes, list the reommending physiian and reason: Father's Rae Cauasian/White Hispani Afrian/Amerian Native Amerian Asian Other: Speify: Yes No Family Medial History Questionnaire Chek yes if an immediate family member has had the listed disease/illness. Desribe the relationship between the baby and the immediate family member affeted with the disease/illness. Immediate family members onsist of the baby's parents and the baby's siblings (inluding siblings that died at or before birth). Family Health History Questions 14. Had Caner or Leukemia? If yes, list type: Mother's Health History and this Pregnany 3. How many live born hildren resulted from the other pregnanies? 15. Had Red Blood Cell Diseases? (i.e. sikle ell disease, thalassemia, Fanoni's anemia, and/or Diamond-Blakfan syndrome) If yes, list type: BMTL-FL-400 Form10 In Effet: 10/98 Revised: 07/03/13 1 of 4 Completed By: Mother Only Mother & Father Other: No Family Member(s) Affeted Norton Healthare Blood and Marrow Transplant Laboratory

Donor/Kit#: COMPREHENSIVE HEALTH/HISTORY RECORD Cord Blood Donor Risk Fator Questionnaire BMTL#: Cord Blood Donor Risk Fator Questionnaire Setion refers to both the baby's mother and the baby's father. At the end of this setion a spae is provided to allow for further larifiation for "yes" answers and the parent it pertains to. Cord Blood Donor Risk Questions 23. In the past 12 weeks, have you or the baby's father had ontat with someone who has reeived the small pox vaine? (Examples of ontat inlude physial intimay, touhing the vaination site, touhing the bandages or overing of the vaination site, or handling the bedding or lothing that had been in ontat with an unbandaged vaination site.) 24. In the Past 12 weeks, have you or the baby's father had any shots or vainations? If yes, please desribe: 25. In the past 12 months: A. Have you had a blood transfusion? B. Have you had a transplant or graft from someone other than yourself, suh as an organ, bone marrow, stem ells, ornea, slera, bone, skin, or other tissue? C. Have you had a tattoo? (inluding "touh-ups", tattos applied by oneself, and those applied by others) D. Have you had an ear, skin, or body piering? E. Have you had an aidental needle stik or have you ome into ontat with someone else's blood? F. Have you had or been treated for HPV or genital herpes, syphilis, gonorrhea, or other sexually transmitted infetions? G. Have you had sexual ontat with a prostitute or anyone else who takes money or drugs or other payment for sex? H. Have you had sexual ontat or lived with a person who has ative or hroni viral hepatitis or yellow jaundie? I. Have you had sex, even one, with anyone who has taken lotting fator onentrate for a bleeding problem suh as hemophilia? J. Have you had sex, even one, with anyone who has HIV/AIDS or has had a positive test for the AIDS virus? K. Have you been in juvenile detention, lokup, jail or prison for more than 72 ontinuous hours? L. Have you had sex, even one, with anyone who has used a needle to take drugs, steroids, or anything else not presribed by a dotor? M. Have you had sexual ontat with a male who has ever had sexual ontat with another male, even one? 26. In the past 3 years: A. Have you had malaria? B. Have you been outside the United States or Canada? If yes, Please list where, when, and for how long? 27. In the past 5 years: A. Have you reeived money, drugs or other payment for sex? B. Have you used a needle, even one, to take drugs, steroids, or anything else not presribed for you by a dotor? C. Have you ever used lotting fator onentrates? 28. Have you ever taken any of the following mediations? A. Growth hormone from human pituitary glands ever? (Used usually for hildren with delayed or impaired growth) B. Insulin from ows (bovine or beef insulin) sine 1980? (used to treat diabetes) C. Hepatitis B immune globulin? (given following an exposure to Hepatitis B. Note: This is different than the Hepatitis B vaine, whih is a series of 3 injetions given over a 6 month period to prevent future infetion to exposures to Hepatitis B.) D. Unliensed vaine? (usually assoiated with a researh protool) BMTL-FL-400 Form10 In Effet: 10/98 Revised: 07/03/13 2 of 4 Yes Norton Healthare Blood and Marrow Transplant Laboratory No

Donor/Kit#: Cord Blood Donor Risk Questions 29. Have you ever hadhepatitis or any positive test for hepatitis (inluding sreening tests)? 37. Have you been diagnosed with West Nile Virus during your pregnany? Bulgaria for hepatitis? 38. Have you ever been in Afria? COMPREHENSIVE HEALTH/HISTORY RECORD 30. Have you ever had Chagas disease and/or a positive test for T. ruzi? 31. Have you ever had babesiosis? 32. Have you ever reeived a dura mater (brain overing) graft? 33. Have you ever had a transplant or medial proedure that involved being exposed to live ells, tissues or organs from an animal? 34. Have you ever lived with or had sexual ontat with anyone who had a transplant or other medial 35. Do you have AIDS or have you ever tested positive for HIV (inluding sreening tests)? 39. Have you ever had sexual ontat with anyone who was born or lived in Afria? Albania proedure that involved being exposed to live ells, tissues or organs from an animal? 36. Have you ever tested positive for HTLV (inluding sreening tests), adult T-ell leukemia, or had unexplained paraparesis (partial paralysis affeting the lower limbs? Austria Belgium Bosnia-Herzegovina Croatia Czeh Republi Denmark Finland Frane Referene Guide for Questions #40 & #42: Countries Defined as Europe Germany Greee Hungary Ireland (Republi of) Italy Liehtenstein Luxembourg Maedonia Netherlands (Holland) Norway Poland Portugal Romania San Marino Slovak Republi BMTL#: United Kingdom: England, Northern Ireland, Sotland, Wales, the Isle of Man, the Channel Islands, Gibraltar or the Falkland Islands Yes No Slovenia Spain Sweden Switzerland Yugoslavia Yugoslavia (Federal Republi of): Kosovo, Montenegro, Serbia 40. From 1980 through 1996, did you spend time that adds up to three months or more in the United Kingdom (refer to hart)? 41. From 1980 through 1996, were you a member of the U.S. military, a ivilian military employee, or a dependent of a member of the U.S. military? If yes, answer the following. If no, skip to question 42. Within the timeframes listed, did you spend a total of 6 months or more assoiated with a military base in any of the following ountries: From 1980 thorugh 1990 in Belgium, the Netherlands, or Germany? From 1980 through 1996 in Spain, Portugal, Turkey, Italy, or Greee? 42. From 1980 to the present: A. Did you spend time that adds up to five years or more in Europe? (refer to hart) B. Did you reeive a blood transfusion in the United Kingdom or Frane? (refer to UK in the hart) Yes No Explain any "Yes" answers that need further larifiation. Indiate baby's mother or baby's father. I have attahed a opy of my prenatal test results or I have asked my dotor to fax my results to at (502) 629-7798? BMTL-FL-400 Form10 In Effet: 10/98 Revised: 07/03/13 3 of 4 Norton Healthare Blood and Marrow Transplant Laboratory

Donor/Kit#: Date BMTL#: I have had the opportunity to ask questions about the information requested on this questionnaire and my questions have been answered to our satisfation. I understand that the requested information is important beause if I am at risk for infetion due to AIDS or other ommuniable disease agents/diseases, my donated ells may transmit these diseases to the reipient of these ells. COMPREHENSIVE HEALTH/HISTORY RECORD Cord Blood Donor Statement of Understanding I understand that postpartum I will be asked to reaffirm the original responses to the questions by staff. I have truthfully answered all of the questions on this questionnaire. I will inform of any pertinent hanges in my health status and will update my phone and address information. (Baby's Mother's signature required, Baby's Father's signature when available or if appliable) Mother's Signature This Setion To Be Completed by Staff Only: s SARS or suspeted SARS? Yes Yes Yes See Donor Eligibility Determination Report (BMTL-FL-700 Form3) for Cord Blood Donor Eligibility Status. Medial Diretor/Clinial Staff Date This Setion To Be Completed by Laboratory Staff Only: Initial Donor Eligibility Approval Postpartum Follow-up Father's Name (please print) Father's Signature Cord Blood Donor Staff Review Addendum: SARS 5. In the past 14 days, do you believe you have been exposed to SARS or to someone who has traveled to, traveled An oral interview was performed with the ord blood donor's mother to omplete this setion (inluding the review of the "Cord Blood Donor Statement of Understanding") s Mother's Name (please print) During time of person-to-person transmission of SARS, the following questions must be answered. 1. In the past 28 days, have you been ill with SARS or suspeted SARS? The Comprehensive Health History Reord was reviewed for ompleteness. Information affeting donation was assessed and my evaluation is doumented where neessary. If further assessment was required, appropriate staff were notified. --- Person-to-Person transmission of SARS not ourring. 2. In the past 14 days, have you ared for, lived with, or had diret ontat with body fluids of a person with 3. In the past 14 days, have you traveled outside of the United States? 4. In the past 14 days, has someone you live with traveled to, traveled through, or resided in areas affeted by SARS? through, or resided in areas affeted by SARS? Reaffirmation of original responses? Yes No Reaffirmed By: Mother Father If No, list hanges: Yes Yes Date No No No No No Initials/Date Infant Name:, Last First Middle Produt Stored? Yes No If No, Complete QA Form. Family Comments: Staff Initials/Date: BMTL-FL-400 Form10 In Effet: 10/98 Revised: 07/03/13 4 of 4 Norton Healthare Blood and Marrow Transplant Laboratory

Cord Blood FAMILY INTRUCTIONS Your Cord Blood Colletion Kit has been assigned the following Donor/Kit # It is the parents responsibility for the following: At the arrival to the birthing faility, inform the staff immediately that you plan to save your baby s ord blood. Give the olletion kit, inluding paperwork, to your nurse. Keep the olletion kit at Room Temperature (59 F - 77 F), in a seure, dry loation. (DO NOT STORE IN A VEHICLE). Make sure that the OB/Midwife and the assisting staff in your delivery room have read and understand the olletion instrutions. If anyone has questions that you an t answer, ontat at (502) 629-7771 or the Tehnologist On-Call at (502) 421-0800. Designate a family member/friend that will be responsible for pakaging the ord blood bag aording to the transport instrutions attahed. Any issue identified by the olletion staff or the designated family member/friend should be resolved prior to initiating transport. It is the designated family member/friend s responsibility to: Follow Instrutions for Transporting Cord Blood attahed and enlosed in the kit. Complete the transport label prior to transport by verifying information with involved olletion staff and/or personally inspet the Cord Blood Unit/Kit for auray and ompleteness. Call Bee-Line Courier Servie for the Cord Blood Unit/Kit pikup at 502-964-9969 OR personally transport the Cord Blood Bag/Kit to Norton Hospital Transfusion Servies. Transport as soon as possible after olletion to allow tehnial proessing to begin within 24 hours of birth. Notify the Tehnologist On-Call by digital beeper at (502) 421-0800 for to begin traking the transport for timely reeipt. The Norton Hospital Transfusion Servies will notify the Tehnologist On-Call when the Cord Blood Bag/Kit is reeived and the ord blood olletion time. The Tehnologist On-Call will then ensure initiation of pikup and proessing within 24 hours. proessing staff will ontat you to verify infant identifiation, reaffirmation/or hanges to the Comprehensive Health/History Reord and disuss initial proessing outomes. If for any reason the ord blood annot be harvested, notify at (502) 629-7771 to arrange for proper disposal of the unused kit. BMTL-FL-400 Form11 In Effet: 10/98 Revised: 07/03/13 Norton Healthare Blood and Marrow Transplant Laboratory

Cord Blood PACKING CORD BLOOD IN BIOHAZARD BAG Items in the biohazard bag to inlude: 1. Clamped/Sealed Cord Blood Bag with Donor Label on bag 2. Biohazard label 3. Deliver To/Speial Handling Tie Tag Items in the poket of the biohazard bag to inlude: 1. Birthing Faility Data Colletion Reord 2. Hospital Labor & Delivery Reord PACKING MATERNAL BLOOD IN BIOHAZARD BAG Items in the biohazard bag to inlude: 6 Labeled tubes of Mother s Blood Items in the poket of the biohazard bag to inlude: Maternal Blood Draw Reord with hospital Mother s ID label attahed. NOTE: Complete and apply Transport Label to the top of the sealed box prior to shipment. NOTIFICATION OF TRANSPORT Notify the Staff when the Cord Blood has been piked for transport by alling the digital pager at (502) 421-0800. Insert your all bak phone number inluding area ode after the two beeps. The tehnologist on-all should all bak within 30 minutes. If your all is not returned, ontat the Norton Hospital operator at (502) 629-8000 and ask to be transferred to transfusion servies. TRANSPORTING INSTRUCTIONS If delivering your baby at Norton Hospital (Downtown): Have a designated family member personally take the kit to the Transfusion Servies on the Ground Floor. If delivering your baby at a Birthing Faility other than Norton Hospital (Downtown): Option 1: Call Bee-Line Courier Servie at (502) 964-9969. Use Aount #2547, for a ord blood bag/kit pikup for transport to: Norton Hospital (Downtown) Transfusion Servies 200 East Chestnut Street Ground Floor, Lab Inside the Louisville area, request a NONSTOP KILLER BEE RUN to your faility. Outside of the Louisville area, request a DIRECT RUN to your faility. Bee-Line will need the Birthing Faility s name, address, ity, state, zip ode and the mother s name, room #, unit loation, and all bak phone number. Option 2: Have a designated family member personally take the kit to Norton Hospital (Downtown) to the Transfusion Servies department. WHEN TRANSPORTING THE CORD BLOOD BAG/KIT BY VEHICLE, THE AMBIENT TEMPERATURE INSIDE THE VEHICLE SHOULD BE KEPT AT APPROXIMATELY 59 F - 77 F. BMTL-FL-400 Form12 In Effet: 10/98 Revised: 07/03/13 Norton Healthare Blood and Marrow Transplant Laboratory

Cord Blood Informed Consent 1. I, and (olletively referred to herein as Parents ), individually, and on behalf of my future born hild, aknowledge by signing this Informed Consent below, that I have reviewed this doument in its entirety and have disussed the proedures detailed herein relating to the olletion of ord blood of my future born hild with my Obstetriian and/or Midwife ( Pratitioner ) and I freely and knowingly give my onsent for my Pratitioner to ollet ord blood from my future born hild. 2. I understand that the Pratitioner will be given the opportunity to onsult with the medial diretor of the Family Link ( Program ) before the extration of ord blood. I understand that partiipation in this linial proedure and the Program is voluntary. If I elet not to partiipate, my deision will not affet my relations with Norton Healthare or result in any penalty or loss of benefits to whih I am otherwise entitled. 3. I have read this Agreement, speifially inluding this Informed Consent, arefully and know I should ask questions about anything whih is unlear before I deide whether to be a partiipant in this Program. I have been given the opportunity to ask these questions of Norton Healthare, and they have been answered to our satisfation. I aknowledge that I have aess to an impartial donor advoate provided by Norton Healthare. 4. I understand the desription of how the ord blood will be harvested and stored and the risks and benefits assoiated with harvesting and storage as identified in the materials provided to me relating to the olletion of ord blood and as otherwise explained to me by my Pratitioner and/or Norton Healthare. By signing where indiated below, I aknowledge that I have reviewed information onerning the risks, benefits, disomforts, and alternatives to ellular donation. I further aknowledge that I have been advised of the following: Cord blood has speial ells that may be used later to treat some types of life-threatening diseases. Umbilial ord blood is rih in hematopoieti stem ells, whih are preursors to healthy blood ells. Using established proedures and validated tehniques, the ord blood harvested immediately after delivery of the baby an be preserved for up to 20 years by freezing and then storing it in nitrogen vapor. Benefits of harvesting and storing ord blood may inlude, but are not neessarily limited to the following: For someone needing an autologous (from oneself) transplant, their stored ord blood ould be used as a stem ell produt option. For someone needing an allogenei (from someone else) transplant, a mathing sibling s ord blood may be appropriate to be used as a stem ell produt option. This would eliminate the need to perform a bone marrow harvest, whih is an operative proedure requiring anesthesia. With stem ells olleted from ord blood, the likelihood of an adverse reation, suh as graft vs. host disease where transplanted ells attak the reipient, is dereased when ompared to bone marrow or peripheral blood. The ord blood harvest is generally painless with no known risks assoiated to the mother or hild. When the baby is born, the umbilial ord is lamped, ut and the baby is separated from the plaenta and the mother. At this point, the Obstetriian/Midwife will perform the harvesting proedure using either the In Utero or Ex Utero olletion method. Page 1 of 4 BMTL-FL-400 Form 13 In Effet: 10/98 Revised: 11/4/13 Norton Healthare Blood and Marrow Transplant Laboratory

For an In Utero olletion, the plaenta remains within the mother s body for the harvest following vaginal or esarean delivery. It is the reommended method beause natural uterine ontrations improve blood flow during the olletion. The plaenta is delivered after the ord blood is harvested. For an Ex Utero olletion, the plaenta is delivered and then plaed in a sterile basin for the harvest. There is a slight inreased risk of mirobial ontamination due to handling of the plaenta and the time delay may result in less ord blood harvested due to lotting. The harvest proedure is performed by inserting the needle of a FDA approved donor olletion bag into the plaental ord vein. Blood enters the olletion bag due to normal pressure flow and gravity. The donor olletion bag ontains an antioagulant to keep the ord blood from lotting. The entire harvesting proedure usually takes less than six minutes and should be ompleted within 10 minutes of birth, before the blood in the ord lots. The Obstetriian, Midwife or birthing enter staff is provided with instrutions for speimen olletion, labeling, proper pakaging and a data olletion reord to omplete. 5. I understand that the expeted outome of olletion is as follows: Optimal ord blood produt being harvested will have a high yield of ellular levels, will be stored in aordane with the Program poliies and may be suitable for future transplant. Suboptimal ord blood produt being harvested will have a lower yield of ellular levels than an optimal harvest, but may still be suitable for future transplant. In aordane with Program poliies, a suboptimal harvest may result in a refund of proessing expenses being returned to me. Cord blood that is not suitable for transplant and/or insuffiient olletions will result in an automati refund of proessing expenses to me and disposal of any olleted blood in aordane with Program poliies. 6. I understand that the expetant mother s blood will be drawn for testing at the time of the delivery admission to determine the presene of hepatitis, HIV (the virus that auses AIDS) and other infetious diseases. If either the mother s blood or the ord blood tests positive for one or more infetious diseases, or laks ertain ellular harateristis, the ord blood may not be eligible for storage. The mother or the baby may be asked to provide additional blood for testing. The results of all blood testing will be handled onsistent with Kentuky laws regarding dislosure by staff. As permitted by appliable dislosure laws, the Parents will be informed of positive test results or ontraindiations of storage by the Medial Diretor and/or the Nurse Coordinator, the mother s Obstetriian, and/or the baby s pediatriian. The Parents have the right to review the results of any test performed and to obtain a opy of these results upon request. 7. I understand that samples may be proured from the ord blood and stored for possible future testing. 8. I understand that by partiipating in the, I will be required to allow, and permit Norton Healthare, and my Pratitioner to review the medial history and reords of me, my future born hild and the father of suh hild to the fullest extent permitted by law. I agree to provide information reasonably requested that relates to the biologial family s medial and geneti history. While my information shall remain onfidential aording to state and federal law, I understand that my personal and familial health information may be dislosed to ertain third-parties where suh dislosure may affet the therapeuti value of the produt. Page 2 of 4 BMTL-FL-400 Form 13 In Effet: 10/98 Revised: 11/4/13 Norton Healthare Blood and Marrow Transplant Laboratory

9. I understand that by storing the ord blood, it may offer me the opportunity to use it in the event of ertain future medial needs, but I further understand that by storing this blood, Norton Healthare is not guaranteeing that the stored blood will be a suitable math or result in suessful treatment. 10. I understand the alternatives to privately storing the ord blood. Alternative proedures to ord blood olletion if therapy as well as transplant is needed, inlude the olletion of the ell produt by bone marrow harvest, whih requires an operative proedure under anesthesia, peripheral blood stem ell olletion, a mononulear ell produt obtained from an unrelated donor program, ontrolling the disease by low dose hemotherapy, reeiving radiation or surgery that does not require a bone marrow resue. 11. I understand that not all ord blood speimens are suitable for freezing and if the mother or the speimen test positive for ertain infetious diseases inluding, but not limited to, HIV, AIDS or hepatitis, or the speimen does not possess ertain essential harateristis, the speimen will not be ryogenially preserved by Norton Healthare. 12. I understand that information about the Program and Norton Healthare s experienes in ord blood harvesting, storage and utilization may be publily revealed or utilized in researh, but that Parents and hild s identity will not be revealed in suh publiations. I understand that I have the right to review the reords pertaining speifially to my hild s ord blood at any time, and I may authorize release of suh reords to an appropriate government ageny or other third-party. 13. I understand that with any tehnique neessitating mehanial support systems, equipment failure and other events that an destroy, damage, or ompromise the tissue for ertain uses an our. Norton Healthare, its subsidiaries and affiliates, their diretors, offiers, employees, agents and onsultants shall not to be liable for any destrution, damage, or ompromise of the ord blood due to any aspet of transport, equipment failure or malfuntion, or aused by failure of utilities, strike, essation of servies or other labor disturbane, any war, ats of a publi enemy, or other disturbane, any fire, wind, earthquake, water, or other ats of God, any failure of any other laboratory or provider, or other ats, omissions, or auses outside Norton s ontrol. All medial information obtained from Parents or about hild shall be treated with the same degree of onfidentially given all medial reords and as may otherwise be required by law. 14. I understand that if I no longer want to preserve the ord blood I an: a) request Norton Healthare to thaw and dispose of the ord blood in aordane with Norton Healthare s poliy for disposal of human tissue; or b) donate it to Norton Healthare whih shall then have sole disretion to determine whether it be (i) used for researh, or (ii) disposed of in aordane with the Norton Healthare poliy for disposal of human tissue. 15. I understand that I will be responsible for harges aording to the fees set forth in the Cord Blood Storage Agreement for the olletion supplies, proessing, freezing and ontinued storage and these fees are subjet to hange. I aknowledge that the proedures and storage may not be overed by my insurane and any insurane laims are my responsibility. 16. I understand that there is urrently no legal preedent in the Commonwealth of Kentuky regarding the status or disposition of frozen ord blood, should a dispute over ownership of ord blood or other affiliated rights arise. Notwithstanding, Norton Healthare shall reasonably use, transfer, and dispose of any ord blood in aordane with my diretives as provided for and allowed pursuant to this Informed Consent and any other doument provided to me in onnetion with the Program. 17. I aknowledge that Norton Healthare, its subsidiaries and affiliates, inluding without limitation Norton Hospital, In., provide no insurane overage, ompensation or free medial are plan to ompensate or are for me if I, my hild, or the ord blood are harmed in any way by any aspet of the Program or the proedures desribed herein. Page 3 of 4 BMTL-FL-400 Form 13 In Effet: 10/98 Revised: 11/4/13 Norton Healthare Blood and Marrow Transplant Laboratory

18. I understand that it may be neessary for Norton Healthare representatives to ommuniate with me onerning the prourement and storage of ord blood both before and after prourement of the ord blood. I hereby onsent to Norton Healthare providing information and allowing the same to be reorded by any automated devie I may use to reord messages delivered to my telephone number. I understand that this onsent for Norton Healthare to leave a message on my answering devie may be revoked at any time by me in writing to Norton Healthare. I hereby represent that I am of legal age and legally ompetent to enter into this Informed Consent. I am not urrently in ative labor (whih, for purposes of this Informed Consent shall mean that I am not urrently experiening regular uterine ontrations, dilation and effaement of the ervix and the desent of the fetus into the birth anal) and I further understand that by signing below I am hereby giving my Informed Consent upon the terms stated herein. Printed Name of Mother Signature of Mother Date Printed Name of Father (optional) Signature of Father (optional) Date Printed Name of Signature of Date Obstetriian/Midwife Obstetriian/Midwife By Signing below, I represent that I am the legal guardian of, and it is her desire to have the ord blood of future hild to be olleted and stored by Norton Healthare pursuant to the terms of this Informed Consent and the other material provided herewith. As her legal guardian, I hereby represent that I am of legal age and legally ompetent to enter into this Informed Consent and I further understand that by signing below I am hereby giving my Informed Consent upon the terms stated herein Printed Name of Legal Guardian Signature of Legal Guardian Date Page 4 of 4 BMTL-FL-400 Form 13 In Effet: 10/98 Revised: 11/4/13 Norton Healthare Blood and Marrow Transplant Laboratory