Service Agreement

This Service Agreement (the "Agreement") governs your use of the services of Analyte Physicians Group, S.C. and its authorized agents (collectively "APG Services," "us" or "we"). By engaging our services, you agree that you have read, understand and consent to this Agreement:

Eligibility Requirements

• You are eighteen (18) years of age or older.
• You are engaging APG Services under your own name and will not misrepresent your identity or impersonate another person.
• You are not pregnant.
• At this time, you do not have a fever in excess of 100.5° F, stomach or abdominal pain, or vomiting. If at any time, you experience any of these symptoms, or your condition worsens, you will immediately contact a local healthcare provider.

Our Services

APG Services agrees to provide the following services ("Services"):

• APG Services will test you for one or more sexually transmitted diseases or infections (including HIV, where applicable) as selected on the order form ("Order").
• The testing will be performed at an independent clinical laboratory ("Lab") in accordance with any Order issued by an APG Services physician.
• APG Services will deliver to you at your contact address (including telephone, email, or other means), medical and educational information, your test(s) results and medically appropriate follow-up actions and/or treatments, including medical prescriptions.
• APG Services will not provide any services for medical emergencies or urgent situations. IF YOU THINK YOU HAVE AN EMERGENCY, CALL 911 IMMEDIATELY.

Your Responsibilities

• You shall be responsible for providing accurate information about your health, and to update your contact address within two (2) days of any change.
• You agree to follow all health-related recommendations, protocols and other instructions provided by APG Services, including the Lab, and you agree that if you decide or fail to follow any of these instructions, then you will be taking an "action contrary to medical advice."
• You agree to contact APG Services no later than (i) two (2) days after receiving notice at your contact address that the results of your tests are ready, or (ii) five (5) days after being tested, whichever comes first.

Service Acceptance

You agree and have the legal right and ability to: (i) enter into this Agreement, (ii) use the services for your personal benefit and (iii) abide by the obligations in the Agreement.

You have made an informed decision to use the Services, and have been given all necessary and relevant information to make that decision. You agree by accepting the Services that you are a patient of APG Services, and are entering into a patient-provider relationship with the healthcare provider(s) that APG Services assigns to you. You give permission (consent) to APG Services to test you for one or more sexually transmitted diseases or infections (including HIV, where applicable) at a Lab. You understand that the testing may involve the collection of body fluids or tissue, including blood or urine ("Sample"), in accordance with standard testing procedure, and that the Lab may require you to complete additional paperwork before testing. You understand that while the tests performed on your Samples are approved by regulatory agencies to detect the presence or absence of a specific disease or infection, they are not perfect or absolute. As stated on our website (the "Site"), there is a statistical possibility that a test may yield a false-positive or a false-negative test result, which may result in an inadvertent misdiagnosis.

You agree that any prescriptions for medical treatment or services that you receive from an APG Services physician shall be solely for your personal use. You agree to fully and carefully read all provided product information and labels and to contact a physician or pharmacist if you have any questions regarding the prescription. APG Services makes no representations or warranties about the adequacy or accuracy of any information provided by the manufacturer, pharmacist or clinician on any prescription drug products or any treatment, therapy or application provided in response to a prescription from an APG Services physician.

Personal Information/Confidentiality

You agree to provide your name, contact address and related personally identifiable information, including private health and medical information, to APG Services and its agents, including the Lab, and to permit APG Services and its agents to exchange this information.

APG Services respects your privacy and takes privacy very seriously. By accepting this Agreement, you consent to permit APG Services to use and disclose your personally identifiable information, including medical information, provided to us or developed while receiving Services as outlined in our Privacy Policy and Notice of Privacy Practices, which are part of the Agreement.

Electronic Medical Record

APG Services maintains an Electronic Medical Record (“EMR”) system and creates a record for each patient (your “Record”). Your Record is created to store your Personal Health Information (PHI), including health conditions, allergies and medications. Any information provided as part of a teleconsultation with an APG Services healthcare provider becomes part of your Record. You agree to provide accurate information, to periodically review such information, and to update such information in your Record, as needed.

APG Services will provide you access to portions of your Record via our website for one (1) year. After one (1) year, you may obtain access to your Record by written requests to APG Services. For additional information regarding use of your Record, please see our Privacy Policy and Notice of Privacy Practices. You agree that you are responsible for confirming any third-party information in your Record.

Public Health Reporting

In some circumstances (such as a positive test result for certain sexually transmitted diseases or infections), APG Services may be required by law to submit your name and address to federal and/or state public health agencies. You may or may not be notified of these disclosures.

Password and PIN

You may access your information on the Site only through the use of a password and/or PIN selected by you. You are solely responsible for maintaining the confidentiality of your password and/or PIN, and for all activities that occur under your password and/or PIN. You agree to prohibit anyone else from using your password and/or PIN and to immediately notify APG Services of any unauthorized use of your password or other security concerns of which you become aware.

Payment of Fees and Cancellation Policy

• At your direction, APG Services will accept payment directly from you or from your health insurance plan or other third-party payer ("Plan"), if APG Services has a contract or other arrangement with your Plan. If APG Services does not have a contract or other arrangement with your Plan, you will be responsible for paying APG Services directly.
• APG Services does not accept payments from any government health programs, including Medicare, Medicaid or TriCare.
• APG Services will charge your credit or debit card for the payment of Services in accordance with APG Services policies and this agreement.
• If you are tested in New York, New Jersey or Rhode Island, you agree to pay for the services of APG Services and of the Lab separately in accordance with instructions for APG Services and state regulations.
• If you choose to use your Plan for payment, APG Services will submit a claim and accept payments in accordance with your Plan's requirements. You agree to pay any necessary co-pays or deductibles as required by your plan. If your Plan denies coverage for any Services, you agree to pay for these Services in the amount typically paid for these services by your Plan.
• You can cancel or change your Order any time prior to the earlier of (i) your visit to the Lab, or (ii) 21 days after accepting this agreement, by contacting us at the phone number listed on our website every day except major holidays.

Term and Termination

This Agreement shall commence on the date your Order with APG Services is completed. Either you or APG Services may terminate this Agreement and your right to use APG Services at any time, with or without cause. This Agreement and the licenses granted to access the EMR shall terminate without notice in the event you (or any authorized person using your account) fail to comply with the terms and conditions of this Agreement. APG Services shall retain your Record in the EMR for a period of time as required by law. You may initiate a new Agreement at any time.

Release/Indemnity

To the extent permitted by law, you agree to release, indemnify and hold APG Services, its owners, officers, directors, affiliates, employees, and agents harmless from all liabilities, claims, expenses arising from injury or personal damage that occurs while you are at the Lab, your use of the Site, your choice of payment method, or your receipt of notices or information at your contact address.

Governing Law

You agree that this relationship is governed by the laws of the State of Illinois. Any legal matters arising under this Agreement must be addressed in the Circuit Court of Cook County, Illinois, or the United States District Court for the Northern District of Illinois.

Notice

APG Services will generally communicate with you using the email address or telephone number you provided to APG Services. In some circumstances, APG Services may communicate with you using the mailing address you provided to APG Services. You may contact APG Services on all matters relating to your order or services provided by APG Services using the following mailing address:

Analyte Health, Inc.
328 South Jefferson Street
Suite 770
Chicago, IL 60661

Updated December 8, 2011