Patient Information

Todays Date:

Patient Name: SS#:

Address: Date of Birth:
City: State: Zip:
Home Ph#: Work Ph#: _______ __ ____ Cell Phone:
Email Address:

PERSON WHO SIGNS CONSENT AND IS RESPONSIBLE FOR BILL SELF (do not complete this section)
Responsible Party Name: Relationship to Patient:
Address: ___ Date of Birth:
City: State: Zip: SS#:
Home Ph#: Work Ph#: Cell Phone:

Consent for Treatment

I hereby consent to such treatment procedures and patient care which, in the judgment of my physician and/or provider, may be
considered necessary or advisable while a patient at Health Link Medical Center. I also understand that Health Link Medical Center may
use my patient treatment data for quality assurance and research purposes, and that my name or identity will not be connected with the
data. I give my consent for these uses.

Signed: Dated:
Responsible Party

Consent for Communicable Disease Testing

Please be assured that we take universal precautions with all patients cells and follow the highest standards to ensure that your cells
are safe. In the event that there is ever any concern of cross-contamination or for random QA sampling we may test your cells.

I hereby consent to communicable disease testing of my blood (which includes HIV, Hepatitis B and C, Syphilis, HTLV, and CMV). All
results are confidential and will not be released without prior specified consent or as required by law. HIV, Hepatitis, and Syphilis are
all required to be reported to the Department of Public Health.

Signed: Dated:
Responsible Party
 Memo of Understanding

Each persons physical make up and condition are completely different. This means that we cannot guarantee how your
individual cells will perform. The majority of the time we are able to obtain cell yields that will meet the doctors
recommendations and your specific treatment plan. However, occasionally, due to each individuals specific make-up, we
do not see cell yields adequate to meet the goals of your treatment.

What this may mean to you:

It is possible that there may not be enough cells to perform all recommended procedures. It does not mean that any
treatment at the clinic will not be of benefit to you. This may also mean that at some point, you will need to have another
procedure which would include another bone marrow draw to obtain additional cells for isolation and re-injection. If there
are not enough cells for the recommended treatment plan, the physician will make recommendations on what he believes
your best options are.

Future Laws
The government may in the future change and/or adopt new laws and regulations affecting or restricting the services being
offered at Health Link Medical Center. Health link Medical Center is entitled to terminate the course of treatment to the extent
required by law without any liability or recourse to you. Health Link Medical Center is entitled to modify its procedures and
take actions needed to comply with changes in or new laws, regulations, standards, and procedures, without liability or
recourse to you.

If you have any questions regarding this Memo of Understanding, please speak with our staff prior to your procedure at 1-
800-281-3757.

I have read the above information and understand that due to the individual nature of each person, the clinic can make no
guarantees on how many cells will be obtained and what the growing capabilities of my cells will be. I also understand that
if there are not enough cells to complete a recommended treatment plan that no refund is available to me.

Patient name, Printed: Date of Birth: ____________________

Signed: Dated:
Responsible Party
 Joint Treatment Program
Procedure Information and Instructions

On the day of your initial appointment, you will be asked to complete paperwork. You will meet with the doctor. Please be
sure to bring any pertinent or requested information, including imaging and paperwork, if not sent previously.

Medication Restriction Information:

Steroids, NSAIDs (ibuprofen, aspirin, naproxen, COX-2 drugs such as Celebrex), certain asthma and allergy medications,
statin medications for high cholesterol, as well as other medications and supplements described in the medication
information sheet should be discontinued 2-4 weeks prior to the bone marrow draw through 6-12 weeks after the re-
injection of cells. It is your responsibility to discuss this with the doctor who has ordered these medications for you.
Please inform the doctor of all medications you are currently taking. Please review medication restriction list.
Disregarding the recommended medication restrictions may significantly decrease the success of your procedure.

It is very important that you drink plenty of fluids and are well hydrated beginning 48 hours prior to your procedure, as
we will be performing both a bone marrow aspiration and a blood draw. If you come from a lower altitude, it is especially
important to drink plenty of fluids (approximately 64 ounces a day).

What can you do to improve the quality of your stem cells?

See: http://www.regenexx.com/2012/05/how-can-i-grow-more-stem-cells-top-10-list-of-things-to-do/

You will be taken back to the procedure room where you will be prepared for the bone marrow aspiration. The procedure
will require you to have a bone marrow sample taken from the back of each of your hips (iliac crest). You will lie on your
stomach on the procedure table where an area at the back of your hip will be numbed. A special needle will be used to
draw marrow blood out of the back of your hip (back of the iliac crest). Fluoroscopy and possible Ultrasound will be used
to assure the optimum location. This will be done on both sides of your hips. If you have pre-arranged to take Valium prior
to the procedure, you must have a driver with you. This will be discussed with you when you schedule your appointment.
Please refer to the post-operative instructions for activities after this procedure.

Not all conditions require all injections or the same timing. Please discuss the schedule that is recommended for you when
setting up your appointments. Please understand that it is not possible to make an absolute pre-determination of the
treatment plan that will be most appropriate for your condition and that only after being evaluated can the doctor
determine the best plan for you.
After the procedure you may eat and drink as tolerated. Please refer to the post operative instructions for activity after
your procedures.
Myofascial Treatment: Many of our patients have significant problems with their ability to move their joints through a full
range of motion because of trigger points in the surrounding muscles. These are portions of the muscles that go off line and
prevent movement. In addition, the capsule of the joint is frequently tight. These problems tend to significantly increase
forces on the joint in the areas where we want to regenerate cartilage. We generally schedule one session of myofascial
therapy in conjunction with your biomechanical evaluation for your first trip to Colorado. In addition, your doctor may
recommend identifying a good myofascial trigger point therapist to continue treatment with after your procedure. If you
are in Colorado, we can take care of these needs. If you are from out of town, here are some resources on the web:
Colorado - Myofascial Therapy: www.istop.org www.myofascialtherapy.org www.rolfguild.org
California - Egoscue: http://www.egoscue.com/therapy_online.php
Finding a therapist and working on eliminating these trigger points while increasing range of motion in the joint will help
your chances of success.

Helping Cells Grow

Blood Flow: You will be asked to use an infra-red unit while youre sitting at work or home after the re-injection
procedure. You should be instructed on how to use this unit on check out. Use up to 30 minutes twice a day for
6 weeks. Please be cautious not to exceed 30 minute intervals! They are available in several sizes you can
purchase one that is site-specific, or for general use.
Supplements: We suggest that you take the Regenexx Advanced Stem Cell Support Formula supplement during
the course of your treatment. This is a proprietary blend of vitamins, herbs and supplements developed by the
Regenexx research team that helps support healthy stem cell function and cartilage production. These can be
ordered on the Regenexx website (www.regenexx.com/cellsupport).
Bracing: We utilize braces for our knee and ankle patients during the procedure. Please refer to your post-op
information for specific orders in regard to your bracing.

If you have any questions or concerns, please do not hesitate to contact us at the office at Oceanside Location: 760-721-
4000 / Los Angeles Location: 310-929-9790 / San Rafael: 415-223-7504.

Thank you for allowing us to provide this care for you!

 Regenexx Registry Participation and No Guarantee

Investigational Procedure and Regenexx Registry

By signing this form you will agree that you are electing to have an investigational or experimental procedure involving
the use of your own stem cells. This means that this procedure is not currently the standard of care in the medical
community. In addition, while we strive to publish our findings from treating patients with Regenexx, many things are still
unknown. For example, here is an incomplete list of the types of things we may not yet know about your procedure: how
long it will work, whether it will solve your problem, whether the procedure will grow new tissue or repair diseased tissue,
the number of years the effects will last, long-term possible negative effects of the procedure, how many people out of 100
will respond, which patients are the best candidates for the procedure, if the procedure will prevent the need for more
invasive surgery, if the procedure will reduce the likelihood of more severe arthritis, etc...

Since this is still a new procedure, there is the requirement that you enter into a Re-implantation Registry through
Regenerative Sciences LLC. As were a research-based clinic, we are committed to tracking the outcome and any potential
complications of your procedure. While we believe the risk of complications with this procedure to be very low, the
Regenexx Treatment Registry allows for the longterm tracking of your health. By your participation in the Treatment
Registry, you grant to Regenerative Sciences the authorization to access, review and share your treatment, procedure and
follow up data. Regenerative Sciences will maintain the privacy of your confidential medical information in compliance with
all local and international laws including, but not limited to, the Health Insurance Portability and Accountability Act (HIPPA)
of 1996 (P.L.104191).

You will receive periodic communications from the Regenexx Registry and be required to fill out tracking forms that detail
the status of your medical condition and any new medical conditions or diagnoses since your stem cell procedure. If you
report a potential complication, this will be tracked through the Regenexx Registry and reviewed both by your treating
physician and the medical director of The Centeno-Schultz Clinic.

No Guarantee
While we strive to provide patients candidacy forms that rank them as GOOD, FAIR, and POOR candidates, like any
medical or surgical procedure, any individual patient may or may not respond to the Regenexx procedure. By signing this
form you also acknowledge that there is no guarantee being provided that this procedure will be effective for your medical
condition and you are waiving any right to a refund of monies paid if the procedure ultimately does not solve your
problem.

Patient name, Printed: Date of Birth: ____________________

Signed: Dated:
Responsible Party
 Medication Restrictions Prior to, During and After:
Regenexx-SD Regenexx-AD Regenexx-SCP Regenexx-PL

Please be sure to notify us of any medication you are taking to make sure there are no contraindications
or need to adjust or withhold for a specified period prior, during or after your procedure.

Before discontinuing any medication prescribed to you by your physician, please discuss and receive
approval from the prescribing physician to discontinue for the times specified below or requested for
this procedure.

We believe that the medications listed below may interfere with the success of the procedure you are
planning.

Please discontinue any medications listed below 3-4 weeks prior to bone marrow or blood draw and for
6-8 weeks after reinjection of cells. Please keep this list readily available during the course of your
procedure.
Anti-inflammatory Agents (VERY IMPORTANT):
NSAIDs (examples Aspirin, Motrin/Ibuprofen, Aleve/Naproxin, COX-2 inhibitors - such as Celebrex,
Voltaren, Feldene/Piroxacam, Indomethacin).
Anti-inflammatories (including Asthma medications like Singulair, Advair, Nasonex)
Also, any other forms i.e. eye drops, skin creams, etc.
Steroids (in any form - including injections, oral, inhaled, topical, drops VERY IMPORTANT
Wait at least 2 months to have the procedure
You should avoid using any kind of steroid until 6 weeks after the re-injection of cells.
All over the counter supplements Erythropoetin (EPO) Chemotherapy Drugs
Alcohol (more than a glass of wine daily) Marijuana Artificial Sweeteners
Blood Donation: Please refrain from donating blood for 2 months prior to your marrow and/or blood draw,
through 2 months after last injection
If you have titanium implants where wear and tear on the implant is suspected, please discuss this with your
doctor!
 Financial and Billing Policy
Regenexx procedures are considered experimental and are not covered by your insurance company. Our clinic will not bill
any associated Regenexx procedures to your insurance plan.

If you choose to bill your insurance carrier, we cannot allocate our billing staff to aid you in this effort, as our past efforts
have proven futile. Further, if you bill your insurance company for something that isnt covered, it may be in violation to
your contract with them. Please be sure to contact your carrier with further questions regarding this issue.

Please call our billing office if you require further clarification on our policies.

Insurance Information
While the Regenexx Procedure is not covered by Medical Insurance carriers, the office visits associated with it typically
are. These include your new patient evaluation and diagnostic ultrasound, as well as any follow up office visits at our clinic.
Additional therapies or appointments not outlined on your Regenexx invoice are not included in the Regenexx procedure
fee.

Please note: It is the patients responsibility to verify whether their insurance requires a referral from their primary
care provider to see a specialist. If no referral has been obtained, and is required, the patient will ultimately be
responsible for all charges billed to insurance.

Please provide the necessary information needed to bill your insurance carrier:

Insurance Carrier (Name)

Claims Address (commonly a P.O. Box)
Member/Subscriber ID and Group Number
Specialist/OV Copay
If you are NOT the primary policyholder:
Policyholders Full Name/Date of Birth
Relation to Policyholder

I understand that it is my responsibility to obtain a referral, should one be required by my insurance company, and understand that all unpaid claims
will become my responsibility should insurance deny payment.
I authorize the release of any private health information necessary to process this claim.
I, the undersigned agree, whether signing as agent or as patient, that in consideration of the services rendered to the patient, to be individually
obligated to pay the bill. Should the account be referred to an attorney for collection, I shall pay reasonable attorneys fees.
I hereby assign payment directly to Health Link Medical Center, BASIC BENEFITS and/or MAJOR MEDICAL (catastrophe) BENEFITS herein specified and
otherwise payable to me but not to exceed the regular charges for this period of treatment. I understand I am financially responsible for any charges
not covered by this assignment.
I understand that upon discharge I may request, in writing, a copy of my records. There is a fee to have my records copied.
I understand that Health Link Medical Center will not bill any of the Regenexx procedures to my insurance plan
I understand that Health Link Medical Center will bill all covered office visits and diagnostic services to my insurance plan and that I am responsible
for all copayments and deductible portions, as dictated by my individual policy.
I understand that Regenexx procedures are experimental and not covered by my insurance

Patient name, Printed: Date of Birth: ____________________

Signed: Dated:
Responsible Party
 HEALTH LINK MEDICAL CENTER
AUTHORIZATION FOR PROCEDURE
Bone Marrow Aspiration and Blood Draw

TO THE PATIENT: You have the right, as a patient, to be informed about you condition and the recommended surgical, medical or diagnostic procedure
to be used, so that you may make the decision whether or not to undergo the procedure after knowing the risks and hazards involved. This disclosure is
not meant to scare or alarm you; it is simply an effort to make you better informed so you may give or withhold you consent to this procedure.

I voluntarily request Dr. Ronald Cohen / Dr. Paul Handleman / Dr. Stephen Derrington / Dr. Vishal Thakral / Dr. Shounuck Patel / as my physician(s), and
such associated technical assistants and other health care providers as he/she may deem necessary, to treat my condition, which has been explained to
my satisfaction in laymans terms.

I UNDERSTAND THAT THE FOLLOWING SURGICAL, MEDICAL AND OR DIAGNOSTIC (S) ARE PLANNED FOR ME, AND I VOLUNTARILY CONSENT AND
AUTHORIZE THESE PROCEDURES(S) (LAY TERMS): BONE MARROW ASPIRATION AND BLOOD DRAW. BONE MARROW ASPIRATION INVOLVES
PLACING A NEEDLE INTO THE BONE MARROW CAVITY AND DRAWING OUT A BLOOD LIKE FLUID THAT WILL BE PROCESSED BY THE HEALTH LINK
MEDICAL CENTER LAB FOR LATER RE-IMPLANTATION INTO ANOTHER BODY AREA.

I understand that my physician may discover other different conditions which may require additional or different procedures than those planned. I
authorize my physician, and said such associates, technical assistants and other health care providers to perform such other procedures which are
advisable in their professional judgment.

I understand that no warranty or guarantee has been made to me as to the result of this procedure or anticipated care.

Just as there may be risks and hazards in continuing my present condition without treatment, there are also risks and hazards related to the performance
of the surgical, medical and/or diagnostic procedures planned for me. I realize that common to surgical, medical and/or diagnostic procedures is the
potential for infection, blood clots in veins and lung, hemorrhage, allergic reaction, or even death. I also realize the following hazards may occur in
connection with this particular procedure: 1. Local pain 2. Bruising/bleeding 3. Infection 4. Drug reaction 5. Soreness at injection site 6.
Numbness 7. Increased pain 8. Paralysis 9. Injury to the bone, muscle or nerve. The above risks and complications are included but not limited to
those listed.

I understand that anesthesia involves additional risks and hazards, may be used for the relief and protection from pain during the planned and any
additional procedures. I realize the anesthesia may have to be changed, possibly without explanation to me. I understand that certain complications may
result from the use of any anesthetic, including use of general anesthetics, range from minor discomfort to injury to vocal cords, teeth or eyes. I understand
that other risks and hazards resulting from spinal or epidural anesthetics include headache and chronic pain.

I have been given an opportunity to ask questions about my condition, alternative forms of treatment, risks of non-treatment, the procedure(s) to be
used, and the risks and hazards involved. I have sufficient information to give this informed consent. My physician has answered my questions to my
satisfaction.

I attest that I have explained the risks, benefits and alternatives of this procedure to this patient/representative.

______________________________________________ ______________
Physician Signature Date

_____________________________________________ ______________ ___________________ Pregnant: Y / N

Signature: Patient/Other Legally Responsible Person Date Relationship

______________________________________________ ______________ _______________________

Signature: Witness Date Title

Your procedure may be videotaped for research or educational purposes. If used for research purposes, the video will serve as a record of exactly what
was performed in the procedure to augment physician notes. Your name will not be used in the research project or published. If used for educational
purposes, your face or name will not be shown to others, just the area where the doctor is working.
________
Initial
 HEALTH LINK MEDICAL CENTER
AUTHORIZATION FOR PROCEDURE
AUTOLOGOUS RE-IMPLANTATION OF BONE MARROW NUCLEATED CELLS INTO A JOINT

TO THE PATIENT: You have the right, as a patient, to be informed about your condition and the recommended surgical, medical or diagnostic procedure
to be used, so that you may make the decision whether or not to undergo the procedure after knowing the risks and hazards involved. This disclosure is
not meant to scare or alarm you; it is simply an effort to make you better informed so you may give or withhold you consent to this procedure.

I voluntarily request Dr. Ronald Cohen / Dr. Paul Handleman / Dr. Stephen Derrington / Dr. Vishal Thakral / Dr. Shounuck Patel as my physician(s), and
such associated technical assistants and other health care providers as he/she may deem necessary, to treat my condition, which has been explained to
my satisfaction in laymans terms.

I understand that the following surgical, medical and or diagnostic (s) are planned for me, and I voluntarily consent and authorize these procedures(s) (lay
terms): Re-injection of own bone marrow nucleated cells (a mixture that contain my stem cells and other cells) into my joint or other structure, the
procedure may include a pre-injection and 1-2 follow up injections into joint. The pre-injection into this joint will occur several days before the bone
marrow procedure. This will involve the injection of a substance to cause a brief inflammatory response and/or my concentrated blood platelets. This
will be followed by a bone marrow aspiration procedure (separate consent form), an intravenous blood draw, and a re-injection of concentrated cells
from my bone marrow into the joint. This reinjection will also include concentrated blood platelets and/or their growth factors and the use of two
prescription drugs used off-label. Finally, several days after the bone marrow/fat procedure, I may receive an injection of my concentrated blood
platelets and the same prescription drugs.

I understand that my physician may discover other different conditions which may require additional or different procedures than those planned. I
authorize my physician, and said such associates, technical assistants and other health care providers to perform such other procedures which are
advisable in their professional judgment.

I understand that no warranty or guarantee has been made to me as to the result of this procedure or anticipated care.

Just as there may be risks and hazards in continuing my present condition without treatment, there are also risks and hazards related to the performance
of the surgical, medical and/or diagnostic procedures planned for me. I realize that common to surgical, medical and/or diagnostic procedures is the
potential for infection, blood clots in veins and lung, hemorrhage, allergic reaction, or even death. I also realize the following hazards may occur depending
on the particular procedure: 1. Local pain 2. Bruising/bleeding 3. Infection 4. Cellulitis at an IV site. 5. Allergic drug reaction 6. Numbness 7.
Increased pain 8. Paralysis 9. Injury to the bone, muscle or nerve 10. Drop in blood pressure 11. Loss of consciousness 11. Abnormal heartbeat
12. Vaso-vagal reaction with vomiting and possible aspiration 12. Increased cancer risk (we have not observed this using your own adult stem cells)
13. Kidney failure (this has only been observed when injecting high volumes of marrow intraveneously) 14. Structural failure at the treatment site 15.
Bony fracture related to instability 16. Bone infection. The above risks and complications are included but not limited to those listed.

I understand that anesthesia involves additional risks and hazards, may be used for the relief and protection from pain during the planned and any
additional procedures. I realize the anesthesia may have to be changed, possibly without explanation to me. I understand that certain complications may
result from the use of any anesthetic, including use of general anesthetics, range from minor discomfort to injury to vocal cords, teeth or eyes. I understand
that other risks and hazards resulting from spinal or epidural anesthetics include headache and chronic pain.

I have been given an opportunity to ask questions about my condition, alternative forms of treatment, risks of non-treatment, the procedure(s) to be
used, and the risks and hazards involved. I have sufficient information to give this informed consent. My physician has answered my questions to my
satisfaction.

THE PHYSICIAN WHO IS PERFORMING YOUR PROCEDURE MAY HAVE A FINANCIAL INTEREST IN THE HEALTH LINK MEDICAL CENTER
CELL LAB, WHERE YOUR BONE MARROW IS BEING PROCESSED. SHOULD YOU HAVE ANY QUESTIONS OR CONCERNS REGARDING THE HEALTH LINK
MEDICAL CENTER CELL LAB, PLEASE DISCUSS THEM WITH YOUR PHYSICIAN.

I attest that I have explained the risks, benefits and alternatives of this procedure to this patient/representative

______________________________________________ ______________
Physician Signature Date

_____________________________________________ ______________ ___________________ Pregnant: Y / N

Signature: Patient/Other Legally Responsible Person Date Relationship

______________________________________________ ______________ _______________________

Signature: Witness Date Title
 Bone Marrow Draw

During the marrow draw, the medical provider places a needle in the back of the hip area to obtain what is called whole
marrow (looks like thick blood). The procedure can cause soreness in the low back for several days to a week. The amount
of soreness will vary, but will usually starts once the numbing medicine wears off (a few hours). Do not take a bath, sit in
the hot tub, or swim for 3 days. A shower 12 hours after the procedure is fine, unless instructed other by the doctor.

If you have a history of low back pain, it is common to have more soreness from the marrow draw.

If you have redness, pus, fever, chills, sweats, or any other symptoms that look like an infection, please contact the doctor.

Fluid and Food Status: Air travel and change in elevation can predispose patients to dehydration. It is very important that
you drink plenty of fluids and are well hydrated beginning 48 hours prior to your procedure, as we will be performing both
a bone marrow aspiration and a blood draw. It is also recommended to avoid all Caffeine products. See Medication
Restriction List. If you come from a lower altitude, it is especially important to drink plenty of fluids (approximately 64
ounces a day). Avoid strenuous activity or heavy lifting for at least 5 hours after you donate blood.

Contact Information:

Health Link Medical Center / Regenexx

Oceanside Location: 760-721-4000 San Rafael Location: 415-223-7504

3142 Vista Way Suite 206 899 Northgate Drive Suite 400
Oceanside, CA 92054 San Rafael, CA 94903

Beverly Hills Location: 310-929-9790

1125 South Beverly Dr. Suite 720
Los Angeles, CA 90035

Additional Instructions:

Patient Signature: __________________________________________ Date: _______________

Medical Office Staff Signature: ________________________________ Date: _______________

 Patient Information
Thrombin Grafts with Mesenchymal Stem Cell Injection

We have started using thrombin matrix grafts with our stem cell injections. We believe this will help the stem cells stay in
the area we place them and give you the best chance at a successful outcome with our stem cell therapies.

Thrombin is a natural protein in our bodies. It cross-links and works with other proteins in the body to create clots when
we are injured. The thrombin we use in our procedure is a strictly lab created product, not from other humans or cows. This
eliminates the risk of infection from this portion of our procedure.

Since a matrix has been created in the location of your injury/degeneration, we would like to give the graft a chance to
mature and allow the stem cells to grow. Therefore, we would like you avoid weight-bearing for hip, knee and ankle
procedures after each of your injections.

What this means to you:

For hip patients:

Please reduce activity for a few days after your cell injection focus on keeping weight off of the hip being treated. You
may follow the rest of our activity instructions as they have been given to you in our other information materials.

For knee patients:

This means you will need to utilize your unloader or immobilizer brace whenever youre actively using the joint. If, for
whatever reason, you do not have a brace, or the doctor did not order a brace for you, you will need to be on crutches
for a few days after each injection. Please follow the rest of our activity instructions as they have been given to you in
our other information materials.

For ankle patients:

This means that you will be set up with an off-the-shelf small brace to assist in stabilizing and immobilizing the ankle.
If you are having your ankle injected, please be sure to wear athletic/tennis shoes that provide support to the ankle.
Do NOT wear sandals, heels, etc.
 Post-Op Instructions for Joints Non-Weight Bearing

Immediately After Your Cell Transplant Procedure

The stem cell injection includes producing a micro injury in the joint. As a result, expect the joint to be sore. This can be
everything from minimally sore to very sore.

Activity: The goal is to allow the stem cells to attach and then to protect them while they differentiate into cartilage. For
this reason, youll be asked to keep the joint as still as possible for 30-60 minutes after the procedure. Do not take a bath
for three days, but a shower 12 hours after the procedure is fine.

1st 3rd Day: For the first day, you should limit activity on the joint. If you have post-op soreness this may be easy to
do, as you may naturally limit motion (your body does this to reduce pressure on the area to allow healing). If you
dont have this, then simply naturally taking a bit of weight off this area is a good idea this first day. Avoid all contact
sports as well as sports that involve impact on that joint.

4th Day 2nd Week: You can start to move normally, no more than 30-60 minutes a day. Avoid all contact sports as well
as sports that involve impact on that joint. Swimming is fine.
Do not lift more than 10 lbs during the first 4 weeks.

3rd-6th Week: Avoid all contact sports as sports that involve impact on that joint. Swimming is fine.

After the 6th Week: Start integrating back all desired activities, adding back 20% per week.

Helping Your Cells Grow:

Blood Flow: You will be asked to use an infra-red unit while youre sitting at work or home after the re-injection
procedure. Use up to 30 minutes twice a day for 6 weeks. Please be cautious not to exceed 30 minute intervals! Infra-
red units are available for purchase at http://www.activeforever.com/p-1701-thermotex-infrared-heating-pad.aspx. They
are available in several sizes; please review what would be appropriate for you. If you have any questions, please talk
with the scheduling coordinator.

Medications: You cant take anti-inflammatory drugs such as Motrin, Aleve, Ibuprofen, or similar NSAIDs. These need to
be avoided for 6-12 weeks after the procedure. In addition, any other drugs you have been asked to avoid, should also be
stopped for the same time period. Please review the Medication Restriction sheet sent previously. Most statin cholesterol
lowering drugs will move stem cells toward producing bone, which is not what we want here, so these need to be avoided
for 6-12 weeks. Steroid medications (such as steroid based asthma inhalers, oral steroids, or steroid injections into the joint
or another joint) will dramatically impair stem cell function, so these are to be avoided as well.

Pain: If you have pain from the procedure, this should resolve within the first 1-3 weeks. If it does not, contact your clinic
doctor. Tylenol is acceptable to take.
Nutrition: We suggest that you take the Regenexx Advanced Stem Cell Support Formula supplement during the course
of your treatment. This is a proprietary blend of vitamins, herbs and supplements developed by the Regenexx research
team that helps support healthy stem cell function and cartilage production. This can be ordered on Website
http://www.healthlinkcenter.com/regenexx-advanced-stem-cell-support-formula.

We also recommend that you take Collagen Type II Formula and a Hyaluronic Acid supplement. We offer both of these
through our office. You can get either purchase these in the office or we can send it to you. Unfortunately, this particular
brand is only available to medical professionals.

If you wish to take your own supplements, they must at a minimum contain:
Hyaluronic Acid (if buying your own supplements, take 50 mg/day)
Our Collagen Type II Formula
Collagen Type II (if buying your own supplements, take 500mg/day) contains Hyaluronic Acid,
Manganese (if buying your own supplements, take 10 mg/day) Collagen II, Manganese and
Vitamin C (in each capsule).
Vitamin C (if buying your own supplements, take 120 mg/day)

Realize that if you are allergic to sea food, this may be a problem with Glucosamine products. In addition, they can change
your bleeding times if you on being monitored on Coumadin.

Since you have a cartilage problem and we want to support healthy maintenance of this cartilage, you should be on these
supplements long-term.

Directions for use:

Collagen Type II - Take 4 caplets in the morning, and 4 at night for two weeks; then, decrease to 2 caplets in the
morning and 2 caplets at night.
Collagen II has the protein building blocks that will support damaged cartilage (80% protein). It naturally
contains sugar and aminos that consist of Hyaluronic Acid, Glucosamine, and Chondroitin (20%
sugar aminos)

Collagen MD Hyaluronic Acid -

Any patient over the age of 25 should take 1 capsule once daily on an empty stomach
Any patient over the age of 30 should take 2 capsule once daily on an empty stomach
Patients over 40 should take 4 capsules twice daily (a.m. and p.m.) on an empty stomach
Hyaluronic Acid is a disaccharide that lubricates every connective tissue of the body. It fills the epithelial
tissue of the skin, which hydrates, plumps, fill fine lines, and leaves the skin with a radiant glow-
profound skin results. It also lubricates the joints, which prevents free radicals from destroying healthy
cartilage, collagen fibrils, which prevent free radicals from damaging healthy collagen and every cell
of the body preventing oxidative stress-grate antioxidant. H.A. also helps to facilitate the movement
of nutrients and waste.
Alcohol and Marijuana:
Alcohol can have profound negative impacts on stem cell function, so this should be avoided for the same 6-12 weeks. A
glass of red wine or white wine with dinner is not a problem, but more than that could pose a risk to the cells. Cannaboids
such as marijuana can also promote bone formation over cartilage (not what we want in this case), so should be avoided.

Complications: Call your clinic doctor if you have excessive swelling, fevers, chills, sweats, local hardness, redness, or pus
at the injection site.

For after hour calls, you may try:

Health Link Medical Center Health Link Medical Center

3142 Vista Way Suite 206 1125 South Beverly Dr. Suite 720
Oceanside, CA 92056 Los Angeles, CA 90035
rcohen@healthlinkcenter.com drvishal@healthlinkcenter.com
drpatel@healthlinkcenter.com

Health Link Medical Center

899 Northgate Drive Suite 400
San Rafael, CA 94903
drderrington@healthlinkcenter.com
drpaul@healthlinkcenter.com

**Please note, the doctors greatly prefer email to phone calls, and they check their email regularly.

Additional Instructions:

If you have any questions or concerns, please do not hesitate to contact us at your facility location listed above.

Patient Signature: ___________________________________________ Date: _________________

Witness: ___________________________________________________ Date: _________________

Thank you for allowing us to provide this care for you!

 Unloader Braces and your Stem Cell Procedure

If a patient has significant loss of cartilage and meniscus in one compartment of the knee or what may be an unstable
meniscus tear, our clinic uses an unloader brace after the stem cells are transplanted into that area. The purpose is to
reduce forces on these cells while still allowing for activity and cyclic loading (the type of intermittent pressure that comes
from walking) which will help the cells differentiate into cartilage or help repair meniscus. These braces can be expensive.
Heres what you should know:

These braces come in left and right models.

These braces come either in medial or lateral compartment unloaders. This means that they can either take pressure off
the inside or outside of the knee, depending where there is more lost cartilage. Make sure you know which area (inside or
outside) where we will want to reduce the pressure.

To review for a moment, you want the correct side of the body (right or left) and the correct unloader compartment
(medial=inside of knee, lateral=outside of knee). For example, if youve lost the cartilage on the inside of the right knee,
youre looking for a right knee medial unloader.

Your unloader brace needs to be adjustable. Many of the models do have adjustment. This means that you need to be
able to adjust the amount of pressure it takes off of the area. We will start with maximum unloading of the effected joint
compartment by increasing the pressure the brace puts on the joint. As treatment progresses, we gradually decrease
brace pressure, eventually discontinuing brace use. The goal here is to allow the cells to set up with small amounts of
joint pressure and then condition them to take larger and larger amounts of joint pressure.

Note: The braces have a length and a circumference (meaning how big they are in diameter). This is important for proper
sizing.

Getting the brace and set up. After you schedule your appointment, we will send your information to a local
representative, and we will provide you with their contact information should you need to get in touch with them. These
representatives will generally contact your insurance to obtain pre-authorization and will work with your insurance
company to get the best coverage possible. The brace is typically covered by insurance and Medicare.

Please discuss with the doctor any specific instructions he may have for you.

Thank you!

OA Brace:
Patient Purchased:_______________________________________________________Date:_______________

Patient Denied:__________________________________________________________Date:_______________

J-Stim:
Patient Purchase:________________________________________________________Date:_______________

Patient Denied:__________________________________________________________Date:_______________
 Thermotex Personal Therapy Systems - Infrared

Indications for Use

You have been prescribed by your physician the Thermotex Personal Therapy System device. The thermal effect of the
deep-penetrating infrared upon tissues may provide temporary relief of minor aches and pains in muscles, joints,
tendons, and tissues. This device helps provide for a temporary improved range and freedom of motion due to muscle
relaxation and temporary minor pain relief. It also aids in the relaxation of muscles and provides a temporary increase in
local blood circulation.

Precautions
Always use caution when connecting the power supply into an electrical outlet.
Never place or store any unit where it can fall or be pulled into a bathtub, sink, toilet, water tank, or bucket.
Never reach for a unit that is plugged into an electrical outlet and has fallen into water.
The outer cover may be removed for cleaning. Hand wash, machine wash, or dry clean.
Do not use while sleeping, on an infant, or leave unit unattended
Check skin under the pad frequently; never use the pad without outer cover in place.
Use cautiously, burn may result from improper use.
Do not use with liniments, salves, or ointments that contain heat producing ingredients. Skin burns could result.
See manual for additional safety instructions. Please read all safety instructions prior to use.

Treatment
Use up to 30-40 minutes twice a day for 6 weeks. Please be cautious not to exceed 30 minute intervals!

Operating Instructions
Place the hard side of your pad towards your body.
The padded side does not heat
The pad has a four position switch (off-low-high-off).
Start treatment on the high setting.
If the treatment is intolerable on the high setting, place a towel between your body and the pad.
The infrared heat penetrations will still be effective.
Turn off the unit after treatment.

Where to purchase
General Use: http://www.activeforever.com/p-5158-thermotex-infrared-heating-pad-gold.aspx
Shoulder-specific: http://www.activeforever.com/p-5162-thermotex-shoulder-infrared-heating-pad.aspx
Knee-specific: http://www.activeforever.com/p-5161-thermotex-knee-infrared-heating-pad.aspx

Patient Purchased: ______________________________________________________Date: _________

Patient Denied: _________________________________________________________Date:_________