was informed by Ms./Mrs./Mr.

Physician Facility: The Arm Clinic

orally and in writing on the relevancy, scope and risks of participation in SOS. I had enough time to read the patient information, understand it and decide whether I wanted to grant this consent. I had enough opportunity to have my questions answered in the scope of a talk to my attending physician. I know that the treating facility and the attending physician or treating facility can monitor my health status in SOS. I also know that SOS primarily serves medical knowledge processing and does not have any direct benefit for me. I am further aware that Arthrex, Inc. and possibly other recipients of my data, are located in "third countries", i.e. countries outside of the European Economic Area, including in the USA, where the European Commission believes that an appropriate data privacy level is not ensured and in particular access by state offices to data may be possible at a wider scope than this would be permitted in the European Economic Area.

I agree to participation in SOS.

Declaration of consent to data collection, processing and use

I consent that, on the one hand Arthrex, Inc as the sole responsible person for the data saved in SOS and AWS and any other contract processors of Arthrex, Inc., and on the other hand the treating physician or treating facility and other recipients of SOS data as responsible person for the data retrieved by them may collect, process and use my data as follows:

1. I consent that Arthrex, Inc., the attending physician, the treating facility, AWS and any other contract processors of Arthrex, Inc. may collect, process and pass on my personal data to the recipients set out in the patient information as described in the Patient Information. This consent expressly also refers to genetic data, biometric data and health data. They are subsequently together referred to as "special categories of personal data".
2. Where recipients of data – including the special categories of personal data – as described in the Patient Information are located in third countries, I expressly consent to the transfer of my personal data to such third countries, although there is not an appropriate level from the point of view of European law regarding data privacy
3. I specifically agree that Arthrex, Inc. and the employees and contract processors of Arthrex, Inc. may access and process my data - including the special categories of personal data - as described in the patient information in order to ensure the technical operation of SOS and to compile and use the patient-specific result reports, data records and average values presented there.
4. I specifically consent that the treating facility or the attending physician and their employees may access and process my personal data - including the special categories of personal data - as described in the patient information in order to monitor my personal treatment progress and to gain an impression of the costs, efficacy and economic efficacy of medical standard interventions, and to improve them.
5. I specifically consent that, as described in the patient information, the limited data record – including the special categories of personal data contained therein – are exchanged and used between the treating facility or the attending physician and their partner facility named in the Annex of the patient information in order to gain an understanding of the costs, efficacy and economic efficiency of medical standard interventions and to improve them.
6. I agree that my patient profile – including the special categories of data contained therein – is saved and used without limitation in time unless I withdraw my consent and that no special deletion period be specified.

The representative of Arthrex, Inc. registered in the European Union is Arthrex GmbH, Erwin-Hielscher-Str. 9, D-81249 Munich.

Once you have completed the above, click submit. Your information will be passed over to the attending physician to be completed and record stored.