THE DIABETES

COMMUNITY

AUTHORIZATION FOR USE OF PROTECTED HEALTH INFORMATION

You authorize Medtronic MiniMed, Inc. d/b/a Medtronic Diabetes or its subsidiaries, contractors or representatives to use your personal information, including but not limited to your contact information and health information, for marketing purposes and to share that information with Medtronic representatives and contractors. Information you may receive includes, but is not limited to: (a) Medtronic Diabetes products, therapies or services; (b) marketing and promotional offers; (c) inquiries about your experience with Medtronic Diabetes products, therapies and services; and/or (d) suggestions for how Medtronic Diabetes can enhance its customer support.

This authorization will expire three (3) years from the later of the date you submit this authorization online; or (ii) the last date products or services were received from Medtronic, but may expire sooner if you revoke it by following the instructions below.

You have the right to revoke this authorization at any time by (i) e-mailing takecontrol@medtronic.com; or (ii) signing into your myHome profile and updating my communication preferences at www.diabetes.shop/myhome. A revocation will not affect actions Medtronic Diabetes has already taken based on this authorization. Information disclosed pursuant to this authorization may be re-disclosed by the recipient of the information and may no longer be protected by the federal privacy standards.

You have the right to refuse to sign this authorization. Refusal to sign will not affect your treatment or health insurance eligibility or benefits.

Questions? Contact our Customer Service Center at 800-646-4633, or by email at takecontrol@medtronic.com.