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<div style="background-color: #314158; text-align: center; color: white;"><br /> <h2 style="text-align: center;">Confirmation of <span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">PatientLabel</span></span> Unblind (Unblinded)<br /><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">Sponsor</span></span> <span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">Protocol</span></span><br /><br /></h2> </div> <div style="border-bottom: 4px solid #5c6b7d; background-color: #f5f6f7;"><br /> <table style="width: 100%; background-color: #f5f6f7;"> <tbody> <tr> <td> <div style="margin-left: 15px;"><img src="http://Genesislogin.Genesislcloud.net/Content/Images/GenesisLogo.png" alt="Logo" width="110" height="50" /></div> </td> <td> <table style="float: right;" align="right"> <tbody> <tr> <td style="color: #6c769b;">User Name:</td> <td><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">UserName</span></span></td> </tr> <tr> <td style="color: #6c769b;">System Transaction Date:</td> <td><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">SystemDate</span></span></td> </tr> <tr> <td style="color: #6c769b;">Site Transaction Date:</td> <td><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">LocalDate</span></span></td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div> <div style="clear: both; text-align: center;"> <table style="margin: 0 auto; width: 700px;" cellspacing="5" cellpadding="4"> <tbody> <tr> <td style="color: #6c769b; text-align: right;">Site Number:</td> <td style="text-align: left;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">SiteID</span></span></td> </tr> <tr> <td style="color: #6c769b; text-align: right;">Site Investigator Name:</td> <td style="text-align: left;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">Investigator</span></span></td> </tr> <tr> <td style="color: #6c769b; text-align: right;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">PatientLabel</span></span> Number:</td> <td style="text-align: left;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">SubjectNumber</span></span></td> </tr> <tr> <td style="color: #6c769b; text-align: right;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">PatientLabel</span></span> Status:</td> <td style="text-align: left;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">PatientStatus</span></span></td> </tr> <tr> <td style="color: #6c769b; text-align: right;">Date of Birth:</td> <td style="text-align: left;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">keyDOB</span></span></td> </tr> <tr> <td style="color: #6c769b; text-align: right;">Gender:</td> <td style="text-align: left;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">keyGender</span></span></td> </tr> <tr> <td style="color: #6c769b; text-align: right;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">PatientLabel</span></span> Initials:</td> <td style="text-align: left;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">keyPatientInitials</span></span></td> </tr> <tr> <td style="color: #6c769b; text-align: right;">Treatment Arm:</td> <td style="text-align: left;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">UNBLINDEDTreatmentArm</span></span></td> </tr> <tr> <td style="color: #6c769b; text-align: right;">Unblinded Date:</td> <td style="text-align: left;"><span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">DateCurrent</span></span></td> </tr> </tbody> </table> <strong><br /><br />Note: </strong>This <span class="keyword" contenteditable="false"><span class="keyword" contenteditable="false">PatientLabel</span></span> has been successfully unblinded.<hr style="border-width: 1px 0px 0px 0px; border-style: inset;" /></div> <div style="background-color: #5c6b7d; color: white; text-align: center;"><br /> <div>Genesis &copy; <span class="keyword" contenteditable="false">YYYY</span> - Please contact Genesis Support for assistance at Genesis.com/support</div> </div>

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Sponsor Protocol Confirmation of PatientLabel Unblind (Unblinded) - Site SiteID - PatientLabel SubjectNumber

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