PRECISION MEDICALSuperior Technology, Superior Service

Atlanta, GASusan Kolyno, HSS, CMA 404-989-5084 404-921-5911 Jeff Zeiler, CEO, Precision Medical

Who We ArePRECISION MEDICAL is a privately owned medical device company

formed in 2014 to promote a new innovated technology based on NON-invasive Bio-marker detection for Autonomic Peripheral Neuropathy(APN).

Hyperion is located in Dallas, TX and our local affiliation is Precision Medical is located in Atlanta, GA.

Precision Medical is an authorized distributor for Hyperion Medical and sudomotor technology.

Confidential: Precision Medical

Smart SKANDISTAL NEUROPATHY (small fiber tissue detection) IS ONE OF THE MORE UNDERDIAGNOSED CONDITIONS ON MEDICAL RECORD TODAY.

All Nerves Can Become Neuropathic

SmartSKAN technology is to the clinician, what an X-ray is to an orthopedic surgeon OR an ultrasound is to a GBYN. Confidential: Precision Medical

What Seperates SmartSKAN

SmartSKAN1) Provides Quantitative Measurement

2) Tracts and Assesses the Patient's condition

3) Easy to Use ( non-invasive)

4) Reproducible – 95%

5) No patient preparation

SmartSKAN is FDA approved and Recognized by the Neuropathy and Diabetes Association s.

Confidential: Precision Medical

Why Use SmartSKAN? HOW OFTEN WOULD YOU BIOPSY A PATIENT IF YOU HAD THE

ADVANTAGE OF AVOIDING THE RISK OF AN INVASIVE BIOPSY PROCEDURE ? SMARTSKAN IS A SIMPLE 3 MINUTE TEST -ASSESSING THE ASYMMETRY OF NERVE ENTRAPMENT In Cardiac conditions - Autonomic neuropathy MUST be recognized to reduce the mortality of CAN(cardiac autonomic neuropathy). Treatments include B-blockers, ACE Inhibitors, clonidine, pyridostigmine, etc, pending symptoms. Confidential: Precision Medical

Large VS Small Nerves Large Nerves ARE Most Commonly Assessed

Nerve Conduction Study (EMG) Monofilament

SmartSKAN Provides Distal Autonomic Nerve (small fiber tissue) diagnosis

Confidential: Precision Medical

How SmartSKAN WorksIn short Iontophoresis(alternate currant) that works in conjunction with

Chromoamperometry(low frequency voltage).

This non-invasive scanner analyses the sweat glands to release chloride ions in response to an electrochemical stimulus.

The level of activity is linked to the status of small nerve fibers innervating sweat glands.

The patient is grounded through grounding pads- securing patient providing accurate results

Confidential: Precision Medical

How It Works- Iontopherisis

As shown above, we see a + and – currant flowing in and out between the dermis and the epidermis tissues. Electrochemical Skin Conductance (ESC) is derived from the chloride ion flow released from the

mild stimulation. Confidential: Precision Medical

Results: ChromoamperometryThe results are concluded through the Conductance ratio

between the current measured and the difference in the voltages obtained (∆anode-cathode)

ESC: Electrochemical Skin Conductance is Obtained when the low voltage is applied to the anode

A broken line indicates that to patient moved , broke the ground and the scan has to be repeated Confidential: Precision Medical

Sudorimetry with SmarkSKANBEFORE ANY CLINICAL SIGNS OR SYMPTOMS ARE PRESENT

Sudomotor dysfunction is the first detection of damage to neurological distubances in DISTAL SMALL FIBER neuropathies. In the graph to the right, the blue lines repersent the autonomic nerves generating upward and stimulating the glands.

Sensitive length-dependent damage includes:

(underlying back disorders) Confidential: Precision Medical

Quantitative MeasurmentsWhat YOU will see on YOUR Test Display

Test display has 4 -components - the radar views - the feet and hand ESC graphs and scores - degrees of asymmetry - patient demographics

Confidential: Precision Medical

Approved Medicare Indications

Amyloid Neuropathy

Diabetic Autonomic Neuropathy

Distal Small Fiber Neuropathy

Idiopathic Neuropathy

Multiple System Atrophy

Pure Autonomic Failure

Relex Sympathic Distopy or Causalgia

Sjogren's SyndromeConfidential: Precision Medical

Other IndicationsHow Do YOU Treat Patient Complaints of Non-Related

Diabetic Pain such as: Tingling of the Hands and Feet, Unexplained Dizziness, Gastric and Bladder Dysfunctions?

SmartSKAN Rules OUT Autonomic Dysfunction

The FDA approves testing to prevent diabetic amputaion through preventative detection of small distal nerve dsyfunction.

Confidential: Precision Medical

Confidential: Precision Medical

Early Detection-Other SmartSKAN is also effective in, ALCOHOL DETECTION – CEREBRAL EDEMA-

HYPOTHYROISM – RENAL – HIV – CONNECTIVE TISSUE DISEASE – B12 DEFICIENCY – CARPAL TUNNEL- PAF(neuro-degeneration) RSD (hands)

MULTIPLE SYSTEM ATROPHY (MSA) is a degenerative neurological brain disorder. This cell degeneration causes problems with movement, balance, and other autonomic functions of the body such as bladder control or blood-pressure regulation.

The cause of MSA is unknown specific risk factors have been identified. Confidential: Precision Medical

Follow UPSNormal and Abnormal Results & Billing

If SmarkSKAN results are NORMAL

It is recommended to repeat testing in 6 to 9 months, depending on patient’s risk factors concerning diabetes, cardio, kidney, hypothyroid, etc)

If SmartSKAN results are ABNORMAL Implement appropriate work-up or referrals Repeat SmartSKAN in 3 months to monitor progress – Nerve regeneration occurs in as little as 40 to 50 days

BILLING State regulated Medicare CPT/ID9 codes provided Billable, office calls, testing, consultations and follow-ups. Precision Medical provides codes for billing.

Confidential: Precision Medical

SmartSKAN is Utilized IN: INTERNAL MEDICINE, Including Rheumatology

Peripheral Pain Syndrome - follow up intervention strategies.

ENDROCRINOLOGY and DIABETES DETECTION Autonomic and peripheral neuropathy/response- Referrals to Neurology or Cardiology

NEUROLOGY: Diagnosis and follow up of small fiber neuropathy or nerve conduction studies

CARDIOLOGY Evaluation for cardia autonomic neuropathy and progression in therapeutic intervention

PM&R Peripheral pain syndrome/symptoms (orthostatic hypotension, gastroparesis, exercise intolerance, follow up

PAIN CLINICS Detect suspected small fiber neuropathy, ID small fiber in patients with

peripheral pain syndromes(e.g.fibromyalgia) Confidential: Precision Medical

Physician's Interpretation GuidePrecision Medical provides a Physician Interpretation Guide to assist in accurately Pinpointing a patient's diagnosis -An example shown below shows a patient with balanced hand and feet asymmetry. The red dotted line indicates the spine. The X's indicate the patient area of the spine where the radial dysfunction and nerve dysfunction exists.

You will receive a full physician interpretation guide and further insturctions to pinpointand disagnois multiple conditions effecting patient outcome.

Confidential: Precision Medical

Additional Options &Solutions with PRECISION

CME TRAINING: Precision Medical offers Continuing Education Credits in Autonomic training for our customers at no extra cost. We carry the most Cost Effective Plans with Half Pay options and NO PENALTY for early pay-offs.

As a bonus, an extra set of plates can be included in the purchase, as well as a Re-Order Plate program.

Precision Medical offers Quality Control and Warranties with all purchase Options. Confidential: Precision Medical

Contact Information

It has been a pleasure to introduce you to SmartSKAN,, Please feel free to contact me for a Full Demonstration Appointment, Clinical Studies or Any Additional Questions at:

medrefer1@ gmail.com

ADVANCED SOLUTIONS

Susan Kolyno, HSS, CMA

ReferencesTavee J, Zhou L. Small fiber neuropathy: A burning problem. Cleveland Clinic J Med. 2009 May; 76(5):297-305

Gibbons CH, Wang N, Freemand R. Capsainin induces degeneration of cutaneous autonomic nerve fibers. Ann Neurol. 2010. Dec;68(6): 888-98.

Freeman R. Not all neuropathy in diabetes is of diabetic etiology: differential diagnosis of diabetic neuropathy. Curr diab Rep. 2009 Dec; 423-31.

Cavaletti G, Alberti P, Frigeni B, Piatti M, Susani E. Chemotherapy-induced neuropathy. Curr Treatment Options Neurol. 2011 Apr; 13(2) 180-90.

Calvet JH, Dupin J, Winiecki H, Schwarz PE. Assessment of small fiber neuropathy through a quick, simple and non invasive method in German diabetes outpatient clinic. Exp Clin Endrocinol Diabetis.2013 Feb; 121(2);80-3.

Papanas N, Vinik Al, Ziegler D. Neuropathy in prediabetes:does the clock start ticking early? Nat Rev Endocrinol, 2011 Jul 12; 7(11); 682-90.

Vinik Al, Erbas T, Casellini CM. Diabetic cardiac autonomic neuropathy, inflamation and cardiovascular disease. J Diabetes Investig. 2013 Jan; 4(1): 4-18

Confidential: Precision Medical

Thank You for Watching

Serving the Southeast & Atlanta AreasContact your Area Representative for Demo Registration TimesAtlanta, GA 404-989-5084 Susan Kolyno404-921-5911 Jeff Zeiler, CEO, Precision Medical

Confidential: Precision Medical

Testing a PatientDEMO VIDEOSetting Appointments for

LIVE DEMONSTRATIONS

Please Contact Your Local

Representative

423-790-7306

Confidential: Precision Medical