SECTION 5 -SUBMITTING A CLAIM TO THE SILICONE MATERIAL CLAIMANTS FUND

Q5-1. "Why do I need to submit medical records or documents that show I was implanted with an
             eligible silicone gel breast implant?"  

To settle your claim you will need to submit medical records or documents that show that you were implanted at any time after January 1, 1976 and before January 1, 1992 with a silicone gel breast implant made by Baxter, Bristol, Bioplasty, Cox-Uphoff (CUI), Mentor, Koken, Silimed, Societe Prometel, or Medasil Surgical.

Q5-2. "How can I get a copy of my medical records and documents to show who made my breast
             implant?

Read through this Section and Tab 1, Part III (1.3) carefully to understand the medical records or documents you need to obtain. Contact the doctor or hospital where your breast implants were implanted and request a copy of your medical records. Those records often list a brand name, catalog number, implant label, or other identifying information about the breast implant you received. You may need a "certified copy" of these medical records. Your doctor's office or hospital will know what this means.
(Read Q5-11 for a definition of certified copy.)

Compare the information in your medical records with the information in this Section to see if it matches any of the criteria for a silicone gel breast implant made by Baxter, Bioplasty, Bristol, Cox-Uphoff (CUI), Mentor, Koken, Silimed, Societe Prometel, or Medasil Surgical.

Q5-3. "What medical records or documents can I submit to show that my silicone gel breast implant
             was made by Baxter, Bioplasty, Bristol, Cox-Uphoff (CUI), Mentor, Koken, Silimed, Societe
             Prometel, or Medasil Surgical?"

There are many ways that you can show that your silicone gel breast implant was made by Baxter, Bioplasty, Bristol, Cox-Uphoff (CUI), Mentor, Koken, Silimed, Societe Prometel, or Medsasil Surgical. Anyone (1) of the following are acceptable ways to do this provided that your records establish that you are implanted with the eligible implant after January 1, 1976 and before January 1, 1992:

A.  Hospital records of the surgeon's report of the surgery -written at or near the time of the implantation
      surgery -that specify one (1) of the eligible brand names or list an eligible implant manufacturer.

B.  A certified copy of your medical records that contains the date of implantation and the implant
      package label demonstrating one (1) of the eligible breast implants as listed at Tab 1, Part III.
      Note: a certified copy is required only if:

      1. The label is on a page that does not affirmatively reveal it to be a part of your hospital or medical
           records and does not have a lot number, serial number, or catalog number on it; or

 2. The hospital records are organized so that the implant label/sticker was put on a page by itself. If
     the page containing the implant label/sticker clearly comes from the hospital's contemporaneous
     record of the implant surgery, has other information relating to the claimant's hospitalization on
     that page, and has sufficient patient identification for the Settlement Facility to tell that it came
     from your records, it falls into the acceptable proof category of contemporaneous hospital
     records, and does not have to be certified.

C. Implant labels clearly marked with a lot, serial or catalog number and which shows the date of
     implantation after January 1, 1976 and before January 1, 1992. The Settlement Facility will
     maintain a list of these lot, serial and catalog numbers, to ensure that no duplicates are used. These
     labels do not have to be certified.

D. Records of the implanting surgeon -written at the time of the implantation surgery after January 1,
     1976 and before January 1, 1992 -that specify one (1) of the eligible brand names or list an
     eligible implant manufacturer.

E. An affirmative statement from the implanting physician (or a responsible person at the treating
     facility where the implantation took place) attesting that you were implanted with an eligible silicone
     gel breast implant along with proof that you were implanted with that breast implant after
     January 1, 1976 and before January 1, 1992. The person making this affirmative statement must
     also provide the basis for that conclusion. This type of proof is acceptable only if the records
     outlined in paragraphs A and B above are not available, and must include a description of what
     steps were taken to secure the types of proof outlined in paragraphs A and B above and explain
     why those records were not available. The statement of steps taken can be provided by your
     attorney. This statement cannot rest upon unacceptable proof as listed in Q5-9.

F. A health insurance claim form, signed by your implanting physician reasonably close to the date of
     the surgery, naming the type of implant used as listed above. The health insurance form should
     show that your eligible silicone gel breast implant was implanted after January 1, 1976 and before
     January 1, 1992.

G. Medical records of the explanting physician (or other physician or appropriate professional who
     examined your implant during or after removal surgery) - written at the time of the examination of
     the breast implant -if that physician or other appropriate professional points out a specific
     characteristic of the breast implant that is on the list of characteristics unique to Baxter, Bioplasty,
     Bristol, Cox-Uphoff (CUI), Mentor, Koken, Silimed, Societe Prometel or Medasil Surgical
     implants as listed in Q5-7. You must still provide a statement or other records to establish that
     your eligible silicone gel breast implant was implanted after January 1, 1976 and before
     January 1, 1992.

H.  A photograph of an explanted breast implant that shows one (1) of the characteristics unique to an
      eligible silicone gel breast implant, as listed in Q5-7, if the photograph is accompanied by a
      statement from the explanting physician identifying the breast implant in the photograph as one
      (s)he removed from you. You must still provide a statement or other records to establish that your
      eligible silicone gel breast implant was implanted after January 1, 1976 and before
      January 1, 1992.

I.   Brand-specific implant control sheets, with cross-references to you, that reasonably appear to be
      contemporaneously kept records in the hospital or implanting physician's office. You must still
      provide a statement or other records to establish that your eligible silicone gel breast implant was
      implanted after January 1, 1976 and before January 1, 1992.

J.   An invoice or packing list from either Baxter, Bioplasty, Bristol, Cox-Uphoff (CUI), Mentor,
      Koken, Silimed, Societe Prometel or Medasil Surgical contained in your medical or hospital
      records relating to the implant surgery. If the Settlement Facility cannot determine that the invoice
      or packing list actually was included in those records, they may require a certified copy of the
      records or a supplemental statement from the records custodian. You must still provide a
      statement or other records to establish that your eligible silicone gel breast implant was implanted
      after January 1, 1976 and before January 1, 1992.

K.  A catalog from Baxter, Bioplasty, Bristol, Cox-Uphoff, Mentor, Koken, Silimed, Societe
      Prometel or Medasil Surgical with a particular type or style of implant circled or otherwise
      marked, if contained in a certified copy of your medical or hospital records relating to the implant
      surgery after January 1, 1976 and before January 1, 1992 which were compiled and/or produced
      before or about the time of that surgery.

L.  Patient Informed Consent forms signed by you and dated close to the date of the implantation
      surgery after January 1, 1976 and before January 1, 1992, accompanied by other
      contemporaneous medical or hospital records verifying that the implantation surgery actually
      occurred and identifying an eligible silicone gel breast implant as the manufacturer.

M. Admissions in pleadings or letters written by Baxter, Bioplasty, Bristol, Cox-Uphoff, Mentor,
      Koken, Silimed, Societe Prometel or Medasil Surgical to you, your representative or your
      physician acknowledging that your breast implants were manufactured by them. You must still  
      provide a statement or other records to establish that your eligible silicone gel breast implant was
      implanted after January 1, 1976 and before January 1, 1992.

N. Warranties mentioning a breast implant brand listed at Tab 1, Part III as being a covered implant,
      if the warranty is contained in a certified copy of your medical or hospital records.

O. Written acceptance of your implant manufacturer from either Baxter, Bioplasty, Bristol, Cox-
      Uphoff (CUI), Mentor, Koken, Silimed, Societe Prometel, or Medasil Surgical (as appropriate to
      your type of implant).

Q5-4. "What brand names are acceptable?"

             A complete list of acceptable brand names is in Tab 1, Part III.

Q5-5. "Are there other words or references I may look for in my medical records to show that my
            silicone gel breast implant was made by one (1) of the eligible manufacturers?"

            Yes. You can look for "Unique Identifiers" described in Q5-6 and Q5-7 or for lot or catalog numbers as
            described in Q5-8.

Q5-6. "What are the "Unique Identifiers?"

             Unique Identifiers are a list of features or characteristics that are unique to breast implants made by each
             company. If your breast implants are removed and examined by the physician who removed them or
             other physician or appropriate professional and (s)he points out specific characteristics of the breast
             implant that are on the list below in Q5-7, then this is acceptable proof.

Q5- 7. "What "Unique Identifiers" are acceptable?"

              For Bristol the unique identifiers are:

              A. Polyurethane for implantations before September 1, 1971 and after December 8, 1978.

              B. Bilumen implants described as having a standard gel implant within, but not attached to, an outer
                   inflatable elastomer shell.

              C. An implant having an SSI valve. An SSI valve can be mentioned by name, or by description; a
                   circular valve that looks like a button, having a slightly rounded dome. It is dacron-mesh reinforced.

              D. An implant having a Ouin-Seal valve. This valve is flat and its entry site is marked with a white dot.

              E. An adjustable reconstructive implant with two puncture seal sites (shell and column).

              F. An implant with "SCL" molded on the shell. G. An implant with radiopaque size markers.

              H. For implantations before September 1, 1971 or after December 8, 1978, an implant shell exhibiting
                   roughness due to adhesive can be treated as a "polyurethane" implant even if the foam cover is
                   gone.

               I. An implant with a "Y-shaped septum."

               For Baxter the unique identifiers are:

              A. Polyurethane for implantations from September 1, 1971 to December 8, 1978.

              B. For implantations September 1, 1971 to December 8, 1978, an implant shell exhibiting roughness
                  due to adhesive can be treated as a "polyurethane" implant even if the foam cover is gone.

              C. An implant with horizontal thin silicone tubing approximately 1 mm in diameter. The tubing lies from
                   edge to edge of patch for orientation purposes. Ends of tubing are "RTV" closed.

              D. An implant with a butterfly silicone fixation patch which is perforated to allow tissue ingrowth. The
                   edges of the patch, but not the face, are adhesed to the main patch.

              E. An implant with a molded or cast number composed of a single letter A, B, or C and followed by a
                   single-digit number.

              F. An implant with a "spiral" or "target" imprinted design composed of concentric rings located on the
                  main patch.

              G. An implant with a retention valve positioned at an acute angle to flange.

              H. An implant with a diagraph (Jenny) valve placed on the anterior face of the implant.
                   (On round styles, valve will be at the apex of the anterior face.)

              Note: Baxter identifiers C-H above related only to implantations before March 31, 1984.

Q5-8. "What are the lot and catalog numbers?"

             Breast implant manufacturers used catalog numbers in sales brochures and breast implant package
             materials. These numbers were sometimes written down in a patient's medical records and can be used
             to identify the breast implants. The lot numbers are different numbers that identify when the implants
             were made. Call the Claims Assistance Program Toll Free at 1-866-874-6099 to ask about the lot or
             catalog numbers listed in your medical records.

Q5-9. "What medical records and documents are unacceptable as proof of manufacturer?"

             Examples of unacceptable proof include:

             1. Your own recollection (or that of a friend or a relative) regarding the brand name or manufacturer of
                  your breast implants.

              2. Records from the International Implant Registry.

              3. Identifying reports from a physician who examined your breast implants during or after removal
                  surgery, if identifiers not on the list of Unique Identifiers are the basis of the identification, or the
                  physician fails to specify the characteristics assumed to be unique, or the physician merely opines,
                  based on his or her experience, that the breast implant was made by a certain manufacturer.

              4. A non-contemporaneous statement by the implanting physician, attempting to supply the acceptable
                  proof listed in the Proof of Manufacturer Form Instructions but qualifying the affirmative statement
                  concerning the type of implant used in a particular patient by phrases like "if I remember correctly"
                  or "to the best of my memory." Statements from medical personnel describing their typical or general
                  practices concerning implant usage during a given time period will be unacceptable proof.

              5. A non-contemporaneous statement by your implanting physician, attempting to provide the
                  acceptable proof that does not name you as a person receiving a particular type or brand of implant
                  will be treated as unacceptable proof.

              6. Records indicating the brand or manufacturer of implants the surgeon planned to use, without
                  confirmation from the implanting physician (or in records relating to the implant surgery) that type of
                  implant was actually used.

Q5-10. "What types of problems or deficiencies are there for proof of manufacturer?"

                   Several minor deficiencies may be found in proof that would otherwise be acceptable. These minor
                   deficiencies include:

               1. You submit acceptable proof but do not submit a Claim Form. It is necessary to submit the
                    completed and signed Claim Form.

               2. You fail to provide a certified copy of medical records for acceptable proof.

               3. An affirmative statement from the implanting physician has been submitted, but the physician failed
                   to provide the basis for his/her conclusion that you received a certain brand of implants. (S)he must
                   write a statement explaining why (s)he believes you received a certain brand of implants.

               4. Medical records have been submitted, but there is no identification on the records themselves
                   indicating that these records relate to you. You will need to obtain a certified copy of the medical
                   records from your implanting physician's office or hospital verifying that the medical records are
                   yours.

               5. The Settlement Facility needs confirmation that the statement or proof you submit came from the
                    physician or someone on the treating facility or physician's staff.

                6. The proof you submit has contradictory evidence of the brand of implant you received. For
                    example, the operative report lists one brand, but you submitted a label of another brand, and both
                    types of proof refer to the same surgery.

                7. You submit a photograph of a breast implant showing one (1) of the Unique Identifiers but you do
                     not provide a statement from the explanting physician identifying the implant in the photograph as
                     the one he/she removed from you. You need to obtain this statement from the physician.

CLAIM FORM INSTRUCTIONS

SILICONE MATERIAL CLAIMANTS AND PARTICIPATING
FOREIGN GEL CLAIMANTS (CLASS 7)

For your convenience are questions and answers taken from the Silicone Material Claimants' Fund (Class 7).
Please read these Instructions and the Claimant Information Guide for more information.

1. "What is the Silicone Gel Material Claimants Fund? (Class 7)?"

      The Silicone Material Claimants' Fund is a fund of $57.5 million (Net Present Value) set aside to make
      Expedited Release or Disease Payments to women who were implanted with certain types of silicone gel
      breast implants from 1976-1991. To be eligible, you must have been implanted with a silicone gel breast
      implant made by one (1) of the manufacturers listed in Question 2. You are not eligible if you were ever
      implanted with a Dow Corning implant. If you were ever implanted with a Dow Corning implant, do not
      complete this form. Call the Settlement Facility Toll Free at 1-866-874-6099 to obtain the correct claim
      forms.

2. "What silicone gel breast implants qualify for settlement benefits?"

      Review the chart below to see if you received a silicone gel breast implant from one (1) of the following
      manufacturers. (Read Section 5 in the Claimant Information Guide for more information.)    
  

3. "What do I need to submit to show who made my silicone gel breast implants?"

       The criteria to show who made your breast implant are the same criteria used in the Revised Settlement
       Program (RSP). If your implant proof in the RSP was acceptable for a silicone gel breast implant, then you
       will not need to submit any additional documents (as long as your records show your eligible silicone gel
       breast implant was implanted from 1976-1991). (The criteria to establish your implant manufacturer
       are set out in Section 5 of the Claimant Information Guide.)

4. "What are the settlement options for silicone material claimants?"

           Silicone Material Claimants can receive payment for:

      A. Expediated  Release Payment.  You can receive payment simply by showing that you were implanted
           from 1976 -1991 with one (1) of the silicone gel breast implants in column A in Question 2 above.

           or

       B. Disease Payment. You can receive payment for one (1) of the nine (9) eligible diseases and conditions if
            you submit medical records and documents that show that you have one (1) of the diseases or conditions
            listed in Question 6 below and you have a related disability or meet the severity criteria for that disease
            or condition.

5. "How much is the Expedited Release Payment?" (Note: This payment is available only to silicone
      material claimants.)

      There is no set payment amount for the Expedited Release Payment. After all claims have been submitted to
      the Silicone Material Claimants' Fund, the Claims Administrator will determine the amount of the Expedited
      Release Payment.

6. "What is the disease payment?" (Note: This payment is available only to silicone material
      claimants.)

      The Disease Payment provides payment if you submit medical records and documents that show that you
      have one (1) of the diseases or conditions listed below and you have a related disability or meet the severity
      criteria for that disease or condition.

      There are nine (9) eligible diseases and conditions in Disease Options 1 and 2. The eligible diseases and
      conditions are:

      1. Atypical Connective Tissue Disease (ACTD)

      2. Atypical Neurological Disease Syndrome (ANDS)

      3. Primary Sjogren's Syndrome (PSS)

      4. Mixed Connective Tissue Disease (MCTD)/ Overlap Syndrome

      5. Systemic Sclerosis / Scleroderma (SS)  

      6. Systemic Lupus Erythematosus (SLE)

      7. Polymyositis (PM)

      8. Dermatomyositis (DM)

      9. General Connective Tissue Symptoms (GCTS)

      (Read Section 7 in the Claimant Information Guide for more information about the Disease Payment.)

7. "How much is the Disease Payment?"

      The payment grid is listed at Question Q2-4 in the Claimant Information Guide. The amount of the Disease
      Payment depends on several things: .

      1. The number of approved disease and expedited release claims; and

      2. Whether you have received or are eligible to receive payment from your implant manufacturer
          (i.e., this is called "marshaling"). (Read Section 12 in the Claimant Information Guide for more information
          on marshaling.)

8. "What do I need to do to receive payment as a Silicone Material Claimant?"

           Follow steps 1-4 below:

       1. Complete and return the claim form by the deadline in Question 14; and

       2. Send in medical records or documents that show that you were implanted with a silicone gel breast 
           implant from Baxter, Bioplasty, Bristol, Cox-Uphoff (CUI), or Mentor. (Read Section 5 in the Claimant
           Information Guide for a list of implant specific brand names, "Unique Identifiers" and other information
           associated with these breast implants.); and

       3. Send in medical records or documents that show that your eligible silicone gel breast implant was
           implanted after January 1, 1976 and before January 1, 1992; and

       4. If you are applying for an Expedited Release Payment, check Box 7 A and sign and return the claim
           form. If you are applying for a Disease Payment, check Box 7B and complete the rest of the claim form.
           Send in the necessary medical records to support the disease and disability or severity you claim.

9. "What are the settlement options for Participating Foreign Gel Claimants?"

      You are eligible to receive a payment if there is excess money in the Silicone Material Claimants' Fund after
      all approved Silicone Material Claimants have been paid. You are not eligible for the Expedited Release or
      Disease Payment.

10. "What do I need to do to qualify as a Participating Foreign Gel Claimant?"

            Follow steps 1-4 below:

        1. Complete and return the claim form by the deadline in Question 14; and

        2. Send in medical records or documents that show that you were implanted with a silicone gel breast
            implant from Koken, Medasil, Silimed, or Societe Promotel. (Read the Claimant Information Guide for
            more information.); and

        3. Send in medical records or documents that show that your eligible silicone gel breast implant was
            implanted after January 1, 1976 and before January 1, 1992; and

        4. Check Box 2B on the claim form stating that you are a Participating Foreign Gel Claimant. Sign and
            return the claim form. Do not answer any other questions on the form.

11. "Are Explant and Rupture payments available to Silicone Material Claimants or Participating
        Foreign Gel Claimants?"

         No.

12. "Can I use the medical records that I have already sent to the MDL Claims Office to support my
        claim?"

        Yes. You do not have to resubmit the same medical records or documents. You must. however. complete
        and return this form.

13. "Question 6 on the claim form asks whether I have received or am eligible to receive payment
        from certain implant manufacturers.  Why is this information necessary?"

        If you received any payment(s) from Baxter, Bristol, 3M, Koken, Medasil, Silimed or Societe Prometel for
        your silicone gel breast implant(s), then your Expedited Release or Disease Payment will be reduced by the
        amount of that prior payment. If you received a substantial payment from your implant manufacturer, it is
        possible that you will not recover any payment from the Silicone Material Claimants' Fund. (Read Section
        12 in the Claimant Information Guide for more information.)       

14. "What is the Deadline to submit a Claim Form and Supporting Documents?"

        You must return this claim form with supporting documents on or before two (2) years after the Effective
         Date.

15. "Can I submit my claim form and documents in a language other than English?"

        If your medical records are in one (1) of the languages listed below, then you may submit your claim form
        and documents in that language. You do not have to translate your documents to English. However, if your
        documents are in a language other than one listed below, then you must translate your documents to
        English. (Read Question Q2-10 in the Claimant Information Guide.)

        You may submit documents in any of the following languages:

        Dutch     Portuguese     French     Spanish     German     Swedish     Korean     Vietnamese

16. "Who can I contact if I have a question or need help?"

        The Claims Assistance Program is available to answer questions about the Silicone Material Claimants'
        Fund. There is no charge to you for this service.
 

SILICONE MATERIAL CLAIMANTS:
LIST OF MANUFACTURERS

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