NINTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of March 1, 2010, among LABORATORY SPECIALISTS OF AMERICA, INC., KROLL LABORATORY SPECIALISTS, INC., and SCIENTIFIC TESTING LABORATORIES, INC. ( the “New Guarantors”), Subsidiaries...

Exhibit 4.19

          NINTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of March 1, 2010, among LABORATORY SPECIALISTS OF AMERICA, INC., KROLL LABORATORY SPECIALISTS, INC., and SCIENTIFIC TESTING LABORATORIES, INC. ( the “New Guarantors”), Subsidiaries of Inverness Medical Innovations, Inc. (or its successor) (the “Issuer”), INVERNESS MEDICAL INNOVATIONS, INC., a Delaware corporation, each of the Guarantors (the “Existing Guarantors”) under the Indenture referred to below, and THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A., as Trustee under the Indenture referred to below (the “Trustee”).

WITNESSETH:

          WHEREAS the Issuer has heretofore executed and delivered to the Trustee an Indenture dated as of August 11, 2009, as amended, supplemented and modified by a Third Supplemental Indenture dated as of September 28, 2009, a Fifth Supplemental Indenture dated as of November 25, 2009, and a Seventh Supplemental Indenture dated as of February 1, 2010 (as so amended, supplemented or modified, and as further amended, supplemented or modified to date, the “Indenture”), by and among the Issuer, the Existing Guarantors and the Trustee, providing for the issuance of 7.875% Senior Notes due 2016 (the “Notes”);

          WHEREAS Section 4.13 of the Indenture provides that under certain circumstances the Issuer is required to cause each of the New Guarantors to execute and deliver to the Trustee a supplemental indenture pursuant to which each of the New Guarantors shall unconditionally and irrevocably guarantee all of the Issuer’s obligations under the Notes pursuant to a guarantee on the terms and conditions set forth herein; and

          WHEREAS pursuant to Section 9.01 of the Indenture, the Trustee, the Issuer and the Existing Guarantors are authorized to execute and deliver this Supplemental Indenture;

          NOW THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt of which is hereby acknowledged, each of the New Guarantors, the Trustee, the Issuer and the Existing Guarantors mutually covenant and agree for the equal and ratable benefit of the Holders as follows:

          SECTION 1. Definitions. For all purposes of this Supplemental Indenture, except as otherwise herein expressly provided or unless the context otherwise requires: (i) the terms and expressions used herein shall have the same meanings as corresponding terms and expressions used in the Indenture; and (ii) the words “herein,” “hereof” and “hereby” and other words of similar import used in this Supplemental Indenture refer to this Supplemental Indenture as a whole and not to any particular section hereof.

          SECTION 2. Agreement to Guarantee. Each of the New Guarantors hereby unconditionally and irrevocably agrees, jointly and severally with all other Guarantors, to guarantee the Issuer’s obligations under the Notes and the Indenture on the terms and subject to the conditions set forth in Article Ten of the Indenture and to be bound by all other applicable provisions of the Indenture.

          SECTION 3. Ratification of Indenture; Supplemental Indenture Part of Indenture. Except as expressly amended hereby, the Indenture is in all respects ratified and confirmed and

all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, and every Holder heretofore or hereafter authenticated and delivered shall be bound hereby.

          SECTION 4. Governing Law. This Supplemental Indenture shall be governed by, and construed in accordance with, the laws of the State of New York, but without giving effect to applicable principles of conflicts of laws to the extent that the application of the laws of another jurisdiction would be required thereby.

          SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency of this Supplemental Indenture or for the recitals contained herein.

          SECTION 6. Counterparts. The parties may sign any number of copies of this Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement.

          SECTION 7. Effect of Headings. The Section headings herein are for convenience only and shall not effect the construction thereof.

[Signature Page Follows]

-2-

          IN WITNESS WHEREOF, the parties hereto have caused this Supplemental Indenture to be duly executed as of the date first above written.

		NEW GUARANTORS:
		LABORATORY SPECIALISTS OF AMERICA,
		INC.,
		as a New Guarantor
		By:				/s/ Xxx XxXxxxxx
				Name:		Xxx XxXxxxxx
				Title:		Assistant Secretary
		KROLL LABORATORY SPECIALISTS, INC.,
		as a New Guarantor
		By:				/s/ Xxx XxXxxxxx
				Name:		Xxx XxXxxxxx
				Title:		Assistant Secretary
		SCIENTIFIC TESTING LABORATORIES, INC.,
		as a New Guarantor
		By:				/s/ Xxx XxXxxxxx
				Name:		Xxx XxXxxxxx
				Title:		Assistant Secretary

Signature Page to Ninth Supplemental Indenture (7.875% Notes — 144A)

		ISSUER:
		INVERNESS MEDICAL INNOVATIONS, INC.
		By:				/s/ Xxxxx X. Xxxxxx
				Name:		Xxxxx X. Xxxxxx
				Title:		Chief Financial Officer and Treasurer

Signature Page to Ninth Supplemental Indenture (7.875% Notes — 144A)

		EXISTING GUARANTORS:
		ALERE HEALTH, LLC
		ALERE HEALTHCARE OF ILLINOIS, INC.
		ALERE HEALTH IMPROVEMENT COMPANY
		ALERE HEALTH SYSTEMS, INC.
		ALERE MEDICAL, INC.
		ALERE WELLOLOGY, INC.
		ALERE WOMEN’S AND CHILDREN’S
		HEALTH, LLC
		AMEDITECH INC.
		APPLIED BIOTECH, INC.
		BINAX, INC.
		BIOSITE INCORPORATED
		CHOLESTECH CORPORATION
		FIRST CHECK DIAGNOSTICS CORP.
		FIRST CHECK ECOM, INC.
		FREE & CLEAR, INC.
		GENECARE MEDICAL GENETICS CENTER,
		INC.
		HEMOSENSE, INC.
		IM US HOLDINGS, LLC
		By:				/s/ Xxxxx X. Xxxxxx
				Name: Xxxxx X. Xxxxxx
				Title (respectively): Vice President and
						Treasurer; Vice President, Finance; Vice
						President, Finance; Vice President and
						Treasurer; Vice President and Treasurer;
						Vice President, Finance; Vice President,
						Finance; General Manager; Vice
						President; Vice President, Finance; Vice
						President, Finance; Vice President,
						Finance and Chief Financial Officer;
						Vice President, Finance; Vice President;
						Vice President, Finance and Treasurer;
						Vice President and Treasurer; Treasurer;
						President

Signature Page to Ninth Supplemental Indenture (7.875% Notes — 144A)

		EXISTING GUARANTORS (continued):
		INNOVACON, INC.
		INNOVATIVE MOBILITY, LLC
		INSTANT TECHNOLOGIES, INC.
		INVERNESS MEDICAL, LLC
		INVERNESS MEDICAL — BIOSTAR INC.
		INVERNESS MEDICAL INNOVATIONS
		NORTH AMERICA, INC.
		INVERNESS MEDICAL INTERNATIONAL
		HOLDING CORP.
		ISCHEMIA TECHNOLOGIES, INC.
		IVC INDUSTRIES, INC.
		MATRITECH, INC.
		OSTEX INTERNATIONAL, INC.
		QUALITY ASSURED SERVICES, INC.
		REDWOOD TOXICOLOGY LABORATORY,
		INC.
		RMD NETWORKS, INC.
		RTL HOLDINGS, INC.
		SELFCARE TECHNOLOGY, INC.
		TAPESTRY MEDICAL, INC.
		XXXXXXX LABORATORIES, LLC
		ZYCARE, INC.
		By:				/s/ Xxxxx X. Xxxxxx
				Name: Xxxxx X. Xxxxxx
				Title (respectively): Vice President, Finance;
						Chief Financial Officer; Vice President,
						Finance; Vice President, Finance; Vice
						President, Finance; Vice President,
						Finance; President; Vice President,
						Finance; Vice President; Vice President,
						Finance; Vice President, Finance; Chief
						Financial Officer; Vice President,
						Finance; Vice President, Finance and
						Treasurer; Vice President, Finance; Vice
						President, Finance; Vice President,
						Finance; Vice President; Chief Financial
						Officer and Treasurer

Signature Page to Ninth Supplemental Indenture (7.875% Notes — 144A)

		EXISTING GUARANTORS (continued):
		MATRIA OF NEW YORK, INC.
		By:				/s/ Xxx Xxxxxxxxx
				Name:		Xxx Xxxxxxxxx
				Title:		President

Signature Page to Ninth Supplemental Indenture (7.875% Notes — 144A)

		TRUSTEE:
		THE BANK OF NEW YORK MELLON TRUST
		COMPANY, N.A.,
		as Trustee
		By:		/s/ Xxxxx X. Xxxxxx
				Name: Xxxxx X. Xxxxxx
				Its: Vice President

Signature Page to Ninth Supplemental Indenture (7.875% Notes — 144A)