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1. Parties: Identification of the maker (patient/debtor) and payee (hospital/healthcare provider)
2. Background: Brief context of the medical services rendered and the resulting bill
3. Definitions: Key terms used in the document including 'Principal Sum', 'Due Date', 'Interest Rate' if applicable
4. Promise to Pay: Unconditional promise to pay the specified amount, including the exact sum and currency
5. Payment Terms: Detailed payment schedule, including due date(s) and installment amounts if applicable
6. Interest: Interest rate (if any) and calculation method
7. Default Provisions: Consequences of missed payments and remedies available to the payee
8. Execution: Signature blocks for all parties and witnesses
1. Security/Collateral: Include when specific assets are pledged as security for the debt
2. Guarantor Provisions: Include when a third party is guaranteeing the payment
3. Insurance Coverage: Include when part of the payment may come from insurance
4. Acceleration Clause: Include when early payment of the entire amount may be required upon specific triggers
5. Assignment Rights: Include when the note may be transferred or assigned to other parties
6. Legal Costs: Include when legal costs for enforcement are to be borne by the maker
1. Schedule A - Hospital Bill Details: Itemized breakdown of medical services and charges
2. Schedule B - Payment Schedule: Detailed installment payment plan if applicable
3. Schedule C - Collateral Details: Description of any assets provided as security
4. Appendix 1 - Copy of Hospital Invoice: Original hospital bill or invoice reference
5. Appendix 2 - Insurance Information: Details of any insurance coverage and expected payments
Payee
Principal Sum
Due Date
Hospital Bill
Medical Services
Interest Rate
Default
Payment Schedule
Installment Payment
Business Day
Guarantor
Security
Event of Default
Late Payment Fee
Notice
Applicable Law
Healthcare Provider
Insurance Coverage
Outstanding Balance
Payment Terms
Default Interest
Acceleration Event
Medical Records
Legal Representative
Force Majeure
Governing Law
Hospital Premises
Treatment Period
Authorized Representative
Interest
Default
Security
Representations and Warranties
Assignment
Notices
Severability
Governing Law
Dispute Resolution
Force Majeure
Confidentiality
Patient Rights
Insurance Claims
Amendment
Waiver
Acceleration
Guarantor Obligations
Legal Costs
Execution
Medical Records Reference
Payment Schedule
Default Interest
Collection Rights
Entire Agreement
Healthcare
Medical Services
Banking & Finance
Insurance
Legal Services
Healthcare Administration
Debt Collection
Legal
Finance
Patient Accounts
Revenue Cycle
Compliance
Risk Management
Collections
Medical Records
Patient Services
Administrative Services
Hospital Administrator
Financial Controller
Medical Billing Manager
Healthcare Finance Officer
Legal Counsel
Credit Control Officer
Patient Accounts Manager
Revenue Cycle Manager
Compliance Officer
Risk Manager
Collections Specialist
Healthcare Operations Manager
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