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1. Date and Place of Execution: Specifies when and where the promissory note is executed
2. Parties: Identifies the maker (patient/debtor) and payee (hospital)
3. Amount: States the principal sum owed in both numbers and words
4. Promise to Pay: Contains the unconditional promise to pay the specified amount
5. Payment Terms: Specifies when and how payment(s) will be made, including installment details if applicable
6. Interest Rate: States any applicable interest rate and how it is calculated
7. Default Provisions: Outlines consequences of failing to make payments as agreed
8. Reference to Hospital Bill: Identifies the specific hospital bill(s) being covered by the note
9. Signature Block: Space for maker's signature and witness attestation
1. Guarantor Section: Required when there is a third party guaranteeing the payment
2. Acceleration Clause: Optional clause making entire amount due upon default of any installment
3. Security Interest: Used when specific assets are pledged as security for the debt
4. Late Payment Charges: Details additional fees for late payments
5. Prepayment Terms: Includes if early payment is allowed and any associated conditions
6. Assignment Rights: Specifies if the hospital can assign the note to third parties
1. Payment Schedule: Detailed breakdown of installment amounts and due dates if applicable
2. Original Hospital Bill: Copy or summary of the hospital bill(s) being referenced
3. Itemized Statement: Detailed breakdown of medical services and charges
4. Identity Verification: Copies of maker's identification documents
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