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1. Insurance Claims: Include when there are pending insurance claims that may affect the final payment amount

2. Guarantor Provisions: Required when a third party is guaranteeing the payment

3. Acceleration Clause: Optional provision allowing the hospital to demand full payment under specific circumstances

4. Prepayment Terms: Include when early payment options with potential discounts are offered

5. Assignment: Include when the hospital may need to assign the debt to a collection agency

6. Medical Records Release: Include when sharing of medical records is necessary for payment processing

1. Schedule A - Medical Services Detail: Itemized list of medical services provided with corresponding costs

2. Schedule B - Payment Schedule: Detailed payment schedule showing installment amounts and due dates

3. Schedule C - Insurance Information: Details of insurance coverage and expected insurance payments

4. Appendix 1 - Hospital Invoice: Copy of the original hospital invoice

5. Appendix 2 - Patient Admission Records: Reference to relevant admission and treatment dates