Form Execution. Medical Practice shall execute such forms (and/or shall cause any of Medical Practice’s Providers or other personnel, as necessary, to execute such forms), including, without limitation, assignments and re-assignments, as may be required to permit MMBS to provide the RCM Services on behalf of Medical Practice. Without limiting the foregoing, Medical Practice shall accurately complete all clinical and charge source data and insurance forms and provide such forms to MMBS in a timely manner(but no later than three (3) business days after the applicable patient encounter). Any charge submitted to MMBS by Medical Practice that is missing any of the billing information required by MMBS may be returned by MMBS to Medical Practice.
Form Execution. Upon the written advice of the Company, signed by any of its duly authorized officers, as to the Record Date, the Agent shall, from a list of the Company's stockholders as of the Record Date to be prepared by the Agent in its capacity as transfer agent of the Company, and from the list of Holders of the Series G1 Preferred Stock and Series G2 Preferred Stock delivered to the Agent pursuant to Section 3.1 above, prepare and record Subscription Certificates in the names of the Holders, setting forth the number of Subscription Rights to subscribe for the Company's Common Stock (and number of shares of Common Stock exercisable pursuant to such Subscription Rights) calculated on the basis of one Subscription Right for each share of Common Stock recorded on the books in the name of each such Holder, or in the case of the Series G1 Preferred Stock and Series G2 preferred Stock, one Subscription Right for each share of Common Stock issuable upon conversion, as certified to the Agent in Section 3.1 above. Each Subscription Certificate shall be dated as of the Record Date and shall be executed manually or by facsimile signature of a duly authorized officer of the Agent. Upon the written advice, signed as aforesaid, as to the effective date of the Registration Statement, the Agent shall promptly countersign and deliver the Subscription Certificate, together with a copy of the Prospectus, instruction letter and any other document as the Company deems necessary or appropriate (collectively the "Subscription Documents"), to all Holders. No Subscription Documents shall be valid for any purpose unless so executed. Delivery shall be by first class mail (without registration or insurance).
Form Execution. Upon the written advice of the Company, signed by any of its duly authorized officers, as to the Record Date, the Agent shall, from a list of the Company's stockholders as of the Record Date to be prepared by the Agent in its capacity as transfer agent of the Company, prepare and record Subscription Certificates in the names of the Holders, setting forth the number of Subscription Rights to subscribe for the Company's Common Stock calculated on the basis of 3.728 Subscription Rights for each share of Common Stock recorded on the books in the name of each such Holder. Each Subscription Certificate shall be dated as of the Record Date and shall be executed manually or by facsimile signature of a duly authorized officer of the Agent. Upon the written advice, signed as aforesaid, as to the effective date of the Registration Statement, the Agent shall promptly countersign and deliver the Subscription Certificate, together with a copy of the Prospectus, instruction letter and any other document as the Company deems necessary or appropriate (collectively the "Subscription Documents"), to all Holders with record addresses in the United States (including its territories and possessions and the District of Columbia). No Subscription Documents shall be valid for any purpose unless so executed. Delivery shall be by first class mail (without registration or insurance).
Form Execution. Upon the written advice of the Company, signed by any of its duly authorized officers, as to the Record Date, the Agent shall, from a list of the Company's stockholders as of the Record Date to be prepared by the Agent in its capacity as transfer agent of the Company, and from the list of Holders of the Series G1 Preferred Stock and Series G2 Preferred Stock delivered to the Agent pursuant to Section 3.1 above, prepare and record Subscription Certificates in the names of the Holders, setting forth the number of Subscription Rights to subscribe for the Company's Common Stock calculated on the basis of one Subscription Right for each share of Common Stock recorded on the books in the name of each such Holder, or in the case of the Series G1 Preferred Stock and Series G2 preferred Stock, one Subscription Right for each share of Common Stock issuable upon conversion, as certified to the Agent in Section 3.1 above. Each Subscription Certificate shall be dated as of the Record Date and shall be executed manually or by facsimile signature of a duly authorized officer of the Agent. Upon the written advice, signed as aforesaid, as to the effective date of the Registration Statement, the Agent shall promptly countersign and deliver the Subscription Certificate, together with a copy of the Prospectus, instruction letter and any other document as the Company deems necessary or appropriate (collectively the "Subscription Documents"), to all Holders. No Subscription Documents shall be valid for any purpose unless so executed. Delivery shall be by first class mail (without registration or insurance).
Form Execution. Client shall execute such forms (and/or shall cause any of Client’s Providers or other personnel, as necessary, to execute such forms), including, without limitation, assignments and re- assignments, as may be required to permit gMed to provide the RCM Services on behalf of Client. Without limiting the foregoing, Client shall accurately complete all clinical and charge source data and insurance forms and provide such forms to gMed in a timely manner (but no later than three (3) business days after the applicable patient encounter). Any charge submitted to gMed by Client that is missing any of the billing information required by gMed may be returned by gMed to Client.
