1 Exhibit 10.4(vii) FIFTH AMENDMENT TO CREDIT AGREEMENT AND GUARANTY FIFTH AMENDMENT TO CREDIT AGREEMENT AND GUARANTY dated as of September 30, 1999 (the "Fifth Amendment") among HEALTH MANAGEMENT SYSTEMS, INC. (the "Borrower"), ACCELERATED CLAIMS...Credit Agreement and Guaranty • January 27th, 2000 • Health Management Systems Inc • Services-computer processing & data preparation • New York
