<PAGE>

                                                                     EXHIBIT 4.9
                             FIXED RATE GLOBAL NOTE

      Unless this certificate is presented by an authorized representative of
The Depository Trust Company, a New York corporation ("DTC"), to Issuer or its
agent for registration of transfer, exchange, or payment, and any certificate
issued is registered in the name of Cede & Co, or in such other name as is
requested by an authorized representative of DTC (and any payment is made to
Cede & Co. or to such other entity as is requested by an authorized
representative of DTC), ANY TRANSFER, PLEDGE, OR OTHER USE HEREOF FOR VALUE OR
OTHERWISE BY OR TO ANY PERSON IS WRONGFUL inasmuch as the registered owner
hereof, Cede & Co., has an interest herein.

 REGISTERED        CUSIP NO. 197677AF4                 PRINCIPAL OR FACE AMOUNT
 No. FX001                                                 $468,689,000.00

                       COLUMBIA/HCA HEALTHCARE CORPORATION
                                      NOTE
                                  (Fixed Rate)

                    * * * [ ] CHECK IF AN INDEXED NOTE * * *
             IF CHECKED, CALCULATION AGENT: _________________________

If this is an Indexed Note, references herein to "principal" shall be deemed to
be the face amount hereof, except that the amount payable upon Maturity of this
Note shall be determined in accordance with the formula or formulas set forth
below or in an attached Addendum hereto.

ORIGINAL ISSUE DATE:         INTEREST RATE:               STATED MATURITY DATE:

JUNE 30, 1995                6.910%                       JUNE 15, 2005

INTEREST PAYMENT DATES:

June 15 and December 15

INITIAL REDEMPTION           INITIAL REDEMPTION           ANNUAL REDEMPTION

N/A                                 N/A                          N/A

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DATE:                    PERCENTAGE:               PERCENTAGE REDUCTION:

N/A                         N/A                            N/A

OPTIONAL REPAYMENT DATE(S): N/A

DAY COUNT CONVENTION

[X] 30/360 FOR THE PERIOD FROM Original Issue Date TO Stated Maturity Date.
[ ] ACTUAL/360 FOR THE PERIOD FROM    TO     .
[ ] ACTUAL/ACTUAL FOR THE PERIOD FROM     TO    .

ADDENDUM ATTACHED:                                     ORIGINAL ISSUE DISCOUNT:

[ ] Yes                                                [ ] Yes
[X] No                                                 [X] No
                                                       Total Amount of OID:
                                                       Yield to Maturity:
                                                       Initial Accrual Period:

OTHER PROVISIONS:

      None.

                                        2
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      Columbia/HCA Healthcare Corporation, a Delaware corporation ("Issuer" or
the "Company," which terms include any successor corporation under the Indenture
hereinafter referred to), for value received, hereby promises to pay to CEDE &
CO., or registered assigns, the principal sum of FOUR HUNDRED SIXTY EIGHT
MILLION, SIX HUNDRED EIGHTY NINE THOUSAND DOLLARS AND NO CENTS, or if this is an
Indexed Note, the principal amount as determined in accordance with the terms
set forth under "Other Provisions" above and/or in the Addendum attached hereto,
on the Stated Maturity Date specified above (except to the extent redeemed or
repaid prior to the Stated Maturity Date), and to pay interest on the principal
or face amount as set forth above at the Interest Rate per annum specified
above, until the principal hereof is paid or duly made available for payment.
Reference herein to "this Note", "hereof", "herein" and comparable terms shall
include an Addendum hereto if an Addendum is specified above.

      The Company will pay interest on each Interest Payment Date specified
above, commencing on the first Interest Payment Date next succeeding the
Original Issue Date specified above, and on the Stated Maturity Date or any
Redemption Date or Optional Repayment Date (if specified as repayable at the
option of the Holder in an attached Addendum) (the date of each such Stated
Maturity Date, Redemption Date and Optional Repayment Date and the date on which
principal or an installment of principal is due and payable by declaration of
acceleration pursuant to the Indenture being referred to hereinafter as a
"Maturity" with respect to principal payable on such date); provided, however,
that if the Original Issue Date is between a Regular Record Date (as defined
below) and the next succeeding Interest Payment Date, interest payments will
commence on the Interest Payment Date immediately following the next succeeding
Regular Record Date. Except as provided above, interest payments will be made on
the Interest Payment Dates shown above. Unless otherwise specified above, the
"Regular Record Date" shall be the date 15 calendar days (whether or not a
Business Day) prior to the applicable Interest Payment Date. Interest on this
Note will accrue from and including the most recent Interest Payment Date to
which interest has been paid or duly provided for or, if no interest has been
paid, from the Original Issue Date specified above, to, but excluding such
Interest Payment Date. If the Maturity or an Interest Payment Date falls on a
day which is not a Business Day as defined below, the payment due on such
Maturity or interest Payment Date will be paid on the next succeeding Business
Day with the same force and effect as if made on such Maturity or Interest
Payment Date, as the case may be, and no interest shall accrue with respect to
such payment for the period from and after such Maturity or Interest Payment
Date. The interest so payable and punctually paid or duly provided for on any
Interest Payment Date will as provided in the Indenture be paid to the Person in
whose name this Note (or one or more Predecessor Securities) is registered at
the close of business on the Regular Record Date for such Interest Payment Date.
Any such interest which is payable, but not punctually paid or duly provided for
on any Interest Payment Date (herein called "Defaulted Interest"), shall
forthwith cease to be payable to the registered Holder on such Regular Record
Date, and may be paid to the Person in whose name this Note (or one or more
Predecessor Securities) is registered at the close of business on a Special
Record Date for the payment of such Defaulted Interest to be fixed by the
Trustee, notice whereof shall be given to the Holder of this Note not less than
10 days prior to such Special Record Date, or may be paid at any time in any
other lawful manner, all as more fully provided in the Indenture.

                                        3
<PAGE>

      Payment of the principal of and interest on this Note will be made at the
Office or Agency of the Company maintained by the Company for such purpose, in
such coin or currency of the United States of America as at the time of payment
is legal tender for payment of public and private debts; provided, however, that
at the option of the Company, payment of interest may be made by check mailed to
the address of the Person entitled thereto as such address shall appear in the
Security Register; and provided, further, that AT THE OPTION OF THE COMPANY, the
Holder of this Note may be entitled to receive payments of principal of and
interest on this Note by wire transfer of immediately available funds if
appropriate wire transfer instructions have been received by the Trustee not
less than 15 days prior to the applicable payment date.

      Unless the certificate of authentication hereon has been executed by or on
behalf of The First National Bank of Chicago, the Trustee for this Note under
the Indenture, or its successor thereunder, by the manual signature of one of
its authorized officers, this Note shall not be entitled to any benefit under
the Indenture or be valid or obligatory for any purpose.

      This Note is issued under an Indenture dated as of December 15,1993
(herein called the "Indenture") between the Company and The First National Bank
of Chicago, to which Indenture and all indentures supplemental thereto reference
is hereby made for a statement of the respective rights thereunder of the
Company, the Trustee and the Holders of this Note and the terms upon which this
Note is to be authenticated and delivered.

      Except as otherwise provided in the Indenture, this Note will be issued in
global form only registered in the name of The Depository Trust Company (the
"Depositary") or its nominee. This Note will not be issued in definitive form,
except as otherwise provided in the Indenture, and ownership of this Note shall
be maintained in book entry form by the Depositary for the accounts of
participating organizations of the Depositary.

      This Note is not subject to any sinking fund and, unless otherwise
provided above in accordance with the provisions of the following paragraphs, is
not redeemable or repayable prior to the Stated Maturity Date.

      If so provided above,this Note may be redeemed by the Company on any date
on and after the Initial Redemption Date, if any, specified above. If no Initial
Redemption Date is set forth above, this Note may not be redeemed prior to the
Stated Maturity Date. On and after the Initial Redemption Date, if any, this
Note may be redeemed at any time in whole or from time to time in part in
increments of $1,000 (provided that any remaining principal hereof shall be at
least $1,000) at the option of the Company at the applicable Redemption Price
(as defined below), together with accrued interest hereon at the applicable rate
payable to the date of redemption (each such date, a "Redemption Date"), on
written notice given not more than 60 nor less than 30 days prior to the
Redemption Date. In the event of redemption of this Note in part only, a new
Note for the unredeemed portion hereof shall be issued in the name of the Holder
hereof upon the surrender hereof.

      Unless otherwise specified above, the "Redemption Price" shall initially
be the Initial Redemption Percentage, specified above, of the principal amount
of this Note to be redeemed and shall decline at each anniversary of the Initial
Redemption Date, shown above, by the Annual

                                        4
<PAGE>

Redemption Percentage Reduction, if any, specified above hereof, of the
principal amount to be redeemed until the Redemption Price is 100% of such
principal amount.

      Unless otherwise specified in an Addendum attached hereto, this Note is
not subject to repayment at the option of the Holder. If this Note shall be
repayable at the option of the Holder as specified in an attached Addendum
hereto, unless otherwise specified in such Addendum, on any Optional Repayment
Date, this Note shall be repayable in whole or in part in increments of $1,000
(provided that any remaining principal hereof shall be at least $1,000) at the
option of the Holder hereof at a repayment price equal to 100% of the principal
amount to be repaid, together with interest thereon payable to the date of
repayment. If specified as repayable at the option of the Holder in such
Addendum, for this Note to be repaid in whole or in part at the option of the
Holder hereof, this Note must be received, with the form entitled "Option to
Elect Repayment" below duly completed, by the Trustee at its Corporate Trust
Office, or such address which the Company shall from time to time notify the
Holders of the Notes, not more than 60 nor less than 30 days prior to the
related Optional Repayment Date. Exercise of such repayment option by the Holder
hereof shall be irrevocable.

      If any Interest Payment Date or the Maturity Date of this Fixed Rate Note
falls on a day that is not a Business Day, the required payment of principal,
premium, if any, and/or interest will be made on the next succeeding Business
Day as if made on the date such payment was due, and no interest will accrue on
such payment for the period from and after such Interest Payment Date or the
Maturity Date, as the case may be, to the date of such payment on the next
succeeding Business Day.

      As used herein, "Business Day" means any day other than a Saturday or
Sunday or any other day on which banks in The City of New York are generally
authorized or obligated by law or executive order to close.

      Notwithstanding anything to the contrary contained herein or in the
Indenture, for purposes of determining the rights of the Holder of this Note for
which the principal thereof is determined by reference to the price or prices of
specified commodities or stocks, interest rate indices, interest or exchange
rate swap indices, the exchange rate of one or more specified currencies
(including a composite currency such as the European Currency Unit) relative to
an indexed currency or such other price, exchange rate or other financial index
or indices as specified above (an "Indexed Note"), in respect of voting for or
against amendments to the Indenture and modifications and the waiver of rights
thereunder, the principal amount of any such Indexed Note shall be deemed to be
equal to the face amount thereof upon issuance. The method for determining the
amount of principal payable at Maturity on an Indexed Note will be specified in
an attached Addendum.

      Any provision contained herein with respect to the calculation of the rate
of interest applicable to this Note, its payment dates or any other matter
relating hereto may be modified as specified in an Addendum relating hereto if
so specified above, and references herein to "as specified above" or similar
language of like import shall also be references to any such Addendum.

      If an Event of Default with respect to this Note shall occur and be
continuing, the principal of this Note may be declared due and payable in the
manner and with the effect provided in the Indenture.

                                        5
<PAGE>

      The Indenture permits, with certain exceptions as therein provided, the
amendment thereof and the modification of the rights and obligations of the
Company and the rights of the Holders of the Securities of each series to be
affected thereby at any time by the Company and the Trustee with the consent of
the a majority of the Holders of the aggregate principal amount of the
Outstanding Securities of each series affected thereby. The Indenture also
contains provisions permitting the Holders of a majority in aggregate principal
amount of the Securities of each series at the time Outstanding, on behalf of
the Holders of all the Securities of such series, to waive compliance by the
Company with certain provisions of the Indenture and certain past defaults under
the Indenture and their consequences. Any such consent or waiver by the Holder
of this Note shall be conclusive and binding upon such Holder and upon all
future Holders of this Note and of any Note issued upon the registration of
transfer hereof or in exchange herefor or in lieu hereof whether or not notation
of such consent or waiver is made upon this Note.

      No reference herein to the Indenture and no provision of this Note or of
the Indenture shall alter or impair the obligation of the Company, which is
absolute and unconditional, to pay the principal of and interest on this Note at
the time, place and rate, and in the coin or currency, herein prescribed.

      As provided in the Indenture and subject to certain limitations therein
set forth, the transfer of this Note may be registered on the Security Register
of the Company, upon surrender of this Note for registration of transfer at the
office or agency of the Company in the Borough of Manhattan, The City of New
York, duly endorsed by, or accompanied by a written instrument of transfer in
form satisfactory to the Company and the Security Registrar duly executed by,
the Holder hereof or by its attorney duly authorized in writing, and thereupon
one or more new Notes of authorized denominations and for the same aggregate
principal amount, will be issued to the designated transferee or transferees.

      This Note is issuable only in registered form without coupons in
denominations of $1,000 and integral multiples thereof.

      No service charge shall be made for any such registration of transfer or
exchange, but the Company may require payment of a sum sufficient to cover any
tax or other governmental charge payable in connection therewith.

      Prior to due presentment of this Note for registration of transfer, the
Company, the Trustee and any agent of the Company or the Trustee may treat the
Person in whose name this Note is registered as the owner hereof for all
purposes, whether or not this Note be overdue, and neither the Company, the
Trustee nor any such agent shall be affected by notice to the contrary.

      The Indenture and this Note shall be governed by and construed in
accordance with the laws of the State of New York.

      All terms used in this Note which are defined in the Indenture shall have
the meanings assigned to them in the Indenture.

                                        6
<PAGE>

      IN WITNESS WHEREOF, the Company has caused this instrument to be duly
executed, manually or in facsimile, and an imprint or facsimile of its corporate
seal to be imprinted hereon.

      [FACSIMILE OF SEAL]                        COLUMBIA/HCA HEALTHCARE
                                                 CORPORATION

      [SEAL]                                     By: /s/ Richard L. Scott
                                                     ------------------------
                                                 Title: President

Attest:

By: /s/ Stephen T. Braun
    Stephen T. Braun
    Secretary

CERTIFICATE OF AUTHENTICATION
This is one of the Securities
of the series designated therein
referred to in the within-mentioned
Indenture.

THE FIRST NATIONAL BANK OF CHICAGO,
as Trustee

By: /s/ [ILLEGIBLE]
    Corporate Trust Administrator Dated: June 30, 1995
    Authorized Officer

                                        7
<PAGE>

                            ASSIGNMENT/TRANSFER FORM

      FOR VALUE RECEIVED the undersigned registered Holder hereby sell(s),
assign(s) and transfer(s) unto
(insert Taxpayer Identification No.)

(Please print or typewrite name and address including postal zip code of
assignee)

the within Note and all rights thereunder, hereby irrevocably constituting and
appointing

attorney to transfer said Note on the books of the Company with full power of
substitution in the premises.

Dated:                 _________________________________

      NOTICE: The signature of the registered Holder to this assignment must
      correspond with the name as written upon the face of the within instrument
      in every particular, without alteration or enlargement or any change
      whatsoever.

                                        8
<PAGE>

                                  ABBREVIATIONS

      The following abbreviations, when used in the inscription on the face of
this instrument, shall be construed as though they were written out in full
according to applicable laws or regulations.

            TEN COM--as tenants in common

            UNIF GIFT MIN ACT-- __________ Custodian _______________
                                  (Cust)              (Minor)

                        Under Uniform Gifts to Minors Act
                        ---------------------------------
                                     (State)

            TEN ENT--as tenants by the entireties
            JT TEN--as joint tenants with right of survivorship
                    and not as tenants in common

      Additional abbreviations may also be used though not in the above list.

                                        9