Document:

ACCUHEALTH, INC.

                 AMENDMENT NO. 3 TO THE NOTE PURCHASE AGREEMENT

     This AMENDMENT NO. 3 TO THE NOTE PURCHASE AGREEMENT (this "Agreement") is
made effective as of February 22 , 2001, among ACCUHEALTH, INC., a New York
corporation (the "Company"), MIDVIEW DRUG, INC. a corporation organized under
the laws of the State of New York ("Midview"), ACCUHEALTH HOME CARE, INC., a
corporation organized under the laws of the State of Delaware ("AHC"), CITIVIEW
DRUG CO., INC., a corporation organized under the laws of the State of New York
("Citiview"), PROHEALTHCARE INFUSION SERVICES, INC., a corporation organized
under the laws of the State of New Jersey ("PHCIS"), HEALIX HEALTHCARE, INC., a
corporation organized under the laws of the State of Delaware ("HHI"), PRN
HOMECARE AGENCY, INC., a corporation organized under the laws of the State of
New York ("PRN"), AMERIX NURSING HOLDINGS, INC., a corporation organized under
the laws of the State of Delaware ("AMERIX"), HEALIX HEALTHCARE, INC., a
corporation organized under the laws of the State of New York ("Healthcare"),
HEALIX HEALTHCARE OF NEW YORK, INC., a corporation organized under the laws of
the State of New York ("Healix NY"), RYE BEACH HEALTHCARE, INC., a corporation
organized under the laws of the State of New York ("Rye Beach"), HEALIX
HEALTHCARE OF NEW JERSEY INC., a corporation organized under the laws of the
State of New Jersey ("Healix NJ") and AMERICARE HOME NURSING SERVICES, INC., a
corporation organized under the laws of the State of New Jersey ("Americare"),
(the Company, Midview, AHC, Citiview, PHCIS, HHI, PRN, Amerix, Healthcare,
Healix NY, Rye Beach, Healix NJ and Americare, each a "Borrower" and, jointly
and severally, the "Borrowers"), RFE INVESTMENT PARTNERS V, L.P., a Delaware
limited partnership ("RFE"), the "RFE Advisory Board Members" listed on the
signature pages hereto, and STERLING/CARL MARKS CAPITAL, INC. ("Sterling") and
together with RFE and the RFE Advisory Board Members, the "Purchasers" and each
a "Purchaser").

     WHEREAS, the Company and the Purchasers and Austin Marxe ("Marxe") are
parties to a Note Purchase Agreement made effective as of July 14, 1998 as
amended by Amendment No. 1 to the Note Purchase Agreement made effective as of
August 21, 1998 and Amendment No. 2 to the Note Purchase Agreement made
effective as of October 26, 1998 (as so amended, the "ORIGINAL AGREEMENT"); and

     WHEREAS, as a condition to the purchase by certain of the Purchasers of the
14% Senior Secured Notes of the Company and its subsidiaries (the "Senior
Notes") pursuant to the 14% Senior Secured Note and Warrant Purchase Agreement
dated as of the date hereof (as in effect from time to time, the "Senior Note
Agreement") among the Company, its subsidiaries and the purchasers named
therein, the Purchasers require that the Original Agreement be amended as
follows:
<PAGE>

         (i)      to provide for the exchange, for those holders who elect to so
                  exchange, of the 12% Convertible Subordinated Notes due July
                  14, 2003 of the Company (as issued under the Original
                  Agreement) held by such electing holders for the new 14%
                  Convertible Subordinated Secured Notes due February 23, 2004,
                  of the Borrowers (as in effect from time to time, the
                  "Replacement Notes"); and

         (ii)     to provide for the execution and delivery by the Borrowers of
                  a Security Agreement granting to RFE Investment Partners V,
                  L.P., as collateral agent, for the benefit of the Purchasers,
                  a security interest in all or substantially all of the assets
                  of the Borrowers in order to secure the Replacement Notes; and

         (iii)    to provide for the amendment and restatement of the
                  Stockholders Agreement and the Registration Rights Agreement
                  to give effect to the issuance of the Replacement Notes and
                  the issuance of additional warrants pursuant to the Senior
                  Note Agreement; and

     WHEREAS, Section 9.4 of the Original Agreement provides that the Original
Agreement may be amended with the written consent of (i) "Purchasers" (as
defined in the Original Agreement) representing 50.1% (the "Majority Interest")
of the interest of the Subordinated Notes (as defined in the Original Agreement)
and/or Common Stock (as defined in the Original Agreement) held by such
"Purchasers" at the time of such amendments and (ii) the Company; and

     WHEREAS, the Purchasers constitute at least the Majority Interest; and

     WHEREAS, as of the date of this Agreement, Marxe has elected to not so
exchange the 12% Convertible Subordinated Note due July 14, 2000 (the "12% Marxe
Note") held by him; and

     WHEREAS, the Purchasers desire to effect the foregoing and to amend such
Agreement.

     NOW, THEREFORE, in consideration of the mutual promises and covenants set
forth herein, the parties hereto agree as follows:

         1.       DEFINED TERMS. Capitalized terms used and not otherwise
defined in this Agreement shall have the meanings given to such terms in the
Original Agreement.

         2.       ISSUANCE OF THE REPLACEMENT NOTES TO PURCHASERS.

     Subject to:

                  a.       the terms and conditions stated herein and in the
                           Original Agreement,

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<PAGE>
                  b.       the execution and delivery by the Borrowers and each
                           Purchaser of this Agreement,

                  c.       the execution and delivery by the Company and each
                           Purchaser and each other party thereto (other than
                           Marxe) of a counterpart to the Amended and Restated
                           Stockholders' Agreement (in the form attached
                           hereto);

                  d.       the execution and delivery by the Company and each
                           Purchaser and each other party thereto (other than
                           Marxe) of a counterpart to the Amended and Restated
                           Registration Rights Agreement (in the form attached
                           hereto),

                  e.       the execution and delivery by the Borrowers of the
                           aforementioned Security Agreement; and

                  f.       the execution and delivery of the Senior Note
                           Agreement and all documents referenced therein,

the Borrowers shall issue to each Purchaser, and such Purchaser shall acquire
from the Borrowers, a Replacement Note in the principal amount set forth next to
such Additional Purchaser on SCHEDULE 1 hereto, in replacement of the Company's
12% Convertible Subordinated Notes due July 14, 2003 held by such Purchaser (the
"Replaced Notes"). All references to the "Notes" or the "Subordinated Notes" in
the Original Agreement shall be deemed to refer to (a) the Replacement Notes (as
same may be amended or otherwise in effect from time to time) and also, unless
the applicable context otherwise provides, any and all Interest Series Notes (as
same may be amended or otherwise in effect from time to time) issued pursuant to
the Replacement Notes and (b) the Marxe Note and, unless the applicable context
otherwise provides, any note (if any) issued pursuant thereto. Promptly after
the issuance of a Replacement Note to a Purchaser, such Purchaser shall return
the related Replaced Note, marked cancelled or, if the Replacement Note is lost
or misplaced, provide a lost note affidavit and indemnity in customary form.

         3.       SECTION 1.5. A new Section 1.5 is hereby added to the Original
Agreement to read in its entirety as follows:

         "1.5.    SUBORDINATION. The Purchasers and the Borrowers (i) reaffirm
the subordinated provisions of the Subordinated Notes and that such provisions
run in favor of and for the benefit of the Senior Creditor (as hereinafter
defined), and (ii) agree that such provisions are supplemented as follows:

(a)               Definitions. As used in this Section 1.5, the following terms
shall have the specified meanings:

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<PAGE>
                  "AGENT" shall mean Rosenthal & Rosenthal, Inc. in its capacity
         as "Collateral Agent" under the Intercreditor Agreement.

                  "BANKRUPTCY CODE" shall mean the provisions of 11 U.S.C.
         Section 101 et Seq., and the Rules and Forms of Practice and Procedure
         in Bankruptcy promulgated by the Supreme Court of the United States.

                  "COLLECTION ACTION" shall mean (a) to demand, take or receive
         from or on behalf of the Company, or any Secondary Party, by setoff or
         in any other manner, the whole or any part of any Junior Debt, (b) to
         exercise any enforcement rights with respect to any collateral to the
         extent it secures the Junior Debt, including any enforcement rights
         arising under any security or similar agreement (notwithstanding that
         the entering into thereof by the Company was permitted by the Senior
         Creditor), or arising under applicable law, (c) to initiate or
         participate with others in any suit, action or proceeding against the
         Company or Secondary Party to (i) enforce payment of or to collect the
         whole or any part of the Junior Debt or (ii) commence judicial
         enforcement of any of the rights and remedies under the Junior Debt
         Documents or applicable law with respect to the Junior Debt, (d) to
         accelerate any Junior Debt, or (e) to exercise any put option or to
         cause the Company, or any Secondary Party to honor any redemption or
         mandatory prepayment obligation under any Junior Debt Document.

                  "INTER-CREDITOR AGREEMENT" shall mean the Intercreditor
         Agreement dated as of February 22, 2001 among the Company (as one of
         the "Borrowers" described thereunder), the other Borrowers, the Lender,
         the initial holders of the Senior Secured Notes, the Purchasers that
         are a party thereto, Rosenthal & Rosenthal as the "Collateral Agent"
         (as defined therein), and the Subordinated Creditor Collateral Agent
         (as defined therein).

                  "JUNIOR DEBT" shall mean all of the obligations of the Company
         now or hereafter owed to the Purchasers under any of the Junior Debt
         Documents.

                  "JUNIOR DEBT DOCUMENTS" shall mean the Subordinated Note
         Agreement, the Subordinated Notes (including without limitation any
         paid-in-kind notes issued pursuant to any Subordinated Note) issued
         thereunder and any all other documents and instruments entered into or
         delivered by or among the Company and the Purchasers in connection
         therewith, but excluding from Junior Debt, for the avoidance or doubt,
         (i) warrants or stock issued by the Company to any of the Purchasers
         and (ii) the Senior Secured Promissory Notes and any related security
         agreements or purchase agreements.

                  "LENDER" shall mean Rosenthal & Rosenthal, Inc., a New York
         corporation, with its address at 1370 Broadway, New York, New York
         10018. "PROCEEDING" shall mean any voluntary or involuntary insolvency,
         bankruptcy, receivership, custodianship, liquidation, dissolution,
         reorganization, assignment for the benefit of creditors, appointment of

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<PAGE>
         a custodian, receiver, trustee or other officer with similar powers or
         any other proceeding for the liquidation, dissolution or other winding
         up of a Person.

                  "ROSENTHAL CREDIT AGREEMENT" shall mean the Loan and Security
         Agreement dated as of February 1, 1996, as amended by Amendment No. 1,
         dated as of February 1, 1996, Amendment No. 2, dated as of February 1,
         1997, Amendment No 3 and Joinder Agreement dated as of July 30, 1997,
         Amendment No. 4 and Joinder Agreement dated as of April 3, 1998 and
         Amendment No. 5, dated as of February 22, 2001, in each case among
         Lender, the Company and the other "Borrowers" referred to therein.

                  "SECONDARY PARTY" shall mean any Person which has any
         liability with respect to the Junior Debt, other than the Company.

                  "SENIOR CREDITOR" shall mean, collectively, the Lender and the
         holders of the Senior Secured Notes.

                  "SENIOR DEBT" shall mean, collectively, (i) the "Obligations,"
         as such term as defined in the Rosenthal Credit Agreement, together
         with (a) all complete or partial refinancings of the Obligations,
         including as any such refinancing occurs in a Proceeding (pursuant to
         the Bankruptcy Code or otherwise), (b) any amendments, modifications,
         renewals or extensions thereof and (c) any interest fees and charges
         accruing thereon after the commencement of a Proceeding, without regard
         to whether or not any of such interest fees and charges is an allowed
         claim, and (ii) all amounts, including principal, interest, costs and
         expenses, at any time owed under the Senior Secured Notes, together
         with (a) all complete or partial refinancings of such amounts,
         including as any such refinancing occurs in a Proceeding (pursuant to
         the Bankruptcy Code or otherwise), (b) any amendments, modifications,
         renewals or extensions thereof and (c) any interest fees and charges
         accruing thereon after the commencement of a Proceeding, without regard
         to whether or not any of such interest fees and charges is an allowed
         claim.

                  "SENIOR DEBT DOCUMENTS" shall mean, collectively, (i) the
         Rosenthal Credit Agreement, (ii) the Senior Secured Notes and (iii) all
         other documents and instruments (other than the Intercreditor
         Agreement) evidencing or pertaining to all or any portion of the Senior
         Debt and any security interests securing any or all of the Senior Debt.

                  "SENIOR SECURED NOTES" shall mean (a) those certain Senior
         Secured Notes, issued by the Company on or about February 22, 2001, in
         the aggregate principal amount of $925,000 and (b) if issued, the Davis
         Note (as defined in the Senior Note Agreement (as defined in the
         Intercreditor Agreement)).

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<PAGE>
                  "SUBORDINATED NOTE AGREEMENT" shall mean this Note Purchase
         Agreement, as amended by Amendment No. 1 to the Note Purchase Agreement
         effective as of August 21, 1998, Amendment No. 2 to the Note Purchase
         Agreement, effective as of October 26, 1998, and Amendment No. 3 to the
         Note Purchase Agreement, effective as of February 22, 2001,

(b)               SUBORDINATION OF JUNIOR DEBT TO SENIOR DEBT. The Company and
the Purchasers covenant and agree (for themselves and any other holder of Junior
Debt) that the payment of any and all of the Junior Debt and all payments under
the Junior Debt Documents shall be subordinate and subject in right of payment,
to the extent and in the manner hereinafter set forth, to the prior payment in
full in cash of the Senior Debt. Each holder of Senior Debt, whether now
outstanding or hereafter created, incurred, assumed or guaranteed, shall be
deemed to have acquired Senior Debt in reliance upon the provisions contained in
this Agreement.

(c)               NO PAYMENT ON JUNIOR DEBT. Unless and until all Senior Debt
shall have been irrevocably paid in full in cash, and notwithstanding any
"Default", "Event of Default' or any similar occurrence (whether now existing or
hereafter occurring) under the Junior Debt Documents, neither the Company shall
not make (or permit any Secondary Party to make), nor shall any Purchaser
receive from the Company or any Secondary Party, any payment of any type
(including, without limitation, by redemption, repurchase or similar
transaction, or by transfer of property), of principal, interest, fees, charges,
expenses, indemnities or any other obligation, on or with respect to the Junior
Debt or the Junior Debt Documents, except that nothing contained in this Section
1.5 (or in the subordination provisions of any Junior Debt instrument) shall, or
shall be interpreted to, limit the right of the Company to issue, and any
Purchaser to receive, any paid in kind notes ("PIK Notes") evidencing accrued
and unpaid interest on Subordinated Notes (and provided that such PIK Notes
shall be subject to the provisions of this Section 1.5 and deemed Subordinated
Notes hereunder) or to convert any Junior Debt into Common Stock of the Company
or from exercising any warrants issued by the Company.

(d)               PROCEEDINGS. In the event of any Proceeding involving the
Company or any Secondary Party, (i) all Senior Debt shall first be irrevocably
paid in full in cash before any payment of or with respect to the Junior Debt
shall be made; (ii) any payment or distribution, whether in cash, property or
securities which, but for the terms hereof, otherwise would be payable or
deliverable in respect of the Junior Debt, shall be paid or delivered directly
to Agent (to be held and/or applied by Agent in accordance with the terms of the
Intercreditor Agreement) until all Senior Debt is paid in full, and each
Purchaser irrevocably authorizes, empowers and directs all receivers, trustees,
liquidators, custodians, conservators and others having authority in the
premises to effect all such payments and distributions, and each Purchaser also
irrevocably authorizes, empowers and directs the Agent to demand, sue for,
collect, seek to recover and receive every such payment or distribution, except
that the Purchasers may receive and retain securities of the Company (or other
applicable Secondary Party) which are subordinate, at least to the extent
provided for in this Section 1.5 with respect to the Junior Debt, to the payment
of the Senior Debt; (iii) each Purchaser agrees to execute and deliver to Agent
or its representative all such further instruments as Agent may reasonably
request confirming the authorization referred to in the foregoing clause (ii);

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<PAGE>
(iv) each Purchaser (in its capacity as such) agrees not to initiate or
prosecute or induce any other person to initiate or prosecute any claim, action
or other proceeding challenging the enforceability of the Senior Debt or any
liens and security interests securing the Senior Debt, and (v) each Purchaser
(in its capacity as such) agrees not to (x) object to any use of cash collateral
by the Company or any Secondary Party under Section 363 of the Bankruptcy Code
if consented to by Agent or Lender (provided, that such consent is given in good
faith for the purpose of protecting the collateral position of the Senior
Creditors) or any borrowing by the Company from Lender under Section 364 of the
Bankruptcy Code including any grant of a lien or security interest by the
Company or any Borrower or any Secondary Party in favor of the Lender (or any
agent) (provided, that the Lender shall have, pursuant to the provisions of the
Intercreditor Agreement, offered the holders of the Senior Secured Notes, an
opportunity to participate in any such borrowing but in the benefit of such lien
or security interest), and (y) assert, in the case of such use or borrowing, any
requirement for adequate protection under Sections 362, 363 or 364 of the
Bankruptcy Code to or for the Purchaser (in its capacity as such) with respect
to any collateral for the Junior Debt, and (vi) each Purchaser agrees to
execute, verify, deliver and file any proofs of claim in respect of the Junior
Debt reasonably requested by Agent in connection with any such Proceeding and
hereby irrevocably authorizes, empowers and appoints Agent its agent and
attorney-in-fact to (x) execute, verify, deliver and file such proofs of claim
of any Purchaser if such Purchaser fails to file such proof by that date which
is 7 days before the expiration of the time to file any such proof and (y) vote
such claim in any such Proceeding upon the failure of any Purchaser to do so
prior to 5 days before the expiration of the time to vote any such claim,
provided, that the Agent shall give the applicable Purchaser(s) prior notice of
the Agent's intent to so vote and the Agent shall not have the right to so vote
if the Purchaser within a reasonable period of time thereafter (and prior to
such expiration time) votes its proof of claim; except as provided for in clause
(x) and (y), the Purchasers shall have the right to file such proofs of claim
and to vote such proofs of claim; provided, further, Agent shall have no
obligation to execute, verify, deliver, file and/or vote any such proof of
claim. In the event that Agent votes any claim in accordance with the authority
granted hereby, no Purchaser shall be entitled to change or withdraw such vote.
The Senior Debt shall continue to be treated as Senior Debt and the provisions
of this Agreement shall continue to govern the relative rights and priorities of
the holders of the Senior Debt and the Purchasers even if all or part of the
Senior Debt or the security interests securing the Senior Debt are subordinated,
set aside, avoided or disallowed in connection with any such Proceeding and this
Agreement shall be reinstated if at any time any payment of any of the Senior
Debt is rescinded or must otherwise be returned by any holder of Senior Debt or
any representative of such holder.

(e)               RESTRICTION ON ACTION BY THE PURCHASERS. Until the Senior Debt
shall have been irrevocably paid in full in cash, no Purchaser (in its capacity
as such) shall, without the prior written consent of the holders of the Senior
Debt, take any Collection Action except that the Purchasers may accelerate the
Junior Debt .

(f)               INCORRECT PAYMENTS. If any payment or distribution on account
of the Junior Debt not permitted to be made by the Company or received by the
Purchasers under this Agreement is received by any Purchaser before all Senior
Debt is irrevocably paid in full in cash and all lending commitments, if any

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<PAGE>
under the Rosenthal Credit Agreement have terminated, such payment or
distribution shall not be commingled with any asset of such Purchaser, shall be
held in trust by such Purchaser for the benefit of the holders of the Senior
Debt and shall be promptly paid over to Agent, or its designated representative,
for application (in accordance with the Intercreditor Agreement) to the payment
of the Senior Debt then remaining unpaid, until all of the Senior Debt is
irrevocably paid in full in cash.

(g)               SALE, TRANSFER, ETC. No Purchaser shall sell, assign, pledge,
dispose of or otherwise transfer all or any portion of the Junior Debt or any
Junior Debt Document unless the applicable transferee shall execute and deliver
to Agent an agreement substantially identical to this Agreement, providing for
the continued subordination and forbearance of the Junior Debt to the Senior
Debt as provided herein and for the continued effectiveness of all of the rights
of the Agent and the holders of the Senior Debt arising under this Agreement.

(h)               LEGENDS. Until the Senior Debt is irrevocably paid in full in
cash and all lending commitments, if any, under the Rosenthal Credit Agreement
have been terminated, each Junior Debt Document at all times shall contain in a
conspicuous manner the following legend:

                  "The rights of the Payee and the obligations of the Maker
                  evidenced hereby are subordinate in the manner and to the
                  extent set forth in Section 1.5 of the [Agreement] [Note
                  Purchase Agreement dated as of July 14, 1998, as amended (the
                  "Purchase Agreement")], to the indebtedness defined as "Senior
                  Debt" thereunder; and each holder of this instrument and any
                  successor, by its acceptance hereof, shall be bound by such
                  subordination provisions."

(i)               RELATIVE RIGHTS. This Section 1.5 defines the relative rights
of the holders of the Senior Debt (in their capacity as such) and the holders of
Junior Debt (in their capacity as such). Nothing herein shall: (i) impair, as
between the Company and the holders of the Junior Debt, the obligation of the
Company, which is absolute and unconditional, to pay principal of and interest
and all other amounts due on or with respect to Junior Debt in accordance with
its terms; (ii) affect the relative rights of holders of Junior Debt and
creditors of the Company (or any Secondary Party) other than holders of Senior
Debt; or (iii) except as expressly provided herein, prevent the holders of
Junior Debt from exercising their available remedies upon a default or an event
of default under the Junior Debt Documents, subject to the rights of holders of
Senior Debt set forth in this Section 1.5.

(j)               SUBROGATION. After all amounts payable under or in respect of
Senior Debt are irrevocably paid in full in cash, the holders of the Junior Debt
shall have the right to be subrogated to the rights of holders of Senior Debt to
receive payments or distributions applicable to Senior Debt (and to any
remaining collateral for same) to the extent that payment or distributions
otherwise payable to the holders of the Junior Debt have been applied to the
payment of Senior Debt. A payment or distribution made under this Agreement to a

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<PAGE>
holder of Senior Debt which otherwise would have been made to the holders of the
Junior Debt is not, as between the Company and the holders of the Junior Debt, a
payment or distribution by the Company on Senior Debt.

(k)               MODIFICATIONS TO SENIOR DEBT. Without limiting the effect of
clauses (a) and (b) of the definition of Senior Debt, at any time and from time
to time without the consent of any Purchaser, without incurring liability to any
Purchaser and without impairing or releasing the obligations of any Purchaser
under this Agreement (including without limitation the provisions of this
Section 1.5), the manner or place of payment or the time of payment or any of
the terms of the Senior Debt or any other matter relating thereto, indirectly
any collateral therefor, may be renewed, altered or amended in any manner,
including any of the terms of any agreement, security agreement, note, guaranty
or other instrument evidencing or securing or otherwise relating to the Senior
Debt.

(l)               CONTINUED EFFECTIVENESS OF THIS AGREEMENT. The terms of this
Agreement, the subordination effected hereby, and the rights and the obligations
of the Purchasers, the Company, Agent and Senior Creditors arising hereunder
shall not be affected, modified or impaired in any manner or to any extent by:
(i) the validity or enforceability (or the lack thereof) of any of the Senior
Debt Documents; or (ii) any exercise or non-exercise of any right, power or
remedy under or in respect of the Senior Debt or the Junior Debt or any of the
Senior Debt Documents or the Junior Debt Documents. Each Purchaser and each
other holder of Junior Debt hereby acknowledges that the provisions of this
Agreement are intended to be enforceable at all times, whether before the
commencement of, after the commencement of, or in connection with or premised on
the occurrence of a Proceeding.

(m)               NO CONTEST BY PURCHASERS. Each Purchaser (in its capacity as
such) agrees that it will not at any time contest the validity, perfection,
priority or enforceability of the Senior Debt, the Senior Debt Documents, or the
liens and security interests of Agent and Senior Creditors in the collateral
securing the Senior Debt, or contest or object to the enforcement of such liens
and security interests on the theory of marshaling of assets. Purchasers agree
that (i) irreparable damage to the holders of Senior Debt would occur if any of
the provisions of this Section 1.5 were not performed or were contested by the
Purchasers and, accordingly (ii) such provisions may be enforced specifically
and by injunctive relief.

(n)               Nothing contained in this Section 1.5 shall, or shall be
interpreted to, limit the terms and provisions of the Intercreditor Agreement
and the relative rights of the Lender, the holders of the Senior Secured Notes
and holders of the Junior Debt thereunder."

                                       9
<PAGE>
         4.       In the event that the provisions of the new Section 1.5 set
forth above are held by a court of competent jurisdiction to not be binding upon
Marxe (e.g., Marxe is not considered a "Purchaser" for purposes thereof), it is
understood and agreed that such provisions shall still be binding upon the
Purchasers who are a party to this Agreement. The Lender reserves its right to
require Marxe, pursuant to Section 3 of the Marxe Note, to execute and deliver
additional subordination agreements.

         5.       REPRESENTATIONS AND WARRANTIES. The representations and
warranties of the "Borrowers" in the Senior Note Agreement are incorporated
herein by reference and repeated (as of the date hereof) for the benefit of the
Purchasers. The Borrowers hereby further represent and warrant that, as of the
date hereof, they have no claims, counterclaims or defenses against the
Purchasers, whether arising out of or other relating in any way to the Notes or
the Agreement or any related agreement or instrument or otherwise.

         6.       GOVERNING LAW. This Agreement shall be governed by, and
construed according to the laws of the State of New York.

         7.       EFFECTIVE DATE. In accordance with the terms of the Original
Agreement, this Agreement will become effective upon execution by the Borrowers
and the Purchasers representing the Majority Interest.

         8.       COUNTERPARTS. This Agreement may be executed in any number of
counterparts, each of which shall be an original, but all of which together
shall constitute one instrument.

         9.       The Purchasers and the Borrowers agree that if Marxe shall, at
any time prior to that date which is eleven (11) days after the date hereof,
elect to exchange the 12% Marxe Note for a promissory note similar in tenor to
the other Replacement Notes (the "Marxe Replacement Note") then the parties
hereto and Marxe shall enter into a supplemental agreement, in reasonable form,
providing for such exchange, and making Marxe, among other things, a Purchaser
for purposes of this Agreement and a secured party under the Security Agreement
referred to in subparagraph 2.e. above, and upon such exchange (if any) the
Replacement Notes shall be deemed to include the Marxe Replacement Note. Unless
and until such exchange, (i) the 12% Marxe Note (and any note issued pursuant
thereto) shall be deemed part of the Subordinated Notes under the Original
Agreement and (ii) Marxe shall not be considered a party hereto (notwithstanding
the fact that there may be a signature block for Marxe on the signature pages
hereto).

       [Signature page to Amendment No. 3 to the Note Purchase Agreement]

                                       10
<PAGE>
                                    * * * * *

       [Signature page to Amendment No. 3 to the Note Purchase Agreement]

                                       11

<PAGE>
         Executed effective as of the date first set forth above.

THE COMPANY:                           ACCUHEALTH, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       MIDVIEW DRUG, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       ACCUHEALTH HOME CARE, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       CITIVIEW DRUG CO., INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       PROHEALTHCARE INFUSION SERVICES, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       HEALIX HEALTHCARE, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

       [Signature page to Amendment No. 3 to the Note Purchase Agreement]

                                       12
<PAGE>
                                       PRN HOMECARE AGENCY, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       AMERIX NURSING HOLDINGS, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       HEALIX HEALTHCARE, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       HEALIX HEALTHCARE OF NEW YORK, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       RYE BEACH HEALTHCARE, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       HEALIX HEALTHCARE OF NEW JERSEY, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

                                       AMERICARE HOME NURSING SERVICES, INC.

                                       By:__________________________________
                                          Its Chief Executive Officer

       [Signature page to Amendment No. 3 to the Note Purchase Agreement]

                                       13
<PAGE>
RFE:                                   RFE INVESTMENT PARTNERS V, L.P.

                                       By: RFE ASSOCIATES V, L.P.
                                           Its General Partner

                                       By: __________________________________
                                           A General Partner

STERLING:                              STERLING/CARL MARKS CAPITAL, INC.

                                       By: __________________________________
                                           Name:
                                           Title:

MARXE:

                                           /s/ AUSTIN MARXE
                                           ----------------------------------
                                           Austin Marxe

       [Signature page to Amendment No. 3 to the Note Purchase Agreement]

                                       14
<PAGE>
RFE ADVISORY BOARD MEMBERS:

                                       /s/ ROBERT D. KENNEDY
                                       --------------------------------------
                                       Robert D. Kennedy

                                       RICHARD A. ROSENTHAL IRA ROLLOVER TRUST
                                       ACCOUNT NO. 1416

                                       By: __________________________________
                                           Name:
                                           Title:

       [Signature page to Amendment No. 3 to the Note Purchase Agreement]

                                       15
<PAGE>
                                                                      SCHEDULE 1

                             SCHEDULE OF PURCHASERS

<TABLE>
<CAPTION>
--------------------------------------------------------------------------------------------------

                                                                           Amount of Accrued and
                                                                          Unpaid Interest (through
                                               Principal Amount of          Closing Date) to be
          Purchaser                             Replacement Note             referred to in the
                                                                              Replacement Note
--------------------------------------------------------------------------------------------------
<S>                                                <C>                    <C>
RFE Investment Partners V L.P.                     $4,970,000             $[     ] (Note: As of
36 Grove Street                                                           12/31/00: $1,685,756)
New Canaan, CT 06840
--------------------------------------------------------------------------------------------------
Robert D. Kennedy                                  $   15,000             $[     ] (Note: As of
2061 Ponus Ridge Road                                                     12/31/00: $4,576)
New Canaan, CT 06840
--------------------------------------------------------------------------------------------------
Richard A. Rosenthal IRA Rollover Trust            $   15,000             $[     ] (Note: As of
c/o Indiana Trust and Investment                                          12/31/00: $4,576)
Management Company
3930 Edison Lakes Parkway
Suite 250
Mishawaka, IN 46545
Attn: David A. Hosinski

--------------------------------------------------------------------------------------------------
Sterling/Carl Marks Capital, Inc.                  $  750,000             [Please compute]
175 Great Neck Road, Suite 408
Great Neck, NY 11021
--------------------------------------------------------------------------------------------------
</TABLE>

       [Signature page to Amendment No. 3 to the Note Purchase Agreement]

                                       16AMENDMENT NO. 5
                         TO LOAN AND SECURITY AGREEMENT

         Amendment No. 5, dated as of February 22, 2001 to the Loan and Security
Agreement identified herein, among ACCUHEALTH, INC., a New York corporation (the
"Company") and the other corporations set forth on the signature pages hereof
who are designated as "Borrowers" (such corporations, together with the Company,
being the "Borrowers"), and ROSENTHAL & ROSENTHAL, INC., a New York corporation
("Lender").

                                    RECITALS:

         1.    Lender and Borrowers (originally or by the "Joinder Agreements"
forming part of Amendments No. 3 and 4 specified below) are parties to that
certain Loan and Security Agreement dated as of April 28, 1994, as amended by
Amendment No. 1 dated as of February 1, 1996, Amendment No. 2 dated as of
February 1, 1997, Amendment No. 3 and Joinder Agreement, dated as of July 30,
1997, and Amendment No. 4 and Joinder Agreement, dated as of April 3, 1998 (as
so amended, the "Loan Agreement"). Except as may be specifically defined herein,
all capitalized terms used in this Amendment shall have the meanings given to
them in the Loan Agreement.

         2.    Following April 1, 2000, (a) under the terms of the Loan
Agreement, (i) the commitment of the Lender to make Revolving Credit Advances
terminated, and (ii) all Obligations became immediately due and payable, and (b)
the Borrowers confirmed that all Obligations of Borrowers, all security
interests of Lender securing such Obligations and all rights of the Lender
continued in full force and effect.

         3.    Following April 1, 2000, Lender has continued to provide certain
advances to the Borrowers on a fully discretionary basis.

         4.    Pursuant to (i) a Note Purchase Agreement dated as of the date
hereof (the "Senior Note Agreement"), certain investors (the "Senior Note
Holders") have agreed to purchase $925,000 in principal amount of the Borrowers'
Senior Secured Notes ("Senior Notes"), and (ii) an Amendment No. 3 to Note
Purchase Agreement, dated as of the date hereof ("Amendment No. 3"), to the Note
Purchase Agreement dated as of July 14, 1998 among the Company and the
"Purchasers" thereunder as previously amended by Amendment No. 1 to the Note
Purchase Agreement made effective as of August 21, 1998 and Amendment No. 2 to
the Note Purchase Agreement made effective as of October 26, 1998 (the
"Subordinated Note Agreement"), the holders of the Company's Subordinated Notes
(the "Subordinated Note Holders") have agreed to amend further the Subordinated
Note Agreement and to have certain replacement notes issued pursuant thereto.
<PAGE>

         5.    In connection with the Senior Note Agreement and Amendment No. 3,
and pursuant to certain security agreements described in the Intercreditor
Agreement referred to herein, the Senior Note Holders and the Subordinated Note
Holders have been granted a security interest in the Collateral, subject to the
terms of the Intercreditor Agreement dated as of the date hereof, among the
Lender, the "Collateral Agent" specified therein, the Senior Note Holders, the
Subordinated Note Holders, the Borrowers and the collateral agent for the
Subordinated Note Holders (the "Intercreditor Agreement").

         6.    The Borrowers have requested that the Lender confirm its
willingness to provide ongoing financing to the Borrowers within the
restrictions and subject to the terms and conditions of the Loan Agreement as
amended hereby.

         7.    To facilitate the foregoing transactions, the parties hereto
amend the Loan Agreement as provided herein.

         NOW, THEREFORE, the parties hereto agree as follows:

         8.    RECITALS. The Lender and the Borrowers confirm, agree to and
adopt all statements made in the Recitals set forth above.

         9.    AMENDMENTS TO LOAN AGREEMENT. Subject to the satisfaction of the
conditions precedent set forth in Section 3 below, the Loan Agreement is hereby
amended as follows:

         2.1.  Section 1(a) is amended as follows:

         (a)   TERMS DELETED:

         Minimum Average Monthly Loan Amount

         Maximum Revolving Amount

         Overadvance Availability

         Overdraft Loans

         Overadvance Rate

         Receivables Availability

         Revolving Interest Rate

         Term Loan

         Term Loan Rate

         Term Note

                                       2
<PAGE>

         PROVIDED, that such deletions shall not impair any references to any of
such terms in the provisions added by this Amendment.

         (b)   TERMS ADDED (in correct alphabetical order):

         "Amendment No. 5" means the Amendment No. 5 to Loan and Security
Agreement dated as of February 22, 2001.

         "Creditor Action" means the taking of any action by a Creditor Party to
enforce its rights under the relevant Creditor Settlement, including without
limitation, the commencement of any action, suit or proceeding against any
Borrower or the property of any Borrower, the obtaining of any judgment against
any Borrower, the issuance of execution or any other attempt to enforce or
perfect a lien or security interest in any property of any Borrower.

         "Creditor Party" means each of the creditors of any of the Borrowers
which is a party to any of the Creditor Settlements.

         "Creditor Settlements" means the Primary Settlements and the Secondary
Settlements.

         "Effective Date" means the date on which all conditions set forth in
Amendment No. 5 shall have been satisfied.

         "Intercreditor Agreement" shall have the meaning set forth in Amendment
No. 5.

         "January 2001 Receivables" means Receivables which as of January 31,
2001 were unpaid more than 150 days following their respective invoice dates.

         "Margin" means one and one-half percent (1 1/2%) per annum; provided,
that following the occurrence and during the continuance of an Event of Default
arising after February 22, 2001, such percent shall be increased by 3% per annum
to 4 1/2% per annum.

         "Maturity Date" means December 31, 2001, unless extended by the prior
written agreement of the Lender; provided, that if on December 31, 2001 (or
later date agreed to by Lender) the unpaid principal balance of the Loans is
equal to or less than the Formula Amount, the Maturity Date shall be extended to
the first Banking Day of the succeeding month, and thereafter to the first
Banking Day of each successive month, so long as the unpaid principal amount of
the Loans is equal to or less than the Formula Amount as at the end of the
immediately prior month; provided, further, that the Maturity Date shall not be
so extended beyond June 30, 2002.

         "Maximum Amount" means the following aggregate unpaid principal amount
of the Loans during the specified periods.

                                       3
<PAGE>

                   Period                           Amount
                   ------                           ------

         January 1 - February 28, 2001            $5,600,000
         March 1- March 31, 2001                  $5,400,000
         April 1 - May 31, 2001                   $5,150,000
         June 1 - July 31, 2001                   $5,050,000
         August 1 - September 30, 2001            $4,650,000
         October 1 - November 30, 2001            $4,200,000
         December 1 - December 31, 2001           $4,000,000

         "Primary Settlements" means the following settlements between any of
the Borrowers and the following creditors of one or more of the Borrowers,
pursuant to which in settlement of the claims of such creditors, any one of more
of the Borrowers agrees to pay and the respective creditor agrees to accept 25%
of the respective creditor's claims against any of the Borrowers in full
satisfaction of such claims:

         (i)   McKesson HBOC, Inc., or any affiliate;

         (ii)  Genzyme Corporation;

         (iii) Perigon Medical Distribution Corp.

         (iv)  Baxter Healthcare

         (v)   Graham-Field Health Products, Inc.

         (vi)  Allied Healthcare Services, Inc.

         "Secondary Settlements" means the settlements between any of the
Borrowers and the creditors of any of the Borrowers identified on Exhibit 1(c)
annexed to Amendment No. 5, except the Primary Settlements.

         "Senior Note Agreement" means the Note Purchase Agreement dated as of
February 22, 2001, among the Borrowers and the "Purchasers" named therein.

         "Specified Taxes" means the unpaid taxes (including any penalties and
interest) as described on Exhibit 1(b) annexed to Amendment No. 5.

         "Subordinated Note Agreement" means the Note Purchase Agreement dated
as of July 14, 1998 among Accuhealth and the "Purchasers" thereunder as amended
by Amendment No. 1 to the Note Purchase Agreement made effective as of August
21, 1998, Amendment No. 2 to the Note Purchase Agreement made effective as of
October 26, 1998 and Amendment No. 3 to Note Purchase Agreement made effective
as of February 22, 2001.

         "Tax Settlement" means a written agreement by one or more of the
Borrowers and the U.S. Internal Revenue Service ("IRS") under which such
Borrowers will pay and the IRS will accept payment of the Specified Taxes in
substantially equal monthly installments over a period of not less than ten (10)
months.

                                       4
<PAGE>

         "Termination Date" means the earliest of (a) the Maturity Date or (b)
the date on which demand is permitted to be made by the Lender pursuant to
Section 1A(b) and Section 19 hereof (on the basis of an Event of Default arising
after February 22, 2001).

         (c)   TERMS AMENDED:

         "Change of Control" shall mean the occurrence of any event which
results in Glenn Davis no longer being an officer of each of the Borrowers.

         "Contract Rate" is amended in its entirety as follows:

                  ""Contract Rate" means an interest rate per annum equal to the
                  Prime Rate plus the Margin."

         "Formula Amount" means an amount equal to seventy-five percent (75%) of
Eligible Receivables.

         "Loans" is amended in its entirety as follows:

         "`Loans' shall have the meaning set forth in Section 1A (a) hereof and
shall include the term "Revolving Credit Advances"."

         "Monthly Average Collections" means for any calendar month the average
of the cash received by Lender as collections on Collateral during that month
and the preceding two calendar months.

         "Monthly Average Sales" means for any calendar month the average of the
Receivables arising during that month and the preceding two calendar months.

         "Permitted Liens" is amended by (x) adding a new clause "(vii)"
immediately after present clause "(vi)" as follows: ",(vii) liens securing the
Senior Notes and liens securing the Subordinated Notes (in each case to the
extent permitted by the Intercreditor Agreement"), (y) renumbering present
clause "(vii)" to be "(viii)", and (z) amending Exhibit 1(a) to be in the form
annexed to Amendment No. 5.

         2.2   The following Section 1A is added to the Loan Agreement:

         "Section 1A. STATUS OF OBLIGATIONS.

         (1)   As of the opening of business on February 22, 2001, all
Obligations consisting of the unpaid principal balances of Revolving Credit
Advances, Overdraft Loans, and the Term Loan, shall be aggregated and shall then
and henceforth be deemed, together with the unpaid principal amount of all
Revolving Credit Advances made on and after such date as "Loans". Borrowers
acknowledge and agree that the unpaid principal balance of the Loans as
constituted and aggregated by this Section 1A(a) was $5,599,625.85 as of the
opening of business on such date.

                                       5
<PAGE>

         (2)   All Loans shall be due and payable on demand; provided, that
Lender shall not make demand until the Termination Date; provided further, that
upon the occurrence after February 22, 2001 of an Event of Default specified in
Section 18(k) hereof, all Loans and all Obligations shall immediately become due
without any demand, as provided in Section 19 hereof."

         2.3   (i)    Section 2(a) of the Loan Agreement is deleted and replaced
by the following:

         "(a)  Subject to the terms and conditions set forth herein and in the
Ancillary Agreements, including that an Event of Default shall not have occurred
after February 22, 2001 and be continuing, Lender shall, until the close of
business on the Banking Day preceding the Maturity Date, make Loans to the
Borrowers from time to time as follows, so long as immediately prior to and
following any such Loan the unpaid principal balance of the Loans shall not
exceed the Maximum Amount:

               (i)    Up to an amount equal to seventy-five percent (75%) of the
         Borrower's Eligible Receivables arising after the Effective Date and
         described in written schedules delivered to Lender by Borrowers in such
         form and detail as Lender shall require;

               (ii)   During any month, an amount equal to the least of (x) the
         monthly payment under the IRS Settlement, (y) the amount of actual cash
         collections received by the Lender after the Effective Date on January
         2001 Receivables, and (z) $20,000.

               (iii)  Up to an amount equal to fifty percent (50%) of: (x) the
         actual cash collections received by Lender after the Effective Date on
         January 2001 Receivables, MINUS (y) all amounts lent under clause (ii)
         above; and

               (iv)   Up to an amount equal to 20% of the actual cash
         collections received by Lender after the Effective Date on Receivables
         within 150 days of their respective invoice dates.

         Except with respect to Loans based on collections on the January 2001
Receivables as set forth in clauses (ii) and (iii) above, no Loan shall be made
based upon collections received by Lender upon Receivables which at any time
remain unpaid more than 150 days after their invoice dates. Such receivables
shall be identified and recorded by Lender in a separate account designated
"Over 150 Receivables", and all collections thereon shall be received and
retained by Lender, subject to the terms of the Intercreditor Agreement.

               (ii)   The following provision shall be added to the text of
Section 2(b) of the Loan Agreement: "further, notwithstanding that Lender shall
not have any obligation to make Loans following the occurrence of and
continuation of any Event of Default occurring after February 22, 2001, or the
failure of a condition precedent, Lender may in its sole and absolute discretion
make one or more Loans without any obligation expressed or implied or arising
therefrom or any course of dealing, to make any Loans."

                                       6
<PAGE>

         2.4   Section 2(h) is deleted, and replaced in its entirety as follows:

         "(h)  Without limiting the effect of Section 21 hereof, subject to the
terms of the Intercreditor Agreement all collections on all Collateral shall be
received by Lender and applied to the repayment of the Obligations in such order
as shall be determined by Lender.

         2.5   Section 3 of the Loan Agreement is deleted and replaced by the
following:

               "3. Repayment of the Loans

         (a)   At any time that the outstanding principal amount of the Loans
exceeds the applicable Maximum Amount, Borrowers shall repay the Loans to the
extent of such excess; and

         (b)   Upon any Eligible Receivable arising after February 22, 2001
becoming ineligible for any reason other than its remaining unpaid for more than
150 days from its invoice date, Borrowers shall immediately pay to Lender 75% of
the amount of such Receivable.

         2.6   Section 5(a) of the Loan Agreement is amended by deleting the
word "applicable" appearing before the term "Contract Rate."

         2.7   Subsections (i) and (ii) of Section 5(b) of the Loan Agreement
are deleted and replaced by the following:

               "Borrowers shall pay to Lender a Facility Fee equal to $3,000
(pro rated for any partial month) following the Effective Date for each month,
in arrears, with the first payment to be due January 31, 2001."

         2.9   (a)    (i) Sections 12(g) and 12(i) are deleted, and (ii) Exhibit
12(h) is amended to be in the form annexed hereto; and

               (b)    (i) Section 12(k) is amended by adding prior to the
semicolon: "except the Specified Taxes so long as such taxes become subject to a
Tax Settlement not later than April 1, 2001".

         2.10  Exhibit 12(m) is amended to be in the form annexed hereto.

         2.11  Section 12 is amended to add the following subsections:

         "(q)  So long as any Obligations remain unpaid, unless the Lender
otherwise consents in writing, the Borrowers will, commencing February 1, 2001:

         (i)   Maintain Monthly Average Sales of not less than $850,000;

         (ii)  Maintain Monthly Average Collections of not less than $1,000,000;

         (r)   Borrowers will notify the Lender in writing immediately upon (i)
any failure of any Borrower to pay any amount under any of the Creditor
Settlements; (ii) any Creditor Party claiming a default by any Borrower under
its respective Creditor Settlement, and (iii) any Creditor Action; and

                                       7
<PAGE>

         (s)   Not later than the seventh Business Day of each month, Borrowers
shall provide to Lender a comparison to budget (as previously delivered to
Lender) of that month's sales, collections, expenses, and payments on Creditor
Settlements."

         2.12  Section 17 of the Loan Agreement is deleted and replaced by the
following:

               "17. Termination of Lender's Commitment, etc.

         The Lender's commitment to make Loans under Section 2(a) and the
Lender's agreement under Section 1A(b) to forebear from making demand for
immediate payment of the Obligations, shall terminate on the close of business
on the Termination Date; provided, however, that no termination of the Lender's
commitment or lapse of the Lender's Agreement to forebear making demand, shall
affect in any way the liability of the Borrowers for the Obligations and the
rights and remedies of the Lender, including with respect to the Collateral and
the Guaranty Agreements."

         2.13  Section 18 of the Loan Agreement is amended as follows:

         (i)   by deleting the text of clauses "(l)" and "(o)" thereof and
substituting in each case: "[intentionally deleted]";

         (ii)  adding the following to clause (b): ", or which constitute
Specified Taxes so long as such taxes become subject to a Tax Settlement no
later than April 1, 2001";

         (iii) deleting clause (n) thereof and substituting the following:

         "(n)  Accuhealth, Inc., Midview Drug, Inc., America Home Nursing
Services, Inc., PRN Homecare Agency, Inc. or any other Borrower with Receivables
at any time of $25,000 shall cease to do business in the ordinary course;"; and

         (iv)  adding to Section 18 the following:

         "(o)  The Borrowers or any of them fails to make any payment due under
any Primary Settlement past any period of grace or cure, or if no period of
grace or cure is expressed in the relevant agreement or stipulation, for a
period of five (5) Business Days.

         (p)   Any Creditor Party to any Primary Settlement takes any Creditor
Action.

         (q)   The Borrowers or any of them fails to make one or more payments
due under any one or more Secondary Settlements past any period of grace or
cure, or if no period of grace or cure is expressed in the relevant agreement or
stipulation, for a period of five (5) Business Days, and any such defaulted
payment, or the aggregate of such defaulted payments, exceeds $25,000.

                                       8
<PAGE>

         (r)   Any one or more of Creditor Parties to any Secondary Settlement
or Secondary Settlements shall take Creditor Action to recover from any of the
Borrowers or any of its property, more than $25,000 in one instance or $35,000
in the aggregate."

         2.14  Section 19 of the Loan Agreement is amended (i) to add after the
term "Events of Default" in lines 2 and 5 thereof and after the word "default"
in line 24 thereof: "(occurring after February 22, 2001)" and (ii) to add at the
end of each of the second to last and third to last sentences in Section 19:
"(subject to the Intercreditor Agreement)".

         2.15  Section 25 of the Loan Agreement shall be amended as follows:

         (a)   With respect to notices to the Lender, a copy shall be provided
to:

         Kaye, Scholer, Fierman, Hays & Handler, LLP
         425 Park Avenue
         New York, N.Y.  10022
         Attention:  Alfred J. Bianco, Esq.
         Telephone:  (212) 836-8294
         Telecopy:    (212) 836-7223

         (b)   With respect to notices to the Borrower:

               "If to the Borrower: Accuhealth, Inc.
                                    Ridge Hill
                                    Yonkers, New York 10710
                                    Telephone:
                                    Telecopy:

               with a copy to:      Baer Marks & Upham, LLP
                                    805 Third Avenue
                                    New York, New York 10022
                                    Attention: Leslie J. Levinson, Esq.
                                    Telephone: (212) 702-5700
                                    Telecopy: (212) 702-5941

         10.   CONDITIONS. The effectiveness of this Amendment is subject to the
following conditions precedent or concurrent, each of which must be satisfied no
later than the date hereof, failing any of which this Agreement shall be null
and void:

         (1)   NO DEFAULT. No Default or Event of Default under the Loan
Agreement, as amended hereby, shall have occurred after February 22, 2001 and be
continuing.

         (2)   WARRANTIES AND REPRESENTATIONS. The warranties and
representations of Borrowers contained in this Amendment, the Loan Agreement, as
amended hereby, and the Ancillary Documents, shall be true and correct in all
material respects as of the date hereof, with the same effect as though made on
such date, except to the extent that such warranties and representations

                                       9
<PAGE>

expressly relate to an earlier date, in which case such representations and
warranties shall have been true and correct in all material respects as of such
earlier date. Borrower hereby represents and warrants that, as of the date
hereof, all of the representations and warranties referred to in the immediately
preceding sentence are true and correct in all material respects as of the date
hereof.

         (3)   ADDITIONAL REPRESENTATIONS AND WARRANTIES. Borrowers hereby
represent and warrant as follows:

               (i)    This Amendment No. 5 and the Loan Agreement, as amended
hereby, constitute legal, valid and binding obligations of Borrowers and are
enforceable against Borrowers in accordance with their respective terms.

               (ii)   Borrowers have no defense, counterclaim or offset with
respect to the Loan Agreement or the Obligations.

         (4)   ADDITIONAL DOCUMENTATION. Lender shall have received each of the
agreements, instruments, documents and other materials set forth on Annex 1
hereto, each of which shall be in form and substance satisfactory to Lender.
Borrowers acknowledge that any "Event of Default" (which is not waived) under
any of the agreements set forth on Annex 1 shall constitute an Event of Default
under the Loan Agreement.

         (e)   Pursuant to the Senior Note Agreement, not less than $850,000 has
been advanced to the Borrowers and the Borrowers shall have received such amount
in good funds;

         (f)   All of the Primary Settlements shall be in full force and effect.

         11.   MISCELLANEOUS.

         (1)   CAPTIONS. Section captions used in this Agreement are for
convenience only, and shall not affect the construction of this Amendment.

         (2)   EFFECT ON THE LOAN AGREEMENT, ETC.

               (i)    Upon the effectiveness of this Amendment, each reference
in the Loan Agreement to "this Agreement", "hereunder", "hereof", "herein" or
words of like import shall mean and be a reference to the Loan Agreement as
amended hereby.

               (ii)   Except as specifically amended herein, the Loan Agreement,
and all other documents, instruments and agreements executed and/or delivered in
connection therewith, shall remain in full force and effect, and are hereby
ratified and confirmed.

               (iii)  The execution, delivery and effectiveness of this
Amendment shall not operate as a waiver of any right, power or remedy of Lender,
no constitute a waiver of any provision of the Loan Agreement, or any other
documents, instruments or agreements executed and/or delivered under or in
connection therewith.

                                       10
<PAGE>

         (3)   GOVERNING LAW. This Amendment shall be a contract made under and
governed by the laws of the State of New York, without regard to conflict or
laws principles. Whenever possible each provision of this Amendment shall be
interpreted in such manner as to be effective and valid under applicable law,
but if any provision of this Amendment shall be prohibited by or invalid under
such law, such provision shall be ineffective to the extent of such prohibition
or invalidity, without invalidating the remainder of such provision or the
remaining provisions of this Amendment.

         (4)   COUNTERPARTS. This Agreement may be executed in any number of
counterparts and by the different parties on separate counterparts, and each
such counterpart shall be deemed to be an original, but all such counterparts
shall together constitute but one and the same Agreement.

         (5)   SUCCESSORS AND ASSIGNS. This Agreement shall be binding upon and
shall inure to the sole benefit of Borrowers, Agent and Lenders and their
respective successors and assigns.

         (6)   REFERENCES. Any reference to the Loan Agreement contained in any
notice, request, certificate, or other document executed concurrently with or
after the execution and delivery of this Agreement shall be deemed to include
this Agreement unless the context shall otherwise require.

         (7)   RELEASE. Without limiting the Loan Agreement and the other Loan
Documents, each Borrower hereby waives any defenses to the enforcement of the
Loan Agreement and of the Ancillary Documents, and hereby releases any claims or
causes of action against Lender which may now or hereafter be available to such
Borrower arising out of: (i) the administration of the Loan Agreement, the
Ancillary Documents or the Obligations prior to the date hereof or as a result
of taking actions permitted hereunder; (ii) the negotiation and execution of
this Agreement; or (iii) any other matter arising prior to the date hereof and
pertaining to the Loan Agreement, the Ancillary Documents or the Obligations.

         (8)   CONTINUED EFFECTIVENESS. Notwithstanding anything contained
herein, the terms of this Agreement are not intended to and do not serve to
effect a novation as to the Loan Agreement. The parties hereto expressly do not
intend to extinguish the Loan Agreement. Instead, it is the express intention of
the parties hereto to reaffirm the indebtedness created under the Loan Agreement
which is evidence thereby and secured by the Collateral. The Loan Agreement as
amended hereby and each of the Ancillary Documents remains in full force and
effect.

         (9)   CONSTRUCTION. Borrowers acknowledge that they have been
represented by their own legal counsel in connection with this Agreement, that
they have exercised independent judgment with respect to this Agreement, and
that they have not relied on Lender's counsel for any advice with respect to
this Agreement.

         (10)  RESERVATION OF RIGHTS. Except as expressly provided herein, the
execution and delivery of this Agreement shall not: (i) constitute an extension,
modification, or waiver of any aspect of the Loan Agreement or the ancillary
Documents; (ii) give rise to any obligation on the part of Lender to extend,

                                       11
<PAGE>

modify or waive any term or condition of the Loan Agreement or the Ancillary
Documents, or (iii) give rise to any defenses or counterclaims to lender's right
to compel payment of the Obligations or to otherwise enforce its rights and
remedies under the Loan Agreement and the Ancillary Documents.

         IN WITNESS WHEREOF, this Amendment has been duly executed as of the day
and year first written above.

ACCUHEALTH, INC.                       MIDVIEW DRUG, INC.

By:                                    By:
   --------------------------------       --------------------------------
Name:                                  Name:
     ------------------------------         ------------------------------
Title:                                 Title:
      -----------------------------          -----------------------------

ACCUHEALTH HOME CARE, INC.             CITIVIEW DRUG CO., INC.

By:                                    By:
   --------------------------------       --------------------------------
Name:                                  Name:
     ------------------------------         ------------------------------
Title:                                 Title:
      -----------------------------          -----------------------------

PROHEALTHCARE INFUSION SERVICES        HEALIX HEALTHCARE, INC.
INC.

By:                                    By:
   --------------------------------       --------------------------------
Name:                                  Name:
     ------------------------------         ------------------------------
Title:                                 Title:
      -----------------------------          -----------------------------

PRN HOMECARE AGENCY, INC.              AMERIX NURSING HOLDINGS, INC.

By:                                    By:
   --------------------------------       --------------------------------
Name:                                  Name:
     ------------------------------         ------------------------------
Title:                                 Title:
      -----------------------------          -----------------------------

HEALIX HEALTHCARE, INC.                HEALIX HEALTHCARE OF NEW YORK INC.

By:                                    By:
   --------------------------------       --------------------------------
Name:                                  Name:
     ------------------------------         ------------------------------
Title:                                 Title:
      -----------------------------          -----------------------------

RYE BEACH HEALTHCARE, INC.             HEALIX HEALTHCARE OF NEW JERSEY, INC.

By:                                    By:
   --------------------------------       --------------------------------
Name:                                  Name:
     ------------------------------         ------------------------------
Title:                                 Title:
      -----------------------------          -----------------------------

                                       12
<PAGE>

AMERICARE HOME NURSING                 ROSENTHAL & ROSENTHAL, INC.
SERVICES, INC.

By:                                    By:
   --------------------------------       --------------------------------
Name:                                  Name:
     ------------------------------         ------------------------------
Title:                                 Title:
      -----------------------------          -----------------------------

CONSENTED AND AGREED TO:

/s/ GLENN C. DAVIS
Glenn C. Davis

                                       13

<PAGE>

                                     ANNEX 1

Senior Note Agreement

Senior Note

Subordinated Note Agreement

Senior Note Security Agreement dated as of February 22, 2001

Subordinated Note Security Agreement dated as of February 22, 2001

                                       14

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