-13-
                                  UNITED STATES

                       SECURITIES AND EXCHANGE COMMISSION

                             WASHINGTON, D.C. 20549


                                  SCHEDULE 13D
                  UNDER THE SECURITIES AND EXCHANGE ACT OF 1934
                                (Amendment No. 1)
                            Patient Infosystems, Inc.
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                                (Name of Issuer)

                          Common Stock, $.001 par value
--------------------------------------------------------------------------------
                         (Title to Class of Securities)

                                    702915109
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                                 (CUSIP NUMBER)

                              Karen E. Shaff, Esq.
                         Principal Financial Group, Inc.
                                 711 High Street
                              Des Moines, IA 50392
--------------------------------------------------------------------------------
                  (Name, Address and Telephone Number of Person
                Authorized to Receive Notices and Communications

                                 September 12, 2003
--------------------------------------------------------------------------------
             (Date of Event Which Requires Filing of This Statement)

If the filing person has previously  filed a statement on Schedule 13G to report
the  acquisition  that is the subject of this  Schedule  13D, and is filing this
schedule because of ss.ss. 240.13d-1(e),  240.13d-1(f),  or 240.13d-1(g),  check
the following box.
[   ]

NOTE:  Schedules  filed in paper format shall include a signed original and five
copies of the schedule,  including all exhibits.  See ss. 240.13d-7(b) for other
parties to whom copies are to be sent.

*The  remainder of this cover page shall be filled out for a reporting  person's
initial filing on this form with respect to the subject class of securities, and
for  any  subsequent   amendment   containing   information  which  would  alter
disclosures provided in a prior cover page.

The information required on the remainder of this cover page shall not be deemed
to be "filed" for the purpose of Section 18 of the  Securities  Exchange  Act of
1934 ("Act") or otherwise  subject to the liabilities of that section of the Act
but  shall be  subject  to all other  provisions  of the Act  (however,  see the
Notes).

CUSIP No. 702915109


1. Names of  Reporting  Persons,  I.R.S.  Identification  Nos. of above  persons
(entities only).

Principal Financial Group, Inc.
--------------------------------------------------------------------------------

2. Check the Appropriate Box if a Member of a Group (See Instructions)

(a)  [ X  ]

(b)  [   ]

3. SEC Use Only

--------------------------------------------------------------------------------

4.  Source of Funds

                                       00
--------------------------------------------------------------------------------

5. Check Box if Disclosure of Legal  Proceedings  is Required  Pursuant to items
2(d) or 2(e)

                                                                          [   ]

6.  Citizenship or Place of Organization

                                    Delaware
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NUMBER OF SHARES                      7.  Sole Voting Power
BENEFICIALLY OWNED BY
EACH REPORTING PERSON
WITH
--------------------------------------------------------------------------------

                                      8.  Shared Voting Power

                                             17,857,800
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                                     9.  Sole Dispositive Power


--------------------------------------------------------------------------------

                                      10.  Shared Dispositive Power

                                             17,857,800
--------------------------------------------------------------------------------

11. Aggregate Amount Beneficially Owned by Each Reporting Person

                                             17,857,800
--------------------------------------------------------------------------------

                                       2


12. Check Box if the Aggregate Amount in Row (11) Excludes Certain Shares

                                                                           [   ]

13. Percent of Class Represented by Amount in Row (11)

                                     61.98%
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14.  Type of Reporting Person

                                       HC
--------------------------------------------------------------------------------



1. Names of  Reporting  Persons,  I.R.S.  Identification  Nos. of above  persons
(entities only).

Principal Financial Services, Inc.
--------------------------------------------------------------------------------

2. Check the Appropriate Box if a Member of a Group (See Instructions)

(a)  [ X  ]

(b)  [   ]

3. SEC Use Only

--------------------------------------------------------------------------------

4.  Source of Funds

                                       00
--------------------------------------------------------------------------------

5. Check Box if Disclosure of Legal  Proceedings  is Required  Pursuant to items
2(d) or 2(e)

                                                                           [   ]

6.  Citizenship or Place of Organization

                                      Iowa
--------------------------------------------------------------------------------

NUMBER OF SHARES                      7.  Sole Voting Power
BENEFICIALLY OWNED BY
EACH REPORTING PERSON                        0
WITH
--------------------------------------------------------------------------------

                                      8.  Shared Voting Power

                                             17,857,800
--------------------------------------------------------------------------------

                                       3


                                      9.  Sole Dispositive Power

                                              0
--------------------------------------------------------------------------------

                                      10.  Shared Dispositive Power

                                             17,857,800
--------------------------------------------------------------------------------

11. Aggregate Amount Beneficially Owned by Each Reporting Person

                                             17,857,800
--------------------------------------------------------------------------------

12. Check Box if the Aggregate Amount in Row (11) Excludes Certain Shares

                                                                           [   ]

13. Percent of Class Represented by Amount in Row (11)

                                     61.98%
--------------------------------------------------------------------------------

14.  Type of Reporting Person

                                       HC
--------------------------------------------------------------------------------



1. Names of  Reporting  Persons,  I.R.S.  Identification  Nos. of above  persons
(entities only).

Principal Life Insurance Company
--------------------------------------------------------------------------------

2. Check the Appropriate Box if a Member of a Group (See Instructions)

(a)  [ X  ]

(b)  [   ]

3. SEC Use Only

--------------------------------------------------------------------------------

4.  Source of Funds
                                             00
--------------------------------------------------------------------------------

5. Check Box if Disclosure of Legal  Proceedings  is Required  Pursuant to items
2(d) or 2(e)

                                                                           [   ]
                                       4


6.  Citizenship or Place of Organization

                                      Iowa
--------------------------------------------------------------------------------

NUMBER OF SHARES                      7.  Sole Voting Power
BENEFICIALLY OWNED BY
EACH REPORTING PERSON
WITH
--------------------------------------------------------------------------------

                                      8.  Shared Voting Power
                                             17,857,800
--------------------------------------------------------------------------------

                                      9.  Sole Dispositive Power

--------------------------------------------------------------------------------

                                      10.  Shared Dispositive Power

                                             17,857,800
--------------------------------------------------------------------------------

11. Aggregate Amount Beneficially Owned by Each Reporting Person

                                             17,857,800
--------------------------------------------------------------------------------

12. Check Box if the Aggregate Amount in Row (11) Excludes Certain Shares

                                                                           [   ]

13. Percent of Class Represented by Amount in Row (11)

                                     61.98%
--------------------------------------------------------------------------------

14.  Type of Reporting Person

                                       IC
--------------------------------------------------------------------------------

ITEM 1.  SECURITY AND ISSUER.

This  statement  relates  to shares  of Series D  Preferred  Stock,  each  share
immediately  convertible  into 120 shares of Common Stock,  $.001 par value,  of
Patient  Infosystems,  Inc.,  whose  principal  offices are located at 46 Prince
Street, Rochester, NY 14607.

ITEM 2.  IDENTITY AND BACKGROUND.

This statement is being filed by: (i) Principal  Financial Group,  Inc. ("PFG"),
(ii) Principal  Financial  Services,  Inc.  ("PFS") and Principal Life Insurance
Company ("PLIC").

                                       5


PFG is a corporation  incorporated under the laws of the State of Delaware.  Its
common stock is publicly  traded on the New York Stock Exchange under the ticker
symbol PFG. PFG is a holding company.  The address of its principal business and
principal office is 711 High Street, Des Moines, Iowa 50392.

PFS, an Iowa  corporation,  is a  wholly-owned  subsidiary  of PFG and a holding
company.  Its  principal  business and  principal  office is located at 711 High
Street, Des Moines, Iowa 50392.

PLIC, a wholly-owned  subsidiary of PFS, is a stock insurance  company organized
under the laws of the State of Iowa. The principal  business activity of PLIC is
the provision of products and services for  businesses,  groups and  individuals
including individual insurance,  pension plans and group/employee  benefits. The
address of its principal  business and principal office is 711 High Street,  Des
Moines, Iowa 50392.

By virtue of their  ownership and control of PLIC, PFG and PFS have the ultimate
voting and dispositive  power with respect to the shares of Patient  Infosystems
Series D  Preferred  Stock  held by PLIC and may be deemed  indirect  beneficial
owners of all the shares of Patient  Infosystems  Series D Preferred Stock owned
by PLIC within the meaning of Rule 13d-3(a) under the Securities Exchange Act of
1934, as amended (the "Act").

Each of PFG, PFS and PLIC is hereafter  referred to individually as a "Reporting
Person" and  collectively  as  "Reporting  Persons."  As  discussed  below,  the
Reporting Persons  collectively may be deemed to be a group,  within the meaning
of Rule  13d-5(b)(1)  under  the Act,  beneficially  owning,  in the  aggregate,
148,815  shares of Patient  Infosystems  Series D Preferred  Stock  which,  upon
conversion to Patient  Infosystems Common Stock,  would represent  approximately
61.98% of the outstanding shares of Patient  Infosystems Common Stock within the
meaning of Rule 13d-3(a) and (d) of the Act.

Attached as Exhibit B hereto and  incorporated by reference  herein is a list of
all Directors and Executive Officers of each Reporting Person. The Directors and
Executive  Officers of the  Reporting  Persons can be contacted at the principle
business address provided above.

To the  knowledge of the Reporting  Persons,  none of the Directors or Executive
Officers of the Reporting  Persons has had any transactions in shares of Patient
Infosystems Series D Preferred Stock during the past 60 days, and no Director or
Executive Officer is a beneficial owner of shares of Patient  Infosystems Series
D Preferred Stock.

All of the Directors and Executive  Officers of the Reporting Persons are United
States  citizens,  except Victor H.  Loewenstein and Elizabeth E. Tallett,  both
directors of PFG, PFS and PLIC, who are citizens of the United Kingdom.

During the last five years, none of the Reporting  Persons,  or the Directors or
Executive  Officers of the Reporting  Persons,  has been convicted in a criminal
proceeding (excluding traffic violations or similar misdemeanors).

During the last five years, none of the Reporting  Persons,  or the Directors or
Executive  Officers  of the  Reporting  Persons,  has  been a  party  of a civil
proceeding of a judicial or administrative body of competent jurisdiction and as


                                       6


a result of such  proceeding  was or is subject to a  judgment,  decree or final
order  enjoining  future  violations of, or prohibiting or mandating  activities
subject  to,  or  finding  any  violation  with  respect  to,  federal  or state
securities law.

ITEM 3.  SOURCE AND AMOUNT OF FUNDS OR OTHER CONSIDERATION.

The shares were paid for by using working capital of the Reporting Person.

ITEM 4.  PURPOSE OF TRANSACTION.

The  Reporting  Person  intends  to hold the  shares  for  long-term  investment
purposes.

PLIC entered into a Note and Stock Purchase  Agreement with Patient  Infosystems
pursuant to which PLIC purchased a Note in the amount of $1.5 million as well as
the 106,989 shares of Series D Preferred  Stock reported  herein in an agreement
dated as of April 10, 2003.  That  agreement  was revised in an amendment  dated
September  12,  2003,  pursuant to which PLIC  purchased a note in the amount of
$475,000 as well as an  additional  41,826  shares of Series D Preferred  Stock.
Pursuant to the Note and Stock Purchase  Agreement,  PLIC will have the right to
convert the Note into Series D Preferred  Stock upon a consummation of a private
placement  of Series D  Preferred  Stock.  Patient  Infosystems  must  amend its
Certificate of  Incorporation  to increase its authorized  Common Stock to allow
for any subsequent conversion of Series D Preferred Stock into Common Stock.

PLIC has also entered into a Creditor  Agreement with all parties except Patient
Infosystems to the Note and Stock Purchase  Agreement.  Pursuant to the Creditor
Agreement,  PLIC will  convert its Note into  Series D Preferred  Stock upon the
closing of an asset purchase agreement between Patient  Infosystems and American
CareSource Corporation.

Other than as set forth above,  the  Reporting  Persons do not have any plans or
proposals which relate to or would result in any of the  transactions  described
in  subparagraphs  (a) through (j) of Item 4 of Schedule  13D under the Act. The
Reporting Persons reserve the right to acquire additional  securities of Patient
Infosystems,  to dispose of securities of Patient  Infosystems at any time or to
formulate other purposes,  plans or proposals  regarding Patient  Infosystems or
any of  its  securities  to the  extent  deemed  advisable  in  light  of  their
respective general  investment and trading policies,  market conditions or other
factors.

ITEM 5.  INTEREST IN SECURITIES OF THE ISSUER.

     (a)  Beneficial Ownership

     The Reporting Persons are the beneficial owners of 148,815 shares of Series
     D Preferred Stock each such share  immediately  convertible into 120 shares
     of Common Stock. Based on Patient  Infosystems' most recent public filings,
     this represents  beneficial ownership of 61.98% of the Patient Infosystems'
     Common Stock.


                                       7


     (b)  Voting and Dispositive Powers

          The Reporting  Persons share voting and dispositive power with respect
          to the shares of Series D Preferred Stock beneficially owned by them.

     (c)  Transactions in Securities of the Company During the Past Sixty Days.

          Otherthan as set forth herein, the Reporting Persons have not made any
          purchase  or sales of  securities  of Patient  Infosystems  during the
          sixty (60) days preceding the date of this Schedule 13D.

     (d)  Dividends and Proceeds

          Other than the Reporting Persons, no person is known to have the right
          to receive or the power to direct the receipt of the  dividends  from,
          or the  proceeds  from the  sale of,  the  Series  D  Preferred  Stock
          beneficially owned by the Reporting Persons.

     (e)  Date Reporting Person Ceased to be Beneficial Owner of More than 5% of
          the Company's Stock.

                                    N/A

ITEM 6. CONTRACTS, ARRANGEMENTS, UNDERSTANDINGS OR RELATIONSHIPS WITH RESPECT TO
SECURITIES OF THE ISSUER.

The  responses  to  Items 2 and 4 are  incorporated  herein  by  reference.  The
amendment to the agreement referenced in Item 4 is attached hereto as Exhibit C.

Other than the above  mentioned  amendment to the agreement,  and the agreements
filed as exhibits with the initial  filing of this  Schedule  13D,  there are no
other contracts,  arrangements,  understandings or relationships with respect to
Patient  Infosystems  securities to which any Reporting  Person is a party or by
which any Reporting Person is bound.

ITEM 7.  MATERIAL TO BE FILED AS EXHIBITS.

                                    Exhibit A - Joint Filing Agreement

                                    Exhibit B - Directors and Executive Officers

                                    Exhibit C - Form of Amendment No. 1 to Note
                                                and Stock Purchase Agreement

                                       8



                                   SIGNATURES

After reasonable inquiry and to the best of the Reporting Person's knowledge and
belief,  the Reporting  Person  certifies that the information set forth in this
statement is true, complete and correct.

September 29, 2003

PRINCIPAL FINANCIAL GROUP, INC.

By:  /S/ JOYCE N. HOFFMAN
     ----------------------------------------
     Joyce N. Hoffman
     Senior Vice President & Corporate Secretary


September 29, 2003

PRINCIPAL FINANCIAL SERVICES, INC.

By:  /S/ JOYCE N. HOFFMAN
     ----------------------------------------
     Joyce N. Hoffman
     Senior Vice President & Corporate Secretary


September 29, 2003

PRINCIPAL LIFE INSURANCE COMPANY

By:  /S/ JOYCE N. HOFFMAN
     ----------------------------------------
     Joyce N. Hoffman
     Senior Vice President & Corporate Secretary




                                       9




                                    EXHIBIT A

                             JOINT FILING AGREEMENT

         In accordance  with Rule 13d-1(k) under the Securities  Exchange Act of
1934, as amended,  each of the parties hereto agrees with the other parties that
the  statement  of Schedule  13D  pertaining  to certain  securities  of Patient
Infosystems,  Inc.  to which  this  agreement  is an  exhibit is filed by and on
behalf of each such party and that any amendment thereto will be filed on behalf
of each such party.

Dated:   September 29, 2003
                                             PRINCIPAL FINANCIAL GROUP, INC.

                                             By:      /S/ JOYCE N. HOFFMAN
                                                      --------------------------
                                                      Joyce N. Hoffman
                                                      Senior Vice President &
                                                      Corporate Secretary

                                             PRINCIPAL FINANCIAL SERVICES, INC.

                                             By:      /S/ JOYCE N. HOFFMAN
                                                      --------------------------
                                                      Joyce N. Hoffman
                                                      Senior Vice President &
                                                      Corporate Secretary

                                             PRINCIPAL LIFE INSURANCE COMPANY

                                             By:      /S/ JOYCE N. HOFFMAN
                                                      --------------------------
                                                      Joyce N. Hoffman
                                                      Senior Vice President &
                                                      Corporate Secretary



                                       10


                                    EXHIBIT B

                        DIRECTORS AND EXECUTIVE OFFICERS



PRINCIPAL FINANCIAL GROUP, INC.

         DIRECTORS
         B. J. (Betsy) Bernard
         J. (Jocelyn)  Carter-Miller
         G. E. (Gary)Costley
         D. J.  (Dave)  Drury
         D.  (Dan)  Gelatt
         J. B.  (Barry)Griswell
         S. L.  (Sandy)  Helton
         C. S.  (Chuck)  Johnson
         W. T. (Bill) Kerr
         R. L. (Dick) Keyser
         V. H. (Victor)  Loewenstein
         A. K. (Arjun) Mathrani
         F. F. (Federico) Pena
         E. E. (Liz) Tallett

EXECUTIVE OFFICERS
         J. B. (Barry)  Griswell,   Chairman,   President  and  Chief
               Executive Officer
         J. E. (John)  Aschenbrenner,  Executive Vice President
         M. T. (Mike) Daley,  Executive  Vice President
         M. H. (Mike) Gersie,  Executive  Vice President and Chief  Financial
                Officer
         J. P. (Jim) McCaughan,  Executive Vice President
         L. D. (Larry)  Zimpleman,  Executive  Vice  President
         E. Z. (Ellen)Lamale,  Senior Vice President and Chief Actuary
         J. M. (Julia)Lawler,  Senior Vice President and Chief Investment
                Officer
         M. A. (Mary) O'Keefe,  Senior Vice President
         K. E. (Karen) Shaff, Senior  Vice  President  and  General  Counsel
         G. P. (Gary) Scholten,  Senior Vice President and Chief Information
                Officer
         N. R. (Norman) Sorensen, Senior Vice President

PRINCIPAL FINANCIAL SERVICES, INC.

DIRECTORS
         B. J. (Betsy) Bernard
         J. (Jocelyn)  Carter-Miller
         G. E. (Gary)Costley
         D. J.  (Dave)  Drury


                                       11


         D.(Dan) Gelatt
         J. B.  (Barry)Griswell
         S. L.  (Sandy)  Helton
         C. S.  (Chuck)  Johnson
         W. T.  (Bill) Kerr
         R. L. (Dick) Keyser
         V. H. (Victor)  Loewenstein
         A. J. (Arjun) Mathrani
         F. F. (Federico) Pena
         E. E. (Liz) Tallett

EXECUTIVE OFFICERS
         J. B. (Barry)  Griswell,   Chairman,   President  and  Chief
                Executive Officer
         J. E. (John)  Aschenbrenner,  Executive Vice President
         M. T. (Mike) Daley,  Executive  Vice President
         M. H. (Mike) Gersie,  Executive  Vice President and Chief  Financial
                Officer
         J. P. (Jim) McCaughan,  Executive Vice President
         L. D. (Larry)  Zimpleman,  Executive  Vice  President
         E. Z. (Ellen)Lamale,  Senior Vice President and Chief Actuary
         J. M. (Julia)Lawler,  Senior Vice President and Chief Investment
                Officer
         M. A. (Mary) O'Keefe,  Senior Vice President
         K. E. (Karen) Shaff, Senior  Vice  President  and  General  Counsel
         G. P. (Gary) Scholten,  Senior Vice President and Chief
                Information Officer
         N. R. (Norman) Sorensen, Senior Vice President

PRINCIPAL LIFE INSURANCE COMPANY

DIRECTORS
         B. J. (Betsy) Bernard
         J. (Jocelyn) Carter-Miller
         G. E. (Gary)Costley
         D. J.  (Dave)  Drury
         D. (Dan)  Gelatt
         J. B. (Barry)Griswell
         S. L. (Sandy)  Helton
         C. S. (Chuck)  Johnson
         W. T. (Bill) Kerr
         R. L. (Dick) Keyser
         V. H. (Victor)  Loewenstein
         A. J. (Arjun) Mathrani
         F. F. (Federico) Pena
         E. E. (Liz) Tallett

EXECUTIVE OFFICERS
         J.B. (Barry)  Griswell,   Chairman,   President  and  Chief
                  Executive Officer
         J.E. (John)  Aschenbrenner,  Executive Vice President

                                       12


         M. T. (Mike) Daley,  Executive  Vice President
         M. H. (Mike) Gersie,  Executive  Vice President and Chief  Financial
                Officer
         J. P. (Jim) McCaughan,  Executive Vice President
         L. D. (Larry)Zimpleman,  Executive  Vice  President
         P. F. (Paul) Bognanno, Senior Vice President
         G. M. (Gary) Cain, Senior Vice President
         C. R. (Bob)  Duncan,  Senior Vice  President
         R. C. (Ralph) Eucher, Senior Vice President
         T. J. (Tom) Graf, Senior Vice  President
         J. N. (Joyce)  Hoffman,  Senior Vice President and  Corporate
                Secretary
         D. J. (Dan)  Houston,  Senior  Vice President
         E. Z. (Ellen)  Lamale,  Senior Vice  President  and Chief Actuary
         J. M. (Julia) Lawler,  Senior Vice President and Chief  Investment
                Officer
         M. A. (Mary)  O'Keefe,  Senior Vice President
         G. P. (Gary)  Scholten,  Senior Vice  President  and Chief
                Information Officer
         K. E. (Karen)  Shaff,  Senior Vice President  and General  Counsel
         R. A. (Bob)  Slepicka,  Senior Vice President
         N. R. (Norman) Sorensen, Senior Vice President



                                       13


              AMENDMENT NO. 1 TO NOTE AND STOCK PURCHASE AGREEMENT

         This is an amendment (this  "Amendment")  dated August ___, 2003 to the
Note and Stock  Purchase  Agreement (as  hereinafter  defined)  between  Patient
Infosystems,  Inc., a Delaware  corporation  (the  "Issuer")  and the  investors
listed on  SCHEDULE A hereto  (each  sometimes  referred  to as a  "Holder"  and
collectively as the "Holders").
                                    RECITALS

THE ISSUER AND THE HOLDERS ARE  PARTIES TO A NOTE AND STOCK  PURCHASE  AGREEMENT
DATED APRIL 10, 2003 (THE "NOTE AND STOCK PURCHASE  AGREEMENT")  UNDER WHICH THE
HOLDERS  LOANED AN AGGREGATE OF $2.5 MILLION TO THE ISSUER AND RECEIVED  198,128
SHARES OF SERIES D 9% CUMULATIVE CONVERTIBLE PREFERRED STOCK OF THE ISSUER.

TO EVIDENCE ITS  OBLIGATIONS  UNDER THE NOTE AND STOCK PURCHASE  AGREEMENT,  THE
ISSUER  ISSUED  CERTAIN  PROMISSORY  NOTES DATED APRIL 10, 2003 TO THE INVESTORS
(THE "NOTES")

AS A CONDITION TO THE EFFECTIVENESS OF THE NOTE AND STOCK PURCHASE AGREEMENT AND
TO SECURE ITS OBLIGATIONS UNDER THE NOTES AND NOTE AND STOCK PURCHASE AGREEMENT,
THE ISSUER  EXECUTED AND DELIVERED TO THE INVESTORS  AND EQUITY  DYNAMICS,  INC.
("ED"), AS COLLATERAL AGENT FOR THE INVESTORS,  A SECURITY AGREEMENT DATED APRIL
10, 2003 (THE "SECURITY  AGREEMENT") IN WHICH IT GRANTED TO THE INVESTORS AND ED
A  SECURITY  INTEREST  ON THE  PROPERTY  THEREIN  DESCRIBED  (THE  "COLLATERAL")
SECURING THE  OBLIGATIONS  OF THE ISSUER TO THE HOLDERS UNDER THE NOTES AND NOTE
AND STOCK PURCHASE AGREEMENT.

THE      PARTIES  WISH TO AMEND THE NOTE AND  STOCK  PURCHASE  AGREEMENT  ON THE
         TERMS AND CONDITIONS SET FORTH HEREIN. NOW, THEREFORE, in consideration
         of the agreement of the parties contained  herein,  and intending to be
         legal bound, the parties hereto agree as follows:

RECITALS AND DEFINITIONS.

         The issuer and the  Holders  acknowledge  and agree that the  foregoing
recitals  are true and  correct  as of the date of this  Amendment.  Capitalized
terms used herein and not defined  shall have the  meanings  assigned to them in
the Note and Stock Purchase Agreement as amended by any prior amendments.

                                       14


AMOUNT DUE.

         The Issuer and the Holders  acknowledge  and agree that an aggregate of
$2.5 million is outstanding under the loans from the Holders to the Issuer under
the Notes and Note and Stock Purchase Agreement.



AMENDMENTS TO NOTE AND STOCK PURCHASE AGREEMENT.
         Subject  to the terms and  conditions  hereof and of the Note and Stock
Purchase  Agreement  and for the  consideration  and in the  amounts  listed  on
SCHEDULE  2.01,  the Issuer  agrees to issue and sell,  and each  Holder  hereby
agrees,  severally and not jointly,  to purchase the Restated  Notes (as defined
below) and the Stock as set forth on SCHEDULE  2.01.  All  proceeds  received by
Issuer from Holders shall be deposited in the  Segregated  Bank Account and will
only be used by Issuer to fund the loans  described  in Section 2.02 of the Note
and Stock  Purchase  Agreement,  subject to the  exceptions set forth in Section
2.07 of the Note and Stock Purchase Agreement.

GENERAL.

         This  Amendment is made  pursuant to Section 8.01 of the Note and Stock
Purchase  Agreement,  and the parties hereto  acknowledge that all provisions of
the Note and Stock Purchase Agreement, except as amended hereby, shall remain in
full force and effect.


NOTES.

         In order to evidence  and  continue  the Notes as amended and  modified
pursuant to this  Amendment,  Issuer shall  execute and deliver to each Holder a
replacement  note in the  form  attached  hereto  as  EXHIBIT  A (the  "RESTATED
NOTES").  The Restated Notes amend,  restate,  replace and continue (but are not
novations or repayments  of ) the Notes.  Amounts owing under the Notes shall be
deemed to be evidenced and continued by the Restated  Notes.  Accrued and unpaid
interest  due and  owing  under the  Notes as of the date of  execution  of this
Amendment  shall be due at the time that the first payment of interest under the
Restated Notes is due and payable.


DEFINITIONS.

         Whenever appearing in the Note and Stock Purchase Agreement,  any other
Purchase  Document,  or any other document  executed and delivered in connection
herewith or therewith the term "NOTE AND STOCK PURCHASE AGREEMENT" and "PURCHASE
AGREEMENT"  shall be  deemed to mean the Note and Stock  Purchase  Agreement  as
amended.

                                       15



REPRESENTATIONS AND WARRANTIES.

         The Issuer  represents and warrants to the Holders that: (i) it has the
power, and has taken all necessary action to authorize, execute and deliver this
Amendment and perform its  obligations in accordance  with the terms  hereunder,
(ii) this Amendment and the Note and Stock Purchase  Agreement as amended by the
Amendment is the legal,  valid and binding  obligation of the Issuer enforceable
against  the  Issuer  in  accordance  with  their  terms  without  any  offsets,
counterclaims or defenses, (iii) the execution, delivery and performance of this
Amendment  by the Issuer will not (a) require any  governmental  approval or any
other consent or approval; or (b) violate, conflict with, result in a breach of,
constitute a default under any agreement to which it is a party, or result in or
require the  creation of any lien upon any of the assets of the Issuer,  (iv) no
Event  of  Default  has  occurred  and is  continuing,  and  (v)  the  financial
information  provided  by the  Issuer  to the  Holders  in  connection  with the
Issuer's  request that the Holders enter into this Amendment is true and correct
in all material respects.



CONDITIONS TO EFFECTIVENESS.

         It shall be a condition to the effectiveness of this Amendment that the
Holders have received the following:



         THIS AMENDMENT, DULY EXECUTED ON BEHALF OF THE ISSUER AND THE HOLDERS;

         THE RESTATED NOTES, DULY EXECUTED BY THE ISSUER; AND

         A CERTIFICATE  FROM THE SECRETARY THE ISSUER (I) TO WHICH IS ATTACHED A
         COPY OF THE CERTIFICATE OF INCORPORATION  CERTIFIED BY THE SECRETARY OF
         STATE OF  DELAWARE  AND A COPY OF THE  BY-LAWS OF THE  ISSUER,  (II) TO
         WHICH IS ATTACHED A RESOLUTION  OF THE BOARD OF  DIRECTORS  AUTHORIZING
         THE EXECUTION,  DELIVERY AND PERFORMANCE OF THIS  AMENDMENT,  AND (III)
         SETTING  FORTH THE NAME AND SAMPLE  SIGNATURE  OF THE  OFFICERS  OF THE
         ISSUER AUTHORIZED TO EXECUTE AND DELIVER THIS AMENDMENT;

INTEGRATION.

         This  Amendment  together  with the Note and Stock  Purchase  Agreement
constitute the entire agreement and understanding  among the parties relating to
the  subject  matter  hereof and  thereof  and  supersede  all prior  proposals,
negotiations, agreements and understandings relating to such subject matter.

                                       16


SEVERABILITY.

         If  any  provision  of  this   Amendment   shall  be  held  invalid  or
unenforceable in whole or in part in any jurisdiction,  such provision shall, as
to such  jurisdiction,  be  ineffective  to the  extent  of such  invalidity  or
enforceability without in any manner affecting the validity or enforceability of
such  provision in any other  jurisdiction  or the remaining  provisions of this
Amendment in any other jurisdiction.



CONFIRMATION OF SECURITY INTEREST.

         By executing this Amendment,  the Issuer confirms and acknowledges that
the Collateral (as defined in the Security  Agreement)  shall continue to secure
Issuer's  obligations  under the Note and Stock  Purchase  Agreement  (as herein
amended) and the other  Purchase  Documents (as amended and  confirmed  hereby).
Issuer  confirms its grant of a security  interest in the Collateral (as defined
in the Security  Agreement) and hereby grants to the Holders a security interest
in such  Collateral  as  collateral  for the  repayment  to the  Holders  of the
obligations of Issuer as described  therein and herein.  For all purposes of the
Security  Agreement,  the term "Secured  Obligations"  as defined  therein shall
include all  obligations  described  therein and the  obligations  of the Issuer
under the  Restated  Note(s).  All other terms and  provisions  of the  Security
Agreement  remain unchanged and the Security  Agreement  continues in full force
and effect on the date hereof.



NO DEFENSES, OFF-SETS OR COUNTERCLAIMS.

         By executing this Amendment,  Issuer confirms and acknowledges  that as
of  the  date  of  execution  hereof,  Issuer  has  no  defenses,   off-sets  or
counterclaims  against any of  Issuer's  obligations  to the  Holders  under the
Purchase Documents,  including the Note and Stock Purchase Agreement (as amended
hereby).   Issuer  hereby  acknowledges  and  agrees  that  the  actual  amounts
outstanding  on the date of  execution  hereof  are  owing the  Holders  without
defense, offset or counterclaim.



INCORPORATION BY REFERENCE.

         This  Amendment is  incorporated  by reference  into the Note and Stock
Purchase  Agreement  and the  other  Purchase  Documents.  Except  as  otherwise
provided  herein,  all of the other  provisions  of the Note and Stock  Purchase
Agreement and the other Purchase Documents are hereby confirmed and ratified and
shall remain in full force and effect as of the date of this Amendment.

                                       17



GOVERNING LAW; SUCCESSORS AND ASSIGNS.

         This  Amendment  is  governed  by the laws of the  State of Iowa and is
binding upon the Issuer and the Holders and their respective  successors  and/or
assigns and/or heirs and executors, as the case may be.



COUNTERPARTS.

         This  Amendment  may be  executed  by one or more of the parties on any
number of separate  counterparts,  and all of said  counterparts  taken together
shall be deemed to constitute one and the same instrument.



                                       18


         IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be
executed by their respective  officers  thereunto duly  authorized,  on the date
first above written.




                                             Patient Infosystems, Inc.


                                             By:   _____________________________
                                             Name: Roger Chaufournier
                                             Title:President

                                             Principal Life Insurance Company


                                             By:  ________________________
                                             Name:
                                             Title:


                                             -----------------------------------
                                             John Pappajohn, Individually



                                             Ann Pappajohn Inter Vivos Trust


                                             By:   _____________________________


                                       19


                                             Name:
                                             Title:


                                             Pappajohn  Shriver  Eide  Nicolas
                                             PC Profit  Sharing Plan FBO
                                             Socrates G. Pappajohn

                                             By:  ______________________________
                                             Name:
                                             Title:



                                       20




                                   SCHEDULE A



                          Holder and Address of Holder


                        Principal Life Insurance Company

                            Attention: Dennis Menken

                       C/o Principal Global Investors, LLC

                                801 Grand Avenue

                             Des Moines, Iowa 50392


                                 John Pappajohn

                            c/o Equity Dynamics, Inc.

                          666 Walnut Street, Suite 2116

                             Des Moines, Iowa 50309


                         Ann Pappajohn Inter Vivos Trust

                            C/o Equity Dynamics, Inc.

                          666 Walnut Street, Suite 2116

                             Des Moines, Iowa 50309


      Pappajohn Shriver Eide Nicolas PC Profit Sharing Plan FBO Socrates G.
                                    Pappajohn

                             c/o Socrates Pappajohn

                              103 East State Street

                                  P.O. Box 1588

                           Mason City, Iowa 50401-3300

                                       21



                                  SCHEDULE 2.01



                      Sale and Purchase of Notes and Stock.

               Allocation of Notes and Shares of Stock to Holders





Holder and Address of Holder                 Note Amount      Shares of Series D
                                                              Preferred Stock

Principal Life Insurance Company
Attention:  Dennis Menken
C/o Principal Global Investors, LLC
801 Grand Avenue
Des Moines, Iowa  50392                      $475,000.00          41,826



Ed Berger
4819 North Sabino Canyon Road
Tucson, AZ  85750                            $50,000               4,403


Ann Pappajohn Children's Trust
c/o  Equity Dynamics, Inc.
666 Walnut Street, Suite 2116
Des Moines, Iowa  50309                      $25,000               2,201


                                       22


John Pappajohn
c/o  Equity Dynamics, Inc.
666 Walnut Street, Suite 2116
Des Moines, Iowa  50309                      $450,000.00           39,624
                                           ---------------        --------------

  Total                                    $1,000,000.00           88,054
                                           ===============        ==============



                                       23