EXHIBIT A


THE SECURITIES REPRESENTED BY THIS INSTRUMENT HAVE NOT BEEN REGISTERED UNDER THE
SECURITIES  ACT OF  1933,  AS  AMENDED,  OR  QUALIFIED  UNDER  APPLICABLE  STATE
SECURITIES LAWS AND HAVE BEEN TAKEN FOR INVESTMENT  PURPOSES ONLY AND NOT WITH A
VIEW TO OR FOR SALE IN CONNECTION WITH ANY DISTRIBUTION  THEREOF. THE SECURITIES
MAY NOT BE SOLD OR OTHERWISE TRANSFERRED IN THE ABSENCE OF SUCH REGISTRATION AND
QUALIFICATION WITHOUT,  EXCEPT UNDER SPECIFIC LIMITED CIRCUMSTANCES,  AN OPINION
OF COUNSEL FOR THE  HOLDER,  CONCURRED  IN BY COUNSEL FOR THE COMPANY  THAT SUCH
REGISTRATION AND QUALIFICATION ARE NOT REQUIRED.


                       INTEGRATED MEDICAL RESOURCES, INC.

                    CONVERTIBLE SUBORDINATED PROMISSORY NOTE

                                                                 Lenexa, Kansas
$______________________                                     _____________, 1998


         1.       Principal and Interest.

                  INTEGRATED MEDICAL RESOURCES,  INC. (the "Company"),  a Kansas
corporation,  for  value  received,  hereby  promises  to pay to  the  order  of
_____________________  or holder  ("Payee") in lawful money of the United States
at  the   address  of  Payee  set  forth   below,   the   principal   amount  of
_______________________________________  ($________________), the amount lent by
Payee to the Company pursuant to that certain Note and Warrant Agreement of even
date herewith (the  "Agreement"),  together with simple interest at a rate equal
to the  sum of the  prime  rate  as  quoted  by the  Bank  of  America  NT & SA,
calculated as of the date hereof, plus one percent (1.0%), per annum.

                  The principal of and accrued  interest on this Note is due and
payable on [6 months],  1998. This Note may be prepaid without penalty, in whole
or in part, at any time.

                  Upon payment in full of all  principal  and  interest  payable
hereunder, this Note shall be surrendered to Company for cancellation.


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         2.       Subordination.

                  (a) "Senior  Indebtedness" means the principal of and premium,
if any,  and interest on  indebtedness  of the Company for money  borrowed  from
commercial  banks,  equipment  lessors or other financial  institutions  under a
secured or unsecured line of credit, term loan or equipment lease.

                  (b) The  Company  agrees  and the  holder  of  each  Note,  by
acceptance thereof,  agrees, expressly for the benefit of the present and future
holders of Senior Indebtedness,  that, except as otherwise provided herein, upon
(i) an event of default under any Senior Indebtedness,  or (ii) any dissolution,
winding  up,  or  liquidation  of the  Company,  whether  or not in  bankruptcy,
insolvency  or  receivership  proceedings,  the Company  shall not pay,  and the
holder of such Note shall not be entitled  to receive,  any amount in respect of
the principal and interest of such Note unless and until the Senior Indebtedness
shall have been paid or otherwise discharged. Upon (1) an event of default under
any Senior  Indebtedness,  or (2) any dissolution,  winding up or liquidation of
the Company,  any payment or  distribution  of assets of the Company,  which the
holder of this Note would be entitled to receive but for the provisions  hereof,
shall be paid by the  liquidating  trustee or agent or other person  making such
payment or distribution  directly to the holders of Senior Indebtedness  ratably
according to the aggregate amounts remaining unpaid on Senior Indebtedness after
giving effect to any concurrent payment or distribution to the holders of Senior
Indebtedness.  Subject to the  payment in full of the  Senior  Indebtedness  and
until this Note is paid in full;  the holder of this Note shall be subrogated to
the rights of the holders of the Senior  Indebtedness (to the extent of payments
or distributions  previously made to the holders of Senior Indebtedness pursuant
to this paragraph 2(b)) to receive  payments or  distributions  of assets of the
Company applicable to the Senior Indebtedness.

                  (c) This Section 2 is not  intended to impair,  as between the
Company,  its creditors (other than the holders of Senior  Indebtedness) and the
holder of this Note, the unconditional and absolute obligation of the Company to
pay the  principal of and interest on the Note or affect the relative  rights of
the holder of this Note and the other  creditors of the Company,  other than the
holders of Senior Indebtedness. Nothing in this Note shall prevent the holder of
this Note from  exercising  all remedies  otherwise  permitted by applicable law
upon default  under the Note,  subject to the rights,  if any, of the holders of
Senior  Indebtedness  in respect to cash,  property or securities of the Company
received upon the exercise of any such remedy.

         3.       Conversion.

                  (a) The  outstanding  principal  balance of this Note shall be
automatically  converted upon the closing of the Company's next equity financing
(the  "Next  Financing")  involving  the  receipt  by  the  Company  of,  in the
aggregate, more than $4,000,000 (excluding amounts received on conversion of the
Notes),  into securities issues in the next equity financing (the  "Securities")
at the  purchase  price paid for the  Securities  by the  investors  in the Next
Financing.

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                  (b) Upon automatic  conversion of this Note,  the  outstanding
principal  shall be converted  automatically  without any further  action by the
holder and whether or not the Note is surrendered to the Company or its transfer
agent. The Company shall not be obligated to issue  certificates  evidencing the
shares of the  securities  issuable upon such automatic  conversion  unless such
Notes are either  delivered to the Company or its transfer  agent, or the holder
notifies the Company or its transfer agent that such Note has been lost,  stolen
or destroyed and executes an agreement  satisfactory to the Company to indemnify
the Company  from any loss  incurred  by it in  connection  with such Note.  The
Company shall, as soon as practicable after such delivery,  or such agreement or
indemnification  issue and deliver at such office to such holder of such Note, a
certificate  or  certificates  for the  securities  to which the holder shall be
entitled  and a check  payable to the holder in the  amount of any  accrued  and
unpaid  interest  on such Note and any cash  amounts  payable as the result of a
conversion into fractional  shares of the Securities.  Such conversion  shall be
deemed to have been made immediately  prior to the close of business on the date
of closing of the Next  Financing.  The  persons or persons  entitled to receive
securities  issuable upon such  conversion  shall be treated for all purposes as
the record holder or holders of such securities on such date.

         4. Attorneys' Fees. If the indebtedness represented by this Note or any
part  thereof  is  collected  in  bankruptcy,  receivership  or  other  judicial
proceedings  or if this Note is placed in the hands of attorneys for  collection
after  default,  the Company  agrees to pay, in  addition to the  principal  and
interest  payable  hereunder,  reasonable  attorneys' fees and costs incurred by
Payee.

         5. Notices.  Any notice,  other  communication  or payment  required or
permitted  hereunder  shall be in writing and shall be deemed to have been given
upon delivery if personally  delivered or upon deposit in the United States mail
for mailing by certified mail, postage prepaid, and addressed as follows:

   If to Payee:  At the address set forth on the signature page of the Agreement

   If to Company: At the address of the Company's principal executive office set
                  forth on page 1 of the Agreement.

Each of the above  addressees  may  change  its  address  for  purposes  of this
paragraph  by giving  to the  other  addressee  notice  of such new  address  in
conformance with this paragraph.


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         6. Acceleration.  This Note shall become immediately due and payable if
(i) the Company  commences any  proceeding  in  bankruptcy  or for  dissolution,
liquidation,  winding up,  composition  or other  relief under state and federal
bankruptcy laws; or (ii) such proceedings are commenced against the Company,  or
a receiver or trustee is appointed for the Company or a substantial  part of its
property,  and such  proceeding  or  appointment  is not dismissed or discharged
within (60) days after its commencement.

         7.  Waivers.   The  Company  hereby  waives  presentment,   demand  for
performance, notice of non-performance, protest, notice of protest and notice of
dishonor.  No delay on the part of Payee in exercising any right hereunder shall
operate  as a  waiver  of such  right or any  other  right.  This  Note is being
delivered in and shall be construed in accordance  with the laws of the State of
Kansas, without regard to the conflicts of laws provisions hereof.

                                      INTEGRATED MEDICAL RESOURCES, INC.


                                      By:  /s/ E. Stanley Kardatzke


                                     Title:  Chairman and CEO



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