[Boutique] Medical Disputes Agreement

Article 1: Medical Disputes Agreement

Party A: name, gender, date of birth, ethnicity, work unit, occupation, address.

Party B: unit name, address.

Legal representative: name, position.

In the case of ****, both parties have reached the following agreement on compensation:

1,……

2,……

This Agreement is made in triplicate. Each Party A and Party B shall hold one copy and submit it to the Municipal Health Bureau for a record with the same legal effect.

......

Party A: Party B: Stamp

Year, month, day, month, day

Part 2: Medical Disputes Agreement

Party A***** clinic arsenic

Party B ID address

Basic condition of the patient

The patient **** was admitted to the hospital on the ** ** ** ** day due to "********" to the party A to see the doctor, to recover the "*******" admitted to the hospital ***.

Both Party A and Party B are willing to resolve disputes over the medical problems of patients. They are willing to resolve the principle of equality, voluntariness, honesty and credit in accordance with the principles of equality, voluntariness, honesty and credit in accordance with the Tort Liability Law, the Medical Accident Treatment Regulations and relevant laws and regulations. The parties voluntarily reached the following compensation agreement on the dispute:

1. Party A agrees with Party B's request for the identification of the cause and responsibility of the medical investigation of the Huanghuang u medical accident.

Second, Party A agrees with Party B's request that the Huai vortex round hooks and the reefs 喾 喾 喾 喾 喾 喾 嗣癖 嗣癖. The compensation fee includes, but is not limited to, the following all expenses that Party A may pay to Party B according to the existing laws of China. Medical expenses, nursing expenses, transportation expenses, hospital food subsidies, nutrition expenses, mental damages, etc. cost.

3. Time and method of payment of compensation payment Party A shall pay in lump sum in cash before the date of the year. Party B shall issue a written receipt certificate to Party A after receiving Party A's compensation.

4. After Party A has paid all the money in accordance with this Agreement, it will end (14) Yifang will terminate all disputes arising from the medical problems of patients. Party B shall no longer claim rights from Party A for any reason or in any way, and the defamation of the deceased shall be the basis for its claim.

5. Party A and Party B confirm the results of the full consultation between the two parties in the witness witnesses. In this process, 2 Huaiwei Wei Wei, coercion, obvious unfairness, major misunderstanding, and the danger of taking people.

6. This Agreement shall be signed and sealed by both parties. The text of the agreement is in triplicate <Yi Yifang has the same legal effect.

person A person B

witness:

year month day

Part 3: Medical Disputes Agreement

Party A: _______________

Party B: _________________

In accordance with the provisions of the Regulations on the Handling of Medical Accidents, both parties have reached the following agreement, under full voluntariness, after consultation:

First, the basic situation of the patient:

Name: Age: Gender: Birthplace: Address:

ID number: Hospital number:

Disease diagnosis:

Treatment results:

2. The level of medical accidents jointly identified by the party:

Third, the cause of medical malpractice

Fourth, the amount of compensation

1. Medical expenses: yuan;

2, lost time: yuan;

3. A meal subsidy for hospitalization: yuan;

4. Accompanying fee: Yuan;

5. Disability living allowance: Yuan;

6, disabled appliances fee: yuan;

7. Funeral expenses: Yuan;

8. Living expenses of dependents: Yuan;

9. Transportation fee: Yuan;

10. Accommodation fee: yuan;

11, mental damage soothing gold: yuan;

12. The transportation expenses and lost time of the spouse and immediate family members of the patient who died in the funeral activities.

Accommodation fee: Yuan

Total: Yuan

V. Time for reimbursement:

6. Liability for breach of contract

Seven, other

1, discharge treatment:

2. If the patient is dead, the body is treated

3, other

8. The above-mentioned agreements shall become effective after they are signed or sealed by both parties.

person A person B:

Agent: Agent:

Date: Date:

witness:

date: