Medical dispute settlement agreement 1
Party A:-
Address:-Tel:-
Party B: Gender: Age: ID number:
Address: Tel:
Relationship with patients: postal code
□ Patient himself □ Legal guardian □ Entrusted agent □ Other immediate family members:
Through friendly negotiation, Party A and Party B agree that the patient (ID number:) will be registered in _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
One,
2. Party A agrees to compensate Party B for RMB in one lump sum, and exempt Party B from the medical expenses of corresponding treatment in our hospital from.
3. Within 10 days after the conciliation statement comes into effect, Party A shall pay all the compensation fees to Party B in one lump sum, and Party B shall issue a written receipt to Party A after receiving the compensation fees paid by Party A. This medical dispute is over.
Four. Party B promises that this dispute will be terminated after this agreement comes into effect and the RMB compensation paid by Party A is received. Party B will not make any demands on Party A for any reason, or ask any third party to hold Party A accountable, and promise not to engage in or spread any behavior that may affect Party A's reputation.
5. If Party A violates the provisions of this Agreement, it shall pay Party B a penalty of ten times the appeal compensation; If Party B violates the agreement in this Agreement, Party B shall not only return the compensation of RMB yuan obtained under this Agreement, but also pay Party A a penalty of 10 times of this fee.
6. This Agreement is made in duplicate, one for each party, and both copies have the same legal effect.
Seven. This agreement shall come into effect after being signed (sealed) by both parties.
Party A: (seal) Party B: (signature) (patient himself)
Year, month, sun, moon, sun.
Witness: (signature)
date month year
Medical dispute settlement agreement II
Party A: _ _ _ _ _ _ _ _ Hospital
Party B (affected party): _ _ _ _ _ _ _ _ _ _ _
Basic information of patients:
Name: _ _ _ _ _ _ _ Gender: _ _ _ _ _ _ Age: _ _ _ _ _ _ Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Hospitalization number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Mediator: _ _ _ _ _ _ _ Lawyer of Law Firm: _ _ _ _ _ _ _ _ _ _
Patient _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _. After _ _ _ _ days in hospital, the treatment results of patients are: death, disability, improvement and rehabilitation.
Party B believes that _ _ _ _ _ _ _ _ _ _ _ _ _ _ was caused by Party A. ..
Party A believes that _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
After mediation by the mediator, both parties voluntarily reached the following compensation agreement on this dispute:
1. Party A and Party B agree to settle the dispute through negotiation, without identifying the reasons and responsibilities of the dispute.
2. Party A voluntarily compensates Party B for medical expenses, lost time, hospital food allowance, escort fee, disability living allowance, living expenses of dependents, continuing treatment fee, death compensation, funeral expenses and mental damage compensation.
Three. Payment time of compensation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Four. Party A and Party B waive all litigation rights based on the creditor-debtor relationship.
5. _ _ _ _ _ _ _ _ _ _ (Dead patient) The body stored in the mortuary must be transported out of the hospital on _ _ _ _ _ _ _ _ _.
Liability for breach of contract by intransitive verbs: This agreement is terminated once, and neither party can go back on its word. If one party goes back on its word, it shall pay the other party RMB as penalty.
Seven. This agreement shall come into force after being signed and sealed by both parties. This agreement is made in triplicate, one for each party and one for the Health Bureau.
Party A: _ _ _ _ _ _ _ _ _ _ _
Party B: _ _ _ _ _ _ _
Mediator: _ _ Law Firm
Attorney: _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Medical dispute settlement agreement
Party A:
Address:
Legal representative (principal responsible person):
Entrusted agent:
Party B:
Gender:
Age:
ID number:
Home address:
Entrusted agent:
ID number:
Home address:
During the period from _ _ _ _ _ to _ _ _ _ _ _ _
1. Both parties agree that this agreement will take effect after it is submitted to Taiyuan Arbitration Commission for arbitration according to law.
2. Considering the actual situation of Party B, Party A agrees to pay Party B RMB one hundred and twenty-five thousand Yuan in three installments. For the first time, the second time and the third time, the dispute between the two parties was resolved once, and there were five medical dispute agreements in the future.
Three. Both parties agree that this agreement is reached on a completely voluntary basis on the basis of consulting medical and legal experts and fully understanding the medical process.
Four. Party A and Party B have no objection to the basic facts of medical disputes. After the mediation comes into effect, both parties agree not to claim other rights in other ways for the civil liability caused by this dispute. Thereafter, both parties shall not defame each other's reputation in any form or for any reason.
5. The arbitration fee is RMB Yuan only, and Party A shall undertake five samples of the medical dispute agreement contract.
This agreement is made in triplicate, one for each party and one for the Arbitration Commission.
Party A: Party B:
Year, month, year, month, year
Medical dispute settlement agreement
Party A: _ _ × Hospital
Party B: _ _ _ _ _ _ (patient or his family)
Whereas the patient was hospitalized in Party A from _ _ _ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Therefore, Party A and Party B, based on the principles of equality, voluntariness, honesty and credit, and in accordance with the provisions of relevant laws, have reached the following fee agreement through full consultation, and both parties shall abide by it.
Article 1 Compensation items and calculation methods;
Party A agrees to compensate Party B as follows:
Medical expenses:
Transportation costs:
Hospitalization food allowance:
Disability compensation:
Death compensation:
Follow-up treatment fee:
Disability assistive devices fee:
Compensation for mental damage:
Others:
Article 2 Party A agrees to pay the sum specified in Article 1 of this agreement to Party B in one lump sum (or in installments) within × days after this agreement comes into effect;
Article 3 After Party A pays all the money agreed in this agreement, all disputes between Party A and Party B due to patients' medical problems will be terminated, and Party B shall not claim rights from Party A for any reason or in any way, otherwise Party B shall unconditionally refund all the money paid by Party A, and shall not use this agreement as the basis for claiming rights;
Article 4 This Agreement is made in duplicate, one for each party, and shall come into effect as of the date when the authorized representatives of both parties sign and seal it.
Party A:
Party B:
date month year
Medical dispute settlement agreement
Party A: _ _ _ _ _ _ _ _ _ (medical institution)
Party B: _ _ _ _ _ _ _ _ _ _ (the affected party)
According to the Regulations on Handling Medical Accidents, Party A and Party B reached the following agreement through negotiation on the basis of complete voluntariness:
First, the basic situation of patients:
Name: Age: Sex: Native place: Address:
ID number: Hospitalization number:
Disease diagnosis:
Treatment results:
Two, the parties * * * with medical accident appraisal level:
Third, the causes of medical accidents
Fourth, the amount of compensation.
1, medical expenses: RMB;
2. Lost time: RMB;
3. Hospitalization food allowance: RMB;
4. Escort fee: RMB;
5. Disability living allowance: RMB;
6. Disability appliance fee: RMB;
7. Funeral expenses: RMB;
8. Living expenses of dependents: RMB;
9. Transportation fee: RMB;
10. Accommodation fee: RMB;
1 1, mental damage compensation: yuan;
12, the spouses and immediate family members of the deceased patients attending the funeral activities need transportation, lost time,
Accommodation fee: RMB (no more than 2 persons)
Total: yuan
Verb (abbreviation for verb) Time to pay compensation:
Liability for breach of contract of intransitive verbs
Seven. others
1, discharged for treatment:
2. If the patient dies, dispose of the body.
3. Others
Eight, the above agreement shall come into force after being signed or sealed by both parties.
Party A: Party B:
Agent:
Date: Date:
Witness:
Date:
Medical dispute settlement agreement
Party A: name, address and identity information;
Party B: name, address and identity information;
Party A and Party B voluntarily reached the following agreement on the compensation for the medical accident that occurred on May 3, 20:
1. Party A shall compensate Party B for medical expenses, death compensation, funeral expenses, spiritual comfort, etc. * * * RMB ten thousand yuan only (in words).
2. Party B designates the _ _ _ _ bank account as the account for accepting the compensation for the medical fault. When Party A's compensation reaches the account designated by Party B, it shall be deemed that Party B has received the compensation. After Party B receives the above expenses, the compensation for personal injury caused by this medical fault accident will be terminated, and Party B shall not claim any rights from Party A, relevant personnel and units. Regardless of the outcome, Party A and the insurance company have nothing to do with Party B..
3. After Party B receives the compensation, there is no dispute between Party A and Party B, and Party A will not hold Party B accountable. Party B shall not ask for any increase or compensation again for any reason. This medical dispute will be terminated at one time, and there is no dispute between the two parties.
Four. After receiving the compensation, Party B promises not to pursue any responsibilities (including civil and criminal) of Party A, and promises not to pursue relevant responsibilities of Party A and relevant personnel.
Verb (abbreviation of verb) The terms of this agreement are agreed by both parties on the principle of fairness and voluntariness, and are the true expression of the meaning of both parties. There is no major misunderstanding or unfairness.
After the signing of this agreement, Party A and Party B promise not to go back on their word, and both parties' rights and obligations have been handled, and they will not pursue legal responsibilities for each other.
Seven. This agreement shall come into force after being signed and sealed by both parties.
Eight. This agreement is made in duplicate, each party holds one copy, which has the same legal effect.
Party A (signature): Party B (signature):
Date: 20th Date: 20th
Medical dispute settlement agreement
Party A: _ _ _ _ _ _ _ _ (medical institution)
Party B: _ _ _ _ _ _ _ _ (the affected party)
With regard to matters related to Party B's illness, Party A and Party B reached the following agreement through negotiation in accordance with the provisions of laws and regulations, on the basis of equality, honesty and credibility:
Rule number one. Basic information of patients:
Name: _ _ _ _ _ _ _ _ _ _ _ Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
ID number: _ _ _ _ _ _ _
Tel: _ _ _ _ _ _ _ _ _ _ _
Article 2. Party B has fully understood Party A's current medical behavior and has a very clear understanding of the medical level. Party B voluntarily stopped proposing medical malpractice appraisal and proposed to settle the dispute once and for all.
Article 3. Party A shall pay Party B RMB _ _ _ _ _ _ in one lump sum, including medical expenses, lost time, hospital food allowance, escort expenses, transportation expenses, accommodation expenses, mental damage compensation and other expenses that may occur due to this diagnosis and treatment.
Article 4. Payment shall be made within _ _ _ _ _ _ days from the date of signing this Agreement, and Party B shall issue a separate receipt after receiving the payment.
Article 5. After Party A pays all the money as agreed, everything caused by medical problems of patients between Party A and Party B will be terminated.
Article 6 Obligations of Party B: Party B guarantees that the contents of this Agreement will be kept confidential and will not be disclosed to a third party, and that it will not make trouble at Party A's place after receiving the money, so as to safeguard Party A's reputation. Party B guarantees that there is no compulsion, major misunderstanding or obvious unfairness when signing this Agreement.
Article 7 Liability for Breach of Contract: If Party B breaches this Agreement, divulges the contents of this Agreement to a third party, or has a dispute with Party A again or demands compensation again, it will be regarded as breach of contract. Party B shall pay the money paid by Party A in double indemnity and compensate all losses caused thereby, including loss of reputation, loss of recovery of legal fees, loss of attorney fees, etc.
Article 8 The above agreement shall come into effect after being signed or sealed by both parties.
Party A: _ _ _ _ Party B: _ _ _ _
Date: _ _ _ Date: _ _ _ _
Medical dispute settlement agreement
Party A: _ _ _ _ _ _ _ _ _ _ _
Party B: _ _ _ _ _ _ _ _ _ _ _
With regard to Party B's illness, based on the principles of equality, voluntariness, honesty and credibility, Party A reached the following agreement through consultation for the purpose of concern:
First, the basic situation of patients:
Name: Age: Gender: Native place: Tel: ID number: Address:
Two. Payment amount: total: RMB yuan.
Three. Payment time: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Four. After Party A pays all the money as agreed, everything caused by medical problems of patients between Party A and Party B will be terminated. Both parties' labor relations are dissolved at the same time, and neither party assumes any responsibility for the other.
5. This Agreement is made in duplicate, with each party holding one copy.
6. The above agreement shall come into effect after being signed or sealed by both parties.
Party A: Party B:
Agent: Agent: Patient.
Date: 20th Date: 20th
8 Relevant provisions of the 2022 Medical Dispute Settlement Agreement;
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★ 2022 copies of mediation agreement between individuals and parties.
★ Mediation agreement template (selected 10)
★ Personal dispute settlement agreement
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★ medical dispute agreement
★ 5 Doctor-patient dispute agreement
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★ Model medical cooperation agreement
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