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醫療事故賠償協議書怎么寫

來源:華律網 2019-03-30 40268 人看過
醫療事故賠償協議書是就醫療事故賠償事宜達成一致所簽訂的協議書,那么,醫療事故賠償協議書該怎么寫呢?本文華律網律師將為您詳細解答。

醫療事故賠償協議書怎么寫

醫療事故賠償協議書

甲方:_______________ (醫療機構)

乙方:_________________ (患方)

甲乙雙方根據《醫療事故處理條例》之規定,經協商,在完全自愿的情況下達成如下協議:

一、患者基本情況:

姓名:   年齡:   性別:   籍貫   住 址:         

身份證號:       住院號:       

疾病診斷:                       

治療結果:                       

二、 甲乙雙方共同認定的醫療事故等級:       

三、 醫療事故原因:       

四、 賠償數額

1、醫療費:    元;

2、誤工費    元;

3、住院伙食補助費:    元;

4、陪護費:    元;

5、殘疾生活補助費:    元;

6、殘疾用具費:    元;

7、喪葬費    元;

8、被撫養人生活費:    元;

9、交通費:    元;

10、住宿費:    元;

11、精神損害撫慰金:    元;

12、患者死亡參加喪葬活動的患者的配偶和直系親屬所需交通費、誤工費、住宿費:    元(不超過2人)

合計:    

五、 賠償款給付時間:    

六、 違約責任:                        

七、 其他

1、 出院處理:            

2、 如為死亡患者,尸體處理:            

3、 其他事項:                

八、 上述協議經雙方簽字或蓋章后生效。

甲方:             乙方:

代理人:            代理人:

日期: 年 月 日         日期: 年 月 日

證人

日期: 年 月 日

注:具體條款根據不同情況可以增減。

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延伸閱讀:
醫療事故鑒定等級有哪些呢
醫療事故鑒定多少錢
醫療事故賠償申請
特邀律師:
高慶律師團隊 天津和平區

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