Doctor-patient agreement 1 Party A: xxxxxx ID number:
Party B: Patients and their families: ID number:
Dear patient's family: In order to make us trust each other, be highly responsible and establish a good doctor-patient relationship, * * * will make joint efforts to completely and successfully cure every patient, and let them embark on the road of rehabilitation and restore health!
Specific to the following protocols:
1. Patient name of Party B ().
2. Party A can guarantee that () is cured.
3. Matters that Party A requires Party B to pay attention to ().
4. Party B shall pay medical expenses to Party A ().
5. When Party B voluntarily requests Party A to treat diseases, please take out the latest diagnosis reports of diseases and other diseases (allergic diseases such as chronic hepatitis, heart and kidney) before seeing a doctor. Just in case, if not declare in advance, once there is a problem, the consequences will be at your own risk.
6. The patients of Party B must be treated according to the treatment plan of Party A's doctor. Do not follow the doctor's advice at your own risk.
7. If the patient of Party B gives up treatment without the consent of the doctor during the treatment, he shall pay 50% of the total expenses to the doctor of Party A..
This agreement is made in duplicate, which shall come into effect after being carefully read and signed.
Party A (signature of doctor):
Party B (signature of patient):
date month year
Doctor-patient agreement 2 Party A: _ _ _ _ _ _ _ _ _ _ _
Address: _ _ _ _ _ _ _ _
Tel: _ _ _ _ _ _ _ _
Party B: _ _ _ _ _ _ _
Address: _ _ _ _ _ _ _ _
Tel: _ _ _ _ _ _ _ _
In line with the purpose of saving lives and serving patients wholeheartedly, and in order to clarify the rights and obligations of both parties, we conclude this contract with Party B through consultation.
I. Responsibility of Party A
1. Medical and technical services;
2. Party A shall provide Party B with "patent prescription drugs for femoral head necrosis" in time;
3. Party A shall truthfully explain to Party B the medication effect during the treatment period from time to time;
4. We promise that the pain will be relieved or disappeared after taking our medicine 1-2 courses of treatment; After 4-5 courses of treatment, the general situation can withstand the test of cycling, walking and other activities; After 6 courses of treatment, the patient can achieve clinical recovery; 1-2 years later, the X-ray returned to normal and the necrotic bone revived.
2. Party B's responsibilities
1. Timely and truthfully reflect the illness;
2. Medication and clinical cooperation according to Party A's requirements;
3. It is forbidden to drink all kinds of alcohol and use hormone drugs;
4. Regular review, reasonable nutrition diet.
III. Current medical history: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Four. Administration time: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
5. Party B takes the medicine according to our requirements, and if the treatment effect is not achieved, it will refund all the medicine fees (except travel expenses and inspection fees).
Matters not mentioned above shall be settled by both parties through negotiation, and this agreement shall come into effect as of the date of signing, in duplicate, with each party holding one copy.
Party A: _ _ _ _ _ _ _ _ _ _ _
Party B: _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Doctor-patient agreement 3 Party A: _ _ _ _ _ _ _ _ _ _ _ _ _ (hospital)
Party B: _ _ _ _ _ _ _ _ _ _ _ _ _ _ (patient)
In order to provide high-quality and low-cost medical services for patients with chronic hepatitis B, our hospital began to implement the rehabilitation plan for chronic hepatitis B. For the smooth implementation of the rehabilitation plan, the hospital signed the following agreement with patients:
1. All kinds of therapeutic drugs and tests provided by Party A to Party B are discounted by 30% according to the current national charging standards on the basis of the national charging standards, and the preferential time is within the rehabilitation plan period.
2. The implementation period of this rehabilitation plan refers to 6 months from the beginning of treatment to the end of a course of treatment.
3. Party B has the right to choose a doctor and adapt to its own treatment plan.
4. Party A does not promise to cure. Because the cure rate of interferon for chronic hepatitis B is only 40%-50%.
5. Party B shall strictly cooperate with Party A's doctor to complete the prescribed course of treatment. If Party B does not cooperate with the handling, it shall bear its own responsibilities.
6. If the prescribed treatment plan cannot be completed due to individual differences during the treatment period, Party A shall replace the treatment plan in time and return the remaining treatment expenses to Party B. ..
7. Party B shall pay all expenses during the rehabilitation plan at the beginning of treatment.
8. Party A shall regularly provide lectures, consultation and publicity materials to Party B free of charge.
9. After the rehabilitation plan is completed, Party B has the right to enjoy a 30% discount on Party A's inspection items within five years.
10. If Party B fails to complete the prescribed course of treatment, Party A has the right to cancel the promised preferential conditions.
Party A (seal): _ _ _ _ Party B (signature): _ _ _ _ _ _
Representative (signature): _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signing place: _ _ _ _ _ _ _ _ _ _ Signing place: _ _ _ _ _ _ _ _ _
Doctor-patient agreement 4 Patient representative:
Name: gender: age: years old Marriage: Tel:
Id card: Address:
The representative is associated with the patient (ID card:).
Medical representative:
Unit: Address:
Legal Representative: Authorized Representative: Tel:
Reasons and contents of the agreement:
Patient, years old, lives in. Because ""was treated in the hospital, the patient disagreed with the diagnosis and treatment process, and a doctor-patient dispute occurred. After mediation by the People's Mediation Committee for Doctor-patient Disputes in Sheyang County, both doctors and patients reached the following agreement through voluntary negotiation:
1. The medical party shall compensate the patient for all expenses in one lump sum, RMB: RMB only.
2. Both parties promise that this agreement is the final solution, and the dispute between doctors and patients will end after this agreement comes into effect.
3. After this agreement comes into effect, both parties shall not claim rights from each other for any reason, and shall not affect their normal working order or damage their reputations.
Representatives of both doctors and patients read the above contents, and the mediator also made a detailed explanation and explanation. This agreement is the expression of the true meaning of both doctors and patients. It will come into effect and be performed after being signed by both parties, and there will be no other disputes in the future.
(This agreement is made in triplicate, one for both doctors and patients and one for the county people's mediation committee for doctor-patient disputes. )
Signature of patient's representative: signature (seal) of medical representative:
Signature (seal) of the representative of the People's Mediation Committee for Medical Disputes in Sheyang County:
20xx year month day
Doctor-patient agreement 5 Party A: _ _ _ _ _ _ _ _ _ _ _ _ _ (hospital)
Party B: _ _ _ _ _ _ _ _ _ _ _ _ _ _ (patient)
In order to provide high-quality and low-cost medical services for patients with chronic hepatitis B, our hospital began to implement the rehabilitation plan for chronic hepatitis B. For the smooth implementation of the rehabilitation plan, the hospital signed the following agreement with patients:
1. All kinds of therapeutic drugs and tests provided by Party A to Party B are discounted by 30% according to the current national charging standards on the basis of the national charging standards, and the preferential time is within the rehabilitation plan period.
2. The implementation period of this rehabilitation plan refers to 6 months from the beginning of treatment to the end of a course of treatment.
3. Party B has the right to choose a doctor and adapt to its own treatment plan.
4. Party A does not promise to cure. Because the cure rate of interferon for chronic hepatitis B is only 40%-50%.
5. Party B shall strictly cooperate with Party A's doctor to complete the prescribed course of treatment. If Party B does not cooperate with the handling, it shall bear its own responsibilities.
6. If the prescribed treatment plan cannot be completed due to individual differences during the treatment period, Party A shall replace the treatment plan in time and return the remaining treatment expenses to Party B. ..
7. Party B shall pay all expenses during the rehabilitation plan at the beginning of treatment.
8. Party A shall regularly provide lectures, consultation and publicity materials to Party B free of charge.
9. After the rehabilitation plan is completed, Party B has the right to enjoy a 30% discount on Party A's inspection items within five years.
10. If Party B fails to complete the prescribed course of treatment, Party A has the right to cancel the promised preferential conditions.
Party A (seal): _ _ _ _ _ _
Party B (signature): _ _ _ _ _ _
Representative (signature): _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Signing place: _ _ _ _ _ _ _ _ _
Signing place: _ _ _ _ _ _ _ _ _
Doctor-patient agreement 6 Party A: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (name, gender, date of birth, nationality, work unit, occupation and address).
Party B: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Legal representative (person in charge): _ _ _ _ _ _ _ _ _ _ _ _ _ _ (name, title).
Party A and Party B have reached the following agreement on compensation for the case of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _:
1、_______________________________________________
2、_______________________________________________
This agreement is made in triplicate, with each party holding one copy.
Party A: _ _ _ _ _ _ _ (signature and handprint)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Party B: _ _ Seal (signature of legal representative)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Doctor-patient agreement 7 Both doctors and patients do not accept or send "red envelopes" Summary: We also solemnly promise: 1. Actively cooperate with diagnosis and treatment activities, truthfully provide medical history and other information, respect science, and make prudent and rational decisions on the objective risks in disease diagnosis and treatment.
Both doctors and patients do not accept and send "red envelopes".
Patient's name and hospitalization number
Dear patients and their families: I sincerely thank you for your trust and choose to go to XX County People's Hospital for medical treatment. In the next period of time, we will face the challenge of disease together. Here, we solemnly promise:
First, uphold the professional spirit of equality, kindness and integrity, take patients as the center and treat patients with dedication.
Second, fully fulfill the obligation of informing and respect patients' rights such as informed consent and privacy.
Three, clean medical practice, do not accept patients and their families "red envelopes", expensive gifts. I sincerely wish you a speedy recovery!
Signature and seal of legal representative:
Doctor:
date month year
XX County People's Hospital: We have received your letter of commitment, and carefully read and understood the relevant contents. Here, we also solemnly promise:
First, actively cooperate with diagnosis and treatment activities, truthfully provide medical history and other information, respect science, and make prudent and rational decisions on the objective risks in disease diagnosis and treatment.
Second, respect the medical staff, care for public facilities, obey the management and arrangement, the patient himself or the patient's representative should effectively communicate and coordinate his own personnel, and * * * should fulfill this commitment.
Three, do not send "red envelopes" and expensive gifts to medical staff, and create a clean and harmonious medical environment.
Patient or patient representative:
date month year
Doctor-patient agreement 8 Party A: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (name, gender, date of birth, nationality, work unit, occupation and address).
Party B: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Legal representative (person in charge): _ _ _ _ _ _ _ _ _ _ _ _ _ _ (name, title).
Party A and Party B have reached the following agreement on compensation for the case of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _:
1、_______________________________________________
2、_______________________________________________
This agreement is made in triplicate, with each party holding one copy.
Party A: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.
Party B: _ _ _ _ Seal (signature of legal representative) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Doctor-patient agreement 9 (name, gender, date of birth, nationality, work unit, occupation, address).
Party B: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Party A and Party B have reached the following agreement on compensation for the case of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _:
1、_______________________________________________
2._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Party A: _ _ _ _ _ _ _ (signature and handprint)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Party B: _ _ Seal (signature of legal representative)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _