醫(yī)療費賠償協(xié)議書模板2024年

?醫(yī)療費賠償協(xié)議書模板2024年合同編號：____________甲方（賠償方）：________________統(tǒng)一社會信用代碼/身份證號：____________地址：________________聯(lián)系人：____________聯(lián)系電話：____________乙方（受償方）：________________統(tǒng)一社會信用代碼/身份證號：____________地址：________________聯(lián)系人：____________聯(lián)系電話：____________鑒于甲乙雙方在平等、自愿、公平、誠實信用的原則基礎(chǔ)上，就甲方因醫(yī)療事故造成乙方人身損害所應(yīng)支付的醫(yī)療費等相關(guān)費用達成如下協(xié)議：一、事故概述1.1事故發(fā)生時間：____年__月__日1.2事故發(fā)生地點：________________1.3事故經(jīng)過：________________（簡要描述事故發(fā)生原因及經(jīng)過）二、賠償項目及金額（1）醫(yī)療費：____元（大寫：________________）（2）住院伙食補助費：____元（大寫：________________）（3）交通費：____元（大寫：________________）（4）住宿費：____元（大寫：________________）（5）護理費：____元（大寫：________________）（6）其他合理費用：____元（大寫：________________）2.2上述賠償金額共計：____元（大寫：________________）三、賠償方式及期限3.1甲方同意在本協(xié)議簽訂之日起____個工作日內(nèi)，將賠償款項一次性支付給乙方。3.2賠償款項支付方式：□銀行轉(zhuǎn)賬□現(xiàn)金支付四、雙方權(quán)利義務(wù)4.1甲方應(yīng)按照本協(xié)議約定及時足額支付賠償款項。4.2乙方在收到賠償款項后，應(yīng)出具書面收據(jù)，并保證不再就此事向甲方提出任何主張。4.3雙方應(yīng)遵守本協(xié)議的約定，不得擅自泄露與協(xié)議有關(guān)的信息。五、爭議解決5.1雙方在履行本協(xié)議過程中發(fā)生的爭議，應(yīng)通過友好協(xié)商解決；協(xié)商不成的，可以向有管轄權(quán)的人民法院提起訴訟。六、其他約定6.1本協(xié)議一式兩份，甲乙雙方各執(zhí)一份。6.2本協(xié)議自甲乙雙方簽字（或蓋章）之日起生效。甲方（賠償方）：________________法定代表人（或授權(quán)代表）：____________簽訂日期：____年__月__日乙方（受償方）：________________法定代表人（或授權(quán)代表）：____________簽訂日期：____年__月__日附件：相關(guān)醫(yī)療費用單據(jù)及證明材料_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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