医疗费赔偿协议书模板2024年

医疗费赔偿协议书模板2024年合同编号：____________甲方（赔偿方）：________________统一社会信用代码/身份证号：____________地址：________________联系人：____________联系电话：____________乙方（受偿方）：________________统一社会信用代码/身份证号：____________地址：________________联系人：____________联系电话：____________鉴于甲乙双方在平等、自愿、公平、诚实信用的原则基础上，就甲方因医疗事故造成乙方人身损害所应支付的医疗费等相关费用达成如下协议：一、事故概述1.1事故发生时间：____年__月__日1.2事故发生地点：________________1.3事故经过：________________（简要描述事故发生原因及经过）二、赔偿项目及金额（1）医疗费：____元（大写：________________）（2）住院伙食补助费：____元（大写：________________）（3）交通费：____元（大写：________________）（4）住宿费：____元（大写：________________）（5）护理费：____元（大写：________________）（6）其他合理费用：____元（大写：________________）2.2上述赔偿金额共计：____元（大写：________________）三、赔偿方式及期限3.1甲方同意在本协议签订之日起____个工作日内，将赔偿款项一次性支付给乙方。3.2赔偿款项支付方式：□银行转账□现金支付四、双方权利义务4.1甲方应按照本协议约定及时足额支付赔偿款项。4.2乙方在收到赔偿款项后，应出具书面收据，并保证不再就此事向甲方提出任何主张。4.3双方应遵守本协议的约定，不得擅自泄露与协议有关的信息。五、争议解决5.1双方在履行本协议过程中发生的争议，应通过友好协商解决；协商不成的，可以向有管辖权的人民法院提起诉讼。六、其他约定6.1本协议一式两份，甲乙双方各执一份。6.2本协议自甲乙双方签字（或盖章）之日起生效。甲方（赔偿方）：________________法定代表人（或授权代表）：____________签订日期：____年__月__日乙方（受偿方）：________________法定代表人（或授权代表）：____________签订日期：____年__月__日附件：相关医疗费用单据及证明材料_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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