癫痫免责协议书范文完整版

癫痫免责协议书范文完整版

甲方（提供方）：_____________________

地址：_________________________________

法定代表人：____________________________

职务：_________________________________

乙方（接受方）：_____________________

地址：_________________________________

身份证号码：____________________________

联系电话：____________________________

电子邮箱：____________________________

鉴于甲方提供特定服务/产品，乙方参与/使用该服务/产品，为明确双方权利义务，保护双方合法权益，双方本着平等自愿的原则，经协商一致，就乙方因自身疾病（癫痫）可能引起的风险和责任免除事宜，达成如下协议：

第一条定义

1.1“服务/产品”指由甲方提供给乙方的特定服务/产品。

1.2“癫痫”指乙方已知的医学状况，可能在任何时间、任何地点突然发作，导致乙方失去意识或行为能力受限。

第二条乙方声明

2.1乙方确认已充分了解自身健康状况，特别是癫痫疾病可能带来的风险和后果。

2.2乙方声明在签订本协议前，已向甲方充分披露自身癫痫状况，并已获得专业医疗人员的建议。

2.3乙方承诺在参与/使用服务/产品期间，将采取一切必要措施以减少疾病发作的风险，包括但不限于按时服药、避免诱发因素等。

第三条甲方声明

3.1甲方确认已充分了解乙方的健康状况，并已采取合理措施以降低乙方疾病发作的风险。

3.2甲方承诺在乙方参与/使用服务/产品期间，提供必要的协助和支持，包括但不限于紧急情况下的救助。

第四条责任免除

4.1乙方明确知晓并同意，由于自身癫痫疾病可能在任何时间、任何地点突然发作，导致乙方自身或第三方人身、财产损害的，甲方不承担任何责任。

4.2乙方同意，因乙方癫痫疾病发作导致的任何损失或损害，甲方不承担赔偿责任，乙方放弃对甲方的一切追索权。

第五条紧急情况处理

5.1甲方应在乙方癫痫发作时提供必要的紧急救助，并协助联系专业医疗人员。

5.2乙方应向甲方提供紧急联系人信息，并确保在紧急情况下能够及时联系。

第六条协议的变更和解除

6.1本协议一经双方签字盖章后生效，未经双方书面同意，任何一方不得擅自变更或解除本协议。

6.2如遇不可抗力因素导致本协议无法履行，双方应协商解决；协商不成的，本协议自动解除。

第七条争议解决

7.1本协议在履行过程中如发生争议，双方应通过友好协商解决；协商不成的，可向甲方所在地人民法院提起诉讼。

第八条其他

8.1本协议一式两份，甲乙双方各执一份，具有同等法律效力。

8.2本协议未尽事宜，双方可另行签订补充协议。

甲方（盖章）：_________________乙方（签字）：_________________

法定代表人（签字）：________________日期：____年____月____日

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