急诊留观患者监护制度

急诊留观患者监护制度合同编号：__________甲方：__________乙方：__________鉴于甲方为一家具有医疗资质的医疗机构，乙方为前来甲方急诊留观的患者或其法定代理人，为规范甲方对乙方在急诊留观期间提供的监护服务，双方经友好协商，就甲方提供监护服务相关事宜达成如下协议：一、甲方提供的监护服务内容：1.1对乙方在急诊留观期间进行全面观察，监测乙方生命体征及病情变化；1.2安排医护人员对乙方进行定期查房，并根据乙方病情调整治疗方案；1.3如有必要，甲方应及时通知乙方或其法定代理人并采取相应救治措施；1.4确保乙方在急诊留观期间的安全，防止意外事故发生。二、乙方义务：2.1如实向甲方提供乙方健康状况、既往病史、药物过敏史等个人信息；2.2遵守甲方规章制度，配合甲方医护人员进行诊疗；2.3按约定时间支付监护服务费用。三、监护服务费用及支付方式：3.1乙方向甲方支付的监护服务费用为人民币____元整（大写：____________________元整）；3.2乙方应按照甲方规定的支付方式及时支付监护服务费用；3.3甲方提供监护服务期间，如乙方病情恶化需转院治疗，甲方应协助乙方办理相关手续，并按照实际发生费用结算。四、违约责任：4.1任何一方违反本协议的约定，导致合同无法履行或造成对方损失的，应承担违约责任，向对方支付违约金，并赔偿损失；4.2甲方未按约定提供监护服务，乙方有权要求甲方退还已支付的监护服务费用；4.3乙方未按约定时间支付监护服务费用，甲方有权终止提供监护服务，并要求乙方支付逾期付款违约金。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；5.2若协商不成，任何一方均有权向甲方所在地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本协议自双方签字（或盖章）之日起生效，有效期为____年，自协议生效之日起计算；6.3本协议未尽事宜，可由双方另行签订补充协议，补充协议与本协议具有同等法律效力。甲方（盖章）：__________乙方（签字/盖章）：__________法定代表人（或负责人）：__________法定代表人（或负责人）：__________签订日期：__________签订日期：__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________一、附件列表：1.甲方医疗资质证明文件2.乙方身份证明文件3