病人危重協(xié)議書(shū)鑒于患者張三，性別男，年齡65歲，因突發(fā)心臟病入院治療，病情危重，可能危及生命，為明確醫(yī)患雙方的權(quán)利和義務(wù)，經(jīng)雙方充分協(xié)商，達(dá)成如下協(xié)議：一、患者基本情況患者張三，身份證號(hào)碼：XXXXXXXXXXXXXXXXXX，住址：XXXXXXXXXXXXXXXXX，入院日期：XXXX年XX月XX日，入院診斷：急性心肌梗死，病情危重，生命體征不穩(wěn)定。二、醫(yī)療措施1.醫(yī)療機(jī)構(gòu)將采取一切必要的醫(yī)療措施，包括但不限于藥物治療、心肺復(fù)蘇、機(jī)械通氣、溶栓治療、介入治療、手術(shù)治療等，以挽救患者生命。2.醫(yī)療機(jī)構(gòu)將根據(jù)患者病情變化，及時(shí)調(diào)整治療方案，并告知患者家屬治療方案及預(yù)期效果。三、患者權(quán)利1.患者有權(quán)獲得醫(yī)療機(jī)構(gòu)提供的醫(yī)療救治服務(wù)，包括但不限于藥物治療、檢查、治療等。2.患者有權(quán)了解自己的病情及治療方案，醫(yī)療機(jī)構(gòu)有義務(wù)向患者及家屬解釋病情及治療方案。3.患者有權(quán)拒絕醫(yī)療機(jī)構(gòu)提供的任何醫(yī)療服務(wù)，但需承擔(dān)因此產(chǎn)生的一切后果。四、患者義務(wù)1.患者有義務(wù)遵守醫(yī)療機(jī)構(gòu)的規(guī)章制度，配合醫(yī)療機(jī)構(gòu)的診療活動(dòng)。2.患者有義務(wù)提供真實(shí)、準(zhǔn)確的個(gè)人健康信息，醫(yī)療機(jī)構(gòu)將嚴(yán)格保密患者隱私。3.患者有義務(wù)按照醫(yī)療機(jī)構(gòu)的安排，接受治療和護(hù)理，不得擅自離開(kāi)醫(yī)療機(jī)構(gòu)。五、醫(yī)療風(fēng)險(xiǎn)1.醫(yī)療機(jī)構(gòu)將盡最大努力保障患者生命安全，但醫(yī)療行為存在固有風(fēng)險(xiǎn)，可能存在治療效果不佳或出現(xiàn)并發(fā)癥等情況。2.如因不可抗力或患者自身原因?qū)е禄颊卟∏閻夯蛩劳觯t(yī)療機(jī)構(gòu)不承擔(dān)相應(yīng)責(zé)任。六、費(fèi)用承擔(dān)1.患者應(yīng)承擔(dān)因治療產(chǎn)生的醫(yī)療費(fèi)用，包括但不限于藥物治療費(fèi)、檢查費(fèi)、治療費(fèi)等。2.患者可向醫(yī)療保險(xiǎn)機(jī)構(gòu)申請(qǐng)報(bào)銷(xiāo)，具體報(bào)銷(xiāo)比例及流程以醫(yī)療保險(xiǎn)機(jī)構(gòu)規(guī)定為準(zhǔn)。七、協(xié)議生效本協(xié)議自雙方簽字或蓋章之日起生效，具有法律效力。八、爭(zhēng)議解決如雙方在履行本協(xié)議過(guò)程中發(fā)生爭(zhēng)議，應(yīng)協(xié)商解決；協(xié)商不成的，可向醫(yī)療機(jī)構(gòu)所在地人民法院提起訴訟。患者簽字：________________________家屬簽字：________________________醫(yī)療機(jī)構(gòu)蓋章：____________________簽訂日期：XXXX年XX月XX日患者手寫(xiě)部分：___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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