How to write the medical dispute claim agreement?

How to write the medical dispute claim agreement? Model text of medical dispute claim agreement: Party A: _ _ _ _ _ _ _ (medical institution) Party B: _ _ _ _ _ _ (patient) reached the following agreement on a completely voluntary basis through consultation: 1. Basic information of patients: name: age: sex: native place: address: ID number: hospitalization number: disease diagnosis: treatment result: 2. The level of medical accident recognized by Fang * * * *: Level 3. Causes of medical accidents: 4. Compensation amount: 1, medical expenses: RMB; 2. Lost time: RMB; 3. Hospitalization food allowance: RMB; 4. Escort fee: RMB; 5. Disability living allowance: RMB; 6. Disability appliance fee: RMB; 7. Funeral expenses: RMB; 8. Living expenses of dependents: RMB; 9. Transportation fee: RMB; 10. Accommodation fee: RMB; 1 1, mental damage compensation: yuan; 12. Transportation expenses, lost time and accommodation expenses required by spouses and immediate family members of patients who died and participated in funeral activities: RMB (no more than 2 persons) Total: RMB compensation payment time: other liabilities for breach of contract 1. Discharge treatment: 2. Disposal of dead patients' bodies; 3. The other agreements mentioned above shall come into effect after being signed or sealed by both parties. Party A: Party B: Agent: Agent: Date: Witness: Date: II Medical Dispute Mediation Agreement Party A: Hospital Party B (patient or patient's close relative): Patient's basic information: Name: gender: age: address: hospitalization number: After mediation, the hospital and the patient voluntarily reached the following compensation agreement on this medical dispute: Party A and Party B agree to clarify the causes and responsibilities of the dispute in case of failure to pass the appraisal. Party A voluntarily compensates Party B: Party A and Party B waive all litigation rights based on the medical dispute. Liability for breach of contract: this agreement ends the one-time handling of medical disputes, and neither party can go back on its word. If one party reneges, it shall pay RMB to the other party as liquidated damages. This agreement shall come into force after being signed and sealed by both parties. This agreement is made in duplicate, one for each party. Party A: Party B: To sum up, after a medical dispute between the parties or patients and the hospital, various injuries may be involved in the claim, which also shows that the hospital is indeed at fault and must bear the liability for compensation to the parties, and the compensation part should be determined in the form of documents after double-counter negotiation.