How to write the consent form for reimbursement of discharged new rural cooperative medical system?

1. Write "NCMS reimbursement agreement after discharge" as the title on the paper, and write down the name, address and contact information of the hospital.

2. Write down the patient's name, ID number and hospitalization number, and record the date and time of the patient's discharge.

3. Briefly describe the patient's disease and treatment process, including main symptoms, diagnosis and medical operation.