Responsibility book for discharged inpatients

Because of the potential safety hazard when patients leave the hospital, accidents or even deaths occur outside the hospital, which not only increases the pain and burden of patients and their families, but also leads to medical disputes. It is of great significance to sign the discharge responsibility book for inpatients, so as to clarify the discharge responsibility of inpatients and avoid risks reasonably. I've compiled some discharge responsibility letters for inpatients for you. I hope you like them.

Responsibility Letter for Inpatients' Discharge (Part One)

Name:

Gender:

Age:

Don't:

Bed number:

Hospitalization number:

I was admitted to the ward bed of xxxXX Hospital on XX, XX. I am in hospital, and my condition has not recovered steadily. The responsible medical staff has publicized the rules that the hospital should abide by to me and my relatives, emphasized the reasons why I can't go out or go out during my hospitalization, and explained to us the possible consequences of leaving the hospital without authorization, such as:

1, accidental injury outside the hospital;

2, the condition aggravation, deterioration, serious complications, infection, bleeding, etc.

3. sudden death;

4. Other serious and unforeseeable accidents.

In view of the above situation, I, my family members and guardians (18 years old or older) are willing to abide by the regulations of the hospital and bear all possible consequences after discharge, which has nothing to do with the inpatient department and the hospital. Special signature is the foundation.

Contact telephone number:

Patient signature:

Signature of family members and guardians:

Relationship with patients:

Year month day hour

The second part of inpatient discharge responsibility book

Department:

Bed number:

Name:

Diagnosis:

I went to bed in 2007. I am in the hospitalization stage, and my physical condition is not stable and healthy. The medical staff in charge publicized the rules that residents should abide by to me and my relatives, emphasized the reasons why they could not go out during hospitalization, and explained to us the possible consequences of leaving the hospital without authorization.

For example:

1, accidental injury outside the hospital;

2, the condition aggravation, deterioration, serious complications, infection, bleeding, etc.

3. sudden death;

4. Other serious and unforeseen accidents;

5, medical insurance and commercial insurance patients discharged from hospital caused by hospitalization expenses will not be reimbursed.

In view of the above situation, I, my family members and guardians (1under 8 years old) are willing to abide by the hospital regulations and bear all possible consequences after discharge, which has nothing to do with the ward and the hospital. Special signature is proof.

Contact telephone number:

Patient signature:

Signature of family members and temporary guardians:

Relationship with patients:

Year month day hour

Responsibility Letter for Inpatients' Discharge (III)

Name:

Department:

Bed number:

Hospitalization number:

Diagnosis:

I was admitted to the ward bed of xx Hospital and was in the hospitalization stage. My condition has not stabilized and recovered. The responsible medical staff has informed me and my relatives of the hospital's regulations on inpatients, emphasized the reasons why I can't go out or go out during my hospitalization, and explained to us the possible consequences of leaving the hospital without authorization, such as:

1, accidental injury outside the hospital;

2, the condition aggravation, deterioration, serious complications, infection, bleeding, etc.

3, the condition changes, can not be diagnosed and treated in time, there are serious complications, and even sudden death; May lose the best opportunity for diagnosis and treatment because of going out; May lose the effect of the original treatment.

4, patients with indwelling catheter fall off, adverse drug reactions can not be found in time, disease precautions can not be informed in time to patients and their families, patients accidentally take drugs outside the hospital, resulting in adverse consequences.

5. There may be accidents other than medical treatment, such as personal accidental injury or even life-threatening, personal property loss.

6. All kinds of medical insurance, commercial insurance and rural cooperative medical care caused by the patient's discharge were refused reimbursement.

In view of the above situation, I, my family members and guardians (18 years old or older) are willing to abide by the regulations of the hospital and bear all possible consequences after discharge, which has nothing to do with the inpatient department and the hospital. Special signature is the foundation.

Contact telephone number:

Patient signature:

Signature of family members and guardians:

Relationship with patients:

Signature of competent doctor:

Year month day hour

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