Application for handling medical malpractice disputes
Serial number:
Relationship between patient ID number and patient
The relationship between the applicant's name, ID number and patient.
Gender address
Age unit
National contact telephone number
Application time
Name of medical institution
Address of medical institution
Relevant facts:
Reason for request:
Specific requirements:
Note: Patients and their families should fill in this form when applying to the health administrative department for medical malpractice dispute settlement.
TLB team won by 37 to 2.
Attachment: Precautions for Filling in the Application for Handling Medical Accident Disputes (TLB-37- 1/2)
1, as specified by the applicant:
When the patient applies, if the living applicant should be the patient himself, you must show the original and copy of my identity certificate; If the patient is incapacitated, the applicant should be the legal agent and guardian of the patient, and you should show the original and photocopy of the patient's identity certificate and the patient's power of attorney (with your own signature or fingerprint/seal); If the patient dies, the applicant should be a close relative of the deceased patient. Ask the applicant to issue a certificate to prove your relationship with the patient's close relatives, such as the household registration book or the certificate issued by the people's political commissar/public security department.
At the time of application, the medical institution shall issue an application form issued by the legal representative of the medical institution, a copy of the practice license of the medical institution, a power of attorney of the agent, a copy of the ID card of the legal person and the agent, and a copy of the first page of the patient's inpatient medical record.
2. The applicant should fill in this form with respect for facts and science.
3. This form must be filled in with pen or signature pen, and no items shall be omitted. To send a registered letter, you must fill in the mailing address in detail.
4 "Relevant facts" should explain the incident in detail and specifically, especially the diagnosis and treatment process related to medical malpractice disputes. The facts are clear, the evidence is conclusive and justified, and a page can be attached if necessary.
5 "reasons for the request" should clarify the legal basis and medical principles of the specific request.
6. "Specific requirements" can be: "Questioning the diagnosis and treatment process; Whether it is a medical accident; What the applicant wants to achieve, such as dealing with the wrong party. "
7. If the time from the occurrence of a medical dispute to the filing of an application has exceeded 1 year, the original and photocopy of the written materials that can prove that he "knew or should have known that his body was injured within 1 year" must be produced.
8. Please submit the original and photocopy of outpatient registration receipt or hospitalization settlement receipt, outpatient medical record or any other supporting materials that can prove the doctor-patient relationship between you and the medical institution on the day of medical dispute.
9. The administrative department of health can't accept a lawsuit brought by you to the people's court for medical malpractice disputes. Please continue the judicial process to resolve the dispute.
10. The administrative department of public health shall conduct a review within 10 days from the date of receiving the applicant's Application for Handling Medical Accident Disputes, and make a written reply on whether to accept it or not.
2) If you question the hospital's diagnosis and treatment process; Whether it is a medical accident, you can apply for medical accident technical appraisal, and how to apply for medical accident technical appraisal?
In the process of dealing with medical disputes, it is often inevitable to determine whether it belongs to medical accidents and what nature the accidents belong to. Therefore, the technical appraisal of medical malpractice is an important step to deal with medical disputes. For patients and their families, hospitals and medical staff, it is necessary to be very clear about the provisions of technical appraisal of medical accidents. Not only patients and their families can put forward accident identification, but also hospitals or medical staff can put forward accident identification.
How do patients and their families apply for technical appraisal of medical malpractice? First of all, we must clarify the following issues:
(1) To apply for technical appraisal of medical malpractice, you must give a clear answer to the nature of the dispute after asking the hospital to investigate and handle it. If the patients and their families are not satisfied with the hospital's reply, and the two sides cannot reach an understanding on the aftermath, they can formally submit it. It is not appropriate to apply directly from the beginning.
(2) To know whether the hospital involved in the dispute has the qualification of medical accident technical appraisal. Generally speaking, provincial hospitals and affiliated hospitals of medical colleges can set up medical malpractice technical appraisal committees with the approval of provincial health administrative departments. For these hospitals, if the hospital's reply to patients and their families is only from the hospital's administrative point of view, then it is necessary to apply to the hospital's medical malpractice technical appraisal Committee first. For city and county hospitals, the appraisal committee is generally located in the city and county health bureau, so it is necessary to apply to the city and county health bureau.
③ Patients and their families should know that it is their right to apply for technical appraisal of medical malpractice. As long as the application is made in accordance with the prescribed procedures, the health administrative department (including provincial hospitals with a first-class medical accident technical appraisal committee) has no right to refuse this legal request of patients and their families, otherwise the patients and their families can put the health administrative department in the dock of administrative litigation.
(4) Patients and their families should understand that applying for technical appraisal of medical malpractice only results in whether it belongs to medical malpractice, what kind of medical malpractice it belongs to, and who will bear the responsibility for medical malpractice. According to the Measures for Handling Medical Accidents, only those that "directly cause the patient's death, disability and dysfunction" can be called medical accidents. For the problems, defects and even general faults of medical personnel that do not necessarily constitute accidents in the medical process, it is not appropriate to formally apply for appraisal. Therefore, patients and their families can consult relevant professional doctors, listen to their analysis opinions and consult relevant departments before putting forward the accident identification, so as to make things better.
⑤ It is most appropriate to ask for technical appraisal of medical malpractice or hand it over to the local health administrative department for handling, after many unsuccessful consultations with the hospital. According to the author's experience, if the main purpose of patients and their families is to obtain financial compensation, it is better to negotiate with the hospital. Under normal circumstances, the compensation amount of the hospital is greater than the second economic compensation amount awarded by the health administrative department and higher than the economic compensation amount awarded by the court. Therefore, patients and their families should fully weigh their demands, negotiate patiently and be reasonable.
6. In some cases, it is inevitable to apply for technical appraisal of medical malpractice, but at this time, an application report should be written according to the facts.
⑦ Technical appraisal of medical malpractice can be divided into application appraisal and entrustment appraisal. The so-called "application for appraisal" means that when medical disputes intensify and patients and their families are unwilling to apply for appraisal, not only patients and their families can apply to the medical accident technical appraisal Committee, but hospitals can also request appraisal as applicants. Or when the medical personnel (i.e., the parties) refuse to accept the qualitative treatment of medical disputes by the hospital, the medical personnel themselves or several parties may also put forward appraisal requirements as applicants. The other is "entrusted appraisal", which usually means that after the health administrative department accepts complaints from patients and their families, or when the people's court considers it necessary to conduct technical appraisal of medical accidents, it can entrust the medical accident technical appraisal Committee to conduct appraisal. The treatment procedures vary from place to place, and some provinces, municipalities directly under the central government and autonomous regions stipulate that the health administrative department should conduct technical appraisal before accepting it. However, for the people's court, medical malpractice identification cannot be used as a prerequisite for accepting the prosecution of patients and their families.
How to write the application report of medical malpractice appraisal? What does the application report include? The format is as follows, for reference only:
Title of application report: generally, the format of "XXX application for technical appraisal and treatment of medical accidents" can be adopted, and XXX represents the patient's name.
Unit accepting application: full name of local health administrative department (or provincial hospital).
Foreword of application report: Briefly describe that XXX Hospital (or including XXX medical staff) caused some serious consequences to patient XXX for some reasons (such as irresponsibility, negligence, violation of operating procedures, etc.). In the process of diagnosis and treatment, it is hereby required to conduct technical appraisal of medical accidents and deal with them seriously. The process of medical malpractice: explain the patient's illness process, admission examination and diagnosis and treatment process concisely, to the point, in detail and accurately, especially the key links of medical malpractice.
The basis of medical malpractice accusation: the main faults of hospitals and medical personnel and their evidence.
Conclusion: It is necessary to make it clear that the above situation is true, safeguard the legitimate rights and interests of patients and their families, and require the health administrative department to handle medical accidents promptly, correctly and fairly. Applicant: patient's signature. If the patient has died, an application should be made by the immediate family. If there are multiple applicants, it must be clear who is the contact person.
Date of application.
Attachment: copies of relevant materials (originals cannot be submitted, only when necessary). If you are not satisfied with the appraisal conclusion of the technical appraisal committee of medical malpractice at the next higher level, you must attach the original appraisal book when you propose a new appraisal to the appraisal committee at the next lower level. In addition, a letter of introduction from the applicant's unit or street can be attached to provide proof of the applicant's identity. If there are witnesses and testimony, the name, work unit or home phone number of the witness shall be stated. It is best to have a copy of the written testimony of the witness to prove the time, place and facts of the accident, and the witness should sign and press the fingerprint. Family members who contact the public security, courts and other departments to conduct forensic autopsy shall indicate the unit that commissioned the autopsy.
References:
/Article/ 125/ 14 1/2005/ 10/ 16/2005 10 1635425 . html
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