癲癇免責協(xié)議書范文完整版

癲癇免責協(xié)議書范文完整版

甲方（提供方）：_____________________

地址：_________________________________

法定代表人：____________________________

職務(wù)：_________________________________

乙方（接受方）：_____________________

地址：_________________________________

身份證號碼：____________________________

聯(lián)系電話：____________________________

電子郵箱：____________________________

鑒于甲方提供特定服務(wù)/產(chǎn)品，乙方參與/使用該服務(wù)/產(chǎn)品，為明確雙方權(quán)利義務(wù)，保護雙方合法權(quán)益，雙方本著平等自愿的原則，經(jīng)協(xié)商一致，就乙方因自身疾?。òd癇）可能引起的風險和責任免除事宜，達成如下協(xié)議：

第一條定義

1.1“服務(wù)/產(chǎn)品”指由甲方提供給乙方的特定服務(wù)/產(chǎn)品。

1.2“癲癇”指乙方已知的醫(yī)學(xué)狀況，可能在任何時間、任何地點突然發(fā)作，導(dǎo)致乙方失去意識或行為能力受限。

第二條乙方聲明

2.1乙方確認已充分了解自身健康狀況，特別是癲癇疾病可能帶來的風險和后果。

2.2乙方聲明在簽訂本協(xié)議前，已向甲方充分披露自身癲癇狀況，并已獲得專業(yè)醫(yī)療人員的建議。

2.3乙方承諾在參與/使用服務(wù)/產(chǎn)品期間，將采取一切必要措施以減少疾病發(fā)作的風險，包括但不限于按時服藥、避免誘發(fā)因素等。

第三條甲方聲明

3.1甲方確認已充分了解乙方的健康狀況，并已采取合理措施以降低乙方疾病發(fā)作的風險。

3.2甲方承諾在乙方參與/使用服務(wù)/產(chǎn)品期間，提供必要的協(xié)助和支持，包括但不限于緊急情況下的救助。

第四條責任免除

4.1乙方明確知曉并同意，由于自身癲癇疾病可能在任何時間、任何地點突然發(fā)作，導(dǎo)致乙方自身或第三方人身、財產(chǎn)損害的，甲方不承擔任何責任。

4.2乙方同意，因乙方癲癇疾病發(fā)作導(dǎo)致的任何損失或損害，甲方不承擔賠償責任，乙方放棄對甲方的一切追索權(quán)。

第五條緊急情況處理

5.1甲方應(yīng)在乙方癲癇發(fā)作時提供必要的緊急救助，并協(xié)助聯(lián)系專業(yè)醫(yī)療人員。

5.2乙方應(yīng)向甲方提供緊急聯(lián)系人信息，并確保在緊急情況下能夠及時聯(lián)系。

第六條協(xié)議的變更和解除

6.1本協(xié)議一經(jīng)雙方簽字蓋章后生效，未經(jīng)雙方書面同意，任何一方不得擅自變更或解除本協(xié)議。

6.2如遇不可抗力因素導(dǎo)致本協(xié)議無法履行，雙方應(yīng)協(xié)商解決；協(xié)商不成的，本協(xié)議自動解除。

第七條爭議解決

7.1本協(xié)議在履行過程中如發(fā)生爭議，雙方應(yīng)通過友好協(xié)商解決；協(xié)商不成的，可向甲方所在地人民法院提起訴訟。

第八條其他

8.1本協(xié)議一式兩份，甲乙雙方各執(zhí)一份，具有同等法律效力。

8.2本協(xié)議未盡事宜，雙方可另行簽訂補充協(xié)議。

甲方（蓋章）：_________________乙方（簽字）：_________________

法定代表人（簽字）：________________日期：____年____月____日

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