Due to potential safety hazards for patients leaving the hospital, accidents or even deaths occur outside the hospital, which not only increases the pain and burden of patients and their families, but can also cause medical disputes. In order to clarify the responsibilities of inpatients for leaving the hospital and reasonably avoid risks, it is of great significance to sign a responsibility letter for inpatients to leave the hospital. I have compiled some hospital discharge responsibility letters for you, I hope you like them.
Inpatient Discharge Responsibility Letter Part 1
Name:
Gender:
Age:
Department Type:
Bed number:
Hospital number:
I was admitted to the ward bed of xxxxx Hospital on xx, xx, xx, and was in the stage of hospitalization. My condition has not yet stabilized and I have recovered. The medical staff in charge has informed me and my relatives about the hospital’s rules for inpatients, emphasized the reasons why we cannot go out or sleep outside during hospitalization, and explained to us the possible consequences of leaving the hospital without permission. Consequences, such as:
1. Accidental injuries outside the hospital;
2. Exacerbation, deterioration, serious complications, infection, bleeding, etc.;
3. Sudden death ;
4. Other serious and unpredictable unexpected situations.
After considering the above situation, I, my family and my guardian (over 18 years old) are willing to abide by the hospital regulations and are responsible for all consequences that may occur after leaving the hospital on my own. It has nothing to do with the inpatient department or the hospital. Special signature as proof.
Contact number:
Patient signature:
Family member and guardian signature:
Relationship with patient:
Year, month, day and hour
Inpatient Discharge Responsibility Letter Part 2
Department:
Bed Number:
Name:
p>Diagnosis:
I am in bed at the age of 18 and am in the stage of hospitalization. My condition is not yet stable and healthy. The doctors and nurses in charge have informed me and my relatives about the hospital’s requirements for inpatients. The system to be followed emphasizes the reasons why we cannot go out or sleep outside during hospitalization, and explains to us the possible consequences of leaving the hospital without permission.
For example:
1. Accidental injuries outside the hospital;
2. Exacerbation, deterioration, serious complications, infection, bleeding, etc.;
< p> 3. Sudden death;4. Other serious unforeseen accidents;
5. Hospitalization expenses caused by medical insurance and commercial insurance patients due to discharge from the hospital will not be reimbursed.
After considering the above situation, I, my family and my guardian (under 18 years of age) are willing to abide by the hospital regulations and are responsible for all consequences that may occur after leaving the hospital on my own, and have nothing to do with the ward or the hospital. Special signature as proof.
Contact number:
Patient’s signature:
Family member and temporary guardian’s signature:
Relationship with patient:
< p> Year, month, day and hourThree articles of inpatient discharge responsibility letter
Name:
Department:
Bed number:< /p>
Hospital number:
Diagnosis:
I was admitted to the ward bed of xx Hospital on the day of the year. I am in the stage of hospitalization and my condition has not yet stabilized and recovered. The supervisor The medical staff have informed me and my relatives about the hospital's rules that inpatients should abide by, emphasized the reasons why they cannot go out or sleep outside during hospitalization, and explained to us the possible consequences of leaving the hospital without permission, such as:
1. Accidental injuries outside the hospital;
2. Exacerbation, deterioration, serious complications, infection, bleeding, etc.;
3. Changes in condition and failure to receive timely diagnosis and treatment, Serious complications, etc., or even sudden death may occur; the best opportunity for diagnosis and treatment may be lost due to going out; the effects of the original treatment may be lost.
4. The indwelling catheter in the patient's body falls off, adverse drug reactions cannot be discovered in time, disease precautions cannot be notified to the patient and their family members in time, and patients accidentally take drugs outside the hospital, causing adverse consequences.
5. Unforeseen accidents other than medical treatment may occur, such as personal injury or even life-threatening injuries, and loss of personal property.
6. Various medical insurance, commercial insurance, rural cooperative medical care, etc. due to the patient's discharge from the hospital were refused reimbursement.
After considering the above situation, I, my family and my guardian (over 18 years old) are willing to abide by the hospital regulations and are responsible for all consequences that may occur after leaving the hospital on my own. It has nothing to do with the inpatient department or the hospital. Special signature as proof.
Contact number:
Patient signature:
Family member and guardian signature:
Relationship with patient:
Signature of the doctor in charge:
Year, month, day and hour
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