媽媽為救他簽下協(xié)議書(shū)英語(yǔ)

媽媽為救他簽下協(xié)議書(shū)英語(yǔ)

AgreementforMedicalTreatmentandCare

ThisAGREEMENTismadeandenteredintothis___________dayof___________,20______,byandbetween:

1._____________(hereinafterreferredtoas"Mother"),aresidentof_____________,whoseaddressis_____________(hereinafterreferredtoas"Mother'sAddress");

2._____________(hereinafterreferredtoas"Child"),aminor,whoseaddressis_____________(hereinafterreferredtoas"Child'sAddress");

3._____________(hereinafterreferredtoas"MedicalProvider"),adulylicensedmedicalprovider,whoseaddressis_____________(hereinafterreferredtoas"Provider'sAddress").

WHEREAS,Childisinneedofmedicaltreatmentandcare;

WHEREAS,Mother,beingthelegalguardianofChild,desirestoensurethatChildreceivesthenecessarymedicaltreatmentandcare;

WHEREAS,MedicalProvideriswillingtoprovidethenecessarymedicaltreatmentandcaretoChild;

NOW,THEREFORE,inconsiderationofthemutualcovenantsandagreementssetforthherein,andforothergoodandvaluableconsideration,thereceiptandsufficiencyofwhichareherebyacknowledged,thepartiesagreeasfollows:

Article1:ScopeofTreatment

1.1TheMedicalProvidershallprovidetoChildthemedicaltreatmentandcareasspecifiedintheattachedScheduleA(hereinafterreferredtoas"TreatmentPlan").

1.2TheTreatmentPlanshallinclude,butnotbelimitedto,thefollowingservices:_____________.

1.3TheMedicalProvidershallhavetherighttoamendtheTreatmentPlanasdeemedmedicallynecessary.

Article2:Consent

2.1MotherherebygivesherfullandirrevocableconsenttotheMedicalProvidertoprovidethemedicaltreatmentandcaretoChildasoutlinedintheTreatmentPlan.

2.2Motheracknowledgesthatshehasbeenfullyinformedofthenature,risks,andbenefitsofthemedicaltreatmentandcaretobeprovidedtoChild.

Article3:Payment

3.1MotheragreestopaytheMedicalProviderforthemedicaltreatmentandcareprovidedtoChildaspertheattachedScheduleB(hereinafterreferredtoas"PaymentSchedule").

3.2ThePaymentScheduleshallspecifytheamountsdue,theduedates,andthemethodofpayment.

3.3Intheeventofanydelayinpayment,Motheragreestopayinterestattherateof_____________perannumontheoutstandingbalance.

Article4:Confidentiality

4.1TheMedicalProvideragreestomaintaintheconfidentialityofallmedicalrecordsandinformationpertainingtoChild.

4.2MotherandChildagreenottodiscloseanyconfidentialinformationobtainedfromtheMedicalProviderwithoutpriorwrittenconsent.

Article5:Termination

5.1ThisAgreementmaybeterminatedbyeitherpartyupon_____________days'writtennoticetotheotherparty.

5.2Intheeventoftermination,MothershallremainliableforallpaymentsdueandowingtotheMedicalProvideruptothedateoftermination.

Article6:GoverningLaw

6.1ThisAgreementshallbegovernedbyandconstruedinaccordancewiththelawsoftheStateof_____________.

Article7:EntireAgreement

7.1ThisAgreementconstitutestheentireagreementbetweenthepartiesandsupersedesallpriornegotiations,representations,andagreements.

Article8:Amendments

8.1ThisAgreementmaynotbeamendedexceptbyawritteninstrumentsignedbybothparties.

Article9:Severability

9.1IfanyprovisionofthisAgreementisheldtobeinvalidorunenforceable,theremainingprovisionsshallremaininfullforceandeffect.

Article10:Notices

10.1AllnoticesrequiredorpermittedunderthisAgreementshallbeinwritingandshallbedeemedtohavebeengivenwhendeliveredtotheaddresssetforthinthisAgreement.

Article11:Waiver

11.1Thewaiverbyeitherpartyofabreachordefaulthereundershallnotbedeemedawaiverofanyprecedingorsubsequentbreachordefault.

Article12:SuccessorsandAssigns

12.1ThisAgreementshallbebindinguponandinuretothebenefitofthepartiesheretoandtheirrespectivesuccessorsandassigns.

Article13:Headings

13.1TheheadingsusedinthisAgreementareforconvenienceonlyandshallnotaffecttheconstructionorinterpretationofthisAgreement.

INWITNESSWHEREOF,thepartieshaveexecutedthisAgreementthedayandyearfirstabovewritten.

Mother:_____________

Signature:_____________

Date:_______