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苏州市社区居民家庭医生服务合约(2012年)

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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.1//EN" "http://www.w3.org/TR/xhtml11/DTD/xhtml11.dtd"><html xmlns="http://www.w3.org/1999/xhtml"><head><meta http-equiv="Content-Type" content="application/xhtml+xml; charset=utf-8" /><title></title><style type="text/css">body{ font-family:'Times New Roman'; font-size:1em; } ul, ol{ margin-top: 0; margin-bottom: 0; } .Normal{page-break-inside:auto;page-break-after:auto;page-break-before:auto;margin-top:0.0pt;margin-bottom:0.0pt;margin-left:0.0pt;text-indent:0.0pt;border-top-style: none;border-left-style: none;border-right-style: none;border-bottom-style: none;font-size:12.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';} .Default-Paragraph-Font{font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';} .Table-Normal{} .Table-Grid{} </style></head><body style="pagewidth:595.3pt;pageheight:841.9pt;"><div class="Section0"><div style="min-height:72pt" /> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">发文名</span><span style="font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">称</span><span style="font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;: </span><span style="color:#000000;font-size:12.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;">苏州市卫生局关于下发《苏州市基层医疗卫生机构深入开展家庭医生制度和农村健康管理团队服务的实施方案》的通</span><span style="color:#000000;font-size:12.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;">知</span><span style="color:#000000;font-size:12.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;">&nbsp;&nbsp;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;font-size: 12pt;"><span style="color:#000000;font-size:12.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;">&#xa0;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;font-size: 12pt;"><span style="color:#000000;font-size:12.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;">&#xa0;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;font-size: 12pt;"><span style="color:#000000;font-size:12.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;">&#xa0;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;font-size: 12pt;"><span style="color:#000000;font-size:12.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;">&#xa0;</span></p> <p class="Normal" style="text-align:right;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">编号:</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  甲方(家庭成员):</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  家庭地址:                   联系电话:</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  乙方(家庭医生):               联系电话:</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  丙方:苏州市社区卫生服务中心(站)</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  为了保障社区居民身体健康,提高社区居民健康生命质量,充分发挥居民健</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">康</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">“</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">守门</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">人</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">”</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">的作用,社区卫生将以满足居民基本健康服务需求为服务理念,用家庭医生服务的模式,提供医疗、预防、保健、康复、健康教育、计划生育指导等有效、方便、经济、综合的卫生保健服务。本</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">着</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">“</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">平等自主,互相尊</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">重</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">”</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">的原则,乙方自愿聘请甲方为自己的家庭医生,甲方愿意为乙方提供相应的健康管理服务,丙方为甲方在对乙方服务过程中提供相关支持和保障。经三方协商,签订以下服务协议:</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  一</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">乙方为甲方提供以下签约服务</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、建立居民健康档案服务。建立居民健康档案,并根据居民个人健康信息,每年对其进</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">行</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">次健康状况评估,制订个性化的健康计划,使居民及时了解自身健康状况。并及时更新,保证健康档案资料的完整性和准确性,为档案隐私尽保护责任。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">2</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、健康教育和健康咨询服务。每季度至少发</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">放</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">份健教材料;每月组织一次健康教育讲座,普及健康知识,开展健康咨询。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">3</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">7</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">岁以下儿童健康管理服务。为适龄儿童提供第一类疫苗接种服务;为新生儿提供家庭访视,</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">为</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">7</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">岁以下儿童提供不少</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">于</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">次的健康管理、咨询指导服务。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">4</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、孕产妇保健管理服务。对孕妇提供不少</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">于</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">5</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">次孕期健康管理服务,为产妇提供产后访视</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">和</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">4</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">2</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">天健康检查;为育龄妇女提供优生优育、避孕节育等健康知识咨询和指导。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">5</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、老年人健康管理服务。每年</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">对</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">6</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">5</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">岁以上老年人提供健康咨询和指导服务不少</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">于</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">4</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">次。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">6</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、慢性病患者管理服务。为明确诊断的高血压</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">2</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">型糖尿病等慢性病患者进行治疗、行为干预、监测和健康评估,提供定期随访、用药指导、健康教育及咨询等服务,每季度不少</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">于</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">次。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">7</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、精神疾病患者管理服务。对居家知情同意的重性精神疾病患者提供随访、康复指导服务,对患者家属进行培训,每季度不少</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">于</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">次;每年提</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">供</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">次健康体检。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">8</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、传染病管理。对居家医学观察的传染病密切接触者提供预防指导。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">9</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、咨询服务。对在健康管理中发现问题的,及时给予医学指导或转诊建议。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">0</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、转诊和预约服务。优先提供三级医院转诊和预约服务。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、上门服务。为行动不便、确有需要的签约居民,提供上门访视、家庭病床等服务。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;"> </span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">2</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、其他服务。根据居民健康需求,开展其他适宜基本医疗卫生服务。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  项</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">目</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">2</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">9</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">0</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">,向所有签约家庭成员提供,项</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">目</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">3</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">4</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">5</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">6</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">7</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">8</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">2</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">请根据签约家庭成员具体情况,在下方选择签约。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;&nbsp;3</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">□</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;&nbsp;4</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">□</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;&nbsp;5</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">□</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;&nbsp;6</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">□</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;&nbsp;7</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">□</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;&nbsp;8</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">□</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;&nbsp;1</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">1</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">□</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">&nbsp;&nbsp;1</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">2</span><span style="color:#000000;font-size:12.5pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';font-weight:normal;">□</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  二</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">服务收费和结算</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  项</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">目</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">1-1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">0</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">,由政府向乙方工作单位购买免费提供给甲方,项</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">目</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">11-1</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">2</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">及其他双方商定服务事项,由乙方根据物价部门的定价或双方协商后报物价部门备案确定。出诊、药品、检查等费用由乙方工作单位收取,出具收据。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  三</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">三方权利与义务</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  (一)甲方</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  甲方所有家庭成员自愿接受以上签约服务,并将身体健康状况及时、如实告知乙方,尊重乙方服务过程,配合卫生行政部门和社区卫生服务中心等对乙方签约服务工作的考核评估。按照双方约定,按时足额支付收费项目费用。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  (二)乙方</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  乙方应保护甲方的个人隐私,履行服务内容告知义务,主动提醒甲方接受服务,及时整理服务信息,保持服务的连续性、综合性、主动性。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  (三)丙方</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  丙方需加强对乙方的管理,并为乙方在对甲方服务过程中提供相关支持和后勤保障。督促乙方按协议做好相关工作。遇到甲乙两方的纠纷,丙方负责协商解决,或通过其他途径解决。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  四</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">协议有效期</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  本协议有效期为一年,从年月日至年月日止。协议期满,若甲方无异议,自动续约。如需解约,甲方需提前一月告知乙方,并签字确认,可申请重新选择家庭医生。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  五</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">甲方签约家庭成员和签约内容</span></p> <table cellspacing="0" style="border-collapse: collapse; width: 100%; "><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;">序号</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;">与签约人关系</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;">姓 名</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;">性别</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;">出生年月</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;">商定服务项目</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;">其他约定</span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';direction: ltr;">1</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';direction: ltr;">2</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';direction: ltr;">3</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';direction: ltr;">4</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';direction: ltr;">5</span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;"><p class="Normal" style="line-height:1.83;margin-right:0.0pt;direction: ltr;"><span style="font-size:9.0pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;direction: ltr;"> </span></p> </td></tr></table><p class="Normal" style="margin-right:0.0pt;direction: ltr;font-size: 12.5pt;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">&#xa0;</span></p> <p class="Normal" style="margin-right:0.0pt;direction: ltr;font-size: 12.5pt;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">&#xa0;</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">  六</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">、</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:bold;">&nbsp;&nbsp;</span><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">附则</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  (一)任何一方未履行本协议项下的义务均视为违约。遇不可抗力造成协议不能履行的,乙方不负责任。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  (二)本协议一式三份,甲乙丙三方各执一份。甲乙双方签字后生效。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  (三)未尽事宜甲乙双方协商处理。如发生争议,由丙方协调甲乙双方协商解决。协商不成,甲方可向当地卫生行政部门反映。</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  甲方代表签名:                       乙方(家庭医生)签名:</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  联系电话:                         服务电话:</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  家庭住址:                         丙方:(盖章)</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  签约时间:年月日</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  解约时间:年月日      </span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  解约原因:</span></p> <p class="Normal" style="text-align:left;line-height:22.0pt;margin-right:0.0pt;direction: ltr;"><span style="color:#000000;font-size:12.5pt;font-family:宋体;mso-fareast-font-family:宋体;mso-bidi-font-family:宋体;font-weight:normal;">  甲方确认:                         乙方确认:</span></p> </div></body></html>

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