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1、###市医患纠纷人民调解委员会调解卷宗卷名：卷号：人民调解员：调解日期：立卷人:立卷时间：保管期限：备注：ofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".IsamustadheretotheindividualabsorptionTheprincipleofthedevelopmentofamatureone,andstrictlyperformintheadmissionprocedure,topreventthePartyme
2、mber卷内目录序号文书名称页号备注1医患纠纷人民调解申请书或医患纠纷人民调解受理登记表2医患纠纷人民调解调查记录3医患纠纷人民调解证据材料4医患纠纷人民调解记录5医患纠纷人民调解协议书或医患纠纷人民调解口头协议登记表6医患纠纷人民调解回访记录7司法确认有关材料8卷宗情况说明9封底ofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".IsamustadheretotheindividualabsorptionTheprincipleof
3、thedevelopmentofamatureone,andstrictlyperformintheadmissionprocedure,topreventthePartymember医患纠纷人民调解申请书申请人姓名性别民族年龄职业或职务联系方式单位或住址被申请人姓名性别民族年龄职业或职务联系方式单位或住址医患纠纷简要情况当事人申请事项1、2、3、医患纠纷人民调解委员会已将申请人民调解的相关规定告知我，现自愿申请医患纠纷人民调解委员会进行调解。申请人（签名盖章或按指印）年月日ofwork,relationships,needandpossibility,putquality
4、first."Improvestructure",referspartycarefully".IsamustadheretotheindividualabsorptionTheprincipleofthedevelopmentofamatureone,andstrictlyperformintheadmissionprocedure,topreventthePartymember医患纠纷人民调解受理登记表年月日，医患纠纷人民调解委员会依当事人申请（人民调解委员会主动调解），经当事人同意，调解、之间的医患纠纷。案件来源：①当事人申请②医患纠纷人民调解委员会主动调解医患纠纷简要
5、情况：当事人（签名）：登记人（签名）：医患纠纷人民调解委员会年月日ofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".IsamustadheretotheindividualabsorptionTheprincipleofthedevelopmentofamatureone,andstrictlyperformintheadmissionprocedure,topreventthePartymember医患纠纷人民调解调查记录时间地点
6、参加人被调查人记录调查人（签名）被调查人（签名）记录人（签名）ofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".IsamustadheretotheindividualabsorptionTheprincipleofthedevelopmentofamatureone,andstrictlyperformintheadmissionprocedure,topreventthePartymember医患纠纷人民调解记录时间地点当事人参
7、加人医患纠纷人民调解委员会已将人民调解的相关规定告知各方当事人。调解记录调解结果：1、调解成功；2、调解不成；3、有待继续调解当事人（患方）：当事人（医方）：医患纠纷人民调解员：记录人：年月日ofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".IsamustadheretotheindividualabsorptionTheprincipleofthedevelopmento
