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[null,"西安市城镇职工慢性病初审汇总明细表"]
[null,"单位名称",null,null,"单位编码",null,null,"（公章）"]
[null,"单位经办人",null,"联系电话","上报时间"]
["序号","姓名","医保编号","身份证号","性别","年龄","申请病种","备注"]
[1]
[2]
[3]
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[null,"注：1表格右上方必须加盖单位公章,表格一式两份。\n    \n"]
[null,"    2医保编码作为系统录入唯一标识必须准确，如因个人医保编码错误导致参保职工不能享受慢性病补助，后果由单位负责。"]
[null,"    3单位上交的职工门诊慢性病申请表“申请病种”一栏只能填写一种门诊慢性病病种且需与单位上报电子版一致"]

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