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["永州市冷水滩区城乡医疗临时救助申请审批表"]
["         街道（乡镇）",{"$nulls":4},"            社区居委会（村）         组      ",{"$nulls":6},"时间:    年  月  日"]
["姓名",{"$nulls":3},"性别",null,"年龄",null,"家庭人口",null,"属别","五保户（三无人员）"]
[{"$nulls":11},"低保户"]
[{"$nulls":11},"边缘户"]
["患病    种类",{"$nulls":4},"个人承担费用",null,null,"低保（五保）存折号"]
[{"$nulls":8},"身份证号码"]
["本人申请"]
[{"$nulls":11},"申请人："]
["审                                                                                  批意见","社区居委会（村）意见",null,"  经调查，该人患           病，                                                                                                                                           ",{"$nulls":5},"街道办 事处、 （乡镇）人民政府意见",null,"   经核实，该人患       病，           "]
[{"$nulls":3},"个人承担医疗费            元，",{"$nulls":7},"个人承担医疗费          元，"]
[{"$nulls":3},"造成生活困难，建议救助。",{"$nulls":7},"造成生活困难，建议救助。"]
[{"$nulls":3},"单位签章：",{"$nulls":7},"   单位签章：                                     "]
[{"$nulls":3},"负责人签字：",{"$nulls":7},"   负责人签字："]
[{"$nulls":3},"             年  月  日 ",{"$nulls":7},"              年  月  日 "]
[null,"区民政局社会救助工作管理局审批意见",null,"     该人因患         病种，个人承担医疗费       元， 根据《 冷政办发                                               "]
[{"$nulls":3},"[2009]22号文件》精神，从       年城乡医疗临时救助资金中救助       元。"]
[]
[{"$nulls":3},"     区社会救助工作管理局签章 ：                                                                                                           "]
[{"$nulls":3},"     负责人签字："]
[{"$nulls":3},"                                           年    月    日 "]
["注：1、申请人需提供诊断证明书，住院发票或新农合、医保结算单（原件），身份证、家庭户口、低保   （五保）证、低保（五保）存折卡（复印件）。"]
["2、此表必须认真属实填写，不能涂改，不能用圆珠笔填写。"]
[]
[]
[]
[{"$nulls":11},0.2]
[{"$nulls":11},0]

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