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1、定点医疗机构申请书申请单位乌鲁木齐市水磨沟区李晶诊所 申请时间2012-3-11新疆维吾尔自治区劳动和社会保障局印制ofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".IsamustadheretotheindividualabsorptionTheprincipleofthedevelopmentofamatureone,andstrictlyperformintheadmissionproce
2、dure,topreventthePartymember单位名称机构代码法人代表所有制形式机构类别医院等级邮政编码单位地址基本医疗保险管理部门执业许可证号联系人联系电话单位开户银行银行帐号卫生技术人员构成小计高级职称中级职称初级职称医生护士医技人员其他人员合计ofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".IsamustadheretotheindividualabsorptionTheprincipleo
3、fthedevelopmentofamatureone,andstrictlyperformintheadmissionprocedure,topreventthePartymember科室设置及病床数科室床位数科室床位数科室床位数申请内容（申请单位印章）法人代表签字： 年月日部门审查意见社会保险行政年月日ofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".Isamustadheret
4、otheindividualabsorptionTheprincipleofthedevelopmentofamatureone,andstrictlyperformintheadmissionprocedure,topreventthePartymemberofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".IsamustadheretotheindividualabsorptionTheprincipleo
5、fthedevelopmentofamatureone,andstrictlyperformintheadmissionprocedure,topreventthePartymember示范文本：惠州市城镇职工基本医疗保险定点医疗机构申请书申请单位：惠州市第九人民医院申请时间 2004年5月21日惠州市劳动和社会保障局印制ofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".Isamustadheretothei
6、ndividualabsorptionTheprincipleofthedevelopmentofamatureone,andstrictlyperformintheadmissionprocedure,topreventthePartymember单位名称惠州市第九人民医院机构代码GB42354985432法人代表林国维所有制形式集体机构类别医疗医院等级二级邮政编码516001单位地址惠州市江北云山东路19号基本医疗保险管理部门惠州市劳动和社会保障局执业许可证号441321546887246联系人李少华联系电话2813458单位开户银行中国银行惠州
7、分行银行帐号10894242235648卫生技术人员小计高级职称中级职称初级职称ofwork,relationships,needandpossibility,putqualityfirst."Improvestructure",referspartycarefully".IsamustadheretotheindividualabsorptionTheprincipleofthedevelopmentofamatureone,andstrictlyperformintheadmissionprocedure,topreventthePartymem
8、ber构成医生106392063护士130263552医技人员69122130其他人员46101010合计3
