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["样   表"]
["医 药 费 报 销 材 料 清 单"]
["教工姓名：张三",null,"工号：000111",null,null,"电话："]
["儿童姓名：张小",null,"儿童病历号：2020001"]
["门诊就诊医院",null,"就诊病历(张、本)",null,"发票数量(张)",null,"转诊单(张)","备注"]
["江苏省中医院",null,4,null,2,null,1]
["南京市口腔医院",null,1,null,1,null,1]
[]
[]
[]
["住院医院",null,"费用明细单(张)",null,"出院小结(张)",null,"住院发票(张)"]
["江苏省人民医院",null,5,null,2,null,1]
[]
["注：儿童报销时请将父母及儿童信息填写完整。"]
[{"$nulls":5},"报销人签字：张三"]
[{"$nulls":5},"日期：2022.9.27"]
[]
[]
[]
["医 药 费 报 销 材 料 清 单"]
["教工姓名：",null,"工号：",null,null,"电话："]
["儿童姓名：",null,"儿童病历号："]
["门诊就诊医院",null,"就诊病历(张、本)",null,"发票数量(张)",null,"转诊单(张)","备注"]
[]
[]
[]
[]
[]
["住院医院",null,"费用明细单(张)",null,"出院小结(张)",null,"住院发票(张)"]
[]
[]
["注：儿童报销时请将父母及儿童信息一并填写完整。"]
[{"$nulls":5},"报销人签字："]
[{"$nulls":5},"日期："]

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