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[]
["附件2"]
["2026年度市属离休人员变更定点医疗、医护机构备案表"]
[]
["单位代码："]
["单位名称（章）：                                    年   月   日                                    主管部门 ："]
["序号","姓名","性别","身份证号码（18位）","门诊定点医疗机构","住院定点医疗、医护机构","是否选择个人账户金     （仅限原市直公费医疗离休人员填写）   ","农行账号         （仅限原市直公费医疗离休人员中选择要个人账户金的填写）","异地安置      是“√”","联系电话"]
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["负责人：                                                                            　    经办人：                                             　　　　　　    联系电话："]
["说明：1、门诊定点医疗机构指离休人员可以从个人账户金中支付就医的定点医疗机构。"]
["      2、住院定点医疗机构指离休人员门诊、住院和个人账户金用完后就医的定点医疗机构。"]
["      3、门诊和住院定点医疗机构可选同一所医疗机构，也可选不同的医疗机构（原市直公费医疗离休人员选择不要个人账户金的，门诊和住院定点医疗机构只能选择同一家）。"]