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["办事处救助慰问活动医疗费用发票明细汇总表"]
["申领人姓名："]
["发票序号","发票类型","票据号码","票据日期","自费金额","备注"]
["1"]
["2"]
["3"]
["4"]
["5"]
["6"]
["7"]
["8"]
["9"]
["10"]
["11"]
["12"]
["13"]
["14"]
["15"]
["16"]
["17"]
["18"]
["19"]
["20"]
["合计",null,"","",null,""]
["填报说明：","1.发票须按照日期前后顺序排列并标号；2.发票类型分为住院、门诊、急诊、购药；3.票据日期中，住院类发票填写入出院日期，门、急诊类发票填写就诊日期，购药类发票填写支付日期；4.自费金额是指个人账户支付与个人现金支付之和；5.最终申领金额以中互会兰办审核计算金额为准。"]

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