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["附件2"]
["长治市基本医疗保险定点医疗机构预付金核定表"]
[" "]
["定点医疗\n机构名称",null,null,"定点医疗机构编码",{"$nulls":3},"医疗机构\n级别"]
[]
["本地职工基本医疗保险基金累计结余可支付月数",{"$nulls":3},"本地居民基本医疗保险基金累计结余\n可支付月数"]
[]
["医保基金预付金额（万元）",null,"城镇职工基本医疗保险",null,"城乡居民基本医疗保险",{"$nulls":3},"合计"]
[]
[]
["市（县区）医保中心主任意见： \n\n  \n   \n       \n\n                     签章： \n                     \n                       年   月   日",{"$nulls":3},"市（县区）医保局意见：\n\n\n\n\n\n                      签章：\n                         \n                        年   月   日  "]
[]
[]
[]
["备注：本表一式两份。"]