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["安徽财贸职业学院参保大学生普通门诊医疗费报销汇总表"]
["学院：",null,null,"班级：",null,"经办人：",null,"填表时间："]
["序号","姓名","性别","学号","校内医疗费\n合计金额","校外医疗费\n合计金额","申请报销\n总金额","实报金额","备注"]
{"$rows_empty":27}
["合计","——","——","——","——","——"]
["辅导员\n初审意见",null,"                            签名：\n                                              年     月   日"]
["学生处\n审核意见",null,"                            签章：\n                                              年     月   日"]
["卫生室\n审核意见",null,"                            签章：\n                                              年     月   日"]
["财务处\n审核意见",null,"                            签章：\n                                              年     月   日  "]
["报销要求：\n   1.班级指定一名经办人统一办理报销手续，负责整理报销材料、填写每人申请报销金额。在校外指定医院就医的，本人须提供医院病历、门诊医疗费发票、校外门诊转诊单等相关报销材料。\n   2.班主任和学生处审核参保学生名单，卫生室审核医药费报销范围，财务处核定每人医药费实报金额。         "]