XLS《农村公示》

,"长治县农村医疗救助申请审批表" ,,

"乡镇办",,

"村委会" ,"患者姓名",,

"性别",,

"年龄",,

"户主姓名",,

"家庭人口",,

, ,"身份证号",,

,,

"医保证号",,

,,

"救助","住院",,

"" ,"联系电话",,

,,

"低保证号",,

,,

"方式","门诊",,

"" ,"家庭住址",,

,,

"五保证号",,

,,

"申请救助对象类别","五保户",,

"" ,"申请救助理由"低保户",,

"" 低收入",,

"" 困难户",,

"" ,,

,,

,,

"申请人签名:",,

,,

"建档立卡贫困户",,

"" ,"患者建行账号"姓名",,

, ,"救助病种","住院总费用","不予补偿费用",,

,"参与补偿费用",,

"已补偿费用","起付线","参与救助费用",,

,"本年度第几次申请救助",,

,"上次救助金额",,

,,

"救助比例",,

,,

,,

"姓名","与户主关系",,

"婚姻状况",,

"身份证号码",,

"从事工作","身体状况","年收入", ,"家庭",,

"户主" ,"成员" ,"情况" ,"赡抚" ,"养人" ,"情况" ,"上年度家庭年总的纯收入/元",,

,,

,,

"上年度家庭年人均纯收入/元",,

,,

, ,"村居","经年月日入户调查,家庭有口人,上年度人均年收入为:元, ,"委会","家庭收入、财产符合{(五保)(低保)(低收入)(困难家庭)}标准.

,"调查","经民主评议,张榜公示.同意按{(五保)(低保)(低收入)(困难家庭)} ,"评估","对象,申请农村医疗救助. ,"意见","调查人:",,

,,

,"负责人:",,

"盖章","年月日",,

,"乡镇办","经年月日入户调查,核实其家庭收入、财产情况,确定该家庭年人" ,"入户调","均年收入为:元.可认定{(五保)(低保)(低收入)(困难)}家庭. ,"查审核","同意按{(五保)(低保)(低收入)(困难家庭)}对象申请表农村医疗救助. ,"意见","调查人:",,

,,

,"审核人:",,

"盖章","年月日",,

,"民政" ,"部门","根据乡镇办审核意见,经集体研究决定:同意",,

,,

,,

"认定该户为家庭.",,

,,

,"审批"支付医疗救助金:万仟佰元整.",,

,,

,"意见" ,,

"承办人:",,

"审核人:",,

,"审批人:",,

"盖章","年月日",,

," 附:

1、个人申请;

2、村委会出具的家庭经济(收入)状况证明;

3、家庭所有成员户口本复印件、身份证复印件;

4、家庭成员的收入证明;

5、出院证;

6、新农合住院补偿审核单原件;

7、新农合医疗证补偿记录复印件;

8、病人建行账号及存款凭条;

9、公示照片及无异议证明;

10、最新的低保、五保、建档立卡贫困户证明" ,"长治县城市医疗救助申请审批表" ,,

"乡镇办",,

"村(居)委会" ,"患者姓名",,

"性别",,

"年龄",,

"户主姓名",,

"家庭人口",,

, ,"身份证号",,

,,

"医保证号",,

,,

"救助","住院",,

"" ,"联系电话",,

,,

"低保证号",,

,,

"方式","门诊",,

"" ,"家庭住址"申请","其他",,

"" ,"申请"救助","低保户",,

"" ,"救助"对象","低收入",,

"" ,"理由",,

,,

,"申请人签名:",,

,"类别","困难户",,

"" ,"患者建行账号"姓名",,

, ,"救助病种","住院总费用","个人应付金额",,

,"自费医疗费用",,

"基金自付金额","起付线","参与救助费用",,

,"本年度第几次申请救助",,