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["附件2："]
["江门市工伤保险定点医疗机构住院费用审核明细表"]
["定点医疗机构名称（盖章）："]
["结算日期： 年 月 日—— 年 月 日",{"$nulls":9},"单位：元"]
[]
["序号","属地","参保号","姓名","住院号","入院日期","出院日期","住院天数","住院总费用","个人应支付额","本次基金应付额"]
["…"]
["…"]
["小计"]
["…"]
["…"]
["小计"]
["…"]
["…"]
["小计"]
["小计"]
[]
["经办人：",{"$nulls":3},"复核人："]
["日期：",{"$nulls":3},"日期："]

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["附件3："]
["江门市工伤保险定点医疗机构住院费用审核汇总表"]
["定点医疗机构名称（盖章）："]
["结算日期： 年 月 日—— 年 月 日",{"$nulls":5},"单位：元"]
[]
["属地","险种","人次","住院天数","住院总费用","个人应支付额","本次基金应付额"]
["市直","工伤保险"]
["蓬江","工伤保险"]
["江海","工伤保险"]
["新会","工伤保险"]
["台山","工伤保险"]
["开平","工伤保险"]
["恩平","工伤保险"]
["鹤山","工伤保险"]
["小计"]
["经办人：",null,null,"复核人："]
["日期：",null,null,"日期："]