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<font size="5"><font size="5"><span style="font-size: 26px;"><strong>医疗费报销单</strong></span><br />
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<span style="font-size: 26px;"><strong><input class="AUTO" datafld="SYS_DATE_CN" hidden="0" name="DATA_52" title="日期" type="text" value="{MACRO}" />&nbsp; </strong></span></font></font>

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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">职工姓名</font></font></strong></span></font></font></div>
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			<td style="border-width: 1.5pt 1pt 1pt; border-style: solid; border-color: rgb(0, 0, 0) black black;" valign="middle">
			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3"><input class="AUTO" datafld="SYS_USERNAME" hidden="0" name="DATA_53" style="width: 146px;" title="职工姓名" type="text" value="{MACRO}" /></font></font></strong></span></font></font></div>
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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">工 作 部 门</font></font></strong></span></font></font></div>
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			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3"><input class="AUTO" datafld="SYS_DEPTNAME_SHORT" hidden="0" name="DATA_54" style="width: 186px;" title="工作部门" type="text" value="{MACRO}" /></font></font></strong></span></font></font></div>
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			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体">附据单<input align="left" hidden="0" maxlength="2" name="DATA_55" size="1" style="width: 19px; height: 32px;" title="张数" type="text" validation="type:int;len:" />张</font></font></strong></span></font></font></div>
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			<td style="border-width: 1pt 1pt 1pt 1.5pt; border-style: solid; border-color: black black black rgb(0, 0, 0);" valign="middle">
			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">家属姓名</font></font></strong></span></font></font></div>
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			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3"><input hidden="0" name="DATA_56" size="16" style="width: 146px; height: 19px;" title="家属姓名" type="text" /></font></font></strong></span></font></font></div>
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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">性 别</font></font></strong></span></font></font></div>
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			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3"><select name="DATA_57" style="width: 50px;" title="性别"><option selected="selected" value="男">男</option><option value="女">女</option> </select></font></font></strong></span></font></font></div>
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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">年 龄</font></font></strong></span></font></font></div>
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			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3"><input hidden="0" name="DATA_58" size="295" style="width: 59px; height: 19px;" title="年龄" type="text" /></font></font></strong></span></font></font></div>
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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">与职工</font></font></strong></span></font></font></div>

			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font size="3">关 系</font></font></strong></span></font></font></div>
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			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3"><input hidden="0" name="DATA_59" size="6" style="width: 64px; height: 19px;" title="关系" type="text" /></font></font></strong></span></font></font></div>
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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">单据中应</font></font></strong></span></font></font></div>

			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font size="3">报销金额</font></font></strong></span></font></font></div>
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			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">￥<input hidden="0" name="DATA_60" size="21" style="width: 168px; height: 19px;" title="应报销金额" type="text" /></font></font></strong></span></font></font></div>
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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">应 报 销</font></font></strong></span></font></font></div>

			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font size="3">比 例(%)</font></font></strong></span></font></font></div>
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			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3"><input hidden="0" name="DATA_61" size="6" style="width: 54px; height: 19px;" title="应报销比例" type="text" /></font></font></strong></span></font></font></div>
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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">实报销</font></font></strong></span></font></font></div>

			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font size="3">金 额</font></font></strong></span></font></font></div>
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			<td colspan="2" style="border-width: 1pt 1.5pt 1pt 1pt; border-style: solid; border-color: black rgb(0, 0, 0) black black;" valign="middle">
			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3"><input class="CALC" name="DATA_62" prec="4" size="15" style="width: 119px; height: 19px;" title="实报销金额" type="text" value="应报销金额*应报销比例/100" /></font></font></strong></span></font></font></div>
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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">实 报 销 金 额 人 民 币（大写）</font></font></strong></span></font></font></div>
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			<div align="left" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3"><input class="CALC" name="DATA_63" prec="4" size="41" style="width: 312px; height: 19px;" title="实际报销金额大写" type="text" value="RMB(实际报销金额)" /></font></font></strong></span></font></font></div>
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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5"><font face="宋体" size="3">审批人:<input class="AUTO" datafld="SYS_USERNAME" hidden="0" name="DATA_64" style="width: 90px;" title="审批人" type="text" value="{MACRO}" /> 复核:<input class="AUTO" datafld="SYS_USERNAME" hidden="0" name="DATA_65" style="width: 90px;" title="复核" type="text" value="{MACRO}" /> 出纳:<input class="AUTO" datafld="SYS_USERNAME" hidden="0" name="DATA_66" style="width: 90px;" title="出纳" type="text" value="{MACRO}" /> 领款人:<input class="AUTO" datafld="SYS_USERNAME" hidden="0" name="DATA_67" style="width: 85px;" title="领款人" type="text" value="{MACRO}" /></font></font></strong></span></font></font></div>
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			<div align="center" style="line-height: 1.5;"><font size="5"><font size="5"><span style="font-size: 26px;"><strong><font size="5">&nbsp;</font></strong></span></font></font></div>
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<font size="5"><font size="5"><span style="font-size: 26px;"><strong> </strong></span></font></font></div>
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