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["城镇职工基本医疗保险参保登记表"]
["单位名称（盖章）：                                  单位编号：                                "]
["序号","姓名","身份证件类型","身份证件号码","申报工资","开始时间","终止时间","变更类别",{"$nulls":4},"手机号码","备注","银行账号"]
[{"$nulls":4},"(元/月)",null,null,"增加","中断","终止","恢复","在职转退休"]
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["填报人：                             联系电话：                       经办机构经办人：             年   月   日"]