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["基本医疗保险参保单位信息变更登记表"]
["单位名称（盖章）：",null,"单位编号:"]
["原登记事项",null,"变更事项"]
["单位名称",null,"单位名称"]
["统一社会信用代码",null,"统一社会信用代码"]
["单位地址",null,"单位地址"]
["单位类型",null,"单位类型"]
["法定代表人","姓名：","法定代表人","姓名："]
[null,"身份证件号码：",null,"身份证件号码："]
[null,"联系电话：",null,"联系电话："]
["单位经办人","姓名：","单位经办人","姓名："]
[null,"联系电话：",null,"联系电话："]
["开户银行","账号：","开户银行","账号："]
[null,"开户行：",null,"开户行："]
["参保险种","□职工基本医疗保险\n□企业补充医疗保险\n□公务员医疗补助\n□生育保险\n□长期护理险\n□职工大病医疗保险","参保险种","□职工基本医疗保险\n□企业补充医疗保险\n□公务员医疗补助\n□生育保险\n□长期护理险\n□职工大病医疗保险"]
["其他"]
["备注"]
[]
["单位经办人：                联系电话：                  填表日期："]