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["（儿童类别）儿童信息登记审核表"]
["填报单位:",{"$nulls":6},"儿童编号:"]
["姓    名",null," 性别",null,"民族",null,null,"出生日期",null,"照片"]
["登记(入院)日期",null,"登记(入院)原因",{"$nulls":4},"养育类型"]
["身份证号",{"$nulls":3},"福利证号"]
["户籍状况",null," 户籍所在地"]
["身体情况",null,"残疾级别",{"$nulls":4},"患病类型"]
["手术时间及     手术内容","   "]
[]
[]
["工学情况",null,"特教类型"]
["患艾滋病  情    况",null,"艾滋儿童救助原因"]
["注销(离院)日期",null,"注销(离院)原因",{"$nulls":4},"死亡处理方式"]
["基本生活费起领年月",null,"基本生活费            停领年月",{"$nulls":4},"福利机构名称"]
["其他救助","低保     五保证     城镇医保     新农合     大病慈善     艾滋病特困救助       其他 "]
[" 备  注"]
["村(社区)委员会的         审查意见",null,"审核人:",null,null,"乡、镇（街道）         审核意见"]
[{"$nulls":4},"(盖  章)",{"$nulls":3},"审核人:","(盖  章)"]
[null,null,"审核日期:",{"$nulls":5},"审核日期:"]
["福利机构                 审核意见"]
[{"$nulls":8},"(盖  章)"]
[{"$nulls":3},"审核人:",{"$nulls":4},"审核日期:"]
["上级民政部门             审批意见"]
[{"$nulls":8},"(盖  章)"]
[{"$nulls":3},"审批人:",{"$nulls":4},"审批日期:"]
["说明: 1、福利机构不填村(社区)委员会和乡、镇（街道）审核意见;村(社区)委员会和乡、镇（街道）不填福利机构审核意见。"]
["      2、机构集中养育孤儿应提交：儿童身份确认复印件、残疾相关证明、手术相关证明（医院诊断）、原抚养人相关资料、安置相关证明；"]
["      3、社会散居孤儿应提交：儿童身份确认复印件、残疾相关证明（医院诊断）、抚养人相关资料、父母相关证明资料、监护协议书。"]

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