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["附件4"]
["全国跨省异地就医费用预付金明细表"]
["制表单位：（部级经办机构签章）"]
[{"$nulls":5},"年度：",{"$nulls":5},"单位：万元"]
["地   区",null,"预付金划出"]
[null,null,"北  京","天  津","河  北","山  西","内蒙古","辽  宁","吉  林","黑龙江","上  海","……","合计"]
["预付金划入","北  京","——"]
[null,"天  津",null,"——"]
[null,"河  北",null,null,"——"]
[null,"山  西",{"$nulls":3},"——"]
[null,"内蒙古",{"$nulls":4},"——"]
[null,"辽  宁",{"$nulls":5},"——"]
[null,"吉  林",{"$nulls":6},"——"]
[null,"黑龙江",{"$nulls":7},"——"]
[null,"上  海",{"$nulls":8},"——"]
[null,"……",{"$nulls":9},"——"]
[null,"合  计",{"$nulls":10},"——"]
[]
["单位负责人：                   审核人：                   制表人：                   制表日期：      "]

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