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Application Form for the Establishment of Medical Institutions

    Government department the application submitted to:

     

     

    Establishing unit (person):

    Address:

    Application

    items to be examined and approved

    Type of establishment:

    Name:

    Chosen address:

    Forms of company ownership:

    Hospital beds (dentist chairs):

    Service target clients:

    Medical subjects:

    Total Investment:

    Registered capital:

    Others

    List of documents submitted:

    (1) Chosen address report:            (    )

    (2) Feasibility report:                  (    )

    (3) Basic information proof documents of establishing unit (person):                             (    )

    (4) Others                            (    )

     

     

     

    Establishing unit (person):            (Seal)

    Date:

     

    Opinions of Public Health Bureau of the prefecture (county)

     

     

     

     

     

     

     

     

     

    Date         (Seal)

    Opinions of examination

    personnel

     

     

     

     

     

    Signature:           Date:

    Opinions of supervising leader

     

     

     

     

     

     

    Signature:           Date:

    Checking and approval of bureau governor

     

     

     

     

     

     

    Signature:           Date: