2《傳統(tǒng)醫(yī)學(xué)師承出師考核申請表》.doc

傳統(tǒng)醫(yī)學(xué)師承出師考核申請表姓 名性 別民 族出 生年 月籍 貫出 生地 點(diǎn)參加工作時間現(xiàn)從事主要職業(yè)學(xué) 歷學(xué) 位身份證號碼單位名稱通訊地址及郵政編碼本人檔案存放單位、地址及郵政編碼聯(lián)系電話傳 真電子郵件地址個 人 簡 歷起止年月學(xué)習(xí)（工作）單位肄畢 業(yè)結(jié)指 導(dǎo) 老 師 姓 名指 導(dǎo) 老 師單 位指 導(dǎo) 老 師 職 稱指 導(dǎo) 老 師工 作 年 限指 導(dǎo) 老 師聯(lián) 系 電 話指 導(dǎo) 老 師通 訊 地 址指導(dǎo)老師主要學(xué)術(shù)思想、臨床經(jīng)驗(yàn)和學(xué)術(shù)專長指 導(dǎo) 老 師意 見簽 名： 年 月 日核準(zhǔn)指導(dǎo)老師執(zhí)業(yè)的衛(wèi)生、中醫(yī)藥行政部門初審意見印 章 年 月 日省級中醫(yī)藥管理部門審核意見 印 章 年 月 日1一律用藍(lán)黑墨水鋼筆或中性筆填寫，內(nèi)容要具體、真實(shí)，字跡要端正清楚。2表內(nèi)的年月時間，一律用公歷阿拉伯?dāng)?shù)字填寫。 3相片一律用近期一寸免冠正面半身照。 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