医療機器保険適用希望書の記載例等について
Contents
1. 2 A 2 B 9 Ez mm2. 1 1 1 AS nn Om 4512345678903 13 IAN 7 4 SN x EE GG OS 3 _ OO x7
3. A2 B 5 RN RS 0 Nn JAN MED TI SDC A2
4. 063 1 I lgooz 063 oi 1 2 MA 3 K046 1 e686e 2 0 i 1 1 ES OO OOOOOO i RR B
5. 2 D O O OO 2 1 40cm OO OO OO 2 3 600mm 30mm lt 1800mm O O OO 4 3 3 1 3 D 001 3 3 OOOO
6. C 1 C 2 7
7. Tm O OO OO OO 1 1 13 JAN 1 062 2
8. 1 1 2 1 0 1 6 4 1 2 9 1 3 0 mn 1 m0 3 Ee 1 7 4 1
9. A OC a 1 MA 2 1 tN SS
10. B 3 1 U 2 x H B
11. gt OO I 1 A1 3 WE I EE OO O OO 1 OO OOO OO A2 1 RE OO OO 3 2 WES
12. 2 1 E O O OO CR 4 2 NS SR C OO 2 1 OO OO OO 5 1 a
13. 1 1 OO OO FAX Im a 1 1 OO O OO OO QO OO OOO to OO OO OO A2 2
14. B 2 1 3 001 3 i 5 OO OO OQ 51 Nd 51 AA OO OO QO 9
15. 4 B MED TI S DC 5 kikihoken mhlw go jp 6 C 1 C 2 C 1 C FAX C 1 C 2
16. 6 AA 1 45 kk 20cm H21 9 19 2 1 2 2 2 4229 JRYMVS 2 2 5 4 A BN RT RRR 2 2 1 078 1 1 4 YK H21 9 19 2 1 2 KA 145 FERRER 2 1 3 ADEKRIANKRR KR 2 2 5 4 12MAuidiobdo 1 11 45 4 OE 13 JAN 1
17. OO OO OQ 2 1 1 OO O 2 1 A2 PRE TANS
18. 1 OO 2 1 RE 2 1 OO 1 6 1 2 OO OO OO 2 1 SN 1
19. 22 3 15 IVD 2 2 2 1 2 0 2 1 2 6 0 2 12 1 1 2 2 2 1 2 0 2 1 2 2 0 2 1 2 2 A1
20. 1 1 EN EE NII 0 1 1 2 OS gt 1 6 OO OO OO 2 1 2 a a OO OO OO 3 OO OO OO 4 2 1
21. C E OO OO AA F A rm a 1 1 k MED I S DC OO OO QO RR TI OO 0 OO OO
22. lt gt OO OO OO 2 1 2 1 4 A OO ON 2 1 0 E El OOOO O i OO OO O QO
23. i lt I VD 3 lg Sa NG
24. 2 I 1 1 2 3 D208 5 6 A 1 1 3 2 1 Gk HE OO OO D235 O A AF 0 0 0 0 I
25. 1 1 45 X XAkkkkkky 2 1 2 2 45 X Xkkkkkkkk 2 1 3 ABS Akh hhh hh kk 2 2 5 4 ABS Akh hhh hh kk 1 1 4 SO 2 CI 001 2
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