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["北京中医药大学东方医院进修申请表"]
["姓名",null,"性别",null,"年龄",null,"健康状况",null,"一寸彩照"]
["民族",null,"籍贯",null,"学历",null,"毕业时间"]
["工作时间",null,"职称",null,"现从事 专业",null,"现任职务"]
[]
["现工作单位地址及邮编"]
["现工作单位医务处电话及本人手机号和邮箱"]
["个人简历","  年  月至  年 月 ",null,"在何学校（单位）任何职务"]
[]
[]
[]
[]
["家庭主要成员","关系","姓名","年龄","政治面貌","工作单位"]
[]
[]
[]
["拟进修学科       （每半年一个科室）",{"$nulls":4},"拟进修时间     （起止时间）",null,"  年  月  日—     年  月  日"]
[" 拟进修专业及目的  （每半年一个科室）"]
["选送单位意见（盖章）"]
["是否为再执业培训：进修□          医师注册再执业培训□"]
["本表请用钢笔或签字笔由本人填写，录取回执以电子邮件形式发回，请填好邮箱地址。"]