YNU_JEUS/app_home/himed/webapps/emr/medirecweb/rex/RFM1370922_건강보험 자가도뇨 소모성재료 급여대상자 변경해지 신청서.rex

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SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="2"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="" MultiLine="1" WordWrap="1" WordSpace="1" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="1" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="2"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text=")" MultiLine="1" WordWrap="1" WordSpace="1" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="1" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="3"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell></Row><Row Size="130"><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="0" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="국민건강보험공단 이사장 귀하" MultiLine="1" WordWrap="1" WordSpace="2" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="9" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="80" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="10" FontBold="1" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="0"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="1" BaseCellRowIndex="4" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="4" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="4" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="4" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="4" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="4" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="4" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="4" BaseCellColIndex="0"/></Row><Row Size="90"><Cell CellType="0" BackStyle="1" BackColor="15395562" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="작성방법" MultiLine="1" WordWrap="1" WordSpace="5" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="9" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림체" FontSize="10" FontBold="1" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="4"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="1" BaseCellRowIndex="5" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="5" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="5" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="5" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="5" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="5" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="5" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="5" BaseCellColIndex="0"/></Row><Row Size="520"><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="0" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text=" ① 변경일 경우 [  ] 변경에 [V], 해지일 경우 [  ] 해지에 [V] 표시합니다.
    - 변경 : 등록신청시 기재한 사항의 변경이 필요할 경우 표시합니다.
    - 해지 : 등록 해지를 신청라 경우 표시합니다.
 ② 수진자 정보(성명, 주민등록, 외국인 등록번호, 전화번호)를 기재합니다.
 ③ 등록 내역의 변경이 있을 경우 작성합니다.
 ④ 해지 사유에 [V]표시를 하고, 입증할 수 있는 서류를 제출합니다. 
   - 의사소견서등
 ⑤ 신청인은 다음에 해당하는 사람이어야 합니다.
    - 수진자(선천성 신경인성 방광환자)
    - 가족 : 민법 제 779에 따른 가족으로 배우자, 직계혈족 및 형제자매이거나 생계를 같이 하는 
	          직계혈족의 배우자, 배우자의 직계혈족  및 배우자의 형제자매" MultiLine="1" WordWrap="1" WordSpace="3" LineSpace="2" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="9" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="20" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="4"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="1" BaseCellRowIndex="6" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="6" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="6" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="6" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="6" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="6" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="6" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="6" BaseCellColIndex="0"/></Row><Row Size="90"><Cell CellType="0" BackStyle="1" BackColor="15395562" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="처리절차" MultiLine="1" WordWrap="1" WordSpace="5" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="9" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림체" FontSize="10" FontBold="1" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="4"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="1" BaseCellRowIndex="7" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="7" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="7" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="7" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="7" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="7" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="7" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="7" BaseCellColIndex="0"/></Row></Rows><Cols><Col Size="250"/><Col Size="300"/><Col Size="200"/><Col Size="200"/><Col Size="100"/><Col Size="150"/><Col Size="200"/><Col Size="250"/><Col Size="200"/></Cols><ConditionalStyles/></Control><Control Type="Control.Table" Name="표1" Visible="0" X1="0" Y1="0" Width="1850" Height="250" FitSection="0" LinkIndex="6" RoundLeftTopEdge="0" RoundRightTopEdge="0" RoundRightBottomEdge="0" RoundLeftBottomEdge="0" ExportLeft="0" ExportTop="0" ExportRight="0" ExportBottom="0"><CellStyles><CellStyle LeftLineStyle="1" RightLineStyle="1" TopLineStyle="1" BottomLineStyle="1" FDiagonalLineStyle="0" BDiagonalLineStyle="0" LeftLineWidth="0.75" RightLineWidth="0.75" TopLineWidth="0.75" BottomLineWidth="0.75" FDiagonalLineWidth="0.75" BDiagonalLineWidth="0.75" LeftLineColor="0" RightLineColor="0" TopLineColor="0" BottomLineColor="0" FDiagonalLineColor="0" BDiagonalLineColor="0"/></CellStyles><Rows><Row Size="80"><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="① 수진자" MultiLine="1" WordWrap="1" WordSpace="0" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="3" ColSpan="1" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="0"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="성  명" MultiLine="1" WordWrap="1" WordSpace="0" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="2" ColSpan="1" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="0"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="" MultiLine="1" WordWrap="1" WordSpace="0" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="2" ColSpan="2" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="0"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="1" BaseCellRowIndex="0" BaseCellColIndex="2"/><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="주민등록번호" MultiLine="1" WordWrap="1" WordSpace="0" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="2" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="0"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="1" BaseCellRowIndex="0" BaseCellColIndex="4"/></Row><Row Size="80"><Cell CellType="1" BaseCellRowIndex="0" BaseCellColIndex="0"/><Cell CellType="1" BaseCellRowIndex="0" BaseCellColIndex="1"/><Cell CellType="1" BaseCellRowIndex="0" BaseCellColIndex="2"/><Cell CellType="1" BaseCellRowIndex="0" BaseCellColIndex="2"/><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="" MultiLine="1" WordWrap="1" WordSpace="0" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="2" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="0"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="1" BaseCellRowIndex="1" BaseCellColIndex="4"/></Row><Row Size="90"><Cell CellType="1" BaseCellRowIndex="0" BaseCellColIndex="0"/><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="전화번호" MultiLine="1" WordWrap="1" WordSpace="0" LineSpace="1" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="1" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="0"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="자 택" MultiLine="1" WordWrap="1" WordSpace="0" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="1" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="0"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="" MultiLine="1" WordWrap="1" WordSpace="0" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="1" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" FontSize="9" FontBold="0" FontUnderline="0" FontItalic="0" FontStrike="0" ForeColor="0" FieldID="-1" FieldIndex="-1" StyleIndex="0"><FieldReferences/><SummaryCondition/><HyperLinkInfo LinkType="0" LinkText="" ToolTipType="0" ToolTipText="" LinkFieldID="-1" LinkFieldIndex="-1" ToolTipFieldID="-1" ToolTipFieldIndex="-1"/><ConditionalStyles/><FieldReferences/></Cell><Cell CellType="0" BackStyle="0" BackColor="16777215" FillStyle="0" FillColor="0" Alignment="1" VerticalAlignment="1" CanGrow="0" CanShrink="0" DataType="0" Text="휴대폰" MultiLine="1" WordWrap="1" WordSpace="0" LineSpace="0" Editable="0" AutoFontSize="0" RowSpan="1" ColSpan="1" OutputFormat="" ReplaceEmpty="" SuppressIfDuplication="0" SuppressIfZero="0" SuppressText="" MergeIfSuppress="0" MergeColumn="0" AddEnterWhenMergeColumn="0" SummaryFunction="0" TopMargin="0" LeftMargin="0" BottomMargin="0" RightMargin="0" FontName="굴림" 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