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["附件1："]
["医师定期考核个人述职表"]
[]
["姓    名",null,"性别",null,"出生年月",null,"政治面貌"]
["民    族",null,"学历",null,"学    位",null,"首次注册时间"]
["毕业学校",{"$nulls":3},"所学专业"]
["从事专业",{"$nulls":3},"技术职称"]
["工作单位",{"$nulls":3},"执业范围"]
["通讯地址",{"$nulls":3},"邮    编",null,"电    话"]
["本次考核周期（最近两年内）主要工作表现"]
["主要   工作   经历   及     进修    情况","起止时间",null,"工作或进修单位",null,"从事何专业工作任何职"]
[]
["科研   成果    获奖"]
["发表   论文   及     著作","题      目",null,null,"发表情况",null,null,"第几作者"]
[]
["主要   工作    成绩"]
["工作   缺点"]
["良好行  为记录"]
["自我评定","1、工作成绩：□合格    □不合格                                        2、职业道德：□合格    □不合格                                        3、业务水平：□合格    □不合格                                     "]
["声明：本人已清楚知道《医师定期考核管理办法》的有关规定，认真核对了上述填写内容，确认以上内容真实可信，且为事实之全部，否则，本人愿承担相应的责任。                                                       "]
[{"$nulls":5},"签名："]
[{"$nulls":5},"日期："]
["注：本表由医师本人如实填写，主要工作表现相关栏目不够填的可另附A4空白页补充。"]

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