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["2017年住院医师规范化培训结业专业理论考核报名表"]
["学号",null,"姓名",null,"性别"]
["证件类型","身份证","证件编号"]
["规培专业",null,null,"报考专业"]
["医师资格证编号"]
["本人承诺："]
["    本人已知悉《关于2017年转入规培硕士专业学位研究生参加住院医师规范化培训结业专业理论考核报名的通知》中的有关内容，自愿报名参加考试。\n    以上信息经本人核对，确保真实有效。\n\n                                       签字：\n\n                                                年    月    日"]
["所在规培基地审核意见："]
["    \n\n\n\n\n 科教科负责人签字：                     盖章：\n\n                                                年    月    日"]
["注：1.“报考专业”应按所在规培专业填写\n    2.请携带身份证、医师资格证书原件及复印件"]