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["四川省医学科学院·四川省人民医院\n 20     级住院医师规范化培训学员基本情况登记表"]
["姓名",null,"性别",null,null,"出生年月",null,null,"正面免冠\n彩色照片\n（1寸）"]
["民族",null,"身份证号码"]
["政治面貌",null,"籍贯","                省       市（县）"]
["体检结果",null,"家庭住址"]
["父母姓名"," 父：          母：",{"$nulls":3},"家庭电话"]
["学历",null,"学位",null,null,"专    业"]
["英语水平",null,"毕业时间",null,null,"毕业学校"]
["是否单位委托培训",null,"委培医院",null,null,"学员本人联系电话"]
["执业证书取得时间",null,"执业类别",null,null,"执业证号"]
["规培专业",null,"规培时间（起止）",null,null,"                          年    月～       年     月"]
["规培期间受何种奖励（奖励种类、获奖项目、等级、排名、年度）"]
["规培期间何时何处、何种原因、受何处分"]
["阶段考核成绩",null,"第一年",null,"第二年",null,"第三年",null,"评优"]
[]
["结业考试情况"]
["是否顺利完成培训（完成时间、证书编号、未完成原因）"]