执业医师变更注册表格

)现役军官( )文职干部( )士官( )职员(    )离退休人员( )文职人员(    )聘用地方其他人员( )变更事项(打√)执业地点(    )执业类别(    )执业范围(    )变更理由原执业机构名称拟执业机构名称医师资格证书编码原执业机构意见原执业类别:                          原从事科目:(单位公章)负责人签名:                          年        月        日附件 4医师变更执业注册申请审核表1原审批发证机关意见原批准类别:                                  原批准科目:(盖章)负责人签名:                                                    年        月        日拟执业机构意见申请类别:                                           拟从事科目:(盖章)负责人签名:                                    年        月        日执业机构上级卫生部门意见审核类别:                                         拟从事科目:(盖章)负责人签名:                                               年        月        日军区级单位或地方卫生部门审批类别:                                                 审批科目:(盖章)负责人签名:                                                      年        月        日备注2