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[null,"江田島市長様",null,null,null,null,null,null,null,"請求年月日","令和　　年　　月　　日"]
[null,"市区町村番号"]
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[null,3,4,2,1,5,7]
[null,null,null,null,null,null,null,null,"住所"]
[null,null,null,null,null,null,null,null,"代表者氏名"]
[null,null,null,null,null,null,null,null,"電話番号"]
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[null,"風しん対策　市区町村別請求書"]
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[null,"医療機関・健診機関番号"]
[null,"医療機関・健診機関名称"]
[null,"請求年月",null,null,null,null,null,null,"2025年3月分"]
[]
[null,"風しんの追加的対策に係る費用の支払については、次の名義の預金口座に\n口座振替されるよう依頼します。"]
[null,"（金融コード）",null,null,null,null,null,null,"（支店名コード）"]
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[null,"（フリガナ）"]
[null,"口座名義人"]
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[null,"抗体検査",null,null,"①健診・HI法"]
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[null,null,null,null,null,null,null,null,null,"消費税率","10","％"]
[null,"※予診のみの費用を市区町村が設定していない場合（０円の場合）は、本請求書に計上しないこと。"]

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[null,"市区町村番号"]
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[null,null,null,null,null,null,null,null,"○○県○○市○○町○丁目○番○号"]
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[null,"風しん対策　市区町村別請求書"]
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[null,"医療機関・健診機関番号",null,null,null,null,null,null,1234567890]
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[null,"請求年月",null,null,null,null,null,null,"2025年3月分"]
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[null,"風しんの追加的対策に係る費用の支払については、次の名義の預金口座に\n口座振替されるよう依頼します。"]
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[null,"（フリガナ）",null,null,"コウセイビョウイン○○○○"]
[null,"口座名義人",null,null,"厚労病院○○○○○○○○○○○○"]
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[null,null,null,null,"小計",null,null,null,0,0,0]
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[null,"合計",null,null,null,null,null,null,0,0,0]
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[null,null,null,null,null,null,null,null,null,"消費税率","10","％"]
[null,"※予診のみの費用を市区町村が設定していない場合（０円の場合）は、本請求書に計上しないこと。"]

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