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[null,"               縣（市）「115-116年度COVID-19疫苗接種計畫」衛生等單位之防疫相關人員擬接種人數統計表"]
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[null,"接種對象類別：","□衛生單位防疫人員 □各消防單位實際擔任救護車緊急救護工作之人員 □空中救護勤務人員"]
[null,"              ","□第一線海巡、岸巡人員 □國際機場、港口入境安全檢查、證照查驗及第一線關務人員 □法醫師"]
[null,null,"□具執業登記之公共衛生師"]
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[null,"填報機關：____________________________",null,"聯絡人：___________________","電話：___________________"]
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[{"$nulls":4},"填表日期____年____月____日","共____頁，第____頁"]
[null,"鄉鎮市區","機關名稱","地址","接種對象人數"]
[{"$nulls":4},"總人數","擬接種人數"]
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[{"$nulls":4}," "]
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[null,"合計"]
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[null,null,"填表人簽名或核章_____________________",null,"覆核人簽名或核章____________________"]