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[null,null,null,null,null,null,null,null,null,null,null,null,"別紙３"]
[null,"神戸市長　あて",null,null,null,null,null,null,null,null,"市町村提出用"]
[null,"市区町村番号"]
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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,"請求年月日",null,null,null,null,null,null,"２０　　　年　　　月　　　日"]
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[null,null,null,null,null,null,null,null,"請求件数","請求金額\n（税抜）","請求金額\n（税込）"]
[null,"抗体検査",null,null,"①健診・HI法"]
[null,null,null,null,"②健診・EIA法"]
[null,null,null,null,"③HI法"]
[null,null,null,null,"④EIA法"]
[null,null,null,null,"⑤夜間休日・HI法"]
[null,null,null,null,"⑥夜間休日・EIA法"]
[null,null,null,null,"小計"]
[null,"予防接種",null,null,"通常（MRワクチン）"]
[null,null,null,null,"通常（単独ワクチン）"]
[null,null,null,null,"予診のみ"]
[null,null,null,null,"小計"]
[null,"合計"]
[]
[null,null,null,null,null,null,null,null,null,"消費税率",null,"％"]
[]
["※消費税率は、接種日現在、令和元年9月末までは8%、10月以降は10%です。"]

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[null,"医療機関・健診機関番号"]
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[null,"請求年月日",null,null,null,null,null,null,"２０　　　年　　　月　　　日"]
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[null,null,null,null,null,null,null,null,"請求件数","請求金額\n（税抜）","請求金額\n（税込）"]
[null,"予防接種",null,null,"風しん単独ワクチン"]
[null,null,null,null,"小計"]
[null,"合計"]
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[null,null,null,null,null,null,null,null,null,"消費税率",null,"％"]
[]
["※消費税率は、接種日現在、令和元年9月末までは8%、10月以降は10%です。"]
[" 　　　  ※単価（風しん単独ワクチン）\n　　　　2019.4～  ：6,000円（税抜）、6,480円（税込）\n　　　　2019.10～：6,000円（税抜）、6,600円（税込）\n　　　　2020.4～  ：6,060円（税抜）、6,666円（税込）\n　　　　2022.4～  ：6,080円（税抜）、6,688円（税込）\n　　　　2024.4～  ：6,140円（税抜）、6,754円（税込）"]