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["                                                                            (機構名稱)　住民名冊"]
["　　年　　月　　日至　　年　　月　　日止（核准床數：　　　床）"]
[null,"填表說明：(請於表格中填入代號)\n一、異動:1.新進 2.退住 3.轉所 4.往生\n二、福利身分別:1.低收入戶 2.中低收入戶 3.中低收入老人生活津貼 4.身心障礙者生活補助\n三、身心障礙類別/等級:如聽障/中度\n四、榮民:1.單身榮民 2.非單身榮民"]
["編號","姓名","性別","身分證字號","出生日期","榮民","福利身分別","身心障礙類別/等級","入出所紀錄",null,"社會局核准收容補助公文",null,null,"自付金額","總額","轉介單位","緊急聯絡人",null,null,"備註\n(插管)"]
[{"$nulls":8},"異動原因","日期","日期","字號","補助金額",{"$nulls":3},"姓名","電話","關係"]
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[null,"負責人(代表人)：",{"$nulls":7},"院長(主任)：","製表人："]
[{"$nulls":10},"聯絡電話："]
[null,"填表說明：","1.本表請每年一、三、五、七、九、十一月十日前陳報。"]
[null,null,"2.本表填造一式二份，一份留自存，一份送臺北市政府社會局老人福利科備查。"]