单位负责人: 财会负责人: 审核: 制表:
业务收支明细表
(医会03表)
编制单位 年 季 金额单位:元(列至角分)
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栏 | | | 实 际 执 行 数 |附:
| |预|-------------------|
| | | | | |制 剂| |
| | |合 计|医疗 |药品 | |其他 |制剂
| 项 目 |算| |收支 |收支 |纯收入|收入 |收支
| | |---|---|---|---|---|---
| | |本|累|本|累|本|累|本|累|本|累|本|累
| |数|月|计|月|计|月|计|月|计|月|计|月|计
次 | | |数|数|数|数|数|数|数|数|数|数|数|数
---|---------|-|-|-|-|-|-|-|-|-|-|-|-|-
1| 收入合计 | | | | | | | | | | | | |
2|医疗收入 | | | | | | | | | | | | |
3| 门诊收入 | | | | | | | | | | | | |
4| 挂号收入 | | | | | | | | | | | | |
5| 检查收入 | | | | | | | | | | | | |
6| 治疗收入 | | | | | | | | | | | | |
7| 放射收入 | | | | | | | | | | | | |
8| 手术收入 | | | | | | | | | | | | |
9| 化验收入 | | | | | | | | | | | | |
10| 输血收入 | | | | | | | | | | | | |
11| 输氧收入 | | | | | | | | | | | | |
12| 其他收入 | | | | | | | | | | | | |
13| 住院收入 | | | | | | | | | | | | |
14| 床位收入 | | | | | | | | | | | | |
15| 检查收入 | | | | | | | | | | | | |
16| 治疗收入 | | | | | | | | | | | | |
17| 放射收入 | | | | | | | | | | | | |
18| 手术收入 | | | | | | | | | | | | |
19| 化验收入 | | | | | | | | | | | | |
20| 输血收入 | | | | | | | | | | | | |
---|---------|-|-|-|-|-|-|-|-|-|-|-|-|-
21| 输氧收入 | | | | | | | | | | | | |
22| 接生收入 | | | | | | | | | | | | |
23| 其他收入 | | | | | | | | | | | | |
24| 业余医疗服务收| | | | | | | | | | | | |
| 入 | | | | | | | | | | | | |
25| 其他医疗收入 | | | | | | | | | | | | |
26| 家庭病床收入| | | | | | | | | | | | |
27| 业余医疗服务| | | | | | | | | | | | |
| 收入 | | | | | | | | | | | | |
28| 其他收入 | | | | | | | | | | | | |
29|药品收入 | | | | | | | | | | | | |
30| 门诊 | | | | | | | | | | | | |
31| 西药收入 | | | | | | | | | | | | |
32| 中成药收入 | | | | | | | | | | | | |
33| 中草药收入 | | | | | | | | | | | | |
34| 住院 | | | | | | | | | | | | |
35| 西药收入 | | | | | | | | | | | | |
36| 中成药收入 | | | | | | | | | | | | |
37| 中草药收入 | | | | | | | | | | | | |
38| 制剂收入 | | | | | | | | | | | | |
39| 西药收入 | | | | | | | | | | | | |
40| 中药收入 | | | | | | | | | | | | |
---|---------|-|-|-|-|-|-|-|-|-|-|-|-|-
41| 其他入收 | | | | | | | | | | | | |
42| 支出合计 | | | | | | | | | | | | |
43| 工资 | | | | | | | | | | | | |
44| 国家职工工资 | | | | | | | | | | | | |
45| 集体职工工资 | | | | | | | | | | | | |
46| 补助工资 | | | | | | | | | | | | |
47| 临时工资 | | | | | | | | | | | | |
48| 卫生津贴 | | | | | | | | | | | | |
49| 粮煤副补贴 | | | | | | | | | | | | |
50| 交通补贴 | | | | | | | | | | | | |
51| 房租补贴 | | | | | | | | | | | | |
52| 取暖补贴 | | | | | | | | | | | | |
53| 夜餐费 | | | | | | | | | | | | |
54| 护教龄津贴 | | | | | | | | | | | | |
55| 业余医疗服务补| | | | | | | | | | | | |
| 贴 | | | | | | | | | | | | |
56| 其他补贴 | | | | | | | | | | | | |
57| 职工福利费 | | | | | | | | | | | | |
58| 福利费 | | | | | | | | | | | | |
59| 工会经费 | | | | | | | | | | | | |
60| 独生子女补助费| | | | | | | | | | | | |
---|---------|-|-|-|-|-|-|-|-|-|-|-|-|-
61| 探亲路费 | | | | | | | | | | | | |
62| 长休待遇 | | | | | | | | | | | | |
63| 退职生活费 | | | | | | | | | | | | |
64| 医药费 | | | | | | | | | | | | |
65| 丧葬及抚恤费 | | | | | | | | | | | | |
66| 遗属补助费 | | | | | | | | | | | | |
67| 其他 | | | | | | | | | | | | |
68| 离退人员费用 | | | | | | | | | | | | |
69| 离休人员费用 | | | | | | | | | | | | |
70| 退休人员费用 | | | | | | | | | | | | |
71| 公务费 | | | | | | | | | | | | |
72| 办公费 | | | | | | | | | | | | |
73| 邮电费 | | | | | | | | | | | | |
74| 差旅费 | | | | | | | | | | | | |
75| 宣传学习费 | | | | | | | | | | | | |
76| 其他 | | | | | | | | | | | | |
77| 药品费 | | | | | | | | | | | | |
78| 西药 | | | | | | | | | | | | |
79| 中成药 | | | | | | | | | | | | |
80| 中草药 | | | | | | | | | | | | |
81|原材料 | | | | | | | | | | | | |
82| 西药 | | | | | | | | | | | | |
83| 中成药 | | | | | | | | | | | | |
84| 中草药 | | | | | | | | | | | | |
85|卫生材料 | | | | | | | | | | | | |
86| 血费 | | | | | | | | | | | | |
87| 氧气费 | | | | | | | | | | | | |
88| 放射材料费 | | | | | | | | | | | | |
89| 化验材料费 | | | | | | | | | | | | |
90| 其他卫生材料费 | | | | | | | | | | | | |
91|其他材料 | | | | | | | | | | | | |
92|低值易耗品 | | | | | | | | | | | | |
93|业务费 | | | | | | | | | | | | |
94| 水电费 | | | | | | | | | | | | |
95| 医疗印刷费 | | | | | | | | | | | | |
96| 燃料及交通工具消| | | | | | | | | | | | |
| 耗费 | | | | | | | | | | | | |
97| 科研费 | | | | | | | | | | | | |
98| 动物饲养费 | | | | | | | | | | | | |
99| 职工培训费 | | | | | | | | | | | | |
100|一般修购费 | | | | | | | | | | | | |
101|大型设备更新维护费| | | | | | | | | | | | |
102| 设备购置费 | | | | | | | | | | | | |
103| 房屋修缮费 | | | | | | | | | | | | |
104| 设备修理费 | | | | | | | | | | | | |
105|租赁费 | | | | | | | | | | | | |
106|其他费用 | | | | | | | | | | | | |
107|收支差额(亏损用负| | | | | | | | | | | | |
|号表示) | | | | | | | | | | | | |
108|加:差额预算补助 | | | | | | | | | | | | |
109|减:出院、门诊病人| | | | | | | | | | | | |
|欠费 | | | | | | | | | | | | |
110|结余(亏损用负号表| | | | | | | | | | | | |
|示) | | | | | | | | | | | | |
111|结余分配 | | | | | | | | | | | | |
112| 事业发展基金 | | | | | | | | | | | | |
113| 福利基金 | | | | | | | | | | | | |
114| 职工奖励基金 | | | | | | | | | | | | |
115| 院长基金 | | | | | | | | | | | | |
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单位领导: 财会负责人: 审核: 制表:
专项资金收支表
(医会04表)
编制单位: 年 季度 金额单位:元
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栏| | | | 专 用 基 金 |专|其
| | |专|------------------|项|他
| 项 目 |合|项| |一|大|事|福|职|院|业余| |借|专
| |计|补|小|般|型|业|利|工|长|服务|其|款|项
次| | |助|计|修|设|发|基|奖|基|提成|他| |资
| | | | |购|备|展|金|励|金| | | |金
-|----------|-|-|-|-|-|-|-|-|-|--|-|-|-
1|年初数 | | | | | | | | | | | | |
| 未完专项占用 | | | | | | | | | | | | |
| 结余资金 | | | | | | | | | | | | |
2|本期增加数 | | | | | | | | | | | | |
| 提取数 | | | | | | | | | | | | |
| 拨入数 | | | | | | | | | | | | |
| 固定资产变价收入 | | | | | | | | | | | | |
| 借入数 | | | | | | | | | | | | |
| 其他增加数 | | | | | | | | | | | | |
3|本期减少数 | | | | | | | | | | | | |
| 用于福利 | | | | | | | | | | | | |
| 用于购置医疗设备 | | | | | | | | | | | | |
| 用于购置其他设备 | | | | | | | | | | | | |
| 用于修缮房屋 | | | | | | | | | | | | |
| 用于设备修理 | | | | | | | | | | | | |
| 用于科研 | | | | | | | | | | | | |
| 核销病人医疗欠费 | | | | | | | | | | | | |
| 发放奖金数 | | | | | | | | | | | | |
| 发放业余服务补贴数| | | | | | | | | | | | |
| 其他减少数 | | | | | | | | | | | | |
4|期末数 | | | | | | | | | | | | |
| 未完专项占用 | | | | | | | | | | | | |
| 结余资金 | | | | | | | | | | | | |
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单位负责人: 财会负责人: 审核: 制表:
往来款项情况表
(医会05表)
编制单位: 年 季度 金额单位:元
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栏| 项 目|金 额|说 明||栏次| 项 目|金额|说明
次| | | || | | |
-|--------|---|---||--|-------|--|--
1|医疗应收款 | | || 7|医疗预收款 | |
2| 在院病人医药费| | || 8| 门诊预收款 | |
3| 出院病人欠费 | | || 9| 住院预收款 | |
4| 门诊病人应收款| | ||10|其它应付款 | |
5|其他应收款 | | || |(按项目填列)| |
|(按项目填列) | | || | | |
-|--------|---|---||--|-------|--|--
|专项应收款 | | || |专项应付款 | |
6| | | ||11| | |
|(按项目填列) | | || |(按项目填列)| |
------------------------------------
单位负责人: 财会负责人: 审核: 制表:
大型购置修缮项目表
(医会06表)
编制单位: 年 季度 金额单位:元
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栏| | | | | 年初未完|本| 本年累计|完| 期末未完|
| | | | | 占用 | | 执行 |工| 占用 |
| |单|数|总|-----|年|-----|实|-----|结
| 项 目| | |预|专|专| |预|专|专| |际|专|专|其|余
| |位|量|算|项|用|其|算|项|用|其|支|项|用| |数
次| | | | |补|基|他| |补|基|他|出|补|基|他|
| | | | |助|金| | |助|金| | |助|金| |
--|------|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-
1|一、大型设备| | | | | | | | | | | | | | |
|购置 | | | | | | | | | | | | | | |
|(以下按设备| | | | | | | | | | | | | | |
|名称列) | | | | | | | | | | | | | | |
2|(1) | | | | | | | | | | | | | | |
3|(2) | | | | | | | | | | | | | | |
4|(3) | | | | | | | | | | | | | | |
5|(4)其他 | | | | | | | | | | | | | | |
6|二、大型修缮| | | | | | | | | | | | | | |
7|(1)业务用房| | | | | | | | | | | | | | |
8|(2)辅助用房| | | | | | | | | | | | | | |
9|(3)生活用房| | | | | | | | | | | | | | |
10|(4)其他 | | | | | | | | | | | | | | |
--|------|-|-|-|-|-|-|-|-|-|-|-|-|-|-|-
11| 合计数 | | | | | | | | | | | | | | |
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