Application for Health Permit 1 Applicant: Application Date:
(official seal)
applicant
Contact number
Unit address
postcode
company representative
Number of employees
represent
Number of people to be inspected: State-owned collectives, individuals, private institutions, institutions, joint-stock enterprises, wholly foreign-owned joint ventures and Sino-foreign cooperative fixed assets (10,000 yuan) Area (square meters)
Economic nature
Confirmation of completion acceptance
Scope and type of production and operation:
Name of application materials and number of confidentiality requirements materials
1, health examination certificate of employees; 2, practitioners health knowledge training certificate; 3. Proof of house property right or lease; 4. Qualification certificate of legal person or legal representative; 5. Health management organization and system; 6. Basic sanitation facilities; 7, equipment layout and process flow chart; 8, municipal health supervision institutions on-site inspection report (issued by the municipal health supervision institutions); 9, preventive health supervision data (new construction, renovation and expansion); (1) Approval letter for sanitary review of construction project design; (two) confirmation of the completion of the construction project; 10, food processing enterprises need to provide the following information; □( 1) enterprise standard (filed by Technical Supervision Bureau); Inspection certificate; (3) the recent (within three months) inspection report of the inspection institution recognized by the municipal public health administrative organ; (4) Two samples, labels and instructions of the finalized packaging products; (5) Other materials:
Confidentiality requirements
(2) enterprise laboratory (inspection equipment, inspection items, name, gender, age, education) or entrustment.
I (unit) guarantee to abide by all laws, regulations and health norms, and ensure that the information provided is accurate, true, legal and effective.
Person in charge of the applicant (signature): MM DD YY.
Date of acceptance: year month day.
Opinions of the Legal Inspection Division:
Health supervision personnel:
Date of transfer to legal inspection department: year, opinion of health supervision institution: month, day.
Date of transfer to hospital: year, opinion of health administrative department: month, day.
Date of transfer to the administrative department of health: year month day.
Go to the examination and approval service center window Date: YY.
Certificate number: date, month, year, month and year (validity: year, month and day).
2 _ township health center health permit application:
I sincerely hope that the clinic will be established in _ _ village, Japan, and under the direct leadership of township health centers, make greater contributions to the basic medical and health services in _ _ village!
I have been engaged in primary medical and health services in _ _ village since I became a doctor 12. Although I didn't study in a medical college, I passed the Chinese medicine course of 10 through self-study and self-examination, but because the self-examination period exceeded the standard, I was not allowed to take the medical practitioner examination, so I gave up the other two courses. /kloc-passed the rural doctor qualification examination in Wuwei county in 0/997, and passed the rural doctor qualification examination in Anhui province in 20xx. In 20xx, my thesis "Pathogenesis of Rheumatoid Arthritis" was adopted by journal of traditional chinese medicine, China. The following year, I wrote "Flowchart of Diagnosis and Treatment": the purpose, characteristics and significance of the formulation were included in the "Symposium on Modernization of Traditional Chinese Medicine and Its Implementation Countermeasures" sponsored by China Society of Traditional Chinese Medicine. In the same year, he entered the field of medical and health system reform in China for research; In 20xx, the Health Department of Anhui Province forwarded the materials of the Ministry of Health, and asked me to conduct medical reform research. From 20xx to 20xx, he successively completed the Analysis Report on the Present Situation and Reform of Medical and Health System in China, the Basic Medical Law of People's Republic of China (PRC) (Draft), the Provisional Conditions for the Formulation of National Basic Medical Care (Draft), and the Implementation Regulations of the Basic Medical Law of People's Republic of China (PRC) (Draft), and served as the coordination group for medical reform in the State Council.
My experience tells me that without the care and training of township hospitals, there would be no me today. When I encountered difficulties in my work, the township health center helped me overcome them; When I have made some achievements on the way forward, township hospitals praise and encourage me, and I will also pay my own strength to repay the kindness given to me by township hospitals.
I know that my basic medical and health service level is far from the requirements of township hospitals. However, I am determined to demand myself in the spirit of the Central Committee of the Communist Party of China Document No.6 (20xx), earnestly study the knowledge of basic medical and health services, resolutely implement the public welfare nature of basic medical and health services, wholeheartedly provide basic medical and health services for the people, and strive for the goal of popularizing basic medical and health services for life.
Please township hospitals for approval!
Application for health permit. County Food Hygiene Supervision Office for Health Permit Application: Sunjiaqiao Middle School is a boarding school with more than 300 boarders. The school is very strict in the management of food hygiene in the canteen, and has set up a special school food hygiene management and supervision institution. The health management system is sound, and the canteen staff are qualified in physical examination and healthy. The canteen operated by the school fully meets the health and safety standards. I applied for a food hygiene license in September 20xx, and the validity of this license has expired. I hereby apply for replacement. Please apply.
Sunjiaqiao high school
Application for health permit 4 applicant
Request date
Made by the Ministry of Health of the People's Republic of China
Name (font size) of the applicant, address of the person in charge (head of household), total number of employees (including temporary workers), fixed assets (10,000 yuan), certificate number of completion acceptance, application form for licensed project (mode of production and operation).
The telephone number of Economic legal and the legal representative shall be the original number of the health permit in the area where the physical examination and training, production and business premises are used.
Application materials (No.,name of materials)
Materials that need to be kept confidential:
Sanitary facilities (name and quantity)
(The above shall be filled in by the applicant) Opinions of the competent department.
Date of receipt of the application, date of acceptance of the application, and number of medical trainees.
Year, month, year, month, year
Number of recipients who have issued certificates.
Preliminary opinion: 1. After written examination and on-site inspection, it meets the certification requirements; 2. ApplicationNo. y05—- Health Permit; 3. Approved licensed projects.
(official seal)
Organizer:
Reviewed by:
Date, year and month
The license issuing organ approves the licensed project.
Seal of issuing authority
Issuer's hygiene license number. : Y05-3-2 is valid until
Date, year and month
Health permit application form 5 XX county health bureau:
XX county, located in, responsible person:, employee, who has obtained the health knowledge training certificate and health certificate of the health department. Our store has a sound health system, complete disinfection facilities, complete fly-proof, dust-proof and rat-proof facilities, a clean and tidy health environment, and a full-time (part-time) health administrator. We hereby apply for a health permit.
Health management personnel:
Applicant:
X year x month x day
Apply for a health permit. County-level food hygiene supervision office applying for hygiene license:
Xxx Middle School is a boarding school with more than 300 boarders. The school is very strict in the management of food hygiene in the canteen, and has set up a special school food hygiene management and supervision institution. The health management system is sound, and the canteen staff are qualified in physical examination and healthy. The canteen operated by the school fully meets the health and safety standards. I applied for a food hygiene license in September 20xx, and the validity of this license has expired. I hereby apply for replacement. Please apply.
Xxx high school
Xx，xx，XX，XX
Application for Health Permit 7 Applicant: _ _ _ _ _ _ _ _ _ _ _ _ _
Date of application: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Made by the Ministry of Health of the People's Republic of China
applicant
Economic nature
represent
Legal person and legal representative
Unit address
telephone
Number of employees
Number of people under inspection
Fixed assets (ten thousand yuan)
Utilization area
Completion acceptance approval number
Original hygiene license number
Statement of licensed project:
Application materials and confidentiality requirements:
Number of pages of material name
Sanitation facilities:
Opinions of the competent department
(official seal)
Date, year and month
Date of receipt of application
Date, year and month
Opinions of the handling supervisor
Opinions of health supervisors:
Date, year and month
Health supervision institutions examine and approve licensed projects.
(official seal)
Date, year and month
Date and quantity of issue
Date, year and month
Number:
The validity period is from day to day.
Date, year and month
Remarks:
Filling instructions
1. Fill in this book and give it to the designated health institution.
2. Use a brush or pen when filling in. The text should be concise and clear, and there should be no alteration. Fill in the blanks with the word "nothing".
3 "application for license project" fill in the scope and types of production and operation.
4. When submitting an application, the following materials must be submitted
(1) Approval letter for design hygiene review of construction project and approval letter for completion hygiene acceptance.
(2) equipment and process flow chart, raw material formula, use standard, special variety approval certificate, health examination and health training certificate of employees.
(3) Basic sanitary facilities, safety materials, inspection equipment and personnel.
(4) Other materials required to be declared by health supervision institutions.
5. Application in duplicate.
8. Application form for hygiene license of county-level food hygiene supervision office:
Shidi Middle School where I am located is a boarding school, which provides breakfast and dinner for boarding students. The school has a student canteen, and a special school food hygiene management and supervision institution has been set up. The health management system is sound, the canteen staff are healthy after physical examination, and the food handling is in full compliance with health and safety management.
In a word, the canteen of Shidi Middle School fully meets the food hygiene and safety standards, and hereby apply for a food license!
I am here to convey
Salute!
Applicant: xxx
Xx，xx，XX，XX
9 county food hygiene supervision office hygiene license application:
Xxx Middle School is a boarding school with more than 300 boarders. The school is very strict in the management of food hygiene in the canteen, and has set up a special school food hygiene management and supervision institution. The health management system is sound, and the canteen staff are qualified in physical examination and healthy. The canteen operated by the school fully meets the hygiene and safety standards. I applied for a food hygiene license in September 20xx, and the validity of this license has expired. I hereby apply for replacement. Please apply.
Hygiene license application 10 County Food Hygiene Supervision Office:
My XX middle school is a boarding middle school, which provides breakfast and dinner for boarding students. The school has a student canteen, and a special school food hygiene management and supervision institution has been set up. The health management system is sound, the canteen staff are healthy after physical examination, and the food handling is in full compliance with health and safety management.
In a word, the canteen of Shidi Middle School fully meets the food hygiene and safety standards, and hereby apply for a food license!
I am here to convey
Salute!
Applicant: Application Template
XX，XX，XX，XX
Health permit application 1 1 xx township hospitals:
I sincerely hope that in the next days, a clinic will be established in xx village, and under the direct leadership of township hospitals, it will make greater contributions to the basic medical and health services in xx village!
I have been a doctor for xx years and have been engaged in primary medical and health services in XX village. Although I didn't study in a medical college, I passed the Chinese medicine course of 10 through self-study and self-examination, but because the self-examination period exceeded the standard, I was not allowed to take the medical practitioner examination, so I gave up the other two courses. /kloc-passed the rural doctor qualification examination in Wuwei county in 0/997, and passed the rural doctor qualification examination in Anhui province in XX. In XX, my thesis "Pathogenesis of Rheumatoid Arthritis" was adopted by journal of traditional chinese medicine, China. The following year, I wrote "Flowchart of Diagnosis and Treatment": the purpose, characteristics and significance of the formulation were included in the "Symposium on Modernization of Traditional Chinese Medicine and Its Implementation Countermeasures" sponsored by China Society of Traditional Chinese Medicine. In the same year, he entered the field of medical and health system reform in China for research; In XX, Anhui Provincial Health Department forwarded the materials of the Ministry of Health and asked me to conduct medical reform research. From XX to XX, he successively completed the Analysis Report on the Present Situation and Reform of Medical and Health System in China, the Basic Medical Law of People's Republic of China (PRC) (Draft), the Provisional Conditions for the Formulation of National Basic Medical Care (Draft), and the Implementation Regulations of the Basic Medical Law of People's Republic of China (PRC) (Draft), etc., and served as the coordination group of medical reform in the State Council, China CYZY 655.
My experience tells me that without the care and training of township hospitals, there would be no me today. When I encountered difficulties in my work, the township health center helped me overcome them; When I have made some achievements on the way forward, township hospitals praise and encourage me, and I will also pay my own strength to repay the kindness given to me by township hospitals.
I know that my basic medical and health service level is far from the requirements of township hospitals. However, I am determined to demand myself in the spirit of the Central Committee of the Communist Party of China XX) No.6 document, earnestly study the knowledge of basic medical and health services, resolutely implement the public welfare nature of basic medical and health services, wholeheartedly provide basic medical and health services for the people, and strive for the goal of popularizing basic medical and health services for life.
Please township hospitals for approval!