"定点医疗机构新增《目录》内医疗服务项目申请表" "医疗机构名称(盖章):联系人:联系电话:登记号: "序号","省物价编码","省医保编码","项目名称","项目内涵","备注","甲乙分类","自理比例","限定支付范围","除外内容","计价单位","价格",,,"医院内部编码","说明" 三","二","一",, "1" "2" "3" "4" "注:申请表一式一份,随附电子表格,并另附书面报告、医疗服务项目简介,大型医疗设备还应提供卫生行政部门、质量技术监督部门的批件或验收合格材料原件及复印件,《目录》即《浙江省基本医疗保险医疗服务项目目录》