医疗广告审批表
申请医疗机构名称(盖章)
湖南省卫生厅印制
Omega-shaped expansion bends. Valve installation location should be easy to operate, and taking into account requirements for wiring, maintenance, check the import and export orientation in accordance with system design or technical documentation requirements. Hanger roots should make full use of the existing structure of the beam or the soleplate, hanger rod when any movable parts and the angle between the vertical, rigid hangers shall not be greater than 3 ?, elastic suspension not greater than 4 ?. Process piping should be above the ground or platform gaps for insulation and supported by expansion bolts secure rooting. Valve and the more heavy component at support hanging frame installation Shi,
填表说明
1、一律用钢笔填写或打印本表。字迹不清或项目不全～不予受理。
2、“经审查合格的医疗广告作品文字内容及样件”一栏～表中填写不下可另附页～但须加盖省级卫生行政部门广告审批骑缝章～否则无效。其中文字内容包括影视、广播广告语言和文字内容。
3、电视医疗广告申请要求提交分镜头脚本～即画面、画面说明、旁白和字幕。
4、异地来湘的医疗广告申请人必须提交医疗机构所在地省级卫生行政部门原审批的广告证明原件、广告的医疗机构执业许可证复印件及有关诊疗科目医师的执业证、资格证复印件。
5、本审批表核发量视刊播审定的情况确定～其中审批机关需存档一份～报送
同级广告监督管理机关一份。
6、本审查表由省级卫生行政部门统一印制～各市、州,县,级卫生行政部门可
复制。
2Valve and the more heavy component at support hanging frame installation Shi,ting. an 4 ?. Process piping should be above the ground or platform gaps for insulation and supported by expansion bolts secure rooable parts and the angle between the vertical, rigid hangers shall not be greater than 3 ?, elastic suspension not greater thny movion requirements. Hanger roots should make full use of the existing
structure of the beam or the soleplate, hanger rod when ants for wiring, maintenance, check the import and export orientation in accordance with system design or technical documentatshaped expansion bends. Valve installation location should be easy to operate, and taking into account requireme-Omega
医疗机构名称
法定医疗机构执业许可证号代表人发证机关诊疗地点邮政编码
联系电话
拟定发布媒介
广告制作单位
广告涉及的诊疗科目
广告涉及的诊疗科目
及有关从业医师姓名、
技术职称
提供的有关证明资料及说明
3ging frame installation Shi,t hanor platform gaps for insulation and supported by expansion bolts secure rooting. Valve and the more heavy component at suppor gid hangers shall not be greater than 3 ?, elastic suspension not greater than 4 ?. Process piping should be above the groundl, rie of the existing structure of the beam or the soleplate, hanger rod when any movable parts and the angle between the
verticaexport orientation in accordance with system design or technical documentation requirements. Hanger roots should make full us g, maintenance, check the import andshaped expansion bends. Valve installation location should be easy to operate, and taking into account requirements for wirin-Omega
医疗广告内容(含广告制作文稿、画面说明，填写不完可另附页)
市、州或县级卫生行政部门(盖章) 初审意见
签名: 日期:
4Valve and the more heavy component at support hanging frame installation Shi,ting. an 4 ?. Process piping should be above the ground or platform gaps for insulation and supported by expansion bolts secure rooable parts and the angle between the vertical, rigid hangers shall not be greater than 3 ?, elastic suspension not greater thny movion requirements. Hanger roots should make full use of the existing
structure of the beam or the soleplate, hanger rod when ants for wiring, maintenance, check the import and export orientation in accordance with system design or technical documentatshaped expansion bends. Valve
installation location should be easy to operate, and taking into account requireme-Omega
经审查的医疗广告作品文字内容及样件(样稿粘贴、样片、样带另附)
省级卫生行政部门(盖章) 审查意见
签名: 日期:
广告审批湘医广证字或湘中医广证字 ( )第号证明文号
有效期自年月至年月止
5ging frame installation Shi,t hanor platform gaps for insulation and supported by expansion bolts secure rooting. Valve and the more heavy component at suppor gid hangers shall not be greater than 3 ?, elastic suspension not greater than 4 ?. Process piping should be above the groundl, rie of the existing structure of the beam or the soleplate, hanger rod when any movable parts and the angle between the
verticaexport orientation in accordance with system design or technical documentation requirements. Hanger roots should make full us g, maintenance, check the import andshaped expansion bends. Valve installation location should be easy to operate, and taking into account requirements for wirin-Omega
异地来湘医疗广告审批
医疗机构名称
医疗机构执业许可证号
发证机关
诊疗地点
提供的有关证明资料及说明
异地医疗广告审查证明文号
经审查合格的医疗广告作品文字内容及样件(样稿粘贴样片、样带另附) 拟定
发布媒介 (列出媒介名称)
省级卫生行政部门
审查意见 (盖章)
签名: 日期:
6Valve and the more heavy component at support hanging frame installation Shi,ting. an 4 ?. Process piping should be above the ground or platform gaps for insulation and supported by expansion bolts secure rooable parts and the angle between the vertical, rigid hangers shall not be greater than 3 ?, elastic suspension not greater thny movion requirements. Hanger roots should make full use of the existing
structure of the beam or the soleplate, hanger rod when ants for wiring, maintenance, check the import and export orientation in accordance with system design or technical documentatshaped expansion bends. Valve installation location should be easy to operate, and taking into account requireme-Omega
附件:
7ging frame installation Shi,t hanor platform gaps for insulation and supported by expansion bolts secure rooting. Valve and the more heavy component at suppor gid hangers shall not be greater than 3 ?, elastic suspension not greater than 4 ?. Process piping should be above the groundl, rie of the existing structure of the beam or the soleplate, hanger rod when any movable parts and the angle between the
verticaexport orientation in accordance with system design or technical documentation requirements. Hanger roots should make full us g, maintenance, check the import andshaped expansion bends. Valve installation location should be easy to operate, and taking into account requirements for wirin-Omega
办理医疗广告出证应提交资料(对其提交的资料、复印件均需加盖公章):
1、湖南省医疗广告审查表一份;
2、医疗机构执业许可证副本原件、正副本复印件;
3、医疗广告涉及从业医师的医师资格证书、执业证书和卫生技术职务资格原件、复印件;
4、诊疗方法的技术资料、医疗广告涉及的相关仪器、材料需提供产品合格
证、注册证、生产经营许可证、进口仪器设备需提供海关商检证复印件;
5、医疗机构的主管卫生行政部门初审意见并签章;
6、医疗广告内容有附页者需用A4纸打印，标明共几页第几页;
7、营利性医疗机构提交工商营业执照。
中医医疗广告和西医医疗广告分别准备材料
电视广告分镜头脚本(样式)请用A4纸另行打印镜号时间镜头类别内容
广告词
对旁白、字幕、画面进行文字说明、画面另1 附页打印
8Valve and the more heavy component at support hanging frame installation Shi,ting. an 4 ?. Process piping should be above the ground or platform gaps for insulation and supported by expansion bolts secure rooable parts and the angle between the vertical, rigid hangers shall not be greater than 3 ?, elastic suspension not greater thny movion
requirements. Hanger roots should make full use of the existing
structure of the beam or the soleplate, hanger rod when ants for wiring, maintenance, check the import and export orientation in accordance with system design or technical documentatshaped expansion bends. Valve installation location should be easy to operate, and taking into account requireme-Omega