3
20
TE5645876457341574
北京市海淀区医疗保障局
城镇职工参保人员异地长期居住备案
TE5645876457341574311204104500302
TE56458764573415743112041045003
0
5856dfa6-f1c4-4c0a-b5a1-54c58d7f63af
46142f18-4031-40b3-b3f8-4cfc8f1e241d
3^5
20
海淀区医保局
110108000000
北京市海淀区医疗保障局
海淀区政务服务中心（上地办公区）:法定工作日: 上午: 09:00 - 12:00; 下午: 13:30 - 17:00; (延时服务时间: 工作日上午08:30 - 09:00; 中午12:00 - 13:30; 下午17:00 - 17:30; 周六上午08:30 - 12:30; );海淀区政务服务中心医保分中心:工作日，上午09:00-12:00，下午13:30-17:00 ( 延时服务时间：工作日早上8:30-9:00，中午12:00-13:30，下午17:00-17:30)
海淀区政务服务中心（上地办公区）:北京市海淀区东北旺南路甲29号四层中厅151-155窗口
海淀区政务服务中心医保分中心:北京市海淀区西四环北路73号中关村人才发展中心南区306室综合窗口
1.本市参保人员有跨省异地就医需求时均可申请办理跨省异地就医备案，办理备案时，需提交《北京市跨省异地就医登记备案表》，如实登记本人信息，并签署《基本医疗保险跨省异地就医备案个人承诺书》，承诺保证本人符合办理条件，所述（填）信息真实、准确、完整、有效，愿意接受信息共享查询核验，由此产生的一切经济损失和法律责任均由本人承担即可备案。（来源《北京市医疗保障局关于进一步做好基本医疗保险跨省异地就医直接结算工作的通知》（京医保发〔2022〕41号）。
2.材料齐全，填写完整，按要求签字。
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