5
05
1111010500005341X2
北京市朝阳区人民政府劲松街道办事处
因病致贫家庭医疗救助
1111010500005341X2511054100300201
1111010500005341X25110541003002
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b03a1589-4df6-40b2-b87f-d68447d8a069
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3^5
05
朝阳区劲松街道
110105017000
北京市朝阳区人民政府劲松街道办事处
朝阳区劲松街道政务服务中心:工作日，上午09:00-12:00，下午14:00-17:30
朝阳区劲松街道政务服务中心:北京市朝阳区广渠路36号院(首城国际B区南门外)一层综合窗口
申请家庭应当填写《申请因病致贫家庭医疗救助经济状况和医疗费用支出情况登记表、声明书、授权书》，如实申报家庭经济状况，授权医保部门对其家庭收入、家庭财产和医疗费用支出情况进行核查。同时提交上一自然年度家庭成员的以下相关材料：
1.户口簿及身份证复印件；
2.《申请因病致贫家庭医疗救助经济状况和医疗费用支出情况登记表、声明书、授权书》；
3.年度收入情况说明及相关财产说明；
4.参加商业保险的，需要提供商业保险主管部门出具的费用结算分割单；
5.对于参加外埠基本医疗保险及参加本市基本医疗保险因特殊原因未能实时结算的本市户籍人员，仍需提交相关医疗费用票据；
6.医保部门认为需要提供的其他证明材料。
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