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[{"$nulls":18},"ИНН",{"$nulls":41},"Приложение N 1 \nк приказу ФНС России \nот 08.11.2023 N ЕА-7-11/824@\n"]
[]
[]
[{"$nulls":18},"КПП",{"$nulls":23},"Стр.",null,null,null,"0",null,"0",null,"1"]
[]
[]
[]
["Форма по КНД 1151156 "]
["Справка \nоб оплате медицинских услуг для представления \nв налоговый орган "]
[]
["Номер справки ",{"$nulls":35},"Номер корректировки",{"$nulls":23},"Отчетный год "]
[]
["Данные медицинской организации/индивидуального предпринимателя, осуществляющего медицинскую деятельность:"]
{"$rows_empty":7}
["(наименование медицинской организации/фамилия, имя, отчество1 индивидуального предпринимателя)"]
[]
["Данные физического лица (его супруга/супруги), оплатившего медицинские  услуги (далее - налогоплательщик):"]
["Фамилия"]
[]
["Имя"]
[]
["Отчество1"]
[]
["ИНН2",{"$nulls":34},"Дата рождения ",{"$nulls":18},".",{"$nulls":5},"."]
[]
["Сведения о документе, удостоверяющем личность:"]
["Код вида документа ",{"$nulls":27},"Серия и номер"]
[]
["Дата выдачи ",{"$nulls":17},".",{"$nulls":5},"."]
[]
["Налогоплательщик и пациент являются одним лицом ",{"$nulls":46},"0 - нет \n1 - да "]
[]
[]
["Сумма расходов на оказанные медицинские услуги по коду услуги \"1\"",{"$nulls":69},"."]
[]
["Сумма расходов на оказанные медицинские услуги по коду услуги \"2\"",{"$nulls":69},"."]
[]
[]
["Достоверность и полноту сведений, указанных \nв настоящей справке, подтверждаю:",{"$nulls":41},"Зона QR-кода "]
[]
[]
[]
[]
[]
[]
[null,"(фамилия, имя, отчество1)"]
[]
[]
[null,"Подпись",{"$nulls":15},"Дата",{"$nulls":7},".",{"$nulls":5},"."]
[]
[null,"Справка составлена на ",{"$nulls":21},"страницах "]
[]
[]
[]
[]
[]
[null,null,"1 Отчество указывается при наличии (относится ко всем листам документа). \n2 ИНН указывается при наличии."]

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["Данные физического лица, которому оказаны медицинские услуги1:"]
["Фамилия"]
[]
["Имя"]
[]
["Отчество"]
[]
["ИНН2",{"$nulls":34},"Дата рождения ",{"$nulls":18},".",{"$nulls":5},"."]
[]
["Сведения о документе, удостоверяющем личность:"]
["Код вида документа ",{"$nulls":27},"Серия и номер"]
[]
["Дата выдачи ",{"$nulls":17},".",{"$nulls":5},"."]
{"$rows_empty":77}
[null,null,"1 Данные заполняются, если налогоплательщик и пациент не являются одним лицом. \n2 ИНН указывается при наличии."]
[]
[]
[]
["     Достоверность и полноту сведений, указанных на данной странице, подтверждаю:"]
[{"$nulls":34},"(подпись)",{"$nulls":26},"(дата)"]