<p class="MsoNormal" align="center" style="text-align:center;"> <b>食品药品在线咨询</b><b><span>登记表</span></b><b></b> </p> <p class="MsoNormal" align="center" style="margin-left:-7.0500pt;text-indent:5.2500pt;text-align:center;"> <span>咨询日期：</span> <span>年</span><span> </span><span>月</span><span> </span><span>日</span><b> </b>食药咨<span>字</span>[ ]<span>第</span><span> </span><span>号</span> </p> <table class="MsoNormalTable" align="center" style="width:677.25pt;"> <tbody> <tr> <td width="903" valign="center" colspan="6" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal" align="center" style="margin-left:21.1000pt;text-indent:-21.1000pt;text-align:center;"> <b><span style="font-family:宋体;font-size:14pt;">咨询人基本情况</span></b><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> </tr> <tr> <td width="75" valign="center" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-family:宋体;font-size:12.0000pt;">姓名</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> <td width="122" valign="center" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-family:宋体;font-size:12.0000pt;"> </span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> <td width="106" valign="center" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-family:宋体;font-size:12.0000pt;">性别</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> <td width="145" valign="center" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-family:宋体;font-size:12.0000pt;"> </span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> <td width="94" valign="center" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">联系电话 </span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> <td width="359" valign="center" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-family:宋体;font-size:12.0000pt;"> </span> </p> </td> </tr> <tr> <td width="197" valign="center" colspan="2" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;"> 身份证号</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> <td width="251" valign="center" colspan="2" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;"> </span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> <td width="94" valign="center" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">电子信箱</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> <td width="359" valign="center" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;"> </span> </p> </td> </tr> <tr> <td width="197" valign="center" colspan="2" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;"> 住所地</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">（经常居住地）</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> <td width="705" valign="center" colspan="4" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;"> </span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> </tr> <tr> <td width="197" valign="center" colspan="2" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <b><span style="font-family:宋体;font-size:14pt;">咨询方式</span></b><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> <td width="705" valign="center" colspan="4" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">A来访 B电话 C信函 D网络 </span><b><span style="font-family:宋体;font-size:12pt;">您的选择：</span></b><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> </tr> <tr> <td width="903" valign="center" colspan="6" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <b><span style="font-family:宋体;font-size:14pt;">咨询事项类别</span></b><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> </tr> <tr> <td width="903" valign="center" colspan="6" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">A食品生产</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">B食品流通</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">C药品</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">D医疗器械</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">E保健食品</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">F化妆品</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">G 餐饮</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">H 行政</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;">I 其他</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <b><span style="font-family:宋体;font-size:12pt;">您的选择：</span></b><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> </tr> <tr> <td width="903" valign="center" colspan="6" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <b><span style="font-family:宋体;font-size:14pt;">咨询事项（关键词）</span></b><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> </tr> <tr> <td width="903" valign="center" colspan="6" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;"> 内容：</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;"> </span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;"> </span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal"> <span style="font-family:宋体;font-size:12.0000pt;"> </span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> </tr> <tr> <td width="903" valign="center" colspan="6" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal"> <b><span style="font-family:宋体;font-size:14pt;">答复意见</span></b><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> </tr> <tr> <td width="903" valign="top" colspan="6" style="border:1.0000pt solid windowtext;"> <p class="MsoNormal" style="text-indent:182pt;"> <span style="font-family:宋体;font-size:14.0000pt;"> </span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> <p class="MsoNormal" style="margin-left:21pt;text-indent:135pt;"> <span style="font-family:宋体;font-size:12.0000pt;"> 接待人员（签字）：</span><span style="font-family:宋体;font-size:12.0000pt;"></span> </p> </td> </tr> </tbody> </table> <p class="MsoNormal"> </p>