国军桃园总医院英文诊断证明申请单

application for an english version of diagnosis statement at the taoyuan armedforces general hospital註：

一、軍人免費，一般身份英文診斷證明（批價代碼：doc003）每份壹佰元整。（the english

version ofdiagnosis statement is free for military personnel.   the general public will becharged nt$100 for thisservice.）

二、本申請單連同醫師開具之英文診斷證明書交由申請人至掛號櫃台批價後，再至服務台用印，始完成手續。（the applicant needs to bring the application and the diagnosis statement

to the cashier.   afterpaying the required fees, the applicant needs to have the statement stamped with

the official tsgh seal at the service counter.）

三、本申請單由服務台收存，並將英文診斷證明書影印一份備查。（the service counter

will retain theapplication and a copy of the diagnosis statement for records.）