《药品经营许可证事项变更》经营范围变更提供资料表格范文.doc

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　　　药房许可证项目变更资料目录　　　　　　　　　　　　　　　　　　　　　　　　　序号资料名称说明备注 1 许可证项目变更申请 1份 2 《药品经营许可证》变更许可登记事项审批表 3份 3 药品布置平面图（新） 1份 4 企业新增设施、设备目录 1份 5 企业管理机构职能设置框图（新） 1份 6 药品经营质量管理体系文件目录（新） 1份 7 从业人员花名册 1份 8 资料真实性声明 1份 9 自查报告 1份 10 企业经营许可证复印件 1份复制件 11 营业执照复印件 1份复制件 12 现场评审表 2份双面打印 13 GSP认证证书复印件备注　经营范围变更（正面1）受理编号：　号变更《药品经营许可证》现场评审表企业名称：申请人：填报日期：2011年月日受理部门：受理日期：2011年月日（反面1）填报说明 1、本表中的表一、续表一及封面内容由企业按实际情况填写，表二中的内容由审查组现场验收及核实后填写（被审查企业意见由企业填写）。 2、药品零售企业经所在地的地（市）及食品药品监督管理局组织审查合格后，由地（市）及食品药品监督管理局填写表三中的审核意见及核准的内容、事项、报食品药品监督管理局备案。 3、本表中一式二份，申请企业和地（市）级食品药品监督管理局各一份。 4、本表中有*号的项为换证企业填写。 5、本表所列各项内容填写不下时均可另附页。表一企业名称变更（申请）日期地址经营面积㎡经济性质经营方式零电话法人代表职称从事药品经营管理工作年限企业负责人职称从事药品经营管理工作年限质量负责人职称从事药品经营管理工作年限经营范围处方药与非处方药：中药材（国限品种除外）、中药饮片、中成药、化学药制剂、抗生素制剂*** 固定资产 *上年销售额 *上年利税 *合格证编号 *发证部门 *发证日期 *许可证编号 *发证部门 *发证日期从业人员数总数其中药学技术人员 2 总数执业药师从业药师驻店药师副主任药师主管药师药师药士其它 2 质量管理机构总人数其中药学技术人员总数执业药师从业药师驻店药师副主任药师主管药师药师药士其它 1 1 营业场所面积（平方米）（ 80）㎡仓贮面积（平方米）仓贮设施设备总面积常温库阴凉库冷库排风扇、温湿度计、灭虫灯、灭火器、柜台、货架、木质底垫、干燥剂、粘鼠板等无无无无变更后企业基本情况（反面2）续表一变更前后情况变更内容经营范围前处方药与非处方药：中药材（国限品种除外）、中药饮片、中成药、化学药制剂、抗生素制剂*** 后处方药与非处方药：中药材（国限品种除外）、中药饮片、中成药、化学药制剂、抗生素制剂、生物制品*** 变更内容企业名称前后变更内容前后所提交的文件、证件、资料目录许可证项目变更申请《药品经营许可证》变更许可事项审批表营业场所方位图药品布置平面图企业新增设施、设备目录声明及保证企业经营许可证营业执照作为一名测量人员，xx认真履行岗位职责，紧密配合施工，制定切实可行的的测量放线方案。保罗回忆自己年少时癿经历，丌断怃耂生命、医疗、道德不哲学乊间癿兰系，丌仅为从医考提供了新规觇，使他们对自己癿职业呾使命有更为深入癿怃耂，耄丏为读考引路，觑人们更勇敢、沉着地看待生命、死亜不未来。situation, causing the livelihood of 100 tailings project management project and South Mining Technology in two engineering work lag. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, strictly abide by the party's political discipline. Strictly abide by the constitution, the principle of Party organization and party political life standards, do not spread against the party's theory and policy advice, not contrary to published The central and provincial Party committee decided to talk, not to divulge the secrets of the party and the state, do not make no illegal organization and participate in various activities, political, spread rumors and false information, not to publish lossy unity of speech, do not damage the unity of things, and never allow individuals above the organization. 2, adhere to the scientific and democratic decision-making the decision to make decisions. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents and so on. To improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit opinions, experts, public hearings and other health system. All major decisions before the risk assessment mechanism and legitimacy review mechanism. Adhere to the interests of the masses and the intention reflected in the policy making process and carry out the work, not acting on their behalf, "across the board" and coercion. (two) the existence of "negative communication" or unwilling to communication problems due to maintenance party team unity. The team members of the division of responsibilities, temperament, interestsDifferences in demand, often leads to different views, different opinions. Individual members of organization and coordination ability, team spirit is not good, work style is not real, simple working methods, lack of knowledge of the wisdom of the people, forgiveness and art for the people, can not deal with different opinions, there are "self sweep the snow in front of the door, all kinds of responsibility fields". Some members of the team division of work coordination, lack of coordination, as extreme liberalization, did not form a work force. In addition, individual cadres lack of leadership training, love "command communication", "negative communication", talk in the work did not take the initiative to talk not correct The science team differences, resolve conflicts. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to further strengthen the education and guidance on the implementation of the central eight provisions, the provincial nine provisions of the county committee of the "ten provisions" extensive publicity, eliminate the ideological （正面3）表二现场审查情况审查组人员签名成员所在单位姓名（签字）审查项目组长：组员：组员：审查情况审查组组长签字：年月日被审查企业意见企业法定代表人（负责人）签字：年月日（企业盖章）新（增、减）设施、设备目录序号名称用途地点数量状态 1 2 3 4 5 6 7 8 9 10 11 12 13 14 声明 ***食品药品监督管理局：本人在申请办理事项的过程中，按规定条件和要求向贵局提供了有关资料，现声明如下： 1、提供的上述资料真实有效，复印件与原件相符； 2、所提供的资料完全与实际相符合； 3、若有提供虚假文件、数据或其他欺骗行为，愿承担相应的法律责任。声明人：（签字）年月日

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