文本内容:
勤物瞽院一般^瘴言登明本瞪明保下述^勤物於本院粉瘵情形本瞪明彳堇瘴富天彝幺合,逾期恕不填彝本瞪明彳堇供一般情5兄使用,不作;公瞪明用本瞪明须有本院盖章及亵瞪瞽白币筵章勤物槿类比勤物品槿:性别:晶片虢碣呼名年龄或生辰状[兄_________________________毛色特徵醴重照片照片畜主姓名_________________________畜主身分瞪虢礁___________________畜主住址_________________________________________________粉瘴日期_________________________________________________主^症状__________________________________________________陶床症状_________________________________________________M横____________________________________________________建^事项__________________________________________________治瘵_____________________________________________________填军日期:。