yyyy/MM/dd XXXXXXXXXE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE X
医薬品医療機器等輸入変更届出控情報 輸入届出番号 XXXXXXXXX1E 廃止識別 X 基本情報変更有無 提出先 届出目的 品目の別 業務の種別 業許可の区分 業許可又は登録番号 変更年月日 X JJJJJJJJJ1JJJE JJJJJJJJJE JJJJJJJJJ1JJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JE XXXXXXXXXE 業許可又は登録年月日 XXXXXXXXE yyyy/MM/dd 届出者情報変更有無 X 届出者業者 XXXXXXXXE 事務所又は製造業所名称 JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJ6JJJJJJJJJ7JJJJJJJJJ8J JJJJJJJJ9JJJJJJJJJE 代表者名 JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJE 事務所又は製造業所所在地 JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJ6JJJJJJJJJ7JJJJJJJJJ8J JJJJJJJJ9JJJJJJJJJ0JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJ6JJ JJJJJJJ7JJJJJJJJJ8JJJJJJJJJ9JJJJJJJJJ0JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJE 備考変更有無 X 備考 JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJ6JJJJJJJJJ7JJJJJJJJJ8J JJJJJJJJ9JJJJJJJJJ0JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJ6JJ JJJJJJJ7JJJJJJJJJ8JJJJJJJJJ9JJJJJJJJJ0JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJ JJJJJJ5JJJJJJJJJ6JJJJJJJJJ7JJJJJJJJJ8JJJJJJJJJ9JJJJJJJE 添付ファイル変更有無 X 添付ファイル変更箇所記述 JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJ6JJJJJJJJJ7JJJJJJJJJ8J JJJJJJJJ9JJJJJJJJJ0JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJ6JJ JJJJJJJ7JJJJJJJJJ8JJJJJJJJJ9JJJJJJJJJ0JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJ JJJJJJ5JJJJJJJJJ6JJJJJJJJJ7JJJJJJJJJ8JJJJJJJJJ9JJJJJJJJJ0JJJJJJJJJ1JJJJJJJJJ2JJJJ JJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJ6JJJJJJJJJ7JJJJJJJJJ8JJJJJJJJJ9JJJJJJJJJ0JJJJJ JJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJ6JJJJJJJJJ7JJJJJJJJJ8JJJJJJ JJJ9JJJJJJJE 添付ファイル郵送有無 JE 外国製造業者 変更区分 認定区分 X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE 認定番号 XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE CAL212-L-1 認定年月日 yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd 1 / 3 医薬品医療機器等輸入変更届出控情報（つづき） 変更区分 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 認定区分 JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJE 認定番号 XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE XXXXXXXXXE CAL212-L-2 認定年月日 yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd yyyy/MM/dd 2 / 3 医薬品医療機器等輸入変更届出控情報（つづき） 3 / 3 変更区分 輸入品目名称 プロダクトコード X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE X JJJJJJJJJ1JJJJJJJJJ2JJJJJJJJJ3JJJJJJJJJ4JJJJJJJJJ5JJJJJJJJJE XXXXXXXXX1XXXXXXXXX2XXXXXXXXX3XXXXXXXXX4XXXXXXXXX5XXXXXXXXXE XXXXXXXXX1XXXXXXXXXE CAL212-L-3
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