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彰化縣輔具資源中心輔具租借滿意度調查表
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一、服務使用者基本資料(1~5項可不填寫)，*為必填項目。
1.輔具使用者
Your answer
2.身分證字號
Your answer
3.出生日期(例：102/11/22)
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4.性別
女
男
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5.電話/手機
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6.身分別
*
一般民眾
身心障礙者
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