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    本機(jī)關(guān)于    年    月    日    時(shí)對(duì)                                        

                                         進(jìn)行檢查，經(jīng)查實(shí)                        

                                                                      。

上述活動(dòng)違反了                                                                  

                  的規(guī)定，被認(rèn)定為非法行為，現(xiàn)決定依法對(duì)該單位         

                                                                      。

特此公告。

  衛(wèi)生行政機(jī)關(guān)名稱并蓋章

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