You can not select more than 25 topics
Topics must start with a letter or number, can include dashes ('-') and can be up to 35 characters long.
134 lines
13 KiB
134 lines
13 KiB
3 months ago
|
<?xml version="1.0" encoding="UTF-8"?>
|
||
|
|
<emr>
|
||
|
|
<page styleline="false" height="210" width="297" lineheight="1.5" letterspace="0.0" paddingleft="10.0" paddingright="10.0" paddingtop="25.0" paddingbottom="10.0" portrait="0" />
|
||
|
|
<headercontent>
|
||
|
|
<![CDATA[
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
<TABLE style="FONT-SIZE: 2.85mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" bgColor=transparent border=0>
|
||
|
|
<TBODY>
|
||
|
|
<TR style="HEIGHT: 34px">
|
||
|
|
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=34 width=1046 colSpan=2 align=center><FONT style="FONT-SIZE: 6.37mm">湖南省永州市$LX$定点医疗机构费用结算申报汇总表</FONT></TD></TR>
|
||
|
|
<TR style="HEIGHT: 28px">
|
||
|
|
<TD style="CURSOR: default" height=28 width=681>医疗机构编号：<SPAN id=E51016F6-C62F-02AA-0B3B-5558117359F3 class=Emr_hdy wattype="static" watid="E51016F6-C62F-02AA-0B3B-5558117359F3" watvalue="JGBM" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JGBM$</SPAN></TD>
|
||
|
|
<TD style="CURSOR: default" height=28 width=362>申报结算日期：<SPAN id=3F596DB6-69BD-4727-B0BA-908577BF1A47 class=Emr_hdy wattype="static" watid="3F596DB6-69BD-4727-B0BA-908577BF1A47" watvalue="SBSJ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$SBSJ$</SPAN></TD></TR>
|
||
|
|
<TR style="HEIGHT: 29px">
|
||
|
|
<TD style="CURSOR: default" height=29 width=1046 colSpan=2>医疗机构名称：<SPAN id=04FD5EDF-AEA4-58E1-7111-2F6D151D8EE0 class=Emr_hdy wattype="static" watid="04FD5EDF-AEA4-58E1-7111-2F6D151D8EE0" watvalue="JGMC" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JGMC$</SPAN></TD></TR></TBODY></TABLE>
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
]]>
|
||
|
|
</headercontent>
|
||
|
|
<content>
|
||
|
|
<![CDATA[
|
||
|
|
|
||
|
|
<TABLE style="FONT-SIZE: 2.85mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; TEXT-ALIGN: center; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" align=center bgColor=transparent border=1 class>
|
||
|
|
<TBODY>
|
||
|
|
<TR class>
|
||
|
|
<TD style="CURSOR: default" height=23 rowSpan=2 width=70 class>医保区划</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 rowSpan=2 width=67 class>医疗类别</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 rowSpan=2 width=40 class>人数</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 rowSpan=2 width=44 class>人次</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 rowSpan=2 width=76 class>医疗费总额</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=267 colSpan=4 class>医保基金支付</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=360 colSpan=6 class>一站式基金支付</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 rowSpan=2 width=51 class>其他支付</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 rowSpan=2 width=61 class>个人自付</TD></TR>
|
||
|
|
<TR class>
|
||
|
|
<TD style="CURSOR: default" height=23 width=73 class>统筹支付</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=64 class>大病支付</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=60 class>家庭帐户</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=68 class>小计</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=55 class>特惠保补偿</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=63 class>医疗救助</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=47 class>医院减免</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=65 class>财政兜底</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=51 class>其他支出</TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=74 class>小计</TD></TR>
|
||
|
|
<P $data>
|
||
|
|
<TR class>
|
||
|
|
<TD style="CURSOR: default" height=23 width=70 class><SPAN id=3DEFD5D5-5416-C914-3DE6-29D464986F35 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="3DEFD5D5-5416-C914-3DE6-29D464986F35" watvalue="TCQH" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^TCQH^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=67 class><SPAN id=A28C9B0F-8C6F-9A44-B209-368D95CEC47F class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="A28C9B0F-8C6F-9A44-B209-368D95CEC47F" watvalue="YLLB" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^YLLB^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=40 class><SPAN id=9C322385-404A-A32B-5A92-90093EA20BC7 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="9C322385-404A-A32B-5A92-90093EA20BC7" watvalue="RS" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^RS^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=44 class><SPAN id=A24EC1A0-F86D-A3F7-17B2-E5C11F916E37 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="A24EC1A0-F86D-A3F7-17B2-E5C11F916E37" watvalue="RC" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^RC^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=76 class><SPAN id=258B6613-509C-CB12-0FD7-08E5C85A06AA class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="258B6613-509C-CB12-0FD7-08E5C85A06AA" watvalue="ZFY" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^ZFY^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=73 class><SPAN id=B5ECD750-D2B5-F4F6-0F96-94FEB8D83A2D class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="B5ECD750-D2B5-F4F6-0F96-94FEB8D83A2D" watvalue="TCZF" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^TCZF^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=64 class><SPAN id=0B174FB6-6622-7D1E-66E0-D85EA42DAFC3 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="0B174FB6-6622-7D1E-66E0-D85EA42DAFC3" watvalue="DBZF" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^DBZF^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=60 class><SPAN id=7300EF50-E072-BB47-86DA-08015F81BD54 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="7300EF50-E072-BB47-86DA-08015F81BD54" watvalue="JTZH" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^JTZH^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=68 class><SPAN id=DD17F48E-0B79-239A-34B8-F8F02ECC3948 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="DD17F48E-0B79-239A-34B8-F8F02ECC3948" watvalue="JJXJ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^JJXJ^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=55 class><SPAN id=17803CE5-F346-54D5-2F4E-E5443AA95152 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="17803CE5-F346-54D5-2F4E-E5443AA95152" watvalue="THB" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^THB^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=63 class><SPAN id=078D24BE-87FB-6117-559C-2AB84829B17C class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="078D24BE-87FB-6117-559C-2AB84829B17C" watvalue="YLJZ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^YLJZ^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=47 class><SPAN id=EB455D36-D135-2E5C-D96B-049042231F89 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="EB455D36-D135-2E5C-D96B-049042231F89" watvalue="YYJM" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^YYJM^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=65 class><SPAN id=276FC6F9-7060-0CF8-A1DE-8CB73F14A421 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="276FC6F9-7060-0CF8-A1DE-8CB73F14A421" watvalue="CZDD" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^CZDD^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=51 class><SPAN id=04DF7BBB-01BE-2422-A92E-EBFCA8CC5F71 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="04DF7BBB-01BE-2422-A92E-EBFCA8CC5F71" watvalue="QTZC" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^QTZC^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=74 class><SPAN id=29DC646C-399F-2785-0219-A2D817E01749 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="29DC646C-399F-2785-0219-A2D817E01749" watvalue="XJ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^XJ^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=51 class><SPAN id=6831E5F9-4029-D7B3-4BAE-72978615DEE7 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="6831E5F9-4029-D7B3-4BAE-72978615DEE7" watvalue="QTZF" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^QTZF^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD>
|
||
|
|
<TD style="CURSOR: default" height=23 width=61 class><SPAN id=F4EF2073-514D-216E-7C1D-D514C8173F64 class=Emr_hdy style="FONT-SIZE: 2.85mm" wattype="static" watid="F4EF2073-514D-216E-7C1D-D514C8173F64" watvalue="GRZF" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^GRZF^</SPAN><FONT style="FONT-SIZE: 2.85mm"></FONT></TD></TR>
|
||
|
|
</P $data></TBODY></TABLE>
|
||
|
|
<P></P>
|
||
|
|
<P> </P>
|
||
|
|
<P>
|
||
|
|
<TABLE class=Emr_table_dotted style="FONT-SIZE: 2.85mm; FONT-FAMILY: 宋体; WIDTH: 100%; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" bgColor=transparent border=0>
|
||
|
|
<TBODY>
|
||
|
|
<TR class=Emr_table_dotted style="HEIGHT: 25px" class="Emr_table_dotted">
|
||
|
|
<TD class=Emr_table_dotted style="CURSOR: default" height=25 width=655 class="Emr_table_dotted">本医疗机构发生医疗费用合计（大写）<SPAN id=C5D50305-4065-A4D1-F5A9-8CC98D8FD774 class=Emr_hdy wattype="static" watid="C5D50305-4065-A4D1-F5A9-8CC98D8FD774" watvalue="ZFYDX" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFYDX$</SPAN></TD>
|
||
|
|
<TD class=Emr_table_dotted style="CURSOR: default" height=25 width=387 class="Emr_table_dotted">（小写）<SPAN id=48DFF02B-85B2-29FC-7E62-6030F2ABD940 class=Emr_hdy wattype="static" watid="48DFF02B-85B2-29FC-7E62-6030F2ABD940" watvalue="ZFYXX" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFYXX$</SPAN></TD></TR>
|
||
|
|
<TR class=Emr_table_dotted style="HEIGHT: 26px" class="Emr_table_dotted">
|
||
|
|
<TD class=Emr_table_dotted style="CURSOR: default" height=26 width=655 class="Emr_table_dotted">本医疗机构垫付金额合计（大写）<SPAN id=A1CBC152-F106-3072-5019-B6AA435E6E7A class=Emr_hdy wattype="static" watid="A1CBC152-F106-3072-5019-B6AA435E6E7A" watvalue="BXDX" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$BXDX$</SPAN></TD>
|
||
|
|
<TD class=Emr_table_dotted style="CURSOR: default" height=26 width=387 class="Emr_table_dotted">（小写）<SPAN id=C87AE1D0-0328-636A-46B0-9458048E2070 class=Emr_hdy wattype="static" watid="C87AE1D0-0328-636A-46B0-9458048E2070" watvalue="BXXX" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$BXXX$</SPAN></TD></TR>
|
||
|
|
<TR class=Emr_table_dotted style="HEIGHT: 28px" class="Emr_table_dotted">
|
||
|
|
<TD class=Emr_table_dotted style="CURSOR: default" height=28 width=655 class="Emr_table_dotted">本医疗机构垫付基本医疗统筹基金合计（大写）<SPAN id=662B4654-F895-AE9A-DF29-14EB90C3BBE8 class=Emr_hdy wattype="static" watid="662B4654-F895-AE9A-DF29-14EB90C3BBE8" watvalue="JJDX" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJDX$</SPAN></TD>
|
||
|
|
<TD class=Emr_table_dotted style="CURSOR: default" height=28 width=387 class="Emr_table_dotted">（小写）<SPAN id=2FFBE1C9-0A66-78CB-B105-12FD8116F4F7 class=Emr_hdy wattype="static" watid="2FFBE1C9-0A66-78CB-B105-12FD8116F4F7" watvalue="JJXX" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJXX$</SPAN></TD></TR>
|
||
|
|
<TR class=Emr_table_dotted style="HEIGHT: 25px" class="Emr_table_dotted">
|
||
|
|
<TD class=Emr_table_dotted style="CURSOR: default" height=25 width=655 class="Emr_table_dotted">统计人：<SPAN id=703AD1F4-9EC9-5625-B3DB-88B0437E44E9 class=Emr_hdy wattype="static" watid="703AD1F4-9EC9-5625-B3DB-88B0437E44E9" watvalue="TJR" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$TJR$</SPAN></TD>
|
||
|
|
<TD class=Emr_table_dotted style="CURSOR: default" height=25 width=387 class="Emr_table_dotted">打印日期：<SPAN id=7A73EC29-3289-50DE-5CC1-E063135071CE class=Emr_hdy wattype="static" watid="7A73EC29-3289-50DE-5CC1-E063135071CE" watvalue="TJSJ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$TJSJ$</SPAN></TD></TR></TBODY></TABLE></P>
|
||
|
|
]]>
|
||
|
|
</content>
|
||
|
|
<footercontent>
|
||
|
|
<![CDATA[
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
|
||
|
|
]]>
|
||
|
|
</footercontent>
|
||
|
|
</emr>
|