klhis/file/reporttemplate/DE3C9D58-C91A-459E-74D0-589.../住院押金单打印/349787eca6f2a2d1a14e50251d9...

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<P align=center><FONT style="FONT-SIZE: 4.93mm"><STRONG><SPAN id=69D307A4-6598-86CE-D0C9-563709666565 class=Emr_hdy wattype="static" watid="69D307A4-6598-86CE-D0C9-563709666565" watvalue="JGID" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JGID$</SPAN>住院押金缴款单</STRONG></FONT></P>
<P>
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" bgColor=transparent border=1 class>
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<TR class>
<TD style="CURSOR: default" height=23 width=39 class>姓名</TD>
<TD style="CURSOR: default" height=23 width=120 class><SPAN id=E668923F-C4E1-0E03-AB98-D2EEA275761A class=Emr_hdy wattype="static" watid="E668923F-C4E1-0E03-AB98-D2EEA275761A" watvalue="XM" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XM$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=43 class>性别</TD>
<TD style="CURSOR: default" height=23 width=36 class><SPAN id=251E44CF-1668-E72E-23B2-933486406B28 class=Emr_hdy wattype="static" watid="251E44CF-1668-E72E-23B2-933486406B28" watvalue="XB" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XB$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=42 class>年龄</TD>
<TD style="CURSOR: default" height=23 width=66 class><SPAN id=47EA7834-E6CA-2142-5241-9896089D8758 class=Emr_hdy wattype="static" watid="47EA7834-E6CA-2142-5241-9896089D8758" watvalue="JZNL" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JZNL$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=73 class>住院号</TD>
<TD style="CURSOR: default" height=23 width=140 class><SPAN id=D4EF8716-1342-4D14-104A-C50362BA94DD class=Emr_hdy wattype="static" watid="D4EF8716-1342-4D14-104A-C50362BA94DD" watvalue="JZNO" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JZNO$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=43 class>科室</TD>
<TD style="CURSOR: default" height=23 width=179 class><SPAN id=5A2112E1-F7CF-5A0C-5B4C-3C63C70086D5 class=Emr_hdy wattype="static" watid="5A2112E1-F7CF-5A0C-5B4C-3C63C70086D5" watvalue="JJKS" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJKS$</SPAN></TD></TR>
<TR class>
<TD style="CURSOR: default" height=23 width=39 class>地址</TD>
<TD style="CURSOR: default" height=23 width=572 colSpan=8 class><SPAN id=8DCB756B-856F-BF7E-5B64-89B0E5A8919C class=Emr_hdy wattype="static" watid="8DCB756B-856F-BF7E-5B64-89B0E5A8919C" watvalue="XZDZ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XZDZ$</SPAN></TD>
<TD height=23 width=179 class></TD></TR></TBODY></TABLE></P>
<P>
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" bgColor=transparent border=1 class>
<TBODY>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=101 class>支付方式</TD>
<TD style="CURSOR: default" height=23 width=690 colSpan=3 class><SPAN id=5612CA59-CC51-BBB2-2F73-159D99ABFE78 class=Emr_hdy wattype="static" watid="5612CA59-CC51-BBB2-2F73-159D99ABFE78" watvalue="ZFFS" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFFS$</SPAN><SPAN id=937E039C-8097-FC96-A6C0-E657317EA311 class=Emr_hdy wattype="static" watid="937E039C-8097-FC96-A6C0-E657317EA311" watvalue="YJJE" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$YJJE$</SPAN><SPAN> </SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=101 class>身份证号码</TD>
<TD style="CURSOR: default" height=23 width=375 class><SPAN id=29B24DA8-7F2E-BE70-C83E-BE769E6EB863 class=Emr_hdy wattype="static" watid="29B24DA8-7F2E-BE70-C83E-BE769E6EB863" watvalue="SFZH" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$SFZH$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=83 class>时间</TD>
<TD style="CURSOR: default" height=23 width=228 class><SPAN id=DF5B0B6A-B84B-83D0-20FC-366E22F928F1 class=Emr_hdy wattype="static" watid="DF5B0B6A-B84B-83D0-20FC-366E22F928F1" watvalue="SKRQ*yyyy-MM-dd HH:mm" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$SKRQ*yyyy-MM-dd HH:mm$</SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=101 class>大写金额</TD>
<TD style="CURSOR: default" height=23 width=375 class><SPAN id=462DE17A-A011-FCAA-FC90-55EB7360B513 class=Emr_hdy wattype="static" watid="462DE17A-A011-FCAA-FC90-55EB7360B513" watvalue="大写金额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$大写金额$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=83 class>小写金额</TD>
<TD style="CURSOR: default" height=23 width=228 class><SPAN id=65FC9111-8764-5ACB-D65C-51F48E0F8FFC class=Emr_hdy wattype="static" watid="65FC9111-8764-5ACB-D65C-51F48E0F8FFC" watvalue="YJJE" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$YJJE$</SPAN></TD></TR>
<TR style="HEIGHT: 50px" class>
<TD style="CURSOR: default" height=50 width=101 class>备注</TD>
<TD style="CURSOR: default" height=50 width=690 colSpan=3 class>
<P>1.预缴金额请当面核实，离柜概不负责； 2.本凭据只作为预收凭据不作为医药费凭据；</P>
<P>3.只凭预缴金发票给予退款；           4.此单是临时收据，不作为报销凭证，请保管好，失后不补；</P></TD></TR></TBODY></TABLE></P>
<P>收费单位章                               交款人签名：                              收费员：<SPAN id=370FE8C5-9CB0-32A7-E93C-5AF880A3779E class=Emr_hdy wattype="static" watid="370FE8C5-9CB0-32A7-E93C-5AF880A3779E" watvalue="SKR" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$SKR$</SPAN> </P>
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