klhis/file/reporttemplate/DE3C9D58-C91A-459E-74D0-5897CAC5F92B/结算单费用/cb8dbb1598de8f5cd56b615523823759.xml

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<emr>
<page styleline="false" height="297" width="210" lineheight="1.5" letterspace="0.0"  paddingleft="10.0" paddingright="10.0" paddingtop="36.8" paddingbottom="10.0" portrait="1" />
<headercontent>
<![CDATA[
<SPAN>
<P>
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; WIDTH: 99%; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 bgColor=transparent border=0>
<TBODY>
<TR style="HEIGHT: 29px">
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=29 vAlign=middle width=715 colSpan=12 align=center><SPAN id=764907BB-9B3D-87DA-4255-DCB0B11E692A class=Emr_hdy style="FONT-SIZE: 4.93mm" align="center" wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="医疗机构" watid="764907BB-9B3D-87DA-4255-DCB0B11E692A">$医疗机构$</SPAN><SPAN id=F7353180-63F6-92B6-E02A-4CF2083999D8 class=Emr_hdy style="FONT-SIZE: 5.23mm" wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="结算类型" watid="F7353180-63F6-92B6-E02A-4CF2083999D8">$结算类型$</SPAN></TD></TR>
<TR style="HEIGHT: 25px">
<TD style="CURSOR: default" height=25 width=59><STRONG>住院号:</STRONG></TD>
<TD style="CURSOR: default" height=25 width=94><SPAN id=C8CE58D3-D4DD-0446-A7AD-6D410564B526 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="住院号" watid="C8CE58D3-D4DD-0446-A7AD-6D410564B526">$住院号$</SPAN><SPAN> </SPAN></TD>
<TD style="CURSOR: default" height=25 width=40><STRONG>姓名:</STRONG></TD>
<TD style="CURSOR: default" height=25 width=82><SPAN id=1E51C271-2360-1596-1E81-11857CC7A196 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="姓名" watid="1E51C271-2360-1596-1E81-11857CC7A196">$姓名$</SPAN></TD>
<TD style="CURSOR: default" height=25 width=40><STRONG>性别:</STRONG></TD>
<TD style="CURSOR: default" height=25 width=42><SPAN id=F879528E-F98B-15DC-43A4-0C1E1710B88F class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="性别" watid="F879528E-F98B-15DC-43A4-0C1E1710B88F">$性别$</SPAN></TD>
<TD style="CURSOR: default" height=25 width=40><STRONG>年龄:</STRONG></TD>
<TD style="CURSOR: default" height=25 width=46><SPAN id=AABA0939-7CE3-1349-8DCD-4A609A0B93CE class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="年龄" watid="AABA0939-7CE3-1349-8DCD-4A609A0B93CE">$年龄$</SPAN></TD>
<TD style="CURSOR: default" height=25 width=40><STRONG>科室:</STRONG></TD>
<TD style="CURSOR: default" height=25 width=133><SPAN id=DE8CDECD-E284-BDCB-07C2-EA5D34741442 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="科室" watid="DE8CDECD-E284-BDCB-07C2-EA5D34741442">$科室$</SPAN></TD>
<TD style="CURSOR: default" height=25 width=39><STRONG>床号:</STRONG></TD>
<TD style="CURSOR: default" height=25 width=49><SPAN id=6CEC5025-1590-1554-64AA-98B2631184DF class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="床号" watid="6CEC5025-1590-1554-64AA-98B2631184DF">$床号$</SPAN></TD></TR>
<TR style="HEIGHT: 23px">
<TD style="CURSOR: default" height=23 width=59><STRONG>医保号:</STRONG></TD>
<TD style="CURSOR: default" height=23 width=561 colSpan=9><SPAN id=6DBEB2E9-7454-FA89-D0C0-27A586924583 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="社保号" watid="6DBEB2E9-7454-FA89-D0C0-27A586924583">$社保号$</SPAN><SPAN>  <STRONG>入院日期：</STRONG><SPAN id=13C5EBA5-B81F-4F4B-A0D1-55E571C7237C class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="入院日期" watid="13C5EBA5-B81F-4F4B-A0D1-55E571C7237C">$入院日期$</SPAN><SPAN>  <STRONG>出院日期：</STRONG><SPAN id=1D47CB47-02A1-4A67-9FDE-D75DEE52952B class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="出院日期" watid="1D47CB47-02A1-4A67-9FDE-D75DEE52952B">$出院日期$</SPAN></SPAN></SPAN></TD>
<TD style="CURSOR: default" height=23 width=39><STRONG>天数:</STRONG></TD>
<TD style="CURSOR: default" height=23 width=49><SPAN id=DCF06CFE-C730-40C5-5F22-B40D41A1E7B0 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="天数" watid="DCF06CFE-C730-40C5-5F22-B40D41A1E7B0">$天数$</SPAN></TD></TR></TBODY></TABLE></P>
<P align=center>
<TABLE style="BORDER-TOP-STYLE: solid; FONT-SIZE: 3.7mm; BORDER-LEFT-STYLE: solid; FONT-FAMILY: 宋体; WIDTH: 717px; BORDER-COLLAPSE: collapse; BORDER-BOTTOM-STYLE: solid; BORDER-RIGHT-STYLE: solid; LINE-HEIGHT: 1.5" borderColor=#000000 cellSpacing=0 cellPadding=0 width="90%" bgColor=transparent border=1>
<TBODY>
<TR style="HEIGHT: 24px">
<TD style="CURSOR: default" height=24 vAlign=middle width=149 align=center>国家编码</TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=201 align=center><SPAN>名称（规格）</SPAN></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=38 align=center>
<P><SPAN>自付</SPAN></P>
<P><SPAN>比例</SPAN></P></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=45 align=center><SPAN> 单位</SPAN></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=40 align=center><SPAN> 数量</SPAN></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=47 align=center>
<P><SPAN>单价</SPAN></P>
<P><SPAN>元</SPAN></P></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=75 align=center><SPAN>总金额</SPAN></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=24 width=58 align=center>
<P><SPAN>自付</SPAN></P>
<P><SPAN>金额</SPAN></P></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " width=64 align=center>
<P>符合</P>
<P>范围</P></TD></TR></TBODY></TABLE>
<P>&nbsp;&nbsp;</P>
<P></TD></TR></TBODY></P></SPAN>
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</headercontent>
<content>
<![CDATA[

<P align=center></P>
<TABLE class=Emr_table_dotted style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; WIDTH: 718px; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#000000 cellSpacing=0 cellPadding=0 width="100%" bgColor=transparent border=0>
<TBODY>
<P $data=""></P>
<TR class=Emr_table_dotted style="HEIGHT: 24px" class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-TOP: #000000 1px solid; BORDER-RIGHT: #000000 1px solid; BORDER-BOTTOM: #000000 1px solid; BORDER-LEFT: #000000 1px solid" height=24 vAlign=middle width=149 align=center class="Emr_table_dotted"><SPAN id=122992C2-FA6E-754B-4932-FBCD67F3F14E class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="ybbm" watid="122992C2-FA6E-754B-4932-FBCD67F3F14E">^ybbm^</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-TOP: #000000 1px solid; BORDER-RIGHT: #000000 1px solid; BORDER-BOTTOM: #000000 1px solid; BORDER-LEFT: #000000 1px solid" height=24 vAlign=middle width=201 align=center class="Emr_table_dotted"><SPAN id=F8C2B6A8-687D-CBFF-C41F-25D0392E1FA5 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="项目名称" watid="F8C2B6A8-687D-CBFF-C41F-25D0392E1FA5">^项目名称^</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-TOP: #000000 1px solid; BORDER-RIGHT: #000000 1px solid; BORDER-BOTTOM: #000000 1px solid; BORDER-LEFT: #000000 1px solid" height=24 vAlign=middle width=38 align=center class="Emr_table_dotted">
<P><SPAN id=773B2285-AD02-070D-B8FB-0B0480249434 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="bl" watid="773B2285-AD02-070D-B8FB-0B0480249434">^bl^</SPAN></P></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-TOP: #000000 1px solid; BORDER-RIGHT: #000000 1px solid; BORDER-BOTTOM: #000000 1px solid; BORDER-LEFT: #000000 1px solid" height=24 vAlign=middle width=46 align=center class="Emr_table_dotted"><SPAN><SPAN id=1B82B114-8FD4-C18C-D1AF-4E9C9DF023F9 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="dw" watid="1B82B114-8FD4-C18C-D1AF-4E9C9DF023F9">^dw^</SPAN></SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-TOP: #000000 1px solid; BORDER-RIGHT: #000000 1px solid; BORDER-BOTTOM: #000000 1px solid; BORDER-LEFT: #000000 1px solid" height=24 vAlign=middle width=41 align=center class="Emr_table_dotted"><SPAN id=EF62678E-FF6D-32D9-1455-D9E5E9AB0BDF class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="sl" watid="EF62678E-FF6D-32D9-1455-D9E5E9AB0BDF">^sl^</SPAN><SPAN></SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-TOP: #000000 1px solid; BORDER-RIGHT: #000000 1px solid; BORDER-BOTTOM: #000000 1px solid; BORDER-LEFT: #000000 1px solid" height=24 vAlign=middle width=46 align=center class="Emr_table_dotted"><SPAN id=E5D0ECA8-3E59-0FF1-8E39-1D124750DAD2 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="dj" watid="E5D0ECA8-3E59-0FF1-8E39-1D124750DAD2">^dj^</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-TOP: #000000 1px solid; BORDER-RIGHT: #000000 1px solid; BORDER-BOTTOM: #000000 1px solid; BORDER-LEFT: #000000 1px solid" height=24 vAlign=middle width=75 align=center class="Emr_table_dotted"><SPAN id=AD66BFC7-3627-7CD3-50F4-E2BB2BBC12B6 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="总金额" watid="AD66BFC7-3627-7CD3-50F4-E2BB2BBC12B6">^总金额^</SPAN><SPAN></SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-TOP: 1px solid; BORDER-RIGHT: 1px solid; BORDER-BOTTOM: 1px solid; BORDER-LEFT: 1px solid" height=24 width=58 align=center class="Emr_table_dotted">
<P><SPAN></SPAN><SPAN id=559C0498-CB5B-7587-11A4-FF16A2313AD7 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="自付" watid="559C0498-CB5B-7587-11A4-FF16A2313AD7">^自付^</SPAN></P></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-TOP: 1px solid; BORDER-RIGHT: 1px solid; BORDER-BOTTOM: 1px solid; BORDER-LEFT: 1px solid" width=64 align=center class="Emr_table_dotted">
<P><SPAN id=C0197C19-DEF9-7132-8170-24A8B195D660 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="基金" watid="C0197C19-DEF9-7132-8170-24A8B195D660">^基金^</SPAN></P></TD></TR>
<P $data=""></P></TBODY></TABLE>
<P></P>
<P>&nbsp;&nbsp;</P>
<P><SPAN>
<TABLE class=Emr_table_dotted style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; WIDTH: 100%; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="96%" bgColor=transparent border=0>
<TBODY>
<TR class=Emr_table_dotted style="HEIGHT: 23px" class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=119 class="Emr_table_dotted"><STRONG>住院总费用：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=108 align=center class="Emr_table_dotted"><SPAN id=9CB2C5C9-0E39-DCC1-1255-B8425D2EE28A class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="住院总费用" watid="9CB2C5C9-0E39-DCC1-1255-B8425D2EE28A">$住院总费用$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=128 class="Emr_table_dotted">  <STRONG>预交金总额：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=93 align=center class="Emr_table_dotted"><SPAN id=771A1D3B-84F6-ADC9-5AE1-EBD991153270 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="押金总额" watid="771A1D3B-84F6-ADC9-5AE1-EBD991153270">$押金总额$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=157 class="Emr_table_dotted"><STRONG>        剩余金额：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=106 align=center class="Emr_table_dotted"><SPAN id=AB139A39-7D8A-8D16-6EF5-B0812F7176DB class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="余额2" watid="AB139A39-7D8A-8D16-6EF5-B0812F7176DB">$余额2$</SPAN></TD></TR>
<TR class=Emr_table_dotted class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" width=710 colSpan=6 class="Emr_table_dotted"><STRONG>其中：</STRONG></TD></TR>
<TR class=Emr_table_dotted style="HEIGHT: 23px" class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=119 class="Emr_table_dotted"><STRONG>个人支付总额：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=108 align=center class="Emr_table_dotted"><SPAN id=51C03232-8F74-FA06-6FDD-73A6DC13450C class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="自付总额" watid="51C03232-8F74-FA06-6FDD-73A6DC13450C">$自付总额$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=128 class="Emr_table_dotted"><STRONG> 基金支付总额：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=93 align=center class="Emr_table_dotted"><SPAN id=BB824B72-D421-257D-BCDB-AD0C05D0D374 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="基金总额" watid="BB824B72-D421-257D-BCDB-AD0C05D0D374">$基金总额$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=157 class="Emr_table_dotted"><STRONG> 个人账户支付：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=106 align=center class="Emr_table_dotted"><SPAN id=4B03BE36-F334-BA54-CD5E-F86EA2474BC0 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="个人账户" watid="4B03BE36-F334-BA54-CD5E-F86EA2474BC0">$个人账户$</SPAN></TD></TR>
<TR class=Emr_table_dotted style="HEIGHT: 22px" class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" height=22 class="Emr_table_dotted"><STRONG>符合范围费用：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=22 vAlign=middle width=108 align=center class="Emr_table_dotted"><SPAN id=14F2AD13-BE64-0727-8D85-048CB0A9013B class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="符合范围" watid="14F2AD13-BE64-0727-8D85-048CB0A9013B">$符合范围$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=22 width=128 class="Emr_table_dotted"><STRONG> 起付线：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=22 vAlign=middle width=93 align=center class="Emr_table_dotted"><SPAN id=296626B6-21F9-A62A-D0AE-4E4F413C4768 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="起付线" watid="296626B6-21F9-A62A-D0AE-4E4F413C4768">$起付线$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=22 width=157 class="Emr_table_dotted"><STRONG> 统筹基金支付：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=22 vAlign=middle width=106 align=center class="Emr_table_dotted"><SPAN id=8B6FEDCB-C940-BBDE-099E-ACCF7E016C9B class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="统筹基金" watid="8B6FEDCB-C940-BBDE-099E-ACCF7E016C9B">$统筹基金$</SPAN></TD></TR>
<TR class=Emr_table_dotted style="HEIGHT: 23px" class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=119 class="Emr_table_dotted"><STRONG>大额基金支付：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=108 align=center class="Emr_table_dotted"><SPAN id=3E4548F0-A6A7-E56E-EC8E-0AF2A7DAF2BC class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="大额基金" watid="3E4548F0-A6A7-E56E-EC8E-0AF2A7DAF2BC">$大额基金$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=128 class="Emr_table_dotted"><STRONG> 大病基金支付：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=93 align=center class="Emr_table_dotted"><SPAN id=B3063A15-3BB4-33AB-AB0A-848B5F0B6F82 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="大病基金" watid="B3063A15-3BB4-33AB-AB0A-848B5F0B6F82">$大病基金$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=157 class="Emr_table_dotted"><STRONG> 医疗救助基金支付：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=106 align=center class="Emr_table_dotted"><SPAN id=B36DA353-EA16-730B-2160-74EE9831748E class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="医疗救助" watid="B36DA353-EA16-730B-2160-74EE9831748E">$医疗救助$</SPAN></TD></TR>
<TR class=Emr_table_dotted style="HEIGHT: 23px" class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=119 class="Emr_table_dotted"><STRONG>公务员基金支付:</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=108 align=center class="Emr_table_dotted"><SPAN id=103A772A-1159-DF48-4B8D-0F4CDE486FE3 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="公务员基金" watid="103A772A-1159-DF48-4B8D-0F4CDE486FE3">$公务员基金$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=128 class="Emr_table_dotted"><STRONG> 补充基金支付：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=93 align=center class="Emr_table_dotted"><SPAN id=778FFD58-AB9D-8E60-903E-B0A45309D9E7 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="补充基金" watid="778FFD58-AB9D-8E60-903E-B0A45309D9E7">$补充基金$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=157 class="Emr_table_dotted"><STRONG> 其他基金支付：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=106 align=center class="Emr_table_dotted"><SPAN id=6BBEA397-341B-3200-9027-1FE3DD5D0B6A class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="其他基金" watid="6BBEA397-341B-3200-9027-1FE3DD5D0B6A">$其他基金$</SPAN></TD></TR>
<TR class=Emr_table_dotted class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" class="Emr_table_dotted"><STRONG>全自费：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" vAlign=middle align=center class="Emr_table_dotted"><SPAN id=81632663-4EF8-7965-DE4F-6CD05853DF1F class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="全自费" watid="81632663-4EF8-7965-DE4F-6CD05853DF1F">$全自费$</SPAN><SPAN> </SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" class="Emr_table_dotted"> <STRONG>超限价自费：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" vAlign=middle align=center class="Emr_table_dotted"><SPAN id=68AE2E25-4174-8CEC-4825-0C5BFC413E15 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="超限价自费" watid="68AE2E25-4174-8CEC-4825-0C5BFC413E15">$超限价自费$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" class="Emr_table_dotted"> <STRONG>先行自付：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" vAlign=middle align=center class="Emr_table_dotted"><SPAN id=8728E53E-D04A-1266-8BD9-8C8831FE37DB class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="先行自付" watid="8728E53E-D04A-1266-8BD9-8C8831FE37DB">$先行自付$</SPAN></TD></TR></TBODY></TABLE></SPAN></P>
<P>&nbsp;</P>
<P>打印日期：<SPAN id=1A7F06E3-2CF6-98A2-1DD1-23A442939DCB class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="日期*yyyy-MM-dd" watid="1A7F06E3-2CF6-98A2-1DD1-23A442939DCB">$日期*yyyy-MM-dd$</SPAN>                打印人：&nbsp;<SPAN id=69FBAFF1-E4E8-C9DE-2337-A5F07C9A03ED class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="打印人" watid="69FBAFF1-E4E8-C9DE-2337-A5F07C9A03ED">$打印人$</SPAN>              病人签字：<U>               </U></P>
<P>&nbsp;</P>
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