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<?xml version="1.0" encoding="UTF-8"?>
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<emr>
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<page styleline="false" height="102" width="186" lineheight="1.3" letterspace="0.0" paddingleft="10.0" paddingright="10.0" paddingtop="10.0" paddingbottom="10.0" portrait="1" />
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<headercontent>
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<![CDATA[
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]]>
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</headercontent>
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<content>
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<![CDATA[
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<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 bgColor=transparent border=1>
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<TBODY>
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<TR>
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<TD style="CURSOR: default" height=23 width=156> <SPAN id=8D5C9696-0165-F15F-0C08-E74875D6CB5D class=Emr_hdy wattype="static" watid="8D5C9696-0165-F15F-0C08-E74875D6CB5D" watvalue="流水号" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$流水号$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=156> <SPAN id=B5A98301-D59D-5F93-264F-AA45665DA53F class=Emr_hdy wattype="static" watid="B5A98301-D59D-5F93-264F-AA45665DA53F" watvalue="医疗机构类型" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$医疗机构类型$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=156> <SPAN id=8EF7F69E-8D53-25B1-276F-09C94C464F0A class=Emr_hdy wattype="static" watid="8EF7F69E-8D53-25B1-276F-09C94C464F0A" watvalue="ZYBAH" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZYBAH$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=156> <SPAN id=2256F803-F5D0-B836-7C97-0826E05556D3 class=Emr_hdy wattype="static" watid="2256F803-F5D0-B836-7C97-0826E05556D3" watvalue="ZYNO" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZYNO$</SPAN></TD></TR></TBODY></TABLE>
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<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 bgColor=transparent border=1>
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<TBODY>
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<TR>
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<TD style="CURSOR: default" height=23 width=209> <SPAN id=05B8EA39-391E-05F2-0EC1-A435972DF40B class=Emr_hdy wattype="static" watid="05B8EA39-391E-05F2-0EC1-A435972DF40B" watvalue="入年" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$入年$</SPAN> <SPAN id=F86FF99A-94AC-2C6B-9F3A-6C868B5E5487 class=Emr_hdy wattype="static" watid="F86FF99A-94AC-2C6B-9F3A-6C868B5E5487" watvalue="入月" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$入月$</SPAN> <SPAN id=9A6586B8-5DA2-B3C4-127A-9DBF8615B943 class=Emr_hdy wattype="static" watid="9A6586B8-5DA2-B3C4-127A-9DBF8615B943" watvalue="入日" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$入日$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=209> <SPAN id=E7985310-F13B-DD14-2EE9-0419047AC18A class=Emr_hdy wattype="static" watid="E7985310-F13B-DD14-2EE9-0419047AC18A" watvalue="出年" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$出年$</SPAN> <SPAN id=119C6F72-3B6B-E5CD-FDD6-101383D0C0FE class=Emr_hdy wattype="static" watid="119C6F72-3B6B-E5CD-FDD6-101383D0C0FE" watvalue="出月" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$出月$</SPAN> <SPAN id=116B51A6-3800-B0B3-EF2C-6FA0BA24F852 class=Emr_hdy wattype="static" watid="116B51A6-3800-B0B3-EF2C-6FA0BA24F852" watvalue="出日" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$出日$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=209> <SPAN id=903B645D-A46E-C157-55CB-881D6779FD89 class=Emr_hdy wattype="static" watid="903B645D-A46E-C157-55CB-881D6779FD89" watvalue="天数" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$天数$</SPAN></TD></TR></TBODY></TABLE>
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<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>
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<TBODY>
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<TR>
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<TD style="CURSOR: default" height=23 width=156> <SPAN id=579AA75C-6705-170F-32D6-63D4B86AF8D7 class=Emr_hdy wattype="static" watid="579AA75C-6705-170F-32D6-63D4B86AF8D7" watvalue="XM" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XM$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=100> <SPAN id=DDB3AA93-0587-020E-E0AC-D04685D92F32 class=Emr_hdy wattype="static" watid="DDB3AA93-0587-020E-E0AC-D04685D92F32" watvalue="XB" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XB$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=159> <SPAN id=86FFE6E6-73FF-DD73-2823-96E2F7913D94 class=Emr_hdy wattype="static" watid="86FFE6E6-73FF-DD73-2823-96E2F7913D94" watvalue="医保类型" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$医保类型$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=206> <SPAN id=197CF8ED-FE30-827A-17E9-6E1C2A418699 class=Emr_hdy wattype="static" watid="197CF8ED-FE30-827A-17E9-6E1C2A418699" watvalue="社保卡" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$社保卡$</SPAN></TD></TR></TBODY></TABLE>
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<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 bgColor=transparent border=1>
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<TBODY>
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<TR>
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<TD style="CURSOR: default" height=23 width=313></TD>
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<TD style="CURSOR: default" height=23 width=313></TD></TR>
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<TR>
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<TD style="CURSOR: default" height=23 width=313><SPAN id=B19EB07D-AD08-D632-9F38-1E26BBA86F47 class=Emr_hdy wattype="static" watid="B19EB07D-AD08-D632-9F38-1E26BBA86F47" watvalue="费用类别1" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别1$</SPAN> <SPAN id=0713AD06-CB9A-5C5C-F499-99220ED175EB class=Emr_hdy wattype="static" watid="0713AD06-CB9A-5C5C-F499-99220ED175EB" watvalue="金额1" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额1$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=313> <SPAN id=CB811E7A-09B4-C5B4-2051-7C20A32D965A class=Emr_hdy wattype="static" watid="CB811E7A-09B4-C5B4-2051-7C20A32D965A" watvalue="费用类别2" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别2$</SPAN> <SPAN id=1C62BBD4-D58B-DBA6-7243-BD16CB031185 class=Emr_hdy wattype="static" watid="1C62BBD4-D58B-DBA6-7243-BD16CB031185" watvalue="金额2" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额2$</SPAN></TD></TR>
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<TR>
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<TD style="CURSOR: default" height=23 width=313><SPAN id=CD2A1866-3CD0-8FF2-D3B2-A18B970DFFBE class=Emr_hdy wattype="static" watid="CD2A1866-3CD0-8FF2-D3B2-A18B970DFFBE" watvalue="费用类别3" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别3$</SPAN> <SPAN id=DDF7B5C5-21C0-62FA-1719-1A058E498A2E class=Emr_hdy wattype="static" watid="DDF7B5C5-21C0-62FA-1719-1A058E498A2E" watvalue="金额3" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额3$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=313> <SPAN id=3975F148-1940-6BAE-FD6C-E704A9F4D4EF class=Emr_hdy wattype="static" watid="3975F148-1940-6BAE-FD6C-E704A9F4D4EF" watvalue="费用类别4" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别4$</SPAN> <SPAN id=AD70D732-152C-38A7-621D-7A225448A432 class=Emr_hdy wattype="static" watid="AD70D732-152C-38A7-621D-7A225448A432" watvalue="金额4" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额4$</SPAN></TD></TR>
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<TR>
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<TD style="CURSOR: default" height=23 width=313><SPAN id=B558B248-05EA-B8BE-2CB2-6C430EBD6BA3 class=Emr_hdy wattype="static" watid="B558B248-05EA-B8BE-2CB2-6C430EBD6BA3" watvalue="费用类别5" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别5$</SPAN> <SPAN id=30083826-C41C-DA61-1A5F-8DE94415FDAD class=Emr_hdy wattype="static" watid="30083826-C41C-DA61-1A5F-8DE94415FDAD" watvalue="金额5" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额5$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=313> <SPAN id=93E86C65-673E-1F00-441F-11440AD3976C class=Emr_hdy wattype="static" watid="93E86C65-673E-1F00-441F-11440AD3976C" watvalue="费用类别6" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别6$</SPAN> <SPAN id=9F174914-D8E3-1BCF-544D-80EFCAA4F009 class=Emr_hdy wattype="static" watid="9F174914-D8E3-1BCF-544D-80EFCAA4F009" watvalue="金额6" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额6$</SPAN></TD></TR>
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<TR>
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<TD style="CURSOR: default" height=23 width=313><SPAN id=7AD1C046-68EE-44B9-DCE8-316F896DE658 class=Emr_hdy wattype="static" watid="7AD1C046-68EE-44B9-DCE8-316F896DE658" watvalue="费用类别7" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别7$</SPAN><SPAN> <SPAN id=FB4BCC37-9184-0E8A-2124-7D2FF3823751 class=Emr_hdy wattype="static" watid="FB4BCC37-9184-0E8A-2124-7D2FF3823751" watvalue="金额7" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额7$</SPAN></SPAN></TD>
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<TD style="CURSOR: default" height=23 width=313> <SPAN id=348E2A8C-50DA-8C62-DCFB-B4DD30B673D2 class=Emr_hdy wattype="static" watid="348E2A8C-50DA-8C62-DCFB-B4DD30B673D2" watvalue="费用类别8" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别8$</SPAN><SPAN> <SPAN id=72EDB2B8-8986-9B35-CC58-05D97CDE2467 class=Emr_hdy wattype="static" watid="72EDB2B8-8986-9B35-CC58-05D97CDE2467" watvalue="金额8" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额8$</SPAN></SPAN></TD></TR>
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<TR>
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<TD style="CURSOR: default" height=23 width=313><SPAN id=24C520E4-3522-774C-00B8-5FAECA35AD9E class=Emr_hdy wattype="static" watid="24C520E4-3522-774C-00B8-5FAECA35AD9E" watvalue="费用类别9" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别9$</SPAN> <SPAN id=128D8410-A9CD-A479-0EC6-9721E9418930 class=Emr_hdy wattype="static" watid="128D8410-A9CD-A479-0EC6-9721E9418930" watvalue="金额9" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额9$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=313> <SPAN id=C35ADC2C-96EB-9305-0088-B740E48A3DFC class=Emr_hdy wattype="static" watid="C35ADC2C-96EB-9305-0088-B740E48A3DFC" watvalue="费用类别10" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别10$</SPAN> <SPAN id=C733B9D6-744D-B84F-7FEE-F06B9441842D class=Emr_hdy wattype="static" watid="C733B9D6-744D-B84F-7FEE-F06B9441842D" watvalue="金额10" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额10$</SPAN></TD></TR>
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<TR>
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<TD style="CURSOR: default" height=23 width=313><SPAN id=1E55C7F7-6F0F-BF8B-F297-9757D6551348 class=Emr_hdy wattype="static" watid="1E55C7F7-6F0F-BF8B-F297-9757D6551348" watvalue="费用类别11" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别11$</SPAN> <SPAN id=5E46CD77-475D-7C3B-BA5E-A90C51F85D1E class=Emr_hdy wattype="static" watid="5E46CD77-475D-7C3B-BA5E-A90C51F85D1E" watvalue="金额11" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额11$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=313> <SPAN id=16D3C668-E93B-CF17-A642-929FC7A660C9 class=Emr_hdy wattype="static" watid="16D3C668-E93B-CF17-A642-929FC7A660C9" watvalue="费用类别12" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别12$</SPAN> <SPAN id=BFCB0D8F-F69E-D179-3B41-61004754ECC5 class=Emr_hdy wattype="static" watid="BFCB0D8F-F69E-D179-3B41-61004754ECC5" watvalue="金额12" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额12$</SPAN></TD></TR></TBODY></TABLE>
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<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>
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<TBODY>
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<TR>
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<TD style="CURSOR: default" height=23 width=368><SPAN> </SPAN><SPAN id=5DC6A018-8F70-4997-EB81-C7D08C686DF1 class=Emr_hdy wattype="static" watid="5DC6A018-8F70-4997-EB81-C7D08C686DF1" watvalue="医疗费总额大写" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$医疗费总额大写$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=254> <SPAN id=4D4F69A5-B0D3-296D-8F1B-879915D893C6 class=Emr_hdy wattype="static" watid="4D4F69A5-B0D3-296D-8F1B-879915D893C6" watvalue="医疗费总额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$医疗费总额$</SPAN></TD></TR></TBODY></TABLE>
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<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 bgColor=transparent border=1>
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<TBODY>
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<TR>
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<TD style="CURSOR: default" height=23 width=209> <SPAN id=C433E7D6-504F-1CB7-B660-8E528BDF7EB8 class=Emr_hdy wattype="static" watid="C433E7D6-504F-1CB7-B660-8E528BDF7EB8" watvalue="预交款" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$预交款$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=209> <SPAN id=BAD661B0-9477-E463-04D5-4E14E7B3FE1A class=Emr_hdy wattype="static" watid="BAD661B0-9477-E463-04D5-4E14E7B3FE1A" watvalue="补收款" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$补收款$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=209> <SPAN id=E5C8D593-A456-D0CC-CBF9-44E1D12DCCE2 class=Emr_hdy wattype="static" watid="E5C8D593-A456-D0CC-CBF9-44E1D12DCCE2" watvalue="退款" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$退款$</SPAN></TD></TR></TBODY></TABLE>
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<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 bgColor=transparent border=1>
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<TBODY>
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<TR>
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<TD style="CURSOR: default" height=23 width=156></TD>
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<TD style="CURSOR: default" height=23 width=156></TD>
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<TD style="CURSOR: default" height=23 width=156></TD>
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<TD height=23 width=156></TD></TR></TBODY></TABLE>
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<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>
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<TBODY>
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<TR>
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<TD style="CURSOR: default" height=23 width=357> <SPAN id=181AA19F-887D-B91C-B389-FB1E47E960CD class=Emr_hdy wattype="static" watid="181AA19F-887D-B91C-B389-FB1E47E960CD" watvalue="COMPANYID" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$COMPANYID$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=78></TD>
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<TD style="CURSOR: default" height=23 width=187><SPAN id=ACD4FB3E-E5D0-598E-F776-0E58A79878ED class=Emr_hdy wattype="static" watid="ACD4FB3E-E5D0-598E-F776-0E58A79878ED" watvalue="打印年" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$打印年$</SPAN><SPAN> <SPAN id=36DA7DB7-3970-DC95-2038-D560D215ADEF class=Emr_hdy wattype="static" watid="36DA7DB7-3970-DC95-2038-D560D215ADEF" watvalue="打印月" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$打印月$</SPAN> <SPAN id=06B6CFC2-BFF0-BFC2-15ED-A593A4AC05CC class=Emr_hdy wattype="static" watid="06B6CFC2-BFF0-BFC2-15ED-A593A4AC05CC" watvalue="打印日" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$打印日$</SPAN></SPAN></TD></TR></TBODY></TABLE>
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