klhis/file/reporttemplate/DE3C9D58-C91A-459E-74D0-5897CAC5F92B/门诊结算单费用/7b10ef7fe89673d623c1e930b26faef6.xml

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<![CDATA[




<SPAN>
<P>
<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="100%" bgColor=transparent border=0>
<TBODY>
<TR class=Emr_table_dotted style="HEIGHT: 29px" class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" height=29 vAlign=middle width=715 colSpan=10 align=center class="Emr_table_dotted"><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></TD></TR>
<TR class=Emr_table_dotted style="HEIGHT: 24px" class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" height=24 vAlign=middle width=709 colSpan=10 align=center class="Emr_table_dotted"><SPAN id=F640EA60-867F-09F6-64D3-4591D6A00C22 class=Emr_hdy style="FONT-SIZE: 4.25mm" wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="结算类型" watid="F640EA60-867F-09F6-64D3-4591D6A00C22">$结算类型$</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=59 class="Emr_table_dotted"><STRONG>姓  名:</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=25 width=94 class="Emr_table_dotted"><SPAN> <SPAN id=B79A4C54-ED99-B2D9-408D-DCA04016B483 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="姓名" watid="B79A4C54-ED99-B2D9-408D-DCA04016B483">$姓名$</SPAN><SPAN> </SPAN></SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=25 width=61 class="Emr_table_dotted"><STRONG>性别:</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=25 width=93 class="Emr_table_dotted"><SPAN id=78A51535-A787-C017-BA12-A2F8273EE6FC class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="性别" watid="78A51535-A787-C017-BA12-A2F8273EE6FC">$性别$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=25 width=68 class="Emr_table_dotted"><STRONG>年龄:</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=25 width=103 class="Emr_table_dotted"><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 class=Emr_table_dotted style="CURSOR: default" height=25 width=66 class="Emr_table_dotted"><STRONG>科室:</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=25 width=151 colSpan=3 class="Emr_table_dotted"><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><SPAN> </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=561 colSpan=8 class="Emr_table_dotted"><SPAN><STRONG>医保号：</STRONG> </SPAN><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>门诊号：<SPAN id=E778B085-A226-0D10-BF10-15387DBBFDFF class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="住院号" watid="E778B085-A226-0D10-BF10-15387DBBFDFF">$住院号$</SPAN>   就诊时间：</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>  </SPAN></SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=39 class="Emr_table_dotted"><STRONG></STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=49 class="Emr_table_dotted"></TD></TR></TBODY></TABLE></P>
<P>
<TABLE style="BORDER-TOP-STYLE: solid; FONT-SIZE: 3.7mm; BORDER-LEFT-STYLE: solid; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; BORDER-BOTTOM-STYLE: solid; BORDER-RIGHT-STYLE: solid; LINE-HEIGHT: 1.5" borderColor=#000000 cellSpacing=0 cellPadding=0 width="100%" bgColor=transparent border=1 class>
<TBODY>
<TR style="HEIGHT: 51px" class>
<TD style="CURSOR: default" height=51 width=279 class>收费项目（规格）</TD>
<TD style="CURSOR: default" height=51 vAlign=middle width=41 align=center class>
<P>自付</P>
<P>比例</P></TD>
<TD style="CURSOR: default" height=51 vAlign=middle width=43 align=center class>单位</TD>
<TD style="CURSOR: default" height=51 vAlign=middle width=40 align=center class>数量</TD>
<TD style="CURSOR: default" height=51 vAlign=middle width=46 align=center class>
<P>单价</P>
<P>元</P></TD>
<TD style="CURSOR: default" height=51 vAlign=middle width=72 align=center class>总金额</TD>
<TD style="CURSOR: default" height=51 vAlign=middle width=59 align=center class>
<P>自付</P>
<P>金额</P></TD>
<TD style="CURSOR: default" height=51 vAlign=middle width=62 align=center class>
<P>符合</P>
<P>范围</P></TD>
<TD style="CURSOR: default" height=51 vAlign=middle width=59 align=center class>备注</TD></TR>
<P $data>
<P $data></P></TBODY></TABLE></TD></TR></TBODY></P></SPAN>




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</headercontent>
<content>
<![CDATA[

<P align=center>
<TABLE style="BORDER-TOP-STYLE: solid; FONT-SIZE: 3.7mm; BORDER-LEFT-STYLE: solid; HEIGHT: 46px; 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 class>
<TBODY>
<P $data>
<TR style="HEIGHT: 24px" class>
<TD style="CURSOR: default" height=24 width=280 class><SPAN id=4B021B07-AA34-5CB4-3056-097BAAD75EFA class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="项目名称" watid="4B021B07-AA34-5CB4-3056-097BAAD75EFA">^项目名称^</SPAN><SPAN></SPAN><BR>
<P><SPAN id=8FC66B5A-DFCB-6CE8-03BB-19D238E00396 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="ybbm" watid="8FC66B5A-DFCB-6CE8-03BB-19D238E00396">^ybbm^</SPAN></P></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=38 align=center class><SPAN id=AE0BA86E-3B21-42DB-A634-6B68CB2C56DE class=Emr_hdy align="center" wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="bl" watid="AE0BA86E-3B21-42DB-A634-6B68CB2C56DE">^bl^</SPAN></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=45 align=center class><SPAN id=C368AE81-2890-1899-C6D9-D0A2B0CDCCA3 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="dw" watid="C368AE81-2890-1899-C6D9-D0A2B0CDCCA3">^dw^</SPAN></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=40 align=center class><SPAN id=B50B6812-EAB0-73DF-10AD-610DEFDC723B class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="sl" watid="B50B6812-EAB0-73DF-10AD-610DEFDC723B">^sl^</SPAN></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=47 align=center class><SPAN id=3BE70DD0-0775-790B-8227-5D3BA98B33F7 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="dj" watid="3BE70DD0-0775-790B-8227-5D3BA98B33F7">^dj^</SPAN></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=75 align=center class><SPAN id=3E48ACA0-E770-FA36-67A5-6E8278DE42DE class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="总金额" watid="3E48ACA0-E770-FA36-67A5-6E8278DE42DE">^总金额^</SPAN></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=58 align=center class><SPAN id=2A972146-4F45-9FB3-2C48-027FD2ACC2CC class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="自付" watid="2A972146-4F45-9FB3-2C48-027FD2ACC2CC">^自付^</SPAN></TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=64 align=center class><SPAN id=90767FA6-A4DA-51BB-253B-172672EB74F9 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="基金" watid="90767FA6-A4DA-51BB-253B-172672EB74F9">^基金^</SPAN></TD>
<TD style="CURSOR: default" height=24 width=60 class><SPAN id=A41C733C-43BC-CA37-2D08-F7659155F0E5 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="备注" watid="A41C733C-43BC-CA37-2D08-F7659155F0E5">^备注^</SPAN></TD></TR>
<P $data></P></TBODY></TABLE></P>
<P>&nbsp;</P>
<P><SPAN>
<TABLE class=Emr_table_dotted style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; WIDTH: 97%; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="96%" bgColor=transparent border=0>
<TBODY>
<TR class=Emr_table_dotted style="HEIGHT: 23px" class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=119 class="Emr_table_dotted"><STRONG>门诊总费用：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=108 align=center class="Emr_table_dotted"><SPAN id=9CB2C5C9-0E39-DCC1-1255-B8425D2EE28A class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="住院总费用" watid="9CB2C5C9-0E39-DCC1-1255-B8425D2EE28A">$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$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=157 class="Emr_table_dotted"><STRONG>       剩余金额：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=106 align=center class="Emr_table_dotted"><SPAN id=A278CA90-D405-4BF7-3F8A-9A804AA7C041 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="余额" watid="A278CA90-D405-4BF7-3F8A-9A804AA7C041">$余额$</SPAN></TD></TR>
<TR class=Emr_table_dotted class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" width=710 colSpan=6 class="Emr_table_dotted"><STRONG>其中：</STRONG></TD></TR>
<TR class=Emr_table_dotted style="HEIGHT: 23px" class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=119 class="Emr_table_dotted"><STRONG>个人支付总额：</STRONG></TD>
<TD class=Emr_table_dotted style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height=23 vAlign=middle width=108 align=center class="Emr_table_dotted"><SPAN id=51C03232-8F74-FA06-6FDD-73A6DC13450C class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="自付总额" watid="51C03232-8F74-FA06-6FDD-73A6DC13450C">$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$</SPAN></TD></TR></TBODY></TABLE></SPAN></P>
<P>&nbsp;</P>
<P>打印日期： <SPAN id=FA2DBD66-7F8C-CAF8-5132-BF29B362AF48 class=Emr_hdy wattype="static" watflag="true" watsuntype="s2" wathdychange="false" watencryptshow="false" watdelete="false" watvalue="日期*yyyy-MM-dd" watid="FA2DBD66-7F8C-CAF8-5132-BF29B362AF48">$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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