klhis/file/reporttemplate/34D5F563-F591-8D63-96E9-1606713CB337/自费结算单费用/b296d6386064fdce7c189af3fbda35bc.xml

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<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" watid="764907BB-9B3D-87DA-4255-DCB0B11E692A" watvalue="医疗机构" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$医疗机构$</SPAN><SPAN id=F7353180-63F6-92B6-E02A-4CF2083999D8 class=Emr_hdy style="FONT-SIZE: 5.23mm" wattype="static" watid="F7353180-63F6-92B6-E02A-4CF2083999D8" watvalue="结算类型" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$结算类型$</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" watid="C8CE58D3-D4DD-0446-A7AD-6D410564B526" watvalue="住院号" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$住院号$</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" watid="1E51C271-2360-1596-1E81-11857CC7A196" watvalue="姓名" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$姓名$</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" watid="F879528E-F98B-15DC-43A4-0C1E1710B88F" watvalue="性别" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$性别$</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" watid="AABA0939-7CE3-1349-8DCD-4A609A0B93CE" watvalue="年龄" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$年龄$</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" watid="DE8CDECD-E284-BDCB-07C2-EA5D34741442" watvalue="科室" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$科室$</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" watid="6CEC5025-1590-1554-64AA-98B2631184DF" watvalue="床号" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$床号$</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" watid="6DBEB2E9-7454-FA89-D0C0-27A586924583" watvalue="社保号" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$社保号$</SPAN><SPAN>  <STRONG>入院日期：</STRONG><SPAN id=13C5EBA5-B81F-4F4B-A0D1-55E571C7237C class=Emr_hdy wattype="static" watid="13C5EBA5-B81F-4F4B-A0D1-55E571C7237C" watvalue="入院日期" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$入院日期$</SPAN><SPAN>  <STRONG>出院日期：</STRONG><SPAN id=1D47CB47-02A1-4A67-9FDE-D75DEE52952B class=Emr_hdy wattype="static" watid="1D47CB47-02A1-4A67-9FDE-D75DEE52952B" watvalue="出院日期" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$出院日期$</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" watid="DCF06CFE-C730-40C5-5F22-B40D41A1E7B0" watvalue="天数" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$天数$</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=89 align=center>收费项目</TD>
<TD style="CURSOR: default" height=24 vAlign=middle width=261 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>费用类别</P>
</TD></TR></TBODY></TABLE>
<P>&nbsp;&nbsp;</P>
<P></TD></TR></TBODY></P></SPAN>












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<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" bgcolor="transparent" border="0" width="100%">
<tbody>
<p $data="">
</p>
<tr class="Emr_table_dotted" style="HEIGHT: 24px">
<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="89" align="center"><span id="122992C2-FA6E-754B-4932-FBCD67F3F14E" class="Emr_hdy" wattype="static" watid="122992C2-FA6E-754B-4932-FBCD67F3F14E" watvalue="ybbm" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^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="261" align="center"><span id="F8C2B6A8-687D-CBFF-C41F-25D0392E1FA5" class="Emr_hdy" wattype="static" watid="F8C2B6A8-687D-CBFF-C41F-25D0392E1FA5" watvalue="项目名称" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^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">
<p><span id="773B2285-AD02-070D-B8FB-0B0480249434" class="Emr_hdy" wattype="static" watid="773B2285-AD02-070D-B8FB-0B0480249434" watvalue="bl" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^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"><span><span id="1B82B114-8FD4-C18C-D1AF-4E9C9DF023F9" class="Emr_hdy" wattype="static" watid="1B82B114-8FD4-C18C-D1AF-4E9C9DF023F9" watvalue="dw" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^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"><span id="EF62678E-FF6D-32D9-1455-D9E5E9AB0BDF" class="Emr_hdy" wattype="static" watid="EF62678E-FF6D-32D9-1455-D9E5E9AB0BDF" watvalue="sl" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^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"><span id="E5D0ECA8-3E59-0FF1-8E39-1D124750DAD2" class="Emr_hdy" wattype="static" watid="E5D0ECA8-3E59-0FF1-8E39-1D124750DAD2" watvalue="dj" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^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"><span id="AD66BFC7-3627-7CD3-50F4-E2BB2BBC12B6" class="Emr_hdy" wattype="static" watid="AD66BFC7-3627-7CD3-50F4-E2BB2BBC12B6" watvalue="总金额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^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">
<p><span></span><span id="559C0498-CB5B-7587-11A4-FF16A2313AD7" class="Emr_hdy" wattype="static" watid="559C0498-CB5B-7587-11A4-FF16A2313AD7" watvalue="自付" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^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">
<p><span id="C0197C19-DEF9-7132-8170-24A8B195D660" class="Emr_hdy" wattype="static" watid="C0197C19-DEF9-7132-8170-24A8B195D660" watvalue="备注" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^备注^</span></p></td></tr>
<p $data=""></p></tbody></table><p></p>
<p>&nbsp;&nbsp;</p>
<p><span>
<table class="Emr_table_dotted" style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; WIDTH: 100%; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" bordercolor="#bfbfbf" cellspacing="0" cellpadding="0" width="96%" bgcolor="transparent" border="0">
<tbody>
<tr class="Emr_table_dotted" style="HEIGHT: 23px">
<td class="Emr_table_dotted" style="CURSOR: default" height="23" width="119"><strong>住院总费用：</strong></td>
<td class="Emr_table_dotted" style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height="23" valign="middle" width="108" align="center"><span id="9CB2C5C9-0E39-DCC1-1255-B8425D2EE28A" class="Emr_hdy" wattype="static" watid="9CB2C5C9-0E39-DCC1-1255-B8425D2EE28A" watvalue="住院总费用" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$住院总费用$</span></td>
<td class="Emr_table_dotted" style="CURSOR: default" height="23" width="128">  <strong>预交金总额：</strong></td>
<td class="Emr_table_dotted" style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height="23" valign="middle" width="93" align="center"><span id="771A1D3B-84F6-ADC9-5AE1-EBD991153270" class="Emr_hdy" wattype="static" watid="771A1D3B-84F6-ADC9-5AE1-EBD991153270" watvalue="押金总额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$押金总额$</span></td>
<td class="Emr_table_dotted" style="CURSOR: default" height="23" width="157"><strong>        剩余金额：</strong></td>
<td class="Emr_table_dotted" style="CURSOR: default; BORDER-BOTTOM: #000000 1px solid" height="23" valign="middle" width="106" align="center"><span id="A278CA90-D405-4BF7-3F8A-9A804AA7C041" class="Emr_hdy" wattype="static" watid="A278CA90-D405-4BF7-3F8A-9A804AA7C041" watvalue="余额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$余额$</span></td></tr>
<tr class="Emr_table_dotted">
</tr></tbody></table></span></p>
<p>&nbsp;</p>
<p>打印日期：<span id="1A7F06E3-2CF6-98A2-1DD1-23A442939DCB" class="Emr_hdy" wattype="static" watid="1A7F06E3-2CF6-98A2-1DD1-23A442939DCB" watvalue="日期*yyyy-MM-dd" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$日期*yyyy-MM-dd$</span>                打印人：&nbsp;<span id="69FBAFF1-E4E8-C9DE-2337-A5F07C9A03ED" class="Emr_hdy" wattype="static" watid="69FBAFF1-E4E8-C9DE-2337-A5F07C9A03ED" watvalue="打印人" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$打印人$</span>              病人签字：<u>               </u></p>
<p>&nbsp;</p>








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