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1923 lines
95 KiB
1923 lines
95 KiB
<?xml version="1.0" encoding="UTF-8"?>
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<emr>
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<page styleline="false" height="297" width="210" lineheight="1.5" 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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]]>
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</headercontent>
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<content>
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<![CDATA[
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<div >
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<P align=center><FONT style="FONT-SIZE: 5mm"><STRONG>中华人民共和国传染病报告卡</STRONG></FONT></P>
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<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5;align-items: center;" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" align=center bgColor=transparent border=0 class>
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<TBODY>
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<TR style="HEIGHT: 20px" class>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
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</TR>
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<TR style="HEIGHT: 25px" class>
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<TD class></TD>
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<TD height=22 colSpan=4 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">卡片ID:</FONT></SPAN></div >
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</TD>
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<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
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<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$卡片ID$</FONT></SPAN></div >
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</TD>
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<TD class></TD>
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<TD colSpan=4 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">卡片类别:</FONT></SPAN></div >
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</TD>
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<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
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<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$卡片类别$</FONT></SPAN></div >
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</TD>
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<TD colSpan=18 class></TD>
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</TR>
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<TR style="HEIGHT: 5px" class></TR>
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<TR style="HEIGHT: 25px" class>
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<TD class></TD>
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<TD height=22 colSpan=4 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">患者姓名:</FONT></SPAN></div >
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</TD>
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<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
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<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$患者姓名$</FONT></SPAN></div >
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</TD>
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<TD class></TD>
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<TD colSpan=4 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">患者家长姓名:</FONT></SPAN></div >
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</TD>
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<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
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<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$患者家长姓名$</FONT></SPAN></div >
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</TD>
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<TD colSpan=18 class></TD>
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</TR>
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<TR style="HEIGHT: 5px" class></TR>
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<TR style="HEIGHT: 25px" class>
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<TD class></TD>
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<TD height=22 colSpan=4 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">性别:</FONT></SPAN></div >
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</TD>
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<TD style="CURSOR: default;" colSpan=6 class>
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<div class="form-check" style="FONT-SIZE: 3.15mm">
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<input type="radio" class="form-check-input" id="radio1" name="optradio" value="option1" $性别1$>男
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<label class="form-check-label" for="radio1"></label>
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<input type="radio" class="form-check-input" id="radio2" name="optradio" value="option2" $性别2$>女
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<label class="form-check-label" for="radio2"></label>
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</div>
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</TD>
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<TD class></TD>
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<TD colSpan=4 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">联系电话:</FONT></SPAN></div >
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</TD>
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<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
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<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$联系电话$</FONT></SPAN></div >
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</TD>
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<TD class></TD>
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<TD colSpan=3 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">出生日期:</FONT></SPAN></div >
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</TD>
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<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=4 class>
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<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$出生日期$</FONT></SPAN></div >
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</TD>
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<TD class></TD>
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<TD colSpan=2 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">民族:</FONT></SPAN></div >
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</TD>
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<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=3 class>
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<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$民族$</FONT></SPAN></div >
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</TD>
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<TD class></TD>
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</TR>
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<TR style="HEIGHT: 5px" class></TR>
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<TR style="HEIGHT: 25px" class>
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<TD class></TD>
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<TD height=22 colSpan=4 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">工作单位:</FONT></SPAN></div >
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</TD>
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<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=31 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$工作单位$</FONT></SPAN></div >
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</TD>
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</TR>
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<TR style="HEIGHT: 5px" class></TR>
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<TR style="HEIGHT: 25px" class>
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<TD class></TD>
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<TD height=22 colSpan=4 class>
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<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">职业:</FONT></SPAN></div >
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</TD>
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
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<div class="form-check" style="FONT-SIZE: 3.15mm">
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<input type="radio" class="form-check-input" id="radio1" name="optradio_zy" value="option1" $职业01$>幼托儿童
|
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<label class="form-check-label" for="radio1"></label>
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</div>
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</TD>
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
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<div class="form-check" style="FONT-SIZE: 3.15mm">
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<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业05$>保育员及保姆
|
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<label class="form-check-label" for="radio1"></label>
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</div>
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</TD>
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
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<div class="form-check" style="FONT-SIZE: 3.15mm">
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<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业09$>医务人员
|
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<label class="form-check-label" for="radio1"></label>
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</div>
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</TD>
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
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<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业13$>牧民
|
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<label class="form-check-label" for="radio1"></label>
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</div>
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</TD>
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
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<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业17$>离退人员
|
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<label class="form-check-label" for="radio1"></label>
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</div>
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</TD>
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</TR>
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<TR style="HEIGHT: 25px" class>
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<TD class></TD>
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<TD height=22 colSpan=4 class>
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</TD>
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
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<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_zy" value="option1" $职业02$>散居儿童
|
|
<label class="form-check-label" for="radio1"></label>
|
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</div>
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</TD>
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
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<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业06$>餐饮食品业
|
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<label class="form-check-label" for="radio1"></label>
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</div>
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</TD>
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
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<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业10$>工人
|
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<label class="form-check-label" for="radio1"></label>
|
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</div>
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</TD>
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
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<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业14$>渔(船)民
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<label class="form-check-label" for="radio1"></label>
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</div>
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</TD>
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
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<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业18$>家务及待业
|
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<label class="form-check-label" for="radio1"></label>
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</div>
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</TD>
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</TR>
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<TR style="HEIGHT: 25px" class>
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<TD class></TD>
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<TD height=22 colSpan=4 class>
|
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</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_zy" value="option1" $职业03$>学生
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
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</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业07$>公共场所服务员
|
|
<label class="form-check-label" for="radio1"></label>
|
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</div>
|
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</TD>
|
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业11$>民工
|
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<label class="form-check-label" for="radio1"></label>
|
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</div>
|
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</TD>
|
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
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<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业15$>海员及长途驾驶员
|
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<label class="form-check-label" for="radio1"></label>
|
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</div>
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</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业20$>不详
|
|
<label class="form-check-label" for="radio1"></label>
|
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</div>
|
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</TD>
|
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</TR>
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|
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<TR style="HEIGHT: 25px" class>
|
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<TD class></TD>
|
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<TD height=22 colSpan=4 class>
|
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</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_zy" value="option1" $职业04$>教师
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业08$>商业服务
|
|
<label class="form-check-label" for="radio1"></label>
|
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</div>
|
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</TD>
|
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业12$>农民
|
|
<label class="form-check-label" for="radio1"></label>
|
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</div>
|
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</TD>
|
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<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
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<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业16$>干部职员
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zy" value="option2" $职业99$>其他
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=7 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">具体的其它职业信息:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=28 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$具体的其它职业信息$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">病人属于:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_brsy" value="option1" $病人属于01$>本县区
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_brsy" value="option2" $病人属于02$>本市其它县区
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_brsy" value="option2" $病人属于03$>本省其它地市
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_brsy" value="option2" $病人属于04$>其他省
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_brsy" value="option2" $病人属于05$>港澳台
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm;">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_brsy" value="option2" $病人属于06$>外籍
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=3 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">现住地址:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD height=22 colSpan=2 class>
|
|
<div style="text-align: right;"><SPAN><FONT style="FONT-SIZE: 3.15mm">省份</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$现住地址省份$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD height=22 colSpan=2 class>
|
|
<div style="text-align: right;"><SPAN><FONT style="FONT-SIZE: 3.15mm">城市</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$现住地址城市$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD height=22 colSpan=1 class>
|
|
<div style="text-align: right;"><SPAN><FONT style="FONT-SIZE: 3.15mm">县</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$现住地址县$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD height=22 colSpan=1 class>
|
|
<div style="text-align: right;"><SPAN><FONT style="FONT-SIZE: 3.15mm">镇</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$现住地址镇$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD height=22 colSpan=1 class>
|
|
<div style="text-align: right;"><SPAN><FONT style="FONT-SIZE: 3.15mm">村</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$现住地址村$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">详细现住地址:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=30 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$详细现住地址$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">身份证号码:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$身份证号码$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD class></TD>
|
|
<TD colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">文化程度:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$文化程度$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=18 class></TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">婚姻状况:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_hyzk" value="option1" $婚姻状况10$>未婚
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hyzk" value="option2" $婚姻状况20$>已婚
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hyzk" value="option2" $婚姻状况21$>初婚
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hyzk" value="option2" $婚姻状况22$>再婚
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hyzk" value="option2" $婚姻状况23$>复婚
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm;">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hyzk" value="option2" $婚姻状况30$>丧偶
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm;">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hyzk" value="option2" $婚姻状况40$>离婚
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm;">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hyzk" value="option2" $婚姻状况90$>未说明的婚姻状况
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">疾病名称:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$疾病名称$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD class></TD>
|
|
<TD colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">其它病名称:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$其它病名称$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=18 class></TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">诊断日期:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$诊断日期$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD class></TD>
|
|
<TD colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">死亡日期:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$死亡日期$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=18 class></TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">备注:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=31 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$备注$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">户籍地类型:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_hjlx" value="option1" $户籍地类型01$>本县区
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hjlx" value="option2" $户籍地类型02$>本市其它县区
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hjlx" value="option2" $户籍地类型03$>本省其它地市
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hjlx" value="option2" $户籍地类型04$>其他省
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hjlx" value="option2" $户籍地类型05$>港澳台
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm;">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_hjlx" value="option2" $户籍地类型06$>外籍
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=3 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">户籍地址:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD height=22 colSpan=2 class>
|
|
<div style="text-align: right;"><SPAN><FONT style="FONT-SIZE: 3.15mm">省份</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$户籍地址省份$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD height=22 colSpan=2 class>
|
|
<div style="text-align: right;"><SPAN><FONT style="FONT-SIZE: 3.15mm">城市</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$户籍地址城市$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD height=22 colSpan=1 class>
|
|
<div style="text-align: right;"><SPAN><FONT style="FONT-SIZE: 3.15mm">县</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$户籍地址县$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD height=22 colSpan=1 class>
|
|
<div style="text-align: right;"><SPAN><FONT style="FONT-SIZE: 3.15mm">镇</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$户籍地址镇$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD height=22 colSpan=1 class>
|
|
<div style="text-align: right;"><SPAN><FONT style="FONT-SIZE: 3.15mm">村</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$户籍地址村$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">户籍地详细地址:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=30 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$户籍地详细地址$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">诊断类型:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_zdlx" value="option1" $诊断类型1$>临床诊断病例
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zdlx" value="option2" $诊断类型2$>确诊病例
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zdlx" value="option2" $诊断类型3$>疑似病例
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zdlx" value="option2" $诊断类型4$>病原携带者
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zdlx" value="option2" $诊断类型5$>阳性检测
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm;">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zdlx" value="option2" $诊断类型6$>埃博拉留观病例
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">病例分类:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_blfl" value="option1" $病例分类1$>急性
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_blfl" value="option2" $病例分类2$>慢性
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_blfl" value="option2" $病例分类3$>未分型
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD height=22 colSpan=3 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">发病日期:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=4 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$发病日期$</FONT></SPAN></div >
|
|
</TD>
|
|
|
|
<TD class></TD>
|
|
<TD height=22 colSpan=6 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">密接者有无相同症状:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=2 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_zz" value="option1" $密接者有无相同症状1$>有
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=2 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zz" value="option2" $密接者有无相同症状0$>无
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
<TR style="HEIGHT: 80px;" class>
|
|
<TD colSpan=38 class>
|
|
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5;align-items: center;border: 1px solid #d4d4d4;" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" height="100%" align=center bgColor=transparent border=0 class>
|
|
<TBODY>
|
|
|
|
<TR style="HEIGHT: 25px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
<div class="form-check" >
|
|
<p align=center><SPAN ><FONT style="FONT-SIZE: 3.5mm">新型冠状病毒感染填写此栏</FONT></SPAN></p>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR class>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">临床严重程度:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_lc" value="option1" $临床严重程度2$>轻型
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_lc" value="option2" $临床严重程度3$>重型
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_lc" value="option2" $临床严重程度4$>危重型
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_lc" value="option2" $临床严重程度5$>无症状感染者
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_lc" value="option2" $临床严重程度6$>普通型
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">输入病例:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_srbl" value="option1" $输入病例1$>是
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_srbl" value="option2" $输入病例0$>否
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=9 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">死亡原因是否与新冠感染有关:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_swxg" value="option1" $死亡原因是否与新冠感染有关1$>是
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_swxg" value="option2" $死亡原因是否与新冠感染有关0$>否
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">直接死亡诊断:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=30 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$直接死亡诊断$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 10px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
</TD>
|
|
</TR>
|
|
</TBODY>
|
|
</TABLE>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 90px;" class>
|
|
<TD colSpan=38 class>
|
|
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5;align-items: center;border: 1px solid #d4d4d4;" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" height="100%" align=center bgColor=transparent border=0 class>
|
|
<TBODY>
|
|
<TR style="HEIGHT: 25px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
<div class="form-check" >
|
|
<p align=center><SPAN ><FONT style="FONT-SIZE: 3.5mm">结核病填写此栏</FONT></SPAN></p>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR class>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=6 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">收治状态:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_szzt" value="option1" $收治状态0$>未收治
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_szzt" value="option2" $收治状态1$>已收治
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_szzt" value="option2" $收治状态3$>已到位未收治
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 10px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
</TD>
|
|
</TR>
|
|
</TBODY>
|
|
</TABLE>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
<TR style="HEIGHT: 90px;" class>
|
|
<TD colSpan=38 class>
|
|
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5;align-items: center;border: 1px solid #d4d4d4;" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" height="100%" align=center bgColor=transparent border=0 class>
|
|
<TBODY>
|
|
<TR style="HEIGHT: 25px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
<div class="form-check" >
|
|
<p align=center><SPAN ><FONT style="FONT-SIZE: 3.5mm">艾滋病/HIV等填写此栏</FONT></SPAN></p>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR class>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=6 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">样本来源:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$样本来源$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=2 class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">样本来源其它:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$样本来源其它$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 1px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=6 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">最有可能感染途径:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$最有可能感染途径$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=2 class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">感染途径其它:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$感染途径其它$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=18 class></TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">接触史(可多选):</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;" colSpan=7 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $注射毒品史$>
|
|
<label class="form-check-label">注射毒品史</label>
|
|
</div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD colSpan=8 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">与患者共用过注射器的人数:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=2 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$与患者共用过注射器的人数$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD style="CURSOR: default;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $输血血制品史$>
|
|
<label class="form-check-label">输血/血制品史</label>
|
|
</div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD style="CURSOR: default;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $其他$>
|
|
<label class="form-check-label">其他</label>
|
|
</div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;" colSpan=7 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $非婚异性性接触史$>
|
|
<label class="form-check-label">非婚异性性接触史</label>
|
|
</div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD colSpan=3 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">记忆中与</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=2 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$人有过非婚性行为$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">人有过非婚性行为?</FONT></SPAN></div >
|
|
</TD>
|
|
|
|
<TD colSpan=1 class></TD>
|
|
<TD style="CURSOR: default;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $母亲阳性$>
|
|
<label class="form-check-label">母亲阳性</label>
|
|
</div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD style="CURSOR: default;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $非商业$>
|
|
<label class="form-check-label">非商业</label>
|
|
</div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;" colSpan=7 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $配偶固定性伴阳性$>
|
|
<label class="form-check-label">配偶/固定性伴阳性</label>
|
|
</div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD style="CURSOR: default;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $职业暴露史$>
|
|
<label class="form-check-label">职业暴露史</label>
|
|
</div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD style="CURSOR: default;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $商业$>
|
|
<label class="form-check-label">商业</label>
|
|
</div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;" colSpan=7 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $男男性行为史$>
|
|
<label class="form-check-label">男男性行为史</label>
|
|
</div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD colSpan=3 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">记忆中与</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=2 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$人有过同性性行为$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=6 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">人有过同性性行为?</FONT></SPAN></div >
|
|
</TD>
|
|
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;" colSpan=7 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $手术史$>
|
|
<label class="form-check-label">手术史</label>
|
|
</div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD style="CURSOR: default;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $献血浆史$>
|
|
<label class="form-check-label">献血(浆)史</label>
|
|
</div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD style="CURSOR: default;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_jcs" value="something" $不详$>
|
|
<label class="form-check-label">不详</label>
|
|
</div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">接触史其他:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=30 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$接触史其他$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">艾滋病诊断日期:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$艾滋病诊断日期$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">实验室检测结论:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_sys" value="option1" $实验室检测结论01$>确认结果阳性
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=7 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_sys" value="option2" $实验室检测结论02$>替代策略检测阳性
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=6 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_sys" value="option2" $实验室检测结论03$>核酸检测阳性
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=9 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">确认(替代策略)检测阳性日期:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$检测阳性日期$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=9 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">确认(替代策略)检测单位:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$检测单位$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=9 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">性病史:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_xbs" value="option1" $性病史1$>有
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_xbs" value="option2" $性病史2$>无
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_xbs" value="option2" $性病史9$>不详
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=9 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">生殖道沙眼衣原体感染:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_sz" value="option1" $生殖道沙眼衣原体感染01$>确诊病例
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_sz" value="option2" $生殖道沙眼衣原体感染02$>无症状感染
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
<TR style="HEIGHT: 10px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
</TD>
|
|
</TR>
|
|
</TBODY>
|
|
</TABLE>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 90px;" class>
|
|
<TD colSpan=38 class>
|
|
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5;align-items: center;border: 1px solid #d4d4d4;" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" height="100%" align=center bgColor=transparent border=0 class>
|
|
<TBODY>
|
|
<TR style="HEIGHT: 25px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
<div class="form-check" >
|
|
<p align=center><SPAN ><FONT style="FONT-SIZE: 3.5mm">手足口病填写此栏</FONT></SPAN></p>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR class>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">重症患者:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_zzhz" value="option1" $重症患者1$>未收治
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=4 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_zzhz" value="option2" $重症患者0$>已收治
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
|
|
<TD colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">实验室结果:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_sysjg" value="option1" $实验室结果1$>未收治
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_sysjg" value="option2" $实验室结果2$>已收治
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_sysjg" value="option2" $实验室结果3$>已收治
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 10px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
</TD>
|
|
</TR>
|
|
</TBODY>
|
|
</TABLE>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 90px;" class>
|
|
<TD colSpan=38 class>
|
|
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5;align-items: center;border: 1px solid #d4d4d4;" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" height="100%" align=center bgColor=transparent border=0 class>
|
|
<TBODY>
|
|
<TR style="HEIGHT: 25px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
<div class="form-check" >
|
|
<p align=center><SPAN ><FONT style="FONT-SIZE: 3.5mm">HB乙肝填写此栏</FONT></SPAN></p>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR class>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=9 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">乙肝HBsAg阳性时间:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_yghbsag" value="option1" $乙肝HBsAg阳性时间1$>大于6个月
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=8 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_yghbsag" value="option2" $乙肝HBsAg阳性时间2$>6个月内由阴性转为阳性
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=8 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_yghbsag" value="option2" $乙肝HBsAg阳性时间3$>既往未检测或结果不详
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=9 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">首次出现乙肝症状和体征时间:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$首次出现乙肝症状和体征时间$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
|
|
<TD style="CURSOR: default;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input class="form-check-input" type="checkbox" id="check1" name="option_bx" value="something" $首次出现乙肝症状和体征时间不详$>
|
|
<label class="form-check-label">不详</label>
|
|
</div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=9 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">乙肝本次ALT:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=5 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$乙肝本次ALT$</FONT></SPAN></div >
|
|
</TD>
|
|
|
|
<TD colSpan=1 class></TD>
|
|
|
|
<TD colSpan=8 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">抗-HBcIgI1:1000检测结果:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_khbjg" value="option1" $抗检测结果1$>阳性
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_khbjg" value="option2" $抗检测结果2$>阴性
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_khbjg" value="option2" $抗检测结果3$>未测
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
|
|
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=9 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">肝穿检测结果:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=5 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_gcjcjg" value="option1" $肝穿检测结果1$>大于6个月
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=8 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_gcjcjg" value="option2" $肝穿检测结果2$>6个月内由阴性转为阳性
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=8 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_gcjcjg" value="option2" $肝穿检测结果3$>既往未检测或结果不详
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=10 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">恢复期血清HBsAg阴转,抗HBs阳转:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio1" name="optradio_fhq" value="option1" $恢复期血清1$>是
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_fhq" value="option2" $恢复期血清2$>否
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 0px solid black;" colSpan=3 class>
|
|
<div class="form-check" style="FONT-SIZE: 3.15mm">
|
|
<input type="radio" class="form-check-input" id="radio2" name="optradio_fhq" value="option2" $恢复期血清3$>未测
|
|
<label class="form-check-label" for="radio1"></label>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 10px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
</TD>
|
|
</TR>
|
|
</TBODY>
|
|
</TABLE>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
|
|
|
|
|
|
<TR style="HEIGHT: 90px;" class>
|
|
<TD colSpan=38 class>
|
|
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5;align-items: center;border: 1px solid #d4d4d4;" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" height="100%" align=center bgColor=transparent border=0 class>
|
|
<TBODY>
|
|
<TR style="HEIGHT: 25px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
<div class="form-check" >
|
|
<p align=center><SPAN ><FONT style="FONT-SIZE: 3.5mm">梅毒病例填写此栏</FONT></SPAN></p>
|
|
</div>
|
|
</TD>
|
|
</TR>
|
|
<TR class>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
<TD ><div style="background-color: #ffffff;width:5mm;HEIGHT:2mm;word-wrap: break-word"><br></div ></TD>
|
|
</TR>
|
|
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=6 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">检验结果(含滴度):</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=29 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$检验结果$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=6 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">诊疗史:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=29 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$诊疗史$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=6 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">特征性临床表现:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=29 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$特征性临床表现$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 10px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=6 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">报告科室:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=29 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">$报告科室$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 10px;" class>
|
|
<TD colSpan=38 style="background-color: #f5f7f9;" class>
|
|
</TD>
|
|
</TR>
|
|
</TBODY>
|
|
</TABLE>
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 15px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">报告单位编码:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$报告单位编码$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">填卡医生:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$填卡医生$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">报告单位名称:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$报告单位名称$</FONT></SPAN></div >
|
|
</TD>
|
|
</TR>
|
|
|
|
<TR style="HEIGHT: 5px" class></TR>
|
|
|
|
<TR style="HEIGHT: 25px" class>
|
|
<TD class></TD>
|
|
<TD colSpan=5 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">报告日期:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$报告日期$</FONT></SPAN></div >
|
|
</TD>
|
|
<TD colSpan=1 class></TD>
|
|
<TD colSpan=4 class>
|
|
<div ><SPAN><FONT style="FONT-SIZE: 3.15mm">联系电话:</FONT></SPAN></div >
|
|
</TD>
|
|
<TD style="CURSOR: default;border-bottom: 1px solid #d4d4d4;" colSpan=6 class>
|
|
<div style="text-align: center;"><SPAN><FONT style="FONT-SIZE: 3.15mm">$联系电话$</FONT></SPAN></div >
|
|
</TD>
|
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<TD colSpan=1 class></TD>
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</TR>
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<TR style="HEIGHT: 5px" class></TR>
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</TBODY>
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</TABLE>
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</div>
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]]>
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</content>
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<footercontent>
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<![CDATA[
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]]>
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</footercontent>
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</emr> |