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klhis/file/reporttemplate/DE3C9D58-C91A-459E-74D0-589.../住院收费发票打印/f557992d4a68c494315e49b5fca...

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<![CDATA[
<P align=center><FONT style="FONT-SIZE: 7.8mm"><STRONG style="FONT-SIZE: 7.8mm">新和县莎拉麦提医院出院结算单</STRONG></FONT></P>
<P align=center><STRONG></STRONG>&nbsp;</P>
<P>
<TABLE style="BORDER-TOP-STYLE: solid; FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; BORDER-BOTTOM-STYLE: solid; BORDER-RIGHT-STYLE: solid; BORDER-LEFT-STYLE: solid; LINE-HEIGHT: 1.5" borderColor=#000000 cellSpacing=0 cellPadding=0 width="100%" bgColor=transparent border=1 class>
<TBODY>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=238 colSpan=2 class> 住院号：<SPAN id=CB78ECFC-ECB2-7F56-1D7D-09227CE8266D class=Emr_hdy wattype="static" watid="CB78ECFC-ECB2-7F56-1D7D-09227CE8266D" watvalue="ZYNO" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZYNO$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=238 colSpan=2 class>姓名：<SPAN id=70F2D8D9-4CAD-E56E-A71E-37DF9D0E3126 class=Emr_hdy wattype="static" watid="70F2D8D9-4CAD-E56E-A71E-37DF9D0E3126" watvalue="XM" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XM$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=238 colSpan=2 class>费别：<SPAN id=14E8AC09-B313-3A18-E9AB-E663D57FE867 class=Emr_hdy wattype="static" watid="14E8AC09-B313-3A18-E9AB-E663D57FE867" watvalue="医保类型" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$医保类型$</SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=238 colSpan=2 class> 入院：<SPAN id=97B2E277-F6A8-6C00-C986-4AE99120E3ED class=Emr_hdy wattype="static" watid="97B2E277-F6A8-6C00-C986-4AE99120E3ED" watvalue="入年" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$入年$</SPAN><SPAN id=59DBA704-0698-A906-5851-9722BB54F396 class=Emr_hdy wattype="static" watid="59DBA704-0698-A906-5851-9722BB54F396" watvalue="入月" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$入月$</SPAN><SPAN id=26AA0139-9513-CF4A-492D-AC247CD1A048 class=Emr_hdy wattype="static" watid="26AA0139-9513-CF4A-492D-AC247CD1A048" watvalue="入日" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$入日$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=238 colSpan=2 class>出院：<SPAN id=208C8777-899F-8DF4-C4AC-58331662B4F7 class=Emr_hdy wattype="static" watid="208C8777-899F-8DF4-C4AC-58331662B4F7" watvalue="出年" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$出年$</SPAN><SPAN id=FD768826-5B3D-1139-C636-27A297E9B080 class=Emr_hdy wattype="static" watid="FD768826-5B3D-1139-C636-27A297E9B080" watvalue="出月" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$出月$</SPAN><SPAN id=40F9900C-387B-AD27-02EE-EE987146C23E class=Emr_hdy wattype="static" watid="40F9900C-387B-AD27-02EE-EE987146C23E" watvalue="出日" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$出日$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=238 colSpan=2 class>共：<SPAN id=9C786869-7DCE-FD6B-220A-D58C663399AE class=Emr_hdy wattype="static" watid="9C786869-7DCE-FD6B-220A-D58C663399AE" watvalue="ZYTS" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZYTS$</SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=51 class></TD>
<TD style="CURSOR: default" height=23 width=183 class></TD>
<TD style="CURSOR: default" height=23 width=38 class></TD>
<TD style="CURSOR: default" height=23 width=198 class></TD>
<TD style="CURSOR: default" height=23 width=39 class></TD>
<TD style="CURSOR: default" height=23 width=198 class></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=51 class></TD>
<TD style="CURSOR: default" height=23 width=183 class><SPAN id=B33DF4AA-EBC4-5770-F4DE-680599E38D5E class=Emr_hdy wattype="static" watid="B33DF4AA-EBC4-5770-F4DE-680599E38D5E" watvalue="费用类别1" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别1$</SPAN> <SPAN id=AED4F851-2B70-818E-D980-B3B77D1E2AF3 class=Emr_hdy wattype="static" watid="AED4F851-2B70-818E-D980-B3B77D1E2AF3" watvalue="金额1" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额1$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=38 class></TD>
<TD style="CURSOR: default" height=23 width=198 class><SPAN id=F7C99A69-038E-DA6E-143A-0C16105C7981 class=Emr_hdy wattype="static" watid="F7C99A69-038E-DA6E-143A-0C16105C7981" watvalue="费用类别2" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别2$</SPAN> <SPAN id=03E625A1-A6AD-A1DF-57A3-D54A28BE1A0E class=Emr_hdy wattype="static" watid="03E625A1-A6AD-A1DF-57A3-D54A28BE1A0E" watvalue="金额2" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额2$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=39 class></TD>
<TD style="CURSOR: default" height=23 width=198 class><SPAN id=E713454B-C0C0-A2F5-242F-18F1BD9EEA49 class=Emr_hdy wattype="static" watid="E713454B-C0C0-A2F5-242F-18F1BD9EEA49" watvalue="费用类别3" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别3$</SPAN> <SPAN id=12E1DE69-393A-6927-1D20-3D1DC8CC2F0F class=Emr_hdy wattype="static" watid="12E1DE69-393A-6927-1D20-3D1DC8CC2F0F" watvalue="金额3" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额3$</SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=51 class></TD>
<TD style="CURSOR: default" height=23 width=183 class><SPAN id=34942C76-561C-1DE2-3B50-9F0C31EE683E class=Emr_hdy wattype="static" watid="34942C76-561C-1DE2-3B50-9F0C31EE683E" watvalue="费用类别4" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别4$</SPAN> <SPAN id=1BE45496-1583-C36B-1228-CE8E8064B9F3 class=Emr_hdy wattype="static" watid="1BE45496-1583-C36B-1228-CE8E8064B9F3" watvalue="金额4" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额4$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=38 class></TD>
<TD style="CURSOR: default" height=23 width=198 class><SPAN id=CBEE9642-AE92-F2D8-7130-8D5B3B90B92D class=Emr_hdy wattype="static" watid="CBEE9642-AE92-F2D8-7130-8D5B3B90B92D" watvalue="费用类别5" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别5$</SPAN> <SPAN id=00FB114E-76AD-7824-D103-F3E7C515139D class=Emr_hdy wattype="static" watid="00FB114E-76AD-7824-D103-F3E7C515139D" watvalue="金额5" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额5$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=39 class></TD>
<TD style="CURSOR: default" height=23 width=198 class><SPAN id=296F03EE-1AFB-3DB7-7CA9-2E2B6BEE1814 class=Emr_hdy wattype="static" watid="296F03EE-1AFB-3DB7-7CA9-2E2B6BEE1814" watvalue="费用类别6" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别6$</SPAN> <SPAN id=59914292-F117-3671-1CAE-1D7A716B4CA3 class=Emr_hdy wattype="static" watid="59914292-F117-3671-1CAE-1D7A716B4CA3" watvalue="金额6" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额6$</SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=51 class></TD>
<TD style="CURSOR: default" height=23 width=183 class><SPAN id=C695F702-E058-B699-F0BE-DED282AC2BD2 class=Emr_hdy wattype="static" watid="C695F702-E058-B699-F0BE-DED282AC2BD2" watvalue="费用类别7" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别7$</SPAN> <SPAN id=74041E90-A800-A9E5-C8CC-60BE4C1FCA71 class=Emr_hdy wattype="static" watid="74041E90-A800-A9E5-C8CC-60BE4C1FCA71" watvalue="金额7" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额7$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=38 class></TD>
<TD style="CURSOR: default" height=23 width=198 class><SPAN id=B08C8255-DF10-9108-8F9D-C575537696E1 class=Emr_hdy wattype="static" watid="B08C8255-DF10-9108-8F9D-C575537696E1" watvalue="费用类别8" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别8$</SPAN><SPAN> <SPAN id=DCDC6CE7-F82A-51B9-4889-5CDA583B47AA class=Emr_hdy wattype="static" watid="DCDC6CE7-F82A-51B9-4889-5CDA583B47AA" watvalue="金额8" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额8$</SPAN></SPAN></TD>
<TD style="CURSOR: default" height=23 width=39 class></TD>
<TD style="CURSOR: default" height=23 width=198 class><SPAN id=B617B72C-68E1-9DCB-28BA-336E8FB9C0D4 class=Emr_hdy wattype="static" watid="B617B72C-68E1-9DCB-28BA-336E8FB9C0D4" watvalue="费用类别9" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别9$</SPAN><SPAN> </SPAN><SPAN id=3B91DD70-2DC8-8A19-819A-BCEF70AE06A1 class=Emr_hdy wattype="static" watid="3B91DD70-2DC8-8A19-819A-BCEF70AE06A1" watvalue="金额9" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额9$</SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=51 class></TD>
<TD style="CURSOR: default" height=23 width=183 class><SPAN id=78097477-C296-AE97-4EC4-CAB3D5810CD4 class=Emr_hdy wattype="static" watid="78097477-C296-AE97-4EC4-CAB3D5810CD4" watvalue="费用类别10" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别10$</SPAN> <SPAN id=FA6C882D-EF80-11BC-548A-4301689865F8 class=Emr_hdy wattype="static" watid="FA6C882D-EF80-11BC-548A-4301689865F8" watvalue="金额10" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额10$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=38 class></TD>
<TD style="CURSOR: default" height=23 width=198 class><SPAN id=D27311C3-2969-5F9C-99AC-AE411724D352 class=Emr_hdy wattype="static" watid="D27311C3-2969-5F9C-99AC-AE411724D352" watvalue="费用类别11" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别11$</SPAN> <SPAN id=C2645593-E4E6-FC85-864F-99B1028B9C19 class=Emr_hdy wattype="static" watid="C2645593-E4E6-FC85-864F-99B1028B9C19" watvalue="金额11" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额11$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=39 class></TD>
<TD style="CURSOR: default" height=23 width=198 class><SPAN id=EF32E1F3-4039-7E24-C441-E2728EDD67D9 class=Emr_hdy wattype="static" watid="EF32E1F3-4039-7E24-C441-E2728EDD67D9" watvalue="费用类别12" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别12$</SPAN> <SPAN id=7A6A6BA6-B196-92A7-5964-DB074DDAB892 class=Emr_hdy wattype="static" watid="7A6A6BA6-B196-92A7-5964-DB074DDAB892" watvalue="金额12" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额12$</SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=51 class></TD>
<TD style="CURSOR: default" height=23 width=183 class><SPAN id=2729457D-01C6-7583-D8A2-8B78B363FA56 class=Emr_hdy wattype="static" watid="2729457D-01C6-7583-D8A2-8B78B363FA56" watvalue="费用类别13" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别13$</SPAN> <SPAN id=2AEB98D7-D58A-59EF-4990-8686AB87F3D4 class=Emr_hdy wattype="static" watid="2AEB98D7-D58A-59EF-4990-8686AB87F3D4" watvalue="金额13" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额13$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=38 class></TD>
<TD style="CURSOR: default" height=23 width=198 class><SPAN id=66A0DEBB-AC30-4049-C274-A6ECCA68A54F class=Emr_hdy wattype="static" watid="66A0DEBB-AC30-4049-C274-A6ECCA68A54F" watvalue="费用类别14" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别14$</SPAN> <SPAN id=558810E9-8F75-F406-7139-1D40E3E50D00 class=Emr_hdy wattype="static" watid="558810E9-8F75-F406-7139-1D40E3E50D00" watvalue="金额14" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额14$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=39 class></TD>
<TD style="CURSOR: default" height=23 width=198 class><SPAN id=1BE549C7-4548-1DC1-2960-F31E1CF4025E class=Emr_hdy wattype="static" watid="1BE549C7-4548-1DC1-2960-F31E1CF4025E" watvalue="费用类别15" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别15$</SPAN><SPAN> <SPAN id=1651F9F7-59EB-10F9-C293-44800D381818 class=Emr_hdy wattype="static" watid="1651F9F7-59EB-10F9-C293-44800D381818" watvalue="金额15" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额15$</SPAN></SPAN></TD></TR>
<TR>
<TD style="CURSOR: default"></TD>
<TD style="CURSOR: default"><SPAN id=635BAD91-7670-C4FB-48ED-B1ADA1680EFC class=Emr_hdy wattype="static" watid="635BAD91-7670-C4FB-48ED-B1ADA1680EFC" watvalue="费用类别16" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别16$</SPAN> <SPAN id=2FEF180F-1274-7730-506D-282421AEA90A class=Emr_hdy wattype="static" watid="2FEF180F-1274-7730-506D-282421AEA90A" watvalue="金额16" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额16$</SPAN></TD>
<TD style="CURSOR: default"></TD>
<TD style="CURSOR: default"><SPAN id=5BCFB9F2-9F56-ABC0-9533-F2A93575135E class=Emr_hdy wattype="static" watid="5BCFB9F2-9F56-ABC0-9533-F2A93575135E" watvalue="费用类别17" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别17$</SPAN> <SPAN id=C9198D73-1C88-0DEE-7F7A-2D144BBA1953 class=Emr_hdy wattype="static" watid="C9198D73-1C88-0DEE-7F7A-2D144BBA1953" watvalue="金额17" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额17$</SPAN></TD>
<TD style="CURSOR: default"></TD>
<TD style="CURSOR: default"><SPAN id=C48EDD08-A8D9-4BA8-9582-7C887A3D0DB5 class=Emr_hdy wattype="static" watid="C48EDD08-A8D9-4BA8-9582-7C887A3D0DB5" watvalue="费用类别18" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别18$</SPAN> <SPAN id=AF73C409-C17E-E271-42D1-3076D9292961 class=Emr_hdy wattype="static" watid="AF73C409-C17E-E271-42D1-3076D9292961" watvalue="金额18" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额18$</SPAN></TD></TR>
<TR>
<TD style="CURSOR: default"></TD>
<TD style="CURSOR: default"><SPAN id=2F672E1F-62F5-0300-02D3-14BDA603CE0E class=Emr_hdy wattype="static" watid="2F672E1F-62F5-0300-02D3-14BDA603CE0E" watvalue="费用类别19" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别19$</SPAN> <SPAN id=73C71B84-19D7-2F4B-9057-8083E1C8F6C3 class=Emr_hdy wattype="static" watid="73C71B84-19D7-2F4B-9057-8083E1C8F6C3" watvalue="金额19" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额19$</SPAN></TD>
<TD style="CURSOR: default"></TD>
<TD style="CURSOR: default"><SPAN id=1922F078-7A85-4353-F1CC-B25FAC207AB2 class=Emr_hdy wattype="static" watid="1922F078-7A85-4353-F1CC-B25FAC207AB2" watvalue="费用类别20" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别20$</SPAN> <SPAN id=28870F85-F227-9C05-FA9A-B7F0720C0BBE class=Emr_hdy wattype="static" watid="28870F85-F227-9C05-FA9A-B7F0720C0BBE" watvalue="金额20" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额20$</SPAN></TD>
<TD style="CURSOR: default"></TD>
<TD></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=51 class></TD>
<TD style="CURSOR: default" height=23 width=183 class>民政救助：</TD>
<TD style="CURSOR: default" height=23 width=38 class></TD>
<TD style="CURSOR: default" height=23 width=198 class>现金支付：<SPAN id=9A744355-62A5-6FB1-BCE9-6965174C71D5 class=Emr_hdy wattype="static" watid="9A744355-62A5-6FB1-BCE9-6965174C71D5" watvalue="合计自费金额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$合计自费金额$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=239 colSpan=2 class>统筹支付：<SPAN id=3C9757AA-E884-D01C-D26A-D37F142271F5 class=Emr_hdy wattype="static" watid="3C9757AA-E884-D01C-D26A-D37F142271F5" watvalue="基本医疗保险统筹基金支出" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$基本医疗保险统筹基金支出$</SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=51 class></TD>
<TD style="CURSOR: default" height=23 width=183 class>总额：<SPAN id=FBFA3EFD-2824-CCD5-29A7-69F40EE0FBC0 class=Emr_hdy wattype="static" watid="FBFA3EFD-2824-CCD5-29A7-69F40EE0FBC0" watvalue="医疗费总额大写" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$医疗费总额大写$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=38 class></TD>
<TD style="CURSOR: default" height=23 width=198 class></TD>
<TD style="CURSOR: default" height=23 width=239 colSpan=2 class>总费用 (小写)：<SPAN id=76DEB165-2B30-DDB3-0863-7EF2C56128C6 class=Emr_hdy wattype="static" watid="76DEB165-2B30-DDB3-0863-7EF2C56128C6" watvalue="医疗费总额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$医疗费总额$</SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=51 class></TD>
<TD style="CURSOR: default" height=23 width=183 class>预交款：<SPAN id=C5D56E03-ADB1-37B0-2460-0F5519DC6AB8 class=Emr_hdy wattype="static" watid="C5D56E03-ADB1-37B0-2460-0F5519DC6AB8" watvalue="预交款" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$预交款$</SPAN></TD>
<TD style="CURSOR: default" height=23 width=238 colSpan=2 class>小写合计：</TD>
<TD style="CURSOR: default" height=23 width=239 colSpan=2 class>应退金额：<SPAN id=41B5FD13-5596-F50F-EC5D-1ABE7A8A2F10 class=Emr_hdy wattype="static" watid="41B5FD13-5596-F50F-EC5D-1ABE7A8A2F10" watvalue="退款" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$退款$</SPAN></TD></TR>
<TR style="HEIGHT: 23px" class>
<TD style="CURSOR: default" height=23 width=51 class></TD>
<TD style="CURSOR: default" height=23 width=183 class></TD>
<TD style="CURSOR: default" height=23 width=38 class></TD>
<TD style="CURSOR: default" height=23 width=198 class></TD>
<TD style="CURSOR: default" height=23 width=239 colSpan=2 class>补交金额：<SPAN id=E94246B8-C125-9F9C-53A9-6D30FE85F19D class=Emr_hdy wattype="static" watid="E94246B8-C125-9F9C-53A9-6D30FE85F19D" watvalue="合计自费金额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$合计自费金额$</SPAN></TD></TR>
<TR class>
<TD style="CURSOR: default" class></TD>
<TD style="CURSOR: default" class></TD>
<TD style="CURSOR: default" width=38 class></TD>
<TD style="CURSOR: default" width=198 class></TD>
<TD style="CURSOR: default" class></TD>
<TD style="CURSOR: default" class></TD></TR></TBODY></TABLE></P>
<TABLE class=Emr_table_dotted style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 bgColor=transparent border=0>
<TBODY>
<TR class=Emr_table_dotted class="Emr_table_dotted">
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=359 class="Emr_table_dotted">结账时间：<SPAN id=25146522-D498-3ABF-69DE-8463C928DCB4 class=Emr_hdy wattype="static" watid="25146522-D498-3ABF-69DE-8463C928DCB4" watvalue="结算日期*yyyy-MM-dd HH:mm:ss" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$结算日期*yyyy-MM-dd HH:mm:ss$</SPAN></TD>
<TD class=Emr_table_dotted style="CURSOR: default" height=23 width=359 class="Emr_table_dotted">收款人：<SPAN id=9A42C661-7156-FF11-673C-6F8DB4D48621 class=Emr_hdy wattype="static" watid="9A42C661-7156-FF11-673C-6F8DB4D48621" watvalue="收款人" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$收款人$</SPAN></TD></TR></TBODY></TABLE>
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