klhis/file/reporttemplate/DE3C9D58-C91A-459E-74D0-5897CAC5F92B/gdzyjsd/1f24f62bae5bde64b0a3dcf12f90d0c7.xml

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<P align=center><FONT style="FONT-SIZE: 5.55mm">       <STRONG>四川省基本医疗保险住院结算单</STRONG></FONT></P>
<P align=right>                                                                                  <FONT style="FONT-SIZE: 3.15mm">单位: 元(保留两位小数)</FONT></P>
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; TEXT-ALIGN: center; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" align=center bgColor=transparent border=1 class>
<TBODY>
<TR style="HEIGHT: 37px" class>
<TD style="CURSOR: default" height=37 width=55 class><FONT style="FONT-SIZE: 3.15mm">患者姓名</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=37 width=100 align=left class><SPAN> </SPAN><SPAN id=3B738666-A9AA-3E20-F30D-FDE7A62C5353 class=Emr_hdy wattype="static" watid="3B738666-A9AA-3E20-F30D-FDE7A62C5353" watvalue="XM" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XM$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=37 width=29 class><FONT style="FONT-SIZE: 3.15mm">性别</FONT></TD>
<TD style="CURSOR: default" height=37 width=31 class><SPAN id=34CE8161-03A3-711D-87AB-E23C7964AC02 class=Emr_hdy wattype="static" watid="34CE8161-03A3-711D-87AB-E23C7964AC02" watvalue="XB" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XB$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=37 width=28 class><FONT style="FONT-SIZE: 3.15mm">年龄</FONT></TD>
<TD style="CURSOR: default" height=37 width=40 class><SPAN id=29176A15-D225-0C59-7B85-D2D56B69C661 class=Emr_hdy wattype="static" watid="29176A15-D225-0C59-7B85-D2D56B69C661" watvalue="NL" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$NL$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=37 width=52 class><FONT style="FONT-SIZE: 3.15mm">社会保障号码</FONT></TD>
<TD style="CURSOR: default" height=37 width=152 class><SPAN id=EEDD9E60-FB8C-0861-2B6D-5A0EB4B026A4 class=Emr_hdy wattype="static" watid="EEDD9E60-FB8C-0861-2B6D-5A0EB4B026A4" watvalue="SFZH" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$SFZH$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=37 width=64 class><FONT style="FONT-SIZE: 3.15mm">社会保障卡卡号(可选)</FONT></TD>
<TD style="CURSOR: default" height=37 width=155 class><SPAN id=D462A8AD-1B6D-7A38-26B7-1BC0B400EFD3 class=Emr_hdy wattype="static" watid="D462A8AD-1B6D-7A38-26B7-1BC0B400EFD3" watvalue="SBKH" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$SBKH$</SPAN><FONT style="FONT-SIZE: 3.15mm"><FONT style="FONT-SIZE: 3.15mm"></FONT></FONT></TD></TR>
<TR style="HEIGHT: 31px" class>
<TD style="CURSOR: default" height=31 width=55 class><FONT style="FONT-SIZE: 3.15mm">参保地</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=31 width=232 colSpan=5 align=left class><SPAN> </SPAN><SPAN id=D075BC60-9B1A-1034-BFC8-C13CD2E4C6A5 class=Emr_hdy wattype="static" watid="D075BC60-9B1A-1034-BFC8-C13CD2E4C6A5" watvalue="CBD" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CBD$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=31 width=52 class><FONT style="FONT-SIZE: 3.15mm">险种类型</FONT></TD>
<TD style="CURSOR: default" height=31 width=152 class><SPAN id=F4F32ECD-50EB-C96C-58F1-D2F336BF0029 class=Emr_hdy wattype="static" watid="F4F32ECD-50EB-C96C-58F1-D2F336BF0029" watvalue="XZ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XZ$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=31 width=64 class><FONT style="FONT-SIZE: 3.15mm">人员类型</FONT></TD>
<TD style="CURSOR: default" height=31 width=155 class><SPAN id=CF83C3DB-8C09-0FF8-E6D4-C6C69B22C4F3 class=Emr_hdy wattype="static" watid="CF83C3DB-8C09-0FF8-E6D4-C6C69B22C4F3" watvalue="RYLX" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$RYLX$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR></TBODY></TABLE>
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; TEXT-ALIGN: center; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" align=center bgColor=transparent border=1 class>
<TBODY>
<TR style="HEIGHT: 32px" class>
<TD style="CURSOR: default" height=32 width=54 class><FONT style="FONT-SIZE: 3.15mm">就医地</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=32 width=86 align=left class><SPAN> </SPAN><SPAN id=98C3599C-949F-E699-34FC-813125C816C1 class=Emr_hdy wattype="static" watid="98C3599C-949F-E699-34FC-813125C816C1" watvalue="JYD" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JYD$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=32 width=79 class><FONT style="FONT-SIZE: 3.15mm">医疗机构编码</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=32 width=105 align=left class><SPAN> </SPAN><SPAN id=67AD5BFD-B846-AF72-1639-30B5276AE776 class=Emr_hdy wattype="static" watid="67AD5BFD-B846-AF72-1639-30B5276AE776" watvalue="JGBM" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JGBM$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=32 width=54 class><FONT style="FONT-SIZE: 3.15mm">医院名称</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=32 width=163 colSpan=3 align=left class><SPAN> </SPAN><SPAN id=1E363A71-9982-4E48-1684-F31B64ADF02E class=Emr_hdy wattype="static" watid="1E363A71-9982-4E48-1684-F31B64ADF02E" watvalue="JGMC" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JGMC$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=32 width=55 class><FONT style="FONT-SIZE: 3.15mm">医院等级</FONT></TD>
<TD style="CURSOR: default" height=32 width=109 class><SPAN id=4A5A0B40-9F04-DACF-0F6B-C1C1D12C9F56 class=Emr_hdy wattype="static" watid="4A5A0B40-9F04-DACF-0F6B-C1C1D12C9F56" watvalue="YYDJ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$YYDJ$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 29px" class>
<TD style="CURSOR: default" height=29 width=54 class><FONT style="FONT-SIZE: 3.15mm">入院方式</FONT></TD>
<TD style="CURSOR: default" height=29 width=272 colSpan=3 class><SPAN id=B74BA717-5FF9-0F29-4942-5B617A855DE4 class=Emr_hdy wattype="static" watid="B74BA717-5FF9-0F29-4942-5B617A855DE4" watvalue="RYFS" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$RYFS$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=54 class><FONT style="FONT-SIZE: 3.15mm">住院号</FONT></TD>
<TD style="CURSOR: default" height=29 width=163 colSpan=3 class><SPAN id=AB2D6977-490B-F7CD-5C2E-7B47EDC8C88B class=Emr_hdy wattype="static" watid="AB2D6977-490B-F7CD-5C2E-7B47EDC8C88B" watvalue="ZYH" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZYH$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=55 class><FONT style="FONT-SIZE: 3.15mm">出院科室</FONT></TD>
<TD style="CURSOR: default" height=29 width=109 class><SPAN id=D610DB5B-123F-0DCC-DC34-25016012BD1D class=Emr_hdy wattype="static" watid="D610DB5B-123F-0DCC-DC34-25016012BD1D" watvalue="CYKS" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CYKS$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 50px" class>
<TD style="CURSOR: default" height=50 width=54 class><FONT style="FONT-SIZE: 3.15mm">主要诊断</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=50 width=272 colSpan=3 align=left class><FONT style="FONT-SIZE: 3.15mm"> <SPAN id=94C1DE2D-1228-2EBA-1E7E-33BA8ED263C5 class=Emr_hdy style="FONT-SIZE: 3.7mm" wattype="static" watid="94C1DE2D-1228-2EBA-1E7E-33BA8ED263C5" watvalue="ZYZD" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZYZD$</SPAN></FONT></TD>
<TD style="CURSOR: default" height=50 width=54 class><FONT style="FONT-SIZE: 3.15mm">次要诊断</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=50 width=329 colSpan=5 align=left class><FONT style="FONT-SIZE: 3.15mm"> <SPAN id=6C9E0F08-0E64-9CB9-1BE4-EE58AF67D532 class=Emr_hdy style="FONT-SIZE: 3.7mm" wattype="static" watid="6C9E0F08-0E64-9CB9-1BE4-EE58AF67D532" watvalue="CYZD" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CYZD$</SPAN></FONT></TD></TR></TBODY></TABLE>
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; TEXT-ALIGN: center; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" align=center bgColor=transparent border=1 class>
<TBODY>
<TR style="HEIGHT: 31px" class>
<TD style="CURSOR: default" height=31 width=54 class><FONT style="FONT-SIZE: 3.15mm">入院日期</FONT></TD>
<TD style="CURSOR: default" height=31 width=143 colSpan=2 class><SPAN id=2E085CDA-2A2F-EA71-19C0-1472358B7725 class=Emr_hdy wattype="static" watid="2E085CDA-2A2F-EA71-19C0-1472358B7725" watvalue="RYRQ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$RYRQ$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=31 width=53 class><FONT style="FONT-SIZE: 3.15mm">出院日期</FONT></TD>
<TD style="CURSOR: default" height=31 width=155 class><SPAN id=B05181E6-34D1-CCBD-8A0A-00607C3E8612 class=Emr_hdy wattype="static" watid="B05181E6-34D1-CCBD-8A0A-00607C3E8612" watvalue="CYRQ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CYRQ$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=31 width=50 class><FONT style="FONT-SIZE: 3.15mm">住院天数</FONT></TD>
<TD style="CURSOR: default" height=31 width=50 class><SPAN id=5CAD6502-1F3A-41B2-BE05-6E71C4B5F095 class=Emr_hdy wattype="static" watid="5CAD6502-1F3A-41B2-BE05-6E71C4B5F095" watvalue="ZYTS" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZYTS$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=31 width=52 class><FONT style="FONT-SIZE: 3.15mm">结算时间</FONT></TD>
<TD style="CURSOR: default" height=31 width=146 colSpan=2 class><SPAN id=DF25E189-F3F0-FBF1-EF86-A864B5E18AD0 class=Emr_hdy wattype="static" watid="DF25E189-F3F0-FBF1-EF86-A864B5E18AD0" watvalue="JSSJ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JSSJ$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR></TBODY></TABLE>
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; WIDTH: 100%; BORDER-COLLAPSE: collapse; TEXT-ALIGN: right; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" align=center bgColor=transparent border=1 class>
<TBODY>
<TR style="HEIGHT: 35px" class>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=61 align=center class><FONT style="FONT-SIZE: 3.15mm">费用名称</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=77 align=center class><FONT style="FONT-SIZE: 3.15mm">总费用</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=61 align=center class><FONT style="FONT-SIZE: 3.15mm">自费</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=76 align=center class><FONT style="FONT-SIZE: 3.15mm">乙类先行自付</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=75 align=center class><FONT style="FONT-SIZE: 3.15mm">超限价自付</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=71 align=center class><FONT style="FONT-SIZE: 3.15mm">费用名称</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=71 align=center class><FONT style="FONT-SIZE: 3.15mm">总费用</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=68 align=center class><FONT style="FONT-SIZE: 3.15mm">自费</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=74 align=center class><FONT style="FONT-SIZE: 3.15mm">乙类先行自付</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=72 align=center class><FONT style="FONT-SIZE: 3.15mm">超限价自付</FONT></TD></TR>
<TR style="HEIGHT: 30px" class>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=26 width=61 align=center class><FONT style="FONT-SIZE: 3.15mm">床位费</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=26 width=77 align=right class><SPAN id=0F40D5C1-17E0-6D23-44C1-4A1E253A08C1 class=Emr_hdy wattype="static" watid="0F40D5C1-17E0-6D23-44C1-4A1E253A08C1" watvalue="ZFY01" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY01$</SPAN></TD>
<TD style="CURSOR: default" height=26 width=61 class><SPAN id=4227DF83-EA4E-BFF1-0D31-D3EF10D165CB class=Emr_hdy wattype="static" watid="4227DF83-EA4E-BFF1-0D31-D3EF10D165CB" watvalue="ZF01" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF01$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=26 width=76 class><SPAN id=24FAECBB-2A0D-0853-261F-64AC05DB8604 class=Emr_hdy wattype="static" watid="24FAECBB-2A0D-0853-261F-64AC05DB8604" watvalue="XX01" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX01$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=26 width=75 class><SPAN id=98AAD2CD-E9D1-3110-E1F0-08CFFFEC00F6 class=Emr_hdy wattype="static" watid="98AAD2CD-E9D1-3110-E1F0-08CFFFEC00F6" watvalue="CXJ01" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ01$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=26 width=71 align=center class><FONT style="FONT-SIZE: 3.15mm">西药费</FONT></TD>
<TD style="CURSOR: default" height=26 width=71 class><SPAN id=2C404C33-C98D-B886-3D42-07D4B1256ECB class=Emr_hdy wattype="static" watid="2C404C33-C98D-B886-3D42-07D4B1256ECB" watvalue="ZFY09" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY09$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=26 width=68 class><SPAN id=E8528990-D511-1487-030B-E51384199D5B class=Emr_hdy wattype="static" watid="E8528990-D511-1487-030B-E51384199D5B" watvalue="ZF09" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF09$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=26 width=74 class><SPAN id=1397506A-B4FF-FFEB-D692-F621F54A3D3D class=Emr_hdy wattype="static" watid="1397506A-B4FF-FFEB-D692-F621F54A3D3D" watvalue="XX09" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX09$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=26 width=72 class><SPAN id=E75ACFD4-CFE2-A900-48A5-E212D4CAFFF1 class=Emr_hdy wattype="static" watid="E75ACFD4-CFE2-A900-48A5-E212D4CAFFF1" watvalue="CXJ09" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ09$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 30px" class>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=29 width=61 align=center class><FONT style="FONT-SIZE: 3.15mm">中药饮片费</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=29 width=77 align=right class><SPAN id=26F205EF-72DC-C3A2-9F08-0B70D1D399B0 class=Emr_hdy wattype="static" watid="26F205EF-72DC-C3A2-9F08-0B70D1D399B0" watvalue="ZFY10" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY10$</SPAN></TD>
<TD style="CURSOR: default" height=29 width=61 class><SPAN id=9B3560A6-5BEA-A134-F83C-D274832539B8 class=Emr_hdy wattype="static" watid="9B3560A6-5BEA-A134-F83C-D274832539B8" watvalue="ZF10" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF10$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=76 class><SPAN id=9BAA6EC5-C0C1-A751-5956-611750B7BA4A class=Emr_hdy wattype="static" watid="9BAA6EC5-C0C1-A751-5956-611750B7BA4A" watvalue="XX10" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX10$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=75 class><SPAN id=F8A66A0C-DEF8-2957-CD78-9E5816788FAB class=Emr_hdy wattype="static" watid="F8A66A0C-DEF8-2957-CD78-9E5816788FAB" watvalue="CXJ10" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ10$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=29 width=71 align=center class><FONT style="FONT-SIZE: 3.15mm">中成药费</FONT></TD>
<TD style="CURSOR: default" height=29 width=71 class><SPAN id=5A2B8F94-E117-8405-83AD-9CFA9E61A79A class=Emr_hdy wattype="static" watid="5A2B8F94-E117-8405-83AD-9CFA9E61A79A" watvalue="ZFY11" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY11$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=68 class><SPAN id=3E68454E-2E45-7865-7367-74BB9A37F26F class=Emr_hdy wattype="static" watid="3E68454E-2E45-7865-7367-74BB9A37F26F" watvalue="ZF11" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF11$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=74 class><SPAN id=FF3DE3B0-92DF-3D8A-73AF-F4464D534369 class=Emr_hdy wattype="static" watid="FF3DE3B0-92DF-3D8A-73AF-F4464D534369" watvalue="XX11" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX11$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=72 class><SPAN id=8794A35B-22BD-C6FD-E787-F0145A8FCE64 class=Emr_hdy wattype="static" watid="8794A35B-22BD-C6FD-E787-F0145A8FCE64" watvalue="CXJ11" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ11$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 30px" class>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=27 width=61 align=center class><FONT style="FONT-SIZE: 3.15mm">诊察费</FONT></TD>
<TD style="CURSOR: default" height=27 width=77 class><SPAN id=2F357CBD-0EAE-5133-68A5-37E89C1CE38A class=Emr_hdy wattype="static" watid="2F357CBD-0EAE-5133-68A5-37E89C1CE38A" watvalue="ZFY02" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY02$</SPAN></TD>
<TD style="CURSOR: default" height=27 width=61 class><SPAN id=D1BB0B0E-C41D-15E9-9824-8948FC9471BC class=Emr_hdy wattype="static" watid="D1BB0B0E-C41D-15E9-9824-8948FC9471BC" watvalue="ZF02" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF02$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=76 class><SPAN id=294FE77F-2D5D-DF68-9DF2-A95A3716F775 class=Emr_hdy wattype="static" watid="294FE77F-2D5D-DF68-9DF2-A95A3716F775" watvalue="XX02" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX02$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=75 class><SPAN id=1A95CFF1-EE26-7ED8-83CD-83717E1F7B0F class=Emr_hdy wattype="static" watid="1A95CFF1-EE26-7ED8-83CD-83717E1F7B0F" watvalue="CXJ02" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ02$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=27 width=71 align=center class><FONT style="FONT-SIZE: 3.15mm">检查费</FONT></TD>
<TD style="CURSOR: default" height=27 width=71 class><SPAN id=0930EB59-C1B2-36B3-1725-63C0E4ADDEE9 class=Emr_hdy wattype="static" watid="0930EB59-C1B2-36B3-1725-63C0E4ADDEE9" watvalue="ZFY03" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY03$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=68 class><SPAN id=8741664B-6616-50EB-24B7-FECB03FB7A23 class=Emr_hdy wattype="static" watid="8741664B-6616-50EB-24B7-FECB03FB7A23" watvalue="ZF03" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF03$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=74 class><SPAN id=C347F086-0D76-E673-A4BB-6829918A6FE8 class=Emr_hdy wattype="static" watid="C347F086-0D76-E673-A4BB-6829918A6FE8" watvalue="XX03" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX03$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=72 class><SPAN id=E94B7C00-5957-7F3B-321E-30A048AE09F3 class=Emr_hdy wattype="static" watid="E94B7C00-5957-7F3B-321E-30A048AE09F3" watvalue="CXJ03" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ03$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 30px" class>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=29 width=61 align=center class><FONT style="FONT-SIZE: 3.15mm">治疗费</FONT></TD>
<TD style="CURSOR: default" height=29 width=77 class><SPAN id=2976065D-1D14-B481-E267-9253A9AB303D class=Emr_hdy wattype="static" watid="2976065D-1D14-B481-E267-9253A9AB303D" watvalue="ZFY05" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY05$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=61 class><SPAN id=B57EB95F-35EF-D321-7AB0-11986523D279 class=Emr_hdy wattype="static" watid="B57EB95F-35EF-D321-7AB0-11986523D279" watvalue="ZF05" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF05$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=76 class><SPAN id=32A659B8-2B42-8BDA-5F8A-774D4C8AD87F class=Emr_hdy wattype="static" watid="32A659B8-2B42-8BDA-5F8A-774D4C8AD87F" watvalue="XX05" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX05$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=75 class><SPAN id=0A8B8FA8-9FED-59B2-327A-054E43625B8C class=Emr_hdy wattype="static" watid="0A8B8FA8-9FED-59B2-327A-054E43625B8C" watvalue="CXJ05" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ05$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=29 width=71 align=center class><FONT style="FONT-SIZE: 3.15mm">护理费</FONT></TD>
<TD style="CURSOR: default" height=29 width=71 class><SPAN id=59F90240-868C-CC13-0FD9-E5FB3C4B42BB class=Emr_hdy wattype="static" watid="59F90240-868C-CC13-0FD9-E5FB3C4B42BB" watvalue="ZFY07" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY07$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=68 class><SPAN id=D72B7CD2-7A0B-48A6-B507-5B8C7FACD9C1 class=Emr_hdy wattype="static" watid="D72B7CD2-7A0B-48A6-B507-5B8C7FACD9C1" watvalue="ZF07" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF07$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=74 class><SPAN id=B726AD2C-3342-C298-4155-6791CCCD5C57 class=Emr_hdy wattype="static" watid="B726AD2C-3342-C298-4155-6791CCCD5C57" watvalue="XX07" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX07$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=72 class><SPAN id=E73A3D77-AD2A-7CE9-8435-E8793E65C5F3 class=Emr_hdy wattype="static" watid="E73A3D77-AD2A-7CE9-8435-E8793E65C5F3" watvalue="CXJ07" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ07$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 30px" class>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=27 width=61 align=center class><FONT style="FONT-SIZE: 3.15mm">手术费</FONT></TD>
<TD style="CURSOR: default" height=27 width=77 class><SPAN id=184931BA-5BC2-0D1E-1960-7BB8B319D100 class=Emr_hdy wattype="static" watid="184931BA-5BC2-0D1E-1960-7BB8B319D100" watvalue="ZFY06" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY06$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=61 class><SPAN id=C626F731-62AC-58EE-DA10-714D888E787C class=Emr_hdy wattype="static" watid="C626F731-62AC-58EE-DA10-714D888E787C" watvalue="ZF06" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF06$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=76 class><SPAN id=3042631F-6326-5BF5-2B59-37399CFC24FF class=Emr_hdy wattype="static" watid="3042631F-6326-5BF5-2B59-37399CFC24FF" watvalue="XX06" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX06$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=75 class><SPAN id=DDDE9E32-7D12-9914-497B-094DAB3DC690 class=Emr_hdy wattype="static" watid="DDDE9E32-7D12-9914-497B-094DAB3DC690" watvalue="CXJ06" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ06$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=27 width=71 align=center class><FONT style="FONT-SIZE: 3.15mm">化验费</FONT></TD>
<TD style="CURSOR: default" height=27 width=71 class><SPAN id=68278131-3EDC-8EF6-6BB5-2C5DC8ED7533 class=Emr_hdy wattype="static" watid="68278131-3EDC-8EF6-6BB5-2C5DC8ED7533" watvalue="ZFY04" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY04$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=68 class><SPAN id=1BFD4A3E-ACA6-83CD-9F81-1C611AA7924D class=Emr_hdy wattype="static" watid="1BFD4A3E-ACA6-83CD-9F81-1C611AA7924D" watvalue="ZF04" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF04$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=74 class><SPAN id=1D1FDB3A-CA0F-3C5E-48B5-3AE3FF40A17B class=Emr_hdy wattype="static" watid="1D1FDB3A-CA0F-3C5E-48B5-3AE3FF40A17B" watvalue="XX04" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX04$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=27 width=72 class><SPAN id=7821CFE9-D6E3-B405-0936-9ACDFD0C3BDD class=Emr_hdy wattype="static" watid="7821CFE9-D6E3-B405-0936-9ACDFD0C3BDD" watvalue="CXJ04" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ04$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 30px" class>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=30 width=61 align=center class><FONT style="FONT-SIZE: 3.15mm">卫生材料费</FONT></TD>
<TD style="CURSOR: default" height=30 width=77 class><SPAN id=8DE7ACC6-D235-E6BD-8379-D10C86D302B1 class=Emr_hdy wattype="static" watid="8DE7ACC6-D235-E6BD-8379-D10C86D302B1" watvalue="ZFY08" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY08$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=30 width=61 class><FONT style="FONT-SIZE: 3.15mm"><SPAN id=B5AFB1ED-EEF1-8521-2E36-211239C565A5 class=Emr_hdy style="FONT-SIZE: 3.7mm" wattype="static" watid="B5AFB1ED-EEF1-8521-2E36-211239C565A5" watvalue="ZF08" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF08$</SPAN></FONT></TD>
<TD style="CURSOR: default" height=30 width=76 class><SPAN id=59CE2914-D670-9093-197D-D96AABE07818 class=Emr_hdy wattype="static" watid="59CE2914-D670-9093-197D-D96AABE07818" watvalue="XX08" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX08$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=30 width=75 class><SPAN id=8FEA9536-14D9-72BD-427B-22F834DDD0DE class=Emr_hdy wattype="static" watid="8FEA9536-14D9-72BD-427B-22F834DDD0DE" watvalue="CXJ08" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ08$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=30 width=71 align=center class><FONT style="FONT-SIZE: 3.15mm">挂号费</FONT></TD>
<TD style="CURSOR: default" height=30 width=71 class><SPAN id=90508484-BDB3-6D70-273B-FCBE057458D3 class=Emr_hdy wattype="static" watid="90508484-BDB3-6D70-273B-FCBE057458D3" watvalue="ZFY13" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY13$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=30 width=68 class><SPAN id=4C327AD2-F279-3F63-D5DD-C33945824640 class=Emr_hdy wattype="static" watid="4C327AD2-F279-3F63-D5DD-C33945824640" watvalue="ZF13" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF13$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=30 width=74 class><SPAN id=2D428DBC-A884-78A7-9D91-9EAA2B7AE74A class=Emr_hdy wattype="static" watid="2D428DBC-A884-78A7-9D91-9EAA2B7AE74A" watvalue="XX13" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX13$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=30 width=72 class><SPAN id=541D348A-6722-C1DC-9FA7-82E468228528 class=Emr_hdy wattype="static" watid="541D348A-6722-C1DC-9FA7-82E468228528" watvalue="CXJ13" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ13$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 30px" class>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=25 width=61 align=center class><FONT style="FONT-SIZE: 3.15mm">其它</FONT></TD>
<TD style="CURSOR: default" height=25 width=77 class><SPAN id=BD09F8FC-6764-6409-C0AA-828DF5B4497B class=Emr_hdy wattype="static" watid="BD09F8FC-6764-6409-C0AA-828DF5B4497B" watvalue="ZFY14" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY14$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=25 width=61 class><SPAN id=71C9A610-CB7E-39CE-E172-2A92FE977C2A class=Emr_hdy wattype="static" watid="71C9A610-CB7E-39CE-E172-2A92FE977C2A" watvalue="ZF14" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF14$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=25 width=76 class><SPAN id=1F5B3D59-1F81-B745-3C62-141666A3B26D class=Emr_hdy wattype="static" watid="1F5B3D59-1F81-B745-3C62-141666A3B26D" watvalue="XX14" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX14$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=25 width=75 class><SPAN id=3BFD142F-A0D1-0652-642B-B86972443077 class=Emr_hdy wattype="static" watid="3BFD142F-A0D1-0652-642B-B86972443077" watvalue="CXJ14" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ14$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=25 width=71 align=center class><FONT style="FONT-SIZE: 3.15mm">一般诊疗费</FONT></TD>
<TD style="CURSOR: default" height=25 width=71 class><SPAN id=23ACCD72-94E2-9939-A8AB-D8D82870FC2D class=Emr_hdy wattype="static" watid="23ACCD72-94E2-9939-A8AB-D8D82870FC2D" watvalue="ZFY12" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY12$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=25 width=68 class><SPAN id=022EE43E-84F6-DF91-ACE1-9E0F08424920 class=Emr_hdy wattype="static" watid="022EE43E-84F6-DF91-ACE1-9E0F08424920" watvalue="ZF12" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF12$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=25 width=74 class><SPAN id=2EA0E6ED-FDBA-31D5-E134-7000A7CE9EEB class=Emr_hdy wattype="static" watid="2EA0E6ED-FDBA-31D5-E134-7000A7CE9EEB" watvalue="XX12" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XX12$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=25 width=72 class><SPAN id=5047426F-A766-771E-7ADE-87D768922B66 class=Emr_hdy wattype="static" watid="5047426F-A766-771E-7ADE-87D768922B66" watvalue="CXJ12" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ12$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR></TBODY></TABLE>
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; TEXT-ALIGN: center; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" align=center bgColor=transparent border=1 class>
<TBODY>
<TR style="HEIGHT: 30px" class>
<TD style="CURSOR: default" height=27 width=60 class><FONT style="FONT-SIZE: 3.15mm">总费用</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=27 width=77 align=right class><SPAN id=207E109B-1786-31D4-AA0D-4523861F51A2 class=Emr_hdy wattype="static" watid="207E109B-1786-31D4-AA0D-4523861F51A2" watvalue="ZFY" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZFY$</SPAN></TD>
<TD style="CURSOR: default" height=27 width=73 class><FONT style="FONT-SIZE: 3.15mm">统筹基金支付范围内费用</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=27 width=67 align=right class><SPAN id=8EA79A76-3CF6-B490-C9A8-BB22C8425B79 class=Emr_hdy wattype="static" watid="8EA79A76-3CF6-B490-C9A8-BB22C8425B79" watvalue="TCJJ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$TCJJ$</SPAN></TD>
<TD style="CURSOR: default" height=27 width=74 class><FONT style="FONT-SIZE: 3.15mm">乙类先行自付费用</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=27 width=72 align=right class><SPAN id=0C19A6D8-FF87-F9FC-BA89-B6F1B5A5B619 class=Emr_hdy wattype="static" watid="0C19A6D8-FF87-F9FC-BA89-B6F1B5A5B619" watvalue="XXZF" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XXZF$</SPAN></TD>
<TD style="CURSOR: default" height=27 width=67 class><FONT style="FONT-SIZE: 3.15mm">超限价自付费用</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=27 width=70 align=right class><SPAN id=5A9E2814-78D5-9421-BE48-01A18CAD93C8 class=Emr_hdy wattype="static" watid="5A9E2814-78D5-9421-BE48-01A18CAD93C8" watvalue="CXJ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$CXJ$</SPAN></TD>
<TD style="CURSOR: default" height=27 width=74 class><FONT style="FONT-SIZE: 3.15mm">自费费用</FONT></TD>
<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=27 width=72 align=right class><SPAN id=8AE53F27-3095-0FB3-DD4F-54AC5F29F479 class=Emr_hdy wattype="static" watid="8AE53F27-3095-0FB3-DD4F-54AC5F29F479" watvalue="ZF" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZF$</SPAN></TD></TR></TBODY></TABLE>
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; TEXT-ALIGN: center; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 align=center bgColor=transparent border=1 class>
<TBODY>
<TR style="HEIGHT: 31px" class>
<TD style="CURSOR: default" height=31 width=130 class><FONT style="FONT-SIZE: 3.15mm">基金支付合计金额</FONT></TD>
<TD style="CURSOR: default" height=31 width=231 class><SPAN id=E9F04AC5-EE7D-E2A4-4973-CDCADC5921FC class=Emr_hdy wattype="static" watid="E9F04AC5-EE7D-E2A4-4973-CDCADC5921FC" watvalue="JJZF" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJZF$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=31 width=112 class><FONT style="FONT-SIZE: 3.15mm">个人现金支付金额</FONT></TD>
<TD style="CURSOR: default" height=31 width=239 class><SPAN id=65AE521B-AE5F-6401-ABB5-47D1E3993CB5 class=Emr_hdy wattype="static" watid="65AE521B-AE5F-6401-ABB5-47D1E3993CB5" watvalue="XJZF" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XJZF$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 29px" class>
<TD style="CURSOR: default" height=29 width=130 class><FONT style="FONT-SIZE: 3.15mm"><SPAN id=10E590A6-71B6-7CBA-1113-84FCEF49D00C class=Emr_hdy wattype="static" watid="10E590A6-71B6-7CBA-1113-84FCEF49D00C" watvalue="JJ1" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJ1$</SPAN></FONT></TD>
<TD style="CURSOR: default" height=29 width=231 class><SPAN id=527F6010-B912-3F0D-5AEA-C193AC732C64 class=Emr_hdy wattype="static" watid="527F6010-B912-3F0D-5AEA-C193AC732C64" watvalue="JJJE1" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJJE1$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=112 class><FONT style="FONT-SIZE: 3.15mm">本次起付标准</FONT></TD>
<TD style="CURSOR: default" height=29 width=239 class><SPAN id=8B3ECC52-8873-A1F6-906E-D93821A57BD3 class=Emr_hdy wattype="static" watid="8B3ECC52-8873-A1F6-906E-D93821A57BD3" watvalue="QFX" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$QFX$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 30px" class>
<TD style="CURSOR: default" height=30 width=130 class><FONT style="FONT-SIZE: 3.15mm"><SPAN id=38C6D174-B876-7305-75DE-EBC2A7215BCD class=Emr_hdy wattype="static" watid="38C6D174-B876-7305-75DE-EBC2A7215BCD" watvalue="JJ2" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJ2$</SPAN></FONT></TD>
<TD style="CURSOR: default" height=30 width=231 class><SPAN id=078E5F01-D638-60F7-429F-C7B1A75E1584 class=Emr_hdy wattype="static" watid="078E5F01-D638-60F7-429F-C7B1A75E1584" watvalue="JJJE2" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJJE2$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=30 width=112 class><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=30 width=239 class><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 29px" class>
<TD style="CURSOR: default" height=29 width=130 class><FONT style="FONT-SIZE: 3.15mm"><SPAN id=3092D23C-E41C-6B22-48AE-C0BAECFD3435 class=Emr_hdy wattype="static" watid="3092D23C-E41C-6B22-48AE-C0BAECFD3435" watvalue="JJ3" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJ3$</SPAN></FONT></TD>
<TD style="CURSOR: default" height=29 width=231 class><SPAN id=8CA4E17E-3E36-DC7B-C375-B29F36F49B81 class=Emr_hdy wattype="static" watid="8CA4E17E-3E36-DC7B-C375-B29F36F49B81" watvalue="JJJE3" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJJE3$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=112 class><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=239 class><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 29px" class>
<TD style="CURSOR: default" height=29 width=130 class><FONT style="FONT-SIZE: 3.15mm"><SPAN id=44D633BB-4DCC-0C15-7D47-6C558F2E4BA5 class=Emr_hdy wattype="static" watid="44D633BB-4DCC-0C15-7D47-6C558F2E4BA5" watvalue="JJ4" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJ4$</SPAN></FONT></TD>
<TD style="CURSOR: default" height=29 width=231 class><SPAN id=2CA9EFF9-80D7-BB7A-1E15-899F26970B26 class=Emr_hdy wattype="static" watid="2CA9EFF9-80D7-BB7A-1E15-899F26970B26" watvalue="JJJE4" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJJE4$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=112 class><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=239 class><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 29px" class>
<TD style="CURSOR: default" height=29 width=130 class><FONT style="FONT-SIZE: 3.15mm"><SPAN id=5F1E409F-9B8F-C5A8-3680-866EB2C33339 class=Emr_hdy wattype="static" watid="5F1E409F-9B8F-C5A8-3680-866EB2C33339" watvalue="JJ5" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJ5$</SPAN></FONT></TD>
<TD style="CURSOR: default" height=29 width=231 class><SPAN id=B5B91062-4196-B1D1-B41A-9B1333EDB228 class=Emr_hdy wattype="static" watid="B5B91062-4196-B1D1-B41A-9B1333EDB228" watvalue="JJJE5" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJJE5$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=112 class><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=29 width=239 class><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR>
<TR style="HEIGHT: 30px" class>
<TD style="CURSOR: default" height=30 width=130 class><FONT style="FONT-SIZE: 3.15mm"><SPAN id=2B161C19-C9B4-EFFB-470A-176B542A3D3A class=Emr_hdy wattype="static" watid="2B161C19-C9B4-EFFB-470A-176B542A3D3A" watvalue="JJ6" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJ6$</SPAN></FONT></TD>
<TD style="CURSOR: default" height=30 width=231 class><SPAN id=A3987491-BA24-2A1C-8424-074E28303EE4 class=Emr_hdy wattype="static" watid="A3987491-BA24-2A1C-8424-074E28303EE4" watvalue="JJJE6" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJJE6$</SPAN><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=30 width=112 class><FONT style="FONT-SIZE: 3.15mm"></FONT></TD>
<TD style="CURSOR: default" height=30 width=239 class><FONT style="FONT-SIZE: 3.15mm"></FONT></TD></TR></TBODY></TABLE><FONT style="FONT-SIZE: 2.81mm"></FONT>
<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 bgColor=transparent border=1 class>
<TBODY>
<P $data><FONT style="FONT-SIZE: 3.15mm"></FONT>
<P $data>
<TR class>
<TD style="CURSOR: default" height=23 width=716 colSpan=2 class><FONT style="FONT-SIZE: 3.15mm">打印时间: <SPAN id=1BE787FC-5FC4-041B-FA37-D916225D8365 class=Emr_hdy wattype="static" watid="1BE787FC-5FC4-041B-FA37-D916225D8365" watvalue="DYSJ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$DYSJ$</SPAN></FONT></TD></TR></P></TBODY></TABLE>
<P><FONT style="FONT-SIZE: 3.15mm">注:1.超限价自付费用是指超目录医保支付标准费用(如集采药品、人工品体、床位费等)</FONT></P>
<P><FONT style="FONT-SIZE: 3.15mm">   2.参保地基金按照参保地返回的基金款项名称打印</FONT></P>
<P><FONT style="FONT-SIZE: 3.15mm">   3.总费用=基金支付合计金额+个人现金支付金额                                病人家属签字：</FONT></P>
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