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<?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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<![CDATA[
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]]>
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</headercontent>
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<content>
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<![CDATA[
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<P></P>
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<P align=center><FONT style="FONT-SIZE: 5.23mm"><STRONG>住院项目费用明细清单</STRONG></FONT></P>
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<P align=left><STRONG></STRONG>
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<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" bgColor=transparent border=1>
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<TBODY>
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<TR style="HEIGHT: 23px">
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<TD style="CURSOR: default" height=23 width=422>就诊机构:<SPAN id=F0F95B27-2F3E-EB02-41D7-D6F8084DA868 class=Emr_hdy wattype="static" watid="F0F95B27-2F3E-EB02-41D7-D6F8084DA868" watvalue="COMPANYID" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$COMPANYID$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=292>打印日期:<SPAN id=FC04B64B-D293-1853-5FB1-6F63A41B85B9 class=Emr_hdy wattype="static" watid="FC04B64B-D293-1853-5FB1-6F63A41B85B9" watvalue="打印日期*yyyy-MM-dd HH:mm" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$打印日期*yyyy-MM-dd HH:mm$</SPAN></TD></TR>
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<TR style="HEIGHT: 23px">
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<TD style="CURSOR: default" height=23 width=422>病人姓名:<SPAN id=9012AEC0-52B6-7C46-5E06-1619B2F02358 class=Emr_hdy wattype="static" watid="9012AEC0-52B6-7C46-5E06-1619B2F02358" watvalue="XM" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$XM$</SPAN><SPAN> <SPAN id=29CEA629-CFF1-FF1A-289E-0A527429DD17 class=Emr_hdy wattype="static" watid="29CEA629-CFF1-FF1A-289E-0A527429DD17" watvalue="BED" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$BED$</SPAN><SPAN> <SPAN id=D4232020-0C46-9261-02D6-5D95A1C73247 class=Emr_hdy wattype="static" watid="D4232020-0C46-9261-02D6-5D95A1C73247" watvalue="JJKS" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJKS$</SPAN></SPAN></SPAN></TD>
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<TD style="CURSOR: default" height=23 width=292>住院号:<SPAN id=4AD52742-582A-DC38-1F83-9659D387256C class=Emr_hdy wattype="static" watid="4AD52742-582A-DC38-1F83-9659D387256C" watvalue="ZYNO" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZYNO$</SPAN><SPAN> 住院次数:<SPAN id=F2A18ABA-4986-3D58-7BCA-AB91FD51217F class=Emr_hdy wattype="static" watid="F2A18ABA-4986-3D58-7BCA-AB91FD51217F" watvalue="ZYNUM" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$ZYNUM$</SPAN></SPAN></TD></TR>
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<TR style="HEIGHT: 23px">
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<TD style="CURSOR: default" height=23 width=422>入院时间:<SPAN id=F8BFAD30-C02A-7ADF-BBF1-C9C7F6F3ACAC class=Emr_hdy wattype="static" watid="F8BFAD30-C02A-7ADF-BBF1-C9C7F6F3ACAC" watvalue="JJRQ*yyyy-MM-dd HH:mm" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$JJRQ*yyyy-MM-dd HH:mm$</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=292>费用日期:<SPAN id=6679C4B9-F989-1F7F-A61C-FFE8ECFE64B8 class=Emr_hdy wattype="static" watid="6679C4B9-F989-1F7F-A61C-FFE8ECFE64B8" watvalue="费用开始日期*yyyy-MM-dd" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用开始日期*yyyy-MM-dd$</SPAN><SPAN> 至<SPAN id=FF247D68-FA49-B395-726F-E0CC32C76479 class=Emr_hdy wattype="static" watid="FF247D68-FA49-B395-726F-E0CC32C76479" watvalue="费用结束日期*yyyy-MM-dd" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用结束日期*yyyy-MM-dd$</SPAN></SPAN></TD></TR></TBODY></TABLE>
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<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" bgColor=transparent border=1>
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<TBODY>
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<TR style="HEIGHT: 23px">
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<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=715 colSpan=6 align=center>费用汇总(单位:元)</TD></TR>
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<TR style="HEIGHT: 23px">
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<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=119 align=center>费用名称</TD>
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<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=119 align=center>费用金额</TD>
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<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=119 align=center>费用名称</TD>
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<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=119 align=center>费用金额</TD>
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<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=119 align=center>费用名称</TD>
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<TD style="CURSOR: default; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " height=23 width=119 align=center>费用金额</TD></TR>
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<TR style="HEIGHT: 22px; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " align=center>
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<TD style="CURSOR: default" height=22><SPAN id=1E8B1190-C609-FE58-9645-694962F0D490 class=Emr_hdy wattype="static" watid="1E8B1190-C609-FE58-9645-694962F0D490" watvalue="费用类别1" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别1$</SPAN></TD>
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<TD style="CURSOR: default" height=22><SPAN id=AB446D18-D50C-9545-1A7D-70B28AB6B564 class=Emr_hdy wattype="static" watid="AB446D18-D50C-9545-1A7D-70B28AB6B564" watvalue="金额1" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额1$</SPAN></TD>
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<TD style="CURSOR: default" height=22><SPAN id=E07CDE4B-AA17-62B0-7910-EE2CD2B8E09D class=Emr_hdy wattype="static" watid="E07CDE4B-AA17-62B0-7910-EE2CD2B8E09D" watvalue="费用类别2" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别2$</SPAN></TD>
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<TD style="CURSOR: default" height=22><SPAN id=172B8F3C-B13B-279D-F62C-3CAF2AA7E154 class=Emr_hdy wattype="static" watid="172B8F3C-B13B-279D-F62C-3CAF2AA7E154" watvalue="金额2" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额2$</SPAN></TD>
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<TD style="CURSOR: default" height=22><SPAN id=62B47A6B-3AAC-4412-AA6F-4111270F6DD7 class=Emr_hdy wattype="static" watid="62B47A6B-3AAC-4412-AA6F-4111270F6DD7" watvalue="费用类别3" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别3$</SPAN></TD>
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<TD style="CURSOR: default" height=22><SPAN id=4D8B2C77-5F44-B895-2E25-45794720AB7C class=Emr_hdy wattype="static" watid="4D8B2C77-5F44-B895-2E25-45794720AB7C" watvalue="金额3" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额3$</SPAN></TD></TR>
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<TR style="HEIGHT: 23px; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " align=center>
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<TD style="CURSOR: default" height=23><SPAN id=9C972F20-9BDD-B3D8-5A2C-9E49425B2508 class=Emr_hdy wattype="static" watid="9C972F20-9BDD-B3D8-5A2C-9E49425B2508" watvalue="费用类别4" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别4$</SPAN></TD>
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<TD style="CURSOR: default" height=23><SPAN id=17EDFDFC-4081-0B86-0D8A-54AC8B133AB4 class=Emr_hdy wattype="static" watid="17EDFDFC-4081-0B86-0D8A-54AC8B133AB4" watvalue="金额4" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额4$</SPAN></TD>
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<TD style="CURSOR: default" height=23><SPAN id=096AC1EB-E5C0-80D2-9DE2-77913FF0E54A class=Emr_hdy wattype="static" watid="096AC1EB-E5C0-80D2-9DE2-77913FF0E54A" watvalue="费用类别5" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别5$</SPAN></TD>
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<TD style="CURSOR: default" height=23><SPAN id=7DA3549B-F45D-7430-F78D-7FC5EA13B202 class=Emr_hdy wattype="static" watid="7DA3549B-F45D-7430-F78D-7FC5EA13B202" watvalue="金额5" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额5$</SPAN></TD>
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<TD style="CURSOR: default" height=23><SPAN id=F75F6BD6-C24A-3E8D-4424-90B2059E6797 class=Emr_hdy wattype="static" watid="F75F6BD6-C24A-3E8D-4424-90B2059E6797" watvalue="费用类别6" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别6$</SPAN></TD>
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<TD style="CURSOR: default" height=23><SPAN id=957394AF-3FB2-EA8A-D946-55AB1B0D15D5 class=Emr_hdy wattype="static" watid="957394AF-3FB2-EA8A-D946-55AB1B0D15D5" watvalue="金额6" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额6$</SPAN></TD></TR>
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<TR style="HEIGHT: 22px; BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " align=center>
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<TD style="CURSOR: default" height=22><SPAN id=580CAE5C-322D-531A-1406-BD9CE4347F42 class=Emr_hdy wattype="static" watid="580CAE5C-322D-531A-1406-BD9CE4347F42" watvalue="费用类别7" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别7$</SPAN></TD>
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<TD style="CURSOR: default" height=22><SPAN id=D1CAFE88-2DB1-F30A-FF9A-8E0C4616AD84 class=Emr_hdy wattype="static" watid="D1CAFE88-2DB1-F30A-FF9A-8E0C4616AD84" watvalue="金额7" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额7$</SPAN></TD>
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<TD style="CURSOR: default" height=22><SPAN id=9BD11A47-BA6B-EF3A-25F6-CE439CAC6832 class=Emr_hdy wattype="static" watid="9BD11A47-BA6B-EF3A-25F6-CE439CAC6832" watvalue="费用类别8" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别8$</SPAN></TD>
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<TD style="CURSOR: default" height=22><SPAN id=5199F6D9-91E2-79CB-08B3-5A047B32DD16 class=Emr_hdy wattype="static" watid="5199F6D9-91E2-79CB-08B3-5A047B32DD16" watvalue="金额8" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额8$</SPAN></TD>
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<TD style="CURSOR: default" height=22><SPAN id=9D9656A8-D105-CFC9-E5C1-01B00F71B47B class=Emr_hdy wattype="static" watid="9D9656A8-D105-CFC9-E5C1-01B00F71B47B" watvalue="费用类别9" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别9$</SPAN></TD>
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<TD style="CURSOR: default" height=22><SPAN id=27B6BC16-96ED-012F-2F36-BDA566D73877 class=Emr_hdy wattype="static" watid="27B6BC16-96ED-012F-2F36-BDA566D73877" watvalue="金额9" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额9$</SPAN></TD></TR>
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<TR style="BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " align=center>
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<TD style="CURSOR: default"><SPAN id=B7DAB955-100E-2892-0DB8-8AEAA3C9B8B5 class=Emr_hdy wattype="static" watid="B7DAB955-100E-2892-0DB8-8AEAA3C9B8B5" watvalue="费用类别10" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别10$</SPAN></TD>
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<TD style="CURSOR: default"><SPAN id=D72A4B25-674C-A934-E0EE-B9D52EE8957C class=Emr_hdy wattype="static" watid="D72A4B25-674C-A934-E0EE-B9D52EE8957C" watvalue="金额10" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额10$</SPAN></TD>
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<TD style="CURSOR: default"><SPAN id=FE792C60-842A-C92F-3484-A7E4ABC7B75D class=Emr_hdy wattype="static" watid="FE792C60-842A-C92F-3484-A7E4ABC7B75D" watvalue="费用类别11" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别11$</SPAN></TD>
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<TD style="CURSOR: default"><SPAN id=C6A3FBF0-7991-B1E8-9C62-70B708A88732 class=Emr_hdy wattype="static" watid="C6A3FBF0-7991-B1E8-9C62-70B708A88732" watvalue="金额11" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额11$</SPAN></TD>
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<TD style="CURSOR: default"><SPAN id=E9C40D51-A529-9CDC-AE61-7604E4A96B20 class=Emr_hdy wattype="static" watid="E9C40D51-A529-9CDC-AE61-7604E4A96B20" watvalue="费用类别12" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$费用类别12$</SPAN></TD>
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<TD style="CURSOR: default"><SPAN id=B090AD5D-E058-47A2-D967-39F8AA016D08 class=Emr_hdy wattype="static" watid="B090AD5D-E058-47A2-D967-39F8AA016D08" watvalue="金额12" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$金额12$</SPAN></TD></TR></TBODY></TABLE>
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<TABLE style="FONT-SIZE: 3.7mm; FONT-FAMILY: 宋体; BORDER-COLLAPSE: collapse; LINE-HEIGHT: 1.5" borderColor=#bfbfbf cellSpacing=0 cellPadding=0 width="100%" bgColor=transparent border=1>
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<TBODY>
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<TR style="BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " align=center>
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<TD style="CURSOR: default" height=23 width=79>处方时间</TD>
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<TD style="CURSOR: default" height=23 width=79>项目编码</TD>
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<TD style="CURSOR: default" height=23 width=148>项目名称</TD>
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<TD style="CURSOR: default" height=23 width=91>规格</TD>
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<TD style="CURSOR: default" height=23 width=61>计价单位</TD>
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<TD style="CURSOR: default" height=23 width=56>单价</TD>
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<TD style="CURSOR: default" height=23 width=46>数量</TD>
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<TD style="CURSOR: default" height=23 width=69>金额</TD>
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<TD style="CURSOR: default" height=23 width=79>费用类别</TD></TR>
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<P $data>
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<TR style="BORDER-TOP-COLOR: ; BORDER-LEFT-COLOR: ; BORDER-BOTTOM-COLOR: ; BORDER-RIGHT-COLOR: " align=center>
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<TD style="CURSOR: default" height=23 width=79><SPAN id=5FB655E8-0401-91FF-61E7-9C12B37AF837 class=Emr_hdy style="FONT-SIZE: 3.15mm" wattype="static" watid="5FB655E8-0401-91FF-61E7-9C12B37AF837" watvalue="JFRQ*yyyy-MM-dd" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^JFRQ*yyyy-MM-dd^</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=79><SPAN id=CBD6AE7E-B60B-035D-E0CB-DF949F2A9F38 class=Emr_hdy style="FONT-SIZE: 3.15mm" wattype="static" watid="CBD6AE7E-B60B-035D-E0CB-DF949F2A9F38" watvalue="BM" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^BM^</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=148><SPAN id=91FCA3D6-9C66-1929-5D3F-7A4A3C856087 class=Emr_hdy style="FONT-SIZE: 3.15mm" wattype="static" watid="91FCA3D6-9C66-1929-5D3F-7A4A3C856087" watvalue="MC" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^MC^</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=91><SPAN id=A91CA9E7-8833-D669-CEA6-25842961D5A0 class=Emr_hdy style="FONT-SIZE: 3.15mm" wattype="static" watid="A91CA9E7-8833-D669-CEA6-25842961D5A0" watvalue="GG" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^GG^</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=61><SPAN id=55F96667-CF63-5F08-41AF-229E2E88DD93 class=Emr_hdy style="FONT-SIZE: 3.15mm" wattype="static" watid="55F96667-CF63-5F08-41AF-229E2E88DD93" watvalue="YZDW" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^YZDW^</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=56><SPAN id=0207F7F1-F456-BF58-1290-71200AAD6274 class=Emr_hdy style="FONT-SIZE: 3.15mm" wattype="static" watid="0207F7F1-F456-BF58-1290-71200AAD6274" watvalue="SFXDJ" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^SFXDJ^</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=46><SPAN id=0A5431EC-8D71-1D40-B0E3-39587E65ABF2 class=Emr_hdy style="FONT-SIZE: 3.15mm" wattype="static" watid="0A5431EC-8D71-1D40-B0E3-39587E65ABF2" watvalue="SFXSL" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^SFXSL^</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=69><SPAN id=D465721D-4D45-F579-97B3-47EE562A3BA1 class=Emr_hdy style="FONT-SIZE: 3.15mm" wattype="static" watid="D465721D-4D45-F579-97B3-47EE562A3BA1" watvalue="SFXZFY" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^SFXZFY^</SPAN></TD>
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<TD style="CURSOR: default" height=23 width=79><SPAN id=B39509FC-DDFE-5FE5-CFB0-C1EECB528240 class=Emr_hdy style="FONT-SIZE: 3.15mm" wattype="static" watid="B39509FC-DDFE-5FE5-CFB0-C1EECB528240" watvalue="FYDL" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">^FYDL^</SPAN></TD></TR>
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<P $data></P></TBODY></TABLE> 患者(或者委托人)签名: 以上总金额:<SPAN id=C4D22A95-7738-B235-15B6-0BD2A48AF652 class=Emr_hdy wattype="static" watid="C4D22A95-7738-B235-15B6-0BD2A48AF652" watvalue="总金额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$总金额$</SPAN>元 预交金额:<SPAN id=792E847B-8E7D-7CA9-00F5-37916900AE0F class=Emr_hdy wattype="static" watid="792E847B-8E7D-7CA9-00F5-37916900AE0F" watvalue="预交金额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$预交金额$</SPAN>元 剩余金额:<SPAN id=DE50AEE6-9C0D-6D51-B52B-F30D45D0EC2A class=Emr_hdy wattype="static" watid="DE50AEE6-9C0D-6D51-B52B-F30D45D0EC2A" watvalue="剩余金额" watdelete="false" watencryptshow="false" wathdychange="false" watsuntype="s2" watflag="true">$剩余金额$</SPAN>元</P>
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<P></P>
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