3044 lines
135 KiB
PHP
3044 lines
135 KiB
PHP
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<head>
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<meta http-equiv=Content-Type content="text/html; charset=utf-8">
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<style id="biakan_4931_Styles">
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@page
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tr
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col
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br
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td
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{mso-style-parent:style0;
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{mso-style-parent:style0;
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{mso-style-parent:style0;
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border-top:.5pt solid windowtext;
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{mso-style-parent:style0;
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font-family:Arial, sans-serif;
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text-align:center;
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border-top:.5pt solid windowtext;
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.xl70
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:left;}
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.xl71
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;}
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.xl72
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:left;
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border-top:none;
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border-right:none;
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border-bottom:.5pt solid windowtext;
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border-left:none;}
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.xl73
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:left;
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border-top:.5pt solid windowtext;
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border-right:none;
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border-bottom:.5pt solid windowtext;
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border-left:none;}
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.xl74
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;
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border-top:.5pt solid windowtext;
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border-right:none;
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border-bottom:none;
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border-left:.5pt solid windowtext;}
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.xl75
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;
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border-top:.5pt solid windowtext;
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border-right:none;
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border-bottom:none;
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border-left:none;}
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.xl76
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;
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border-top:.5pt solid windowtext;
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border-right:.5pt solid windowtext;
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border-bottom:none;
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border-left:none;}
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.xl77
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;
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border:.5pt solid windowtext;}
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.xl78
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-weight:700;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;
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border-top:.5pt solid windowtext;
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border-right:none;
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border-bottom:none;
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border-left:none;}
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.xl79
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-weight:700;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;
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border-top:.5pt solid windowtext;
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border-right:.5pt solid windowtext;
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border-bottom:none;
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border-left:none;}
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.xl80
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-weight:700;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:left;}
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.xl81
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;
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border-top:none;
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border-right:.5pt solid windowtext;
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border-bottom:none;
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border-left:none;}
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.xl82
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:left;
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border-top:none;
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border-right:none;
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border-bottom:none;
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border-left:.5pt solid windowtext;}
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.xl83
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:left;
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border-top:none;
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border-right:.5pt solid windowtext;
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border-bottom:none;
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border-left:none;}
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.xl84
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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border-top:.5pt solid windowtext;
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border-right:.5pt solid windowtext;
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border-bottom:none;
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border-left:none;}
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.xl85
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;
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border-top:none;
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border-right:none;
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border-bottom:.5pt solid windowtext;
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border-left:none;}
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.xl86
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;
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border-top:none;
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border-right:.5pt solid windowtext;
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border-bottom:.5pt solid windowtext;
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border-left:none;}
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.xl87
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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border-top:none;
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border-right:.5pt solid windowtext;
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border-bottom:none;
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border-left:none;}
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.xl88
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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border-top:none;
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border-right:none;
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border-bottom:none;
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border-left:.5pt solid windowtext;}
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.xl89
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|
{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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border-top:none;
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border-right:none;
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border-bottom:.5pt solid windowtext;
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border-left:.5pt solid windowtext;}
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.xl90
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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border-top:none;
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border-right:none;
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border-bottom:.5pt solid windowtext;
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border-left:none;}
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.xl91
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{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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border-top:none;
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border-right:.5pt solid windowtext;
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border-bottom:.5pt solid windowtext;
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border-left:none;}
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.xl92
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|
{mso-style-parent:style0;
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font-size:11.0pt;
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font-weight:700;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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text-align:center;
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border-top:none;
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border-right:none;
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border-bottom:.5pt solid windowtext;
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border-left:none;}
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.xl93
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|
{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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mso-font-charset:0;
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border-top:.5pt solid windowtext;
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border-right:none;
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border-bottom:none;
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border-left:.5pt solid windowtext;}
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.xl94
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|
{mso-style-parent:style0;
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font-size:11.0pt;
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font-family:Arial, sans-serif;
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|
mso-font-charset:0;
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border-top:.5pt solid windowtext;
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border-right:none;
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|
border-bottom:none;
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|
border-left:none;}
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|
.xl95
|
|
{mso-style-parent:style0;
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|
font-size:11.0pt;
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|
font-family:Arial, sans-serif;
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|
mso-font-charset:0;
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|
text-align:center;
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|
border-top:.5pt solid windowtext;
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|
border-right:none;
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border-bottom:.5pt solid windowtext;
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border-left:.5pt solid windowtext;}
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.xl96
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|
{mso-style-parent:style0;
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|
font-size:11.0pt;
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|
font-family:Arial, sans-serif;
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|
mso-font-charset:0;
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|
text-align:center;
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|
border-top:.5pt solid windowtext;
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|
border-right:none;
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|
border-bottom:.5pt solid windowtext;
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|
border-left:none;}
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|
.xl97
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|
{mso-style-parent:style0;
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|
font-size:11.0pt;
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|
font-family:Arial, sans-serif;
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|
mso-font-charset:0;
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|
text-align:center;
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|
border-top:.5pt solid windowtext;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl98
|
|
{mso-style-parent:style0;
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|
font-size:11.0pt;
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|
font-family:Arial, sans-serif;
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|
mso-font-charset:0;
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|
text-align:left;
|
|
vertical-align:top;}
|
|
.xl99
|
|
{mso-style-parent:style0;
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|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
vertical-align:top;}
|
|
.xl100
|
|
{mso-style-parent:style0;
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|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
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|
text-align:left;
|
|
vertical-align:top;
|
|
white-space:normal;}
|
|
.xl101
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
border-top:none;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl102
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl103
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl104
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl105
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
border-top:none;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl106
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl107
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl108
|
|
{mso-style-parent:style0;
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|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl109
|
|
{mso-style-parent:style0;
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|
font-size:11.0pt;
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|
font-weight:700;
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|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
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|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:.5pt solid windowtext;
|
|
white-space:normal;}
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|
.xl110
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;
|
|
white-space:normal;}
|
|
.xl111
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;
|
|
white-space:normal;}
|
|
.xl112
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl113
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl114
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl115
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl116
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;}
|
|
.xl117
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl118
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl119
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl120
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl121
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl122
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:top;}
|
|
.xl123
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;}
|
|
.xl124
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl125
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
vertical-align:middle;}
|
|
.xl126
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl127
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl128
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl129
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
mso-number-format:"dd\\-mmm";
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl130
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
mso-number-format:"dd\\-mmm";
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl131
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
mso-number-format:"dd\\-mmm";
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl132
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl133
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
mso-number-format:"dd\\-mmm";
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl134
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
mso-number-format:"dd\\-mmm";
|
|
text-align:center;
|
|
vertical-align:middle;}
|
|
.xl135
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl136
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl137
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
mso-number-format:"dd\\-mmm";
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl138
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl139
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:top;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl140
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:top;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl141
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:top;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl142
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:middle;}
|
|
.xl143
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl144
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:top;
|
|
border-top:none;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl145
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:top;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl146
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:top;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl147
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:top;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl148
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:top;
|
|
border-top:none;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:.5pt solid windowtext;
|
|
border-left:none;}
|
|
.xl149
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:right;}
|
|
.xl150
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl151
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-weight:700;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
border-top:.5pt solid windowtext;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
.xl152
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:top;
|
|
border:.5pt solid windowtext;}
|
|
.xl153
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:center;
|
|
vertical-align:middle;
|
|
border:.5pt solid windowtext;}
|
|
.xl154
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
text-align:left;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:none;
|
|
border-bottom:none;
|
|
border-left:.5pt solid windowtext;}
|
|
.xl155
|
|
{mso-style-parent:style0;
|
|
font-size:11.0pt;
|
|
font-family:Arial, sans-serif;
|
|
mso-font-charset:0;
|
|
vertical-align:middle;
|
|
border-top:none;
|
|
border-right:.5pt solid windowtext;
|
|
border-bottom:none;
|
|
border-left:none;}
|
|
</style>
|
|
</head>
|
|
<body link="#467886" vlink="#96607D" class=xl64>
|
|
<div id="biakan_4931" align=center x:publishsource="Excel">
|
|
@php
|
|
$data = [];
|
|
$data['keterangan'] = $periksa->keterangan;
|
|
if (!empty($komponens)) {
|
|
foreach ($komponens as $rows) {
|
|
$key = trim($rows->komponen);
|
|
if (!empty($key)) {
|
|
if ($key == 'keterangan') {
|
|
$data['keterangan'] .= $rows->isidata;
|
|
} else {
|
|
$data[$key] = $rows->isidata;
|
|
}
|
|
}
|
|
}
|
|
}
|
|
@endphp
|
|
<table border=0 cellpadding=0 cellspacing=0 width=961 style='border-collapse: collapse;table-layout:fixed;width:713pt'>
|
|
<col class=xl64 width=31 style='mso-width-source:userset;mso-width-alt:981; width:23pt'>
|
|
<col class=xl64 width=15 style='mso-width-source:userset;mso-width-alt:469; width:11pt'>
|
|
<col class=xl64 width=23 style='mso-width-source:userset;mso-width-alt:725; width:17pt'>
|
|
<col class=xl64 width=168 style='mso-width-source:userset;mso-width-alt:5376; width:126pt'>
|
|
<col class=xl64 width=23 span=3 style='mso-width-source:userset;mso-width-alt: 725;width:17pt'>
|
|
<col class=xl64 width=20 span=4 style='mso-width-source:userset;mso-width-alt: 640;width:15pt'>
|
|
<col class=xl64 width=23 span=25 style='mso-width-source:userset;mso-width-alt: 725;width:17pt'>
|
|
<col class=xl64 width=31 style='mso-width-source:userset;mso-width-alt:981;width:23pt'>
|
|
<tr>
|
|
<td class=xl64 width=31 style='width:23pt'> </td>
|
|
<td class=xl64 width=15 style='width:11pt'> </td>
|
|
<td colspan=6 class=xl63 width=280 style='width:209pt'>Barcode NIK</td>
|
|
<td class=xl63 width=20 style='width:15pt'> </td>
|
|
<td class=xl63 width=20 style='width:15pt'> </td>
|
|
<td class=xl63 width=20 style='width:15pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td class=xl64 width=23 style='width:17pt'> </td>
|
|
<td colspan=9 class=xl63 width=207 style='width:153pt'>Barcode TBC.05</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=6 class=xl63><img src="{!! route('generate.barcode', ['data' => $nik ?? $periksa->nofoto]) !!}" alt="Barcode" style="max-width: 100%; height: auto;"> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=9 class=xl63><img src="{!! route('generate.barcode', ['data' => $nik ?? $periksa->nofoto]) !!}" alt="Barcode" style="max-width: 100%; height: auto;"> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=6 class=xl65 style='border-right:.5pt solid black'>PENANGGULANGAN TBC NASIONAL</td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=9 class=xl65 style='border-right:.5pt solid black'>TBC.05</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl63> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=9 class=xl68>INDONESIA 2020/EDISI 3</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=34 class=xl63>FORMULIR PERMOHONAN PEMERIKSAAN BAKTERIOLOGIS TBC</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl70>Nama Fasyankes</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=11 class=xl72>{!! $periksa->nmrs !!}</td>
|
|
<td class=xl64> </td>
|
|
<td colspan=7 class=xl70>Nama Dokter Pengirim</td>
|
|
<td class=xl71>:</td>
|
|
<td colspan=10 class=xl72>{!! $periksa->klinisi !!}</td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'><td height=3 style='height:2.0pt'></td><td></td><td colspan=34></td></tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl70>Kode Fasyankes</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=11 class=xl72>{!! $periksa->ruangan_id !!}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'><td height=3 style='height:2.0pt'></td><td></td><td colspan=34></td></tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl70>No. Rekam Medis</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=11 class=xl72>{!! $periksa->noregister !!}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'><td height=3 style='height:2.0pt'></td><td></td><td colspan=34></td></tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl70>Nama Terduga</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=11 class=xl72>{!! $periksa->nmpasien !!}</td>
|
|
<td class=xl64> </td>
|
|
<td colspan=7 class=xl70>No. Telp. Pasien</td>
|
|
<td class=xl71>:</td>
|
|
<td colspan=10 class=xl72>{!! $periksa->tlppasien !!}</td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'><td height=3 style='height:2.0pt'></td><td></td><td colspan=34></td></tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl70>No. Induk Kependudukan</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=11 class=xl72>{{$nik}}</td>
|
|
<td class=xl64> </td>
|
|
<td colspan=7 class=xl70>No. BPJS</td>
|
|
<td class=xl71>:</td>
|
|
<td colspan=10 class=xl72>{{$bpjs}}</td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'><td height=3 style='height:2.0pt'></td><td></td><td colspan=34></td></tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl70>Jenis Kelamin</td>
|
|
<td class=xl64>:</td>
|
|
<td class=xl77>
|
|
@if ($periksa->jkpasien == 'L')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td colspan=4 class=xl82 style='border-right:.5pt solid black;border-left: none'>Laki - Laki</td>
|
|
<td class=xl77>
|
|
@if ($periksa->jkpasien != 'L')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td colspan=5 class=xl82>Perempuan</td>
|
|
<td class=xl64> </td>
|
|
<td colspan=7 class=xl70>Umur</td>
|
|
<td class=xl71>:</td>
|
|
<td colspan=10 class=xl72>{!! $periksa->usia !!}</td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'><td height=3 style='height:2.0pt'></td><td></td><td colspan=34></td></tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl70>Alamat Lengkap</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=30 class=xl72>{!! $periksa->alamatpasien !!}</td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'><td height=3 style='height:2.0pt'></td><td></td><td colspan=34></td></tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=30 class=xl72> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'><td height=3 style='height:2.0pt'></td><td></td><td colspan=34></td></tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl70>Kabupaten / Kota</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=10 class=xl147>{!! $periksa->getPasien->kota ?? '-' !!}</td>
|
|
<td class=xl64> </td>
|
|
<td colspan=19 class=xl122>Jenis Terduga / Pasien TBC</td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'><td height=3 style='height:2.0pt'></td><td></td><td colspan=34></td></tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl70>Provinsi</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=10 class=xl98>{!! $periksa->getPasien->keterangan ?? '-' !!}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl153>
|
|
@if (isset($data['inlineCheckbox1']) && $data['inlineCheckbox1'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td colspan=3 class=xl154 style='border-right:.5pt solid black;border-left: none'>TBC SO</td>
|
|
<td class=xl153>
|
|
@if (isset($data['inlineCheckbox2']) && $data['inlineCheckbox2'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td colspan=3 class=xl154 style='border-right:.5pt solid black;border-left:none'>TBC RO</td>
|
|
<td class=xl153>
|
|
@if (isset($data['inlineCheckbox3']) && $data['inlineCheckbox3'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td colspan=3 class=xl154 style='border-right:.5pt solid black;border-left:none'>Anak</td>
|
|
<td class=xl153>
|
|
@if (isset($data['inlineCheckbox4']) && $data['inlineCheckbox4'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td colspan=2 class=xl154>HIV</td>
|
|
<td class=xl155> </td>
|
|
<td class=xl153>
|
|
@if (isset($data['inlineCheckbox5']) && $data['inlineCheckbox5'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td colspan=2 class=xl123>DM</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl71> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl93> </td>
|
|
<td colspan=15 class=xl78 style='border-right:.5pt solid black'>No. Identitas Sediaan</td>
|
|
<td class=xl64> </td>
|
|
<td colspan=18 class=xl80>Lama Riwayat Pengobatan Terduga / Pasien TBC</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td colspan=15 class=xl71 style='border-right:.5pt solid black'>{{$data['id_noidsediaan'] ?? ''}}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl152>
|
|
@php
|
|
if (isset($data['id_lamariwayatpengobatantb']) && $data['id_lamariwayatpengobatantb'] == 'Riwayat Pengobatan < 5 tahun'){
|
|
$rw1 = ' ';
|
|
$rw2 = '√';
|
|
} else {
|
|
$rw2 = ' ';
|
|
$rw1 = '√';
|
|
}
|
|
echo $rw1;
|
|
@endphp
|
|
</td>
|
|
<td colspan=16 class=xl145>Riwayat Pengobatan >=5 tahun</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td colspan=5 class=xl98>Tanggal pengambilan contoh uji</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=9 class=xl98 style='border-right:.5pt solid black'>{{ $data['id_tanggalpengambilancontohuji'] ?? ''}}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl152>{!! $rw2 !!}</td>
|
|
<td colspan=16 class=xl145>Riwayat Pengobatan < 5tahun</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td colspan=5 class=xl98>Tanggal pengiriman contoh uji</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=9 class=xl98 style='border-right:.5pt solid black'>{{ $data['id_tanggalpengirimancontohuji'] ?? ''}}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td colspan=5 class=xl98>Tanda tangan pengambilan contoh uji</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=9 class=xl98 style='border-right:.5pt solid black'> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=16 class=xl150>Alasan Pemeriksaan :</td>
|
|
<td class=xl121> </td>
|
|
<td class=xl84> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl89> </td>
|
|
<td colspan=15 class=xl85 style='border-right:.5pt solid black'> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>
|
|
@php
|
|
if (isset($data['id_alasanpemeriksaan']) && $data['id_alasanpemeriksaan'] == 'Diagnosis TBS'){
|
|
$d2 = ' ';
|
|
$d1 = '√';
|
|
$d3 = ' ';
|
|
} else if (isset($data['id_alasanpemeriksaan']) && $data['id_alasanpemeriksaan'] == 'Diagnosis Baseline TBC'){
|
|
$d1 = ' ';
|
|
$d2 = '√';
|
|
$d3 = ' ';
|
|
} else {
|
|
$d1 = ' ';
|
|
$d3 = '√';
|
|
$d2 = ' ';
|
|
}
|
|
echo $d1;
|
|
@endphp
|
|
</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=12 class=xl70>Diagnosis TBC</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl87> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $d2 !!}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=12 class=xl70>Diagnosis Baseline TBC</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl87> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td colspan=4 class=xl139 style='border-right:.5pt solid black'>Jenis Pemeriksaan</td>
|
|
<td class=xl63> </td>
|
|
<td colspan=11 class=xl139 style='border-right:.5pt solid black'>Lokasi Anatomi</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $d3 !!}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=12 class=xl70>Akhir Pengobatan</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl87> </td>
|
|
</tr>
|
|
@php
|
|
if (isset($data['id_jenispemeriksaantb']) && $data['id_jenispemeriksaantb'] == 'Mikroskopis'){
|
|
$j1 = '√';
|
|
$j2 = ' ';
|
|
$j3 = ' ';
|
|
$j4 = ' ';
|
|
$j5 = ' ';
|
|
$j6 = ' ';
|
|
$j7 = ' ';
|
|
$j8 = ' ';
|
|
$j9 = ' ';
|
|
$j10 = ' ';
|
|
} else if (isset($data['id_jenispemeriksaantb']) && $data['id_jenispemeriksaantb'] == 'TCM MTB Rif (Xpert)'){
|
|
$j2 = '√';
|
|
$j1 = ' ';
|
|
$j3 = ' ';
|
|
$j4 = ' ';
|
|
$j5 = ' ';
|
|
$j6 = ' ';
|
|
$j7 = ' ';
|
|
$j8 = ' ';
|
|
$j9 = ' ';
|
|
$j10 = ' ';
|
|
} else if (isset($data['id_jenispemeriksaantb']) && $data['id_jenispemeriksaantb'] == 'TCM XDR (Xpert)'){
|
|
$j3 = '√';
|
|
$j2 = ' ';
|
|
$j1 = ' ';
|
|
$j4 = ' ';
|
|
$j5 = ' ';
|
|
$j6 = ' ';
|
|
$j7 = ' ';
|
|
$j8 = ' ';
|
|
$j9 = ' ';
|
|
$j10 = ' ';
|
|
} else if (isset($data['id_jenispemeriksaantb']) && $data['id_jenispemeriksaantb'] == 'TCM MTB Rif (Truenat)'){
|
|
$j4 = '√';
|
|
$j2 = ' ';
|
|
$j3 = ' ';
|
|
$j1 = ' ';
|
|
$j5 = ' ';
|
|
$j6 = ' ';
|
|
$j7 = ' ';
|
|
$j8 = ' ';
|
|
$j9 = ' ';
|
|
$j10 = ' ';
|
|
} else if (isset($data['id_jenispemeriksaantb']) && $data['id_jenispemeriksaantb'] == 'TCM MTB Rif INH (BDMAX)'){
|
|
$j5 = '√';
|
|
$j2 = ' ';
|
|
$j3 = ' ';
|
|
$j4 = ' ';
|
|
$j1 = ' ';
|
|
$j6 = ' ';
|
|
$j7 = ' ';
|
|
$j8 = ' ';
|
|
$j9 = ' ';
|
|
$j10 = ' ';
|
|
} else if (isset($data['id_jenispemeriksaantb']) && $data['id_jenispemeriksaantb'] == 'PCR Open System'){
|
|
$j6 = '√';
|
|
$j2 = ' ';
|
|
$j3 = ' ';
|
|
$j4 = ' ';
|
|
$j5 = ' ';
|
|
$j1 = ' ';
|
|
$j7 = ' ';
|
|
$j8 = ' ';
|
|
$j9 = ' ';
|
|
$j10 = ' ';
|
|
} else if (isset($data['id_jenispemeriksaantb']) && $data['id_jenispemeriksaantb'] == 'LPA lini 1'){
|
|
$j7 = '√';
|
|
$j2 = ' ';
|
|
$j3 = ' ';
|
|
$j4 = ' ';
|
|
$j5 = ' ';
|
|
$j6 = ' ';
|
|
$j1 = ' ';
|
|
$j8 = ' ';
|
|
$j9 = ' ';
|
|
$j10 = ' ';
|
|
} else if (isset($data['id_jenispemeriksaantb']) && $data['id_jenispemeriksaantb'] == 'LPA lini 2'){
|
|
$j8 = '√';
|
|
$j2 = ' ';
|
|
$j3 = ' ';
|
|
$j4 = ' ';
|
|
$j5 = ' ';
|
|
$j6 = ' ';
|
|
$j7 = ' ';
|
|
$j1 = ' ';
|
|
$j9 = ' ';
|
|
$j10 = ' ';
|
|
} else if (isset($data['id_jenispemeriksaantb']) && $data['id_jenispemeriksaantb'] == 'Biakan'){
|
|
$j9 = '√';
|
|
$j2 = ' ';
|
|
$j3 = ' ';
|
|
$j4 = ' ';
|
|
$j5 = ' ';
|
|
$j6 = ' ';
|
|
$j7 = ' ';
|
|
$j8 = ' ';
|
|
$j1 = ' ';
|
|
$j10 = ' ';
|
|
} else {
|
|
$j10 = '√';
|
|
$j2 = ' ';
|
|
$j3 = ' ';
|
|
$j4 = ' ';
|
|
$j5 = ' ';
|
|
$j6 = ' ';
|
|
$j7 = ' ';
|
|
$j8 = ' ';
|
|
$j9 = ' ';
|
|
$j1 = ' ';
|
|
}
|
|
if (isset($data['tekslokasianatomi']) && $data['tekslokasianatomi'] != ''){
|
|
$p2 = '√';
|
|
$p1 = ' ';
|
|
} else {
|
|
$p1 = '√';
|
|
$p2 = ' ';
|
|
}
|
|
@endphp
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $j1 !!}</td>
|
|
<td colspan=2 class=xl70 style='border-right:.5pt solid black'>Mikroskopis</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $p1 !!}</td>
|
|
<td colspan=9 class=xl82 style='border-right:.5pt solid black;border-left: none'>Paru</td>
|
|
<td class=xl64> </td>
|
|
<td colspan=16 class=xl82>Pemantauan kemajuan pengobatan (Follow up)</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl87> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $j2 !!}</td>
|
|
<td colspan=2 class=xl70 style='border-right:.5pt solid black'>TCM MTB Rif (Xpert)</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $p2 !!}</td>
|
|
<td colspan=9 class=xl82 style='border-right:.5pt solid black;border-left: none'>Ekstraparu</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=5 class=xl149>Bulan ke :</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl77>{!! $data['id_bulankemajuantbfollow'] ?? '' !!}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl87> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $j3 !!}</td>
|
|
<td colspan=2 class=xl70 style='border-right:.5pt solid black'>TCM CDR (Xpert)</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl70>Lokasi :</td>
|
|
<td colspan=6 class=xl70 style='border-right:.5pt solid black'>{!! $data['id_ekstraparu'] ?? '' !!}</td>
|
|
<td class=xl64> </td>
|
|
<td colspan=16 class=xl82>Pemeriksaan ulang ke- :</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl87> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $j4 !!}</td>
|
|
<td colspan=2 class=xl70 style='border-right:.5pt solid black'>TCM MTB Rif (Truenant)</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl89> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl91> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=5 class=xl149>Bulan ke :</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl77>{!! $data['id_bulanpemeriksaanulang'] ?? '' !!}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl87> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $j5 !!}</td>
|
|
<td colspan=2 class=xl70 style='border-right:.5pt solid black'>TCM (MTB (Rif INH (BDMAX)</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=16 class=xl82>Pemeriksaan setelah selesai pengobatan :</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl87> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $j6 !!}</td>
|
|
<td colspan=2 class=xl70 style='border-right:.5pt solid black'>PCR Open System</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=5 class=xl149>Bulan ke :</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl77>{!! $data['id_bulanpemeriksaansetelahselesai'] ?? '' !!}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl87> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $j7 !!}</td>
|
|
<td colspan=2 class=xl70 style='border-right:.5pt solid black'>LPA lini 1</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=11 class=xl145>No. Reg. TBC/TBC RO Fasyankes</td>
|
|
<td class=xl64>:</td>
|
|
<td colspan=6 class=xl98 style='border-right:.5pt solid black'>{!! $data['id_noregfasyankes'] ?? '' !!}</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $j8 !!}</td>
|
|
<td colspan=2 class=xl70 style='border-right:.5pt solid black'>LPA lini 2</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=11 class=xl146>No. Reg. TBC/TBC RO Kota</td>
|
|
<td class=xl90>:</td>
|
|
<td colspan=6 class=xl147 style='border-right:.5pt solid black'>{!! $data['id_noregkota'] ?? '' !!}</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $j9 !!}</td>
|
|
<td colspan=2 class=xl70 style='border-right:.5pt solid black'>Biakan</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>{!! $j10 !!}</td>
|
|
<td colspan=2 class=xl70 style='border-right:.5pt solid black'>Paket standar uji kepekaan</td>
|
|
<td class=xl70> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'>
|
|
<td height=3 class=xl64 style='height:2.0pt'> </td>
|
|
<td class=xl89> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl90> </td>
|
|
<td class=xl91> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=30 class=xl92>Secara visual dahak tampak (berilah tanda V pada kotak)</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl139 style='border-right:.5pt solid black'>Contoh Uji</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl93> </td>
|
|
<td class=xl94> </td>
|
|
<td class=xl94> </td>
|
|
<td class=xl94> </td>
|
|
<td class=xl94> </td>
|
|
<td class=xl94> </td>
|
|
<td class=xl94> </td>
|
|
<td class=xl94> </td>
|
|
<td class=xl84> </td>
|
|
<td class=xl93> </td>
|
|
<td colspan=5 class=xl75>Nanah lendir</td>
|
|
<td class=xl84> </td>
|
|
<td class=xl93> </td>
|
|
<td colspan=5 class=xl75>Bercak darah</td>
|
|
<td class=xl84> </td>
|
|
<td class=xl93> </td>
|
|
<td colspan=5 class=xl75>Air Liur</td>
|
|
<td class=xl84> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>
|
|
@if (isset($data['id_contohuji']) && $data['id_contohuji'] == 'Dahak')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl87>Dahak</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=8 class=xl82>Sewaktu / Pagi</td>
|
|
<td class=xl87> </td>
|
|
<td class=xl88> </td>
|
|
<td colspan=5 class=xl95 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox6']) && $data['inlineCheckbox6'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl87> </td>
|
|
<td class=xl88> </td>
|
|
<td colspan=5 class=xl95 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox7']) && $data['inlineCheckbox7'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl87> </td>
|
|
<td class=xl88> </td>
|
|
<td colspan=5 class=xl95 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox8']) && $data['inlineCheckbox8'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl87> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'>
|
|
<td height=3 class=xl64 style='height:2.0pt'></td>
|
|
<td class=xl88></td>
|
|
<td class=xl71></td>
|
|
<td class=xl87></td>
|
|
<td class=xl64></td>
|
|
<td class=xl64></td>
|
|
<td class=xl82></td>
|
|
<td class=xl70></td>
|
|
<td class=xl70></td>
|
|
<td class=xl70></td>
|
|
<td class=xl70></td>
|
|
<td class=xl70></td>
|
|
<td class=xl70></td>
|
|
<td class=xl70></td>
|
|
<td class=xl87></td>
|
|
<td class=xl88></td>
|
|
<td class=xl64></td>
|
|
<td class=xl64></td>
|
|
<td class=xl71></td>
|
|
<td class=xl71></td>
|
|
<td class=xl71></td>
|
|
<td class=xl81></td>
|
|
<td class=xl102></td>
|
|
<td class=xl64></td>
|
|
<td class=xl64></td>
|
|
<td class=xl64></td>
|
|
<td class=xl71></td>
|
|
<td class=xl71></td>
|
|
<td class=xl81></td>
|
|
<td class=xl88></td>
|
|
<td class=xl64></td>
|
|
<td class=xl64></td>
|
|
<td class=xl71></td>
|
|
<td class=xl71></td>
|
|
<td class=xl71></td>
|
|
<td class=xl81></td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl77>
|
|
@if (isset($data['id_contohuji']) && $data['id_contohuji'] != 'Dahak')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl87>Lainnya : {!! $data['id_contohujilainnya'] ?? '' !!}</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=8 class=xl82>Sewaktu / Pagi</td>
|
|
<td class=xl87> </td>
|
|
<td class=xl88> </td>
|
|
<td colspan=5 class=xl95 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox9']) && $data['inlineCheckbox9'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl87> </td>
|
|
<td class=xl88> </td>
|
|
<td colspan=5 class=xl95 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox10']) && $data['inlineCheckbox10'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl81> </td>
|
|
<td class=xl88> </td>
|
|
<td colspan=5 class=xl95 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox11']) && $data['inlineCheckbox11'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl81> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'>
|
|
<td height=3 class=xl64 style='height:2.0pt'></td>
|
|
<td class=xl89></td>
|
|
<td class=xl90></td>
|
|
<td class=xl91></td>
|
|
<td class=xl64></td>
|
|
<td class=xl64></td>
|
|
<td class=xl89></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl91></td>
|
|
<td class=xl89></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl91></td>
|
|
<td class=xl89></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td colspan=3 class=xl85 style='border-right:.5pt solid black'></td>
|
|
<td class=xl89></td>
|
|
<td class=xl90></td>
|
|
<td class=xl90></td>
|
|
<td colspan=4 class=xl85 style='border-right:.5pt solid black'></td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=30 class=xl121>* Lingkari yang sesuai</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=10 class=xl71>Malang, {{$tanggal}}</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=10 class=xl71>{{$periksa->klinisi}}</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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</tr>
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<tr>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td colspan=34 class=xl63>HASIL PEMERIKSAAN BAKTERIOLOGIS TBC</td>
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</tr>
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<tr>
|
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<td class=xl64> </td>
|
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<td class=xl71> </td>
|
|
<td class=xl64 colspan=12 style='mso-ignore:colspan'>No. Register Lab. (sesuai Buku Register Lab TBC.04) : .....</td>
|
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<td class=xl64> </td>
|
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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<td class=xl64> </td>
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</tr>
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<tr height=3 style='mso-height-source:userset;height:2.0pt'>
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<td height=3 class=xl64 style='height:2.0pt'> </td>
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<td class=xl71> </td>
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<td colspan=34 class=xl63> </td>
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</tr>
|
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<tr style='mso-height-source:userset;height:50.0pt'>
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<td class=xl64 style='height:50.0pt'> </td>
|
|
<td colspan=3 class=xl106 style='border-right:.5pt solid black'>Contoh uji *)</td>
|
|
<td colspan=4 class=xl109 width=89 style='border-right:.5pt solid black;border-left:none;width:66pt'>Tanggal Hasil Dilaporkan</td>
|
|
<td colspan=28 class=xl106 style='border-right:.5pt solid black;border-left:none'>Hasil Pemeriksaan Mikroskopis (BTA/lainnya) **)</td>
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</tr>
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<tr style='mso-height-source:userset;height:16.0pt'>
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<td class=xl64 style='height:16.0pt'> </td>
|
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<td class=xl74> </td>
|
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<td class=xl78> </td>
|
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<td class=xl79> </td>
|
|
<td colspan=4 rowspan=6 class=xl113 style='border-right:.5pt solid black;border-bottom:.5pt solid black'>{!! $data['hasilpemeriksaantbbiakan_tgl'] ?? '' !!}</td>
|
|
<td class=xl116> </td>
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<td class=xl116> </td>
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<td colspan=3 class=xl123>+++</td>
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<td class=xl116> </td>
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<td class=xl116> </td>
|
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<td colspan=3 class=xl124>++</td>
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<td class=xl116> </td>
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<td class=xl116> </td>
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<td colspan=3 class=xl124>+</td>
|
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<td class=xl116> </td>
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<td class=xl116> </td>
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<td colspan=3 class=xl124>1-9 ***)</td>
|
|
<td class=xl116> </td>
|
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<td class=xl116> </td>
|
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<td colspan=3 class=xl124>Neg</td>
|
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<td class=xl125> </td>
|
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<td class=xl123> </td>
|
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<td class=xl117> </td>
|
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</tr>
|
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<tr style='mso-height-source:userset;height:16.0pt'>
|
|
<td class=xl64 style='height:16.0pt'> </td>
|
|
<td class=xl102> </td>
|
|
<td class=xl77>{!! $data['hasilpemeriksaantbbiakan_mikroskopispagi'] ?? '' !!}</td>
|
|
<td class=xl87>Pagi</td>
|
|
<td class=xl116> </td>
|
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<td class=xl116> </td>
|
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<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
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@if (isset($data['inlineCheckbox12']) && $data['inlineCheckbox12'] != '')
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|
√
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@else
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@endif
|
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</td>
|
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<td class=xl116> </td>
|
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<td class=xl116> </td>
|
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<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox13']) && $data['inlineCheckbox13'] != '')
|
|
√
|
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@else
|
|
|
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@endif
|
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</td>
|
|
<td class=xl116> </td>
|
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<td class=xl116> </td>
|
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<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox14']) && $data['inlineCheckbox14'] != '')
|
|
√
|
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@else
|
|
|
|
@endif
|
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</td>
|
|
<td class=xl116> </td>
|
|
<td class=xl116> </td>
|
|
<td colspan=3 class=xl129 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox15']) && $data['inlineCheckbox15'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
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</td>
|
|
<td class=xl116> </td>
|
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<td class=xl116> </td>
|
|
<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox16']) && $data['inlineCheckbox16'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl125> </td>
|
|
<td class=xl123> </td>
|
|
<td class=xl117> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'>
|
|
<td height=3 class=xl64 style='height:2.0pt'></td>
|
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<td class=xl102></td>
|
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<td class=xl63></td>
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<td class=xl101></td>
|
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<td class=xl118></td>
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<td class=xl119></td>
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<td class=xl119></td>
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<td class=xl119></td>
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<td class=xl132></td>
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<td class=xl132></td>
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<td class=xl119></td>
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<td class=xl119></td>
|
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<td class=xl119></td>
|
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<td class=xl132></td>
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<td class=xl132></td>
|
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<td class=xl119></td>
|
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<td class=xl119></td>
|
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<td class=xl119></td>
|
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<td class=xl132></td>
|
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<td class=xl132></td>
|
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<td class=xl119></td>
|
|
<td class=xl119></td>
|
|
<td class=xl119></td>
|
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<td class=xl133></td>
|
|
<td class=xl132></td>
|
|
<td class=xl119></td>
|
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<td class=xl119></td>
|
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<td class=xl119></td>
|
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<td class=xl132></td>
|
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<td class=xl132></td>
|
|
<td class=xl132></td>
|
|
<td class=xl120></td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'>
|
|
<td height=3 class=xl64 style='height:2.0pt'></td>
|
|
<td class=xl102></td>
|
|
<td class=xl63></td>
|
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<td class=xl101></td>
|
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<td class=xl116></td>
|
|
<td class=xl116></td>
|
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<td class=xl116></td>
|
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<td class=xl116></td>
|
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<td class=xl123></td>
|
|
<td class=xl123></td>
|
|
<td class=xl116></td>
|
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<td class=xl116></td>
|
|
<td class=xl116></td>
|
|
<td class=xl123></td>
|
|
<td class=xl123></td>
|
|
<td class=xl116></td>
|
|
<td class=xl116></td>
|
|
<td class=xl116></td>
|
|
<td class=xl123></td>
|
|
<td class=xl123></td>
|
|
<td class=xl116></td>
|
|
<td class=xl116></td>
|
|
<td class=xl116></td>
|
|
<td class=xl134></td>
|
|
<td class=xl123></td>
|
|
<td class=xl116></td>
|
|
<td class=xl116></td>
|
|
<td class=xl116></td>
|
|
<td class=xl123></td>
|
|
<td class=xl123></td>
|
|
<td class=xl123></td>
|
|
<td class=xl117></td>
|
|
</tr>
|
|
<tr style='mso-height-source:userset;height:16.0pt'>
|
|
<td class=xl64 style='height:16.0pt'> </td>
|
|
<td class=xl102> </td>
|
|
<td class=xl77>{!! $data['hasilpemeriksaantbbiakan_mikroskopisswaktu'] ?? '' !!}</td>
|
|
<td class=xl87>Sewaktu / Pagi</td>
|
|
<td class=xl116> </td>
|
|
<td class=xl116> </td>
|
|
<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox17']) && $data['inlineCheckbox17'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td class=xl116> </td>
|
|
<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox18']) && $data['inlineCheckbox18'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td class=xl116> </td>
|
|
<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox19']) && $data['inlineCheckbox19'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td class=xl116> </td>
|
|
<td colspan=3 class=xl129 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox20']) && $data['inlineCheckbox20'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td class=xl116> </td>
|
|
<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox21']) && $data['inlineCheckbox21'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl125> </td>
|
|
<td class=xl123> </td>
|
|
<td class=xl117> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'>
|
|
<td height=3 class=xl64 style='height:2.0pt'></td>
|
|
<td class=xl103></td>
|
|
<td class=xl90></td>
|
|
<td class=xl91></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl136></td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=34 class=xl63> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl71> </td>
|
|
<td class=xl64 colspan=12 style='mso-ignore:colspan'>No. Register Lab. (sesuai Buku Register Lab TBC.04) : ...</td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'>
|
|
<td height=3 class=xl64 style='height:2.0pt'> </td>
|
|
<td class=xl71> </td>
|
|
<td colspan=34 class=xl63> </td>
|
|
</tr>
|
|
<tr style='mso-height-source:userset;height:50.0pt'>
|
|
<td class=xl64 style='height:50.0pt'> </td>
|
|
<td colspan=3 class=xl106 style='border-right:.5pt solid black'>Contoh uji *)</td>
|
|
<td colspan=4 class=xl109 width=89 style='border-right:.5pt solid black; border-left:none;width:66pt'>Tanggal Hasil Dilaporkan</td>
|
|
<td colspan=3 class=xl109 width=60 style='border-right:.5pt solid black; border-left:none;width:45pt'>Metode Uji</td>
|
|
<td colspan=25 class=xl106 style='border-right:.5pt solid black;border-left: none'>Hasil Pemeriksaan Mikroskopis (BTA/lainnya) **)</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td colspan=3 class=xl74 style='border-right:.5pt solid black'> </td>
|
|
<td colspan=4 rowspan=7 class=xl112 style='border-right:.5pt solid black; border-bottom:.5pt solid black'>{!! $data['hasilpemeriksaantbbiakan_tglbiakan'] ?? '' !!}</td>
|
|
<td colspan=3 rowspan=2 class=xl112 style='border-right:.5pt solid black'>MGIT</td>
|
|
<td class=xl112 style='border-top:none;border-left:none'> </td>
|
|
<td colspan=3 class=xl124>Pos</td>
|
|
<td class=xl113> </td>
|
|
<td class=xl113> </td>
|
|
<td colspan=3 class=xl124>Neg</td>
|
|
<td class=xl113> </td>
|
|
<td class=xl113> </td>
|
|
<td colspan=3 class=xl124>NTM</td>
|
|
<td class=xl113> </td>
|
|
<td class=xl113> </td>
|
|
<td colspan=3 class=xl124>KTM</td>
|
|
<td class=xl113> </td>
|
|
<td class=xl113> </td>
|
|
<td colspan=3 class=xl124>TDL</td>
|
|
<td class=xl114> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl102> </td>
|
|
<td class=xl77>{!! $data['hasilpemeriksaantbbiakan_mgitpagi'] ?? '' !!}</td>
|
|
<td class=xl87>Pagi</td>
|
|
<td class=xl115> </td>
|
|
<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox22']) && $data['inlineCheckbox22'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td class=xl116> </td>
|
|
<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox23']) && $data['inlineCheckbox23'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td class=xl116> </td>
|
|
<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox24']) && $data['inlineCheckbox24'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td class=xl116> </td>
|
|
<td colspan=3 class=xl129 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox25']) && $data['inlineCheckbox25'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td class=xl116> </td>
|
|
<td colspan=3 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox26']) && $data['inlineCheckbox26'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl117> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'>
|
|
<td height=3 class=xl64 style='height:2.0pt'></td>
|
|
<td class=xl88></td>
|
|
<td class=xl64></td>
|
|
<td class=xl87></td>
|
|
<td colspan=3 class=xl104 style='border-right:.5pt solid black;border-left:none'></td>
|
|
<td class=xl118></td>
|
|
<td class=xl132></td>
|
|
<td class=xl132></td>
|
|
<td class=xl119></td>
|
|
<td class=xl119></td>
|
|
<td class=xl119></td>
|
|
<td class=xl132></td>
|
|
<td class=xl132></td>
|
|
<td class=xl119></td>
|
|
<td class=xl119></td>
|
|
<td class=xl119></td>
|
|
<td class=xl132></td>
|
|
<td class=xl132></td>
|
|
<td class=xl119></td>
|
|
<td class=xl119></td>
|
|
<td class=xl119></td>
|
|
<td class=xl133></td>
|
|
<td class=xl132></td>
|
|
<td class=xl119></td>
|
|
<td class=xl119></td>
|
|
<td class=xl119></td>
|
|
<td class=xl132></td>
|
|
<td class=xl132></td>
|
|
<td class=xl132></td>
|
|
<td class=xl120></td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'>
|
|
<td height=3 class=xl64 style='height:2.0pt'></td>
|
|
<td class=xl88></td>
|
|
<td class=xl64></td>
|
|
<td class=xl87></td>
|
|
<td class=xl63></td>
|
|
<td class=xl63></td>
|
|
<td class=xl63></td>
|
|
<td class=xl112></td>
|
|
<td class=xl124></td>
|
|
<td class=xl124></td>
|
|
<td class=xl113></td>
|
|
<td class=xl113></td>
|
|
<td class=xl113></td>
|
|
<td class=xl124></td>
|
|
<td class=xl124></td>
|
|
<td class=xl113></td>
|
|
<td class=xl113></td>
|
|
<td class=xl113></td>
|
|
<td class=xl124></td>
|
|
<td class=xl124></td>
|
|
<td class=xl113></td>
|
|
<td class=xl113></td>
|
|
<td class=xl113></td>
|
|
<td class=xl137></td>
|
|
<td class=xl124></td>
|
|
<td class=xl113></td>
|
|
<td class=xl113></td>
|
|
<td class=xl113></td>
|
|
<td class=xl124></td>
|
|
<td class=xl124></td>
|
|
<td class=xl124></td>
|
|
<td class=xl114></td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl87> </td>
|
|
<td colspan=3 rowspan=3 class=xl115 style='border-right:.5pt solid black;border-bottom:.5pt solid black'>LJ</td>
|
|
<td class=xl115> </td>
|
|
<td colspan=2 class=xl123>3+</td>
|
|
<td class=xl116> </td>
|
|
<td colspan=2 class=xl123>2+</td>
|
|
<td class=xl125> </td>
|
|
<td colspan=2 class=xl123>1+</td>
|
|
<td class=xl116> </td>
|
|
<td colspan=2 class=xl123>1-9 ***)</td>
|
|
<td class=xl125> </td>
|
|
<td colspan=2 class=xl123>Neg</td>
|
|
<td class=xl116> </td>
|
|
<td colspan=2 class=xl123>NTM</td>
|
|
<td class=xl116> </td>
|
|
<td colspan=2 class=xl123>KTM</td>
|
|
<td class=xl125> </td>
|
|
<td colspan=2 class=xl123>TDL</td>
|
|
<td class=xl117> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl88> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl87> </td>
|
|
<td class=xl115> </td>
|
|
<td colspan=2 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox27']) && $data['inlineCheckbox27'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td colspan=2 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox28']) && $data['inlineCheckbox28'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl125> </td>
|
|
<td colspan=2 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox29']) && $data['inlineCheckbox29'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td colspan=2 class=xl129 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox30']) && $data['inlineCheckbox30'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl125> </td>
|
|
<td colspan=2 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox31']) && $data['inlineCheckbox31'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td colspan=2 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox32']) && $data['inlineCheckbox32'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl116> </td>
|
|
<td colspan=2 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox33']) && $data['inlineCheckbox33'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl125> </td>
|
|
<td colspan=2 class=xl126 style='border-right:.5pt solid black'>
|
|
@if (isset($data['inlineCheckbox34']) && $data['inlineCheckbox34'] != '')
|
|
√
|
|
@else
|
|
|
|
@endif
|
|
</td>
|
|
<td class=xl117> </td>
|
|
</tr>
|
|
<tr height=3 style='mso-height-source:userset;height:2.0pt'>
|
|
<td height=3 class=xl64 style='height:2.0pt'></td>
|
|
<td class=xl89></td>
|
|
<td class=xl90></td>
|
|
<td class=xl91></td>
|
|
<td class=xl138></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl135></td>
|
|
<td class=xl136></td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=34 class=xl63> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=12 class=xl70>Mengetahui</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=21 class=xl70>Tanda tangan pemeriksa</td>
|
|
<td colspan=12 class=xl70>Dokter PJ pemeriksaan Lab</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=21 class=xl98><!-- $ttdexecutor --> </td>
|
|
<td colspan=12 class=xl98>{!! $tandatangan !!}</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=21 class=xl70>{!! $periksa->nmexcutor !!}</td>
|
|
<td colspan=12 class=xl70>{!! $periksa->nmdokter !!}</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td colspan=34 class=xl63> </td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64>*)</td>
|
|
<td colspan=33 class=xl70>Diisi sesuai dengan kode huruf sesuai identitas sediaan/waktu pengambilan dahak</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl64>**)</td>
|
|
<td colspan=33 class=xl70>Hasil pemeriksaan Mikroskopis, TCM dan Biakan : beri tanda rumput pada hasil pemeriksaan yang sesuai</td>
|
|
</tr>
|
|
<tr>
|
|
<td class=xl64> </td>
|
|
<td class=xl64> </td>
|
|
<td class=xl99>****)</td>
|
|
<td colspan=33>Isi dengan jumlah BTA (misalnya 2 BTA, 7 BTA) / koloni yang ditemukan</td>
|
|
</tr>
|
|
<![if supportMisalignedColumns]>
|
|
<tr height=0 style='display:none'>
|
|
<td width=31 style='width:23pt'> </td>
|
|
<td width=15 style='width:11pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=168 style='width:126pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=20 style='width:15pt'> </td>
|
|
<td width=20 style='width:15pt'> </td>
|
|
<td width=20 style='width:15pt'> </td>
|
|
<td width=20 style='width:15pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
<td width=23 style='width:17pt'> </td>
|
|
</tr>
|
|
<![endif]>
|
|
</table>
|
|
</div>
|
|
</body>
|
|
</html>
|