<band height="804">
<textField>
<reportElement x="0" y="44" width="555" height="14" uuid="2c2c779f-b976-4237-b015-6090c3225557"/>
<textElement textAlignment="Center">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA["E-mail : "+$P{emailrs}]]></textFieldExpression>
</textField>
<rectangle>
<reportElement x="0" y="65" width="557" height="645" uuid="5efab5f7-d253-4f54-804a-1cdb91cce032"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</rectangle>
<textField>
<reportElement x="164" y="67" width="207" height="14" uuid="e639886f-7e8a-4542-8834-6e2b10aac592"/>
<textElement>
<font fontName="Tahoma" size="8" isBold="false"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[$F{nm_pasien}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="164" y="81" width="207" height="14" uuid="5313eb3c-a735-4f2f-be58-53b96fde3959"/>
<textElement>
<font fontName="Tahoma" size="8" isBold="false"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[$F{jk}.replaceAll( "L","Laki-Laki" ).replaceAll( "P","Perempuan" )]]></textFieldExpression>
</textField>
<textField pattern="dd/MM/yyyy">
<reportElement x="164" y="95" width="207" height="14" uuid="91db409e-9799-453a-81f2-1b11974c411f"/>
<textElement>
<font fontName="Tahoma" size="8" isBold="false"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[$F{tgl_lahir}]]></textFieldExpression>
</textField>
<textField>
<reportElement mode="Transparent" x="440" y="67" width="116" height="14" uuid="6108141c-e6c6-4f78-b561-77300bd63ca8"/>
<textElement verticalAlignment="Middle">
<font fontName="Tahoma" size="8" isBold="false"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[$F{no_rkm_medis}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="440" y="81" width="116" height="14" uuid="22eddd6d-a091-4baa-9122-63aba605c2ac"/>
<textElement>
<font fontName="Tahoma" size="8" isBold="false"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[$F{umurdaftar}+" "+$F{sttsumur}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="440" y="95" width="116" height="14" uuid="c9f0de87-b90e-490d-a864-7d65e890c4ad"/>
<textElement>
<font fontName="Tahoma" size="8" isBold="false"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[$F{png_jawab}]]></textFieldExpression>
</textField>
<staticText>
<reportElement x="378" y="67" width="56" height="14" uuid="18c43161-0111-4c40-a343-d13b116b2655"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[No RM]]></text>
</staticText>
<staticText>
<reportElement x="378" y="81" width="56" height="14" uuid="ed651861-0fa7-4451-a1eb-747ede335510"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Umur]]></text>
</staticText>
<staticText>
<reportElement x="378" y="95" width="56" height="14" uuid="9a56a4c7-681e-470d-b76b-85f34d8c790c"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Cara Bayar]]></text>
</staticText>
<staticText>
<reportElement x="435" y="67" width="7" height="14" uuid="793bd8a9-efed-4b25-bb02-b13d2f139c83"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="435" y="81" width="7" height="14" uuid="be4150fe-6097-43f0-9b9b-de87f0a9915d"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="435" y="95" width="7" height="14" uuid="27c3a272-e10a-46e2-948e-ac20d0b37a5d"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<line>
<reportElement x="0" y="112" width="557" height="1" uuid="82da4d05-ebe2-4cc6-826d-5a567ff2dc56"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</line>
<line>
<reportElement x="372" y="65" width="1" height="47" uuid="1d5f65b7-6f8d-40d9-ac42-e8b745200bf0"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</line>
<staticText>
<reportElement x="157" y="67" width="7" height="14" uuid="eb2d8840-e1d4-4438-929f-9b743d2e8696"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="88" y="67" width="70" height="14" uuid="1d9e6cf2-93c4-4d1c-9247-8b6d4f3fa7ed"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Nama Pasien]]></text>
</staticText>
<staticText>
<reportElement x="1" y="74" width="80" height="14" uuid="c0b17eee-a932-433a-a09e-e5323980bad3"/>
<textElement textAlignment="Center" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[FORMULIR]]></text>
</staticText>
<staticText>
<reportElement x="1" y="88" width="80" height="14" uuid="34057b40-5bd2-4c57-9ed6-af7e50738a8a"/>
<textElement textAlignment="Center" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[ASUHAN GIZI]]></text>
</staticText>
<line>
<reportElement x="83" y="65" width="1" height="47" uuid="725018ca-cad8-4027-b119-9c88f507ae61"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</line>
<staticText>
<reportElement x="88" y="81" width="70" height="14" uuid="73734d7b-f33d-42b9-b6ad-6db25261570a"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Jenis Kelamin]]></text>
</staticText>
<staticText>
<reportElement x="88" y="95" width="70" height="14" uuid="c99b4fe5-32c8-46fe-9e90-8c414a4ea14d"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Tanggal Lahir]]></text>
</staticText>
<staticText>
<reportElement x="157" y="81" width="7" height="14" uuid="9266a183-25bc-4e98-9201-1b7b1beab194"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="157" y="95" width="7" height="14" uuid="854f8232-feac-4619-ab6d-2f7d7e02be74"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<line>
<reportElement x="0" y="802" width="557" height="1" uuid="b33ba12e-e000-400c-8e7b-b8b517d15a08"/>
<graphicElement>
<pen lineWidth="2.0" lineStyle="Solid"/>
</graphicElement>
</line>
<staticText>
<reportElement x="6" y="115" width="70" height="14" uuid="d58606b1-d2ae-4414-8f0d-8bdea995d74f"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[TANGGAL]]></text>
</staticText>
<staticText>
<reportElement x="6" y="129" width="70" height="14" uuid="ae808cbb-424a-438f-a0fa-b63d2e56919c"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[DIAGNOSA]]></text>
</staticText>
<staticText>
<reportElement x="78" y="115" width="5" height="14" uuid="9f84f77d-a00e-4ddc-8946-8530d4e6d840"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="78" y="129" width="5" height="14" uuid="f8931bcb-a932-47d6-a1cb-ea109030c03f"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<line>
<reportElement x="0" y="145" width="557" height="1" uuid="9633dad3-62e2-4e79-ae59-5604eb717ac7"/>
<graphicElement>
<pen lineWidth="0.75"/>
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</line>
<staticText>
<reportElement x="0" y="147" width="555" height="14" uuid="3e78fb34-6646-4d5e-a853-c7a96cf303d6"/>
<textElement textAlignment="Center" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[PENGKAJIAN GIZI]]></text>
</staticText>
<staticText>
<reportElement x="6" y="157" width="82" height="14" uuid="84b9be1c-8f09-4c16-b50c-1a1cd5373def"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[ANTROPOMERI :]]></text>
</staticText>
<staticText>
<reportElement x="26" y="172" width="30" height="14" uuid="8cad9dcf-a5f1-4d0e-a2aa-5cba490d4b09"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[BB]]></text>
</staticText>
<textField>
<reportElement x="57" y="172" width="74" height="14" uuid="5bd8cffd-009d-4d7a-a47b-b5ff35b09d5c"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[": "+$F{antropometri_bb}+" Kg"]]></textFieldExpression>
</textField>
<staticText>
<reportElement x="26" y="185" width="30" height="14" uuid="7e42f998-db9e-43b5-8607-475cd6259f71"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[TB]]></text>
</staticText>
<textField>
<reportElement x="57" y="185" width="74" height="14" uuid="12a12e25-177e-4663-9c70-a8512cec44f5"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[": "+$F{antropometri_tb}+" Cm"]]></textFieldExpression>
</textField>
<textField>
<reportElement x="57" y="198" width="74" height="14" uuid="90b13222-8377-4b9c-ba75-2ec148fd1642"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[": "+$F{antropometri_imt}+" Kg/Cm"]]></textFieldExpression>
</textField>
<staticText>
<reportElement x="26" y="198" width="30" height="14" uuid="b0b2c972-eaae-42d0-9139-ea7d41915144"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[IMT]]></text>
</staticText>
<staticText>
<reportElement x="161" y="172" width="30" height="14" uuid="a224dad6-cbe6-46f9-ade3-0d248e5ac55f">
<property name="com.jaspersoft.studio.unit.width" value="px"/>
</reportElement>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[LiLA]]></text>
</staticText>
<staticText>
<reportElement x="161" y="185" width="30" height="14" uuid="cf15db3c-6ac3-4da4-87e0-3580f2a8f003">
<property name="com.jaspersoft.studio.unit.width" value="px"/>
</reportElement>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[TL]]></text>
</staticText>
<line>
<reportElement x="0" y="214" width="557" height="1" uuid="e042cdf8-6bcb-4f3e-8d0e-3a10b20597a7"/>
<graphicElement>
<pen lineWidth="0.75"/>
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</line>
<staticText>
<reportElement x="6" y="215" width="70" height="14" uuid="35797dd7-cb31-44c6-ae47-55c0ec294401"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[BIOKIMIA :]]></text>
</staticText>
<line>
<reportElement x="0" y="269" width="557" height="1" uuid="3d2e8484-8d46-4853-b13d-659746eee27f"/>
<graphicElement>
<pen lineWidth="0.75"/>
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</line>
<staticText>
<reportElement x="6" y="270" width="82" height="14" uuid="d523cf0e-2e22-4ae2-96d6-cec58856bc77"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[FISIK / KLINIS :]]></text>
</staticText>
<line>
<reportElement x="0" y="321" width="557" height="1" uuid="fa4489bf-977d-4abe-add6-b1e3eefece9a"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</line>
<staticText>
<reportElement x="6" y="322" width="70" height="14" uuid="944de6bb-eb07-4453-bcd8-dbc4122244b0"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[RIWAYAT GIZI :]]></text>
</staticText>
<line>
<reportElement x="0" y="337" width="557" height="1" uuid="05387c79-7161-444e-a01a-1ab129ce16fe"/>
<graphicElement>
<pen lineWidth="0.75"/>
</graphicElement>
</line>
<staticText>
<reportElement x="26" y="340" width="97" height="14" uuid="3601ce4d-1f03-45ef-8de9-6a90266924d3"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[ALERGI MAKANAN :]]></text>
</staticText>
<staticText>
<reportElement x="226" y="351" width="42" height="14" uuid="e8bd1f73-879f-4f7d-bd31-772c38be7e77"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[YA]]></text>
</staticText>
<staticText>
<reportElement x="251" y="351" width="42" height="14" uuid="787b5e92-e4ae-46f6-bbc1-cee8cd0583d3"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[TIDAK]]></text>
</staticText>
<staticText>
<reportElement x="56" y="366" width="139" height="14" uuid="9937c29f-4044-4781-a20e-1a08d34cef8a"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Telur]]></text>
</staticText>
<staticText>
<reportElement x="56" y="379" width="139" height="14" uuid="1158cd25-d56d-47cb-b03b-535727bdbac2"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Susu sapi dan produk olahannya]]></text>
</staticText>
<staticText>
<reportElement x="56" y="392" width="139" height="14" uuid="44a2c070-9930-47ea-a6b6-0052f33f389a"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Kacang kedelai / tanah]]></text>
</staticText>
<staticText>
<reportElement x="56" y="405" width="139" height="14" uuid="da482072-7e03-4508-9667-e7ca81d944fd"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Gluten / gandum]]></text>
</staticText>
<staticText>
<reportElement x="361" y="366" width="109" height="14" uuid="c986dbb9-3227-4773-863d-d188e2edb7c3"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Udang]]></text>
</staticText>
<staticText>
<reportElement x="361" y="379" width="109" height="14" uuid="626c2d20-16cb-4747-bd32-ac09a258632d"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Ikan]]></text>
</staticText>
<staticText>
<reportElement x="361" y="392" width="109" height="14" uuid="32fa8dc6-97b9-4bd2-b784-1d8453fbc1b4"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[Hazelnut / almont]]></text>
</staticText>
<staticText>
<reportElement x="26" y="428" width="139" height="14" uuid="e6b8ffb0-01df-4a54-ae36-94a3697d563a"/>
<textElement textAlignment="Left" verticalAlignment="Middle">
<font fontName="Tahoma" size="8"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[POLA MAKAN :]]></text>
</staticText>
<rectangle>
<reportElement x="227" y="369" width="9" height="9" uuid="e065ddce-14c5-4717-994d-7e5347f058ba"/>
<graphicElement>
<pen lineWidth="0.5"/>
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<rectangle>
<reportElement x="227" y="382" width="9" height="9" uuid="f6496095-242a-4daf-87f8-f05b7536ac48"/>
<graphicElement>
<pen lineWidth="0.5"/>
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<rectangle>
<reportElement x="227" y="395" width="9" height="9" uuid="4604a1dd-f9c6-42ce-86f4-dda4024c8a52"/>
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<rectangle>
<reportElement x="227" y="408" width="9" height="9" uuid="dfc33540-2fd3-4ce4-91b0-b3912ac6f565"/>
<graphicElement>
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<rectangle>
<reportElement x="492" y="369" width="9" height="9" uuid="ba79cdb2-8051-4db7-9e27-da169189efd8"/>
<graphicElement>
<pen lineWidth="0.5"/>
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<rectangle>
<reportElement x="492" y="382" width="9" height="9" uuid="da3a0d92-82f8-4b51-be2f-c79d65f0608b"/>
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<rectangle>
<reportElement x="492" y="395" width="9" height="9" uuid="8fffeb47-19f3-4c73-92c4-536e6f6e7dbb"/>
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<rectangle>
<reportElement x="524" y="395" width="9" height="9" uuid="c4bc0687-be19-4e9a-bf0f-da7216db640c"/>
<graphicElement>
<pen lineWidth="0.5"/>
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<rectangle>
<reportElement x="260" y="369" width="9" height="9" uuid="cde8c6cd-ede5-490f-942a-d44d11f1a73f"/>
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<rectangle>
<reportElement x="524" y="369" width="9" height="9" uuid="309e8f3d-e3a5-4253-885a-f6c47bf77f69"/>
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<rectangle>
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<rectangle>
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<rectangle>
<reportElement x="260" y="395" width="9" height="9" uuid="415b1391-57e5-4b02-b3a4-851bcf15876d"/>
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