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<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8" isBold="false"/>
</textElement>
<text><![CDATA[CHECK LIST KELENGKAPAN PENDAFTARAN PASIEN]]></text>
</staticText>
<textField>
<reportElement x="91" y="63" width="97" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{poli}]]></textFieldExpression>
</textField>
<staticText>
<reportElement x="1" y="15" width="261" height="15"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8" isBold="false"/>
</textElement>
<text><![CDATA[IGD/IRJ/IRI]]></text>
</staticText>
<line>
<reportElement x="5" y="44" width="252" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement x="11" y="63" width="75" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[KLINIK DITUJU]]></text>
</staticText>
<staticText>
<reportElement x="11" y="78" width="75" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[NAMA]]></text>
</staticText>
<staticText>
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<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[NO.RM]]></text>
</staticText>
<staticText>
<reportElement x="11" y="108" width="75" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[CARA PEMBAYARAN]]></text>
</staticText>
<staticText>
<reportElement x="11" y="123" width="75" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[TANGGAL PERIKSA]]></text>
</staticText>
<staticText>
<reportElement x="86" y="63" width="5" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="86" y="78" width="5" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
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<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
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<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[:]]></text>
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<staticText>
<reportElement x="86" y="123" width="5" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[:]]></text>
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<staticText>
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<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[ NO.ANTRI :]]></text>
</staticText>
<textField>
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<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{antrian}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="91" y="78" width="161" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{nama}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="91" y="93" width="161" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{norm}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="91" y="108" width="161" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{bayar}]]></textFieldExpression>
</textField>
<textField pattern="dd/MM/yyyy" isBlankWhenNull="true">
<reportElement x="91" y="123" width="161" height="15"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<textFieldExpression class="java.util.Date"><![CDATA[$F{sekarang}]]></textFieldExpression>
</textField>
<line>
<reportElement x="2" y="0" width="260" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="6" y="146" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement x="6" y="147" width="13" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[NO]]></text>
</staticText>
<staticText>
<reportElement x="21" y="147" width="136" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[PERSYARATAN]]></text>
</staticText>
<staticText>
<reportElement x="157" y="147" width="100" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[CHECK LIST]]></text>
</staticText>
<staticText>
<reportElement x="232" y="157" width="25" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Bag]]></text>
</staticText>
<staticText>
<reportElement x="207" y="157" width="25" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Bag]]></text>
</staticText>
<staticText>
<reportElement x="182" y="157" width="25" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Bag]]></text>
</staticText>
<staticText>
<reportElement x="157" y="157" width="25" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Bag]]></text>
</staticText>
<line>
<reportElement x="6" y="156" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="6" y="175" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement x="182" y="166" width="25" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[......]]></text>
</staticText>
<staticText>
<reportElement x="232" y="166" width="25" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[......]]></text>
</staticText>
<staticText>
<reportElement x="207" y="166" width="25" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[......]]></text>
</staticText>
<staticText>
<reportElement x="157" y="166" width="25" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[......]]></text>
</staticText>
<staticText>
<reportElement x="21" y="176" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[SKP]]></text>
</staticText>
<staticText>
<reportElement x="21" y="186" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Surat Rujukan]]></text>
</staticText>
<staticText>
<reportElement x="21" y="196" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Foto Copy Kartu Peserta]]></text>
</staticText>
<staticText>
<reportElement x="21" y="206" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Foto Copy KTP]]></text>
</staticText>
<staticText>
<reportElement x="21" y="216" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Foto Copy KK]]></text>
</staticText>
<staticText>
<reportElement x="21" y="226" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Foto Copy Surat Keterangan beda tanggal]]></text>
</staticText>
<staticText>
<reportElement x="21" y="235" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Lahir dan Nama]]></text>
</staticText>
<staticText>
<reportElement x="21" y="245" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Foto Copy Akte Kelahiran]]></text>
</staticText>
<staticText>
<reportElement x="21" y="255" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Lain-Lain :]]></text>
</staticText>
<line>
<reportElement x="6" y="185" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="6" y="195" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="6" y="205" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="6" y="215" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="6" y="225" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="6" y="244" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="6" y="254" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="6" y="264" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement x="21" y="265" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[a)]]></text>
</staticText>
<line>
<reportElement x="6" y="274" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement x="21" y="275" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[b)]]></text>
</staticText>
<staticText>
<reportElement x="21" y="285" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[c)]]></text>
</staticText>
<line>
<reportElement x="6" y="284" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="6" y="294" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement x="21" y="295" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[]]></text>
</staticText>
<line>
<reportElement x="6" y="304" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement x="21" y="305" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[]]></text>
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<line>
<reportElement x="6" y="314" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
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</line>
<staticText>
<reportElement x="21" y="315" width="136" height="17"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Paraf Petugas Check List]]></text>
</staticText>
<line>
<reportElement x="6" y="332" width="251" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="5" y="147" width="1" height="185"/>
<graphicElement>
<pen lineWidth="0.5"/>
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</line>
<staticText>
<reportElement x="6" y="176" width="12" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
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<text><![CDATA[1]]></text>
</staticText>
<staticText>
<reportElement x="6" y="186" width="12" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[2]]></text>
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<staticText>
<reportElement x="6" y="196" width="12" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[3]]></text>
</staticText>
<staticText>
<reportElement x="6" y="206" width="12" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
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<text><![CDATA[4]]></text>
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<staticText>
<reportElement x="6" y="216" width="12" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
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<text><![CDATA[5]]></text>
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<staticText>
<reportElement x="6" y="226" width="12" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[6]]></text>
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<staticText>
<reportElement x="6" y="245" width="12" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
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<text><![CDATA[7]]></text>
</staticText>
<staticText>
<reportElement x="6" y="255" width="12" height="9"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[8]]></text>
</staticText>
<line>
<reportElement x="19" y="147" width="1" height="185"/>
<graphicElement>
<pen lineWidth="0.5"/>
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</line>
<line>
<reportElement x="156" y="147" width="1" height="185"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="181" y="157" width="1" height="175"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="206" y="157" width="1" height="175"/>
<graphicElement>
<pen lineWidth="0.5"/>
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</line>
<line>
<reportElement x="231" y="157" width="1" height="175"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<line>
<reportElement x="257" y="147" width="1" height="185"/>
<graphicElement>
<pen lineWidth="0.5"/>
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</line>
<staticText>
<reportElement x="11" y="359" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[Nb :]]></text>
</staticText>
<staticText>
<reportElement x="34" y="368" width="223" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[- Pengisian kolom check list diisi oleh masing-masing bagian]]></text>
</staticText>
<staticText>
<reportElement x="34" y="377" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[ dengan tanda (V)]]></text>
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<staticText>
<reportElement x="34" y="395" width="223" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
</textElement>
<text><![CDATA[- Semua Persyaratan foto copy rangkap 3]]></text>
</staticText>
<staticText>
<reportElement x="34" y="386" width="136" height="9"/>
<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="7" isBold="false"/>
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<text><![CDATA[]]></text>
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<line>
<reportElement x="1" y="1" width="1" height="455"/>
<graphicElement>
<pen lineWidth="0.5"/>
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<line>
<reportElement x="262" y="1" width="1" height="455"/>
<graphicElement>
<pen lineWidth="0.5"/>
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<line>
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<graphicElement>
<pen lineWidth="0.5"/>
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<textField>
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<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="8"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{namars}]]></textFieldExpression>
</textField>
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