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				<text><![CDATA[FORMULIR PENERIMAAN PASIEN]]></text>
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				<text><![CDATA[NOMOR REKAM MEDIK]]></text>
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				<text><![CDATA[No. Register]]></text>
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				<text><![CDATA[Tanggal Masuk]]></text>
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				<textElement textAlignment="Justified" lineSpacing="Single">
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				<text><![CDATA[:]]></text>
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				<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
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				<text><![CDATA[Nama Pasien]]></text>
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				<text><![CDATA[Umur]]></text>
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				<textElement textAlignment="Left" verticalAlignment="Middle" lineSpacing="Single">
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				<text><![CDATA[Jenis Kelamin]]></text>
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				<text><![CDATA[:]]></text>
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				<text><![CDATA[:]]></text>
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				<text><![CDATA[NAMA IBU]]></text>
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				<textElement textAlignment="Left" lineSpacing="Single">
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				<text><![CDATA[NO Identititas]]></text>
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				<text><![CDATA[(KTP/SIM/ Paspor)]]></text>
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				<text><![CDATA[Pendidikan]]></text>
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				<text><![CDATA[:]]></text>
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				<textElement textAlignment="Left" lineSpacing="Single">
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				<text><![CDATA[Alamat]]></text>
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				<text><![CDATA[Hubungan Keluarga :]]></text>
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				<text><![CDATA[:]]></text>
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				<text><![CDATA[:]]></text>
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				<text><![CDATA[:]]></text>
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				<text><![CDATA[:]]></text>
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					<font fontName="Tahoma" size="10" isBold="false"/>
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				<textElement verticalAlignment="Middle" lineSpacing="Single">
					<font fontName="Tahoma" size="10" isBold="false"/>
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				<textFieldExpression class="java.lang.String"><![CDATA[$F{pekerjaanpj}]]></textFieldExpression>
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				<reportElement x="24" y="213" width="117" height="13"/>
				<textElement textAlignment="Left" lineSpacing="Single">
					<font fontName="Tahoma"/>
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				<text><![CDATA[Agama]]></text>
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				<textElement textAlignment="Left" lineSpacing="Single">
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				<text><![CDATA[:]]></text>
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				<textElement textAlignment="Left" lineSpacing="Single">
					<font fontName="Tahoma"/>
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				<text><![CDATA[No Telp ( Rumah/HP )]]></text>
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				<textElement textAlignment="Left" lineSpacing="Single">
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				<text><![CDATA[Nama Keluarga]]></text>
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				<textElement textAlignment="Left" lineSpacing="Single">
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				<text><![CDATA[Status]]></text>
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				<textElement textAlignment="Left" lineSpacing="Single">
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				<text><![CDATA[Bila Ada Sesuatu]]></text>
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				<text><![CDATA[:]]></text>
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