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<text><![CDATA[Nomor Kode RS]]></text>
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<text><![CDATA[No. RM]]></text>
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<textFieldExpression><![CDATA[3311228]]></textFieldExpression>
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<textFieldExpression><![CDATA[$F{no_rkm_medis}]]></textFieldExpression>
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<textFieldExpression><![CDATA[$F{jk}.equals("L")? "Laki-Laki":"Perempuan"]]></textFieldExpression>
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<text><![CDATA[:]]></text>
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<text><![CDATA[No. Kartu Pasien]]></text>
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<textFieldExpression><![CDATA[$F{tgl_lahir}]]></textFieldExpression>
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<text><![CDATA[Tanggal Lahir]]></text>
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<text><![CDATA[:]]></text>
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<text><![CDATA[A. DIAGNOSIS]]></text>
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<text><![CDATA[Dokter yang merawat]]></text>
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<text><![CDATA[Nama Dokter]]></text>
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<text><![CDATA[Peserta BPJS]]></text>
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<text><![CDATA[:]]></text>
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<text><![CDATA[PBI Kelas III]]></text>
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<text><![CDATA[Executive.......]]></text>
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<text><![CDATA[Kode ICD X]]></text>
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<text><![CDATA[Kode ICD IX]]></text>
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<text><![CDATA[B. TINDAKAN / PROSEDUR]]></text>
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<text><![CDATA[C. PEMERIKSAAN PENUNJANG]]></text>
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<text><![CDATA[D. BIAYA]]></text>
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<textFieldExpression><![CDATA[$P{kotars}+", ..................................."]]></textFieldExpression>
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<text><![CDATA[LEMBAR CASEMIX]]></text>
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<text><![CDATA[Diagnosis utama :]]></text>
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<text><![CDATA[Diagnosis Sekunder :]]></text>
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<text><![CDATA[Operatif :]]></text>
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<text><![CDATA[Non Operatif :]]></text>
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<text><![CDATA[C A R E | C O M M I T M E N T | C O N S C I E N C E]]></text>
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<text><![CDATA[Peserta JKN]]></text>
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