<band height="381">
<rectangle>
<reportElement x="45" y="1" width="510" height="379"/>
<graphicElement>
<pen lineWidth="1.0"/>
</graphicElement>
</rectangle>
<textField>
<reportElement mode="Transparent" x="180" y="97" width="375" height="13"/>
<textElement verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="10" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$F{nm_pasien}]]></textFieldExpression>
</textField>
<staticText>
<reportElement x="57" y="97" width="116" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Nama]]></text>
</staticText>
<staticText>
<reportElement mode="Opaque" x="45" y="59" width="510" height="18" forecolor="#FFFFFF" backcolor="#464646"/>
<textElement textAlignment="Center" verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="12" isBold="true" isItalic="true"/>
</textElement>
<text><![CDATA[SCREENING AWAL PASIEN MASUK RAWAT JALAN]]></text>
</staticText>
<staticText>
<reportElement x="173" y="97" width="5" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<textField>
<reportElement mode="Transparent" x="276" y="111" width="251" height="13"/>
<textElement verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="10" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[" / "+$F{jk}.replaceAll("L","Laki-Laki").replaceAll("P","Perempuan")]]></textFieldExpression>
</textField>
<staticText>
<reportElement x="172" y="111" width="5" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="56" y="111" width="116" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Tgl. Lahir / Jenis Kel.]]></text>
</staticText>
<textField>
<reportElement mode="Transparent" x="179" y="125" width="378" height="13"/>
<textElement verticalAlignment="Top" lineSpacing="Single">
<font fontName="Tahoma" size="10" isBold="false"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$F{alamat}]]></textFieldExpression>
</textField>
<staticText>
<reportElement x="172" y="125" width="5" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<staticText>
<reportElement x="56" y="125" width="116" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Alamat]]></text>
</staticText>
<staticText>
<reportElement x="195" y="146" width="47" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Lokal]]></text>
</staticText>
<textField pattern="dd/MM/yyyy">
<reportElement mode="Transparent" x="180" y="111" width="96" height="13"/>
<textElement verticalAlignment="Middle" lineSpacing="Single">
<font fontName="Tahoma" size="10" isBold="false"/>
</textElement>
<textFieldExpression class="java.util.Date"><![CDATA[$F{tgl_lahir}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="114" y="21" width="368" height="14"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma" size="10"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{alamatrs}+", "+$P{kotars}+", "+$P{propinsirs}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="114" y="32" width="368" height="14"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma" size="10"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{kontakrs}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="114" y="5" width="368" height="17"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma" size="14"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA[$P{namars}]]></textFieldExpression>
</textField>
<image scaleImage="FillFrame" onErrorType="Blank">
<reportElement x="60" y="5" width="51" height="51"/>
<imageExpression class="java.io.InputStream"><![CDATA[$P{logo}]]></imageExpression>
</image>
<textField>
<reportElement x="114" y="43" width="368" height="14"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma" size="10"/>
</textElement>
<textFieldExpression class="java.lang.String"><![CDATA["E-mail : "+$P{emailrs}]]></textFieldExpression>
</textField>
<staticText>
<reportElement x="57" y="83" width="116" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" isBold="true" isUnderline="true"/>
</textElement>
<text><![CDATA[Identitas Pasien :]]></text>
</staticText>
<staticText>
<reportElement x="56" y="146" width="116" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" isBold="true" isUnderline="true"/>
</textElement>
<text><![CDATA[Bahasa]]></text>
</staticText>
<staticText>
<reportElement x="172" y="146" width="5" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<rectangle>
<reportElement x="180" y="147" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="245" y="146" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="260" y="145" width="47" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Nasional]]></text>
</staticText>
<staticText>
<reportElement x="323" y="145" width="29" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Asing]]></text>
</staticText>
<rectangle>
<reportElement x="308" y="146" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="355" y="145" width="5" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<line>
<reportElement x="366" y="157" width="161" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement x="56" y="161" width="116" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" isBold="true" isUnderline="true"/>
</textElement>
<text><![CDATA[Kesadaran]]></text>
</staticText>
<staticText>
<reportElement x="172" y="161" width="5" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[:]]></text>
</staticText>
<rectangle>
<reportElement x="180" y="162" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="195" y="161" width="65" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Sadar Penuh]]></text>
</staticText>
<staticText>
<reportElement x="276" y="161" width="65" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Somenolen]]></text>
</staticText>
<rectangle>
<reportElement x="261" y="162" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="345" y="162" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="360" y="161" width="65" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Coma]]></text>
</staticText>
<staticText>
<reportElement x="56" y="182" width="154" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" isBold="true" isUnderline="true"/>
</textElement>
<text><![CDATA[Trasnportasi & Mobiliosasi :]]></text>
</staticText>
<rectangle>
<reportElement x="56" y="197" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="71" y="196" width="174" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Jalan sendiri]]></text>
</staticText>
<rectangle>
<reportElement x="56" y="212" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="71" y="211" width="174" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Jalan dengan dibantu orang lain]]></text>
</staticText>
<staticText>
<reportElement x="71" y="226" width="124" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Jalan dengan dibantu alat :]]></text>
</staticText>
<rectangle>
<reportElement x="56" y="227" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<line>
<reportElement x="196" y="238" width="331" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement x="56" y="246" width="154" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma" isBold="true" isUnderline="true"/>
</textElement>
<text><![CDATA[Pasien diteruskan ke :]]></text>
</staticText>
<rectangle>
<reportElement x="56" y="261" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="71" y="260" width="150" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[IGD]]></text>
</staticText>
<rectangle>
<reportElement x="56" y="276" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="71" y="275" width="53" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Poliklinik :]]></text>
</staticText>
<line>
<reportElement x="126" y="287" width="135" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<rectangle>
<reportElement x="287" y="261" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="302" y="260" width="114" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Pemeriksaan Radiologi :]]></text>
</staticText>
<staticText>
<reportElement x="427" y="260" width="42" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Kontrol]]></text>
</staticText>
<rectangle>
<reportElement x="412" y="261" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<rectangle>
<reportElement x="471" y="261" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="486" y="260" width="42" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Sinar]]></text>
</staticText>
<staticText>
<reportElement x="302" y="275" width="114" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Pemeriksaan Radiologi :]]></text>
</staticText>
<rectangle>
<reportElement x="287" y="276" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<staticText>
<reportElement x="71" y="290" width="53" height="13"/>
<textElement textAlignment="Left" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Lain-lain :]]></text>
</staticText>
<rectangle>
<reportElement x="56" y="291" width="11" height="11"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</rectangle>
<line>
<reportElement x="126" y="302" width="401" height="1"/>
<graphicElement>
<pen lineWidth="0.5"/>
</graphicElement>
</line>
<staticText>
<reportElement x="372" y="310" width="114" height="13"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Petugas Screening,]]></text>
</staticText>
<staticText>
<reportElement x="358" y="362" width="148" height="13"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma"/>
</textElement>
<text><![CDATA[Tanda tangan & Nama Terang]]></text>
</staticText>
<staticText>
<reportElement x="339" y="350" width="186" height="13"/>
<textElement textAlignment="Center" lineSpacing="Single">
<font fontName="Tahoma" isUnderline="true"/>
</textElement>
<text><![CDATA[( )]]></text>
</staticText>
</band>