<band height="78" splitType="Stretch">
<staticText>
<reportElement x="1" y="55" width="550" height="23" uuid="ee7a4847-ec68-44b5-a675-e2643f0be1a3"/>
<textElement textAlignment="Center">
<font fontName="Tahoma" size="12" isBold="false"/>
<paragraph lineSpacing="Single"/>
</textElement>
<text><![CDATA[FORMULIR PEMINTAAN RAWAT INAP]]></text>
</staticText>
<textField>
<reportElement x="3" y="25" width="548" height="14" uuid="56fa4d7b-b138-45bb-850e-181f8ae26a22"/>
<textElement textAlignment="Center">
<font fontName="Tahoma" size="9"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[$P{kontakrs}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="3" y="0" width="548" height="17" uuid="2a991d2e-fd65-4f37-943c-bcd7410d81e3"/>
<textElement textAlignment="Center">
<font fontName="Tahoma" size="12"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[$P{namars}]]></textFieldExpression>
</textField>
<textField>
<reportElement x="3" y="35" width="548" height="14" uuid="9fb32a30-de31-462e-9e03-25c48f8a7d10"/>
<textElement textAlignment="Center">
<font fontName="Tahoma" size="9"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA["E-mail : "+$P{emailrs}]]></textFieldExpression>
</textField>
<line>
<reportElement x="1" y="48" width="550" height="1" uuid="2e3fd572-d8af-4258-a84f-86e433df1a6e"/>
<graphicElement>
<pen lineWidth="2.0" lineStyle="Double"/>
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</line>
<textField>
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<textElement textAlignment="Center">
<font fontName="Tahoma" size="9"/>
<paragraph lineSpacing="Single"/>
</textElement>
<textFieldExpression><![CDATA[$P{alamatrs}+", "+$P{kotars}+", "+$P{propinsirs}]]></textFieldExpression>
</textField>
<image scaleImage="FillFrame" onErrorType="Blank">
<reportElement x="1" y="2" width="48" height="45" uuid="e9ea9c07-72ec-4135-9175-8de22b552029"/>
<imageExpression><![CDATA[$P{logo}]]></imageExpression>
</image>
</band>