2014年河南省公务员招警考试体检项目表人事部、卫生部现行标准的《公务员录用体检表》
<p class="MsoBodyTextIndent" style="text-indent:37.75pt"><span lang="EN-US"> </span></p><p class="MsoBodyTextIndent2" style="text-indent:33.7pt"><b><span lang="EN-US" style="mso-bidi-font-size:16.0pt;font-family:宋体;color:red"> </span></b></p>
<p class="MsoNormal" align="right" style="text-align:right"><b><span style="font-size:18.0pt;mso-bidi-font-size:12.0pt;font-family:
楷体_GB2312;mso-hansi-font-family:宋体;letter-spacing:2.2pt">体检编号</span></b><b><span lang="EN-US" style="font-size:18.0pt;
mso-bidi-font-size:12.0pt;font-family:楷体_GB2312;letter-spacing:2.2pt">00001</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt;font-family:楷体_GB2312;mso-hansi-font-family:宋体;
letter-spacing:2.2pt"><o:p></o:p></span></b></p>
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mso-fareast-font-family:黑体;letter-spacing:2.2pt"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:34.0pt;
mso-line-height-rule:exactly"><b><span style="font-size:22.0pt;mso-bidi-font-size:12.0pt;font-family:宋体;mso-ascii-font-family:
"Times New Roman";mso-hansi-font-family:"Times New Roman";letter-spacing:1.0pt">公务员录用</span></b><b><span lang="EN-US" style="font-size:22.0pt;
mso-bidi-font-size:12.0pt;letter-spacing:1.0pt"><o:p></o:p></span></b></p>
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mso-line-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;letter-spacing:
1.1pt"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="font-size:48.0pt;mso-bidi-font-size:12.0pt;font-family:
黑体;mso-ascii-font-family:"Times New Roman";letter-spacing:.8pt">体</span></b><b><span lang="EN-US" style="font-size:48.0pt;
mso-bidi-font-size:12.0pt;mso-fareast-font-family:黑体;letter-spacing:.8pt"> </span></b><b><span style="font-size:48.0pt;mso-bidi-font-size:12.0pt;font-family:
黑体;mso-ascii-font-family:"Times New Roman";letter-spacing:.8pt">检</span></b><b><span lang="EN-US" style="font-size:48.0pt;
mso-bidi-font-size:12.0pt;mso-fareast-font-family:黑体;letter-spacing:.8pt"> </span></b><b><span style="font-size:48.0pt;mso-bidi-font-size:12.0pt;font-family:
黑体;mso-ascii-font-family:"Times New Roman";letter-spacing:.8pt">表</span></b><b><span lang="EN-US" style="font-size:48.0pt;
mso-bidi-font-size:12.0pt;mso-fareast-font-family:黑体;letter-spacing:2.2pt"><o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:宋体"> </span></b></p>
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<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;
font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;
font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;
font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;
font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="font-size:22.0pt;mso-bidi-font-size:12.0pt;font-family:
黑体;mso-hansi-font-family:宋体;letter-spacing:1.0pt">中华人民共和国人事部<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="font-size:22.0pt;mso-bidi-font-size:12.0pt;font-family:
黑体;mso-hansi-font-family:宋体;letter-spacing:1.0pt">中华人民共和国卫生部</span></b><b><span lang="EN-US" style="font-family:黑体;
mso-hansi-font-family:宋体;letter-spacing:1.0pt"><o:p></o:p></span></b></p>
<p class="MsoNormal" style="text-indent:136.4pt"><b><span lang="EN-US" style="font-size:24.0pt;mso-bidi-font-size:12.0pt;
font-family:黑体;mso-hansi-font-family:宋体;letter-spacing:5.0pt"> </span></b></p>
<p class="MsoNormal" style="text-indent:136.4pt"><b><span style="font-size:24.0pt;mso-bidi-font-size:12.0pt;font-family:
黑体;mso-hansi-font-family:宋体;letter-spacing:5.0pt">体检须知<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">为了准确反映受检者身体的真实状况,请注意以下事项:<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">1.</span><span style="font-size:15.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">均应到指定医院进行体检,其它医疗单位的检查结果一律无效。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">2.</span><span style="font-size:15.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">严禁弄虚作假、冒名顶替;如隐瞒病史影响体检结果的,后果自负。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">3.</span><span style="font-size:15.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">体检表上贴近期二寸免冠照片一张,并加盖公章。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">4.</span><span style="font-size:15.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">本表第二页由受检者本人填写(用黑色签字笔或钢笔),要求字迹清楚,无涂改,病史部分要如实、逐项填齐,不能遗漏。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">5.</span><span style="font-size:15.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">体检前一天请注意休息,勿熬夜,不要饮酒,避免剧烈运动。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">6.</span><span style="font-size:15.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">体检当天需进行采血、<span lang="EN-US">B</span>超等检查,请在受检前禁食<span lang="EN-US">8-12</span>小时。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">7.</span><span style="font-size:15.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">女性受检者月经期间请勿做妇科及尿液检查,待经期完毕后再补检;怀孕或可能已受孕者,事先告知医护人员,勿做<span lang="EN-US">X</span>光检查。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">8.</span><span style="font-size:15.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">请配合医生认真检查所有项目,勿漏检。若自动放弃某一检查项目,将会影响对您的录用。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">9.</span><span style="font-size:15.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">体检医师可根据实际需要,增加必要的相应检查、检验项目。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体">10.</span><span style="font-size:15.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">如对体检结果有疑义,请按有关规定办理。<span lang="EN-US"><o:p></o:p></span></span></p>
<p class="MsoNormal" style="text-indent:31.6pt;mso-char-indent-count:2.0"><span lang="EN-US" style="font-size:15.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></p>
<div align="center">
<table class="MsoNormalTable" border="1" cellspacing="0" cellpadding="0" style="border: none;">
<tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid;
height:20.4pt">
<td width="79" colspan="2" style="width: 59.45pt; border-width: 1.5pt 1pt 1pt 1.5pt; border-color: windowtext; padding: 0cm 5.4pt; height: 20.4pt;">
<p class="MsoNormal" align="center" style="text-align:center;tab-stops:27.0pt"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体;letter-spacing:
1.5pt;mso-font-kerning:0pt">姓 名</span></b><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"><o:p></o:p></span></b></p>
</td>
<td width="72" colspan="2" style="width: 54pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 20.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
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<td width="132" colspan="5" style="width: 99pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 20.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">性 别<span lang="EN-US"><o:p></o:p></span></span></b></p>
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<td width="60" style="width: 45pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 20.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
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<td width="84" colspan="2" style="width: 63pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 20.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">出生年月<span lang="EN-US"><o:p></o:p></span></span></b></p>
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<td width="48" style="width: 36pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 20.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
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<td width="99" colspan="2" rowspan="5" style="width: 73.95pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 20.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">照<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">片<span lang="EN-US"><o:p></o:p></span></span></b></p>
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<tr style="mso-yfti-irow:1;page-break-inside:avoid;height:27.35pt">
<td width="79" colspan="2" style="width: 59.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 27.35pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">民 族<span lang="EN-US"><o:p></o:p></span></span></b></p>
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<td width="72" colspan="2" style="width: 54pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 27.35pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="132" colspan="5" style="width: 99pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 27.35pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">婚 姻状况<span lang="EN-US"><o:p></o:p></span></span></b></p>
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<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 27.35pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 27.35pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">籍 贯<span lang="EN-US"><o:p></o:p></span></span></b></p>
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<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 27.35pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
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<tr style="mso-yfti-irow:2;page-break-inside:avoid;height:19.3pt">
<td width="79" colspan="2" style="width: 59.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 19.3pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">文化程度<span lang="EN-US"><o:p></o:p></span></span></b></p>
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<td width="72" colspan="2" style="width: 54pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 19.3pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
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<td width="132" colspan="5" style="width: 99pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 19.3pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">联系电话<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="192" colspan="4" style="width: 144pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 19.3pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:3;page-break-inside:avoid;height:11.9pt">
<td width="79" colspan="2" style="width: 59.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 11.9pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">职 业<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="72" colspan="2" style="width: 54pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 11.9pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="132" colspan="5" style="width: 99pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 11.9pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">工作单位<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">(毕业院校)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="192" colspan="4" style="width: 144pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 11.9pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:4;page-break-inside:avoid;height:18.6pt">
<td width="79" colspan="2" style="width: 59.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 18.6pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">报考职位<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="72" colspan="2" style="width: 54pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 18.6pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="132" colspan="5" style="width: 99pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 18.6pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">身份证号<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="192" colspan="4" style="width: 144pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 18.6pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:5;page-break-inside:avoid;height:1.0pt">
<td width="574" colspan="15" style="width: 430.4pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 1pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:19.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">请本人如实详细填写下列项目<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">(在每一项后的空格中打“<span lang="EN-US">√</span>”回答“有”或“无”,如故意隐瞒,后果自负)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:6;page-break-inside:avoid;height:29.25pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">病名<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">有<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">无<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">治愈时间<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">病名<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">有<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">无<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 29.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">治愈时间<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:7;page-break-inside:avoid;height:1.0cm">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">高血压病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">糖尿病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:8;page-break-inside:avoid;height:21.0pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">冠心病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">甲亢<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:9;page-break-inside:avoid;height:22.05pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 22.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">风心病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 22.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 22.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 22.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 22.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">贫血<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 22.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 22.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 22.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:10;page-break-inside:avoid;height:21.0pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">先心病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">癫痫<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:11;page-break-inside:avoid;height:29.4pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">心肌病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">精神病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 29.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:12;page-break-inside:avoid;height:21.0pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">支气管扩张<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">神经官能症<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:13;page-break-inside:avoid;height:23.45pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 23.45pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">支气管哮喘<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 23.45pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 23.45pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 23.45pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 23.45pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">吸毒史<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 23.45pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 23.45pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 23.45pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:14;page-break-inside:avoid;height:31.1pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 31.1pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">肺气肿<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 31.1pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 31.1pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 31.1pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 31.1pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">急慢性肝炎<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 31.1pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 31.1pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 31.1pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:15;page-break-inside:avoid;height:24.85pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 24.85pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">消化性溃疡<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 24.85pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 24.85pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 24.85pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 24.85pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">结核病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 24.85pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 24.85pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 24.85pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:16;page-break-inside:avoid;height:25.2pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.2pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">肝硬化<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.2pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.2pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.2pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.2pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">性传播疾病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.2pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.2pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 25.2pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:17;page-break-inside:avoid;height:25.55pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.55pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">胰腺疾病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.55pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.55pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.55pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.55pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">恶性肿瘤<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.55pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 25.55pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 25.55pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:18;page-break-inside:avoid;height:21.0pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">急慢性肾炎<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">手术史<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 21pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:19;page-break-inside:avoid;height:26.25pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">肾功能不全<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">严重外伤史<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 26.25pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:20;page-break-inside:avoid;height:29.05pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.05pt;">
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">结缔组织病<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" colspan="2" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="3" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="48" style="width: 36pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 29.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="99" colspan="2" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 29.05pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:21;page-break-inside:avoid;height:68.4pt">
<td width="91" colspan="3" style="width: 68.45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 68.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">备 注:<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="483" colspan="12" style="width: 361.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 68.4pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:22;page-break-inside:avoid;height:63.15pt">
<td width="574" colspan="15" style="width: 430.4pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 63.15pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> <o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">受检者签字:<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">体检日期:<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"> </span>日<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:23;page-break-inside:avoid;height:36.0pt">
<td width="57" style="width: 43pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">身高<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="130" colspan="4" style="width: 97.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">厘米<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" colspan="2" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">体重<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="96" colspan="3" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="right" style="margin-left:20.05pt;text-align:right;
text-indent:-20.05pt;mso-char-indent-count:-1.77"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">公斤<span lang="EN-US"> <o:p></o:p></span></span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">血压<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="147" colspan="3" style="width: 109.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" style="text-indent:42.15pt"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体">/
mmHg <o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:24;page-break-inside:avoid;height:36.0pt">
<td width="57" rowspan="6" style="width: 43pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">内<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="517" colspan="14" style="width: 387.4pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" style="text-indent:12.05pt"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">病史:曾患过何种疾病(起病时间及目前症状)。<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="text-indent:12.05pt"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:25;page-break-inside:avoid;height:36.0pt">
<td width="94" colspan="3" style="width: 70.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">心脏<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="192" colspan="6" style="width: 144pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">心界<span lang="EN-US"> <o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">杂音<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="231" colspan="5" style="width: 172.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">心率<span lang="EN-US"> </span>次<span lang="EN-US">/</span>分<span lang="EN-US"> </span>律<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:26;page-break-inside:avoid;height:36.0pt">
<td width="94" colspan="3" style="width: 70.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">肺<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="192" colspan="6" style="width: 144pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">腹部<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="147" colspan="3" style="width: 109.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:27;page-break-inside:avoid;height:36.0pt">
<td width="94" colspan="3" style="width: 70.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">肝<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="192" colspan="6" style="width: 144pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">神经系统<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="147" colspan="3" style="width: 109.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:28;page-break-inside:avoid;height:36.0pt">
<td width="94" colspan="3" style="width: 70.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">脾<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="192" colspan="6" style="width: 144pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="147" colspan="3" style="width: 109.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:29;page-break-inside:avoid;height:36.0pt">
<td width="94" colspan="3" style="width: 70.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="276" colspan="8" style="width: 207pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="77" colspan="2" style="width: 57.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="70" style="width: 52.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:30;page-break-inside:avoid;height:36.0pt">
<td width="57" rowspan="6" style="width: 43pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">外<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="517" colspan="14" style="width: 387.4pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">病史:曾做过何种手术或有无外伤史(名称及时间),目前功能如何。<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:31;page-break-inside:avoid;height:36.0pt">
<td width="142" colspan="5" style="width: 106.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">甲状腺<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" colspan="4" style="width: 108pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">乳腺<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="147" colspan="3" style="width: 109.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:32;page-break-inside:avoid;height:36.0pt">
<td width="142" colspan="5" style="width: 106.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">浅表<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">淋巴结<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" colspan="4" style="width: 108pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">皮肤<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="147" colspan="3" style="width: 109.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:33;page-break-inside:avoid;height:36.0pt">
<td width="142" colspan="5" style="width: 106.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">脊柱<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">四肢关节<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" colspan="4" style="width: 108pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">头颅<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="147" colspan="3" style="width: 109.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:34;page-break-inside:avoid;height:36.0pt">
<td width="142" colspan="5" style="width: 106.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">肛门<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">外生殖器<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" colspan="4" style="width: 108pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="147" colspan="3" style="width: 109.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:35;page-break-inside:avoid;height:36.0pt">
<td width="142" colspan="5" style="width: 106.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="228" colspan="6" style="width: 171pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="77" colspan="2" style="width: 57.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="70" style="width: 52.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:36;page-break-inside:avoid;height:36.0pt">
<td width="57" rowspan="5" style="width: 43pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">眼<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="142" colspan="5" rowspan="2" style="width: 106.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">裸眼<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">视力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="72" colspan="2" style="width: 54pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">右<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="72" colspan="2" rowspan="2" style="width: 54pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">矫正<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">视力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">右<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="77" colspan="2" rowspan="2" style="width: 57.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="70" rowspan="2" style="width: 52.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:37;page-break-inside:avoid;height:36.0pt">
<td width="72" colspan="2" style="width: 54pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">左<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="84" colspan="2" style="width: 63pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">左<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:38;page-break-inside:avoid;height:36.0pt">
<td width="142" colspan="5" style="width: 106.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">色觉<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="375" colspan="9" style="width: 280.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:39;page-break-inside:avoid;height:36.0pt">
<td width="142" colspan="5" style="width: 106.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="375" colspan="9" style="width: 280.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" style="text-indent:24.1pt"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:40;mso-yfti-lastrow:yes;page-break-inside:avoid;
height:36.0pt">
<td width="142" colspan="5" style="width: 106.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="228" colspan="6" style="width: 171pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="77" colspan="2" style="width: 57.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="70" style="width: 52.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<!---->
<tr height="0">
<td width="57" style="border: none;"></td>
<td width="22" style="border: none;"></td>
<td width="12" style="border: none;"></td>
<td width="60" style="border: none;"></td>
<td width="36" style="border: none;"></td>
<td width="12" style="border: none;"></td>
<td width="48" style="border: none;"></td>
<td width="24" style="border: none;"></td>
<td width="12" style="border: none;"></td>
<td width="60" style="border: none;"></td>
<td width="36" style="border: none;"></td>
<td width="48" style="border: none;"></td>
<td width="48" style="border: none;"></td>
<td width="29" style="border: none;"></td>
<td width="70" style="border: none;"></td>
</tr>
<!---->
</tbody></table>
</div>
<table class="MsoNormalTable" border="1" cellspacing="0" cellpadding="0" style="border: none;">
<tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid;
height:45.35pt">
<td width="47" rowspan="5" style="width: 35.5pt; border-width: 1.5pt 1pt 1pt 1.5pt; border-color: windowtext; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:宋体">耳鼻喉科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="109" colspan="2" style="width: 82.1pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">听力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="209" colspan="3" style="width: 156.8pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:宋体">左耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:宋体">右耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="111" style="width: 83.25pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">嗅觉<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="211" colspan="2" valign="top" style="width: 158pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" style="text-indent:12.05pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:1;page-break-inside:avoid;height:35.45pt">
<td width="109" colspan="2" style="width: 82.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">外耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="209" colspan="3" style="width: 156.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly;
mso-element:frame;mso-element-frame-hspace:9.0pt;mso-element-wrap:around;
mso-element-anchor-vertical:page;mso-element-anchor-horizontal:page;
mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="111" style="width: 83.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">鼻<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="211" colspan="2" style="width: 158pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:2;page-break-inside:avoid;height:35.45pt">
<td width="109" colspan="2" style="width: 82.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">鼻咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="209" colspan="3" style="width: 156.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
<td width="111" style="width: 83.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">口咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="211" colspan="2" style="width: 158pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:3;page-break-inside:avoid;height:35.45pt">
<td width="109" colspan="2" style="width: 82.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">喉咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="209" colspan="3" style="width: 156.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
<td width="111" style="width: 83.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="211" colspan="2" style="width: 158pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:4;page-break-inside:avoid;height:35.45pt">
<td width="109" colspan="2" style="width: 82.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="320" colspan="4" style="width: 240.05pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
<td width="94" style="width: 70.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="117" style="width: 87.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:5;page-break-inside:avoid;height:1.0cm">
<td width="47" rowspan="4" style="width: 35.5pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:宋体">口腔科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="109" colspan="2" style="width: 82.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">唇腭<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="208" colspan="2" style="width: 156.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:宋体"> </span></b></p>
</td>
<td width="112" colspan="2" style="width: 83.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">舌<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="211" colspan="2" valign="top" style="width: 158pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:6;page-break-inside:avoid;height:32.6pt">
<td width="109" colspan="2" style="width: 82.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.6pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">龋齿<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="208" colspan="2" style="width: 156.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.6pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:宋体"> </span></b></p>
</td>
<td width="112" colspan="2" style="width: 83.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.6pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">口吃<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="211" colspan="2" style="width: 158pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.6pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:7;page-break-inside:avoid;height:39.7pt">
<td width="109" colspan="2" style="width: 82.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">口腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">粘膜<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="208" colspan="2" style="width: 156.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:宋体"> </span></b></p>
</td>
<td width="112" colspan="2" style="width: 83.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="211" colspan="2" style="width: 158pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:8;page-break-inside:avoid;height:35.45pt">
<td width="109" colspan="2" style="width: 82.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="320" colspan="4" style="width: 240.05pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
</td>
<td width="94" style="width: 70.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="117" style="width: 87.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:9;page-break-inside:avoid;height:104.9pt">
<td width="47" rowspan="6" style="width: 35.5pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 104.9pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:宋体;mso-ascii-font-family:
"Times New Roman";mso-hansi-font-family:"Times New Roman"">妇</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt"><o:p></o:p></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:宋体;mso-ascii-font-family:
"Times New Roman";mso-hansi-font-family:"Times New Roman"">科</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt;font-family:宋体"><o:p></o:p></span></b></p>
</td>
<td width="640" colspan="8" style="width: 480.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 104.9pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
宋体">病史<span lang="EN-US">: </span>初潮<span lang="EN-US"> </span>周期<span lang="EN-US"> </span>量(多、中、少)末次月经<span lang="EN-US"> </span>绝经年龄<span lang="EN-US"> </span>岁<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
宋体">结婚年龄:<span lang="EN-US"> </span>孕<span lang="EN-US"> </span>产<span lang="EN-US"> </span>末产<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
宋体">难产:<span lang="EN-US"> </span>手术史:</span></b><b><span lang="EN-US" style="font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:10;page-break-inside:avoid;height:35.45pt">
<td width="53" rowspan="5" style="width: 39.9pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">内<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:宋体">诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="70" colspan="2" style="width: 52.7pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="517" colspan="5" style="width: 387.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 35.45pt;">
<p class="MsoNormal" style="text-indent:36.15pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:宋体"> </span></b><b><span style="font-size:12.0pt;font-family:
宋体">阴道<span lang="EN-US"> </span>分泌物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:11;page-break-inside:avoid;height:36.85pt">
<td width="587" colspan="7" style="width: 440.25pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
宋体">宫颈:大小(正常、肥大、萎缩) 糜烂(无、轻、中、重) 质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:12;page-break-inside:avoid;height:36.85pt">
<td width="587" colspan="7" style="width: 440.25pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
宋体">宫体:<span lang="EN-US"> </span>位<span lang="EN-US"> </span>大小<span lang="EN-US"> </span>活动<span lang="EN-US"> </span>质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:13;page-break-inside:avoid;height:36.85pt">
<td width="587" colspan="7" style="width: 440.25pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
宋体">附件:正常<span lang="EN-US">
</span>压痛(左右)<span lang="EN-US">
</span>增厚(左右)<span lang="EN-US"> </span>肿物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:14;page-break-inside:avoid;height:36.85pt">
<td width="587" colspan="7" style="width: 440.25pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
宋体">刮片:<span lang="EN-US"> </span>初诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:15;mso-yfti-lastrow:yes;page-break-inside:avoid;
height:50.7pt">
<td width="688" colspan="9" style="width: 515.65pt; border-right-color: windowtext; border-bottom-color: windowtext; border-left-color: windowtext; border-right-width: 1.5pt; border-bottom-width: 1.5pt; border-left-width: 1.5pt; border-top-style: none; padding: 0cm 5.4pt; height: 50.7pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
宋体">建议:<span lang="EN-US">
</span>医师签字</span></b><b><span lang="EN-US" style="font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<!---->
<tr height="0">
<td width="47" style="border: none;"></td>
<td width="53" style="border: none;"></td>
<td width="56" style="border: none;"></td>
<td width="14" style="border: none;"></td>
<td width="194" style="border: none;"></td>
<td width="1" style="border: none;"></td>
<td width="111" style="border: none;"></td>
<td width="94" style="border: none;"></td>
<td width="117" style="border: none;"></td>
</tr>
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</tbody></table>
<table class="MsoNormalTable" border="1" cellspacing="0" cellpadding="0" style="border: none;">
<tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid;
height:45.35pt">
<td width="55" rowspan="5" style="width: 41.4pt; border-width: 1.5pt 1pt 1pt 1.5pt; border-color: windowtext; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">鼻<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">喉<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">听力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" style="width: 108pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
line-height:150%;font-family:宋体">左耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
line-height:150%;font-family:宋体">右耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="120" style="width: 90pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">耳部<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="195" colspan="3" valign="top" style="width: 145.95pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" style="text-indent:12.05pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:1;page-break-inside:avoid;height:34.0pt">
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">鼻部<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" style="width: 108pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly;
mso-element:frame;mso-element-frame-hspace:9.0pt;mso-element-wrap:around;
mso-element-anchor-vertical:page;mso-element-anchor-horizontal:margin;
mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体">
<o:p></o:p></span></b></p>
</td>
<td width="120" style="width: 90pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">咽部<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="195" colspan="3" style="width: 145.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:2;page-break-inside:avoid;height:34.0pt">
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">喉部<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="459" colspan="5" style="width: 343.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:3;page-break-inside:avoid;height:34.0pt">
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="459" colspan="5" style="width: 343.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" style="text-indent:24.1pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:4;page-break-inside:avoid;height:34.0pt">
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="264" colspan="2" style="width: 198pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:5;page-break-inside:avoid;height:1.0cm">
<td width="55" rowspan="4" style="width: 41.4pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">口<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">唇腭舌<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" style="width: 108pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="120" style="width: 90pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">颞下颌关节<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="195" colspan="3" valign="top" style="width: 145.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 1cm;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:6;page-break-inside:avoid;height:39.7pt">
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">腮腺<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" style="width: 108pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="120" style="width: 90pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="195" colspan="3" style="width: 145.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:7;page-break-inside:avoid;height:39.7pt">
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">口腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">粘膜<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" style="width: 108pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="120" style="width: 90pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="195" colspan="3" style="width: 145.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:8;page-break-inside:avoid;height:34.0pt">
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="264" colspan="2" style="width: 198pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="96" colspan="2" style="width: 72pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" style="width: 73.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:9;page-break-inside:avoid;height:45.35pt">
<td width="55" rowspan="9" style="width: 41.4pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">妇<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">科<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="519" colspan="6" style="width: 388.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 45.35pt;">
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">病史<span lang="EN-US">/</span>月经史:初潮<span lang="EN-US"> </span>岁<span lang="EN-US"> </span>经期<span lang="EN-US">/</span>周期<span lang="EN-US"> / </span>量(多、中、少) 末次月经<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:10;page-break-inside:avoid;height:39.7pt">
<td width="519" colspan="6" style="width: 388.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 39.7pt;">
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">检查项目:<span lang="EN-US">1.</span>已婚女性作外阴部检查、阴道窥器检查及阴道<span lang="EN-US">-</span>腹部双合诊检查。<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> 2.</span></b><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">未婚女性作外阴部检查、直肠<span lang="EN-US">-</span>腹部双合诊检查。<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:11;page-break-inside:avoid;height:34.0pt">
<td width="204" colspan="2" style="width: 153pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">已婚女性(内诊)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="315" colspan="4" style="width: 235.95pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">未婚女性(肛诊)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:12;page-break-inside:avoid;height:34.0pt">
<td width="60" style="width: 45pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" style="width: 108pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> <o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="120" style="width: 90pt; border-right-color: windowtext; border-bottom-color: windowtext; border-left-color: windowtext; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; border-top-style: none; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="195" colspan="3" style="width: 145.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> <o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:13;page-break-inside:avoid;height:34.0pt">
<td width="60" style="width: 45pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">阴道<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" style="width: 108pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="120" style="width: 90pt; border-right-color: windowtext; border-bottom-color: windowtext; border-left-color: windowtext; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; border-top-style: none; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体">/<o:p></o:p></span></b></p>
</td>
<td width="195" colspan="3" style="width: 145.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:14;page-break-inside:avoid;height:34.0pt">
<td width="60" style="width: 45pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">宫颈<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" style="width: 108pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="120" style="width: 90pt; border-right-color: windowtext; border-bottom-color: windowtext; border-left-color: windowtext; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; border-top-style: none; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体">/<o:p></o:p></span></b></p>
</td>
<td width="195" colspan="3" style="width: 145.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:15;page-break-inside:avoid;height:34.0pt">
<td width="60" style="width: 45pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">宫体<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" style="width: 108pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="120" style="width: 90pt; border-right-color: windowtext; border-bottom-color: windowtext; border-left-color: windowtext; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; border-top-style: none; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">宫体<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="195" colspan="3" style="width: 145.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:16;page-break-inside:avoid;height:34.0pt">
<td width="60" style="width: 45pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">附件<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="144" style="width: 108pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="120" style="width: 90pt; border-right-color: windowtext; border-bottom-color: windowtext; border-left-color: windowtext; border-right-width: 1pt; border-bottom-width: 1pt; border-left-width: 1pt; border-top-style: none; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">附件<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="195" colspan="3" style="width: 145.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal" style="text-indent:36.15pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
margin;mso-element-left:center;mso-element-top:72.8pt;mso-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:17;mso-yfti-lastrow:yes;page-break-inside:avoid;
height:42.55pt">
<td width="60" style="width: 45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 42.55pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="264" colspan="2" style="width: 198pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 42.55pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 64pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 42.55pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:margin;mso-element-left:center;mso-element-top:
72.8pt;mso-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="109" colspan="2" style="width: 81.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 42.55pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<!---->
<tr height="0">
<td width="55" style="border: none;"></td>
<td width="60" style="border: none;"></td>
<td width="144" style="border: none;"></td>
<td width="120" style="border: none;"></td>
<td width="85" style="border: none;"></td>
<td width="11" style="border: none;"></td>
<td width="99" style="border: none;"></td>
</tr>
<!---->
</tbody></table>
<table class="MsoNormalTable" border="1" cellspacing="0" cellpadding="0" style="border: none;">
<tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid;
height:41.85pt">
<td width="43" rowspan="5" style="width: 32.2pt; border-width: 1.5pt 1pt 1pt 1.5pt; border-color: windowtext; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">耳鼻喉科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">听力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">左耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">右耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">嗅觉<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="text-indent:12.05pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:1;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">外耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly;
mso-element:frame;mso-element-frame-hspace:9.0pt;mso-element-wrap:around;
mso-element-anchor-vertical:page;mso-element-anchor-horizontal:page;
mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:2;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:3;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">喉咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:4;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:5;page-break-inside:avoid;height:26.15pt">
<td width="43" rowspan="4" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">唇腭<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">舌<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:6;page-break-inside:avoid;height:30.1pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">龋齿<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口吃<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:7;page-break-inside:avoid;height:36.65pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">粘膜<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:8;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:9;page-break-inside:avoid;height:96.85pt">
<td width="43" rowspan="6" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">妇<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">科</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
<td width="580" colspan="8" style="width: 435.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">病史<span lang="EN-US">: </span>初潮<span lang="EN-US"> </span>周期<span lang="EN-US"> </span>量(多、中、少)末次月经<span lang="EN-US"> </span>绝经年龄<span lang="EN-US"> </span>岁<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">结婚年龄:<span lang="EN-US"> </span>孕<span lang="EN-US"> </span>产<span lang="EN-US"> </span>末产<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">难产:<span lang="EN-US"> </span>手术史:</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:10;page-break-inside:avoid;height:32.7pt">
<td width="48" rowspan="5" style="width: 36.2pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">内<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="64" colspan="2" style="width: 47.8pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="468" colspan="5" style="width: 351.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="text-indent:36.15pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体">阴道<span lang="EN-US"> </span>分泌物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:11;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫颈:大小(正常、肥大、萎缩) 糜烂(无、轻、中、重) 质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:12;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫体:<span lang="EN-US"> </span>位<span lang="EN-US"> </span>大小<span lang="EN-US"> </span>活动<span lang="EN-US"> </span>质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:13;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">附件:正常<span lang="EN-US"> </span>压痛(左右)<span lang="EN-US"> </span>增厚(左右)<span lang="EN-US"> </span>肿物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:14;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">刮片:<span lang="EN-US"> </span>初诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:15;page-break-inside:avoid;height:46.8pt">
<td width="623" colspan="9" style="width: 467.55pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 46.8pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">建议:<span lang="EN-US"> </span>医师签字</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:16;page-break-inside:avoid;height:41.85pt">
<td width="43" rowspan="5" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">耳鼻喉科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">听力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">左耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">右耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">嗅觉<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="text-indent:12.05pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:17;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">外耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly;
mso-element:frame;mso-element-frame-hspace:9.0pt;mso-element-wrap:around;
mso-element-anchor-vertical:page;mso-element-anchor-horizontal:page;
mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:18;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:19;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">喉咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:20;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:21;page-break-inside:avoid;height:26.15pt">
<td width="43" rowspan="4" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">唇腭<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">舌<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:22;page-break-inside:avoid;height:30.1pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">龋齿<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口吃<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:23;page-break-inside:avoid;height:36.65pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">粘膜<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:24;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:25;page-break-inside:avoid;height:96.85pt">
<td width="43" rowspan="6" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">妇<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">科</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
<td width="580" colspan="8" style="width: 435.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">病史<span lang="EN-US">: </span>初潮<span lang="EN-US"> </span>周期<span lang="EN-US"> </span>量(多、中、少)末次月经<span lang="EN-US"> </span>绝经年龄<span lang="EN-US"> </span>岁<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">结婚年龄:<span lang="EN-US"> </span>孕<span lang="EN-US"> </span>产<span lang="EN-US"> </span>末产<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">难产:<span lang="EN-US"> </span>手术史:</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:26;page-break-inside:avoid;height:32.7pt">
<td width="48" rowspan="5" style="width: 36.2pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">内<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="64" colspan="2" style="width: 47.8pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="468" colspan="5" style="width: 351.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="text-indent:36.15pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体">阴道<span lang="EN-US"> </span>分泌物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:27;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫颈:大小(正常、肥大、萎缩) 糜烂(无、轻、中、重) 质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:28;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫体:<span lang="EN-US"> </span>位<span lang="EN-US"> </span>大小<span lang="EN-US"> </span>活动<span lang="EN-US"> </span>质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:29;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">附件:正常<span lang="EN-US"> </span>压痛(左右)<span lang="EN-US"> </span>增厚(左右)<span lang="EN-US"> </span>肿物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:30;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">刮片:<span lang="EN-US"> </span>初诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:31;page-break-inside:avoid;height:46.8pt">
<td width="623" colspan="9" style="width: 467.55pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 46.8pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">建议:<span lang="EN-US">
</span>医师签字</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:32;page-break-inside:avoid;height:41.85pt">
<td width="43" rowspan="5" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">耳鼻喉科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">听力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">左耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">右耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">嗅觉<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="text-indent:12.05pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:33;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">外耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly;
mso-element:frame;mso-element-frame-hspace:9.0pt;mso-element-wrap:around;
mso-element-anchor-vertical:page;mso-element-anchor-horizontal:page;
mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:34;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:35;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">喉咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:36;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:37;page-break-inside:avoid;height:26.15pt">
<td width="43" rowspan="4" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">唇腭<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">舌<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:38;page-break-inside:avoid;height:30.1pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">龋齿<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口吃<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:39;page-break-inside:avoid;height:36.65pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">粘膜<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:40;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:41;page-break-inside:avoid;height:96.85pt">
<td width="43" rowspan="6" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">妇<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">科</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
<td width="580" colspan="8" style="width: 435.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">病史<span lang="EN-US">: </span>初潮<span lang="EN-US"> </span>周期<span lang="EN-US"> </span>量(多、中、少)末次月经<span lang="EN-US"> </span>绝经年龄<span lang="EN-US"> </span>岁<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">结婚年龄:<span lang="EN-US"> </span>孕<span lang="EN-US"> </span>产<span lang="EN-US"> </span>末产<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">难产:<span lang="EN-US"> </span>手术史:</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:42;page-break-inside:avoid;height:32.7pt">
<td width="48" rowspan="5" style="width: 36.2pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">内<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="64" colspan="2" style="width: 47.8pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="468" colspan="5" style="width: 351.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="text-indent:36.15pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体">阴道<span lang="EN-US"> </span>分泌物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:43;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫颈:大小(正常、肥大、萎缩) 糜烂(无、轻、中、重) 质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:44;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫体:<span lang="EN-US"> </span>位<span lang="EN-US"> </span>大小<span lang="EN-US"> </span>活动<span lang="EN-US"> </span>质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:45;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">附件:正常<span lang="EN-US"> </span>压痛(左右)<span lang="EN-US"> </span>增厚(左右)<span lang="EN-US"> </span>肿物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:46;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">刮片:<span lang="EN-US"> </span>初诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:47;page-break-inside:avoid;height:46.8pt">
<td width="623" colspan="9" style="width: 467.55pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 46.8pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">建议:<span lang="EN-US">
</span>医师签字</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:48;page-break-inside:avoid;height:41.85pt">
<td width="43" rowspan="5" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">耳鼻喉科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">听力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">左耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">右耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">嗅觉<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="text-indent:12.05pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:49;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">外耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly;
mso-element:frame;mso-element-frame-hspace:9.0pt;mso-element-wrap:around;
mso-element-anchor-vertical:page;mso-element-anchor-horizontal:page;
mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:50;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:51;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">喉咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:52;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:53;page-break-inside:avoid;height:26.15pt">
<td width="43" rowspan="4" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">唇腭<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">舌<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:54;page-break-inside:avoid;height:30.1pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">龋齿<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口吃<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:55;page-break-inside:avoid;height:36.65pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">粘膜<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:56;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:57;page-break-inside:avoid;height:96.85pt">
<td width="43" rowspan="6" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">妇<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">科</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
<td width="580" colspan="8" style="width: 435.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">病史<span lang="EN-US">: </span>初潮<span lang="EN-US"> </span>周期<span lang="EN-US"> </span>量(多、中、少)末次月经<span lang="EN-US"> </span>绝经年龄<span lang="EN-US"> </span>岁<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">结婚年龄:<span lang="EN-US"> </span>孕<span lang="EN-US"> </span>产<span lang="EN-US"> </span>末产<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">难产:<span lang="EN-US"> </span>手术史:</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:58;page-break-inside:avoid;height:32.7pt">
<td width="48" rowspan="5" style="width: 36.2pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">内<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="64" colspan="2" style="width: 47.8pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="468" colspan="5" style="width: 351.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="text-indent:36.15pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">阴道<span lang="EN-US"> </span>分泌物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:59;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫颈:大小(正常、肥大、萎缩) 糜烂(无、轻、中、重) 质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:60;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫体:<span lang="EN-US"> </span>位<span lang="EN-US"> </span>大小<span lang="EN-US"> </span>活动<span lang="EN-US"> </span>质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:61;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">附件:正常<span lang="EN-US"> </span>压痛(左右)<span lang="EN-US"> </span>增厚(左右)<span lang="EN-US"> </span>肿物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:62;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">刮片:<span lang="EN-US"> </span>初诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:63;page-break-inside:avoid;height:46.8pt">
<td width="623" colspan="9" style="width: 467.55pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 46.8pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">建议:<span lang="EN-US"> </span>医师签字</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:64;page-break-inside:avoid;height:41.85pt">
<td width="43" rowspan="5" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">耳鼻喉科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">听力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">左耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">右耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">嗅觉<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="text-indent:12.05pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:65;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">外耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly;
mso-element:frame;mso-element-frame-hspace:9.0pt;mso-element-wrap:around;
mso-element-anchor-vertical:page;mso-element-anchor-horizontal:page;
mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:66;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:67;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">喉咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:68;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:69;page-break-inside:avoid;height:26.15pt">
<td width="43" rowspan="4" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">唇腭<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">舌<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:70;page-break-inside:avoid;height:30.1pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">龋齿<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口吃<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:71;page-break-inside:avoid;height:36.65pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">粘膜<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:72;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:73;page-break-inside:avoid;height:96.85pt">
<td width="43" rowspan="6" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">妇<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">科</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
<td width="580" colspan="8" style="width: 435.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">病史<span lang="EN-US">: </span>初潮<span lang="EN-US"> </span>周期<span lang="EN-US"> </span>量(多、中、少)末次月经<span lang="EN-US"> </span>绝经年龄<span lang="EN-US"> </span>岁<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">结婚年龄:<span lang="EN-US"> </span>孕<span lang="EN-US"> </span>产<span lang="EN-US"> </span>末产<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">难产:<span lang="EN-US"> </span>手术史:</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:74;page-break-inside:avoid;height:32.7pt">
<td width="48" rowspan="5" style="width: 36.2pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">内<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="64" colspan="2" style="width: 47.8pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="468" colspan="5" style="width: 351.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="text-indent:36.15pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体">阴道<span lang="EN-US"> </span>分泌物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:75;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫颈:大小(正常、肥大、萎缩) 糜烂(无、轻、中、重) 质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:76;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫体:<span lang="EN-US"> </span>位<span lang="EN-US"> </span>大小<span lang="EN-US"> </span>活动<span lang="EN-US"> </span>质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:77;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">附件:正常<span lang="EN-US"> </span>压痛(左右)<span lang="EN-US"> </span>增厚(左右)<span lang="EN-US"> </span>肿物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:78;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">刮片:<span lang="EN-US"> </span>初诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:79;page-break-inside:avoid;height:46.8pt">
<td width="623" colspan="9" style="width: 467.55pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 46.8pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">建议:<span lang="EN-US">
</span>医师签字</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:80;page-break-inside:avoid;height:41.85pt">
<td width="43" rowspan="5" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">耳鼻喉科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">听力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">左耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">右耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">嗅觉<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="text-indent:12.05pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:81;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">外耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly;
mso-element:frame;mso-element-frame-hspace:9.0pt;mso-element-wrap:around;
mso-element-anchor-vertical:page;mso-element-anchor-horizontal:page;
mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:82;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:83;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">喉咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:84;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:85;page-break-inside:avoid;height:26.15pt">
<td width="43" rowspan="4" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">唇腭<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">舌<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:86;page-break-inside:avoid;height:30.1pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">龋齿<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口吃<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:87;page-break-inside:avoid;height:36.65pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">粘膜<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:88;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:89;page-break-inside:avoid;height:96.85pt">
<td width="43" rowspan="6" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">妇<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">科</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
<td width="580" colspan="8" style="width: 435.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">病史<span lang="EN-US">: </span>初潮<span lang="EN-US"> </span>周期<span lang="EN-US"> </span>量(多、中、少)末次月经<span lang="EN-US"> </span>绝经年龄<span lang="EN-US"> </span>岁<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">结婚年龄:<span lang="EN-US"> </span>孕<span lang="EN-US"> </span>产<span lang="EN-US"> </span>末产<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">难产:<span lang="EN-US"> </span>手术史:</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:90;page-break-inside:avoid;height:32.7pt">
<td width="48" rowspan="5" style="width: 36.2pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">内<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="64" colspan="2" style="width: 47.8pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="468" colspan="5" style="width: 351.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="text-indent:36.15pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体">阴道<span lang="EN-US"> </span>分泌物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:91;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫颈:大小(正常、肥大、萎缩) 糜烂(无、轻、中、重) 质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:92;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫体:<span lang="EN-US"> </span>位<span lang="EN-US"> </span>大小<span lang="EN-US"> </span>活动<span lang="EN-US"> </span>质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:93;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">附件:正常<span lang="EN-US"> </span>压痛(左右)<span lang="EN-US"> </span>增厚(左右)<span lang="EN-US"> </span>肿物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:94;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">刮片:<span lang="EN-US"> </span>初诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:95;page-break-inside:avoid;height:46.8pt">
<td width="623" colspan="9" style="width: 467.55pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 46.8pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">建议:<span lang="EN-US">
</span>医师签字</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:96;page-break-inside:avoid;height:41.85pt">
<td width="43" rowspan="5" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">耳鼻喉科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">听力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">左耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">右耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">嗅觉<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="text-indent:12.05pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:97;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">外耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly;
mso-element:frame;mso-element-frame-hspace:9.0pt;mso-element-wrap:around;
mso-element-anchor-vertical:page;mso-element-anchor-horizontal:page;
mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:98;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:99;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">喉咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:100;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:101;page-break-inside:avoid;height:26.15pt">
<td width="43" rowspan="4" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">唇腭<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">舌<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:102;page-break-inside:avoid;height:30.1pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">龋齿<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口吃<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:103;page-break-inside:avoid;height:36.65pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">粘膜<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:104;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:105;page-break-inside:avoid;height:96.85pt">
<td width="43" rowspan="6" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">妇<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">科</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
<td width="580" colspan="8" style="width: 435.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">病史<span lang="EN-US">: </span>初潮<span lang="EN-US"> </span>周期<span lang="EN-US"> </span>量(多、中、少)末次月经<span lang="EN-US"> </span>绝经年龄<span lang="EN-US"> </span>岁<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">结婚年龄:<span lang="EN-US"> </span>孕<span lang="EN-US"> </span>产<span lang="EN-US"> </span>末产<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">难产:<span lang="EN-US"> </span>手术史:</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:106;page-break-inside:avoid;height:32.7pt">
<td width="48" rowspan="5" style="width: 36.2pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">内<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="64" colspan="2" style="width: 47.8pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="468" colspan="5" style="width: 351.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="text-indent:36.15pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体">阴道<span lang="EN-US"> </span>分泌物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:107;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫颈:大小(正常、肥大、萎缩) 糜烂(无、轻、中、重) 质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:108;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫体:<span lang="EN-US"> </span>位<span lang="EN-US"> </span>大小<span lang="EN-US"> </span>活动<span lang="EN-US"> </span>质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:109;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">附件:正常<span lang="EN-US"> </span>压痛(左右)<span lang="EN-US"> </span>增厚(左右)<span lang="EN-US"> </span>肿物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:110;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">刮片:<span lang="EN-US"> </span>初诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:111;page-break-inside:avoid;height:46.8pt">
<td width="623" colspan="9" style="width: 467.55pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 46.8pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">建议:<span lang="EN-US">
</span>医师签字</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:112;page-break-inside:avoid;height:41.85pt">
<td width="43" rowspan="5" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">耳鼻喉科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">听力<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">左耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" style="line-height:150%;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;line-height:
150%;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">右耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">嗅觉<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 41.85pt;">
<p class="MsoNormal" style="text-indent:12.05pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:113;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">外耳<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="line-height:18.0pt;mso-line-height-rule:exactly;
mso-element:frame;mso-element-frame-hspace:9.0pt;mso-element-wrap:around;
mso-element-anchor-vertical:page;mso-element-anchor-horizontal:page;
mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> <o:p></o:p></span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:114;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">鼻咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:115;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">喉咽<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="190" colspan="3" style="width: 142.15pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="101" style="width: 75.5pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:116;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:117;page-break-inside:avoid;height:26.15pt">
<td width="43" rowspan="4" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly;mso-element:frame;mso-element-frame-hspace:9.0pt;
mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:
12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔科<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">唇腭<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">舌<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" valign="top" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 26.15pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:118;page-break-inside:avoid;height:30.1pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">龋齿<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口吃<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 30.1pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:119;page-break-inside:avoid;height:36.65pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">口腔<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">粘膜<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="189" colspan="2" style="width: 141.55pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
</td>
<td width="101" colspan="2" style="width: 76.1pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="191" colspan="2" style="width: 143.25pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 36.65pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:120;page-break-inside:avoid;height:32.7pt">
<td width="99" colspan="2" style="width: 74.45pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">建议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="290" colspan="4" style="width: 217.65pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
</td>
<td width="85" style="width: 63.9pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">医师签字<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="106" style="width: 79.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:121;page-break-inside:avoid;height:96.85pt">
<td width="43" rowspan="6" style="width: 32.2pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">妇<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:
仿宋_GB2312"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:14.0pt;mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312">科</span></b><b><span lang="EN-US" style="font-size:14.0pt;
mso-bidi-font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
<td width="580" colspan="8" style="width: 435.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 96.85pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">病史<span lang="EN-US">: </span>初潮<span lang="EN-US"> </span>周期<span lang="EN-US"> </span>量(多、中、少)末次月经<span lang="EN-US"> </span>绝经年龄<span lang="EN-US"> </span>岁<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">结婚年龄:<span lang="EN-US"> </span>孕<span lang="EN-US"> </span>产<span lang="EN-US"> </span>末产<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">难产:<span lang="EN-US"> </span>手术史:</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:122;page-break-inside:avoid;height:32.7pt">
<td width="48" rowspan="5" style="width: 36.2pt; border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">内<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;mso-element:frame;
mso-element-frame-hspace:9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:
page;mso-element-anchor-horizontal:page;mso-element-left:638.35pt;mso-element-top:
69.05pt;mso-height-rule:exactly"><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:宋体">诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="64" colspan="2" style="width: 47.8pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-style: none; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">外阴<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="468" colspan="5" style="width: 351.35pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 32.7pt;">
<p class="MsoNormal" style="text-indent:36.15pt;mso-element:frame;mso-element-frame-hspace:
9.0pt;mso-element-wrap:around;mso-element-anchor-vertical:page;mso-element-anchor-horizontal:
page;mso-element-left:638.35pt;mso-element-top:69.05pt;mso-height-rule:exactly"><b><span lang="EN-US" style="font-size:12.0pt;
font-family:仿宋_GB2312;mso-hansi-font-family:宋体"> </span></b><b><span style="font-size:12.0pt;font-family:仿宋_GB2312;mso-hansi-font-family:
宋体">阴道<span lang="EN-US"> </span>分泌物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:123;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫颈:大小(正常、肥大、萎缩) 糜烂(无、轻、中、重) 质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:124;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">宫体:<span lang="EN-US"> </span>位<span lang="EN-US"> </span>大小<span lang="EN-US"> </span>活动<span lang="EN-US"> </span>质地(软、中、硬)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:125;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">附件:正常<span lang="EN-US"> </span>压痛(左右)<span lang="EN-US"> </span>增厚(左右)<span lang="EN-US"> </span>肿物<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:126;page-break-inside:avoid;height:34.0pt">
<td width="532" colspan="7" style="width: 399.15pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 34pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">刮片:<span lang="EN-US"> </span>初诊<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:127;mso-yfti-lastrow:yes;page-break-inside:avoid;
height:46.8pt">
<td width="623" colspan="9" style="width: 467.55pt; border-right-color: windowtext; border-bottom-color: windowtext; border-left-color: windowtext; border-right-width: 1.5pt; border-bottom-width: 1.5pt; border-left-width: 1.5pt; border-top-style: none; padding: 0cm 5.4pt; height: 46.8pt;">
<p class="MsoNormal"><b><span style="font-size:12.0pt;font-family:
仿宋_GB2312;mso-hansi-font-family:宋体">建议:<span lang="EN-US"> </span>医师签字</span></b><b><span lang="EN-US" style="font-family:仿宋_GB2312;
mso-hansi-font-family:宋体"><o:p></o:p></span></b></p>
</td>
</tr>
<!---->
<tr height="0">
<td width="43" style="border: none;"></td>
<td width="48" style="border: none;"></td>
<td width="51" style="border: none;"></td>
<td width="13" style="border: none;"></td>
<td width="176" style="border: none;"></td>
<td width="1" style="border: none;"></td>
<td width="101" style="border: none;"></td>
<td width="85" style="border: none;"></td>
<td width="106" style="border: none;"></td>
</tr>
<!---->
</tbody></table>
<div align="center">
<table class="MsoNormalTable" border="1" cellspacing="0" cellpadding="0" style="margin-left: -11.8pt; border: none;">
<tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid;
height:485.45pt;mso-row-margin-right:5.85pt">
<td width="63" colspan="2" style="width: 47.3pt; border-width: 1.5pt 1pt 1pt 1.5pt; border-color: windowtext; padding: 0cm 5.4pt; height: 485.45pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">心<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="mso-bidi-font-size:
10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">电<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:25.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">图<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="519" colspan="2" style="width: 389pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 485.45pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">建议:<span lang="EN-US"> </span>医师签字:<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td style="border: none; padding: 0cm;" width="8"><p class="MsoNormal"> </p></td>
</tr>
<tr style="mso-yfti-irow:1;page-break-inside:avoid;height:191.5pt;mso-row-margin-right:
5.85pt">
<td width="63" colspan="2" style="width: 47.3pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 191.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:23.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">胸<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:23.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">部<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:23.0pt;
mso-line-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体">X<o:p></o:p></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:23.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">光<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:23.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">片<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="519" colspan="2" style="width: 389pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 191.5pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">建议:<span lang="EN-US"> </span>医师签字:<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td style="border-top-style: none; border-right-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; padding: 0cm;" width="8"><p class="MsoNormal"> </p></td>
</tr>
<tr style="mso-yfti-irow:2;height:222.85pt;mso-row-margin-left:8.3pt">
<td style="border: none; padding: 0cm;" width="11"><p class="MsoNormal"> </p></td>
<td width="60" colspan="2" style="width: 44.9pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 222.85pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:22.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">腹<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:22.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">部<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:22.0pt;
mso-line-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体">B<o:p></o:p></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:22.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">超<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:22.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">检<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:22.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">查<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="519" colspan="2" valign="top" style="width: 388.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 222.85pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">建议:<span lang="EN-US"> </span>医师签字:<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:3;page-break-inside:avoid;height:376.1pt;mso-row-margin-left:
8.3pt">
<td style="border: none; padding: 0cm;" width="11"><p class="MsoNormal"> </p></td>
<td width="60" colspan="2" rowspan="2" style="width: 44.9pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 376.1pt;">
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">体<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">检<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">结<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">论<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">及<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">建<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="mso-bidi-font-size:10.5pt;
font-family:宋体">议<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="519" colspan="2" valign="top" style="width: 388.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 376.1pt;">
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:4;mso-yfti-lastrow:yes;page-break-inside:avoid;
height:90.35pt;mso-row-margin-left:8.3pt">
<td style="border: none; padding: 0cm;" width="11"><p class="MsoNormal"> </p></td>
<td width="519" colspan="2" style="width: 388.95pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 90.35pt;">
<p class="MsoNormal" style="text-indent:325.25pt"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
<p class="MsoNormal" style="text-indent:240.95pt"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">体检医院签章处<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> <o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">主检医师签字:<span lang="EN-US"> </span>年<span lang="EN-US"> </span>月<span lang="EN-US"> </span>日<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<!---->
<tr height="0">
<td width="11" style="border: none;"></td>
<td width="52" style="border: none;"></td>
<td width="8" style="border: none;"></td>
<td width="511" style="border: none;"></td>
<td width="8" style="border: none;"></td>
</tr>
<!---->
</tbody></table>
</div>
<p class="MsoNormal" align="center" style="text-align:center"><span lang="EN-US"> </span></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="font-size:18.0pt;font-family:黑体;mso-hansi-font-family:
宋体"> </span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span style="font-size:18.0pt;font-family:黑体;mso-hansi-font-family:
宋体">检 验 项 目<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center"><b><span lang="EN-US" style="font-size:18.0pt;mso-bidi-font-size:12.0pt;
font-family:黑体;mso-hansi-font-family:宋体;letter-spacing:2.2pt"> </span></b></p>
<table class="MsoNormalTable" border="1" cellspacing="0" cellpadding="0" style="margin-left: -3.6pt; border: none;">
<tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid;
height:43.5pt">
<td width="60" rowspan="2" style="width: 45pt; border-width: 1.5pt 1pt 1pt 1.5pt; border-color: windowtext; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">血<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">常<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">规<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="242" style="width: 181.8pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">白细胞总数(<span lang="EN-US">WBC</span>)及分类<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-color: windowtext; border-top-width: 1.5pt; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">血红蛋白(<span lang="EN-US">HGB</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:1;page-break-inside:avoid;height:43.5pt">
<td width="242" style="width: 181.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">红细胞总数(<span lang="EN-US">RBC</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">血小板计数(<span lang="EN-US">PLT</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:2;page-break-inside:avoid;height:43.5pt">
<td width="60" rowspan="3" style="width: 45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">血<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">生<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">化<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="242" style="width: 181.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">丙氨酸氨基转移酶(<span lang="EN-US">ALT</span>)<span lang="EN-US"> <o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">尿素氮(<span lang="EN-US">BUN</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:3;page-break-inside:avoid;height:43.5pt">
<td width="242" style="width: 181.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">天冬氨酸氨基转移酶(<span lang="EN-US">AST</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">肌酐(<span lang="EN-US">CR</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:4;page-break-inside:avoid;height:43.5pt">
<td width="242" style="width: 181.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">葡萄糖(<span lang="EN-US">GLU</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:5;page-break-inside:avoid;height:43.5pt">
<td width="60" style="width: 45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">免<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">疫<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="242" style="width: 181.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">艾滋病病毒抗体(抗<span lang="EN-US">HIV</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">梅毒血清特异性抗体(<span lang="EN-US">TPHA</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:6;page-break-inside:avoid;height:43.5pt">
<td width="60" rowspan="5" style="width: 45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">尿<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">常<span lang="EN-US"><o:p></o:p></span></span></b></p>
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">规<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="242" style="width: 181.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">糖(<span lang="EN-US">GLU</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">蛋白质(<span lang="EN-US">PRO</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:7;page-break-inside:avoid;height:43.5pt">
<td width="242" style="width: 181.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">胆红素(<span lang="EN-US">TBIL</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">尿胆原(<span lang="EN-US">URO</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:8;page-break-inside:avoid;height:43.5pt">
<td width="242" style="width: 181.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">比重(<span lang="EN-US">SG</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">红细胞(<span lang="EN-US">BLO</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:9;page-break-inside:avoid;height:43.5pt">
<td width="242" style="width: 181.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">酸碱度(<span lang="EN-US">PH</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">白细胞(<span lang="EN-US">LEU</span>)<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:10;page-break-inside:avoid;height:43.5pt">
<td width="242" style="width: 181.8pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">镜检<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="262" style="width: 196.2pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
<tr style="mso-yfti-irow:11;mso-yfti-lastrow:yes;page-break-inside:avoid;
height:43.5pt">
<td width="60" style="width: 45pt; border-top-style: none; border-left-color: windowtext; border-left-width: 1.5pt; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal"><b><span style="mso-bidi-font-size:10.5pt;font-family:宋体">其他<span lang="EN-US"><o:p></o:p></span></span></b></p>
</td>
<td width="504" colspan="2" style="width: 378pt; border-top-style: none; border-left-style: none; border-bottom-color: windowtext; border-bottom-width: 1.5pt; border-right-color: windowtext; border-right-width: 1.5pt; padding: 0cm 5.4pt; height: 43.5pt;">
<p class="MsoNormal" align="center" style="text-align:center;line-height:20.0pt;
mso-line-height-rule:exactly"><b><span lang="EN-US" style="mso-bidi-font-size:10.5pt;font-family:宋体"> </span></b></p>
</td>
</tr>
</tbody></table>
<p class="MsoNormal" align="center" style="text-align:center"><span lang="EN-US"> </span></p><p></p> 凡哥,无论特警普警都是这张表吗?
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