tag:blogger.com,1999:blog-82642342776845234852024-03-08T08:40:42.727-08:00Nd Dia RianiNur Dia Rianihttp://www.blogger.com/profile/07878859972547746126noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-8264234277684523485.post-8669225306743763972011-11-19T07:13:00.000-08:002011-11-19T07:13:16.385-08:00CONTOH FORMAT SURAT RUJUKAN<!--[if !mso]> <style>
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</div><div align="center" class="MsoNormal" style="color: blue; text-align: center;"><b><span style="font-family: "Arial","sans-serif"; font-size: 14pt; line-height: 115%;">SURAT RUJUKAN</span></b></div><div class="MsoNormal" style="color: blue;"><span style="height: 168px; left: -31px; position: relative; top: 29px; width: 682px; z-index: 1;"><img height="139" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image004.gif" width="682" /></span><span style="font-family: "Arial","sans-serif";"> </span></div><div class="MsoNormal" style="color: blue;"><br />
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</div><br clear="ALL" style="color: blue;" /> <div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Yth. Dokter Gigi<span> </span>:.............................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Di RSU<span> </span>:.............................................</span></div><div class="MsoNormal" style="color: blue; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Mohon pemeriksaan dan pengobatan lebih lanjut terhadap penderita, </span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Nama Pasien<span> </span>:...................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Jenis Kelamin<span> </span>:....................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Umur<span> </span>:....................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">No. Telpon<span> </span><span> </span>:....................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Alamat Rumah <span> </span>:....................................................</span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Anamnesa</span></div><div class="MsoListParagraphCxSpFirst" style="color: blue; margin-left: 72pt; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif";"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif";">Keluhan : ........................................................................................................................................................................................................................................................</span></div><div class="MsoListParagraphCxSpLast" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Diagnosa sementara <span> </span>: .................................................................................................</span></div><div class="MsoNormal" style="color: blue; margin-left: 108pt;"><span style="font-family: "Arial","sans-serif";"><span> </span>................................................................................................. </span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Kasus<span> </span>:...................................................................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";"><span> </span>....................................................................................................</span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Terapi/Obat yang telah diberikan : ..........................................................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";"><span> </span><span> </span><span> </span>..........................................................................................</span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Demikian surat rujukan ini kami kirim, kami mohon balasan atas surat rujukan ini. Atas perhatian Bapak/Ibu kami ucapkan terima kasih.<span> </span></span></div><div class="MsoListParagraph" style="color: blue; margin-left: 72pt;"><br />
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</div><div class="MsoNormal" style="color: blue; margin-left: 288pt; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";"><span> </span>Hormat Kami</span></div><div class="MsoListParagraphCxSpFirst" style="color: blue; margin-left: 72pt;"><br />
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</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 324pt;"><span style="font-family: "Arial","sans-serif";">(..............................)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 288pt; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">No. SIP:..................</span></div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 288pt; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 288pt; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 288pt; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 288pt; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 0cm; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Lembar 1 : Untuk Dokter Gigi dituju</span></div><div class="MsoListParagraphCxSpLast" style="color: blue; margin-left: 0cm; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Lembar 2 : Arsip Pengirim</span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 0cm; text-align: center;"><b><span style="font-family: "Arial","sans-serif"; font-size: 14pt; line-height: 115%;">JAWABAN RUJUKAN</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 0cm; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 0cm; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpLast" style="color: blue; margin-left: 0cm; text-align: center;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Berikut ini adalah hasil pemeriksaan dan pengobatan atas pasien :</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">No. Registrasi<span> </span>:....................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Nama Pasien<span> </span>:....................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Jenis Kelamin<span> </span>:....................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Umur<span> </span>:....................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">No. Telpon<span> </span>:....................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Alamat Rumah <span> </span>:....................................................</span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Keterangan tindak lanjut yang dianjurkan :</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: blue; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span> <span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Konsul selesai</span></div><div class="MsoListParagraphCxSpMiddle" style="color: blue; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span> <span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Perlu kontrol kembali (sebutkan)............................................</span></div><div class="MsoListParagraphCxSpMiddle" style="color: blue; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span> <span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Perlu konsul ke ahli lain (sebutkan).......................................</span></div><div class="MsoListParagraphCxSpMiddle" style="color: blue; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span> <span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Perlu dirawat dengan indikasi (sebutkan).............................</span></div><div class="MsoListParagraphCxSpLast" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Hasil pemeriksaan :</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">..............................................................................................................................................................................................................................................................................</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Diagnosa :</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Perawatan yang sudah dilakukan :</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">..............................................................................................................................................................................................................................................................................</span></div><div class="MsoListParagraphCxSpFirst" style="color: blue; margin-left: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; line-height: 115%;"><span> </span>Demikian balasan surat rujukan ini kami kirim. Atas perhatian Bapak/Ibu kami ucapkan terimaksih.</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 324pt; text-align: center;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; line-height: 115%;"><span> </span></span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 324pt; text-align: center;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; line-height: 115%;"><span> </span>..........Tgl. .........</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 0cm; text-align: center;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; line-height: 115%;"><span> </span>Hormat Kami,</span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 0cm; text-align: center;"><br />
</div><div align="right" class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 0cm; text-align: right;"><span style="font-family: "Arial","sans-serif"; font-size: 14pt; line-height: 115%;">(.....................)</span></div><div align="right" class="MsoListParagraphCxSpLast" style="color: blue; margin-left: 0cm; text-align: right;"><span style="font-family: "Arial","sans-serif"; font-size: 10pt; line-height: 115%;">NO.SIP : No. SIP: P1277665509</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";"><img alt="GAMBAR POLTEK.jpg" height="70" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image005.jpg" width="46" /></span><span style="font-family: "Arial","sans-serif";"><span> </span><img alt="POLTEKKES KEMENKES JAKARTA 1 JURUSAN KEPERAWATAN GIGI" height="75" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image003.gif" width="526" /><span> </span></span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div align="center" class="MsoNormal" style="color: blue; text-align: center;"><b><span style="font-family: "Arial","sans-serif"; font-size: 14pt; line-height: 115%;">SURAT RUJUKAN</span></b></div><div class="MsoNormal" style="color: blue;"><span style="height: 168px; left: -31px; position: relative; top: 29px; width: 682px; z-index: 3;"><img height="139" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image006.gif" width="682" /></span><span style="font-family: "Arial","sans-serif";"> </span></div><br clear="ALL" style="color: blue;" /> <div class="MsoNormal" style="color: blue;"><span style="height: 26px; margin-left: 545px; margin-top: 7px; position: absolute; width: 89px; z-index: -8;"><img height="26" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image007.gif" width="89" /></span><span style="height: 26px; margin-left: 545px; margin-top: 7px; position: absolute; width: 89px; z-index: -9;"><img height="26" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image007.gif" width="89" /></span><span style="font-family: "Arial","sans-serif";"></span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue;"><br />
</div><br clear="ALL" style="color: blue;" /> <div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Yth. Dokter Gigi<span> </span>: </span><span>Drg. M Iqbal Rosada</span><span style="font-family: "Arial","sans-serif";"></span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Di RSU<span> </span>: Rs Fatmawati</span></div><div class="MsoNormal" style="color: blue; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Mohon pemeriksaan dan pengobatan lebih lanjut terhadap penderita, </span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Nama Pasien<span> </span>: Prasmanan Sutomo</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Jenis Kelamin<span> </span>: Laki-laki</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Umur<span> </span>: 45 tahun</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">No. Telpon<span> </span><span> </span>: </span><span style="font-family: "Arial","sans-serif";">08576243512</span><span style="font-family: "Arial","sans-serif";"></span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";">Alamat Rumah <span> </span>: </span><span style="font-family: "Arial","sans-serif";">Meruyung kec. Limo rt 02/ rw 07</span><span style="font-family: "Arial","sans-serif";"></span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue;"><b><span style="font-family: "Arial","sans-serif";">Anamnesa :</span></b></div><div class="MsoListParagraphCxSpFirst" style="color: blue; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif";"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif";">Keluhan : Gigi terasa sakit bila digunakan untuk makan-makanan yang dingin<span> </span>dan panas</span></div><div class="MsoListParagraphCxSpLast" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoNormal" style="color: blue; margin-left: 4cm; text-indent: -4cm;"><b><span style="font-family: "Arial","sans-serif";">Diagnosa sementara<span> </span>:</span></b><span style="font-family: "Arial","sans-serif";"> Gigi 3.8<span> </span>berposisi miring dan perlu dilakukan perawatan serta<span> </span>pencabutan.</span></div><div class="MsoNormal" style="color: blue; margin-left: 108pt;"><br />
</div><div class="MsoNormal" style="color: blue;"><b><span style="font-family: "Arial","sans-serif";">Kasus<span> </span>:</span></b><span style="font-family: "Arial","sans-serif";"> Impaksi gigi 3.8</span></div><div class="MsoNormal" style="color: blue;"><span style="font-family: "Arial","sans-serif";"><span> </span></span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue;"><b><span style="font-family: "Arial","sans-serif";">Terapi/Obat yang telah diberikan :</span></b><span style="font-family: "Arial","sans-serif";"> Pemberian obat analgetik untuk meredakan rasa sakit</span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Demikian surat rujukan ini kami kirim, kami mohon balasan atas surat rujukan ini. Atas perhatian Bapak/Ibu kami ucapkan terima kasih.<span> </span></span></div><div class="MsoListParagraph" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue; margin-left: 252pt; text-indent: 36pt;"><span style="height: 53px; left: 0px; margin-left: 418px; margin-top: 22px; position: absolute; width: 92px; z-index: 7;"><img height="53" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image008.gif" width="92" /></span><span style="font-family: "Arial","sans-serif";"><span> </span><span> </span>Hormat Kami,</span></div><div class="MsoListParagraphCxSpFirst" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoNormal" style="color: blue; margin-left: 288pt;"><span style="font-family: "Arial","sans-serif";"><span> </span>(</span><span>Drg. M Iqbal Rosada</span><span style="font-family: "Arial","sans-serif";">)</span></div><div class="MsoNormal" style="color: blue; margin-left: 288pt;"><span style="font-family: "Arial","sans-serif";"><span> </span>No. SIP: P1277665509</span></div><div class="MsoListParagraphCxSpFirst" style="color: blue; margin-left: 288pt; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 288pt; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 288pt; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 288pt; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 0cm; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Lembar 1 : Untuk Dokter Gigi dituju</span></div><div class="MsoListParagraphCxSpLast" style="color: blue; margin-left: 0cm; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Lembar 2 : Arsip Pengirim</span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: blue; margin-left: 72pt;"><br />
</div><div class="MsoNormal" style="color: blue; line-height: normal;"><br />
</div><div align="center" class="MsoListParagraphCxSpFirst" style="color: blue; line-height: normal; margin-left: 0cm; text-align: center;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">JAWABAN RUJUKAN</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: blue; line-height: normal; margin-left: 0cm; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: blue; line-height: normal; margin-left: 0cm; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpLast" style="color: blue; line-height: normal; margin-left: 0cm; text-align: center;"><span style="font-family: "Arial","sans-serif";">Berikut ini adalah hasil pemeriksaan dan pengobatan atas pasien :</span></div><div class="MsoNormal" style="color: blue; line-height: normal;"><span style="font-family: "Arial","sans-serif";">No. Registrasi<span> </span>: 133-44-35</span></div><div class="MsoNormal" style="color: blue; line-height: normal;"><span style="font-family: "Arial","sans-serif";">Nama Pasien<span> </span><span> </span>: Prasmanan Sutomo</span></div><div class="MsoNormal" style="color: blue; line-height: normal;"><span style="font-family: "Arial","sans-serif";">Jenis Kelamin<span> </span>: Laki-laki</span></div><div class="MsoNormal" style="color: blue; line-height: normal;"><span style="font-family: "Arial","sans-serif";">Umur<span> </span>: 45 tahun</span></div><div class="MsoNormal" style="color: blue; line-height: normal;"><span style="font-family: "Arial","sans-serif";">No. Telpon<span> </span>: </span><span style="font-family: "Arial","sans-serif";">08576243512</span><span style="font-family: "Arial","sans-serif";"></span></div><div class="MsoNormal" style="color: blue; line-height: normal;"><span style="font-family: "Arial","sans-serif";">Alamat Rumah <span> </span>: </span><span style="font-family: "Arial","sans-serif";">Meruyung kec. Limo rt 02/ rw 07</span><span style="font-family: "Arial","sans-serif";"></span></div><div class="MsoNormal" style="color: blue;"><br />
</div><div class="MsoNormal" style="color: blue; line-height: normal;"><b><span style="font-family: "Arial","sans-serif";">Keterangan tindak lanjut yang dianjurkan :</span></b></div><div class="MsoListParagraph" style="color: blue; line-height: normal;"><span style="height: 22px; left: 0px; margin-left: 21px; margin-top: 0px; position: absolute; width: 24px; z-index: 8;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td bgcolor="white" height="22" style="background: none repeat scroll 0% 0% white; border: 0.75pt solid black; vertical-align: top;" width="24"><span style="left: 0pt; position: absolute; z-index: 8;"> <table cellpadding="0" cellspacing="0"><tbody>
<tr> <td> <div class="shape" style="padding: 4.35pt 7.95pt;"> <div class="MsoNormal"><br />
</div></div></td> </tr>
</tbody></table></span> </td> </tr>
</tbody></table></span><span style="font-family: "Arial","sans-serif";"><span> </span>Konsul selesai</span></div><div class="MsoNormal" style="color: blue; line-height: normal;"><span style="height: 17px; margin-left: 21px; margin-top: 1px; position: absolute; width: 20px; z-index: -4;"><img height="17" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image009.gif" width="20" /></span><span style="font-family: "Arial","sans-serif";"><span> </span>√<span> </span>Perlu kontrol kembali (</span><i><span style="font-family: "Arial","sans-serif"; font-size: 9pt;">1 minggu kemudian kembali lagi untuk melakukan operasi gigi 3.8.</span></i><i><span style="font-family: "Arial","sans-serif";">)</span></i><span style="font-family: "Arial","sans-serif"; font-size: 9pt;"></span></div><div class="MsoListParagraph" style="color: blue; line-height: normal;"><span style="height: 18px; left: 0px; margin-left: 21px; margin-top: 0px; position: absolute; width: 20px; z-index: 10;"><img height="18" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image010.gif" width="20" /></span><span style="font-family: "Arial","sans-serif";"><span> </span>Perlu konsul ke ahli lain (sebutkan).......................................</span></div><div class="MsoNormal" style="color: blue; line-height: normal;"><span style="height: 18px; margin-left: 21px; margin-top: 1px; position: absolute; width: 20px; z-index: 11;"><img height="18" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image010.gif" width="20" /></span><span style="font-family: "Arial","sans-serif";"><span> </span>Perlu dirawat dengan indikasi (sebutkan).............................</span></div><div class="MsoListParagraph" style="color: blue; line-height: normal;"><br />
</div><div class="MsoNormal" style="color: blue; line-height: normal;"><b><span style="font-family: "Arial","sans-serif";">Hasil pemeriksaan :</span></b></div><div class="MsoNormal" style="color: blue; line-height: normal;"><i><span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Terdepat gigi impaksi pada gigi 3.8 dan perlu dilakukan perawatan dan operasi untuk pencabutan gigi 3.8.</span></i></div><div class="MsoNormal" style="color: blue; line-height: normal;"><b><span style="font-family: "Arial","sans-serif";">Diagnosa : </span></b></div><div class="MsoNormal" style="color: blue; line-height: normal;"><i><span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Impaksi gigi 3.8</span></i></div><div class="MsoNormal" style="color: blue; line-height: normal;"><b><span style="font-family: "Arial","sans-serif";">Perawatan yang sudah dilakukan : </span></b></div><div class="MsoNormal" style="color: blue; line-height: normal;"><i><span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Pemberian obat analgetik untuk meredakan rasa sakit pada gigi.</span></i></div><div class="MsoListParagraphCxSpFirst" style="color: blue; line-height: normal; margin-left: 0cm;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: blue; line-height: normal; margin-left: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Demikian balasan surat rujukan ini kami kirim. Atas perhatian Bapak/Ibu kami ucapkan terimaksih.</span></div><div align="center" class="MsoListParagraphCxSpLast" style="color: blue; line-height: normal; margin-left: 324pt; text-align: center;"><span style="font-family: "Arial","sans-serif";"><span> </span></span></div><div class="MsoNormal" style="color: blue; line-height: normal; margin-left: 252pt; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Jakarta, 19 November 2011</span></div><div class="MsoNormal" style="color: blue; line-height: normal; margin-left: 288pt; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Hormat Kami,</span></div><div class="MsoListParagraphCxSpFirst" style="color: blue; line-height: normal; margin-left: 0cm;"><span> <table align="left" cellpadding="0" cellspacing="0"><tbody>
<tr> <td height="13" width="435"><br />
</td> </tr>
<tr> <td><br />
</td> <td><img height="43" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image011.gif" width="93" /></td> </tr>
</tbody></table></span><span style="font-family: "Arial","sans-serif";"> </span></div><div class="MsoListParagraphCxSpMiddle" style="color: blue; line-height: normal; margin-left: 0cm;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: blue; line-height: normal; margin-left: 72pt;"><br />
</div><br clear="ALL" style="color: blue;" /> <div class="MsoNormal" style="color: blue; line-height: normal; margin-left: 252pt; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">(Drg. Widya Anggraini,sp.Bm)</span></div><div class="MsoNormal" style="color: blue; line-height: normal; margin-left: 288pt;"><span style="font-family: "Arial","sans-serif";"><span> </span>No. SIP: P17110012544</span></div><div align="right" class="MsoListParagraphCxSpFirst" style="color: blue; line-height: normal; margin-left: 0cm; text-align: right;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: blue; line-height: normal; margin-left: 0cm;"><br />
</div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>Nur Dia Rianihttp://www.blogger.com/profile/07878859972547746126noreply@blogger.com4tag:blogger.com,1999:blog-8264234277684523485.post-69654769001459330122011-11-19T07:08:00.003-08:002011-11-19T07:08:22.858-08:00CONTOH FORMAT REKAM MEDIK<!--[if !mso]> <style>
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</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Arial","sans-serif"; font-size: 22pt; line-height: 115%;">Rekam Medis</span></b></div><div class="MsoListParagraph" style="text-indent: -18pt;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Definisi Rekam Medis</span></b></div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Definisi <span>Rekam Medis</span> dalam berbagai kepustakaan dituliskan dalam berbagai pengertian, seperti dibawab ini:</span></div><div class="MsoListParagraphCxSpFirst" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Definisi Rekam Medis Menurut Edna K Huffman</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">: <span>Rekam Medis</span> adalab berkas yang menyatakan siapa, apa, mengapa, dimana, kapan dan bagaimana pelayanan yang diperoleb seorang pasien selama dirawat atau menjalani pengobatan.</span></div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Definisi Rekam Medis Menurut Permenkes No. 749a/Menkes!Per/XII/1989</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">: <span>Rekam Medis</span> adalah berkas yang beiisi catatan dan dokumen mengenai identitas pasien, basil pemeriksaan, pengobatan, tindakan dan pelayanan lainnya yang diterima pasien pada sarana kesebatan, baik rawat jalan maupun rawat inap.</span></div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Definisi Rekam Medis Menurut Gemala Hatta : Rekam Medis</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"> merupakan kumpulan fakta tentang kehidupan seseorang dan riwayat penyakitnya, termasuk keadaan sakit, pengobatan saat ini dan saat lampau yang ditulis oleb para praktisi kesehatan dalam upaya mereka memberikan pelayanan kesehatan kepada pasien.</span></div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Permenkes No. 749a/Menkes!Per/XII/1989 Menurut Waters dan Murphy </span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">: <span>Rekam Medis</span> adalah Kompendium (ikhtisar) yang berisi informasi tentang keadaan pasien selama perawatan atau selama pemeliharaan kesehatan”.</span></div><div class="MsoListParagraphCxSpMiddle"><br />
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</div><div class="MsoListParagraphCxSpLast" style="text-indent: -18pt;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Isi Rekam Medis</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Isi Rekam Medis merupakan catatan keadaan tubuh dan kesehatan, termasuk data tentang identitas dan data medis seorang pasien. Secara umum isi Rekam Medis dapat dibagi dalam dua kelompok data yaitu:</span></div><div class="MsoListParagraphCxSpFirst" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Data medis atau data klinis</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">: Yang termasuk data medis adalah segala data tentang riwayat penyakit, hasil pemeriksaan fisik, diagnosis, pengobatan serta hasilnya, laporan dokter, perawat, hasil pemeriksaan laboratorium, ronsen dsb. Data-data ini merupakan data yang bersifat rahasia (confidential) sebingga tidak dapat dibuka kepada pibak ketiga tanpa izin dari pasien yang bersangkutan kecuali jika ada alasan lain berdasarkan peraturan atau perundang-undangan yang memaksa dibukanya informasi tersebut.</span></div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Data sosiologis atau data non-medis</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">: Yang termasuk data ini adalah segala data lain yang tidak berkaitan langsung dengan data medis, seperti data identitas, data sosial ekonomi, alamat dsb. Data ini oleh sebagian orang dianggap bukan rahasia, tetapi menurut sebagian lainnya merupakan data yang juga bersifat rahasia (confidensial).</span></div><div class="MsoListParagraphCxSpMiddle"><br />
</div><div class="MsoListParagraphCxSpLast" style="text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>C.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Penyelenggaraan Rekam Medis</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Penyelenggaraan Rekam Medis pada suatu sarana pelayanan kesehatan merupakan salah satu indikator mutu pelayanan pada institusi tersebut. Berdasarkan data pada <span>Rekam Medis</span> tersebut akan dapat dinilai apakah pelayanan yang diberikan sudah cukup baik mutunya atau tidak, serta apakah sudah sesuai standar atau tidak. Untuk itulah, maka pemerintah, dalam hal ini <span>Departemen Kesehatan</span> merasa perlu mengatur tata cara penyelenggaraan Rekam Medis dalam suatu peraturan menteri keehatan agar jelas rambu-rambunya, yaitu berupa <span>Permenkes No.749a1Menkes/Per/XII/1989</span>.</span></div><div class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Secara garis besar penyelenggaraan <span>Rekam Medis</span> dalam Permenkes tersebut diatur sebagai berikut:</span></div><div class="MsoListParagraphCxSpFirst" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Rekam Medis harus segera dibuat dan dilengkapi seluruhnya setelah pasien menerima pelayanan (pasal 4). Hal ini dimaksudkan agar data yang dicatat masih original dan tidak ada yang terlupakan karena adanya tenggang waktu.</span></div><div class="MsoListParagraphCxSpLast" style="text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Setiap pencatatan Rekam Medis harus dibubuhi nama dan tanda tangan petugas pelayanan kesehatan. Hal ini diperlukan untuk memudahkan sistim pertanggung-jawaban atas pencatatan tersebut (pasal 5).</span></div><div class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Pada saat seorang pasien berobat ke dokter, sebenamya telah terjadi suatu hubungan kontrak terapeutik antara pasien dan dokter. Hubungan tersebut didasarkan atas kepercayaan pasien bahwa dokter tersebut mampu mengobatinya, dan akan merahasiakan semua rahasia pasien yang diketahuinya pada saat hubungan tersebut terjadi.</span></div><div class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Dalam hubungan tersebut se«ara otomatis akan banyak data pribadi pasien tersebut yang akan diketahui oleh dokter serta tenaga kesehatan yang memeriksa pasien tersebut. Sebagian dari rahasia tadi dibuat dalam bentuk tulisan yang kita kenal sebagai Rekam Medis. Dengan demikian, kewajiban tenaga kesehatan untuk menjaga rahasia kedokteran, mencakup juga kewajiban untuk menjaga kerahasiaan isi Rekam Medis.</span></div><div class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Pada prinsipnya isi <span>Rekam Medis adalah milik pasien</span>, sedangkan <span>berkas Rekam Medis (secara fisik) adalah milik Rumah Sakit atau institusi kesehatan</span>. Pasal 10 Permenkes No. 749a menyatakan bahwa berkas rekam medis itu merupakan milik sarana pelayanan kesehatan, yang harus disimpan sekurang-kurangnya untuk jangka waktu 5 tahun terhitung sejak tanggal terakhir pasien berobat. Untuk tujuan itulah di setiap institusi pelayanan kesehatan, dibentuk Unit Rekam Medis yang bertugas menyelenggarakan proses pengelolaan serta penyimpanan Rekam Medis di institusi tersebut.</span></div><div class="MsoListParagraph" style="text-indent: -18pt;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>D.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Manfaat Rekam Medis</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin-left: 18pt; text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Permenkes no. 749a tahun 1989 menyebutkan bahwa <b>Rekam Medis</b> memiliki 5 ,manfaat yaitu:</span></div><ol start="1" type="1"><li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Sebagai dasar pemeliharaan kesehatan dan pengobatan pasien</span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Sebagai bahan pembuktian dalam perkara hukum</span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Bahan untuk kepentingan penelitian</span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Sebagai dasar pembayaran biaya pelayanan kesehatan dan</span></li>
<li class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Sebagai bahan untuk menyiapkan statistik kesehatan.</span></li>
</ol><div class="MsoNormal" style="text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Dalam kepustakaan dikatakan bahwa rekam medis memiliki 5 manfaat, yang untuk mudahnya disingkat sebagai <b>ALFRED</b>, yaitu:</span></div><div class="MsoListParagraphCxSpFirst" style="text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Adminstratlve value</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">: Rekam medis merupakan rekaman data adminitratif pelayanan kesehatan.</span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span> </span><b>Legal value</b>: Rekam medis dapat.dijadikan bahan pembuktian di pengadilan</span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Financial value</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">: Rekam medis dapat dijadikan dasar untuk perincian biaya pelayanan kesehatan yang harus dibayar oleh pasien</span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Research value</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">: Data Rekam Medis dapat dijadikan bahan untuk penelitian dalam lapangan kedokteran, keperawatan dan kesehatan.</span></div><div class="MsoListParagraphCxSpLast" style="text-indent: -18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Education value</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">: Data-data dalam Rekam Medis dapat bahan pengajaran dan pendidikan mahasiswa kedokteran, keperawatan serta tenaga kesehatan lainnya.</span></div><div class="MsoNormal"><br />
</div><div class="MsoListParagraph" style="text-indent: -18pt;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span>E.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Penyimpanan Rekam Medis</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Dalam audit medis, umumnya sumber data yang digunakan adalah rekam medis pasien, baik yang rawat jalan maupun yang rawat inap. Rekam medis adalah sumber data yang paling baik di rumah sakit, meskipun banyak memiliki kelemahan. Beberapa kelemahan rekam medis adalah sering tidak adanya beberapa data yang bersifat sosial-ekonomi pasien, seringnya pengisian rekam medis yang tak lengkap, tidak tercantumnya persepsi pasien, tidak berisi penatalaksanaan “pelengkap” seperti penjelasan dokter dan perawat, seringkali tidak memuat kunjungan kontrol pasca perawatan inap, dll.</span></div><div class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Dampak dari <span>audit medis</span> yang diharapkan tentu saja adalah peningkatan mutu dan efektifitas pelayanan medis di sarana kesehatan tersebut. Namun di samping itu, kita juga perlu memperhatikan dampak lain, seperti dampaknya terhadap perilaku para profesional, tanggung-jawab manajemen terhadap nilai dari audit medis tersebut, seberapa jauh mempengaruhi beban kerja, rasa akuntabilitas, prospek karier dan moral, dan jenis pelatihan yang diperlukan.</span></div><div class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Diantara semua <span>manfaat Rekam Medis</span>, yang terpenting adalah aspek legal Rekam Medis. Pada kasus malpraktek medis, keperawatan maupun farmasi, Rekam Medis merupakan salah satu bukti tertulis yang penting. Berdasarkan informasi dalam Rekam Medis, petugas hukum serta <span>Majelis Hakim</span> dapat menentukan benar tidaknya telah terjadi tindakan malpraktek, bagaimana terjadinya malpraktek tersebut serta menentukan siapa sebenarnya yang bersalah dalam perkara tersebut.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Sumber : http://astaqauliyah.com/2007/10/rekam-medis-defenisi-dan-kegunaannya/</span></div><div class="MsoNormal"><br />
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</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-size: 18pt; line-height: 115%;">REKAM MEDIK JURUSAN KEPERAWATAN GIGI </span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-size: 18pt; line-height: 115%;">POLTEKKES KEMENKES JAKARTA 1</span></b></div><div style="border: 1pt solid windowtext; padding: 1pt 4pt;"> <div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>No. Dok. Medik<span> </span>:</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Nama Pasien<span> </span>: <span> </span>Agama<span> </span>: </div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Tanggal Lahir<span> </span>: <span> </span>Jenis Kelamin<span> </span>: P / Lk</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Pendidikan<span> </span>: <span> </span>Warga Negara<span> </span>: </div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Pekerjaan<span> </span>:</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Alamat<span> </span>: </div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><br />
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</div><div style="border: 1pt solid windowtext; padding: 1pt 4pt;"> <div class="MsoNormal" style="border: medium none; padding: 0cm;">Status Perkawinan :<span> </span>Cara Masuk :<br />
1. Kawin<span> </span>4. Janda<span> </span>1. Dokter</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">2. Belum Kawin<span> </span>5. Dibawah Umur<span> </span>2. Puskesmas</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">3. Duda<span> </span>3. RS. Lain</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>4. Instansi Lain</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>5. Kasus Polisi</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>6. Datang Sendiri</div></div><div class="MsoNormal"><br />
</div><div style="border: 1pt solid windowtext; padding: 1pt 4pt;"> <div class="MsoNormal" style="border: medium none; padding: 0cm;">Nama Penanggung Jawab<span> </span>Tanggal Masuk :<span> </span>Tanggal Keluar</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Pembayaran<span> </span>Tanggal<span> </span>:<span> </span>Tanggal<span> </span>:</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">...........................................<span> </span>Bulan<span> </span>:<span> </span>Bulan <span> </span>:</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>Tahun<span> </span>:<span> </span>Tahun<span> </span>:</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Alamat<span> </span>:<span> </span>Jam<span> </span>:<span> </span>Jam<span> </span>:</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><br />
</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><br />
</div></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td style="border-color: black white black black; border-style: solid; border-width: 1pt; padding: 0cm 5.4pt; width: 153.95pt;" valign="top" width="205"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Keadaan keluar</div></td> <td style="border-color: black white black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 154.05pt;" valign="top" width="205"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Cara keluar</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 154.1pt;" valign="top" width="205"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 75.5pt;"> <td style="border-color: -moz-use-text-color white black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 75.5pt; padding: 0cm 5.4pt; width: 153.95pt;" valign="top" width="205"> <div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span>Sembuh</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span>Membaik</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span>Belum sembuh</div></td> <td style="border-color: -moz-use-text-color white black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 75.5pt; padding: 0cm 5.4pt; width: 154.05pt;" valign="top" width="205"> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span>Diizinkan pulang</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pulang paksa</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>6.<span style="font: 7pt "Times New Roman";"> </span></span></span>Lari</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>7.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pindah rumah sakit</div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>8.<span style="font: 7pt "Times New Roman";"> </span></span></span>Dirujuk ke</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 75.5pt; padding: 0cm 5.4pt; width: 154.1pt;" valign="top" width="205"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 75.85pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 75.85pt; padding: 0cm 5.4pt; width: 153.95pt;" valign="top" width="205"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Dokter yang merawat</div></td> <td colspan="2" style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 75.85pt; padding: 0cm 5.4pt; width: 308.15pt;" valign="top" width="411"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span> </span>Tanda tangan </div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div style="border: 1pt solid windowtext; padding: 1pt 4pt;"> <div class="MsoNormal" style="border: medium none; padding: 0cm;">Keluhan Utama :</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><br />
</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><br />
</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><br />
</div></div><div class="MsoNormal">Keluhan Umum :</div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; width: 696px;"><tbody>
<tr style="height: 14.8pt;"> <td colspan="2" nowrap="nowrap" style="border: 1pt solid windowtext; height: 14.8pt; padding: 0cm 5.4pt; width: 266pt;" valign="bottom" width="355"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">Dewasa</span></div></td> <td colspan="2" nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 256.1pt;" valign="bottom" width="341"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">Anak-anak</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">1</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Jantung<span> </span>: ada/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">1</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Jantung<span> </span>: ada/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">2</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Darah Tinggi<span> </span>: ada/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">2</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Campak/cacar Air<span> </span>: ada/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">3</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit TBC<span> </span><span> </span>: ada/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">3</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit TBC<span> </span>: ada/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">4</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Diabetes Mellitus<span> </span><span> </span><span> </span>: ada/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">4</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Diabetes Mellitus<span> </span>: ada/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">5</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Asma<span> </span>: ada/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">5</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Asma<span> </span>: ada/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">6</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Hepatitis<span> </span>: ada/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">6</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Hepatitis<span> </span>: ada/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">7</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Alergi<span> </span>: ada/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">7</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Alergi<span> </span>: ada/tidak ada</span></div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal">RIWAYAT KESEHATAN UMUM :</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Ya</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Tidak</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Pasien merasa dalam keadaan sehat</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Selama 5 tahun terakhir ini, pasien pernah dinyatakan mengalami penyakit serius, menjalani operasi dan atu dirawat inap di rumah sakit?</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Jika YA........ tulis nama penyakitnya:</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">..........................................................</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Pasien mempunyai kelainan pembekuan darah</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Pasien mempunyai reaksi alergi terhadap hal-hal sebagai berikut:</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Makanan............................................................................</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Obat-obatan.......................................................................</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Obat yang disuntik(obat bius)............................................</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Cuaca dan lain-lain.............................................................</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Pasien sedang dalam perawatan/mengonsumsi obat yang diresepkan/tidak diresepkan oleh dokter/dokter gigi</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">RIWAYAT KESEHATAN GIGI :</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Ya</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Tidak</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pasien pernah dirawat gigi sebelumnya?</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span>Jika sudah pernah dirawat sebelumya apakah pengalaman perawatannya tidak memuaskan/menjadi cemas/takut diperiksa ulang?</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pasien mengetahui bagaimana cara memelihara kesehatan gigi dan mulut yang baik dan benar?</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>d.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pasien menyikat gigi sebanyak 2 kali sehari atau lebih dan waktunya adalah sesudah makan dan sebelum tidur?</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>e.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pasien menjaga kesehatan gigi dengan mengurangi makanan yang lengket dan manis-manis serta memperbanyak makanan buah-buahan?</div></td> <td style="border-color: -moz-use-text-color windowtext black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 21.75pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 21.75pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>f.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pasien mempunyai kebiasaan sebagai berikut:</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Minum teh/kopi.....................................................................</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Minuman beralkohol.............................................................</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Minuman bersoda.................................................................</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Merokok................................................................................</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Mengunyah satu sisi.............................................................</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Mengunyah siri/tembakau...................................................</div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Menggigit benda keras.........................................................</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.75pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 5.4pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.75pt; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 5.4pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div style="border: 1pt solid windowtext; padding: 1pt 4pt;"> <div class="MsoNormal" style="border: medium none; padding: 0cm;">PEMERIKSAAN OBYEKTIF</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">A. Pemeriksaan Ekstra Oral</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>- Muka<span> </span>:</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>- Kelenjar Lymphe<span> </span>:<span> </span>*kanan :</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>*kiri<span> </span>:</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">B. Pemeriksaan Intra Oral</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">1. Jaringan Lunak Mulut</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">- Bibir<span> </span>: Norma / ada kelainan</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">- Lidah<span> </span>: Norma / ada kelainan</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">- Mukosa Bukal<span> </span>: Norma / ada kelainan</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">- Mukosa Palatinal : Norma / ada kelainan</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">- Gingiva<span> </span>: Norma / ada kelainan</div></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">2. Kebersihan Mulut / OHI-S</div><div align="center" class="MsoNormal" style="text-align: center;"><span style="height: 51px; left: 0px; margin-left: 399px; margin-top: 2px; position: absolute; width: 3px; z-index: 1;"><img height="51" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="3" /></span><span style="height: 51px; left: 0px; margin-left: 199px; margin-top: 2px; position: absolute; width: 3px; z-index: 2;"><img height="51" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image002.gif" width="3" /></span><span style="height: 2px; left: 0px; margin-left: 41px; margin-top: 27px; position: absolute; width: 517px; z-index: 3;"><img height="2" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image003.gif" width="517" /></span>18<span> </span>17<span> </span>16<span> </span>15<span> </span>14<span> </span>13<span> </span>12<span> </span>11<span> </span>21<span> </span>22<span> </span>23<span> </span>24<span> </span>25<span> </span>26<span> </span>27<span> </span>28</div><div align="center" class="MsoNormal" style="text-align: center;">48<span> </span>47<span> </span>46<span> </span>45<span> </span>44<span> </span><span> </span>43<span> </span>42<span> </span>41<span> </span>31<span> </span>32<span> </span>33<span> </span>34<span> </span>35<span> </span>36<span> </span>37<span> </span>38</div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div class="MsoNormal"><span> </span>Debris <span> </span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr style="height: 18.65pt;"> <td style="border: 1pt solid black; height: 18.65pt; padding: 0cm 5.4pt; width: 40.85pt;" valign="top" width="54"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 18.65pt; padding: 0cm 5.4pt; width: 42.55pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 18.65pt; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> </tr>
<tr style="height: 20.35pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.35pt; padding: 0cm 5.4pt; width: 40.85pt;" valign="top" width="54"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.35pt; padding: 0cm 5.4pt; width: 42.55pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span> </span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.35pt; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span> </span>Calculus</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr style="height: 18.65pt;"> <td style="border: 1pt solid black; height: 18.65pt; padding: 0cm 5.4pt; width: 40.85pt;" valign="top" width="54"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 18.65pt; padding: 0cm 5.4pt; width: 42.55pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 18.65pt; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> </tr>
<tr style="height: 20.35pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.35pt; padding: 0cm 5.4pt; width: 40.85pt;" valign="top" width="54"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.35pt; padding: 0cm 5.4pt; width: 42.55pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.35pt; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal" style="text-align: justify;"><br />
</div><table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 6.75pt; margin-right: 6.75pt;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 47.95pt;" valign="top" width="64"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><span> </span>DI<span> </span><span> </span>CI<span> </span><span> </span><span> </span><span> </span>OHI-S<span> </span>Kriteria OHI-S</div><table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 6.75pt; margin-right: 6.75pt;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 47.95pt;" valign="top" width="64"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 6.75pt; margin-right: 6.75pt;"><tbody>
<tr style="height: 5.25pt;"> <td style="border: 1pt solid black; height: 5.25pt; padding: 0cm 5.4pt; width: 48.9pt;" valign="top" width="65"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 6.75pt; margin-right: 6.75pt;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 47.95pt;" valign="top" width="64"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><span> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">C. Status Lokalis Gigi Geligi</div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 4.55pt; width: 576px;"><tbody>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border: 1pt solid windowtext; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">55</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">54</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">53</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">52</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">51</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">61</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">62</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">63</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">64</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">65</span></div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border: 1pt solid windowtext; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext -moz-use-text-color; border-style: solid none; border-width: 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">18</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">17</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color -moz-use-text-color windowtext; border-style: none none solid; border-width: medium medium 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">16</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">15</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">14</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">13</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">12</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">11</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">21</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">22</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">23</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">24</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">25</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">26</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">27</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">28</span></div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">48</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">47</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color -moz-use-text-color windowtext; border-style: none none solid; border-width: medium medium 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">46</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">45</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">44</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">43</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">42</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">41</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">31</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">32</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">33</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">34</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">35</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">36</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">37</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">38</span></div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color -moz-use-text-color windowtext; border-style: none none solid; border-width: medium medium 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">85</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">84</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">83</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">82</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">81</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">71</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">72</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">73</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">74</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">75</span></div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Kode Status Karies Gigi</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td colspan="2" style="border: 1pt solid black; padding: 0cm 5.4pt; width: 125.9pt;" valign="top" width="168"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">GIGI</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Status/Kondisi</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Tetap</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Susu</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">0</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">A</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Sehat</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">1</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">B</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi Berlubang</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">2</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">C</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Tumpatan dengan Karies</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">3</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">D</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Tumpatan tanpa Karies</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">4</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">E</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi dicabut karena karies</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">5</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi dicabut oleh sebab lain</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">6</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Sealant, Varnish</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">7</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">F</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Abutment, Mahkota khusus</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">8</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">G</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi tidak tumbuh</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">9</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 70.85pt;" valign="top" width="94"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.35pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi tidak termasuk kriteria diatas</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal">Kelainan Jaringan Keras Gigi</div><div class="MsoNormal">Gigi Tetap :</div><div class="MsoNormal"><span> </span>D :</div><div class="MsoNormal"><span> </span>M :</div><div class="MsoNormal"><span style="height: 2px; margin-left: -10px; margin-top: 24px; position: absolute; width: 135px; z-index: 18;"><img height="2" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image004.gif" width="135" /></span><span> </span>F :</div><div class="MsoNormal">DMF-T<span> </span>:</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Gigi Susu :</div><div class="MsoNormal"><span> </span>d :</div><div class="MsoNormal"><span> </span>e :</div><div class="MsoNormal"><span style="height: 2px; margin-left: -10px; margin-top: 27px; position: absolute; width: 135px; z-index: 19;"><img height="2" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image005.gif" width="135" /></span><span> </span>f :</div><div class="MsoNormal">def-t<span> </span>:</div><div class="MsoNormal">D. KELAINAN GIGI :</div><div class="MsoNormal">-<span> </span>Bentuk<span> </span>:</div><div class="MsoNormal">- Jumlah<span> </span>:</div><div class="MsoNormal">- Warna<span> </span>:</div><div class="MsoNormal">- Posisi<span> </span>:</div><div class="MsoNormal">-Ukuran<span> </span>:</div><div class="MsoNormal">-Struktur:</div><div class="MsoNormal">Status Pemeriksaan Gigi Geligi :</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Inspeksi</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Sondasi</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Termis</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Perkusi</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Palpasi</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Mobilitas</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Masalah</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.75pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 57.8pt;" valign="top" width="77"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal">Pengolahan Data :</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Indikator</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">TARGET</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">PENCAPAIAN</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">KESENJANGAN</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">PROSENTASE</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">PRIORITAS</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">DMF-T</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">def-t</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">OHI-S</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Konsul Ke :</div><div class="MsoNormal">-Bagian Pencegahan :</div><div class="MsoNormal">-Bagian Pengawetan :</div><div class="MsoNormal">-Bagian Pencabutan<span> </span>:</div><div class="MsoNormal">-Lain-lain <span> </span><span> </span>:</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Rencana Perawatan</div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 4.55pt; width: 643px;"><tbody>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border: 1pt solid windowtext; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">TANGGAL</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">GIGI</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">MASALAH</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">RENCANA TERAPI</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">PARAF</span></div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Perawatan</div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 4.55pt; width: 643px;"><tbody>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border: 1pt solid windowtext; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">TANGGAL</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">GIGI</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">MASALAH</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">TERAPI</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">PARAF</span></div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 78pt;" valign="bottom" width="104"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 57pt;" valign="bottom" width="76"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-size: 18pt; line-height: 115%;">REKAM MEDIK JURUSAN KEPERAWATAN GIGI </span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-size: 18pt; line-height: 115%;">POLTEKKES KEMENKES JAKARTA 1</span></b></div><div style="border: 1pt solid windowtext; padding: 1pt 4pt;"> <div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>No. Dok. Medik<span> </span>: 23-20-11</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Nama Pasien<span> </span>: Raisyah Zakyah Sohwa<span> </span>Agama<span> </span>:<span> </span>Islam</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Tanggal Lahir<span> </span>: 23 September 1991<span> </span>Jenis Kelamin<span> </span>: P / <s>Lk</s></div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Pendidikan<span> </span>: Mahasiswa<span> </span>Warga Negara <span> </span>: Indonesia<span> </span></div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Pekerjaan<span> </span>: Mahasiswa</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Alamat<span> </span>: Jalan Lebak Bulus 4 no 23B</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><br />
</div></div><div class="MsoNormal" style="line-height: normal;"><br />
</div><div style="border: 1pt solid windowtext; padding: 1pt 4pt;"> <div class="MsoNormal" style="border: medium none; padding: 0cm;"><span style="height: 32px; margin-left: 0px; margin-top: 52px; position: absolute; width: 96px; z-index: -24;"><img height="32" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image006.gif" width="96" /></span>Status Perkawinan :<span> </span>Cara Masuk :<br />
1. Kawin<span> </span><span> </span>4. Janda<span> </span>1. Dokter</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">2. Belum Kawin<span> </span>5. Dibawah Umur<span> </span>2. Puskesmas</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">3. Duda<span> </span>3. RS. Lain</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>4. Instansi Lain</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span style="height: 30px; margin-left: 322px; margin-top: 31px; position: absolute; width: 132px; z-index: -23;"><img height="30" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image007.gif" width="132" /></span><span> </span>5. Kasus Polisi</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>6. Datang Sendiri</div></div><div class="MsoNormal"><br />
</div><div style="border: 1pt solid windowtext; padding: 1pt 4pt;"> <div class="MsoNormal" style="border: medium none; padding: 0cm;">Nama Penanggung Jawab<span> </span>Tanggal Masuk <span> </span>Tanggal Keluar</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Pembayaran<span> </span>Tanggal<span> </span>: 24 <span> </span>Tanggal<span> </span>: 30</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Raisyah Zakyah Sohwa<span> </span><span> </span><span> </span>Bulan<span> </span>:Maret<span> </span>Bulan <span> </span>:Maret</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>Tahun<span> </span>:2011<span> </span>Tahun<span> </span>:2011</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Alamat<span> </span>: <span> </span>Jam<span> </span>: 8.00<span> </span>Jam<span> </span>: 10.00</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">Jalan Lebak Bulus 4 no 23B</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><br />
</div></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td style="border-color: black white black black; border-style: solid; border-width: 1pt; padding: 0cm 5.4pt; width: 153.95pt;" valign="top" width="205"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Keadaan keluar</div></td> <td style="border-color: black white black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 154.05pt;" valign="top" width="205"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="height: 24px; left: 0px; margin-left: 16px; margin-top: 12px; position: absolute; width: 134px; z-index: -22;"><img height="24" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image008.gif" width="134" /></span>Cara keluar</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 154.1pt;" valign="top" width="205"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 75.5pt;"> <td style="border-color: -moz-use-text-color white black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 75.5pt; padding: 0cm 5.4pt; width: 153.95pt;" valign="top" width="205"> <div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>9.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="height: 21px; left: 0px; margin-left: 20px; margin-top: 16px; position: absolute; width: 97px; z-index: -21;"><img height="21" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image009.gif" width="97" /></span>Sembuh</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>10.<span style="font: 7pt "Times New Roman";"> </span></span></span>Membaik</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>11.<span style="font: 7pt "Times New Roman";"> </span></span></span>Belum sembuh</div></td> <td style="border-color: -moz-use-text-color white black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 75.5pt; padding: 0cm 5.4pt; width: 154.05pt;" valign="top" width="205"> <div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>12.<span style="font: 7pt "Times New Roman";"> </span></span></span>Diizinkan pulang</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>13.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pulang paksa</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>14.<span style="font: 7pt "Times New Roman";"> </span></span></span>Lari</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>15.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pindah rumah sakit</div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>16.<span style="font: 7pt "Times New Roman";"> </span></span></span>Dirujuk ke</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 75.5pt; padding: 0cm 5.4pt; width: 154.1pt;" valign="top" width="205"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 75.85pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 75.85pt; padding: 0cm 5.4pt; width: 153.95pt;" valign="top" width="205"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Dokter yang merawat</div><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Drg.Widya Anggraini</div></td> <td colspan="2" style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 75.85pt; padding: 0cm 5.4pt; width: 308.15pt;" valign="top" width="411"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="height: 77px; margin-left: 53px; margin-top: 14px; position: absolute; width: 142px; z-index: 8;"><img height="77" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image010.gif" width="142" /></span><span> </span>Tanda tangan </div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div style="border: 1pt solid windowtext; padding: 1pt 4pt;"> <div class="MsoNormal" style="border: medium none; padding: 0cm;">Keluhan Utama : Pasien datang ingin ditambal giginya karena berlubang dibagian kiri bawah belakang semenjak 2 bulan yang lalu terasa linu jika terkena rangsangan dingin</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><br />
</div></div><div class="MsoNormal">Keluhan Umum :</div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; width: 696px;"><tbody>
<tr style="height: 14.8pt;"> <td colspan="2" nowrap="nowrap" style="border: 1pt solid windowtext; height: 14.8pt; padding: 0cm 5.4pt; width: 266pt;" valign="bottom" width="355"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">Dewasa</span></div></td> <td colspan="2" nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 256.1pt;" valign="bottom" width="341"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">Anak-anak</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">1</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Jantung<span> </span>: <s>ada</s>/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">1</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Jantung<span> </span><span> </span>: <s>ada</s>/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">2</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Darah Tinggi<span> </span>: <s>ada</s>/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">2</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Campak/cacar Air<span> </span>: <s>ada</s>/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">3</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit TBC<span> </span><span> </span>: <s>ada</s>/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">3</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit TBC<span> </span><span> </span><span> </span>: <s>ada</s>/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">4</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Diabetes Mellitus<span> </span><span> </span>: <s>ada</s>/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">4</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Diabetes Mellitus<span> </span>: <s>ada</s>/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">5</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Asma<span> </span><span> </span><span> </span>: <s>ada</s>/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">5</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Asma<span> </span><span> </span>: <s>ada</s>/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">6</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Hepatitis<span> </span>: <s>ada</s>/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">6</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Hepatitis<span> </span>: <s>ada</s>/tidak ada</span></div></td> </tr>
<tr style="height: 14.8pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">7</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 249.6pt;" valign="bottom" width="333"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Alergi<span> </span>: <s>ada</s>/tidak ada</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 16.4pt;" valign="bottom" width="22"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">7</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 14.8pt; padding: 0cm 5.4pt; width: 239.7pt;" valign="bottom" width="320"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Penyakit Alergi<span> </span><span> </span><span> </span>: <s>ada</s>/tidak ada</span></div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">RIWAYAT KESEHATAN UMUM :</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Ya</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Tidak</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Pasien merasa dalam keadaan sehat</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Selama 5 tahun terakhir ini, pasien pernah dinyatakan mengalami penyakit serius, menjalani operasi dan atu dirawat inap di rumah sakit?</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Jika YA........ tulis nama penyakitnya:</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">..........................................................</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Pasien mempunyai kelainan pembekuan darah</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Pasien mempunyai reaksi alergi terhadap hal-hal sebagai berikut:</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Makanan............................................................................</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Obat-obatan.......................................................................</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Obat yang disuntik(obat bius)............................................</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Cuaca dan lain-lain.............................................................</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 338.55pt;" valign="top" width="451"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Pasien sedang dalam perawatan/mengonsumsi obat yang diresepkan/tidak diresepkan oleh dokter/dokter gigi</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 63.75pt;" valign="top" width="85"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 59.8pt;" valign="top" width="80"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal">RIWAYAT KESEHATAN GIGI :</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Ya</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Tidak</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>g.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pasien pernah dirawat gigi sebelumnya?</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>h.<span style="font: 7pt "Times New Roman";"> </span></span></span>Jika sudah pernah dirawat sebelumya apakah pengalaman perawatannya tidak memuaskan/menjadi cemas/takut diperiksa ulang?</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>i.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pasien mengetahui bagaimana cara memelihara kesehatan gigi dan mulut yang baik dan benar?</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>j.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pasien menyikat gigi sebanyak 2 kali sehari atau lebih dan waktunya adalah sesudah makan dan sebelum tidur?</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraph" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>k.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pasien menjaga kesehatan gigi dengan mengurangi makanan yang lengket dan manis-manis serta memperbanyak makanan buah-buahan?</div></td> <td style="border-color: -moz-use-text-color windowtext black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">X</div></td> </tr>
<tr style="height: 21.75pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 21.75pt; padding: 0cm 5.4pt; width: 352.7pt;" valign="top" width="470"> <div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>l.<span style="font: 7pt "Times New Roman";"> </span></span></span>Pasien mempunyai kebiasaan sebagai berikut:</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Minum teh/kopi.....................................................................</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Minuman beralkohol.............................................................</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Minuman bersoda.................................................................</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Merokok................................................................................</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Mengunyah satu sisi.............................................................</div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Mengunyah siri/tembakau...................................................</div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: 0.0001pt; text-indent: -18pt;"><span><span>-<span style="font: 7pt "Times New Roman";"> </span></span></span>Menggigit benda keras.........................................................</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.75pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"> <div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 5.4pt; text-align: center;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.75pt; padding: 0cm 5.4pt; width: 52.7pt;" valign="top" width="70"> <div align="center" class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 5.4pt; text-align: center;">X</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div style="border: 1pt solid windowtext; padding: 1pt 4pt;"> <div class="MsoNormal" style="border: medium none; padding: 0cm;">PEMERIKSAAN OBYEKTIF</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">A. Pemeriksaan Ekstra Oral</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>- Muka<span> </span>: Simetris</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>- Kelenjar Lymphe<span> </span>:<span> </span>*kanan : -</div><div class="MsoNormal" style="border: medium none; padding: 0cm;"><span> </span>*kiri<span> </span>: teraba, keras</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">B. Pemeriksaan Intra Oral</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">1. Jaringan Lunak Mulut</div><div class="MsoNormal" style="border: medium none; padding: 0cm;">- Bibir<span> </span>: Norma / <s>ada kelainan</s></div><div class="MsoNormal" style="border: medium none; padding: 0cm;">- Lidah<span> </span>: Norma / <s>ada kelainan</s></div><div class="MsoNormal" style="border: medium none; padding: 0cm;">- Mukosa Bukal<span> </span>: Norma / <s>ada kelainan</s></div><div class="MsoNormal" style="border: medium none; padding: 0cm;">- Mukosa Palatinal : Norma / <s>ada kelainan</s></div><div class="MsoNormal" style="border: medium none; padding: 0cm;">- Gingiva<span> </span>: Norma / <s>ada kelainan</s></div></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">2. Kebersihan Mulut / OHI-S</div><div align="center" class="MsoNormal" style="text-align: center;"><span style="height: 32px; left: 0px; margin-left: 471px; margin-top: 29px; position: absolute; width: 30px; z-index: -19;"><img height="32" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image011.gif" width="30" /></span><span style="height: 32px; left: 0px; margin-left: 297px; margin-top: 29px; position: absolute; width: 31px; z-index: -18;"><img height="32" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image012.gif" width="31" /></span><span style="position: relative; z-index: -17;"><span style="height: 32px; left: 471px; position: absolute; top: -3px; width: 30px;"><img height="32" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image011.gif" width="30" /></span></span><span style="height: 51px; left: 0px; margin-left: 399px; margin-top: 2px; position: absolute; width: 3px; z-index: 12;"><img height="51" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="3" /></span><span style="height: 51px; left: 0px; margin-left: 199px; margin-top: 2px; position: absolute; width: 3px; z-index: 13;"><img height="51" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image002.gif" width="3" /></span><span style="height: 2px; left: 0px; margin-left: 41px; margin-top: 27px; position: absolute; width: 517px; z-index: 14;"><img height="2" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image003.gif" width="517" /></span>18<span> </span>17<span> </span>16<span> </span>15<span> </span>14<span> </span>13<span> </span>12<span> </span>11<span> </span>21<span> </span>22<span> </span>23<span> </span>24<span> </span>25<span> </span>26<span> </span>27<span> </span>28</div><div align="center" class="MsoNormal" style="text-align: center;">48<span> </span>47<span> </span>46<span> </span>45<span> </span>44<span> </span><span> </span>43<span> </span>42<span> </span>41<span> </span>31 <span> </span>32<span> </span>33<span> </span>34<span> </span>35<span> </span>36<span> </span>37<span> </span>38</div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div class="MsoNormal"><span> </span>Debris <span> </span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr style="height: 18.65pt;"> <td style="border: 1pt solid black; height: 18.65pt; padding: 0cm 5.4pt; width: 40.85pt;" valign="top" width="54"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">3</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 18.65pt; padding: 0cm 5.4pt; width: 42.55pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">3</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 18.65pt; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">2</div></td> </tr>
<tr style="height: 20.35pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.35pt; padding: 0cm 5.4pt; width: 40.85pt;" valign="top" width="54"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">1</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.35pt; padding: 0cm 5.4pt; width: 42.55pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span> </span>3</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.35pt; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">3</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span> </span>Calculus</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr style="height: 18.65pt;"> <td style="border: 1pt solid black; height: 18.65pt; padding: 0cm 5.4pt; width: 40.85pt;" valign="top" width="54"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">0</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 18.65pt; padding: 0cm 5.4pt; width: 42.55pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">0</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 18.65pt; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">2</div></td> </tr>
<tr style="height: 20.35pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.35pt; padding: 0cm 5.4pt; width: 40.85pt;" valign="top" width="54"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">0</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.35pt; padding: 0cm 5.4pt; width: 42.55pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">1</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.35pt; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">2</div></td> </tr>
</tbody></table><div class="MsoNormal" style="text-align: justify;"><br />
</div><table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 6.75pt; margin-right: 6.75pt;"><tbody>
<tr style="height: 35.2pt;"> <td style="border: 1pt solid black; height: 35.2pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">2,5 + 0,83</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">= 3,33</div></td> </tr>
</tbody></table><div class="MsoNormal"><span style="height: 29px; margin-left: 351px; margin-top: 33px; position: absolute; width: 26px; z-index: -13;"><img height="29" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image013.gif" width="26" /></span><span> </span>DI<span> </span><span> </span>CI<span> </span><span> </span><span> </span><span> </span>OHI-S<span> </span><span> </span>Kriteria OHI-S</div><table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 6.75pt; margin-right: 6.75pt;"><tbody>
<tr style="height: 35.2pt;"> <td style="border: 1pt solid black; height: 35.2pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;"><img height="36" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image015.gif" width="55" /></span></div></td> </tr>
</tbody></table><table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 6.75pt; margin-right: 6.75pt;"><tbody>
<tr style="height: 35.2pt;"> <td style="border: 1pt solid black; height: 35.2pt; padding: 0cm 5.4pt; width: 55.05pt;" valign="top" width="73"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;"><img height="36" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image017.gif" width="55" /></span></div></td> </tr>
</tbody></table><table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 6.75pt; margin-right: 6.75pt;"><tbody>
<tr style="height: 28pt;"> <td style="border: 1pt solid black; height: 28pt; padding: 0cm 5.4pt; width: 83.4pt;" valign="top" width="111"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">B<span> </span>/<span> </span>S<span> </span>/<span> </span>K<span> </span></div></td> </tr>
</tbody></table><div class="MsoNormal"><span> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">C. Status Lokalis Gigi Geligi</div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 4.55pt; width: 576px;"><tbody>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border: 1pt solid windowtext; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">55</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">54</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">53</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">52</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">51</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">61</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">62</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">63</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">64</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">65</span></div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border: 1pt solid windowtext; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;"> 9</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">9 </span></div></td> <td nowrap="nowrap" style="border-color: windowtext -moz-use-text-color; border-style: solid none; border-width: 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">9</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">1 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">9 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">9 </span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">1 </span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;"> 9</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">9 </span></div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">18</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">17</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color -moz-use-text-color windowtext; border-style: none none solid; border-width: medium medium 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">16</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">15</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">14</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">13</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">12</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">11</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">21</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">22</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">23</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">24</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">25</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">26</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">27</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">28</span></div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">48</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">47</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color -moz-use-text-color windowtext; border-style: none none solid; border-width: medium medium 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">46</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">45</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">44</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">43</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">42</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">41</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">31</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">32</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">33</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">34</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">35</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">36</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">37</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">38</span></div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;"> 9</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">9 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color -moz-use-text-color windowtext; border-style: none none solid; border-width: medium medium 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">1 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;"> 0</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;"> 0</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;"> 0</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;"> 0</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">3 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">0 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">9 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: red;">9 </span></div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">85</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">84</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">83</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">82</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">81</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">71</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">72</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">73</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">74</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">75</span></div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><br />
</div></td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 24pt;" valign="bottom" width="32"><br />
</td> <td nowrap="nowrap" style="height: 15pt; padding: 0cm 5.4pt; width: 48pt;" valign="bottom" width="64"><br />
</td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal">Kode Status Karies Gigi</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td colspan="2" style="border: 1pt solid black; padding: 0cm 5.4pt; width: 147.15pt;" valign="top" width="196"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">GIGI</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Status/Kondisi</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Tetap</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">Susu</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">0</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">A</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Sehat</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">1</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">B</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi Berlubang</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">2</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">C</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Tumpatan dengan Karies</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">3</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">D</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Tumpatan tanpa Karies</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">4</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">E</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi dicabut karena karies</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">5</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi dicabut oleh sebab lain</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">6</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Sealant, Varnish</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">7</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">F</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Abutment, Mahkota khusus</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">8</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">G</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi tidak tumbuh</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 62.1pt;" valign="top" width="83"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">9</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 3cm;" valign="top" width="113"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 191.4pt;" valign="top" width="255"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi tidak termasuk kriteria diatas</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal">Kelainan Jaringan Keras Gigi</div><div class="MsoNormal">Gigi Tetap :</div><div class="MsoNormal"><span> </span>D : 3</div><div class="MsoNormal"><span> </span>M : 1</div><div class="MsoNormal"><span style="height: 2px; margin-left: -21px; margin-top: 25px; position: absolute; width: 163px; z-index: 16;"><img height="2" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image018.gif" width="163" /></span><span> </span>F : -<span> </span></div><div class="MsoNormal">DMF-T<span> </span>: 4</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Gigi Susu :</div><div class="MsoNormal"><span> </span>d : -</div><div class="MsoNormal"><span> </span>e : -</div><div class="MsoNormal"><span style="height: 2px; margin-left: -13px; margin-top: 26px; position: absolute; width: 163px; z-index: 17;"><img height="2" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image019.gif" width="163" /></span><span> </span>f : -</div><div class="MsoNormal">def-t<span> </span>: -</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">D. KELAINAN GIGI :</div><div class="MsoNormal">-<span> </span>Bentuk<span> </span>: -</div><div class="MsoNormal">- Jumlah<span> </span>: -</div><div class="MsoNormal">- Warna<span> </span>: -</div><div class="MsoNormal">- Posisi<span> </span>: -</div><div class="MsoNormal">-Ukuran<span> </span>: -</div><div class="MsoNormal">-Struktur<span> </span>: -</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Status Pemeriksaan Gigi Geligi :</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Inspeksi</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Sondasi</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Termis</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Perkusi</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Palpasi</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Mobilitas</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Masalah</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">1.4</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Karies Media<span> </span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: Symbol;"><span>+</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: Symbol;"><span>+</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi berlubang dengan berdenyut spontan lebih dari 30 detik</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">2.6</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Karies profunda</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">gigi lubang besar dengan keluhan dulu pernah terasa sakit berdenyut spontan,apabila terkena rangsangan asam,manis,dingin,panas terasa linu.sekarang apabila digunakan untuk makan tidak terasa linu dan terasa sakit. </div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">4.6</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Karies dentin/ karies superfisialis</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: Symbol;"><span>+</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">-</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Gigi berlubang kecil dan terasa linu kurang dari 30 detik</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 33.75pt;" valign="top" width="45"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 81.75pt;" valign="top" width="109"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 45.85pt;" valign="top" width="61"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 49.65pt;" valign="top" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 42.5pt;" valign="top" width="57"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 52.65pt;" valign="top" width="70"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 113.45pt;" valign="top" width="151"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal">Pengolahan Data :</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">Indikator</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">TARGET</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">PENCAPAIAN</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">KESENJANGAN</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">PROSENTASE</div></td> <td style="border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">PRIORITAS</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">DMF-T</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span>≤</span> 3</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">4</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">3 - 4 = -1</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;"><img height="36" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image021.gif" width="139" /></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">III</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">def-t</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span>≤</span> 3</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">0</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">3 – 0 = 0</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;"><img height="36" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image023.gif" width="113" /></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">II</div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">OHI-S</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span>≤</span> 1,2</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">3,33</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">1.2 – 3,3 = -2,1 </div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Calibri","sans-serif"; font-size: 11pt; line-height: 115%;"><img height="38" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image025.gif" width="146" /></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 77.05pt;" valign="top" width="103"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;">I</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Konsul Ke :</div><div class="MsoNormal">-Bagian Pencegahan : 1.4, 4.6, 2.6</div><div class="MsoNormal">-Bagian Pengawetan : 2.6, 3.6, 3.1</div><div class="MsoNormal">-Bagian Pencabutan<span> </span>: -</div><div class="MsoNormal">-Lain-lain <span> </span><span> </span>: -</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Rencana Perawatan</div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 4.55pt; width: 643px;"><tbody>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border: 1pt solid windowtext; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">TANGGAL</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">GIGI</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">MASALAH</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">RENCANA TERAPI</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="height: 33px; left: 0px; margin-left: 0px; margin-top: 28px; position: absolute; width: 67px; z-index: 20;"><img height="33" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image026.gif" width="67" /></span><span style="color: black;">PARAF</span></div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 24-03-11</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 2.6,3.6,3.1</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Terdapat karang gigi</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Pro scalling </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="height: 32px; margin-left: 41px; margin-top: 12px; position: absolute; width: 67px; z-index: 21;"><img height="32" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image027.gif" width="67" /></span><span style="color: black;"> </span></div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 26-03-11</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">1.4 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Gigi berlubang (Karies media)</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="height: 33px; margin-left: 106px; margin-top: 8px; position: absolute; width: 67px; z-index: 23;"><img height="33" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image028.gif" width="67" /></span><span style="color: black;">Pro konservasi </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 28-03-11</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">4.6</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Gigi berlubang (karies dentin) </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Pro konservasi </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="height: 33px; margin-left: 24px; margin-top: 7px; position: absolute; width: 67px; z-index: 22;"><img height="33" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image029.gif" width="67" /></span><span style="color: black;"> </span></div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 30-03-11</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 2.6 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Gigi berlubang besar (ganggren pulpa) </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Pro extrasi </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 64.65pt;" valign="bottom" width="86"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 49.6pt;" valign="bottom" width="66"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 205.55pt;" valign="bottom" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 87.2pt;" valign="bottom" width="116"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span> </span>Perawatan</div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 4.55pt; width: 643px;"><tbody>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border: 1pt solid windowtext; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">TANGGAL</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">GIGI</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">MASALAH</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">TERAPI</span></div></td> <td nowrap="nowrap" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><span style="color: black;">PARAF</span></div></td> </tr>
<tr style="height: 25.75pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 25.75pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 24-03-11</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 25.75pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">2.6,3.6,3.1</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 25.75pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Terdapat karang gigi</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 25.75pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Pembersihan karang gigi.</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 25.75pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="position: relative; z-index: 25;"><span style="height: 33px; left: 15px; position: absolute; top: -14px; width: 67px;"><img height="33" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image030.gif" width="67" /></span></span><span style="color: black;"></span></div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"><span> </span>26-03-11 </span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 1.4</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Gigi berlubang(karies media)</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> Penambalan gigi dengan tambalan sewarna dengan gigi.</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="position: relative; z-index: 26;"><span style="height: 33px; left: 8px; position: absolute; top: -4px; width: 67px;"><img height="33" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image031.gif" width="67" /></span></span><span style="color: black;"> </span></div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 28-03-11</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 4.6</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;">Gigi berlubang(karies dentin)</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> Penambalan gigi dengan tambalan sewarna dengan gigi.</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="height: 33px; margin-left: 0px; margin-top: 14px; position: absolute; width: 67px; z-index: 27;"><img height="33" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image032.gif" width="67" /></span><span style="color: black;"> </span></div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 30-03-11</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> 2.6</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> Gigi berlubang besar (karies profunda) dengan ganggren pulpa</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="color: black;"> Pencabutan gigi dengan sitoject dengan menggunakan tang cabut.</span></div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="position: relative; z-index: 24;"><span style="height: 33px; left: 7px; position: absolute; top: -27px; width: 68px;"><img height="33" src="file:///C:/Users/Rolla/AppData/Local/Temp/msohtmlclip1/01/clip_image033.gif" width="68" /></span></span><span style="color: black;"> </span></div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"><br />
</td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
<tr style="height: 15pt;"> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15pt; padding: 0cm 5.4pt; width: 71.75pt;" valign="bottom" width="96"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 63.25pt;" valign="bottom" width="84"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 129pt;" valign="bottom" width="172"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 143pt;" valign="bottom" width="191"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> <td nowrap="nowrap" style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 15pt; padding: 0cm 5.4pt; width: 75pt;" valign="bottom" width="100"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div align="center" class="MsoPlainText" style="text-align: center;"><br />
</div><div align="center" class="MsoPlainText" style="text-align: center;"><br />
</div><div align="center" class="MsoPlainText" style="text-align: center;"><br />
</div><div align="center" class="MsoPlainText" style="text-align: center;"><br />
</div><div class="MsoNormal"><br />
</div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>Nur Dia Rianihttp://www.blogger.com/profile/07878859972547746126noreply@blogger.com4tag:blogger.com,1999:blog-8264234277684523485.post-26891120246544266482011-11-19T06:52:00.001-08:002011-11-19T06:58:37.409-08:00CONTOH FORMAT BUKU PERJANJIAN<m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac><br />
<div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">BUKU PERJANJIAN</span></div><div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">KLINIK KEPERAWATAN GIGI</span></div><div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">POLiTEKnik KESehatan KEMENterian KESehatan JAKARTA I<br />
JALAN LEBAK BULUS III NO 1 CILANDAK-JAKARTA SELATAN</span></div><div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><br />
</div><br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">Jam praktik</span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Hari : Senin – sabtu</span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Jam : 8.00 – 15.00</span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">Nama dokter</span></div><div class="MsoListParagraphCxSpFirst" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Drg. Widya Anggraini,sp.bm : Dokter Spesialis Bedah Mulut</span><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Drg. Laila Qodria,sp.ortho : Dokter Spesialis Orthodontia</span><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Drg. Kiki Aditia,sp.prostho : Dokter Spesialis Prothodontia</span><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Drg. Ike Natiroh :</span><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">5.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Drg. M Iqbal Rosada :</span><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;">6.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Drg. Nur Dia Riani :</span><span style="font-family: Algerian; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt;"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; margin-left: 36pt; width: 579px;"><tbody>
<tr style="height: 18.1pt;"> <td colspan="2" style="border: 1pt solid windowtext; height: 18.1pt; padding: 0cm 5.4pt; width: 163.95pt;" width="219"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: Algerian; font-size: 12pt;">Jadwal Praktik</span></div></td> <td rowspan="2" style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" width="361"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: Algerian; font-size: 12pt;">Nama Dokter</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: Algerian; font-size: 12pt;">Hari</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: Algerian; font-size: 12pt;">Jam</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: Algerian; font-size: 12pt;">SENIN</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">08.00 – 10.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Ike Natiroh</span></div></td> </tr>
<tr style="height: 17.25pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 17.25pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 17.25pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">10.00 – 12.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 17.25pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Widya Anggraini,sp.BM</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">13.00 – 15.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Laila Qodria, Sp.Ortho</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: Algerian; font-size: 12pt;">selasa</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">08.00 – 10.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. M Iqbal Rosada</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">10.00 – 12.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Nur Dia Riani</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">13.00 – 15.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Kiki Aditia, sp.prostho</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: Algerian; font-size: 12pt;">Rabu</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">08.00 – 10.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. M Iqbal Rosada</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">10.00 – 12.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Laila Qodria, sp.ortho</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">13.00 – 15.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Widya Anggraini,sp.bm</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: Algerian; font-size: 12pt;">Kamis</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">08.00 – 10.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Nur Dia Riani</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">10.00 – 12.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Kiki Aditia,sp.prostho</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">13.00 – 15.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Ike Natiroh</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: Algerian; font-size: 12pt;">Jumat</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">08.00 – 10.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Widya Anggraini,sp.bm</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">10.00 – 12.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Nur Dia Riani</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">13.00 – 15.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Kiki Aditia,sp.prostho</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: Algerian; font-size: 12pt;">Sabtu</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">08.00 – 10.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Laila Qodria,sp.ortho</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">10.00 – 12.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. Ike Natiroh</span></div></td> </tr>
<tr style="height: 18.1pt;"> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; height: 18.1pt; padding: 0cm 5.4pt; width: 62.75pt;" valign="top" width="84"><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><br />
</div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 101.2pt;" valign="top" width="135"><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">13.00 – 15.00</span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 18.1pt; padding: 0cm 5.4pt; width: 270.45pt;" valign="top" width="361"><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0cm 0cm 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Drg. M Iqbal Rosada</span></div></td> </tr>
</tbody></table>Nur Dia Rianihttp://www.blogger.com/profile/07878859972547746126noreply@blogger.com0tag:blogger.com,1999:blog-8264234277684523485.post-77758809097583197442011-09-07T21:50:00.001-07:002011-09-07T21:50:56.941-07:00MAKALAH SISTEM PEREDARAN DARAH<link href="file:///C:%5CDOCUME%7E1%5CCLIENT%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CDOCUME%7E1%5CCLIENT%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_editdata.mso" rel="Edit-Time-Data"></link><!--[if !mso]> <style>
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<div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 22pt;">SISTEM PERDARAN<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 22pt;">DARAH MANUSIA<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><br />
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</div><div class="MsoNormal" style="line-height: normal;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kelompok 1<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: normal;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nama anggota :<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: normal; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">M.IQBAL ROSADA<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">IKE NATIROH<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">KIKI ADITTIA<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpLast" style="line-height: normal; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">NUR DIA RIANI<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: normal;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">POLTEKKES KEMENKES JAKARTA 1<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><span style="font-family: "Times New Roman","serif";">Jl. Lebak Bulus III No.1 – Cilandak Barat Jakarta Selatan Telp. (021) 766 4015 Fax. (021) 766 4015<o:p></o:p></span></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 20pt; line-height: 115%;">KATA PENGANTAR<o:p></o:p></span></b></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div style="line-height: 115%; text-align: justify; text-indent: 0.5in;">Puji syukur saya ucapkan atas kehadirat Allah SWT, karena dengan rahmat dan karunia-Nya kami masih diberi kesempatan untuk menyelesaikan makalah ini. Tidak lupa kami ucapkan kepada dosen pembimbing dan teman-teman yang telah memberikan dukungan dalam menyelesaikan makalah ini.</div><div style="line-height: 115%; text-align: justify; text-indent: 0.5in;">Kami menyadari bahwa dalam penulisan makalah ini masih banyak kekurangan, oleh sebab itu kami sangat mengharapkan kritik dan saran yang membangun. Dan semoga dengan selesainya makalah ini dapat bermanfaat bagi pembaca dan teman-teman. </div><div style="line-height: 115%; text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 20pt; line-height: 115%;">DAFTAR ISI<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Kata Pengantar……………………………………………………………………………………...<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Daftar Isi. …………………………………………………………………………………………..<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bab I Pendahuluan …………………………………………………………………………………<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span> </span>I.1 Latar Belakang…………………………………………………………………………..<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span> </span>I.2 Tujuan Penulisan………………………………………………………………………..<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bab II Isi……………………………………………………………………………………………<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.1 Jantung</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">………………………………………………………………………………..<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-left: 0.5in; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.11 Bagian-bagian dari jantung: ………………………………………………<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-left: 0.5in; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.12 Siklus jantung …………………………………………………………<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-left: 0.5in; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.13 Daya Pompa Jantung……………………………………………………<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-left: 0.5in; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.2 Arteri dan Vena</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">………………………………………………………<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-left: 0.5in; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.21 <span>Arteri </span>………………………………………………………………<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-left: 0.5in; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.22 Vena </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">…………………………………………………………………….<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.3 Kapiler </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">……………………………………………………………………..<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.4 Macam – macam Peredaran Darah </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">……………………………………………….<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.5 Darah</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">…………………………………………………………………………….<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-left: 0.5in; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.51 Sel Darah Merah</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">……………………………………………………………<span><o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-left: 0.5in; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">II.52 Sel Darah Putih </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">……………………………………………………………<span><o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> <span> </span>II.53 <span>Trombosit</span>……………………………………………………………….<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; 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<span> </span>III.1 Kesimpulan<br />
<div class="MsoNormal"><span style="font-size: 12pt; line-height: 115%;">Daftar Pustaka……………………………………………………………………………………………………………………………<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal;"><br />
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</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 20pt; line-height: 115%;">BAB I<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 20pt; line-height: 115%;">PENDAHULUAN<o:p></o:p></span></b></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">I.1 Latar Belakang<span> </span><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">I.2 Tujuan Penulisan<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;">Tujuan dalam penulisan makalah ini adalah untuk menambah pengetahuan dan diharapkan bermanfaat bagi kita semua.</div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 20pt; line-height: 115%;">BAB II<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 20pt; line-height: 115%;">ISI<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 22pt;">SISTEM PERDARAN DARAH MANUSIA<o:p></o:p></span></b></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.1 JANTUNG</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Jantung meruapakan sebuah organ yang sangat vital bagi tubuh kita dan merupakn sebuah organ yang terdiri dari otot-otot jantung . Jantung mempunyai bentuk seperti jantung pisang<b><o:p></o:p></b></span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.11 Bagian-bagian dari jantung:<o:p></o:p></span></b></div><div class="MsoListParagraph" style="text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Jantung terbungkus oleh kntong perikardium yang terdiri dari : <o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">LAMINA PANISTALIS disebelah luar <o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; line-height: 115%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">LAMINA VISELARIS yang menempel pada dinding jantung <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Jantung mempunyai empat ruang yaitu:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; line-height: 115%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Dua serambi (atrium)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; line-height: 115%;"><span>ü<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Dua bilik (ventrikal)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 38.25pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Lapisan jantung terdiri dari :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Lapisan ENDOKARDIUM<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span> </span>Lapisan MIOKARDIUM<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Lapisan PERIKARDIUM<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Katup – katup jantung<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; line-height: 115%;"><span>©<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">VALVULA BIKOSPIDALIS<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; line-height: 115%;"><span>©<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">VALVULA SEMINULARIS ARTERI PILMONARIS<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12pt; line-height: 115%;"><span>©<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">VALVULA SEMINULRIS AORTA<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.12 Siklus jantung <o:p></o:p></span></b></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Siklus jantung merupakan kejadian yg terjadi dlm jantung selama peredaran darah.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Gerakan jantung terdiri dari 2 jenis :<o:p></o:p></span></div><ul type="disc"><li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Konstriksi(sistole) lama konstriksi 0,3 detik <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pengendoran(diastole) lama pengendoran 0,5 detik <o:p></o:p></span></li>
</ul><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.13 Daya Pompa Jantung<o:p></o:p></span></b></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Dalm keadaan istirahat jantung beredar 70 kali/menit. Pda waktu bnyk pergerakan kecepatan jantung bisa dicapai 150 kali/menit dengn daya pompa 20-25 liter/menit. Setiap menit jumlah volume darah tepat sma sekali dialirkn dari vena ke jantung<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.2 ARTERI DAN VENA</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.21</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> <b>Arteri </b><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Arteri merupkan pembuluh darah yng keluar dari jantung yang membawa darah keseluruh bagian dan alat tubuh. Pembuluh darah yang paling besar disebut AORTA dan arteri pulmonaris mempunyai garis tengah 1-3 cm, arteri ini mempunyai cabang-cabang ke seluruh tubuh yang disebut ARTERIOLA<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Arteri mempunyai dinding yang kuat dan tebal tetapi sifat nya elastis dan terdiri dari 3 lapisan yaitu:<o:p></o:p></span></div><ul type="disc"><li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">TUNIKA INTERMA/INTERNA yaitu lapisan yang paling dalam sekali berhubungan dengan darah dan terdiri dari jaringan endotel <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">TUNIKA MEDIA yaitu lapisan tengah yang terdiri dari jaringan otot yang sifat nya elastis dan temask otot polos <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">TUNIK EKSTERNA/ADVENTISIA yaitu lapisan yang paling luar sekali terdiri dari jaringan ikat gembur yang berguna menguat kan dinding arteri <o:p></o:p></span></li>
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</div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.22 Vena </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Vena merupakan pembuluh darah balik yaitu pembuluh darah yang membawa darah dari bagian/alat-alat tubuh masuk kedalam jantung.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Katup-ktup pda vena kebnyakan terdiri dari dua kelompok yang gunanya untuk mencegh agar drah tidak kembali lagi. Vena-vena yang ukuran nya besar diantara nya vena kava dan vena pulmonaris,vena ini juga mempunyai cbang yang lebih kecil yang disebut venolus yng selanjut nya menjadi kapiler<o:p></o:p></span></div><ul type="disc"><li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Vena cava superior yaitu vena yg bertugas mmbawa darah dari bagian ats tubuh menuju serambi kanan jantung <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Ven cava inferior yaitu vena yg bertugs membawa darah dri bagian bwah tubuh ke sermbi kanan jantung <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Vena cava pulmonaris yaitu vena yg bertugas mmbawa darah dari paru-paru keserambi kiri jantung <o:p></o:p></span></li>
</ul><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.3 Kapiler </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kapiler (pembuluh rambut) merupakan pembuluh darah yang sangat halus. Diameter nya kira-kira 0,008 mm. dinding nya terdiri dari satu lapisan endotel. Bagian tubuh yang tidak tedapat kapiler yaitu: rambut,kuku, dan tulang rawan. Pembuluh darah apiler pada umum nya meliputi sel-sel jaringan.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Fungsi kapiler:<o:p></o:p></span></div><ul type="disc"><li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> alat penghubung antara pembuluh darah arteri dan vena<o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> tempat terjadinya pertukaran zat-zat antara darah dan cairan jaringan <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> mengambil hasil-hasil dari kelenjar <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> menyerap zat makanan yang terdapat diusus <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> menyaring darah yang terdapat diginjal <o:p></o:p></span></li>
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</div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.4 MACAM - MACAM PEREDARAN DARAH</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></div><ol start="1" type="1"><li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Peredran darah panjang/besar/sitemik <o:p></o:p></span></li>
</ol><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Peredran darah panjang/besar/sitemik adalah peredaran darah yang mengalirkan darah yang kaya oksigen dari bilik (ventrikal) kiri jantung lalu diedarkan keseluruh jaringan tubuh. Oksigen bertukar dengan karbondioksida dijaringan tubuh. Lalu darah yg kaya karbondioksid dibawa melalui vena menuju serambi kanan (atrium) jantung<o:p></o:p></span></div><ol start="1" type="1"><li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> Peredaran darah pendek/kecil/pulmonal <o:p></o:p></span></li>
</ol><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Peredaran darah pendek/kecil/pulmonal adalah peredran darah yang mengalirkan darah dari jantung ke paru-paru dan kembali lagi kejantung. Darah yag kaya karbondioksid dari bilik kanan dialirkan ke paru-paru melalui arteri pulmonalis,di alveolus paru-paru darah tersebut bertukar dgn darah yang kaya oksigen yang selanjutnya akan dialirkan ke serambi kiri jantung melalui vena pulmonalis <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Proses peredaran darah dipengaruhi oleh:<o:p></o:p></span></div><ul type="disc"><li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> kecepatan darah <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> luas penampang pembuluh darah <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> tekanan darah <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> kerja otot yang terdapat pada jantung dan pembuluh darah <o:p></o:p></span></li>
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</div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.5 Darah</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Darah adalah suatu jaringan tubuh yang terdapat didalam pembuluh darah yg berwarna merah, di dlm tubuh manusia tedapat darah kira-kira 4 sampai 5 liter <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kandungan yang terdapat dalam darah :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 57pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">AIR : 91%<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 57pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">PROTEIN : 3% (albunin,globulin dan fbrinogen)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 57pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">MINERAL : 0,9% (natrium klorida,natrium karbonat,garam fosfat,magnesium,kalsium,dan zat besi)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 57pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> BAHAN ORGANIK : 0,1%(glukosa,lemk,asam urat,kreatin,kolesterol dan asam amino)<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 57pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.51 Sel Darah Merah<o:p></o:p></span></b></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Sel darah merah berfungsi untuk mengikat oksegin dari paru-paru untuk diedarkan keseluruh jaringan tubuh dan mengikat karbon dioksida dari jaringan tubuh untuk dikeluarkan melalui paru-paru.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span> </span>CIRI-CIRI:<o:p></o:p></span></div><ul type="disc"><li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bentuk nya seperti cakram/bikonfal dan tidak mempunyai inti <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Ukuran diameter nya kira-kira 7,7 unit(0.007mm)<o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tidak bergerak <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Banyak nya kira-kira 5 juta dalam 1mm³ (4½ JUTA) <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Warna nya kuning kemerah-merahan <o:p></o:p></span></li>
</ul><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.52 Sel Darah Putih <o:p></o:p></span></b></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Sel darah putih berfungsi sebagai serdadu tubuh yaitu membunuh dan memakan bibit penyakit/bakteri yg masuk kedalam jaringan RES (sistem retikuloedotel)<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">CIRI-CIRI:<o:p></o:p></span></div><ul type="disc"><li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> bentuk berubah-rubah <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> dapat bergerak dngan perantaraan kaki palsu(pseudopodia)<o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> mempunyai bermacam-macam inti sel <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> berwarna bening (tidak berwarna) <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> banyak nya dlm 1 mm³ darah kira-kira 6000-9000 <o:p></o:p></span></li>
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</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> <b>II.53</b> <b>TROMBOSIT</b><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Trombosit merupakan benda2 kecil yang mati yang bentuk dan ukuranya bermacam-macam, bulat,lonjong, warnnya putih,normal pada orang dewasa 200.000-300.000/mm³. Trombosit berfungsi dalam pembekuan darah <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> <b>II.54 <span>Plasma darah </span></b><o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Plasma darah Adalah larutan yang berwarna jernih kekuningan dan mengandungi bahan larut dalam air. Lebih kurang 90% daripada plasma terdiri daripada air.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bahan larut yang terkandung dalam plasma:<o:p></o:p></span></div><ul type="disc"><li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Garam-garam <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bahan-bahan makanan – glukosa, asid amino<o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Protin darah – fibrinogen, globulin dan albumin<o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bahan-bahan kumuh terutama urea<o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Hormon <o:p></o:p></span></li>
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<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> garam-garam mineral<o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> protein darah <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> zat makanan <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> hormon <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> antibodi/antioksida <o:p></o:p></span></li>
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</div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">II.6 Kelainan pada sitem peredaran darah<o:p></o:p></span></b></div><ul type="disc"><li class="MsoNormal" style="text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">arteriosklerosis</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> yaitu pengersan pembuluh nadi karena endapan lemak berbentuk plak(kerak) <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> <i>anemia </i>yaitu rendahnya kadar hemoglobin dalam darah atau berkurangnya jumlah eritrosit dalam darah <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> varises </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">yaitu pelebaran pembuluh darah di betis <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> hemeroid </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">yaitu pelebaran pembuluh darah di sekitar dubur <o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> <i> ambolus yaitu tersumbat nya pembuluh darah karena benda yang tidak bergerak </i><o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> hemofilia yaitu kelainan darah yg menyebabkan darh sukar membeku </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> leukemia yaitu peningkatan jumlah eritrosit secara tidak terkendali </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">erithroblastosis fetalis yaitu rusak nya eritosit bayi/janin akibat aglutinasi dari antibodi yang berasal dari ibu </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> thalasemia yaitu anemia yg diakibatkan oleh rusak nya gen pembentuk hemoglobin yg bersifat menurun </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> hipertensi yaitu tekanan darah tinggi akibat arteriosklerosis </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></li>
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</div><div align="center" style="text-align: center;"><b><span style="font-size: 20pt;">BAB III<o:p></o:p></span></b></div><div align="center" style="text-align: center;"><b><span style="font-size: 20pt;">PENUTUP<o:p></o:p></span></b></div><b><span style="font-size: 11pt;">III.1 Kesimpulan<o:p></o:p></span></b><br />
<div class="MsoNormal"><span> </span>Sistem peredaran darah pada manusia tersusun atas jantung sebagai pusat peredaran darah, pembuluh-pembuluh darah (<span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><a href="http://id.wikipedia.org/wiki/Arteri" title="Arteri"><span style="color: black;">arteri</span></a>,v<u>ena</u>,k</span><span style="color: black;"><a href="http://id.wikipedia.org/w/index.php?title=Kapiler&action=edit&redlink=1" title="Kapiler (halaman belum tersedia)"><span style="color: black;">apiler</span></a></span>) dan darah itu sendiri. <span style="color: black;">Ada dua jenis sistem peredaran darah: </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Peredran darah panjang/besar/sitemik <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Peredran darah panjang/besar/sitemik adalah peredaran darah yang mengalirkan darah yang kaya oksigen dari bilik (ventrikal) kiri jantung lalu diedarkan keseluruh jaringan tubuh. Oksigen bertukar dengan karbondioksida dijaringan tubuh. Lalu darah yg kaya karbondioksid dibawa melalui vena menuju serambi kanan (atrium) jantung<o:p></o:p></span></div><div class="MsoListParagraph" style="text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 115%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Peredaran darah pendek/kecil/pulmonal <o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Peredaran darah pendek/kecil/pulmonal adalah peredran darah yang mengalirkan darah dari jantung ke paru-paru dan kembali lagi kejantung. Darah yag kaya karbondioksid dari bilik kanan dialirkan ke paru-paru melalui arteri pulmonalis,di alveolus paru-paru darah tersebut bertukar dgn darah yang kaya oksigen yang selanjutnya akan dialirkan ke serambi kiri jantung melalui vena pulmonalis <o:p></o:p></span></div><div class="MsoNormal"><br />
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</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-size: 20pt; line-height: 115%;">DAFTAR PUSTAKA<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin-left: 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 115%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 115%;"><a href="http://www.google.com/">www.google.com</a><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 115%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 115%;">www.wikipedia-indonesia.co.id<o:p></o:p></span></div>Nur Dia Rianihttp://www.blogger.com/profile/07878859972547746126noreply@blogger.com0tag:blogger.com,1999:blog-8264234277684523485.post-78040583900503461352011-03-26T20:03:00.001-07:002011-03-26T20:03:52.277-07:00Untuk Mu CintaBiar saja rindu ini tetap di hatiku..<br />
Ku ingin rindu ini selalu menghiasi hari-hari ku..<br />
Walaw ku ingin memandang wajah mu..<br />
Ku ingin waktu yg menjawabnya..<br />
Dan biarlah semua berjalan apa adanya..<br />
<br />
Walaw kau tak inginkanku..<br />
Biarlah..<br />
Tetapi perlu kau ketahu..<br />
Rasa cinta ini hanya untuk mu..<br />
Sampai ku yakin kau bukan untuk ku...Nur Dia Rianihttp://www.blogger.com/profile/07878859972547746126noreply@blogger.com0tag:blogger.com,1999:blog-8264234277684523485.post-62648979551968596742011-03-26T00:39:00.001-07:002011-03-26T00:39:00.177-07:00Cerita CintaSiapa si yg g heboh..yg g seneng..yg g bhagia dnger kta CINTA..smua orang butuh cinta,akupun sma...<br />
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Tpi apalh arti cinta bila orang yg kita cinta sudh pergi dri hidup kita?? Bulshhiiit.. bwat orang2 yg bilang ''CINTA GA HARUS MEMILIKI'' sesungguh'a bwat orang yg berkta sperti itu,adlh orang2 yg membohongi perasaan mereka sendiri..<br />
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Hati ini sakitttt.. Sesakit ditikam belati..hati ini pedih seperti digores pechan kaca..Ketika mengetahui kenyataan bahwa cinta pergi..<br />
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Aku g bisa membohongi perasaan ini..aku g bisa menutupi ksedihn ini..aku g bisa lari dri knyataan ini..dan aku g tau hrus berbuat apa?ketika mengatahui cinta itu pergi.. Yg bisa aku lakukan hanyalah menangis meratapi knyataan ini..<br />
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Tepat 3 hri cinta pergi..sungguh pilu hati ini..meski aku berusaha mengikhlaskn kepergian'a..tpi apa??apa?? Tetap..dikesndirian ku teteskan air mata lagi lagi dan lagi... Berat hati ini untuk mengikhlaskan'a...<br />
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Hati berkata.. Tidak siap ketika cinta mendpatkn sosok pengganti aku??? Sungguh pilu pilu hati ketika suatu saat mengetahui'a...<br />
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Cinta..disini ku berharap kau kembali..kembali kepadaku..kembali menemani hari2 ku..kembali menggoreskn cerita cinta kita berdua...<br />
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Tpi apa???mungkin hrapan itu hnyalah harapn kosong..harapn yg aku tahu tdk mungkin menjadi nyata..<br />
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Cinta..perlu kmu ketahui..aku disini menunggu dirimu...menunggu kehadirnmu kembali..<br />
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Aku tetap syang kamu syang.. 05.11.10Nur Dia Rianihttp://www.blogger.com/profile/07878859972547746126noreply@blogger.com0