| ' ' | '医疗保险结算单 / 异地就医结算回执' | '结算单号 '${settleNo}' 结算日期 '${settleDate}' 参保地 '${insuredPlace} |
| '结算单号 / NO.' | '结算日期 / DATE' | '参保地 / 参保类型' | '就医地 / 医疗机构' |
| ${settleNo} | ${settleDate} | ${insuredPlace} | ${treatPlace} |
| '患者姓名 / 身份证号' | '医保卡号 / 参保状态' | '就医类型' | '备案编号 / 备案日期' |
| ${patientInfo} | ${cardInfo} | ${treatType} | ${recordInfo} |
| '入院 / 出院日期' | '结算方式' | '医保经办机构' | |
| ${dateInfo} | ${settleWay} | ${insuranceOrg} |
'医保费用结算明细'
| '序号' | '费用类别' | '发生金额' | '统筹支付' | '个人账户支付' | '个人自付' | '备注' |
|---|---|---|---|---|---|---|
| ${itemName1} | ${itemSpec1} | ${itemUnit1} | ${itemQty1} | ${itemPrice1} | ${itemAmount1} | ${itemTax1} |
| ${itemName2} | ${itemSpec2} | ${itemUnit2} | ${itemQty2} | ${itemPrice2} | ${itemAmount2} | ${itemTax2} |
| ${itemName3} | ${itemSpec3} | ${itemUnit3} | ${itemQty3} | ${itemPrice3} | ${itemAmount3} | ${itemTax3} |
| ${itemName4} | ${itemSpec4} | ${itemUnit4} | ${itemQty4} | ${itemPrice4} | ${itemAmount4} | ${itemTax4} |
| ${itemName5} | ${itemSpec5} | ${itemUnit5} | ${itemQty5} | ${itemPrice5} | ${itemAmount5} | ${itemTax5} |
| ${itemName6} | ${itemSpec6} | ${itemUnit6} | ${itemQty6} | ${itemPrice6} | ${itemAmount6} | ${itemTax6} |
| '费用合计' | '—' | '￥'${totalFee} | '￥'${fundPay} | '—' | '￥'${selfPay} | '—' |
| ' ' | '医保结算结果' |
${totalLine}
| ' ' | '备注 / REMARKS' |
${remark}
// 签章区：card| '（医疗机构公章 / 财务专用章占位）' | '（骑缝章 / 二维码占位）' |
| '医疗机构：'${insuranceOrg} | '骑缝章沿右边线骑缝加盖' |
| '出具日期：'${settleDate} | '二维码打印于右上角方框内' |
| '医保经办人：'${operator} | '复核：'${reviewer} | '参保人签收：'${patientSign} |