<html><head><meta name="qrichtext" content="1" /></head><body style="font-size:10pt;font-family:Sans">
<p align="center"><span style="font-family:Trebuchet Ms [Microsoft];font-size:16pt;font-weight:600">Clinique de Vitrolles </span><span style="font-family:Trebuchet Ms [Microsoft]"><br /></span><span style="font-size:8pt">Rue Bel Air<br />13127 </span>VITROLLES <br /><span style="font-family:Andale Mono Ipa;font-size:8pt">Tél:   04 42 46 26 26   </span></p>
<p>  <span style="font-family:Arial;font-size:8pt">     <br /> </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">Document édité Le:</span><span style="font-family:Arial;font-size:8pt">    {{DD-MM-YYYY}}            </span><span style="font-family:Arial;font-size:8pt;font-weight:600"> <br /> </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">par:</span><span style="font-family:Arial;font-size:8pt">      {{NOM MEDECIN}}      {{PRENOM MEDECIN}}   </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">N° ID:</span><span style="font-family:Arial;font-size:8pt"> {{IDENTIFICATION MEDECIN}}<br /> </span><span style="font-family:Arial;font-size:9pt;font-weight:600;text-decoration:underline">utilisateur:</span><span style="font-family:Arial;font-size:9pt;font-weight:400">          </span><span style="font-family:Arial;font-size:8pt">{{NOM USER}}      {{PRENOM USER}}</span><span style="font-family:Arial;font-size:9pt;font-weight:400"><br /></span><span style="font-family:Arial;font-size:8pt"> </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">Codes et actes  CCAM de l'hospitalisation du:</span><span style="font-family:Arial;font-size:8pt">  {{DATE ENTREE}}   </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">au</span><span style="font-family:Arial;font-size:8pt">  {{DATE SORTIE}} <br /> </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">de</span><span style="font-family:Arial;font-size:8pt"> {{TITRE PATIENT}} {{NOM PATIENT}} {{PRENOM PATIENT}}<br /> </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">Age:</span><span style="font-family:Arial;font-size:8pt"> {{AGE PATIENT}}   </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">Sexe:</span><span style="font-family:Arial;font-size:8pt"> {{SEXE PATIENT}}   </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">Né(e) le:</span><span style="font-family:Arial;font-size:8pt">  {{DATE NAISSANCE PATIENT}} </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">à</span><span style="font-family:Arial;font-size:8pt"> {{VILLE NAISSANCE PATIENT}}<br /> </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">Adresse: </span><span style="font-family:Arial;font-size:8pt"> {{ADRESSE PATIENT UNE LIGNE}}<br /></span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">Téléphone:</span><span style="font-family:Arial;font-size:8pt"> {{NUM. TEL1 PATIENT}}<br /></span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">N° Sécurité Sociale:</span><span style="font-family:Arial;font-size:8pt"> {{NUM. SECU PATIENT}} <br /></span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">Numéro patient:</span><span style="font-family:Arial;font-size:8pt"> {{NUM PATIENT}}                    </span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">Dossier Hospi:</span><span style="font-family:Arial;font-size:8pt"> {{NUM DOSSIER}}<br /></span><span style="font-family:Arial;font-size:8pt;font-weight:600;text-decoration:underline">Base de Travail:</span><span style="font-family:Arial;font-size:8pt"> {{BASE TRAVAIL}}</span><br /></p>
</body></html>
