<%@ Page Language="C#" AutoEventWireup="true" CodeBehind="SettlementDetails.aspx.cs" Inherits="Medical.MInterFace.SysRuralCooperative.SettlementDetails" %>

<!DOCTYPE html>
<html>
<head>
    <title></title>
    <link href="../../css/style.css" rel="stylesheet" type="text/css" />
</head>
<body>
    <table class="pt-edit">
        <tr>
            <th>个人编号</th>
            <td><input type="text" id="个人编号" runat="server" /></td>
            <th>报审单号</th>
            <td><input type="text" id="报审单号" runat="server" /></td>
        </tr>
        <tr>
            <th>医疗费总额</th>
            <td><input type="text" id="医疗费总额" runat="server" /></td>
            <th>自费金额</th>
            <td><input type="text" id="自费金额" runat="server" /></td>
        </tr>
        <tr>
            <th>自理金额备用</th>
            <td><input type="text" id="自理金额备用" runat="server" /></td>
            <th>符合补偿范围费用</th>
            <td><input type="text" id="符合补偿范围费用" runat="server" /></td>
        </tr>
        <tr>
            <th>本次进入统筹费用</th>
            <td><input type="text" id="本次进入统筹费用" runat="server" /></td>
            <th>本次进入大额费用</th>
            <td><input type="text" id="本次进入大额费用" runat="server" /></td>
        </tr>
        <tr>
            <th>起付标准自付金额</th>
            <td><input type="text" id="起付标准自付金额" runat="server" /></td>
            <th>统筹分段自付金额</th>
            <td><input type="text" id="统筹分段自付金额" runat="server" /></td>
        </tr>
        <tr>
            <th>统筹支付金额</th>
            <td><input type="text" id="统筹支付金额" runat="server" /></td>
            <th>大额分段自付金额</th>
            <td><input type="text" id="大额分段自付金额" runat="server" /></td>
        </tr>
        <tr>
            <th>大额支付金额</th>
            <td><input type="text" id="大额支付金额" runat="server" /></td>
            <th>超封顶线自付金额</th>
            <td><input type="text" id="超封顶线自付金额" runat="server" /></td>
        </tr>
        <tr>
            <th>个人现金支付金额</th>
            <td><input type="text" id="个人现金支付金额" runat="server" /></td>
            <th>家庭账户支付金额</th>
            <td><input type="text" id="家庭账户支付金额" runat="server" /></td>
        </tr>
        <tr>
            <th>超标准住院床位费</th>
            <td><input type="text" id="超标准住院床位费" runat="server" /></td>
            <th>实际补偿金额</th>
            <td><input type="text" id="实际补偿金额" runat="server" /></td>
        </tr>
        <tr>
            <th>单据号</th>
            <td><input type="text" id="单据号" runat="server" /></td>
            <th>补偿比例</th>
            <td><input type="text" id="补偿比例" runat="server" /></td>
        </tr>
        <tr>
            <th>床日付费包干总费用</th>
            <td><input type="text" id="床日付费包干总费用" runat="server" /></td>
            <th>床日付费结算金额</th>
            <td><input type="text" id="床日付费结算金额" runat="server" /></td>
        </tr>
        <tr>
            <th>大病补充保险补偿减免</th>
            <td><input type="text" id="大病补充保险补偿减免" runat="server" /></td>
            <th>分组规定付费标准</th>
            <td><input type="text" id="分组规定付费标准" runat="server" /></td>
        </tr>
        <tr>
            <th>基金付费标准</th>
            <td><input type="text" id="基金付费标准" runat="server" /></td>
        </tr>
    </table>
    <div class="pt-padding" style="text-align:center">
        <input type="button" value="关闭" class="pt-button active" onclick="top.OpenClose('Settlement_Details')" />
    </div>
</body>
</html>
