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| 住院号 | {{encounterNosd}} | 姓名 | {{patientName}} | 性别 | {{gender}} | 年龄 | {{age}} |
| 病区/科室 | {{inHospitalOrgName}} | 床号 | {{bedName}} | 医保类型 | {{contractName}} | ||
| 收费项目 | 住院预缴款 | ||||||
| 支付方式 | {{paymentMethod}} | ||||||
| 金额(大写) | {{amountInWords}} | ||||||
| 金额(小写) | {{balanceAmount}} | ||||||