@  INTERACTIVE T1/TP1 1994
@
@  File: FH2T043W.TXT
@  NoForm: 043 NoElem: N14..N22
@
@  Description: Personnes a charge
@
!F 06 00 73 06
!H Nom du patient
@----------------------------------------------------------
 1:                    5:                    9:
 2:                    6:                   10:
 3:                    7:                   11:
 4:                    8:                   12:
 Choix [  ]         13 = Autre [                ]
@----------------------------------------------------------
!D 05 01
!D 05 02
!D 05 03
!D 05 04
!D 27 01
!D 27 02
!D 27 03
!D 27 04
!D 49 01
!D 49 02
!D 49 03
!D 49 04
!D 09 05
!D 33 05
!A 06 00 73 06
!H Name of patient
@----------------------------------------------------------
 1:                    5:                    9:
 2:                    6:                   10:
 3:                    7:                   11:
 4:                    8:                   12:
 Choice [  ]        13 = Other [                ]
@----------------------------------------------------------
!D 05 01
!D 05 02
!D 05 03
!D 05 04
!D 27 01
!D 27 02
!D 27 03
!D 27 04
!D 49 01
!D 49 02
!D 49 03
!D 49 04
!D 10 05
!D 33 05
@
