带复选告知书模版-二倍行距

告知书模版   2024-07-20 11:23   52   0  
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    <table cellspacing="0" cellpadding="0" border="0" align="left" style="height: 850px;width: 100%;margin-bottom: 10px;margin-top:5px;border-collapse: collapse;border: none;">
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                    <div style="display: flex;display: -webkit-flex;">尊敬的病友/家属/单位护送者:</div>
                    <div>
                        <span style="display: inline-block;text-indent: 2em">为了保证您/您的亲属/单位员工</span>
                        <span style="min-width: 130px;display: inline-block;border-bottom: 1px solid black;white-space:pre-line;white-space: pre-wrap;">{{ shows && shows['9963000010001'] || ''}}</span>
                       在住院期间的安全、促进疾病早日康复,依据您/您的亲属/单位员工病情现状,存在以下高危性伤害/跌倒/噎食/损客行为倾向的危险因素:
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                    <div style="display: flex;display: -webkit-flex;margin-top: 10px">
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('最近一年内曾有不明原因跌倒经历') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">最近一年内曾有不明原因跌倒经历</div>
                        </div>
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 80px;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('头晕、眩晕、体位性低血压') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">头晕、眩晕、体位性低血压</div>
                        </div>
                    </div>
                    <div style="display: flex;display: -webkit-flex;margin-top: 10px">
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('年龄在65岁以上') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">年龄在65岁以上</div>
                        </div>
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 192px;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('精神行为异常') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">精神行为异常</div>
                        </div>
                    </div>
                    <div style="display: flex;display: -webkit-flex;margin-top: 10px">
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('智能障碍') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">智能障碍</div>
                        </div>
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 234px;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('体能虚弱') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">体能虚弱</div>
                        </div>
                    </div>
                    <div style="display: flex;display: -webkit-flex;margin-top: 10px">
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('步态不稳') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">步态不稳</div>
                        </div>
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 234px;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('活动障碍、肢体偏瘫') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">活动障碍、肢体偏瘫</div>
                        </div>
                    </div>
                    <div style="display: flex;display: -webkit-flex;margin-top: 10px">
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('吞咽功能障碍') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">吞咽功能障碍</div>
                        </div>
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 206px;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('睡眠障碍') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">睡眠障碍</div>
                        </div>
                    </div>
                    <div style="display: flex;display: -webkit-flex;margin-top: 10px">
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('视力障碍') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">视力障碍</div>
                        </div>
                        <div style="display: flex;display: -webkit-flex;">
                            <div style="width: 15px;height: 15px;margin: 5px 5px 0 234px;border: 1px solid black;">
                                <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010002']">{{ shows['9963000010002'].includes('兴奋躁动/行为紊乱') ? '√' : '' }}</span>
                            </div>
                            <div style="flex: 1;">兴奋躁动/行为紊乱</div>
                        </div>
                    </div>
                    <div style="display: flex;display: -webkit-flex;margin-top: 10px">服用影响意识或活动的药物:</div>
                    <div style="display: flex;display: -webkit-flex;">
                        <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                            <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010003']">{{ shows['9963000010003'].includes('镇静安眠剂') ? '√' : '' }}</span>
                        </div>
                        <div style="flex: 1;">镇静安眠剂</div>&nbsp;&nbsp;
                        <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                            <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010003']">{{ shows['9963000010003'].includes('降压利尿剂') ? '√' : '' }}</span>
                        </div>
                        <div style="flex: 1;">降压利尿剂</div>&nbsp;&nbsp;
                        <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                            <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010003']">{{ shows['9963000010003'].includes('镇挛抗癫剂') ? '√' : '' }}</span>
                        </div>
                        <div style="flex: 1;">镇挛抗癫剂</div>&nbsp;&nbsp;
                        <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                            <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010003']">{{ shows['9963000010003'].includes('麻醉止痛剂') ? '√' : '' }}</span>
                        </div>
                        <div style="flex: 1;">麻醉止痛剂</div>&nbsp;&nbsp;
                        <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                            <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010003']">{{ shows['9963000010003'].includes('抗精神病药物') ? '√' : '' }}</span>
                        </div>
                        <div style="flex: 1;">抗精神病药物</div>&nbsp;&nbsp;
                    </div>
                    <div style="display: flex;display: -webkit-flex;">
                        <div style="width: 15px;height: 15px;margin: 5px 5px 0 0;border: 1px solid black;">
                            <span style="display: block;margin-top: -5px;" v-if="shows && shows['9963000010003']">{{ shows['9963000010003'].includes('其他') ? '√' : '' }}</span>
                        </div>
                        <div>其他:</div>
                        <div style=";width: 610px;text-align: left;border-bottom: 1px solid black;white-space:pre-line;white-space: pre-wrap;">
                            <div v-if="shows && shows['9963000010004'] && shows['9963000010003'].includes('其他')">{{ shows['9963000010004']}}</div>
                        </div>
                    </div>
                    <div style="display: flex;display: -webkit-flex;margin: 10px 10px 0 30px">
                        因以上因素的存在,您/您的亲属/单位员工在住院期间,极易发生坠床/跌倒/骨折/噎食等危险,故予
                    </div>
                    <div style="display: flex;display: -webkit-flex;">告知并请您积极配合医护人员做好预防措施。</div>
                    <div style="display: flex;display: -webkit-flex;margin: 30px 10px 0 30px">上述内容护士已讲明,我对住院期间可能出现的坠床/跌倒/骨折/噎食等风险表示充分理解,并愿意积极</div>
                    <div style="display: flex;display: -webkit-flex;">配合做好各项预防保护措施,将坠床/跌倒/骨折/噎食等意外的可能性降至最小,如若发生上述意外,我家属</div>
                    <div style="display: flex;display: -webkit-flex;">自愿承担一切后果。</div>
                    <div style="display: flex;display: -webkit-flex;margin: 30px 0 0 30px">患者签字:____________</div>
                    <div style="display: flex;display: -webkit-flex;margin: 30px 0 0 30px">
                        <div>医护人员签字:____________</div>
                    </div>
                    <div style="display: flex;display: -webkit-flex;justify-content: flex-end;margin: 20px 20px 0 0">
                        <div>签字日期:</div>
                        <div style="width: 50px"></div>年
                        <div style="width: 50px"></div>月
                        <div style="width: 50px"></div>日
                    </div>
                </div>
            </td>
        </tr>
    </table>
</div>