<![CDATA[
<div><p><span style="background-color: rgb(0, 0, 0);"><br></span></p><p style="text-align: left;"><span style="font-size: 24pt;"><strong> <span style="font-size: 24pt;"><strong>입원상담 및 예정자</strong></span></strong></span></p><p style="text-align: left;"><span style="font-size: 24pt;"><strong><span style="font-size: 12pt;"><br></span></strong></span></p><p style="text-align: left;"><span style="font-size: 24pt;"><strong><span style="font-size: 12pt;">*소견서: 2 장(소견서 보낸 병원명도 기입) *전화상담: 3통 *방문상담: 0 회</span><span style="font-size: 24pt;"><strong></strong></span></strong></span></p><p>이동귀 : 고대구로병원</p><p>전복례 : 보라매병원</p><p>김명자 : 강남성심병원<br></p><p><br></p><table width="709" class="txc-table" style="border: currentColor; border-image: none; width: 709px; font-family: gulim; font-size: 13.33px; border-collapse: collapse;" border="0" cellspacing="0" cellpadding="0"><tbody><tr><td style="border: 1px solid rgb(0, 0, 0); border-image: none; width: 54px; height: 55px; background-color: rgb(232, 217, 255);"><p style="text-align: center;"><strong> 성명</strong></p></td><td style="width: 71px; height: 55px; border-top-color: rgb(0, 0, 0); border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; background-color: rgb(232, 217, 255);"><p style="text-align: center;"><strong>성별/나이<span id="goog_1974062816"></span><span id="goog_1974062817"></span> </strong></p></td><td style="width: 98px; height: 55px; border-top-color: rgb(0, 0, 0); border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; background-color: rgb(232, 217, 255);"><p style="text-align: center;"><strong> 환자와의 관계</strong></p></td><td style="width: 158px; height: 55px; border-top-color: rgb(0, 0, 0); border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; background-color: rgb(232, 217, 255);"><p style="text-align: center;"><strong> 주요사항</strong></p></td><td style="width: 70px; height: 55px; border-top-color: rgb(0, 0, 0); border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; background-color: rgb(232, 217, 255);"><p style="text-align: center;"><strong>상담자 </strong></p></td><td style="width: 76px; height: 55px; border-top-color: rgb(0, 0, 0); border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; background-color: rgb(232, 217, 255);"><p style="text-align: center;"><strong>입원예정일<span id="goog_1974062828"></span><span id="goog_1974062829"></span> </strong></p></td><td style="width: 99px; height: 55px; border-top-color: rgb(0, 0, 0); border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; background-color: rgb(232, 217, 255);"><p style="text-align: center;"><strong>보호자연락처<span id="goog_1974062832"></span><span id="goog_1974062833"></span> </strong></p></td><td style="width: 81px; height: 55px; border-top-color: rgb(0, 0, 0); border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; background-color: rgb(232, 217, 255);"><p style="text-align: center;"><strong>피드백 </strong></p></td></tr><tr><td style="width: 54px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"><p style="text-align: center;">이동귀 </p></td><td style="width: 71px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">F/78 </p></td><td style="width: 98px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">딸<br></p></td><td style="width: 158px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">고대구로병원. 인공호흡기 VRE. L-TUBE. 보호자딸 효녀, 경제적부담 </p></td><td style="width: 70px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">원광연 </p></td><td style="width: 76px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">다음주<br></p></td><td style="width: 99px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">010-4024-0068 </p></td><td style="width: 81px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">5/18일 이후 입원하기로 함 5/22 입원하기로 함<br></p></td></tr><tr><td style="width: 54px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"><p style="text-align: center;">전복례<span id="goog_681258725"></span><span id="goog_681258726"></span> </p></td><td style="width: 71px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">F/82 </p></td><td style="width: 98px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">딸 </p></td><td style="width: 158px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">보라매병원. 대퇴부골절, 상완골 골절, 수술후 간단한 재활원하심 </p></td><td style="width: 70px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">원광연 </p></td><td style="width: 76px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">5/16<span id="goog_681258755"></span><span id="goog_681258756"></span> </p></td><td style="width: 99px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">010-8731-7012 </p></td><td style="width: 81px; height: 70px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">5/16 입원하기로 결정하심 /입원후 퇴원하심</p></td></tr><tr><td style="width: 54px; height: 65px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"><p style="text-align: center;"> 김명자</p></td><td style="width: 71px; height: 65px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">F/84 </p></td><td style="width: 98px; height: 65px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">아들 </p></td><td style="width: 158px; height: 65px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">강남성심병원, 편마비, 뇌출혈 </p></td><td style="width: 70px; height: 65px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">원광연 </p></td><td style="width: 76px; height: 65px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">미정 </p></td><td style="width: 99px; height: 65px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">010-6315-7709 </p></td><td style="width: 81px; height: 65px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;">식구들과 상의후 연락주기로 함 5/21 통화 연결이 안됨</p></td></tr><tr><td style="width: 54px; height: 56px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 71px; height: 56px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 98px; height: 56px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 158px; height: 56px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 70px; height: 56px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 76px; height: 56px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 99px; height: 56px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 81px; height: 56px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td></tr><tr><td style="width: 54px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 71px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 98px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 158px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 70px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 76px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 99px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 81px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td></tr><tr><td style="width: 54px; height: 63px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 71px; height: 63px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 98px; height: 63px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 158px; height: 63px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 70px; height: 63px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 76px; height: 63px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 99px; height: 63px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 81px; height: 63px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td></tr><tr><td style="width: 54px; height: 54px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 71px; height: 54px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 98px; height: 54px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 158px; height: 54px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 70px; height: 54px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 76px; height: 54px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 99px; height: 54px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 81px; height: 54px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td></tr><tr><td style="width: 54px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 71px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 98px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 158px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 70px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 76px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 99px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 81px; height: 64px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td></tr><tr><td style="width: 54px; height: 57px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-left-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-right-style: solid; border-bottom-style: solid; border-left-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 71px; height: 57px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 98px; height: 57px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 158px; height: 57px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 70px; height: 57px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 76px; height: 57px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 99px; height: 57px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td><td style="width: 81px; height: 57px; border-right-color: rgb(0, 0, 0); border-bottom-color: rgb(0, 0, 0); border-right-width: 1px; border-bottom-width: 1px; border-right-style: solid; border-bottom-style: solid;"><p style="text-align: center;"> </p></td></tr></tbody></table><p><br></p></div><p><br></p>
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