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<meta charset="utf-8">
<title>Untitled Document</title>
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<table width="505" border="1" align="center" bordercolor="#000000">
  <tr>
    <td><div align="center"><img src="kopnu.jpg" alt="RSINU DEMAK" width="882" height="119"/></div></td>
  </tr>
</table>
<table width="888" border="0"  align="center">
  <tr>
    <td width="153"><span class="style26">Konfirmasi Akhir </span></td>
    <td width="10">&nbsp;</td>
    <td width="682">&nbsp;</td>
  </tr>
  <tr>
    <td>Nomor Rekam Medik</td>
    <td>:</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td><span class="style26">Nama Pasien </span></td>
    <td><span class="style26">:</span></td>
    <td><?php echo($nm) ?></td>
  </tr>
  <tr>
    <td><span class="style26">Alamat</span></td>
    <td><span class="style26">:</span></td>
    <td><?php echo($al) ?></td>
  </tr>
  <tr>
    <td></td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td>Penjamin</td>
    <td>:</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td>Nomor Kartu</td>
    <td>:</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td>Poli</td>
    <td>:</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td>Dokter</td>
    <td>:</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td>Hari dan Jam</td>
    <td>:</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td></td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td colspan="3"></td>
  </tr>
  <tr>
    <td colspan="3">Jika data ini benar, klik tombol 
      <input type="button" name="Submit2" value="Proses Pendaftaran" onClick="location='Admisi.php'"/> 
      untuk melanjutkan pendaftaran</td>
  </tr>
  <tr>
    <td colspan="3">Jika data ini salah, klik tombol
    <input type="button" name="Submit" value="&lt;&lt; Kembali" onClick="location='Admisi.php'"/> 
    untuk kembali ke halaman sebelumnya</td>
  </tr>
</table>
</html>