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|style="background:teal; border-radius: 0 0 0 14px; border:0px solid #AFA3BF"| | |style="background:teal; border-radius: 0 0 0 14px; border:0px solid #AFA3BF"| | ||
|style="background:teal" | | |style="background:teal" | | ||
!width=180 align=right|<font size="4" color=teal>MEDICAL RECORD</font> | !width=180 align=right style="line-height: 130%;"|<font size="4" color=teal>MEDICAL RECORD</font> | ||
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|style="background:teal; border-radius: 14px 0 0 0; border:0px solid #AFA3BF"| | |style="background:teal; border-radius: 14px 0 0 0; border:0px solid #AFA3BF"| |