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2 lines
106 KiB
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<p style="text-align: center;"><span style="font-family: 宋体, SimSun; font-size: 20px;"><strong><span leipiplugins="select" id="SS_MinZu" title="下拉框" name="leipiNewField" data-sftable="MinZu"></span>民族</strong></span></p><p style="text-align: center;"><span style="font-family: 宋体, SimSun; font-size: 20px;"><strong>困境儿童</strong></span></p><p><span style="font-family: 宋体, SimSun; font-size: 20px;"><strong>编号：</strong></span><input type="text" value="" id="TB_BillNo" name="TB_BillNo" data-key="BillNo" data-name="编号" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></p><p><span style="font-family: 宋体, SimSun; font-size: 20px;"></span></p><center><table style="border: medium none; border-collapse: collapse;" data-sort="sortDisabled" width="-60"><tbody><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">儿童基本信息<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="152.66666666666666"><br/></th></tr><tr><td style="word-break: break-all; text-align: center;" width="87" valign="top" height="49"><span style="font-size: 16px;"></span>儿童姓名 <br/></td><td style="word-break: break-all;" width="175" valign="top" height="49"><input type="text" value="" id="TB_UC_ETName" name="TB_UC_ETName" data-key="UC_ETName" data-name="儿童姓名" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td style="word-break: break-all;" width="153.66666666666666" valign="top" height="49"><span style="font-size: 16px;">身份证号</span> <br/></td><td style="word-break: break-all;" width="64" valign="top" height="49"><input type="text" value="" id="TB_UC_ETSFZ" name="TB_UC_ETSFZ" data-key="UC_ETSFZ" data-name="儿童身份证" data-type="Text" class="form-control" leipiplugins="text" style="width:120px" placeholder=""/></td><td style="word-break: break-all;" width="91.66666666666667" valign="top" height="40"><span style="font-size: 16px;"></span> 户籍状况</td><td style="word-break: break-all;" width="120.99999999999999" valign="top" height="20"><span leipiplugins="enum" style="margin-top:1px;display:block;" id="SR_UC_ETHuJi" title="单选" name="leipiNewField" data-key="UC_ETHuJi" data-type="Radio" data-bindkey="HuJi"><label style="vertical-align:middle;"><input type="radio" value="0" id="RB_UC_ETHuJi_0" name="RB_UC_ETHuJi" data-key="UC_ETHuJi" data-type="Radio" data-bindkey="HuJi" style="width:15px;height:15px;vertical-align:-1px;"/>农村社区 </label><label style="vertical-align:middle;"><input type="radio" value="1" id="RB_UC_ETHuJi_1" name="RB_UC_ETHuJi" data-key="UC_ETHuJi" data-type="Radio" data-bindkey="HuJi" style="width:15px;height:15px;vertical-align:-1px;"/>城市社区 </label></span></td><td style="word-break: break-all;" width="159" valign="top" height="20"><br/></td><td style="word-break: break-all;" width="152.66666666666666" valign="top" height="20"><br/></td></tr><tr><td style="word-break: break-all; text-align: center;" width="86" valign="top"> 性别 <br/></td><td style="word-break: break-all;" width="175" valign="top"><span leipiplugins="enum" id="SR_UC_ETXingBie" title="单选" name="leipiNewField" data-key="UC_ETXingBie" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_ETXingBie_0" name="RB_UC_ETXingBie" data-key="UC_ETXingBie" data-type="Radio" data-bindkey="XingBie" style="width:15px;height:15px;"/>女</label> <label><input type="radio" value="1" id="RB_UC_ETXingBie_1" name="RB_UC_ETXingBie" data-key="UC_ETXingBie" data-type="Radio" data-bindkey="XingBie" style="width:15px;height:15px;"/>男</label><br/></span></td><td style="word-break: break-all;" width="153.66666666666666" valign="top"><span leipiplugins="select" id="SS_MinZu" title="下拉框" name="leipiNewField" data-sftable="MinZu"><span leipiplugins="select" id="SS_MinZu" title="下拉框" name="leipiNewField" data-sftable="MinZu">民族</span></span></td><td style="word-break: break-all;" width="193" valign="top"><span leipiplugins="select" id="SS_MinZu" title="下拉框" name="leipiNewField" data-sftable="MinZu"><span leipiplugins="select" id="SS_MinZu" title="下拉框" name="leipiNewField" data-sftable="MinZu"><span leipiplugins="select" id="SS_UC_ETMinZu" title="下拉框" name="leipiNewField" data-sftable="MinZu"><select id="DDL_UC_ETMinZu" name="DDL_UC_ETMinZu" data-type="7" data-key="UC_ETMinZu" class="form-control"><option value="">UC_ETMinZu</option></select></span></span></span></td><td style="word-break: break-all;" width="91.66666666666667" valign="top"><span style="font-size: 16px;"></span> <br/></td><td style="word-break: break-all;" width="120.99999999999999" valign="top"><br/></td><td style="word-break: break-all;" width="159" valign="top"><br/></td><td style="word-break: break-all;" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="border-left-color: rgb(0, 0, 0); border-top-color: rgb(0, 0, 0); word-break: break-all; text-align: center;" width="86" valign="top">户籍地址<br/></td><td colspan="1" rowspan="1" style="border-left-color: rgb(0, 0, 0); border-top-color: rgb(0, 0, 0); word-break: break-all;" width="175" valign="top"><span leipiplugins="select" id="SS_UC_SF" title="下拉框" name="leipiNewField" data-sftable="CN_SF"><select id="DDL_UC_SF" name="DDL_UC_SF" data-type="CreateTable" data-key="UC_SF" class="form-control" style="width: 90%;"><option value="">UC_SF</option></select></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top"><span leipiplugins="select" id="SS_UC_City" title="下拉框" name="leipiNewField" data-sftable="CN_City"><select id="DDL_UC_City" name="DDL_UC_City" data-type="CreateTable" data-key="UC_City" class="form-control" style="width: 90%;"><option value="">UC_City</option></select></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="66" valign="top"><span leipiplugins="select" id="SS_UC_QX" title="下拉框" name="leipiNewField" data-sftable="CN_QX"><select id="DDL_UC_QX" name="DDL_UC_QX" data-type="CreateTable" data-key="UC_QX" class="form-control"><option value="">UC_QX</option></select></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top"><p><span leipiplugins="select" id="SS_CN_JieDao" title="下拉框" name="leipiNewField" data-sftable="CN_JieDao"><span leipiplugins="select" id="SS_UC_JieDao" title="下拉框" name="leipiNewField" data-sftable="CN_JieDao"><select id="DDL_UC_JieDao" name="DDL_UC_JieDao" data-type="CreateTable" data-key="UC_JieDao" class="form-control" style="width: 90%;"><option value="">UC_JieDao</option></select></span></span></p></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><span leipiplugins="select" id="SS_UC_SQ" title="下拉框" name="leipiNewField" data-sftable="CN_SQ"><select id="DDL_UC_SQ" name="DDL_UC_SQ" data-type="CreateTable" data-key="UC_SQ" class="form-control"><option value="">UC_SQ</option></select></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all; text-align: center;" width="86" valign="top">现住址<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top"><span leipiplugins="select" id="SS_UC_SF2" title="下拉框" name="leipiNewField" data-sftable="CN_SF"><select id="DDL_UC_SF2" name="DDL_UC_SF2" data-type="CreateTable" data-key="UC_SF2" class="form-control" style="width: 90%;"><option value="">UC_SF2</option></select></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top"><span leipiplugins="select" id="SS_UC_City2" title="下拉框" name="leipiNewField" data-sftable="CN_City"><select id="DDL_UC_City2" name="DDL_UC_City2" data-type="CreateTable" data-key="UC_City2" class="form-control" style="width: 90%;"><option value="">UC_City2</option></select></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="67" valign="top"><span leipiplugins="select" id="SS_UC_QX2" title="下拉框" name="leipiNewField" data-sftable="CN_QX"><select id="DDL_UC_QX2" name="DDL_UC_QX2" data-type="CreateTable" data-key="UC_QX2" class="form-control"><option value="">UC_QX2</option></select></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top"><span leipiplugins="select" id="SS_UC_JieDao2" title="下拉框" name="leipiNewField" data-sftable="CN_JieDao"><select id="DDL_UC_JieDao2" name="DDL_UC_JieDao2" data-type="CreateTable" data-key="UC_JieDao2" class="form-control"><option value="">UC_JieDao2</option></select></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><span leipiplugins="select" id="SS_UC_SQ2" title="下拉框" name="leipiNewField" data-sftable="CN_SQ"><select id="DDL_UC_SQ2" name="DDL_UC_SQ2" data-type="CreateTable" data-key="UC_SQ2" class="form-control"><option value="">UC_SQ2</option></select></span></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><th><br/></th><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">等级<span leipiplugins="enum" id="SS_DJ" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="DJ"><select id="DDL_DJ" name="DDL_DJ" data-type="EnumSelect" data-key="DJ" class="form-control"><option value="0">一级</option><option value="1">二级</option><option value="2">三级</option><option value="3">四级</option></select></span></td><td colspan="1" rowspan="1" valign="top">困境类型</td><td colspan="1" rowspan="1" valign="top"><span leipiplugins="enum" id="SS_KJLX" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="KJLX"><select id="DDL_KJLX" name="DDL_KJLX" data-type="EnumSelect" data-key="KJLX" class="form-control"><option value="0">孤儿</option><option value="1">无人抚养</option><option value="2">重疾</option></select></span></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">村（居）儿童主任信息<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="152.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all; text-align: center;" width="86" valign="top">姓名<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top"><input type="text" value="" id="TB_UC_CZRXM" name="TB_UC_CZRXM" data-key="UC_CZRXM" data-name="村主任姓名" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">电话号码<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="68" valign="top"><input type="text" value="" id="TB_UC_CZRDH" name="TB_UC_CZRDH" data-key="UC_CZRDH" data-name="村主任电话" data-type="Text" class="form-control" leipiplugins="text" style="width:120px" placeholder=""/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top"><label> </label></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="152.66666666666666" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">儿童身体状况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="152.66666666666666"><br/></th></tr><tr><td colspan="2" rowspan="1" style="word-break: break-all;" width="0" valign="top"><span leipiplugins="enum" id="SR_UC_ETJKZK" title="单选" name="leipiNewField" data-key="UC_ETJKZK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_ETJKZK_0" name="RB_UC_ETJKZK" data-key="UC_ETJKZK" data-type="Radio" data-bindkey="JKZK" style="width:15px;height:15px;"/>健康</label> <label><input type="radio" value="1" id="RB_UC_ETJKZK_1" name="RB_UC_ETJKZK" data-key="UC_ETJKZK" data-type="Radio" data-bindkey="JKZK" style="width:15px;height:15px;"/>不健康</label></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="3" style="word-break: break-all; text-align: center;" width="127" valign="top">残疾<br/></td><td colspan="7" rowspan="1" style="word-break: break-all;" valign="top"><p>儿童残疾类型</p><p><span leipiplugins="enum" id="SC_UC_ETCJLX" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_ETCJLX" data-bindkey="CJLX"><label><input type="checkbox" value="0" id="CB_UC_ETCJLX_0" name="CB_UC_ETCJLX" data-key="UC_ETCJLX" data-type="EnumCheckBox" data-bindkey="CJLX" style="width:15px;height:15px;"/>智力残疾 </label><label><input type="checkbox" value="1" id="CB_UC_ETCJLX_1" name="CB_UC_ETCJLX" data-key="UC_ETCJLX" data-type="EnumCheckBox" data-bindkey="CJLX" style="width:15px;height:15px;"/>肢体残疾 </label><label><input type="checkbox" value="2" id="CB_UC_ETCJLX_2" name="CB_UC_ETCJLX" data-key="UC_ETCJLX" data-type="EnumCheckBox" data-bindkey="CJLX" style="width:15px;height:15px;"/>精神残疾 </label><label><input type="checkbox" value="3" id="CB_UC_ETCJLX_3" name="CB_UC_ETCJLX" data-key="UC_ETCJLX" data-type="EnumCheckBox" data-bindkey="CJLX" style="width:15px;height:15px;"/>孤独症 </label><label><input type="checkbox" value="4" id="CB_UC_ETCJLX_4" name="CB_UC_ETCJLX" data-key="UC_ETCJLX" data-type="EnumCheckBox" data-bindkey="CJLX" style="width:15px;height:15px;"/>视力残疾 </label><label><input type="checkbox" value="5" id="CB_UC_ETCJLX_5" name="CB_UC_ETCJLX" data-key="UC_ETCJLX" data-type="EnumCheckBox" data-bindkey="CJLX" style="width:15px;height:15px;"/>听力残疾 </label><label><input type="checkbox" value="6" id="CB_UC_ETCJLX_6" name="CB_UC_ETCJLX" data-key="UC_ETCJLX" data-type="EnumCheckBox" data-bindkey="CJLX" style="width:15px;height:15px;"/>言语残疾 </label><label><input type="checkbox" value="7" id="CB_UC_ETCJLX_7" name="CB_UC_ETCJLX" data-key="UC_ETCJLX" data-type="EnumCheckBox" data-bindkey="CJLX" style="width:15px;height:15px;"/>多重残疾 </label><label><input type="checkbox" value="8" id="CB_UC_ETCJLX_8" name="CB_UC_ETCJLX" data-key="UC_ETCJLX" data-type="EnumCheckBox" data-bindkey="CJLX" style="width:15px;height:15px;"/>预防接种异常反应残疾 </label><label><input type="checkbox" value="9" id="CB_UC_ETCJLX_9" name="CB_UC_ETCJLX" data-key="UC_ETCJLX" data-type="EnumCheckBox" data-bindkey="CJLX" style="width:15px;height:15px;"/>其他 </label></span><br/></p></td></tr><tr><td colspan="7" rowspan="1" style="word-break: break-all;" valign="top"><input type="text" value="" id="TB_UC_CanJiSM" name="TB_UC_CanJiSM" data-key="UC_CanJiSM" data-name="其它残疾说明" data-type="Text" class="form-control" leipiplugins="text" style="width: 50%;" placeholder=""/></td></tr><tr><td colspan="7" rowspan="1" style="word-break: break-all;" valign="top"><p>残疾类型</p><p><span leipiplugins="enum" id="SR_UC_DJ" title="单选" name="leipiNewField" data-key="UC_DJ" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_DJ_0" name="RB_UC_DJ" data-key="UC_DJ" data-type="Radio" data-bindkey="DJ" style="width:15px;height:15px;"/>一级</label> <label><input type="radio" value="1" id="RB_UC_DJ_1" name="RB_UC_DJ" data-key="UC_DJ" data-type="Radio" data-bindkey="DJ" style="width:15px;height:15px;"/>二级</label> <label><input type="radio" value="2" id="RB_UC_DJ_2" name="RB_UC_DJ" data-key="UC_DJ" data-type="Radio" data-bindkey="DJ" style="width:15px;height:15px;"/>三级</label> <label><input type="radio" value="3" id="RB_UC_DJ_3" name="RB_UC_DJ" data-key="UC_DJ" data-type="Radio" data-bindkey="DJ" style="width:15px;height:15px;"/>四级</label> </span></p></td></tr><tr><td colspan="1" rowspan="1" style="text-align: center;" width="127" valign="top">重病</td><td colspan="7" rowspan="1" style="word-break: break-all;" valign="top"><p><span leipiplugins="enum" id="SC_UC_ETZhongBing" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_ETZhongBing" data-bindkey="ZhongBing"><label><input type="checkbox" value="0" id="CB_UC_ETZhongBing_0" name="CB_UC_ETZhongBing" data-key="UC_ETZhongBing" data-type="EnumCheckBox" data-bindkey="ZhongBing" style="width:15px;height:15px;"/>艾滋病毒感染 </label><label><input type="checkbox" value="1" id="CB_UC_ETZhongBing_1" name="CB_UC_ETZhongBing" data-key="UC_ETZhongBing" data-type="EnumCheckBox" data-bindkey="ZhongBing" style="width:15px;height:15px;"/>白血病 </label><label><input type="checkbox" value="2" id="CB_UC_ETZhongBing_2" name="CB_UC_ETZhongBing" data-key="UC_ETZhongBing" data-type="EnumCheckBox" data-bindkey="ZhongBing" style="width:15px;height:15px;"/>先天性心脏病 </label><label><input type="checkbox" value="3" id="CB_UC_ETZhongBing_3" name="CB_UC_ETZhongBing" data-key="UC_ETZhongBing" data-type="EnumCheckBox" data-bindkey="ZhongBing" style="width:15px;height:15px;"/>尿毒症 </label><label><input type="checkbox" value="4" id="CB_UC_ETZhongBing_4" name="CB_UC_ETZhongBing" data-key="UC_ETZhongBing" data-type="EnumCheckBox" data-bindkey="ZhongBing" style="width:15px;height:15px;"/>慢性肾功能衰竭 </label><label><input type="checkbox" value="5" id="CB_UC_ETZhongBing_5" name="CB_UC_ETZhongBing" data-key="UC_ETZhongBing" data-type="EnumCheckBox" data-bindkey="ZhongBing" style="width:15px;height:15px;"/>器官移植 </label><label><input type="checkbox" value="6" id="CB_UC_ETZhongBing_6" name="CB_UC_ETZhongBing" data-key="UC_ETZhongBing" data-type="EnumCheckBox" data-bindkey="ZhongBing" style="width:15px;height:15px;"/>恶性肿瘤 </label><label><input type="checkbox" value="7" id="CB_UC_ETZhongBing_7" name="CB_UC_ETZhongBing" data-key="UC_ETZhongBing" data-type="EnumCheckBox" data-bindkey="ZhongBing" style="width:15px;height:15px;"/>颅内良性肿瘤 </label><label><input type="checkbox" value="8" id="CB_UC_ETZhongBing_8" name="CB_UC_ETZhongBing" data-key="UC_ETZhongBing" data-type="EnumCheckBox" data-bindkey="ZhongBing" style="width:15px;height:15px;"/>上年度医保政策规定的住院和门诊治疗费用1年中自付部分超过2万元的疾病 </label></span></p></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">教育情况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="152.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="3" style="word-break: break-all;" valign="top">法定教育</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">学历</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top"><span leipiplugins="select" id="SS_UC_XueLi" title="下拉框" name="leipiNewField" data-sftable="cn_XueLi"><select id="DDL_UC_XueLi" name="DDL_UC_XueLi" data-type="CreateTable" data-key="UC_XueLi" class="form-control"><option value="">UC_XueLi</option></select></span></td><td colspan="2" rowspan="1" style="word-break: break-all;" width="274.6666666666667" valign="top"><span leipiplugins="select" id="SS_UC_xlxq" title="下拉框" name="leipiNewField" data-sftable="CN_xlxq"><select id="DDL_UC_xlxq" name="DDL_UC_xlxq" data-type="CreateTable" data-key="UC_xlxq" class="form-control"><option value="">UC_xlxq</option></select></span></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="127" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">学校名称<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top"><input type="text" value="" id="TB_UC_XueXiaoMingChen" name="TB_UC_XueXiaoMingChen" data-key="UC_XueXiaoMingChen" data-name="儿童学校名称" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">班级<br/></td><td rowspan="1" style="word-break: break-all;" width="68" valign="top" align="null"><input type="text" value="" id="TB_UC_BanJi" name="TB_UC_BanJi" data-key="UC_BanJi" data-name="儿童班级" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="5" valign="top"><br/></td><td colspan="1" rowspan="1" width="145" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top"> 老师姓名<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><input type="text" value="" id="TB_UC_LaoShiXingMing" name="TB_UC_LaoShiXingMing" data-key="UC_LaoShiXingMing" data-name="老师姓名" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">老师电话<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="68" valign="top"><input type="text" value="" id="TB_UC_LaoShiDianHua" name="TB_UC_LaoShiDianHua" data-key="UC_LaoShiDianHua" data-name="老师电话" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="5" valign="top"><br/></td><td colspan="1" rowspan="1" width="145" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">参加课外辅导班<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><span leipiplugins="enum" id="SR_UC_IsFDB" title="单选" name="leipiNewField" data-key="UC_IsFDB" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_IsFDB_0" name="RB_UC_IsFDB" data-key="UC_IsFDB" data-type="Radio" data-bindkey="IFFDB" style="width:15px;height:15px;"/>是</label> <label><input type="radio" value="1" id="RB_UC_IsFDB_1" name="RB_UC_IsFDB" data-key="UC_IsFDB" data-type="Radio" data-bindkey="IFFDB" style="width:15px;height:15px;"/>否</label> </span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="338.6666666666667" valign="top"><span leipiplugins="enum" id="SS_UC_FDBZQ" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="FDBZQ"><select id="DDL_UC_FDBZQ" name="DDL_UC_FDBZQ" data-type="EnumSelect" data-key="UC_FDBZQ" class="form-control"><option value="0">每天</option><option value="1">休息日</option><option value="2">寒暑假</option></select></span></td><td colspan="1" rowspan="1" width="72" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top"><span leipiplugins="enum" id="SS_FDBZQ" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="FDBZQ"></span><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">相关经历<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="152.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">遭受侵害和虐待<br/></td><td colspan="4" rowspan="1" style="word-break: break-all;" width="683.6666666666666" valign="top"><span leipiplugins="enum" id="SC_UC_ETNDZL" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_ETNDZL" data-bindkey="NDZL"><label><input type="checkbox" value="0" id="CB_UC_ETNDZL_0" name="CB_UC_ETNDZL" data-key="UC_ETNDZL" data-type="EnumCheckBox" data-bindkey="NDZL" style="width:15px;height:15px;"/>性侵害 </label><label><input type="checkbox" value="1" id="CB_UC_ETNDZL_1" name="CB_UC_ETNDZL" data-key="UC_ETNDZL" data-type="EnumCheckBox" data-bindkey="NDZL" style="width:15px;height:15px;"/>拐卖 </label><label><input type="checkbox" value="2" id="CB_UC_ETNDZL_2" name="CB_UC_ETNDZL" data-key="UC_ETNDZL" data-type="EnumCheckBox" data-bindkey="NDZL" style="width:15px;height:15px;"/>遗弃 </label><label><input type="checkbox" value="3" id="CB_UC_ETNDZL_3" name="CB_UC_ETNDZL" data-key="UC_ETNDZL" data-type="EnumCheckBox" data-bindkey="NDZL" style="width:15px;height:15px;"/>虐待 </label><label><input type="checkbox" value="4" id="CB_UC_ETNDZL_4" name="CB_UC_ETNDZL" data-key="UC_ETNDZL" data-type="EnumCheckBox" data-bindkey="NDZL" style="width:15px;height:15px;"/>暴力伤害 </label><label><input type="checkbox" value="5" id="CB_UC_ETNDZL_5" name="CB_UC_ETNDZL" data-key="UC_ETNDZL" data-type="EnumCheckBox" data-bindkey="NDZL" style="width:15px;height:15px;"/>其它 </label></span></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">情况简述<br/></td><td colspan="4" rowspan="1" style="word-break: break-all;" width="683.6666666666666" valign="top"><textarea id="TB_UC_ETNDSM" name="TB_UC_ETNDSM" data-key="UC_ETNDSM" data-name="侵害简述" data-type="Textarea" leipiplugins="textarea" value="" orgrich="0" orgfontsize="12" orgwidth="600" orgheight="80" style="font-size: 12px; width: 528px; height: 59px; margin: 0px;"></textarea></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">失足未成年人<br/></td><td colspan="4" rowspan="1" style="word-break: break-all;" width="683.6666666666666" valign="top"><span leipiplugins="enum" id="SC_UC_ETSZLX" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_ETSZLX" data-bindkey="SZLX"><label><input type="checkbox" value="0" id="CB_UC_ETSZLX_0" name="CB_UC_ETSZLX" data-key="UC_ETSZLX" data-type="EnumCheckBox" data-bindkey="SZLX" style="width:15px;height:15px;"/>追究刑事责任 </label><label><input type="checkbox" value="1" id="CB_UC_ETSZLX_1" name="CB_UC_ETSZLX" data-key="UC_ETSZLX" data-type="EnumCheckBox" data-bindkey="SZLX" style="width:15px;height:15px;"/>治安拘留 </label><label><input type="checkbox" value="2" id="CB_UC_ETSZLX_2" name="CB_UC_ETSZLX" data-key="UC_ETSZLX" data-type="EnumCheckBox" data-bindkey="SZLX" style="width:15px;height:15px;"/>符条件不诉 </label></span></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">情况简述<br/></td><td colspan="4" rowspan="1" style="word-break: break-all;" width="683.6666666666666" valign="top"><textarea id="TB_UC_SZSM" name="TB_UC_SZSM" data-key="UC_SZSM" data-name="失足简述" data-type="Textarea" leipiplugins="textarea" value="" orgrich="0" orgfontsize="12" orgwidth="600" orgheight="80" style="font-size: 12px; width: 528px; height: 59px; margin: 0px;"></textarea></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">遭遇突发事件<br/></td><td colspan="4" rowspan="1" style="word-break: break-all;" width="683.6666666666666" valign="top"><span leipiplugins="enum" id="SC_UC_ETTFLX" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_ETTFLX" data-bindkey="TFLX"><label><input type="checkbox" value="0" id="CB_UC_ETTFLX_0" name="CB_UC_ETTFLX" data-key="UC_ETTFLX" data-type="EnumCheckBox" data-bindkey="TFLX" style="width:15px;height:15px;"/>火灾 </label><label><input type="checkbox" value="1" id="CB_UC_ETTFLX_1" name="CB_UC_ETTFLX" data-key="UC_ETTFLX" data-type="EnumCheckBox" data-bindkey="TFLX" style="width:15px;height:15px;"/>爆炸 </label><label><input type="checkbox" value="2" id="CB_UC_ETTFLX_2" name="CB_UC_ETTFLX" data-key="UC_ETTFLX" data-type="EnumCheckBox" data-bindkey="TFLX" style="width:15px;height:15px;"/>交通事故 </label><label><input type="checkbox" value="3" id="CB_UC_ETTFLX_3" name="CB_UC_ETTFLX" data-key="UC_ETTFLX" data-type="EnumCheckBox" data-bindkey="TFLX" style="width:15px;height:15px;"/>人身伤害 </label><label><input type="checkbox" value="4" id="CB_UC_ETTFLX_4" name="CB_UC_ETTFLX" data-key="UC_ETTFLX" data-type="EnumCheckBox" data-bindkey="TFLX" style="width:15px;height:15px;"/>其它 </label></span></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">情况简述<br/></td><td colspan="4" rowspan="1" style="word-break: break-all;" width="683.6666666666666" valign="top"><textarea id="TB_UC_TFSM" name="TB_UC_TFSM" data-key="UC_TFSM" data-name="突发简述" data-type="Textarea" leipiplugins="textarea" value="" orgrich="0" orgfontsize="12" orgwidth="600" orgheight="80" style="font-size: 12px; width: 528px; height: 59px; margin: 0px;"></textarea></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">流浪儿童<br/></td><td colspan="4" rowspan="1" style="word-break: break-all;" width="683.6666666666666" valign="top"><span leipiplugins="enum" id="SR_UC_ETLLLX" title="单选" name="leipiNewField" data-key="UC_ETLLLX" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_ETLLLX_0" name="RB_UC_ETLLLX" data-key="UC_ETLLLX" data-type="Radio" data-bindkey="LLLX" style="width:15px;height:15px;"/>长期在外地流浪儿童</label> <label><input type="radio" value="1" id="RB_UC_ETLLLX_1" name="RB_UC_ETLLLX" data-key="UC_ETLLLX" data-type="Radio" data-bindkey="LLLX" style="width:15px;height:15px;"/>外地在本地长期流浪儿童</label> </span></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">情况简述<br/></td><td colspan="4" rowspan="1" style="word-break: break-all;" width="683.6666666666666" valign="top"><textarea id="TB_UC_LLSM" name="TB_UC_LLSM" data-key="UC_LLSM" data-name="流浪简述" data-type="Textarea" leipiplugins="textarea" value="" orgrich="0" orgfontsize="12" orgwidth="600" orgheight="80" style="font-size: 12px; width: 528px; height: 59px; margin: 0px;"></textarea></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">父母情况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="152.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">父亲姓名<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top"><input type="text" value="" id="TB_UC_FQXM" name="TB_UC_FQXM" data-key="UC_FQXM" data-name="父亲姓名" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">父亲身份证号</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="68" valign="top"><input type="text" value="" id="TB_UC_FQSFZH" name="TB_UC_FQSFZH" data-key="UC_FQSFZH" data-name="父亲身份证号" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top">父亲联系电话</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><input type="text" value="" id="TB_UC_FQLXDH" name="TB_UC_FQLXDH" data-key="UC_FQLXDH" data-name="父亲联系电话" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">母亲姓名<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top"><input type="text" value="" id="TB_UC_MQXM" name="TB_UC_MQXM" data-key="UC_MQXM" data-name="母亲姓名" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top">母亲身份证号</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="68" valign="top"><input type="text" value="" id="TB_UC_MQSFZH" name="TB_UC_MQSFZH" data-key="UC_MQSFZH" data-name="母亲身份证号" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top">母亲联系电话</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><input type="text" value="" id="TB_UC_MQLXDH" name="TB_UC_MQLXDH" data-key="UC_MQLXDH" data-name="母亲联系电话" data-type="Text" class="form-control" leipiplugins="text" style="width:120px" placeholder=""/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="2" rowspan="1" style="word-break: break-all;" valign="top">父亲基本情况<br/></td><td colspan="1" rowspan="1" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="72" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="127" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">生存状况<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><span leipiplugins="enum" id="SS_SCZK" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="SCZK"><span leipiplugins="enum" id="SS_UC_FDSCZK" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="SCZK"><select id="DDL_UC_FDSCZK" name="DDL_UC_FDSCZK" data-type="EnumSelect" data-key="UC_FDSCZK" class="form-control"><option value="0">存活</option><option value="1">自然死亡</option><option value="2">宣告死亡</option><option value="3">未知</option></select></span></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="152.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="2" style="word-break: break-all;" valign="top">健康状况</td><td colspan="1" rowspan="2" style="word-break: break-all;" width="0" valign="top"><br/><p><span leipiplugins="enum" id="SS_JKZK" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="JKZK" data-key="JKZK"></span><span leipiplugins="enum" id="SR_UC_FDJKZK" title="单选" name="leipiNewField" data-key="UC_FDJKZK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_FDJKZK_0" name="RB_UC_FDJKZK" data-key="UC_FDJKZK" data-type="Radio" data-bindkey="JKZK" style="width:15px;height:15px;"/>健康</label> <label><input type="radio" value="1" id="RB_UC_FDJKZK_1" name="RB_UC_FDJKZK" data-key="UC_FDJKZK" data-type="Radio" data-bindkey="JKZK" style="width:15px;height:15px;"/>不健康</label> </span></p><p><br/></p></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="138" valign="top">残疾</td><td rowspan="1" style="word-break: break-all;" colspan="5" valign="top" align="null"><span leipiplugins="enum" id="SR_UC_FDSTZK" title="单选" name="leipiNewField" data-key="UC_FDSTZK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_FDSTZK_0" name="RB_UC_FDSTZK" data-key="UC_FDSTZK" data-type="Radio" data-bindkey="STZK" style="width:15px;height:15px;"/>二级以上残疾</label> <label><input type="radio" value="1" id="RB_UC_FDSTZK_1" name="RB_UC_FDSTZK" data-key="UC_FDSTZK" data-type="Radio" data-bindkey="STZK" style="width:15px;height:15px;"/>三级四级精神残疾</label> <label><input type="radio" value="2" id="RB_UC_FDSTZK_2" name="RB_UC_FDSTZK" data-key="UC_FDSTZK" data-type="Radio" data-bindkey="STZK" style="width:15px;height:15px;"/>三级四级智力残疾</label> </span></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">重病<br/></td><td colspan="5" rowspan="1" style="word-break: break-all;" width="624" valign="top"><input type="text" value="" id="TB_UC_FDZBSM" name="TB_UC_FDZBSM" data-key="UC_FDZBSM" data-name="父亲重病说明" data-type="Text" class="form-control" leipiplugins="text" style="width: 80%;" placeholder=""/></td></tr><tr><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SS_JHRSTZK" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="JHRSTZK"></span><span leipiplugins="enum" id="SS_JHRSTZK" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="JHRSTZK"><select id="DDL_JHRSTZK" name="DDL_JHRSTZK" data-type="EnumSelect" data-key="JHRSTZK" class="form-control"><option value="0">健康</option><option value="1">残疾</option><option value="2">重病</option></select></span>监护人身体状况<span leipiplugins="enum" id="SS_JHRSTZKdtl" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="JHRSTZKDtl"><select id="DDL_JHRSTZKdtl" name="DDL_JHRSTZKdtl" data-type="EnumSelect" data-key="JHRSTZKdtl" class="form-control"><option value="100">一级</option><option value="200">精神</option><option value="101">二级</option><option value="201">身体</option><option value="202">外伤</option></select></span>监护人身体状况Dtl</td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" valign="top" height="43">其它状况</td><td colspan="3" rowspan="1" style="word-break: break-all;" valign="top" height="43"><span leipiplugins="enum" id="SR_UC_FDQTZK" title="单选" name="leipiNewField" data-key="UC_FDQTZK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_FDQTZK_0" name="RB_UC_FDQTZK" data-key="UC_FDQTZK" data-type="Radio" data-bindkey="QTZK" style="width:15px;height:15px;"/>宣告失踪</label> <label><input type="radio" value="1" id="RB_UC_FDQTZK_1" name="RB_UC_FDQTZK" data-key="UC_FDQTZK" data-type="Radio" data-bindkey="QTZK" style="width:15px;height:15px;"/>离家出走</label> <label><input type="radio" value="2" id="RB_UC_FDQTZK_2" name="RB_UC_FDQTZK" data-key="UC_FDQTZK" data-type="Radio" data-bindkey="QTZK" style="width:15px;height:15px;"/>长期在外打工</label> <label><input type="radio" value="3" id="RB_UC_FDQTZK_3" name="RB_UC_FDQTZK" data-key="UC_FDQTZK" data-type="Radio" data-bindkey="QTZK" style="width:15px;height:15px;"/>服刑在押</label> <label><input type="radio" value="4" id="RB_UC_FDQTZK_4" name="RB_UC_FDQTZK" data-key="UC_FDQTZK" data-type="Radio" data-bindkey="QTZK" style="width:15px;height:15px;"/>强制戒毒</label> </span></td><td rowspan="1" width="91.66666666666667" valign="top" height="43" align="null"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top" height="43"><br/></td><td colspan="1" rowspan="1" width="159" valign="top" height="43"><br/></td><td colspan="1" rowspan="1" width="88.66666666666666" valign="top" height="43"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">羁押时间<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><input type="text" value="" id="TB_UC_FDJYDate" name="TB_UC_FDJYDate" data-key="UC_FDJYDate" data-name="父亲羁押时间" data-type="Date" class="form-control Wdate" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">期限<input type="text" value="" id="TB_UC_FDJYQX" name="TB_UC_FDJYQX" data-key="UC_FDJYQX" data-name="父亲羁押期限" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/>月</td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">剩余<input type="text" value="" id="TB_UC_FDJYSY" name="TB_UC_FDJYSY" data-key="UC_FDJYSY" data-name="父亲羁押剩余" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/>月</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="88.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">隔离时间<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><input type="text" value="" id="TB_UC_FDGLDate" name="TB_UC_FDGLDate" data-key="UC_FDGLDate" data-name="父亲隔离时间" data-type="Date" class="form-control Wdate" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">期限<input type="text" value="" id="TB_UC_FDGLQX" name="TB_UC_FDGLQX" data-key="UC_FDGLQX" data-name="父亲隔离期限" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/>月</td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">剩余<input type="text" value="" id="TB_UC_FDGLSY" name="TB_UC_FDGLSY" data-key="UC_FDGLSY" data-name="父亲隔离剩余" data-type="Text" class="form-control" leipiplugins="text" style="width:120px" placeholder=""/>月</td><td colspan="1" rowspan="1" width="91.66666666666667"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="88.66666666666666" valign="top"><br/></td></tr><tr><td colspan="6" rowspan="1" style="word-break: break-all;" width="989.0000000000001" valign="top">其它需要说明的情况：<input type="text" value="" id="TB_UC_FDXYSM" name="TB_UC_FDXYSM" data-key="UC_FDXYSM" data-name="父亲其它需要说明" data-type="Text" class="form-control" leipiplugins="text" style="width: 80%;"/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td></tr><tr><th style="word-break: break-all;"><span style="font-size: 12px;">母亲基本情况<br/></span></th><td colspan="1" rowspan="1" style="word-break: break-all;" width="158.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="88.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" valign="top">生存状况</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><span leipiplugins="enum" id="SS_UC_MDSCZK" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="SCZK"><select id="DDL_UC_MDSCZK" name="DDL_UC_MDSCZK" data-type="EnumSelect" data-key="UC_MDSCZK" class="form-control"><option value="0">存活</option><option value="1">自然死亡</option><option value="2">宣告死亡</option><option value="3">未知</option></select></span></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="88.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="2" style="word-break: break-all;" valign="top">健康状况<br/></td><td colspan="1" rowspan="2" style="word-break: break-all;" width="0" valign="top"><p><br/></p><p><span leipiplugins="enum" id="SR_UC_MDJKZK" title="单选" name="leipiNewField" data-key="UC_MDJKZK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_MDJKZK_0" name="RB_UC_MDJKZK" data-key="UC_MDJKZK" data-type="Radio" data-bindkey="JKZK" style="width:15px;height:15px;"/>健康</label> <label><input type="radio" value="1" id="RB_UC_MDJKZK_1" name="RB_UC_MDJKZK" data-key="UC_MDJKZK" data-type="Radio" data-bindkey="JKZK" style="width:15px;height:15px;"/>不健康</label> </span></p></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="138" valign="top">残疾</td><td rowspan="1" style="word-break: break-all;" colspan="5" valign="top" align="null"><span leipiplugins="enum" id="SR_UC_MDSTZK" title="单选" name="leipiNewField" data-key="UC_MDSTZK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_MDSTZK_0" name="RB_UC_MDSTZK" data-key="UC_MDSTZK" data-type="Radio" data-bindkey="STZK" style="width:15px;height:15px;"/>二级以上残疾</label> <label><input type="radio" value="1" id="RB_UC_MDSTZK_1" name="RB_UC_MDSTZK" data-key="UC_MDSTZK" data-type="Radio" data-bindkey="STZK" style="width:15px;height:15px;"/>三级四级精神残疾</label> <label><input type="radio" value="2" id="RB_UC_MDSTZK_2" name="RB_UC_MDSTZK" data-key="UC_MDSTZK" data-type="Radio" data-bindkey="STZK" style="width:15px;height:15px;"/>三级四级智力残疾</label> </span></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">重病<br/></td><td colspan="5" rowspan="1" style="word-break: break-all;" width="624" valign="top"><input type="text" value="" id="TB_UC_MDZBSM" name="TB_UC_MDZBSM" data-key="UC_MDZBSM" data-name="母亲重病说明" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">其它状况<br/></td><td colspan="3" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SR_UC_MDQTZK" title="单选" name="leipiNewField" data-key="UC_MDQTZK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_MDQTZK_0" name="RB_UC_MDQTZK" data-key="UC_MDQTZK" data-type="Radio" data-bindkey="QTZK" style="width:15px;height:15px;"/>宣告失踪</label> <label><input type="radio" value="1" id="RB_UC_MDQTZK_1" name="RB_UC_MDQTZK" data-key="UC_MDQTZK" data-type="Radio" data-bindkey="QTZK" style="width:15px;height:15px;"/>离家出走</label> <label><input type="radio" value="2" id="RB_UC_MDQTZK_2" name="RB_UC_MDQTZK" data-key="UC_MDQTZK" data-type="Radio" data-bindkey="QTZK" style="width:15px;height:15px;"/>长期在外打工</label> <label><input type="radio" value="3" id="RB_UC_MDQTZK_3" name="RB_UC_MDQTZK" data-key="UC_MDQTZK" data-type="Radio" data-bindkey="QTZK" style="width:15px;height:15px;"/>服刑在押</label> <label><input type="radio" value="4" id="RB_UC_MDQTZK_4" name="RB_UC_MDQTZK" data-key="UC_MDQTZK" data-type="Radio" data-bindkey="QTZK" style="width:15px;height:15px;"/>强制戒毒</label> </span></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="88.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">羁押时间</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><input type="text" value="" id="TB_UC_MDJYDate" name="TB_UC_MDJYDate" data-key="UC_MDJYDate" data-name="母亲羁押时间" data-type="Date" class="form-control Wdate" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">期限<input type="text" value="" id="TB_UC_MDJYQX" name="TB_UC_MDJYQX" data-key="UC_MDJYQX" data-name="母亲羁押期限" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/>月</td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">剩余<input type="text" value="" id="TB_UC_MDJYSY" name="TB_UC_MDJYSY" data-key="UC_MDJYSY" data-name="母亲羁押剩余" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/>月</td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="88.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">隔离时间</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><input type="text" value="" id="TB_UC_MDGLDate" name="TB_UC_MDGLDate" data-key="UC_MDGLDate" data-name="母亲隔离时间" data-type="Date" class="form-control Wdate" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top"><p>期限<input type="text" value="" id="TB_UC_MDGLQX" name="TB_UC_MDGLQX" data-key="UC_MDGLQX" data-name="母亲隔离期限" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/>月</p></td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><p>剩余<input type="text" value="" id="TB_UC_MDGLSY" name="TB_UC_MDGLSY" data-key="UC_MDGLSY" data-name="母亲隔离剩余" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/>月</p></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="88.66666666666666" valign="top"><br/></td></tr><tr><td colspan="5" rowspan="1" style="word-break: break-all;" width="798.6666666666666" valign="top">其它需要说明的情况：<input type="text" value="" id="TB_UC_MDXYSM" name="TB_UC_MDXYSM" data-key="UC_MDXYSM" data-name="母亲需要说明情况" data-type="Text" class="form-control" leipiplugins="text" style="width: 90%;"/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">实际监护人情况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="88.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">实际监护人一<br/></td><td colspan="1" rowspan="1" width="175" valign="top"><br/></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="88.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">姓名<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top"><input type="text" value="" id="TB_UC_JHRXM1" name="TB_UC_JHRXM1" data-key="UC_JHRXM1" data-name="监护人姓名1" data-type="Text" class="form-control" leipiplugins="text" style="width:120px" placeholder=""/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">身份证<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="68" valign="top"><input type="text" value="" id="TB_UC_JHRSFZ1" name="TB_UC_JHRSFZ1" data-key="UC_JHRSFZ1" data-name="监护人身份证1" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top">联系电话<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><input type="text" value="" id="TB_UC_JHRDH1" name="TB_UC_JHRDH1" data-key="UC_JHRDH1" data-name="监护人电话1" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="159" valign="top">教育程度<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="88.66666666666666" valign="top"><span leipiplugins="enum" id="SS_UC_JHRJYCD1" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="JYCD"><select id="DDL_UC_JHRJYCD1" name="DDL_UC_JHRJYCD1" data-type="EnumSelect" data-key="UC_JHRJYCD1" class="form-control"><option value="0">文盲/半文盲</option><option value="1">小学</option><option value="2">初中</option><option value="3">中职</option><option value="4">高中</option><option value="5">大专</option><option value="6">本科</option><option value="7">硕士及以上</option></select></span></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">身体状况<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><span leipiplugins="enum" id="SC_UC_JHRSTZK1" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_JHRSTZK1" data-bindkey="JHRSTZK"><label><input type="checkbox" value="0" id="CB_UC_JHRSTZK1_0" name="CB_UC_JHRSTZK1" data-key="UC_JHRSTZK1" data-type="EnumCheckBox" data-bindkey="JHRSTZK" style="width:15px;height:15px;"/>健康 </label><label><input type="checkbox" value="1" id="CB_UC_JHRSTZK1_1" name="CB_UC_JHRSTZK1" data-key="UC_JHRSTZK1" data-type="EnumCheckBox" data-bindkey="JHRSTZK" style="width:15px;height:15px;"/>残疾 </label><label><input type="checkbox" value="2" id="CB_UC_JHRSTZK1_2" name="CB_UC_JHRSTZK1" data-key="UC_JHRSTZK1" data-type="EnumCheckBox" data-bindkey="JHRSTZK" style="width:15px;height:15px;"/>重病 </label></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">与儿童关系<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SS_UC_YETGX1" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="YETGX"><select id="DDL_UC_YETGX1" name="DDL_UC_YETGX1" data-type="EnumSelect" data-key="UC_YETGX1" class="form-control" style="width: 90%;"><option value="0">父亲</option><option value="1">母亲</option><option value="2">爷爷</option><option value="3">奶奶</option><option value="4">外公</option><option value="5">外婆</option><option value="6">其它</option></select></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top"><input type="CheckBox" value="" id="CB_UC_IsTZ1" name="CB_UC_IsTZ1" data-key="UC_IsTZ1" data-name="是否同住1" data-type="CheckBox" leipiplugins="text" style="margin: 4px 0px;vertical-align:middle"/> 是否同住</td><td rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top" align="null"><br/></td><td rowspan="1" style="word-break: break-all;" width="159" valign="top" align="null"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">实际监护人二<br/></td><td colspan="1" rowspan="1" width="0" valign="top"><br/></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">姓名</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><input type="text" value="" id="TB_UC_JHRXM2" name="TB_UC_JHRXM2" data-key="UC_JHRXM2" data-name="监护人姓名2" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">身份证</td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><input type="text" value="" id="TB_UC_JHRSFZ2" name="TB_UC_JHRSFZ2" data-key="UC_JHRSFZ2" data-name="监护人身份证2" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top">联系电话</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><input type="text" value="" id="TB_UC_JHRLXDH2" name="TB_UC_JHRLXDH2" data-key="UC_JHRLXDH2" data-name="监护人联系电话2" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="159" valign="top">教育程度</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="82.66666666666666" valign="top"><span leipiplugins="enum" id="SS_JYCD2" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="JYCD"><span leipiplugins="enum" id="SS_UC_JYCD2" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="JYCD"><select id="DDL_UC_JYCD2" name="DDL_UC_JYCD2" data-type="EnumSelect" data-key="UC_JYCD2" class="form-control"><option value="0">文盲/半文盲</option><option value="1">小学</option><option value="2">初中</option><option value="3">中职</option><option value="4">高中</option><option value="5">大专</option><option value="6">本科</option><option value="7">硕士及以上</option></select></span></span></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">身体状况</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><span leipiplugins="enum" id="SC_UC_JHRSTZK2" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_JHRSTZK2" data-bindkey="JHRSTZK"><label><input type="checkbox" value="0" id="CB_UC_JHRSTZK2_0" name="CB_UC_JHRSTZK2" data-key="UC_JHRSTZK2" data-type="EnumCheckBox" data-bindkey="JHRSTZK" style="width:15px;height:15px;"/>健康 </label><label><input type="checkbox" value="1" id="CB_UC_JHRSTZK2_1" name="CB_UC_JHRSTZK2" data-key="UC_JHRSTZK2" data-type="EnumCheckBox" data-bindkey="JHRSTZK" style="width:15px;height:15px;"/>残疾 </label><label><input type="checkbox" value="2" id="CB_UC_JHRSTZK2_2" name="CB_UC_JHRSTZK2" data-key="UC_JHRSTZK2" data-type="EnumCheckBox" data-bindkey="JHRSTZK" style="width:15px;height:15px;"/>重病 </label></span></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top">与儿童关系</td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SS_UC_YETGX2" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="YETGX"><select id="DDL_UC_YETGX2" name="DDL_UC_YETGX2" data-type="EnumSelect" data-key="UC_YETGX2" class="form-control" style="width: 80%;"><option value="0">父亲</option><option value="1">母亲</option><option value="2">爷爷</option><option value="3">奶奶</option><option value="4">外公</option><option value="5">外婆</option><option value="6">其它</option></select></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="117" valign="top"><input type="CheckBox" value="" id="CB_UC_IsTZ2" name="CB_UC_IsTZ2" data-key="UC_IsTZ2" data-name="是否同住2" data-type="CheckBox" leipiplugins="text" style="margin: 4px 0px;vertical-align:middle"/> 是否同住<br/></td><td rowspan="1" style="word-break: break-all;" width="117" valign="top" align="null"><br/></td><td rowspan="1" style="word-break: break-all;" width="117" valign="top" align="null"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">实际监护人三<br/></td><td colspan="1" rowspan="1" width="0" valign="top"><br/></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><p>姓名</p><p><br/></p></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="0" valign="top"><input type="text" value="" id="TB_UC_JHRXM3" name="TB_UC_JHRXM3" data-key="UC_JHRXM3" data-name="监护人姓名3" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">身份证</td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><input type="text" value="" id="TB_UC_JHRSFZ3" name="TB_UC_JHRSFZ3" data-key="UC_JHRSFZ3" data-name="监护人身份证3" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top">联系电话</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><input type="text" value="" id="TB_UC_JHRLXDH3" name="TB_UC_JHRLXDH3" data-key="UC_JHRLXDH3" data-name="监护人联系电话3" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="159" valign="top">教育程度</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="82.66666666666666" valign="top"><span leipiplugins="enum" id="SS_UC_JYCD3" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="JYCD"><select id="DDL_UC_JYCD3" name="DDL_UC_JYCD3" data-type="EnumSelect" data-key="UC_JYCD3" class="form-control"><option value="0">文盲/半文盲</option><option value="1">小学</option><option value="2">初中</option><option value="3">中职</option><option value="4">高中</option><option value="5">大专</option><option value="6">本科</option><option value="7">硕士及以上</option></select></span></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">身体状况</td><td colspan="1" rowspan="1" width="0" valign="top"><span leipiplugins="enum" id="SC_UC_JHRSTZK3" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_JHRSTZK3" data-bindkey="JHRSTZK"><label><input type="checkbox" value="0" id="CB_UC_JHRSTZK3_0" name="CB_UC_JHRSTZK3" data-key="UC_JHRSTZK3" data-type="EnumCheckBox" data-bindkey="JHRSTZK" style="width:15px;height:15px;"/>健康 </label><label><input type="checkbox" value="1" id="CB_UC_JHRSTZK3_1" name="CB_UC_JHRSTZK3" data-key="UC_JHRSTZK3" data-type="EnumCheckBox" data-bindkey="JHRSTZK" style="width:15px;height:15px;"/>残疾 </label><label><input type="checkbox" value="2" id="CB_UC_JHRSTZK3_2" name="CB_UC_JHRSTZK3" data-key="UC_JHRSTZK3" data-type="EnumCheckBox" data-bindkey="JHRSTZK" style="width:15px;height:15px;"/>重病 </label></span></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top">与儿童关系</td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SS_UC_YETGX3" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="YETGX"><select id="DDL_UC_YETGX3" name="DDL_UC_YETGX3" data-type="EnumSelect" data-key="UC_YETGX3" class="form-control" style="width: 80%;"><option value="0">父亲</option><option value="1">母亲</option><option value="2">爷爷</option><option value="3">奶奶</option><option value="4">外公</option><option value="5">外婆</option><option value="6">其它</option></select></span></td><td colspan="3" rowspan="1" style="word-break: break-all;" valign="top"><input type="CheckBox" value="" id="CB_UC_IsTZ3" name="CB_UC_IsTZ3" data-key="UC_IsTZ3" data-name="是否同住3" data-type="CheckBox" leipiplugins="text" style="margin: 4px 0px;vertical-align:middle"/> 是否同住</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="82.66666666666666" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">家庭经济情况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="82.66666666666666"><br/></th></tr><tr><td colspan="3" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SR_UC_IsPK" title="单选" name="leipiNewField" data-key="UC_IsPK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_IsPK_0" name="RB_UC_IsPK" data-key="UC_IsPK" data-type="Radio" data-bindkey="SFPK" style="width:15px;height:15px;"/>非贫困家庭</label> <label><input type="radio" value="1" id="RB_UC_IsPK_1" name="RB_UC_IsPK" data-key="UC_IsPK" data-type="Radio" data-bindkey="SFPK" style="width:15px;height:15px;"/>贫困家庭</label></span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">贫困类型</td><td colspan="4" rowspan="1" style="word-break: break-all;" width="683.6666666666666" valign="top"><span leipiplugins="enum" style="margin-top:1px;display:block;" id="SC_PKLX" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="PKLX" data-bindkey="PKLX"><span leipiplugins="enum" id="SC_UC_PKLX" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_PKLX" data-bindkey="PKLX"><label><input type="checkbox" value="0" id="CB_UC_PKLX_0" name="CB_UC_PKLX" data-key="UC_PKLX" data-type="EnumCheckBox" data-bindkey="PKLX" style="width:15px;height:15px;"/>最低生活保障 </label><label><input type="checkbox" value="1" id="CB_UC_PKLX_1" name="CB_UC_PKLX" data-key="UC_PKLX" data-type="EnumCheckBox" data-bindkey="PKLX" style="width:15px;height:15px;"/>特因供养 </label><label><input type="checkbox" value="2" id="CB_UC_PKLX_2" name="CB_UC_PKLX" data-key="UC_PKLX" data-type="EnumCheckBox" data-bindkey="PKLX" style="width:15px;height:15px;"/>建档立卡户 </label><label><input type="checkbox" value="3" id="CB_UC_PKLX_3" name="CB_UC_PKLX" data-key="UC_PKLX" data-type="EnumCheckBox" data-bindkey="PKLX" style="width:15px;height:15px;"/>低收入户（低保边缘户） </label><label><input type="checkbox" value="4" id="CB_UC_PKLX_4" name="CB_UC_PKLX" data-key="UC_PKLX" data-type="EnumCheckBox" data-bindkey="PKLX" style="width:15px;height:15px;"/>临时救助 </label><label><input type="checkbox" value="5" id="CB_UC_PKLX_5" name="CB_UC_PKLX" data-key="UC_PKLX" data-type="EnumCheckBox" data-bindkey="PKLX" style="width:15px;height:15px;"/>其它 <br/></label></span></span></td><td rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top" align="null"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="141" valign="top">情形简述<br/></td><td rowspan="1" colspan="4" style="word-break: break-all;" width="683.6666666666666" valign="top" align="null"><input type="text" value="" id="TB_UC_QTQKSM" name="TB_UC_QTQKSM" data-key="UC_QTQKSM" data-name="贫困情况说明" data-type="Text" class="form-control" leipiplugins="text" style="width: 90%;" placeholder=""/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">生长关爱需求<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="82.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">儿童主要诉求<br/></td><td colspan="1" rowspan="1" width="175" valign="top"><br/></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="8" rowspan="1" style="word-break: break-all;" valign="top"><textarea id="TB_UC_ETSQ" name="TB_UC_ETSQ" data-key="UC_ETSQ" data-name="儿童诉求" data-type="Textarea" leipiplugins="textarea" value="" orgrich="0" orgfontsize="12" orgwidth="600" orgheight="80" style="font-size: 12px; width: 528px; height: 59px; margin: 0px;"></textarea></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">家庭主要诉求<br/></td><td colspan="1" rowspan="1" width="0" valign="top"><br/></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td></tr><tr><td colspan="8" rowspan="1" style="word-break: break-all;" valign="top"><textarea id="TB_UC_JTSQ" name="TB_UC_JTSQ" data-key="UC_JTSQ" data-name="家庭诉求" data-type="Textarea" leipiplugins="textarea" value="" orgrich="0" orgfontsize="12" orgwidth="600" orgheight="80" style="font-size: 12px; width: 528px; height: 59px; margin: 0px;"></textarea></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">儿童生活保障情况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="82.66666666666666"><br/></th></tr><tr><td colspan="2" rowspan="1" style="word-break: break-all;" width="0" valign="top"><span leipiplugins="enum" id="SR_UC_BZQK" title="单选" name="leipiNewField" data-key="UC_BZQK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_BZQK_0" name="RB_UC_BZQK" data-key="UC_BZQK" data-type="Radio" data-bindkey="SHBZ" style="width:15px;height:15px;"/>未保障</label> <label><input type="radio" value="1" id="RB_UC_BZQK_1" name="RB_UC_BZQK" data-key="UC_BZQK" data-type="Radio" data-bindkey="SHBZ" style="width:15px;height:15px;"/>已保障</label> </span></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">保障方式<br/></td><td colspan="5" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SC_UC_BZFS" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_BZFS" data-bindkey="UC_BZFS"><label><input type="checkbox" value="0" id="CB_UC_BZFS_0" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>孤儿 </label><label><input type="checkbox" value="1" id="CB_UC_BZFS_1" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>父母监护缺失 </label><label><input type="checkbox" value="10" id="CB_UC_BZFS_10" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>特困供养 </label><label><input type="checkbox" value="11" id="CB_UC_BZFS_11" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>建档立卡 </label><label><input type="checkbox" value="12" id="CB_UC_BZFS_12" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>临时救助 </label><label><input type="checkbox" value="13" id="CB_UC_BZFS_13" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>低收入家庭（低保边缘户） </label><label><input type="checkbox" value="14" id="CB_UC_BZFS_14" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>其它 </label><label><input type="checkbox" value="2" id="CB_UC_BZFS_2" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>父母无力履行监护职责 </label><label><input type="checkbox" value="3" id="CB_UC_BZFS_3" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>重残 </label><label><input type="checkbox" value="4" id="CB_UC_BZFS_4" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>生活补贴 </label><label><input type="checkbox" value="5" id="CB_UC_BZFS_5" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>护理补贴 </label><label><input type="checkbox" value="6" id="CB_UC_BZFS_6" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>重病 </label><label><input type="checkbox" value="7" id="CB_UC_BZFS_7" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>流浪儿童 </label><label><input type="checkbox" value="8" id="CB_UC_BZFS_8" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>贫困家庭 </label><label><input type="checkbox" value="9" id="CB_UC_BZFS_9" name="CB_UC_BZFS" data-key="UC_BZFS" data-type="EnumCheckBox" data-bindkey="UC_BZFS" style="width:15px;height:15px;"/>低保 </label></span></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">说明<br/></td><td colspan="5" rowspan="1" style="word-break: break-all;" valign="top"><textarea id="TB_UC_BZSM" name="TB_UC_BZSM" data-key="UC_BZSM" data-name="保障说明" data-type="Textarea" leipiplugins="textarea" value="" orgrich="0" orgfontsize="12" orgwidth="600" orgheight="80" style="font-size: 12px; width: 80%; height: 59px; margin: 0px;" placeholder=""></textarea></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">发放金额（元）<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top"><input type="text" value="" id="TB_UC_FFJE" name="TB_UC_FFJE" data-key="UC_FFJE" data-name="生活保障发放金额" data-type="Money" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">发放周期<br/></td><td colspan="2" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SR_UC_FFZQ" title="单选" name="leipiNewField" data-key="UC_FFZQ" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_FFZQ_0" name="RB_UC_FFZQ" data-key="UC_FFZQ" data-type="Radio" data-bindkey="FFZQ" style="width:15px;height:15px;"/>每月</label> <label><input type="radio" value="1" id="RB_UC_FFZQ_1" name="RB_UC_FFZQ" data-key="UC_FFZQ" data-type="Radio" data-bindkey="FFZQ" style="width:15px;height:15px;"/>每季</label> <label><input type="radio" value="2" id="RB_UC_FFZQ_2" name="RB_UC_FFZQ" data-key="UC_FFZQ" data-type="Radio" data-bindkey="FFZQ" style="width:15px;height:15px;"/>半年一次</label> <label><input type="radio" value="3" id="RB_UC_FFZQ_3" name="RB_UC_FFZQ" data-key="UC_FFZQ" data-type="Radio" data-bindkey="FFZQ" style="width:15px;height:15px;"/>一年一次</label> </span></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">发放方式<br/></td><td colspan="2" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SR_UC_FFFS" title="单选" name="leipiNewField" data-key="UC_FFFS" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_FFFS_0" name="RB_UC_FFFS" data-key="UC_FFFS" data-type="Radio" data-bindkey="FFFS" style="width:15px;height:15px;"/>现金</label> <label><input type="radio" value="1" id="RB_UC_FFFS_1" name="RB_UC_FFFS" data-key="UC_FFFS" data-type="Radio" data-bindkey="FFFS" style="width:15px;height:15px;"/>社会化打卡发放</label> </span></td><td colspan="1" rowspan="1" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">收领人<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top"><input type="text" value="" id="TB_UC_SLRXM" name="TB_UC_SLRXM" data-key="UC_SLRXM" data-name="保障金收领人姓名" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top">收领人与儿童关系<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="68" valign="top"><span leipiplugins="enum" id="SS_UC_SLRYETGX" title="下拉框" name="leipiNewField" data-type="EnumSelect" data-bindkey="YETGX"><select id="DDL_UC_SLRYETGX" name="DDL_UC_SLRYETGX" data-type="EnumSelect" data-key="UC_SLRYETGX" class="form-control"><option value="0">父亲</option><option value="1">母亲</option><option value="2">爷爷</option><option value="3">奶奶</option><option value="4">外公</option><option value="5">外婆</option><option value="6">其它</option></select></span></td><td colspan="2" rowspan="1" style="word-break: break-all;" width="289" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="82.66666666666666" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">教育资助情况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="82.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="127" valign="top"><span leipiplugins="enum" id="SR_UC_JYZZ" title="单选" name="leipiNewField" data-key="UC_JYZZ" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_JYZZ_0" name="RB_UC_JYZZ" data-key="UC_JYZZ" data-type="Radio" data-bindkey="JYZZ" style="width:15px;height:15px;"/>无</label> <label><input type="radio" value="1" id="RB_UC_JYZZ_1" name="RB_UC_JYZZ" data-key="UC_JYZZ" data-type="Radio" data-bindkey="JYZZ" style="width:15px;height:15px;"/>有</label> </span></td><td rowspan="1" style="word-break: break-all;" width="127" valign="top" align="null"><br/></td><td colspan="1" rowspan="1" width="153.66666666666666" valign="top"><br/></td><td colspan="1" rowspan="1" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="151" valign="top"><p>教育资助详情</p></td><td rowspan="1" style="word-break: break-all;" colspan="5" valign="top" align="null"><span leipiplugins="enum" id="SC_UC_JYZZZL" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_JYZZZL" data-bindkey="JYZZZL"><label><input type="checkbox" value="0" id="CB_UC_JYZZZL_0" name="CB_UC_JYZZZL" data-key="UC_JYZZZL" data-type="EnumCheckBox" data-bindkey="JYZZZL" style="width:15px;height:15px;"/>免学杂费 </label><label><input type="checkbox" value="1" id="CB_UC_JYZZZL_1" name="CB_UC_JYZZZL" data-key="UC_JYZZZL" data-type="EnumCheckBox" data-bindkey="JYZZZL" style="width:15px;height:15px;"/>免书本费 </label><label><input type="checkbox" value="2" id="CB_UC_JYZZZL_2" name="CB_UC_JYZZZL" data-key="UC_JYZZZL" data-type="EnumCheckBox" data-bindkey="JYZZZL" style="width:15px;height:15px;"/>减保教费 </label><label><input type="checkbox" value="3" id="CB_UC_JYZZZL_3" name="CB_UC_JYZZZL" data-key="UC_JYZZZL" data-type="EnumCheckBox" data-bindkey="JYZZZL" style="width:15px;height:15px;"/>教育资助 </label><label><input type="checkbox" value="4" id="CB_UC_JYZZZL_4" name="CB_UC_JYZZZL" data-key="UC_JYZZZL" data-type="EnumCheckBox" data-bindkey="JYZZZL" style="width:15px;height:15px;"/>孤儿教学项目资助 </label><label><input type="checkbox" value="5" id="CB_UC_JYZZZL_5" name="CB_UC_JYZZZL" data-key="UC_JYZZZL" data-type="EnumCheckBox" data-bindkey="JYZZZL" style="width:15px;height:15px;"/>慈善圆梦行动 </label><label><input type="checkbox" value="6" id="CB_UC_JYZZZL_6" name="CB_UC_JYZZZL" data-key="UC_JYZZZL" data-type="EnumCheckBox" data-bindkey="JYZZZL" style="width:15px;height:15px;"/>其它 </label></span></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">减保教费金额<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="164" valign="top"><input type="text" value="" id="TB_UC_JBJF" name="TB_UC_JBJF" data-key="UC_JBJF" data-name="减保教费" data-type="Money" class="form-control" leipiplugins="text" style="width:120px"/></td><td rowspan="1" style="word-break: break-all;" width="164" valign="top" align="null">教育资助金额<br/></td><td rowspan="1" style="word-break: break-all;" width="164" valign="top" align="null"><input type="text" value="" id="TB_UC_JYZZJE" name="TB_UC_JYZZJE" data-key="UC_JYZZJE" data-name="教育资助" data-type="Money" class="form-control" leipiplugins="text" style="width:120px"/></td><td rowspan="1" style="word-break: break-all;" width="164" valign="top" align="null">孤儿教学项目资助金额<br/></td><td rowspan="1" style="word-break: break-all;" width="164" valign="top" align="null"><p><input type="text" value="" id="TB_UC_GEJXZZJE" name="TB_UC_GEJXZZJE" data-key="UC_GEJXZZJE" data-name="孤儿教学资助金额" data-type="Money" class="form-control" leipiplugins="text" style="width:120px"/></p></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="159" valign="top">慈善圆梦<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><input type="text" value="" id="TB_UC_CSYMJE" name="TB_UC_CSYMJE" data-key="UC_CSYMJE" data-name="慈善圆梦金额" data-type="Money" class="form-control" leipiplugins="text" style="width:120px"/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top">
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其它<br/></td><td colspan="7" rowspan="1" style="word-break: break-all;" valign="top"><input type="text" value="" id="TB_UC_JYQTSM" name="TB_UC_JYQTSM" data-key="UC_JYQTSM" data-name="教育其它情况说明" data-type="Text" class="form-control" leipiplugins="text" style="width: 40%;"/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">医疗救助情况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="82.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">基本医疗保险<br/></td><td colspan="2" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SR_UC_YLBXQK" title="单选" name="leipiNewField" data-key="UC_YLBXQK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_YLBXQK_0" name="RB_UC_YLBXQK" data-key="UC_YLBXQK" data-type="Radio" data-bindkey="YLBX" style="width:15px;height:15px;"/>政府资助参保</label> <label><input type="radio" value="1" id="RB_UC_YLBXQK_1" name="RB_UC_YLBXQK" data-key="UC_YLBXQK" data-type="Radio" data-bindkey="YLBX" style="width:15px;height:15px;"/>自费参保</label> <label><input type="radio" value="2" id="RB_UC_YLBXQK_2" name="RB_UC_YLBXQK" data-key="UC_YLBXQK" data-type="Radio" data-bindkey="YLBX" style="width:15px;height:15px;"/>未参保</label> </span></td><td colspan="1" rowspan="1" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">商业意外保险<br/></td><td colspan="2" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" id="SR_UC_SYBXQK" title="单选" name="leipiNewField" data-key="UC_SYBXQK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_SYBXQK_0" name="RB_UC_SYBXQK" data-key="UC_SYBXQK" data-type="Radio" data-bindkey="YLBX" style="width:15px;height:15px;"/>政府资助参保</label> <label><input type="radio" value="1" id="RB_UC_SYBXQK_1" name="RB_UC_SYBXQK" data-key="UC_SYBXQK" data-type="Radio" data-bindkey="YLBX" style="width:15px;height:15px;"/>自费参保</label> <label><input type="radio" value="2" id="RB_UC_SYBXQK_2" name="RB_UC_SYBXQK" data-key="UC_SYBXQK" data-type="Radio" data-bindkey="YLBX" style="width:15px;height:15px;"/>未参保</label> </span></td><td colspan="1" rowspan="1" width="68" valign="top"><br/></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">病患救助情况<br/></td><td colspan="2" rowspan="1" valign="top"><span leipiplugins="enum" id="SR_UC_BHJZQK" title="单选" name="leipiNewField" data-key="UC_BHJZQK" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_BHJZQK_0" name="RB_UC_BHJZQK" data-key="UC_BHJZQK" data-type="Radio" data-bindkey="BHJZ" style="width:15px;height:15px;"/>大病慈善救助</label> <label><input type="radio" value="1" id="RB_UC_BHJZQK_1" name="RB_UC_BHJZQK" data-key="UC_BHJZQK" data-type="Radio" data-bindkey="BHJZ" style="width:15px;height:15px;"/>明天计划</label> <label><input type="radio" value="2" id="RB_UC_BHJZQK_2" name="RB_UC_BHJZQK" data-key="UC_BHJZQK" data-type="Radio" data-bindkey="BHJZ" style="width:15px;height:15px;"/>其它</label> </span></td><td colspan="3" rowspan="1" style="word-break: break-all;" width="471.99999999999994" valign="top"><input type="text" value="" id="TB_UC_JZSM" name="TB_UC_JZSM" data-key="UC_JZSM" data-name="救助说明" data-type="Text" class="form-control" leipiplugins="text" style="width: 90%;" placeholder=""/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">康复救助情况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="82.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="2" style="word-break: break-all;" width="86" valign="top">康复训练</td><td colspan="1" rowspan="1" width="175" valign="top">康复机构名称</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="153.66666666666666" valign="top"><input type="text" value="" id="TB_UC_KFJGMC" name="TB_UC_KFJGMC" data-key="UC_KFJGMC" data-name="康复机构名称" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="68" valign="top">康复效果</td><td colspan="2" rowspan="1" style="word-break: break-all;" width="289" valign="top"><input type="text" value="" id="TB_UC_KFXG" name="TB_UC_KFXG" data-key="UC_KFXG" data-name="康复效果" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top">未参加原因<br/></td><td colspan="3" rowspan="1" style="word-break: break-all;" width="419.6666666666667" valign="top"><span leipiplugins="enum" id="SC_UC_MCJKFYY" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_MCJKFYY" data-bindkey="MCJKF"><label><input type="checkbox" value="0" id="CB_UC_MCJKFYY_0" name="CB_UC_MCJKFYY" data-key="UC_MCJKFYY" data-type="EnumCheckBox" data-bindkey="MCJKF" style="width:15px;height:15px;"/>交通因素 </label><label><input type="checkbox" value="1" id="CB_UC_MCJKFYY_1" name="CB_UC_MCJKFYY" data-key="UC_MCJKFYY" data-type="EnumCheckBox" data-bindkey="MCJKF" style="width:15px;height:15px;"/>家庭人力因素 </label><label><input type="checkbox" value="2" id="CB_UC_MCJKFYY_2" name="CB_UC_MCJKFYY" data-key="UC_MCJKFYY" data-type="EnumCheckBox" data-bindkey="MCJKF" style="width:15px;height:15px;"/>不知道政策 </label><label><input type="checkbox" value="3" id="CB_UC_MCJKFYY_3" name="CB_UC_MCJKFYY" data-key="UC_MCJKFYY" data-type="EnumCheckBox" data-bindkey="MCJKF" style="width:15px;height:15px;"/>康复效果不佳 </label><label><input type="checkbox" value="4" id="CB_UC_MCJKFYY_4" name="CB_UC_MCJKFYY" data-key="UC_MCJKFYY" data-type="EnumCheckBox" data-bindkey="MCJKF" style="width:15px;height:15px;"/>其它 </label></span></td><td rowspan="1" style="word-break: break-all;" width="91.66666666666667" valign="top" align="null"><input type="text" value="" id="TB_UC_BKFYYSM" name="TB_UC_BKFYYSM" data-key="UC_BKFYYSM" data-name="不康复原因说明" data-type="Text" class="form-control" leipiplugins="text" style="width:120px"/></td><td colspan="1" rowspan="1" width="5" valign="top"><br/></td><td colspan="1" rowspan="1" width="145" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="2" style="word-break: break-all;" width="86" valign="top">矫正器具配备</td><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top">已配备<br/></td><td colspan="6" rowspan="1" style="word-break: break-all;" width="773.6666666666666" valign="top"><span leipiplugins="enum" id="SC_UC_YPJZ" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_YPJZ" data-bindkey="YPJZ"><label><input type="checkbox" value="0" id="CB_UC_YPJZ_0" name="CB_UC_YPJZ" data-key="UC_YPJZ" data-type="EnumCheckBox" data-bindkey="YPJZ" style="width:15px;height:15px;"/>验配视助器 </label><label><input type="checkbox" value="1" id="CB_UC_YPJZ_1" name="CB_UC_YPJZ" data-key="UC_YPJZ" data-type="EnumCheckBox" data-bindkey="YPJZ" style="width:15px;height:15px;"/>验配助听器（双耳） </label><label><input type="checkbox" value="2" id="CB_UC_YPJZ_2" name="CB_UC_YPJZ" data-key="UC_YPJZ" data-type="EnumCheckBox" data-bindkey="YPJZ" style="width:15px;height:15px;"/>配装假肢、适配轮椅、坐姿椅、站立架、助行器 </label><label><input type="checkbox" value="3" id="CB_UC_YPJZ_3" name="CB_UC_YPJZ" data-key="UC_YPJZ" data-type="EnumCheckBox" data-bindkey="YPJZ" style="width:15px;height:15px;"/>配基本型人工耳蜗 </label><label><input type="checkbox" value="4" id="CB_UC_YPJZ_4" name="CB_UC_YPJZ" data-key="UC_YPJZ" data-type="EnumCheckBox" data-bindkey="YPJZ" style="width:15px;height:15px;"/>末收取费用 </label></span></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top">未配备<br/></td><td colspan="5" rowspan="1" style="word-break: break-all;" width="765" valign="top"><span leipiplugins="enum" id="SC_UC_WPJZ" title="复选框" name="leipiNewField" data-type="EnumCheckBox" data-key="UC_WPJZ" data-bindkey="WPJZ"><label><input type="checkbox" value="0" id="CB_UC_WPJZ_0" name="CB_UC_WPJZ" data-key="UC_WPJZ" data-type="EnumCheckBox" data-bindkey="WPJZ" style="width:15px;height:15px;"/>不需要 </label><label><input type="checkbox" value="1" id="CB_UC_WPJZ_1" name="CB_UC_WPJZ" data-key="UC_WPJZ" data-type="EnumCheckBox" data-bindkey="WPJZ" style="width:15px;height:15px;"/>不知道 </label><label><input type="checkbox" value="2" id="CB_UC_WPJZ_2" name="CB_UC_WPJZ" data-key="UC_WPJZ" data-type="EnumCheckBox" data-bindkey="WPJZ" style="width:15px;height:15px;"/>不符合政策 </label></span></td><td colspan="1" rowspan="1" width="145" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">司法援助情况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="82.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="124" valign="top"><span leipiplugins="enum" id="SR_UC_SFXY" title="单选" name="leipiNewField" data-key="UC_SFXY" data-type="Radio"><label><input type="radio" value="0" id="RB_UC_SFXY_0" name="RB_UC_SFXY" data-key="UC_SFXY" data-type="Radio" data-bindkey="SFXY" style="width:15px;height:15px;"/>需要</label> <label><input type="radio" value="1" id="RB_UC_SFXY_1" name="RB_UC_SFXY" data-key="UC_SFXY" data-type="Radio" data-bindkey="SFXY" style="width:15px;height:15px;"/>不需要</label> </span></td><td rowspan="1" style="word-break: break-all;" colspan="4" width="683.6666666666666" valign="top" align="null"><textarea id="TB_UC_SFYZSM" name="TB_UC_SFYZSM" data-key="UC_SFYZSM" data-name="司法援助说明" data-type="Textarea" leipiplugins="textarea" value="" orgrich="0" orgfontsize="12" orgwidth="600" orgheight="80" style="font-size: 12px; width: 528px; height: 59px; margin: 0px;"></textarea></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr class="firstRow"><th colspan="6" style="word-break: break-all;" width="989.0000000000001">群团组织及社会关爱情况<br/></th><th colspan="1" style="word-break: break-all;" width="159"><br/></th><th colspan="1" style="word-break: break-all;" width="82.66666666666666"><br/></th></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">有无存在</td><td colspan="3" rowspan="1" style="word-break: break-all;" valign="top"><span leipiplugins="enum" style="margin-top:1px;display:block;" id="SR_UC_ISGE" title="单选" name="leipiNewField" data-key="UC_ISGE" data-type="Radio" data-bindkey="JYZZ"><label style="vertical-align:middle;"><input type="radio" value="0" id="RB_UC_ISGE_0" name="RB_UC_ISGE" data-key="UC_ISGE" data-type="Radio" data-bindkey="JYZZ" style="width:15px;height:15px;vertical-align:-1px;"/>无 </label><label style="vertical-align:middle;"><input type="radio" value="1" id="RB_UC_ISGE_1" name="RB_UC_ISGE" data-key="UC_ISGE" data-type="Radio" data-bindkey="JYZZ" style="width:15px;height:15px;vertical-align:-1px;"/>有 </label></span></td><td colspan="1" rowspan="1" width="91.66666666666667" valign="top"><br/></td><td colspan="1" rowspan="1" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top">关爱情况说明<br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="169" valign="top"><input type="CheckBox" value="" id="CB_UC_IsZYZJD" name="CB_UC_IsZYZJD" data-key="UC_IsZYZJD" data-name="是否志愿者结对" data-type="CheckBox" leipiplugins="text" style="margin: 4px 0px;vertical-align:middle"/>志愿者结对</td><td rowspan="1" style="word-break: break-all;" colspan="3" valign="top" align="null"><input type="text" value="" id="TB_UC_ZYZSM" name="TB_UC_ZYZSM" data-key="UC_ZYZSM" data-name="志愿者说明" data-type="Text" class="form-control" leipiplugins="text" style="width: 80%;"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" style="word-break: break-all;" width="86" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="175" valign="top"><input type="CheckBox" value="" id="CB_UC_IsBMJD" name="CB_UC_IsBMJD" data-key="UC_IsBMJD" data-name="是否部门结对" data-type="CheckBox" leipiplugins="text" style="margin: 4px 0px;vertical-align:middle"/>部门(单位)结对</td><td colspan="3" rowspan="1" style="word-break: break-all;" valign="top"><input type="text" value="" id="TB_UC_BMDJSM" name="TB_UC_BMDJSM" data-key="UC_BMDJSM" data-name="部门对结说明" data-type="Text" class="form-control" leipiplugins="text" style="width: 80%;"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="120.99999999999999" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="159" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" width="82.66666666666666" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><input type="CheckBox" value="" id="CB_UC_IsSHJZ" name="CB_UC_IsSHJZ" data-key="UC_IsSHJZ" data-name="是否社会捐助" data-type="CheckBox" leipiplugins="text" style="margin: 4px 0px;vertical-align:middle"/>社会捐助</td><td colspan="3" rowspan="1" style="word-break: break-all;" valign="top"><input type="text" value="" id="TB_UC_SHJZSM" name="TB_UC_SHJZSM" data-key="UC_SHJZSM" data-name="社会捐助说明" data-type="Text" class="form-control" leipiplugins="text" style="width: 80%;"/></td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td></tr><tr><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" style="word-break: break-all;" valign="top"><input type="CheckBox" value="" id="CB_UC_IsQTJZ" name="CB_UC_IsQTJZ" data-key="UC_IsQTJZ" data-name="是否其它捐助" data-type="CheckBox" leipiplugins="text" style="margin: 4px 0px;vertical-align:middle"/>其它</td><td colspan="3" rowspan="1" style="word-break: break-all;" valign="top"><input type="text" value="" id="TB_UC_QTGASM" name="TB_UC_QTGASM" data-key="UC_QTGASM" data-name="其它关爱说明" data-type="Text" class="form-control" leipiplugins="text" style="width: 80%;"/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td><td colspan="1" rowspan="1" valign="top"><br/></td></tr></tbody></table></center><p><br/></p> |