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Baris Template ini hanya perlu diisi ketika memilih tipe item berjenis "Template"

<table class="MsoTableGrid" border="1" cellspacing="0" cellpadding="0" style="border: none;">
 <tbody><tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;mso-border-alt:
 solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 No<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border:solid windowtext 1.0pt;border-left:
 none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Uraian<o:p></o:p>
 </td>
 <td width="105" style="width:79.05pt;border:solid windowtext 1.0pt;border-left:
 none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Ceklist
 (√ )<o:p></o:p>
 </td>
 <td width="115" style="width:86.3pt;border:solid windowtext 1.0pt;border-left:
 none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Keterangan<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;border-top:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 1.<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Distensi<o:p></o:p>
 </td>
 <td width="105" valign="top" style="width:79.05pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 <td width="115" valign="top" style="width:86.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 </tr>
 <tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;border-top:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 2.<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Nyeri Tekan<o:p></o:p>
 </td>
 <td width="105" valign="top" style="width:79.05pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 <td width="115" valign="top" style="width:86.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 </tr>
 <tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;border-top:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 3.<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Lokasi<o:p></o:p>
 </td>
 <td width="105" valign="top" style="width:79.05pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 <td width="115" valign="top" style="width:86.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 </tr>
 <tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;border-top:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 4.<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Meteorismus<o:p></o:p>
 </td>
 <td width="105" valign="top" style="width:79.05pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 <td width="115" valign="top" style="width:86.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 </tr>
 <tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;border-top:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 5.<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Peristaltik<o:p></o:p>
 </td>
 <td width="105" valign="top" style="width:79.05pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 <td width="115" valign="top" style="width:86.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 </tr>
 <tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;border-top:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 6.<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Tugor<o:p></o:p>
 </td>
 <td width="105" valign="top" style="width:79.05pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 <td width="115" valign="top" style="width:86.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 </tr>
 <tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;border-top:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 7.<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Asites<o:p></o:p>
 </td>
 <td width="105" valign="top" style="width:79.05pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 <td width="115" valign="top" style="width:86.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 </tr>
 <tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;border-top:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 8.<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Hepar<o:p></o:p>
 </td>
 <td width="105" valign="top" style="width:79.05pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 <td width="115" valign="top" style="width:86.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 </tr>
 <tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;border-top:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 9.<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Lien<o:p></o:p>
 </td>
 <td width="105" valign="top" style="width:79.05pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 <td width="115" valign="top" style="width:86.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 </tr>
 <tr>
 <td width="43" style="width:32.0pt;border:solid windowtext 1.0pt;border-top:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 10.<o:p></o:p>
 </td>
 <td width="161" style="width:120.45pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Massa<o:p></o:p>
 </td>
 <td width="105" valign="top" style="width:79.05pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 <td width="115" valign="top" style="width:86.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
  
 </td>
 </tr>
</tbody></table>

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