<Global.Microsoft.VisualBasic.CompilerServices.DesignerGenerated()> _
Partial Class Form5
    Inherits System.Windows.Forms.Form

    'Form overrides dispose to clean up the component list.
    <System.Diagnostics.DebuggerNonUserCode()> _
    Protected Overrides Sub Dispose(ByVal disposing As Boolean)
        Try
            If disposing AndAlso components IsNot Nothing Then
                components.Dispose()
            End If
        Finally
            MyBase.Dispose(disposing)
        End Try
    End Sub

    'Required by the Windows Form Designer
    Private components As System.ComponentModel.IContainer

    'NOTE: The following procedure is required by the Windows Form Designer
    'It can be modified using the Windows Form Designer.  
    'Do not modify it using the code editor.
    <System.Diagnostics.DebuggerStepThrough()> _
    Private Sub InitializeComponent()
        Me.Label1 = New System.Windows.Forms.Label
        Me.Label2 = New System.Windows.Forms.Label
        Me.Label3 = New System.Windows.Forms.Label
        Me.Label4 = New System.Windows.Forms.Label
        Me.TextBox1 = New System.Windows.Forms.TextBox
        Me.TextBox2 = New System.Windows.Forms.TextBox
        Me.TextBox3 = New System.Windows.Forms.TextBox
        Me.TextBox4 = New System.Windows.Forms.TextBox
        Me.Label10 = New System.Windows.Forms.Label
        Me.Label5 = New System.Windows.Forms.Label
        Me.txtlast = New System.Windows.Forms.TextBox
        Me.txtfirst = New System.Windows.Forms.TextBox
        Me.txtmid = New System.Windows.Forms.TextBox
        Me.Label6 = New System.Windows.Forms.Label
        Me.TextBox8 = New System.Windows.Forms.TextBox
        Me.Label7 = New System.Windows.Forms.Label
        Me.Label8 = New System.Windows.Forms.Label
        Me.Label9 = New System.Windows.Forms.Label
        Me.Label11 = New System.Windows.Forms.Label
        Me.TextBox9 = New System.Windows.Forms.TextBox
        Me.cmb = New System.Windows.Forms.ComboBox
        Me.cmb2 = New System.Windows.Forms.ComboBox
        Me.TextBox10 = New System.Windows.Forms.TextBox
        Me.Label12 = New System.Windows.Forms.Label
        Me.Label13 = New System.Windows.Forms.Label
        Me.TextBox11 = New System.Windows.Forms.TextBox
        Me.Label14 = New System.Windows.Forms.Label
        Me.Label15 = New System.Windows.Forms.Label
        Me.Label16 = New System.Windows.Forms.Label
        Me.TextBox12 = New System.Windows.Forms.TextBox
        Me.TextBox13 = New System.Windows.Forms.TextBox
        Me.TextBox14 = New System.Windows.Forms.TextBox
        Me.Label17 = New System.Windows.Forms.Label
        Me.Label18 = New System.Windows.Forms.Label
        Me.TextBox15 = New System.Windows.Forms.TextBox
        Me.TextBox16 = New System.Windows.Forms.TextBox
        Me.TextBox17 = New System.Windows.Forms.TextBox
        Me.Label19 = New System.Windows.Forms.Label
        Me.Label20 = New System.Windows.Forms.Label
        Me.TextBox18 = New System.Windows.Forms.TextBox
        Me.TextBox19 = New System.Windows.Forms.TextBox
        Me.TextBox20 = New System.Windows.Forms.TextBox
        Me.TextBox21 = New System.Windows.Forms.TextBox
        Me.TextBox22 = New System.Windows.Forms.TextBox
        Me.TextBox23 = New System.Windows.Forms.TextBox
        Me.Label21 = New System.Windows.Forms.Label
        Me.GroupBox1 = New System.Windows.Forms.GroupBox
        Me.txtbday = New System.Windows.Forms.TextBox
        Me.CheckBox7 = New System.Windows.Forms.CheckBox
        Me.CheckBox6 = New System.Windows.Forms.CheckBox
        Me.CheckBox5 = New System.Windows.Forms.CheckBox
        Me.CheckBox4 = New System.Windows.Forms.CheckBox
        Me.TextBox24 = New System.Windows.Forms.TextBox
        Me.CheckBox3 = New System.Windows.Forms.CheckBox
        Me.CheckBox2 = New System.Windows.Forms.CheckBox
        Me.CheckBox1 = New System.Windows.Forms.CheckBox
        Me.TextBox27 = New System.Windows.Forms.TextBox
        Me.TextBox26 = New System.Windows.Forms.TextBox
        Me.txtdischarge = New System.Windows.Forms.TextBox
        Me.txtadmission = New System.Windows.Forms.TextBox
        Me.Label33 = New System.Windows.Forms.Label
        Me.Label32 = New System.Windows.Forms.Label
        Me.Label31 = New System.Windows.Forms.Label
        Me.Label30 = New System.Windows.Forms.Label
        Me.Label29 = New System.Windows.Forms.Label
        Me.Label28 = New System.Windows.Forms.Label
        Me.Label27 = New System.Windows.Forms.Label
        Me.Label25 = New System.Windows.Forms.Label
        Me.Label26 = New System.Windows.Forms.Label
        Me.Label22 = New System.Windows.Forms.Label
        Me.Label23 = New System.Windows.Forms.Label
        Me.Label24 = New System.Windows.Forms.Label
        Me.Label34 = New System.Windows.Forms.Label
        Me.TextBox25 = New System.Windows.Forms.TextBox
        Me.TextBox28 = New System.Windows.Forms.TextBox
        Me.TextBox29 = New System.Windows.Forms.TextBox
        Me.CheckBox8 = New System.Windows.Forms.CheckBox
        Me.CheckBox9 = New System.Windows.Forms.CheckBox
        Me.Label35 = New System.Windows.Forms.Label
        Me.Label36 = New System.Windows.Forms.Label
        Me.Label37 = New System.Windows.Forms.Label
        Me.Label38 = New System.Windows.Forms.Label
        Me.Label39 = New System.Windows.Forms.Label
        Me.Label40 = New System.Windows.Forms.Label
        Me.Label41 = New System.Windows.Forms.Label
        Me.Label42 = New System.Windows.Forms.Label
        Me.Label43 = New System.Windows.Forms.Label
        Me.Label44 = New System.Windows.Forms.Label
        Me.Label45 = New System.Windows.Forms.Label
        Me.Label46 = New System.Windows.Forms.Label
        Me.TextBox30 = New System.Windows.Forms.TextBox
        Me.TextBox31 = New System.Windows.Forms.TextBox
        Me.TextBox32 = New System.Windows.Forms.TextBox
        Me.CheckBox10 = New System.Windows.Forms.CheckBox
        Me.CheckBox11 = New System.Windows.Forms.CheckBox
        Me.CheckBox12 = New System.Windows.Forms.CheckBox
        Me.CheckBox13 = New System.Windows.Forms.CheckBox
        Me.CheckBox14 = New System.Windows.Forms.CheckBox
        Me.CheckBox15 = New System.Windows.Forms.CheckBox
        Me.CheckBox16 = New System.Windows.Forms.CheckBox
        Me.CheckBox17 = New System.Windows.Forms.CheckBox
        Me.CheckBox18 = New System.Windows.Forms.CheckBox
        Me.CheckBox19 = New System.Windows.Forms.CheckBox
        Me.CheckBox20 = New System.Windows.Forms.CheckBox
        Me.CheckBox21 = New System.Windows.Forms.CheckBox
        Me.CheckBox22 = New System.Windows.Forms.CheckBox
        Me.CheckBox23 = New System.Windows.Forms.CheckBox
        Me.CheckBox24 = New System.Windows.Forms.CheckBox
        Me.CheckBox25 = New System.Windows.Forms.CheckBox
        Me.CheckBox26 = New System.Windows.Forms.CheckBox
        Me.CheckBox27 = New System.Windows.Forms.CheckBox
        Me.CheckBox28 = New System.Windows.Forms.CheckBox
        Me.CheckBox29 = New System.Windows.Forms.CheckBox
        Me.CheckBox30 = New System.Windows.Forms.CheckBox
        Me.CheckBox31 = New System.Windows.Forms.CheckBox
        Me.CheckBox32 = New System.Windows.Forms.CheckBox
        Me.CheckBox33 = New System.Windows.Forms.CheckBox
        Me.CheckBox34 = New System.Windows.Forms.CheckBox
        Me.CheckBox35 = New System.Windows.Forms.CheckBox
        Me.CheckBox36 = New System.Windows.Forms.CheckBox
        Me.CheckBox37 = New System.Windows.Forms.CheckBox
        Me.cmb3 = New System.Windows.Forms.ComboBox
        Me.GroupBox1.SuspendLayout()
        Me.SuspendLayout()
        '
        'Label1
        '
        Me.Label1.AutoSize = True
        Me.Label1.Location = New System.Drawing.Point(8, 57)
        Me.Label1.Name = "Label1"
        Me.Label1.Size = New System.Drawing.Size(114, 13)
        Me.Label1.TabIndex = 0
        Me.Label1.Text = "NAME OF HOSPITAL:"
        '
        'Label2
        '
        Me.Label2.AutoSize = True
        Me.Label2.Location = New System.Drawing.Point(64, 80)
        Me.Label2.Name = "Label2"
        Me.Label2.Size = New System.Drawing.Size(62, 13)
        Me.Label2.TabIndex = 1
        Me.Label2.Text = "ADDRESS:"
        '
        'Label3
        '
        Me.Label3.AutoSize = True
        Me.Label3.Location = New System.Drawing.Point(711, 46)
        Me.Label3.Name = "Label3"
        Me.Label3.Size = New System.Drawing.Size(96, 13)
        Me.Label3.TabIndex = 2
        Me.Label3.Text = "HOSPITAL CODE:"
        '
        'Label4
        '
        Me.Label4.AutoSize = True
        Me.Label4.Location = New System.Drawing.Point(707, 72)
        Me.Label4.Name = "Label4"
        Me.Label4.Size = New System.Drawing.Size(108, 13)
        Me.Label4.TabIndex = 3
        Me.Label4.Text = "MED. RECORD NO.:"
        '
        'TextBox1
        '
        Me.TextBox1.Location = New System.Drawing.Point(123, 51)
        Me.TextBox1.Name = "TextBox1"
        Me.TextBox1.Size = New System.Drawing.Size(541, 20)
        Me.TextBox1.TabIndex = 6
        '
        'TextBox2
        '
        Me.TextBox2.Location = New System.Drawing.Point(123, 77)
        Me.TextBox2.Name = "TextBox2"
        Me.TextBox2.Size = New System.Drawing.Size(541, 20)
        Me.TextBox2.TabIndex = 7
        '
        'TextBox3
        '
        Me.TextBox3.Location = New System.Drawing.Point(812, 39)
        Me.TextBox3.Name = "TextBox3"
        Me.TextBox3.Size = New System.Drawing.Size(204, 20)
        Me.TextBox3.TabIndex = 7
        '
        'TextBox4
        '
        Me.TextBox4.Location = New System.Drawing.Point(818, 65)
        Me.TextBox4.Name = "TextBox4"
        Me.TextBox4.Size = New System.Drawing.Size(204, 20)
        Me.TextBox4.TabIndex = 8
        '
        'Label10
        '
        Me.Label10.AutoSize = True
        Me.Label10.Font = New System.Drawing.Font("Tahoma", 15.75!, System.Drawing.FontStyle.Bold, System.Drawing.GraphicsUnit.Point, CType(0, Byte))
        Me.Label10.Location = New System.Drawing.Point(179, 105)
        Me.Label10.Name = "Label10"
        Me.Label10.Size = New System.Drawing.Size(419, 25)
        Me.Label10.TabIndex = 17
        Me.Label10.Text = "ADMISSION AND DISCHARGE RECORD"
        '
        'Label5
        '
        Me.Label5.AutoSize = True
        Me.Label5.Location = New System.Drawing.Point(6, 16)
        Me.Label5.Name = "Label5"
        Me.Label5.Size = New System.Drawing.Size(75, 13)
        Me.Label5.TabIndex = 6
        Me.Label5.Text = "NAME NAME:"
        '
        'txtlast
        '
        Me.txtlast.Location = New System.Drawing.Point(87, 13)
        Me.txtlast.Name = "txtlast"
        Me.txtlast.Size = New System.Drawing.Size(190, 20)
        Me.txtlast.TabIndex = 9
        Me.txtlast.Text = "lastname"
        '
        'txtfirst
        '
        Me.txtfirst.Location = New System.Drawing.Point(283, 13)
        Me.txtfirst.Name = "txtfirst"
        Me.txtfirst.Size = New System.Drawing.Size(190, 20)
        Me.txtfirst.TabIndex = 10
        Me.txtfirst.Text = "Firstname"
        '
        'txtmid
        '
        Me.txtmid.Location = New System.Drawing.Point(479, 13)
        Me.txtmid.Name = "txtmid"
        Me.txtmid.Size = New System.Drawing.Size(190, 20)
        Me.txtmid.TabIndex = 11
        Me.txtmid.Text = "Middle Name"
        '
        'Label6
        '
        Me.Label6.AutoSize = True
        Me.Label6.Location = New System.Drawing.Point(6, 46)
        Me.Label6.Name = "Label6"
        Me.Label6.Size = New System.Drawing.Size(133, 13)
        Me.Label6.TabIndex = 12
        Me.Label6.Text = "PERMANENT ADDRESS:"
        '
        'TextBox8
        '
        Me.TextBox8.Location = New System.Drawing.Point(145, 43)
        Me.TextBox8.Name = "TextBox8"
        Me.TextBox8.Size = New System.Drawing.Size(524, 20)
        Me.TextBox8.TabIndex = 13
        '
        'Label7
        '
        Me.Label7.AutoSize = True
        Me.Label7.Location = New System.Drawing.Point(6, 77)
        Me.Label7.Name = "Label7"
        Me.Label7.Size = New System.Drawing.Size(52, 13)
        Me.Label7.TabIndex = 14
        Me.Label7.Text = "TEL NO.:"
        '
        'Label8
        '
        Me.Label8.AutoSize = True
        Me.Label8.Location = New System.Drawing.Point(218, 75)
        Me.Label8.Name = "Label8"
        Me.Label8.Size = New System.Drawing.Size(31, 13)
        Me.Label8.TabIndex = 15
        Me.Label8.Text = "SEX:"
        '
        'Label9
        '
        Me.Label9.AutoSize = True
        Me.Label9.Location = New System.Drawing.Point(366, 77)
        Me.Label9.Name = "Label9"
        Me.Label9.Size = New System.Drawing.Size(79, 13)
        Me.Label9.TabIndex = 16
        Me.Label9.Text = "CIVIL STATUS"
        '
        'Label11
        '
        Me.Label11.AutoSize = True
        Me.Label11.Location = New System.Drawing.Point(560, 79)
        Me.Label11.Name = "Label11"
        Me.Label11.Size = New System.Drawing.Size(32, 13)
        Me.Label11.TabIndex = 17
        Me.Label11.Text = "AGE:"
        '
        'TextBox9
        '
        Me.TextBox9.Location = New System.Drawing.Point(67, 74)
        Me.TextBox9.Name = "TextBox9"
        Me.TextBox9.Size = New System.Drawing.Size(145, 20)
        Me.TextBox9.TabIndex = 18
        '
        'cmb
        '
        Me.cmb.FormattingEnabled = True
        Me.cmb.Items.AddRange(New Object() {"MALE", "FEMALE"})
        Me.cmb.Location = New System.Drawing.Point(257, 74)
        Me.cmb.Name = "cmb"
        Me.cmb.Size = New System.Drawing.Size(103, 21)
        Me.cmb.TabIndex = 19
        '
        'cmb2
        '
        Me.cmb2.FormattingEnabled = True
        Me.cmb2.Items.AddRange(New Object() {"Single", "Married"})
        Me.cmb2.Location = New System.Drawing.Point(454, 74)
        Me.cmb2.Name = "cmb2"
        Me.cmb2.Size = New System.Drawing.Size(103, 21)
        Me.cmb2.TabIndex = 20
        '
        'TextBox10
        '
        Me.TextBox10.Location = New System.Drawing.Point(595, 76)
        Me.TextBox10.Name = "TextBox10"
        Me.TextBox10.Size = New System.Drawing.Size(74, 20)
        Me.TextBox10.TabIndex = 21
        '
        'Label12
        '
        Me.Label12.AutoSize = True
        Me.Label12.Location = New System.Drawing.Point(6, 112)
        Me.Label12.Name = "Label12"
        Me.Label12.Size = New System.Drawing.Size(65, 13)
        Me.Label12.TabIndex = 22
        Me.Label12.Text = "BIRTHDAY:"
        '
        'Label13
        '
        Me.Label13.AutoSize = True
        Me.Label13.Location = New System.Drawing.Point(257, 113)
        Me.Label13.Name = "Label13"
        Me.Label13.Size = New System.Drawing.Size(102, 13)
        Me.Label13.TabIndex = 24
        Me.Label13.Text = "BIRTHDAY PLACE:"
        '
        'TextBox11
        '
        Me.TextBox11.Location = New System.Drawing.Point(360, 107)
        Me.TextBox11.Name = "TextBox11"
        Me.TextBox11.Size = New System.Drawing.Size(309, 20)
        Me.TextBox11.TabIndex = 25
        '
        'Label14
        '
        Me.Label14.AutoSize = True
        Me.Label14.Location = New System.Drawing.Point(6, 138)
        Me.Label14.Name = "Label14"
        Me.Label14.Size = New System.Drawing.Size(81, 13)
        Me.Label14.TabIndex = 26
        Me.Label14.Text = "NATIONALITY:"
        '
        'Label15
        '
        Me.Label15.AutoSize = True
        Me.Label15.Location = New System.Drawing.Point(192, 138)
        Me.Label15.Name = "Label15"
        Me.Label15.Size = New System.Drawing.Size(61, 13)
        Me.Label15.TabIndex = 27
        Me.Label15.Text = "RELIGION:"
        '
        'Label16
        '
        Me.Label16.AutoSize = True
        Me.Label16.Location = New System.Drawing.Point(356, 138)
        Me.Label16.Name = "Label16"
        Me.Label16.Size = New System.Drawing.Size(80, 13)
        Me.Label16.TabIndex = 28
        Me.Label16.Text = "OCCUPATION:"
        '
        'TextBox12
        '
        Me.TextBox12.Location = New System.Drawing.Point(87, 135)
        Me.TextBox12.Name = "TextBox12"
        Me.TextBox12.Size = New System.Drawing.Size(109, 20)
        Me.TextBox12.TabIndex = 29
        '
        'TextBox13
        '
        Me.TextBox13.Location = New System.Drawing.Point(256, 135)
        Me.TextBox13.Name = "TextBox13"
        Me.TextBox13.Size = New System.Drawing.Size(103, 20)
        Me.TextBox13.TabIndex = 30
        '
        'TextBox14
        '
        Me.TextBox14.Location = New System.Drawing.Point(434, 135)
        Me.TextBox14.Name = "TextBox14"
        Me.TextBox14.Size = New System.Drawing.Size(235, 20)
        Me.TextBox14.TabIndex = 31
        '
        'Label17
        '
        Me.Label17.AutoSize = True
        Me.Label17.Location = New System.Drawing.Point(8, 170)
        Me.Label17.Name = "Label17"
        Me.Label17.Size = New System.Drawing.Size(156, 13)
        Me.Label17.TabIndex = 32
        Me.Label17.Text = "EMPLOYER (Type of Business)"
        '
        'Label18
        '
        Me.Label18.AutoSize = True
        Me.Label18.Location = New System.Drawing.Point(301, 171)
        Me.Label18.Name = "Label18"
        Me.Label18.Size = New System.Drawing.Size(0, 13)
        Me.Label18.TabIndex = 29
        '
        'TextBox15
        '
        Me.TextBox15.Location = New System.Drawing.Point(169, 165)
        Me.TextBox15.Name = "TextBox15"
        Me.TextBox15.Size = New System.Drawing.Size(132, 20)
        Me.TextBox15.TabIndex = 33
        '
        'TextBox16
        '
        Me.TextBox16.Location = New System.Drawing.Point(307, 164)
        Me.TextBox16.Name = "TextBox16"
        Me.TextBox16.Size = New System.Drawing.Size(217, 20)
        Me.TextBox16.TabIndex = 34
        '
        'TextBox17
        '
        Me.TextBox17.Location = New System.Drawing.Point(530, 165)
        Me.TextBox17.Name = "TextBox17"
        Me.TextBox17.Size = New System.Drawing.Size(139, 20)
        Me.TextBox17.TabIndex = 35
        '
        'Label19
        '
        Me.Label19.AutoSize = True
        Me.Label19.Location = New System.Drawing.Point(63, 204)
        Me.Label19.Name = "Label19"
        Me.Label19.Size = New System.Drawing.Size(96, 13)
        Me.Label19.TabIndex = 36
        Me.Label19.Text = "FATHER'S NAME:"
        '
        'Label20
        '
        Me.Label20.AutoSize = True
        Me.Label20.Location = New System.Drawing.Point(6, 230)
        Me.Label20.Name = "Label20"
        Me.Label20.Size = New System.Drawing.Size(154, 13)
        Me.Label20.TabIndex = 37
        Me.Label20.Text = "MOTHER'S (MAIDEN)  NAME:"
        '
        'TextBox18
        '
        Me.TextBox18.Location = New System.Drawing.Point(169, 198)
        Me.TextBox18.Name = "TextBox18"
        Me.TextBox18.Size = New System.Drawing.Size(195, 20)
        Me.TextBox18.TabIndex = 38
        '
        'TextBox19
        '
        Me.TextBox19.Location = New System.Drawing.Point(370, 198)
        Me.TextBox19.Name = "TextBox19"
        Me.TextBox19.Size = New System.Drawing.Size(154, 20)
        Me.TextBox19.TabIndex = 39
        '
        'TextBox20
        '
        Me.TextBox20.Location = New System.Drawing.Point(530, 201)
        Me.TextBox20.Name = "TextBox20"
        Me.TextBox20.Size = New System.Drawing.Size(139, 20)
        Me.TextBox20.TabIndex = 40
        '
        'TextBox21
        '
        Me.TextBox21.Location = New System.Drawing.Point(169, 230)
        Me.TextBox21.Name = "TextBox21"
        Me.TextBox21.Size = New System.Drawing.Size(195, 20)
        Me.TextBox21.TabIndex = 41
        '
        'TextBox22
        '
        Me.TextBox22.Location = New System.Drawing.Point(370, 233)
        Me.TextBox22.Name = "TextBox22"
        Me.TextBox22.Size = New System.Drawing.Size(154, 20)
        Me.TextBox22.TabIndex = 42
        '
        'TextBox23
        '
        Me.TextBox23.Location = New System.Drawing.Point(530, 233)
        Me.TextBox23.Name = "TextBox23"
        Me.TextBox23.Size = New System.Drawing.Size(139, 20)
        Me.TextBox23.TabIndex = 43
        '
        'Label21
        '
        Me.Label21.AutoSize = True
        Me.Label21.Location = New System.Drawing.Point(6, 265)
        Me.Label21.Name = "Label21"
        Me.Label21.Size = New System.Drawing.Size(139, 13)
        Me.Label21.TabIndex = 44
        Me.Label21.Text = "ADMISSION  DATE / TIME"
        '
        'GroupBox1
        '
        Me.GroupBox1.Controls.Add(Me.txtbday)
        Me.GroupBox1.Controls.Add(Me.CheckBox7)
        Me.GroupBox1.Controls.Add(Me.CheckBox6)
        Me.GroupBox1.Controls.Add(Me.CheckBox5)
        Me.GroupBox1.Controls.Add(Me.CheckBox4)
        Me.GroupBox1.Controls.Add(Me.TextBox24)
        Me.GroupBox1.Controls.Add(Me.CheckBox3)
        Me.GroupBox1.Controls.Add(Me.CheckBox2)
        Me.GroupBox1.Controls.Add(Me.CheckBox1)
        Me.GroupBox1.Controls.Add(Me.TextBox27)
        Me.GroupBox1.Controls.Add(Me.TextBox26)
        Me.GroupBox1.Controls.Add(Me.txtdischarge)
        Me.GroupBox1.Controls.Add(Me.txtadmission)
        Me.GroupBox1.Controls.Add(Me.Label33)
        Me.GroupBox1.Controls.Add(Me.Label32)
        Me.GroupBox1.Controls.Add(Me.Label31)
        Me.GroupBox1.Controls.Add(Me.Label30)
        Me.GroupBox1.Controls.Add(Me.Label29)
        Me.GroupBox1.Controls.Add(Me.Label28)
        Me.GroupBox1.Controls.Add(Me.Label27)
        Me.GroupBox1.Controls.Add(Me.Label25)
        Me.GroupBox1.Controls.Add(Me.Label26)
        Me.GroupBox1.Controls.Add(Me.Label21)
        Me.GroupBox1.Controls.Add(Me.TextBox23)
        Me.GroupBox1.Controls.Add(Me.TextBox22)
        Me.GroupBox1.Controls.Add(Me.TextBox21)
        Me.GroupBox1.Controls.Add(Me.TextBox20)
        Me.GroupBox1.Controls.Add(Me.TextBox19)
        Me.GroupBox1.Controls.Add(Me.TextBox18)
        Me.GroupBox1.Controls.Add(Me.Label20)
        Me.GroupBox1.Controls.Add(Me.Label19)
        Me.GroupBox1.Controls.Add(Me.TextBox17)
        Me.GroupBox1.Controls.Add(Me.TextBox16)
        Me.GroupBox1.Controls.Add(Me.TextBox15)
        Me.GroupBox1.Controls.Add(Me.Label18)
        Me.GroupBox1.Controls.Add(Me.Label17)
        Me.GroupBox1.Controls.Add(Me.TextBox14)
        Me.GroupBox1.Controls.Add(Me.TextBox13)
        Me.GroupBox1.Controls.Add(Me.TextBox12)
        Me.GroupBox1.Controls.Add(Me.Label16)
        Me.GroupBox1.Controls.Add(Me.Label15)
        Me.GroupBox1.Controls.Add(Me.Label14)
        Me.GroupBox1.Controls.Add(Me.TextBox11)
        Me.GroupBox1.Controls.Add(Me.Label13)
        Me.GroupBox1.Controls.Add(Me.Label12)
        Me.GroupBox1.Controls.Add(Me.TextBox10)
        Me.GroupBox1.Controls.Add(Me.cmb2)
        Me.GroupBox1.Controls.Add(Me.cmb)
        Me.GroupBox1.Controls.Add(Me.TextBox9)
        Me.GroupBox1.Controls.Add(Me.Label11)
        Me.GroupBox1.Controls.Add(Me.Label9)
        Me.GroupBox1.Controls.Add(Me.Label8)
        Me.GroupBox1.Controls.Add(Me.Label7)
        Me.GroupBox1.Controls.Add(Me.TextBox8)
        Me.GroupBox1.Controls.Add(Me.Label6)
        Me.GroupBox1.Controls.Add(Me.txtmid)
        Me.GroupBox1.Controls.Add(Me.txtfirst)
        Me.GroupBox1.Controls.Add(Me.txtlast)
        Me.GroupBox1.Controls.Add(Me.Label5)
        Me.GroupBox1.Font = New System.Drawing.Font("Microsoft Sans Serif", 8.25!)
        Me.GroupBox1.Location = New System.Drawing.Point(15, 133)
        Me.GroupBox1.Name = "GroupBox1"
        Me.GroupBox1.Size = New System.Drawing.Size(679, 405)
        Me.GroupBox1.TabIndex = 4
        Me.GroupBox1.TabStop = False
        '
        'txtbday
        '
        Me.txtbday.Location = New System.Drawing.Point(86, 108)
        Me.txtbday.Name = "txtbday"
        Me.txtbday.Size = New System.Drawing.Size(163, 20)
        Me.txtbday.TabIndex = 67
        '
        'CheckBox7
        '
        Me.CheckBox7.AutoSize = True
        Me.CheckBox7.Location = New System.Drawing.Point(266, 369)
        Me.CheckBox7.Name = "CheckBox7"
        Me.CheckBox7.Size = New System.Drawing.Size(34, 17)
        Me.CheckBox7.TabIndex = 66
        Me.CheckBox7.Text = "D"
        Me.CheckBox7.UseVisualStyleBackColor = True
        '
        'CheckBox6
        '
        Me.CheckBox6.AutoSize = True
        Me.CheckBox6.Location = New System.Drawing.Point(222, 369)
        Me.CheckBox6.Name = "CheckBox6"
        Me.CheckBox6.Size = New System.Drawing.Size(33, 17)
        Me.CheckBox6.TabIndex = 65
        Me.CheckBox6.Text = "C"
        Me.CheckBox6.UseVisualStyleBackColor = True
        '
        'CheckBox5
        '
        Me.CheckBox5.AutoSize = True
        Me.CheckBox5.Location = New System.Drawing.Point(169, 369)
        Me.CheckBox5.Name = "CheckBox5"
        Me.CheckBox5.Size = New System.Drawing.Size(33, 17)
        Me.CheckBox5.TabIndex = 64
        Me.CheckBox5.Text = "B"
        Me.CheckBox5.UseVisualStyleBackColor = True
        '
        'CheckBox4
        '
        Me.CheckBox4.AutoSize = True
        Me.CheckBox4.Location = New System.Drawing.Point(117, 369)
        Me.CheckBox4.Name = "CheckBox4"
        Me.CheckBox4.Size = New System.Drawing.Size(33, 17)
        Me.CheckBox4.TabIndex = 63
        Me.CheckBox4.Text = "V"
        Me.CheckBox4.UseVisualStyleBackColor = True
        '
        'TextBox24
        '
        Me.TextBox24.Location = New System.Drawing.Point(454, 344)
        Me.TextBox24.Name = "TextBox24"
        Me.TextBox24.Size = New System.Drawing.Size(215, 20)
        Me.TextBox24.TabIndex = 62
        '
        'CheckBox3
        '
        Me.CheckBox3.AutoSize = True
        Me.CheckBox3.Location = New System.Drawing.Point(240, 329)
        Me.CheckBox3.Name = "CheckBox3"
        Me.CheckBox3.Size = New System.Drawing.Size(98, 17)
        Me.CheckBox3.TabIndex = 61
        Me.CheckBox3.Text = "FORMER OPD"
        Me.CheckBox3.UseVisualStyleBackColor = True
        '
        'CheckBox2
        '
        Me.CheckBox2.AutoSize = True
        Me.CheckBox2.Location = New System.Drawing.Point(183, 329)
        Me.CheckBox2.Name = "CheckBox2"
        Me.CheckBox2.Size = New System.Drawing.Size(48, 17)
        Me.CheckBox2.TabIndex = 60
        Me.CheckBox2.Text = "OLD"
        Me.CheckBox2.UseVisualStyleBackColor = True
        '
        'CheckBox1
        '
        Me.CheckBox1.AutoSize = True
        Me.CheckBox1.Location = New System.Drawing.Point(134, 329)
        Me.CheckBox1.Name = "CheckBox1"
        Me.CheckBox1.Size = New System.Drawing.Size(52, 17)
        Me.CheckBox1.TabIndex = 59
        Me.CheckBox1.Text = "NEW"
        Me.CheckBox1.UseVisualStyleBackColor = True
        '
        'TextBox27
        '
        Me.TextBox27.Location = New System.Drawing.Point(423, 301)
        Me.TextBox27.Name = "TextBox27"
        Me.TextBox27.Size = New System.Drawing.Size(139, 20)
        Me.TextBox27.TabIndex = 58
        '
        'TextBox26
        '
        Me.TextBox26.Location = New System.Drawing.Point(115, 298)
        Me.TextBox26.Name = "TextBox26"
        Me.TextBox26.Size = New System.Drawing.Size(158, 20)
        Me.TextBox26.TabIndex = 44
        '
        'txtdischarge
        '
        Me.txtdischarge.Location = New System.Drawing.Point(499, 265)
        Me.txtdischarge.Name = "txtdischarge"
        Me.txtdischarge.Size = New System.Drawing.Size(170, 20)
        Me.txtdischarge.TabIndex = 57
        '
        'txtadmission
        '
        Me.txtadmission.Location = New System.Drawing.Point(158, 259)
        Me.txtadmission.Name = "txtadmission"
        Me.txtadmission.Size = New System.Drawing.Size(170, 20)
        Me.txtadmission.TabIndex = 56
        '
        'Label33
        '
        Me.Label33.AutoSize = True
        Me.Label33.Location = New System.Drawing.Point(10, 373)
        Me.Label33.Name = "Label33"
        Me.Label33.Size = New System.Drawing.Size(96, 13)
        Me.Label33.TabIndex = 55
        Me.Label33.Text = "CLASSIFICATION:"
        '
        'Label32
        '
        Me.Label32.AutoSize = True
        Me.Label32.Location = New System.Drawing.Point(8, 353)
        Me.Label32.Name = "Label32"
        Me.Label32.Size = New System.Drawing.Size(94, 13)
        Me.Label32.TabIndex = 54
        Me.Label32.Text = "SOCIAL SERVICE"
        '
        'Label31
        '
        Me.Label31.AutoSize = True
        Me.Label31.Location = New System.Drawing.Point(334, 350)
        Me.Label31.Name = "Label31"
        Me.Label31.Size = New System.Drawing.Size(105, 13)
        Me.Label31.TabIndex = 53
        Me.Label31.Text = "(Physician / Agency)"
        '
        'Label30
        '
        Me.Label30.AutoSize = True
        Me.Label30.Location = New System.Drawing.Point(336, 330)
        Me.Label30.Name = "Label30"
        Me.Label30.Size = New System.Drawing.Size(86, 13)
        Me.Label30.TabIndex = 52
        Me.Label30.Text = "REFERRED BY:"
        '
        'Label29
        '
        Me.Label29.AutoSize = True
        Me.Label29.Location = New System.Drawing.Point(6, 333)
        Me.Label29.Name = "Label29"
        Me.Label29.Size = New System.Drawing.Size(116, 13)
        Me.Label29.TabIndex = 51
        Me.Label29.Text = "TIME OF ADMISSION:"
        '
        'Label28
        '
        Me.Label28.AutoSize = True
        Me.Label28.Location = New System.Drawing.Point(279, 304)
        Me.Label28.Name = "Label28"
        Me.Label28.Size = New System.Drawing.Size(133, 13)
        Me.Label28.TabIndex = 51
        Me.Label28.Text = "ATTENDING PHYSICIAN:"
        '
        'Label27
        '
        Me.Label27.AutoSize = True
        Me.Label27.Location = New System.Drawing.Point(8, 304)
        Me.Label27.Name = "Label27"
        Me.Label27.Size = New System.Drawing.Size(99, 13)
        Me.Label27.TabIndex = 50
        Me.Label27.Text = "TOTAL NO. DAYS:"
        '
        'Label25
        '
        Me.Label25.AutoSize = True
        Me.Label25.Location = New System.Drawing.Point(413, 277)
        Me.Label25.Name = "Label25"
        Me.Label25.Size = New System.Drawing.Size(0, 13)
        Me.Label25.TabIndex = 48
        '
        'Label26
        '
        Me.Label26.AutoSize = True
        Me.Label26.Location = New System.Drawing.Point(334, 265)
        Me.Label26.Name = "Label26"
        Me.Label26.Size = New System.Drawing.Size(145, 13)
        Me.Label26.TabIndex = 47
        Me.Label26.Text = "DISCHARGE  DATE  / TIME"
        '
        'Label22
        '
        Me.Label22.AutoSize = True
        Me.Label22.Location = New System.Drawing.Point(700, 98)
        Me.Label22.Name = "Label22"
        Me.Label22.Size = New System.Drawing.Size(118, 13)
        Me.Label22.TabIndex = 18
        Me.Label22.Text = "ALERT ALLERGIC TO:"
        '
        'Label23
        '
        Me.Label23.AutoSize = True
        Me.Label23.Location = New System.Drawing.Point(700, 120)
        Me.Label23.Name = "Label23"
        Me.Label23.Size = New System.Drawing.Size(264, 13)
        Me.Label23.TabIndex = 19
        Me.Label23.Text = "HOSPITALIZATION PLAN COMPANY / INDIV.NAME"
        '
        'Label24
        '
        Me.Label24.AutoSize = True
        Me.Label24.Location = New System.Drawing.Point(700, 165)
        Me.Label24.Name = "Label24"
        Me.Label24.Size = New System.Drawing.Size(153, 13)
        Me.Label24.TabIndex = 20
        Me.Label24.Text = "HEALTH INSURANCE NAME:"
        '
        'Label34
        '
        Me.Label34.AutoSize = True
        Me.Label34.Location = New System.Drawing.Point(700, 192)
        Me.Label34.Name = "Label34"
        Me.Label34.Size = New System.Drawing.Size(59, 13)
        Me.Label34.TabIndex = 21
        Me.Label34.Text = "MEDICRE:"
        '
        'TextBox25
        '
        Me.TextBox25.Location = New System.Drawing.Point(818, 91)
        Me.TextBox25.Name = "TextBox25"
        Me.TextBox25.Size = New System.Drawing.Size(269, 20)
        Me.TextBox25.TabIndex = 22
        '
        'TextBox28
        '
        Me.TextBox28.Location = New System.Drawing.Point(710, 137)
        Me.TextBox28.Name = "TextBox28"
        Me.TextBox28.Size = New System.Drawing.Size(375, 20)
        Me.TextBox28.TabIndex = 23
        '
        'TextBox29
        '
        Me.TextBox29.Location = New System.Drawing.Point(852, 163)
        Me.TextBox29.Name = "TextBox29"
        Me.TextBox29.Size = New System.Drawing.Size(233, 20)
        Me.TextBox29.TabIndex = 24
        '
        'CheckBox8
        '
        Me.CheckBox8.AutoSize = True
        Me.CheckBox8.Location = New System.Drawing.Point(765, 192)
        Me.CheckBox8.Name = "CheckBox8"
        Me.CheckBox8.Size = New System.Drawing.Size(47, 17)
        Me.CheckBox8.TabIndex = 67
        Me.CheckBox8.Text = "SSS"
        Me.CheckBox8.UseVisualStyleBackColor = True
        '
        'CheckBox9
        '
        Me.CheckBox9.AutoSize = True
        Me.CheckBox9.Location = New System.Drawing.Point(812, 193)
        Me.CheckBox9.Name = "CheckBox9"
        Me.CheckBox9.Size = New System.Drawing.Size(51, 17)
        Me.CheckBox9.TabIndex = 68
        Me.CheckBox9.Text = "GSIS"
        Me.CheckBox9.UseVisualStyleBackColor = True
        '
        'Label35
        '
        Me.Label35.AutoSize = True
        Me.Label35.Location = New System.Drawing.Point(700, 218)
        Me.Label35.Name = "Label35"
        Me.Label35.Size = New System.Drawing.Size(122, 13)
        Me.Label35.TabIndex = 69
        Me.Label35.Text = "DATA FURNISHED BY:"
        '
        'Label36
        '
        Me.Label36.AutoSize = True
        Me.Label36.Location = New System.Drawing.Point(700, 241)
        Me.Label36.Name = "Label36"
        Me.Label36.Size = New System.Drawing.Size(146, 13)
        Me.Label36.TabIndex = 70
        Me.Label36.Text = "ADDRESS OF INFORMANT;"
        '
        'Label37
        '
        Me.Label37.AutoSize = True
        Me.Label37.Location = New System.Drawing.Point(700, 263)
        Me.Label37.Name = "Label37"
        Me.Label37.Size = New System.Drawing.Size(131, 13)
        Me.Label37.TabIndex = 71
        Me.Label37.Text = "RELATION TO PATIENT:"
        '
        'Label38
        '
        Me.Label38.AutoSize = True
        Me.Label38.Location = New System.Drawing.Point(700, 290)
        Me.Label38.Name = "Label38"
        Me.Label38.Size = New System.Drawing.Size(129, 13)
        Me.Label38.TabIndex = 72
        Me.Label38.Text = "ADMISSION DIAGNOSIS"
        '
        'Label39
        '
        Me.Label39.AutoSize = True
        Me.Label39.Location = New System.Drawing.Point(951, 287)
        Me.Label39.Name = "Label39"
        Me.Label39.Size = New System.Drawing.Size(80, 13)
        Me.Label39.TabIndex = 73
        Me.Label39.Text = "ICD CODE NO."
        '
        'Label40
        '
        Me.Label40.AutoSize = True
        Me.Label40.Location = New System.Drawing.Point(700, 319)
        Me.Label40.Name = "Label40"
        Me.Label40.Size = New System.Drawing.Size(128, 13)
        Me.Label40.TabIndex = 74
        Me.Label40.Text = "PRINCIPAL DIAGNOSIS:"
        '
        'Label41
        '
        Me.Label41.AutoSize = True
        Me.Label41.Location = New System.Drawing.Point(700, 344)
        Me.Label41.Name = "Label41"
        Me.Label41.Size = New System.Drawing.Size(107, 13)
        Me.Label41.TabIndex = 75
        Me.Label41.Text = "OTHER DIAGNOSIS"
        '
        'Label42
        '
        Me.Label42.AutoSize = True
        Me.Label42.Location = New System.Drawing.Point(700, 369)
        Me.Label42.Name = "Label42"
        Me.Label42.Size = New System.Drawing.Size(203, 13)
        Me.Label42.TabIndex = 76
        Me.Label42.Text = "PRICIPAL OPERATION / PROCEDURE:"
        '
        'Label43
        '
        Me.Label43.AutoSize = True
        Me.Label43.Location = New System.Drawing.Point(700, 390)
        Me.Label43.Name = "Label43"
        Me.Label43.Size = New System.Drawing.Size(217, 13)
        Me.Label43.TabIndex = 77
        Me.Label43.Text = "OTHER OPERATION (S) PROCEDURE (S):"
        '
        'Label44
        '
        Me.Label44.AutoSize = True
        Me.Label44.Location = New System.Drawing.Point(697, 416)
        Me.Label44.Name = "Label44"
        Me.Label44.Size = New System.Drawing.Size(241, 13)
        Me.Label44.TabIndex = 78
        Me.Label44.Text = "ACCIDENT / INJURIES / POISONING (E CODE)"
        '
        'Label45
        '
        Me.Label45.AutoSize = True
        Me.Label45.Location = New System.Drawing.Point(698, 436)
        Me.Label45.Name = "Label45"
        Me.Label45.Size = New System.Drawing.Size(131, 13)
        Me.Label45.TabIndex = 79
        Me.Label45.Text = "PLACE OF OCCURANCE:"
        '
        'Label46
        '
        Me.Label46.AutoSize = True
        Me.Label46.Location = New System.Drawing.Point(700, 459)
        Me.Label46.Name = "Label46"
        Me.Label46.Size = New System.Drawing.Size(76, 13)
        Me.Label46.TabIndex = 80
        Me.Label46.Text = "DISPOSITION"
        '
        'TextBox30
        '
        Me.TextBox30.Location = New System.Drawing.Point(845, 211)
        Me.TextBox30.Name = "TextBox30"
        Me.TextBox30.Size = New System.Drawing.Size(233, 20)
        Me.TextBox30.TabIndex = 81
        '
        'TextBox31
        '
        Me.TextBox31.Location = New System.Drawing.Point(845, 235)
        Me.TextBox31.Name = "TextBox31"
        Me.TextBox31.Size = New System.Drawing.Size(233, 20)
        Me.TextBox31.TabIndex = 82
        '
        'TextBox32
        '
        Me.TextBox32.Location = New System.Drawing.Point(845, 260)
        Me.TextBox32.Name = "TextBox32"
        Me.TextBox32.Size = New System.Drawing.Size(233, 20)
        Me.TextBox32.TabIndex = 83
        '
        'CheckBox10
        '
        Me.CheckBox10.AutoSize = True
        Me.CheckBox10.Location = New System.Drawing.Point(971, 316)
        Me.CheckBox10.Name = "CheckBox10"
        Me.CheckBox10.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox10.TabIndex = 67
        Me.CheckBox10.UseVisualStyleBackColor = True
        '
        'CheckBox11
        '
        Me.CheckBox11.AutoSize = True
        Me.CheckBox11.Font = New System.Drawing.Font("Microsoft Sans Serif", 9.75!, System.Drawing.FontStyle.Regular, System.Drawing.GraphicsUnit.Point, CType(0, Byte))
        Me.CheckBox11.Location = New System.Drawing.Point(992, 315)
        Me.CheckBox11.Name = "CheckBox11"
        Me.CheckBox11.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox11.TabIndex = 88
        Me.CheckBox11.UseVisualStyleBackColor = True
        '
        'CheckBox12
        '
        Me.CheckBox12.AutoSize = True
        Me.CheckBox12.Font = New System.Drawing.Font("Microsoft Sans Serif", 11.25!, System.Drawing.FontStyle.Regular, System.Drawing.GraphicsUnit.Point, CType(0, Byte))
        Me.CheckBox12.Location = New System.Drawing.Point(1013, 315)
        Me.CheckBox12.Name = "CheckBox12"
        Me.CheckBox12.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox12.TabIndex = 89
        Me.CheckBox12.UseVisualStyleBackColor = True
        '
        'CheckBox13
        '
        Me.CheckBox13.AutoSize = True
        Me.CheckBox13.Font = New System.Drawing.Font("Microsoft Sans Serif", 12.0!, System.Drawing.FontStyle.Regular, System.Drawing.GraphicsUnit.Point, CType(0, Byte))
        Me.CheckBox13.Location = New System.Drawing.Point(1034, 316)
        Me.CheckBox13.Name = "CheckBox13"
        Me.CheckBox13.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox13.TabIndex = 90
        Me.CheckBox13.UseVisualStyleBackColor = True
        '
        'CheckBox14
        '
        Me.CheckBox14.AutoSize = True
        Me.CheckBox14.Location = New System.Drawing.Point(1037, 341)
        Me.CheckBox14.Name = "CheckBox14"
        Me.CheckBox14.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox14.TabIndex = 94
        Me.CheckBox14.UseVisualStyleBackColor = True
        '
        'CheckBox15
        '
        Me.CheckBox15.AutoSize = True
        Me.CheckBox15.Location = New System.Drawing.Point(1016, 340)
        Me.CheckBox15.Name = "CheckBox15"
        Me.CheckBox15.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox15.TabIndex = 93
        Me.CheckBox15.UseVisualStyleBackColor = True
        '
        'CheckBox16
        '
        Me.CheckBox16.AutoSize = True
        Me.CheckBox16.Location = New System.Drawing.Point(995, 340)
        Me.CheckBox16.Name = "CheckBox16"
        Me.CheckBox16.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox16.TabIndex = 92
        Me.CheckBox16.UseVisualStyleBackColor = True
        '
        'CheckBox17
        '
        Me.CheckBox17.AutoSize = True
        Me.CheckBox17.Location = New System.Drawing.Point(974, 341)
        Me.CheckBox17.Name = "CheckBox17"
        Me.CheckBox17.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox17.TabIndex = 91
        Me.CheckBox17.UseVisualStyleBackColor = True
        '
        'CheckBox18
        '
        Me.CheckBox18.AutoSize = True
        Me.CheckBox18.Location = New System.Drawing.Point(971, 318)
        Me.CheckBox18.Name = "CheckBox18"
        Me.CheckBox18.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox18.TabIndex = 67
        Me.CheckBox18.UseVisualStyleBackColor = True
        '
        'CheckBox19
        '
        Me.CheckBox19.AutoSize = True
        Me.CheckBox19.Font = New System.Drawing.Font("Microsoft Sans Serif", 9.75!, System.Drawing.FontStyle.Regular, System.Drawing.GraphicsUnit.Point, CType(0, Byte))
        Me.CheckBox19.Location = New System.Drawing.Point(992, 317)
        Me.CheckBox19.Name = "CheckBox19"
        Me.CheckBox19.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox19.TabIndex = 88
        Me.CheckBox19.UseVisualStyleBackColor = True
        '
        'CheckBox20
        '
        Me.CheckBox20.AutoSize = True
        Me.CheckBox20.Font = New System.Drawing.Font("Microsoft Sans Serif", 11.25!, System.Drawing.FontStyle.Regular, System.Drawing.GraphicsUnit.Point, CType(0, Byte))
        Me.CheckBox20.Location = New System.Drawing.Point(1013, 317)
        Me.CheckBox20.Name = "CheckBox20"
        Me.CheckBox20.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox20.TabIndex = 89
        Me.CheckBox20.UseVisualStyleBackColor = True
        '
        'CheckBox21
        '
        Me.CheckBox21.AutoSize = True
        Me.CheckBox21.Font = New System.Drawing.Font("Microsoft Sans Serif", 12.0!, System.Drawing.FontStyle.Regular, System.Drawing.GraphicsUnit.Point, CType(0, Byte))
        Me.CheckBox21.Location = New System.Drawing.Point(1034, 318)
        Me.CheckBox21.Name = "CheckBox21"
        Me.CheckBox21.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox21.TabIndex = 90
        Me.CheckBox21.UseVisualStyleBackColor = True
        '
        'CheckBox22
        '
        Me.CheckBox22.AutoSize = True
        Me.CheckBox22.Location = New System.Drawing.Point(971, 342)
        Me.CheckBox22.Name = "CheckBox22"
        Me.CheckBox22.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox22.TabIndex = 91
        Me.CheckBox22.UseVisualStyleBackColor = True
        '
        'CheckBox23
        '
        Me.CheckBox23.AutoSize = True
        Me.CheckBox23.Location = New System.Drawing.Point(995, 342)
        Me.CheckBox23.Name = "CheckBox23"
        Me.CheckBox23.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox23.TabIndex = 92
        Me.CheckBox23.UseVisualStyleBackColor = True
        '
        'CheckBox24
        '
        Me.CheckBox24.AutoSize = True
        Me.CheckBox24.Location = New System.Drawing.Point(1016, 342)
        Me.CheckBox24.Name = "CheckBox24"
        Me.CheckBox24.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox24.TabIndex = 93
        Me.CheckBox24.UseVisualStyleBackColor = True
        '
        'CheckBox25
        '
        Me.CheckBox25.AutoSize = True
        Me.CheckBox25.Location = New System.Drawing.Point(1037, 343)
        Me.CheckBox25.Name = "CheckBox25"
        Me.CheckBox25.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox25.TabIndex = 94
        Me.CheckBox25.UseVisualStyleBackColor = True
        '
        'CheckBox26
        '
        Me.CheckBox26.AutoSize = True
        Me.CheckBox26.Location = New System.Drawing.Point(1039, 366)
        Me.CheckBox26.Name = "CheckBox26"
        Me.CheckBox26.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox26.TabIndex = 98
        Me.CheckBox26.UseVisualStyleBackColor = True
        '
        'CheckBox27
        '
        Me.CheckBox27.AutoSize = True
        Me.CheckBox27.Location = New System.Drawing.Point(1018, 365)
        Me.CheckBox27.Name = "CheckBox27"
        Me.CheckBox27.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox27.TabIndex = 97
        Me.CheckBox27.UseVisualStyleBackColor = True
        '
        'CheckBox28
        '
        Me.CheckBox28.AutoSize = True
        Me.CheckBox28.Location = New System.Drawing.Point(997, 365)
        Me.CheckBox28.Name = "CheckBox28"
        Me.CheckBox28.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox28.TabIndex = 96
        Me.CheckBox28.UseVisualStyleBackColor = True
        '
        'CheckBox29
        '
        Me.CheckBox29.AutoSize = True
        Me.CheckBox29.Location = New System.Drawing.Point(976, 366)
        Me.CheckBox29.Name = "CheckBox29"
        Me.CheckBox29.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox29.TabIndex = 95
        Me.CheckBox29.UseVisualStyleBackColor = True
        '
        'CheckBox30
        '
        Me.CheckBox30.AutoSize = True
        Me.CheckBox30.Location = New System.Drawing.Point(1040, 395)
        Me.CheckBox30.Name = "CheckBox30"
        Me.CheckBox30.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox30.TabIndex = 102
        Me.CheckBox30.UseVisualStyleBackColor = True
        '
        'CheckBox31
        '
        Me.CheckBox31.AutoSize = True
        Me.CheckBox31.Location = New System.Drawing.Point(1019, 394)
        Me.CheckBox31.Name = "CheckBox31"
        Me.CheckBox31.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox31.TabIndex = 101
        Me.CheckBox31.UseVisualStyleBackColor = True
        '
        'CheckBox32
        '
        Me.CheckBox32.AutoSize = True
        Me.CheckBox32.Location = New System.Drawing.Point(998, 394)
        Me.CheckBox32.Name = "CheckBox32"
        Me.CheckBox32.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox32.TabIndex = 100
        Me.CheckBox32.UseVisualStyleBackColor = True
        '
        'CheckBox33
        '
        Me.CheckBox33.AutoSize = True
        Me.CheckBox33.Location = New System.Drawing.Point(977, 395)
        Me.CheckBox33.Name = "CheckBox33"
        Me.CheckBox33.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox33.TabIndex = 99
        Me.CheckBox33.UseVisualStyleBackColor = True
        '
        'CheckBox34
        '
        Me.CheckBox34.AutoSize = True
        Me.CheckBox34.Location = New System.Drawing.Point(1040, 414)
        Me.CheckBox34.Name = "CheckBox34"
        Me.CheckBox34.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox34.TabIndex = 106
        Me.CheckBox34.UseVisualStyleBackColor = True
        '
        'CheckBox35
        '
        Me.CheckBox35.AutoSize = True
        Me.CheckBox35.Location = New System.Drawing.Point(1016, 414)
        Me.CheckBox35.Name = "CheckBox35"
        Me.CheckBox35.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox35.TabIndex = 105
        Me.CheckBox35.UseVisualStyleBackColor = True
        '
        'CheckBox36
        '
        Me.CheckBox36.AutoSize = True
        Me.CheckBox36.Location = New System.Drawing.Point(998, 414)
        Me.CheckBox36.Name = "CheckBox36"
        Me.CheckBox36.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox36.TabIndex = 104
        Me.CheckBox36.UseVisualStyleBackColor = True
        '
        'CheckBox37
        '
        Me.CheckBox37.AutoSize = True
        Me.CheckBox37.Location = New System.Drawing.Point(974, 416)
        Me.CheckBox37.Name = "CheckBox37"
        Me.CheckBox37.Size = New System.Drawing.Size(15, 14)
        Me.CheckBox37.TabIndex = 103
        Me.CheckBox37.UseVisualStyleBackColor = True
        '
        'cmb3
        '
        Me.cmb3.FormattingEnabled = True
        Me.cmb3.Items.AddRange(New Object() {"DISCHARGE", "TRANSFERRED", "HAMA", "ABSOND", "RECOVERED", "DIED", "48 HOURS", "+48 HOURS", "IMPROVE", "UNIMPROVE", "AUTOPSY", "NOT AUTOPSY"})
        Me.cmb3.Location = New System.Drawing.Point(800, 456)
        Me.cmb3.Name = "cmb3"
        Me.cmb3.Size = New System.Drawing.Size(231, 21)
        Me.cmb3.TabIndex = 107
        '
        'Form5
        '
        Me.AutoScaleDimensions = New System.Drawing.SizeF(6.0!, 13.0!)
        Me.AutoScaleMode = System.Windows.Forms.AutoScaleMode.Font
        Me.BackColor = System.Drawing.SystemColors.ActiveCaption
        Me.ClientSize = New System.Drawing.Size(1090, 549)
        Me.Controls.Add(Me.cmb3)
        Me.Controls.Add(Me.CheckBox34)
        Me.Controls.Add(Me.CheckBox35)
        Me.Controls.Add(Me.CheckBox36)
        Me.Controls.Add(Me.CheckBox37)
        Me.Controls.Add(Me.CheckBox30)
        Me.Controls.Add(Me.CheckBox31)
        Me.Controls.Add(Me.CheckBox32)
        Me.Controls.Add(Me.CheckBox33)
        Me.Controls.Add(Me.CheckBox26)
        Me.Controls.Add(Me.CheckBox27)
        Me.Controls.Add(Me.CheckBox28)
        Me.Controls.Add(Me.CheckBox29)
        Me.Controls.Add(Me.CheckBox25)
        Me.Controls.Add(Me.CheckBox21)
        Me.Controls.Add(Me.CheckBox24)
        Me.Controls.Add(Me.CheckBox18)
        Me.Controls.Add(Me.CheckBox23)
        Me.Controls.Add(Me.CheckBox19)
        Me.Controls.Add(Me.CheckBox22)
        Me.Controls.Add(Me.CheckBox20)
        Me.Controls.Add(Me.CheckBox14)
        Me.Controls.Add(Me.CheckBox15)
        Me.Controls.Add(Me.CheckBox16)
        Me.Controls.Add(Me.CheckBox17)
        Me.Controls.Add(Me.CheckBox13)
        Me.Controls.Add(Me.CheckBox12)
        Me.Controls.Add(Me.CheckBox11)
        Me.Controls.Add(Me.CheckBox10)
        Me.Controls.Add(Me.TextBox32)
        Me.Controls.Add(Me.TextBox31)
        Me.Controls.Add(Me.TextBox30)
        Me.Controls.Add(Me.Label46)
        Me.Controls.Add(Me.Label45)
        Me.Controls.Add(Me.Label44)
        Me.Controls.Add(Me.Label43)
        Me.Controls.Add(Me.Label42)
        Me.Controls.Add(Me.Label41)
        Me.Controls.Add(Me.Label40)
        Me.Controls.Add(Me.Label39)
        Me.Controls.Add(Me.Label38)
        Me.Controls.Add(Me.Label37)
        Me.Controls.Add(Me.Label36)
        Me.Controls.Add(Me.Label35)
        Me.Controls.Add(Me.CheckBox9)
        Me.Controls.Add(Me.CheckBox8)
        Me.Controls.Add(Me.TextBox29)
        Me.Controls.Add(Me.TextBox28)
        Me.Controls.Add(Me.TextBox25)
        Me.Controls.Add(Me.Label34)
        Me.Controls.Add(Me.Label24)
        Me.Controls.Add(Me.Label23)
        Me.Controls.Add(Me.Label22)
        Me.Controls.Add(Me.Label10)
        Me.Controls.Add(Me.TextBox4)
        Me.Controls.Add(Me.TextBox3)
        Me.Controls.Add(Me.TextBox2)
        Me.Controls.Add(Me.TextBox1)
        Me.Controls.Add(Me.GroupBox1)
        Me.Controls.Add(Me.Label4)
        Me.Controls.Add(Me.Label3)
        Me.Controls.Add(Me.Label2)
        Me.Controls.Add(Me.Label1)
        Me.Name = "Form5"
        Me.Text = "ADMISSION AND DISCHARGE RECORD"
        Me.GroupBox1.ResumeLayout(False)
        Me.GroupBox1.PerformLayout()
        Me.ResumeLayout(False)
        Me.PerformLayout()

    End Sub
    Friend WithEvents Label1 As System.Windows.Forms.Label
    Friend WithEvents Label2 As System.Windows.Forms.Label
    Friend WithEvents Label3 As System.Windows.Forms.Label
    Friend WithEvents Label4 As System.Windows.Forms.Label
    Friend WithEvents TextBox1 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox2 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox3 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox4 As System.Windows.Forms.TextBox
    Friend WithEvents Label10 As System.Windows.Forms.Label
    Friend WithEvents Label5 As System.Windows.Forms.Label
    Friend WithEvents txtlast As System.Windows.Forms.TextBox
    Friend WithEvents txtfirst As System.Windows.Forms.TextBox
    Friend WithEvents txtmid As System.Windows.Forms.TextBox
    Friend WithEvents Label6 As System.Windows.Forms.Label
    Friend WithEvents TextBox8 As System.Windows.Forms.TextBox
    Friend WithEvents Label7 As System.Windows.Forms.Label
    Friend WithEvents Label8 As System.Windows.Forms.Label
    Friend WithEvents Label9 As System.Windows.Forms.Label
    Friend WithEvents Label11 As System.Windows.Forms.Label
    Friend WithEvents TextBox9 As System.Windows.Forms.TextBox
    Friend WithEvents cmb As System.Windows.Forms.ComboBox
    Friend WithEvents cmb2 As System.Windows.Forms.ComboBox
    Friend WithEvents TextBox10 As System.Windows.Forms.TextBox
    Friend WithEvents Label12 As System.Windows.Forms.Label
    Friend WithEvents Label13 As System.Windows.Forms.Label
    Friend WithEvents TextBox11 As System.Windows.Forms.TextBox
    Friend WithEvents Label14 As System.Windows.Forms.Label
    Friend WithEvents Label15 As System.Windows.Forms.Label
    Friend WithEvents Label16 As System.Windows.Forms.Label
    Friend WithEvents TextBox12 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox13 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox14 As System.Windows.Forms.TextBox
    Friend WithEvents Label17 As System.Windows.Forms.Label
    Friend WithEvents Label18 As System.Windows.Forms.Label
    Friend WithEvents TextBox15 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox16 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox17 As System.Windows.Forms.TextBox
    Friend WithEvents Label19 As System.Windows.Forms.Label
    Friend WithEvents Label20 As System.Windows.Forms.Label
    Friend WithEvents TextBox18 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox19 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox20 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox21 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox22 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox23 As System.Windows.Forms.TextBox
    Friend WithEvents Label21 As System.Windows.Forms.Label
    Friend WithEvents GroupBox1 As System.Windows.Forms.GroupBox
    Friend WithEvents Label25 As System.Windows.Forms.Label
    Friend WithEvents Label26 As System.Windows.Forms.Label
    Friend WithEvents Label30 As System.Windows.Forms.Label
    Friend WithEvents Label29 As System.Windows.Forms.Label
    Friend WithEvents Label28 As System.Windows.Forms.Label
    Friend WithEvents Label27 As System.Windows.Forms.Label
    Friend WithEvents Label32 As System.Windows.Forms.Label
    Friend WithEvents Label31 As System.Windows.Forms.Label
    Friend WithEvents Label33 As System.Windows.Forms.Label
    Friend WithEvents txtdischarge As System.Windows.Forms.TextBox
    Friend WithEvents txtadmission As System.Windows.Forms.TextBox
    Friend WithEvents TextBox26 As System.Windows.Forms.TextBox
    Friend WithEvents CheckBox3 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox2 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox1 As System.Windows.Forms.CheckBox
    Friend WithEvents TextBox27 As System.Windows.Forms.TextBox
    Friend WithEvents CheckBox7 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox6 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox5 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox4 As System.Windows.Forms.CheckBox
    Friend WithEvents TextBox24 As System.Windows.Forms.TextBox
    Friend WithEvents Label22 As System.Windows.Forms.Label
    Friend WithEvents Label23 As System.Windows.Forms.Label
    Friend WithEvents Label24 As System.Windows.Forms.Label
    Friend WithEvents Label34 As System.Windows.Forms.Label
    Friend WithEvents TextBox25 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox28 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox29 As System.Windows.Forms.TextBox
    Friend WithEvents CheckBox8 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox9 As System.Windows.Forms.CheckBox
    Friend WithEvents Label35 As System.Windows.Forms.Label
    Friend WithEvents Label36 As System.Windows.Forms.Label
    Friend WithEvents Label37 As System.Windows.Forms.Label
    Friend WithEvents Label38 As System.Windows.Forms.Label
    Friend WithEvents Label39 As System.Windows.Forms.Label
    Friend WithEvents Label40 As System.Windows.Forms.Label
    Friend WithEvents Label41 As System.Windows.Forms.Label
    Friend WithEvents Label42 As System.Windows.Forms.Label
    Friend WithEvents Label43 As System.Windows.Forms.Label
    Friend WithEvents Label44 As System.Windows.Forms.Label
    Friend WithEvents Label45 As System.Windows.Forms.Label
    Friend WithEvents Label46 As System.Windows.Forms.Label
    Friend WithEvents TextBox30 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox31 As System.Windows.Forms.TextBox
    Friend WithEvents TextBox32 As System.Windows.Forms.TextBox
    Friend WithEvents CheckBox10 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox11 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox12 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox13 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox14 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox15 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox16 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox17 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox18 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox19 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox20 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox21 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox22 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox23 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox24 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox25 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox26 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox27 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox28 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox29 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox30 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox31 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox32 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox33 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox34 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox35 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox36 As System.Windows.Forms.CheckBox
    Friend WithEvents CheckBox37 As System.Windows.Forms.CheckBox
    Friend WithEvents cmb3 As System.Windows.Forms.ComboBox
    Friend WithEvents txtbday As System.Windows.Forms.TextBox
End Class
