$TP_insco_1  $TP_insco_2  $TP_insco_3  $TP_insco_4  $TP_insco_5  $TP_insco_6
  $TP_enc_insurance_nr
  $TP_enc_insurance_name
  $TP_enc_insurance_subarea
 
  $title
  $name_last, $name_first
  $TP_date_birth

$LDSickReport
$TP_main_address

$LDSickConfirm

  $LDSickUntil:
  $TP_date_end
  $LDStartingFrom:
  $TP_date_start
  $LDConfirmedOn:
  $TP_date_confirm

 

$TP_dept_sigstamp
  $LDInsurersCopy
  $LDDiagnosis2:
  $TP_diagnosis