%FDF-1.2
1 0 obj
<<
/FDF <<
/F (form.pdf)
/Fields [
<< /T (patient_id) /V <FEFF00310032003300340035> >>
<< /T (patient_name) /V <FEFF5C717530592A90CE> >>
<< /T (Dr_name) /V <FEFF4F5085E4533B5E2B> >>
<< /T (sex) /V <FEFF7537> >>
<< /T (KOYOMI) /V <FEFF0031003900320035> >>
<< /T (year) /V <FEFF00350030> >>
<< /T (month) /V <FEFF0031> >>
<< /T (day) /V <FEFF0032> >>
<< /T (input_year) /V <FEFF0032003000320036> >>
<< /T (input_month) /V <FEFF0037> >>
<< /T (input_day) /V <FEFF00320038> >>
<< /T (INPUT_TIMES) /V <FEFF0031> >>
]
>>
>>
endobj
trailer
<< /Root 1 0 R >>
%%EOF
