<hr style="border: 1px solid black;     margin: 5px 0; ">

<table style="width: 100%;" >
    <tr>
        <td style="width: 25%;font-weight: bold;"> Patient Name   </td>
        <td style="width: 25%;"> {$name}     </td>
        <td style="width: 25%;font-weight: bold;"> Patient ID   </td>
        <td style="width: 25%;"> <img id="xx"  src="{$hosturl}/../upload/barcodes/{$statusNo}.png" height="20">     </td>
    </tr>
    <tr>
        <td style="width: 25%;font-weight: bold;"> Age / Sex    </td>
        <td style="width: 25%;"> {$age}   / {$sex}      </td>
        <td style="width: 25%;font-weight: bold;"> Requested Date     </td>
        <td style="width: 25%;">  {$req_date} {$req_time} </td>
    </tr>
    <tr>
        <td style="width: 25%;font-weight: bold;"> Referred By   </td>
        <td style="width: 25%;">{$doctor_name}     </td>
        <td style="width: 25%;font-weight: bold;"> Printed In   </td>
        <td style="width: 25%;">   {$dateTime}   </td>
    </tr>
</table>


<hr style="border: 1px solid black;  margin: 5px 0;">


<div class="row">

    <div class="col-md-12">