Prokalite | İLAÇ VE TIBBİ SARF MALZEME İMHA TUTANAK FORMU

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İY.FR.004 - İLAÇ VE TIBBİ SARF MALZEME İMHA TUTANAK FORMU

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Demo Hastanesi (Prokalite.Com) İLAÇ VE TIBBİ SARF MALZEME İMHA TUTANAK FORMU

Doküman Kodu: İY.FR.004

Yayın Tarihi: 14.04.2016

Revizyon Tarihi: 18.02.2022

Revizyon No: 2

Sayfa: Otomatik

Sıra No	Servis Adı	Malzeme Adı	Birimi	Miktarı	Birim Fiyatı	Toplam Tutarı	İmha Nedenleri
							Miadının Geçmesi
							Kırılması
							Kontamine Olması
							Bozulması
							Miadının Geçmesi
							Kırılması
							Kontamine Olması
							Bozulması
							Miadının Geçmesi
							Kırılması
							Kontamine Olması
							Bozulması
							Miadının Geçmesi
							Kırılması
							Kontamine Olması
							Bozulması
							Miadının Geçmesi
							Kırılması
							Kontamine Olması
							Bozulması
							Miadının Geçmesi
							Kırılması
							Kontamine Olması
							Bozulması

NOT: Bu form ilgili sorumlular tarafından imzalandıktan sonra bir nüshası eczaneye ve bir nüshası da imha komisyonuna teslim edilir.

BAŞTABİP

SAĞLIK BAKIM HİZ MÜD.

İDARİ ve MALİ İŞLER MÜD

SORUMLU HEKİM

SORUMLU HEMŞİRE

<meta charset="utf-8"/>
<table style="border-collapse:collapse; width:882px" class=" cke_show_border" cellspacing="0"><tbody><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:justify; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Sıra No</span></strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:justify; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Servis Adı</span></strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:justify; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Malzeme Adı</span></strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:justify; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Birimi</span></strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:justify; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Miktarı</span></strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:justify; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Birim Fiyatı</span></strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:justify; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Toplam Tutarı</span></strong></span></td><td colspan="2" style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">İmha Nedenleri</span></strong></span></td></tr><tr><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Miadının Geçmesi</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kırılması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kontamine Olması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Bozulması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Miadının Geçmesi</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kırılması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kontamine Olması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Bozulması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Miadının Geçmesi</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kırılması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kontamine Olması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Bozulması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Miadının Geçmesi</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kırılması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kontamine Olması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Bozulması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Miadının Geçmesi</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kırılması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kontamine Olması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Bozulması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Miadının Geçmesi</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kırılması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kontamine Olması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Bozulması</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle">       </td></tr></tbody></table><table style="border-collapse:collapse" class=" cke_show_border" cellspacing="0"><tbody><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:14px"><span style="color:black">NOT: Bu form ilgili sorumlular tarafından imzalandıktan sonra bir nüshası eczaneye ve bir nüshası da imha komisyonuna teslim edilir.</span></span></td></tr></tbody></table><p><br></p><table style="width:100%" cellspacing="1" cellpadding="1" border="1"><tbody><tr><td style="width:277px"><p>BAŞTABİP</p><p><br></p><p><br></p><p><br></p></td><td style="width:279px"><p>SAĞLIK BAKIM HİZ MÜD.</p><p><br></p><p><br></p><p><br></p></td><td style="width:256px"><p>İDARİ ve MALİ İŞLER MÜD</p><p><br></p><p><br></p><p><br></p></td></tr><tr><td style="width:277px"><p>SORUMLU HEKİM</p><p><br></p><p><br></p><p><br></p></td><td style="width:279px"><p>SORUMLU HEMŞİRE</p><p><br></p><p><br></p><p><br></p></td><td style="width:256px"><br></td></tr></tbody></table>