HASTANIN BERABERİNDE GETİRDİĞİ İLAÇLARI TESLİM ALMA FORMU

Örnek Doküman

İY.FR.009 - HASTANIN BERABERİNDE GETİRDİĞİ İLAÇLARI TESLİM ALMA FORMU

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Demo Hastanesi (Prokalite.Com) HASTANIN BERABERİNDE GETİRDİĞİ İLAÇLARI TESLİM ALMA FORMU

Doküman Kodu: İY.FR.009

Yayın Tarihi: 26.11.2014

Revizyon Tarihi: 18.02.2022

Revizyon No: 3

Sayfa: Otomatik

HASTANIN ADI SOYADI

TARİH

TESLİM ALINAN İLAÇLAR

SON KULLANIM TARİHİ

MİKTARI

TESLİM EDEN ADI SOYADI

TESLİM ALAN ADI SOYADI

TARİH

HASTAYA İADE EDİLEN İLAÇLAR

SON KULLANIM TARİHİ

MİKTARI

TESLİM EDEN ADI SOYADI

TESLİM ALAN ADI SOYADI

Not 1:Hastanın beraberinde getirdiği ilaçların miat kontrolü ve fiziksel durum kontrolü yapılmalıdır.

Not 2: Miadı geçmiş veya fiziksel yapısında değişim tespit edilen ilaçların imhası hasta veya hasta yakınına bilgilendirme yapılarak ilgili serviste gerçekleştirilir.

Not 3: Hasta taburcu olduğunda form hasta dosyasına eklenmelidir.

Not 4: Hastanın Beraberinde Getirdiği İlaçların Yönetimi Talimatına bakınız.

<table style="border-collapse:collapse; height:1100px; width:882px" class=" cke_show_border" cellspacing="0"><tbody><tr><td colspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:middle">HASTANIN ADI SOYADI </td></tr><tr><td rowspan="10" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle">TARİH</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; text-align:center; vertical-align:middle; width:427px">TESLİM ALINAN İLAÇLAR </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; text-align:center; vertical-align:middle; width:199px">SON KULLANIM TARİHİ</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; text-align:center; vertical-align:middle; width:167px">MİKTARI</td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td colspan="4" rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:middle"><table style="width:882px" class="cke_show_border" cellspacing="1" cellpadding="1"><tbody><tr><td style="text-align:center">TESLİM EDEN ADI SOYADI </td><td style="text-align:center">TESLİM ALAN ADI SOYADI</td></tr></tbody></table> </td></tr><tr></tr><tr></tr><tr></tr><tr><td rowspan="11" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle">TARİH</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; text-align:center; vertical-align:middle; width:427px">HASTAYA İADE EDİLEN İLAÇLAR </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; text-align:center; vertical-align:middle; width:199px">SON KULLANIM TARİHİ</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; text-align:center; vertical-align:middle; width:167px">MİKTARI</td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:427px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:199px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:167px"> </td></tr><tr><td colspan="4" rowspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:middle"><table style="width:882px" class="cke_show_border" cellspacing="1" cellpadding="1"><tbody><tr><td style="text-align:center">TESLİM EDEN ADI SOYADI </td><td style="text-align:center">TESLİM ALAN ADI SOYADI</td></tr></tbody></table> </td></tr><tr></tr><tr></tr><tr></tr><tr><td colspan="4" style="border-bottom:none; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:middle">Not 1:Hastanın beraberinde getirdiği ilaçların miat kontrolü ve fiziksel durum kontrolü yapılmalıdır.</td></tr><tr><td colspan="4" style="border-bottom:none; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle">Not 2: Miadı geçmiş veya fiziksel yapısında değişim tespit edilen ilaçların imhası hasta veya hasta yakınına bilgilendirme yapılarak ilgili serviste gerçekleştirilir.</td></tr><tr><td colspan="4" style="border-bottom:none; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle">Not 3: Hasta taburcu olduğunda form hasta dosyasına eklenmelidir.</td></tr><tr><td colspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle">Not 4: Hastanın Beraberinde Getirdiği İlaçların Yönetimi Talimatına bakınız.</td></tr></tbody></table>

Örnek Doküman

İlaç Yönetimi - Form

İY.FR.009 - HASTANIN BERABERİNDE GETİRDİĞİ İLAÇLARI TESLİM ALMA FORMU

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