Anestezi Birimi Yeşil-Kırmızı Reçeteye Tabi İlaçlar ve Yüksek Riskli Anestezi İlaçları Günlük Kullanım ve Devir Teslim Formu

Örnek Doküman

AH.FR.012 - Anestezi Birimi Yeşil-Kırmızı Reçeteye Tabi İlaçlar ve Yüksek Riskli Anestezi İlaçları Günlük Kullanım ve Devir Teslim Formu

Paylaş

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Demo Hastanesi (Prokalite.Com) Anestezi Birimi Yeşil-Kırmızı Reçeteye Tabi İlaçlar ve Yüksek Riskli Anestezi İlaçları Günlük Kullanım ve Devir Teslim Formu

Doküman Kodu: AH.FR.012

Yayın Tarihi: 24.09.2021

Revizyon Tarihi: 12.04.2022

Revizyon No: 1

Sayfa: Otomatik

İlaç Adı	Devir Alınan Miktar	Eczaneden Gelen Miktar	Kullanılan Miktar	Devir Edilen Miktar	Hasta Bilgileri / Kullanılan İlaçlar		Tarih:
Sevorane 250 ml Şişe
Ketalar 500 mg Flk.
Pental 0.5 gr Flk.
Propofol 20 ml Amp.
Dormicum 5 ml Amp.
Fentanly 2ml.Amp.
Esmeron 50 mg Flk.
Tracrium
Lysthenon 100 mg. Amp.
Morphine
Ultramex-Contramal
Ultiva


					Teslim Alan	Teslim Eden
İlaç Adı	Devir Alınan Miktar	Eczaneden Gelen Miktar	Kullanılan Miktar	Devir Edilen Miktar	Hasta Bilgileri / Kullanılan İlaçlar		Tarih:
Sevorane 250 ml.Şişe
Ketalar 500 mg. Flk.
Pental 0.5 gr Flk.
Propofol 20 ml. Amp.
Dormicum 5 ml Amp.
Fentanly 2 ml. Amp.
Esmeron 50 mg. Flk.
Tracrium
Lysthenon 100 mg. Amp.
Morphine
Ultramex-Contromal
Ultiva


					Teslim Alan	Teslim Eden

<table cellspacing="0" style="border-collapse:collapse">
	<tbody>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:62px; text-align:center; vertical-align:middle; width:234px">İlaç Adı</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:middle; width:80px">Devir 
			Alınan 
			Miktar</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:middle; width:64px">Eczaneden 
			Gelen 
			Miktar</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:middle; width:64px">Kullanılan 
			Miktar</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:middle; width:64px">Devir 
			Edilen 
			Miktar</td>
			<td colspan="2" style="border-bottom:1px solid black; border-left:none; border-right:.7px solid black; border-top:1px solid black; text-align:center; vertical-align:middle; width:699px">Hasta Bilgileri / Kullanılan İlaçlar</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top; width:180px">Tarih:</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Sevorane 250 ml Şişe</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td colspan="3" rowspan="14" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Ketalar 500 mg Flk.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Pental 0.5 gr Flk.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Propofol 20 ml Amp.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Dormicum 5 ml Amp.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Fentanly 2ml.Amp.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Esmeron 50 mg Flk.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Tracrium</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Lysthenon 100 mg. Amp.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Morphine</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Ultramex-Contramal</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Ultiva</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:80px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:middle"> </td>
			<td 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; width:64px"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">Teslim Alan</td>
			<td colspan="2" style="border-bottom:1px solid black; border-left:1px solid black; border-right:.7px solid black; border-top:1px solid black; text-align:left; vertical-align:top">Teslim Eden</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:50px; text-align:center; vertical-align:middle">İlaç Adı</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:80px">Devir 
			Alınan 
			Miktar</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px">Eczaneden 
			Gelen 
			Miktar</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px">Kullanılan 
			Miktar</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px">Devir 
			Edilen 
			Miktar</td>
			<td colspan="2" style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:1px solid black; text-align:center; vertical-align:middle">Hasta Bilgileri / Kullanılan İlaçlar</td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top">Tarih:</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Sevorane 250 ml.Şişe</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td colspan="3" rowspan="14" style="border-bottom:.7px solid black; border-left:1px solid black; border-right:.7px solid black; border-top:1px solid black; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Ketalar 500 mg. Flk.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Pental 0.5 gr Flk.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Propofol 20 ml. Amp.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Dormicum 5 ml Amp.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Fentanly 2 ml. Amp.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Esmeron 50 mg. Flk.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Tracrium</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Lysthenon 100 mg. Amp.</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Morphine</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Ultramex-Contromal</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom">Ultiva</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:bottom"> </td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">Teslim Alan</td>
			<td colspan="2" style="border-bottom:1px solid black; border-left:1px solid black; border-right:.7px solid black; border-top:1px solid black; text-align:left; vertical-align:top">Teslim Eden</td>
		</tr>
	</tbody>
</table>

Örnek Doküman

Ameliyathane - Form

AH.FR.012 - Anestezi Birimi Yeşil-Kırmızı Reçeteye Tabi İlaçlar ve Yüksek Riskli Anestezi İlaçları Günlük Kullanım ve Devir Teslim Formu

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