ES.PL.001 - EVDE SAĞLIK HİZMETLERİ HASTA ZİYARET PLANI

Doküman Kodu: ES.PL.001
Yayın Tarihi: 19.02.2019
Revizyon Tarihi: 05.09.2022
Revizyon No: 2
Paylaş:
DİKKAT! Buradaki bilgiler sağlık profesyonelleri için hazırlanmıştır. Arama motorları vs. ile bu sayfadaki bilgilere ulaştıysanız, sağlık profesyonellerine danışmadan, sadece buradaki bilgiler ile hareket etmeyiniz.
Doküman Önizlemesi

(Logonuz Burada)
Demo Hastanesi (Prokalite.Com) EVDE SAĞLIK HİZMETLERİ HASTA ZİYARET PLANI
Doküman Kodu: ES.PL.001
Yayın Tarihi: 19.02.2019
Revizyon Tarihi: 05.09.2022
Revizyon No: 2
Sayfa: Otomatik
Not: Her ziyarette bir sonraki ziyaret tarihi hastanın ihtiyacına göre planlanıp kayıt altına alınacaktır. Ayrıca Hasta/hasta yakınına bir sonraki ziyaret tarihi bildirilecektir.
HASTA ADI-SOYADI:
NO	PLANLANAN ZİYARET TARİHİ	GERŞEKLEŞEN ZİYARET TARİHİ	HEKİM-HEMŞİRE	YAPILAN İŞLEM	SONUÇ
Evde Sağlık Hizmetleri bölümündeki diğer plan örnekleri

Tümünü gör (2)
ES.PL.002 EVDE SAĞLIK HİZMETLERİ TIBBİ BAKIM PLANI
Dokümanlarınızı Prokalite ile yönetin
Tüm dokümanlarınızı kolayca oluşturun, güncelleyin veya revize edin. Bu örneği editöre ekleyip kurumunuza uyarlayabilirsiniz.
Doküman Yönetimi Ücretsiz Deneyin
Bu kodu Prokalite sistemindeki doküman editörüne yapıştırarak dokümanı kurumunuza uyarlayabilirsiniz.
<p><strong><span style="font-size:11.0pt">Not: Her ziyarette bir sonraki ziyaret tarihi hastanın ihtiyacına göre planlanıp kayıt altına alınacaktır. Ayrıca Hasta/hasta yakınına bir sonraki ziyaret tarihi bildirilecektir.</span></strong></p><table style="border-collapse:collapse; width:882px" class=" cke_show_border" cellspacing="0"><tbody><tr><td colspan="7" style="border-color:black; border-style:solid; border-width:1px; height:20px; vertical-align:middle; width:599px"><span style="font-size:13px"><strong><span style="color:black">HASTA ADI-SOYADI:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></strong></span></td></tr><tr><td style="border-bottom:none; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:center; vertical-align:middle; width:64px"><span style="font-size:12px"><strong><span style="color:black">NO</span></strong></span></td><td style="border-bottom:none; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:64px"><span style="font-size:12px"><strong><span style="color:black">PLANLANAN ZİYARET TARİHİ</span></strong></span></td><td style="border-bottom:none; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle; width:64px"><span style="font-size:12px"><strong><span style="color:black">GERŞEKLEŞEN ZİYARET TARİHİ</span></strong></span></td><td style="border-color:currentcolor black currentcolor currentcolor; border-style:none solid none none; border-width:medium 1px medium medium; text-align:center; vertical-align:middle; width:161px"><span style="font-size:12px"><strong><span style="color:black">HEKİM-HEMŞİRE</span></strong></span></td><td colspan="2" style="border-color:black black currentcolor currentcolor; border-style:solid solid none none; border-width:1px 1px medium medium; text-align:center; vertical-align:middle; width:366px"><span style="font-size:12px"><strong><span style="color:black">YAPILAN İŞLEM</span></strong></span></td><td style="border-color:currentcolor black currentcolor currentcolor; border-style:none solid none none; border-width:medium 1px medium medium; text-align:center; vertical-align:middle; width:119px"><span style="font-size:12px"><strong><span style="color:black">SONUÇ</span></strong></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td 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; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:26px; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:64px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:161px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td><td colspan="2" style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:366px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></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:119px"><span style="font-size:13px"><span style="color:black">&nbsp;</span></span></td></tr></tbody></table>