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HB.FR.002 - HEMŞİRE TEDAVİ FORMU

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Demo Hastanesi (Prokalite.Com) HEMŞİRE TEDAVİ FORMU

Doküman Kodu: HB.FR.002

Yayın Tarihi: 13.11.2014

Revizyon Tarihi: 06.09.2022

Revizyon No: 3

Sayfa: Otomatik

BARKOD				TARİH


ORDER- İLAÇ ADI	İLAÇ VER.	İLAÇ VER.	İLAÇ VER.	İLAÇ UYG. ZAMANI	İLAÇ UYG. ZAMANI	İLAÇ UYG. ZAMANI	İLAÇ UYG. ZAMANI	İLAÇ UYG. ZAMANI	İLAÇ UYG. ZAMANI
ORDER- İLAÇ ADI	YOLU	DOZU	SÜRESİ	UYGULAYAN HEMŞİRE	UYGULAYAN HEMŞİRE	UYGULAYAN HEMŞİRE	UYGULAYAN HEMŞİRE	UYGULAYAN HEMŞİRE	UYGULAYAN HEMŞİRE

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<table style="border-collapse: collapse; width: 1292px;" class=" cke_show_border" cellspacing="0"><tbody><tr><td colspan="4" rowspan="3" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:51px; text-align:left; vertical-align:top; width:397px"><span style="font-size:11px"><strong>BARKOD</strong></span></td><td colspan="6" 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:497px"><span style="font-size:11px"><strong>TARİH</strong></span></td></tr><tr><td rowspan="2" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:34px; text-align:center; vertical-align:middle; width:76px"><span style="font-size:11px"><strong> </strong></span></td><td rowspan="2" 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:86px"><span style="font-size:11px"><strong> </strong></span></td><td rowspan="2" 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:85px"><span style="font-size:11px"><strong> </strong></span></td><td rowspan="2" 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:85px"><span style="font-size:11px"><strong> </strong></span></td><td rowspan="2" 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:80px"><span style="font-size:11px"><strong> </strong></span></td><td rowspan="2" 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:85px"><span style="font-size:11px"><strong> </strong></span></td></tr><tr></tr><tr><td rowspan="2" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:60px; text-align:center; vertical-align:middle; width:205px"><span style="font-size:11px"><strong>ORDER- İLAÇ  ADI</strong></span></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:64px"><span style="font-size:11px"><strong>İLAÇ VER.</strong></span></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:64px"><span style="font-size:11px"><strong>İLAÇ VER.</strong></span></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:64px"><span style="font-size:11px"><strong>İLAÇ VER.</strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:76px"><span style="font-size:11px"><strong>İLAÇ UYG. ZAMANI</strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:86px"><span style="font-size:11px"><strong>İLAÇ UYG. ZAMANI</strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:85px"><span style="font-size:11px"><strong>İLAÇ UYG. ZAMANI</strong></span><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:85px"><span style="font-size:11px"><strong>İLAÇ UYG. ZAMANI</strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:80px"><span style="font-size:11px"><strong>İLAÇ UYG. ZAMANI</strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:85px"><span style="font-size:11px"><strong>İLAÇ UYG. ZAMANI</strong></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; height:28px; text-align:center; vertical-align:middle; width:64px"><span style="font-size:11px"><strong>YOLU</strong></span></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:64px"><span style="font-size:11px"><strong>DOZU</strong></span></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:64px"><span style="font-size:11px"><strong>SÜRESİ</strong></span></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:76px"><span style="font-size:11px"><strong>UYGULAYAN HEMŞİRE</strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:86px"><span style="font-size:11px"><strong>UYGULAYAN HEMŞİRE</strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:85px"><span style="font-size:11px"><strong>UYGULAYAN HEMŞİRE</strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:85px"><span style="font-size:11px"><strong>UYGULAYAN HEMŞİRE</strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:80px"><span style="font-size:11px"><strong>UYGULAYAN HEMŞİRE</strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle; width:85px"><span style="font-size:11px"><strong>UYGULAYAN HEMŞİRE</strong></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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><span style="font-size:13px"> </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:33px; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:33px; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:33px; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom"><br></td></tr></tbody></table>