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AS.YD.023 - AŞI DOLABI MİADI DOLAN AŞILARI İMHA TUTANAĞI

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Demo Hastanesi (Prokalite.Com) AŞI DOLABI MİADI DOLAN AŞILARI İMHA TUTANAĞI

Doküman Kodu: AS.YD.023

Yayın Tarihi: 19.04.2017

Revizyon Tarihi: 24.09.2021

Revizyon No: 1

Sayfa: Otomatik

….……………………İlçesi ……………………………………Hastanesinde bulunan, aşağıda adı, son kullanma tarihi, miktarı, lot ve seri numarası belirtilen aşılar tüketilememiştir. (………………………………………………………………………………………………………………………………nedeni ile)

Son kullanma tarihi dolduğundan imha edilmek üzere soğuk zincirden çıkarılmıştır. …./……/………

Aşı (ticari ve aşı adı)	Miktarı	Miktarı(flk/amp)	Seri no	Lot no	Son Kullanma Tarihi
Aşı (ticari ve aşı adı)	(doz)	Miktarı(flk/amp)	Seri no	Lot no	Son Kullanma Tarihi

AŞI VE SOĞUK ZİNCİR SORUMLUSU				BAŞHEKİM

ADI SOYADI				ADI SOYADI

İmza				İmza

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<p><br></p><table style="border-collapse:collapse" class=" cke_show_border" cellspacing="0"><tbody><tr><td style="border-color:initial; border-style:none; border-width:initial; vertical-align:middle"><span style="font-size:16px"><span style="color:black">….……………………İlçesi ……………………………………Hastanesinde bulunan, aşağıda adı, son kullanma tarihi, miktarı, lot ve seri numarası belirtilen aşılar tüketilememiştir. (………………………………………………………………………………………………………………………………nedeni ile) </span></span></td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:justify; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Son kullanma tarihi dolduğundan imha edilmek üzere soğuk zincirden çıkarılmıştır. …./……/………</span></span></td></tr></tbody></table><p><br></p><p><br></p><table style="border-collapse: collapse; width: 882px;" class=" cke_show_border" cellspacing="0"><tbody><tr><td rowspan="2" 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:middle"><span style="font-size:16px"><strong><span style="color:black">Aşı (ticari ve aşı adı)</span></strong></span></td><td style="border-bottom:none; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Miktarı</span></strong></span></td><td rowspan="2" 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:middle"><span style="font-size:16px"><strong><span style="color:black">Miktarı(flk/amp)</span></strong></span><br></td><td rowspan="2" 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:middle"><span style="font-size:16px"><strong><span style="color:black">Seri no </span></strong></span></td><td rowspan="2" 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:middle"><span style="font-size:16px"><strong><span style="color:black">Lot no </span></strong></span></td><td rowspan="2" 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:middle"><span style="font-size:16px"><strong><span style="color:black">Son Kullanma Tarihi</span></strong></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">(doz) </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:none; text-align:justify; vertical-align:middle"><p><br></p></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><p><br></p></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><p><br></p></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><p><br></p></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><p><br></p></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><p><br></p></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><p><br></p></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><p><br></p></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><p><br></p></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:justify; vertical-align:middle"><br></td></tr></tbody></table><p><br></p><table style="border-collapse: collapse; width: 882px;" class=" cke_show_border" cellspacing="0"><tbody><tr><td colspan="4" style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><span style="font-size:15px"><strong><span style="color:black">AŞI VE SOĞUK ZİNCİR SORUMLUSU</span></strong></span><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><span style="font-size:15px"><span style="color:black"><strong>BAŞHEKİM</strong> </span></span></td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td></tr><tr><td colspan="2" style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><span style="font-size:15px"><span style="color:black">ADI SOYADI</span></span></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><span style="font-size:15px"><span style="color:black">ADI SOYADI</span></span></td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><span style="font-size:15px"><span style="color:black">İmza</span></span></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><span style="font-size:15px"><span style="color:black">İmza</span></span></td></tr></tbody></table>