NARKOTİK İLAÇLAR DEVİR TESLİM LİSTESİ

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HB.LS.001 - NARKOTİK İLAÇLAR DEVİR TESLİM LİSTESİ

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Demo Hastanesi (Prokalite.Com) NARKOTİK İLAÇLAR DEVİR TESLİM LİSTESİ

Doküman Kodu: HB.LS.001

Yayın Tarihi: 01.10.2010

Revizyon Tarihi: 26.09.2022

Revizyon No: 1

Sayfa: Otomatik

TARİH:

ALDOLAN:

LARGACTİL:

DEVİR ALINAN MİKTAR:

ECZANEDEN GELEN MİKTAR:

KULLANILAN MİKTAR:

(hangi hastaya kullanıldı ise hastanın barkot numarası)

DEVREDİLEN MİKTAR:

DİAZEM:

NORODOL:

DEVİR ALINAN MİKTAR:

ECZANEDEN GELEN MİKTAR:

KULLANILAN MİKTAR:

(hangi hastaya kullanıldı ise hastanın barkot numarası)

DEVREDİLEN MİKTAR:

CONTRAMAL:

DORMICUM:

DEVİR ALINAN MİKTAR:

ECZANEDEN GELEN MİKTAR:

KULLANILAN MİKTAR:

(hangi hastaya kullanıldı ise hastanın barkot numarası)

DEVREDİLEN MİKTAR:

MORFİN:

FENTANYL:

DEVİR ALINAN MİKTAR:

ECZANEDEN GELEN MİKTAR:

KULLANILAN MİKTAR:

(hangi hastaya kullanıldı ise hastanın barkot numarası)

DEVREDİLEN MİKTAR:

AKİNETON:

DİAZEPAM DESİTİN REKTAL TÜP:

DEVİR ALINAN MİKTAR:

ECZANEDEN GELEN MİKTAR:

KULLANILAN MİKTAR:

(hangi hastaya kullanıldı ise hastanın barkot numarası)

DEVREDİLEN MİKTAR:

TESLİM EDEN

İMZA

TESLİM ALAN

İMZA

<table style="border-collapse:collapse; width:882px" class=" cke_show_border" cellspacing="0"><tbody><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top; width:163px">   TARİH:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:156px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top; width:19px"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">ALDOLAN:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">LARGACTİL:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    DEVİR ALINAN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    DEVİR ALINAN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    ECZANEDEN GELEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td colspan="2" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    ECZANEDEN GELEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    KULLANILAN MİKTAR:</td><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    KULLANILAN MİKTAR:</td><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td></tr><tr><td colspan="8" style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">     (hangi hastaya kullanıldı ise hastanın barkot numarası)</td><td colspan="8" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">     (hangi hastaya kullanıldı ise hastanın barkot numarası)</td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    DEVREDİLEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    DEVREDİLEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">DİAZEM:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">NORODOL:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    DEVİR ALINAN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    DEVİR ALINAN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    ECZANEDEN GELEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td colspan="2" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    ECZANEDEN GELEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    KULLANILAN MİKTAR:</td><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    KULLANILAN MİKTAR:</td><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td></tr><tr><td colspan="8" style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">     (hangi hastaya kullanıldı ise hastanın barkot numarası)</td><td colspan="8" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">     (hangi hastaya kullanıldı ise hastanın barkot numarası)</td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    DEVREDİLEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">   DEVREDİLEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">CONTRAMAL:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">DORMICUM:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    DEVİR ALINAN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    DEVİR ALINAN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    ECZANEDEN GELEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td colspan="2" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    ECZANEDEN GELEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    KULLANILAN MİKTAR:</td><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    KULLANILAN MİKTAR:</td><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td></tr><tr><td colspan="8" style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">     (hangi hastaya kullanıldı ise hastanın barkot numarası)</td><td colspan="8" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">     (hangi hastaya kullanıldı ise hastanın barkot numarası)</td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    DEVREDİLEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">   DEVREDİLEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">MORFİN:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">FENTANYL:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    DEVİR ALINAN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    DEVİR ALINAN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    ECZANEDEN GELEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td colspan="2" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    ECZANEDEN GELEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    KULLANILAN MİKTAR:</td><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    KULLANILAN MİKTAR:</td><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td></tr><tr><td colspan="8" style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">     (hangi hastaya kullanıldı ise hastanın barkot numarası)</td><td colspan="8" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">     (hangi hastaya kullanıldı ise hastanın barkot numarası)</td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    DEVREDİLEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">   DEVREDİLEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">AKİNETON:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td colspan="5" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">DİAZEPAM DESİTİN REKTAL TÜP:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    DEVİR ALINAN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    DEVİR ALINAN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    ECZANEDEN GELEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td colspan="2" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    ECZANEDEN GELEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    KULLANILAN MİKTAR:</td><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">    KULLANILAN MİKTAR:</td><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top"> </td></tr><tr><td colspan="8" style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">     (hangi hastaya kullanıldı ise hastanın barkot numarası)</td><td colspan="8" style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">     (hangi hastaya kullanıldı ise hastanın barkot numarası)</td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; height:16px; text-align:left; vertical-align:top">    DEVREDİLEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top">   DEVREDİLEN MİKTAR:</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; text-align:left; vertical-align:top"> </td></tr></tbody></table><table style="border-collapse:collapse; width:882px" class=" cke_show_border" cellspacing="0"><tbody><tr><td colspan="2" style="border-bottom:1px solid black; border-left:1px solid black; border-right:none; border-top:1px solid black; height:57px; text-align:left; vertical-align:top; width:128px">TESLİM EDEN</td><td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:1px solid black; text-align:left; vertical-align:top; width:64px"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:1px solid black; text-align:left; vertical-align:top; width:64px">İMZA </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top; width:64px"> </td><td colspan="2" style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:1px solid black; text-align:left; vertical-align:top; width:128px">TESLİM ALAN</td><td style="border-bottom:1px solid black; border-left:none; border-right:none; border-top:1px solid black; text-align:left; vertical-align:top; width:64px"> </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:left; vertical-align:top; width:64px">İMZA</td></tr></tbody></table>

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HB.LS.001 - NARKOTİK İLAÇLAR DEVİR TESLİM LİSTESİ

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