CENAZE KİMLİK KARTI

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YS.YD.002 - CENAZE KİMLİK KARTI

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Demo Hastanesi (Prokalite.Com) CENAZE KİMLİK KARTI

Doküman Kodu: YS.YD.002

Yayın Tarihi: 04.04.2016

Revizyon Tarihi: 01.11.2022

Revizyon No: 2

Sayfa: Otomatik

TARİH:...../......./20......
T.C.
ADI-SOYADI
DOĞ.YERİ VE TARİHİ
ADLİ VAKA MI?	□ EVET □HAYIR
PROTOKOL NO
ÖLÜM TARİH VE SAATİ
MORGA GİRİŞ TARİH VE SAATİ
SERVİSİ /DOLDURAN PERS.AD/SOYAD/İMZA

✁...............................

TARİH:...../......./20......
T.C.
ADI-SOYADI
DOĞ.YERİ VE TARİHİ
ADLİ VAKA MI?	□ EVET □HAYIR
PROTOKOL NO
ÖLÜM TARİH VE SAATİ
MORGA GİRİŞ TARİH VE SAATİ
SERVİSİ /DOLDURAN PERS.AD/SOYAD/İMZA

✁...............................

TARİH:...../......./20......
T.C.
ADI-SOYADI
DOĞ.YERİ VE TARİHİ
ADLİ VAKA MI?	□ EVET □HAYIR
PROTOKOL NO
ÖLÜM TARİH VE SAATİ
MORGA GİRİŞ TARİH VE SAATİ
SERVİSİ /DOLDURAN PERS.AD/SOYAD/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:20px; text-align:left; vertical-align:top; width:238px">TARİH:...../......./20......</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom; width:269px"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:20px; text-align:left; vertical-align:top">T.C.</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">ADI-SOYADI</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">DOĞ.YERİ VE TARİHİ</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">ADLİ VAKA MI?</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top">    □ EVET      □HAYIR</td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">PROTOKOL NO</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">ÖLÜM TARİH VE SAATİ</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">MORGA GİRİŞ TARİH VE SAATİ</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:40px; text-align:left; vertical-align:top; width:238px">SERVİSİ /DOLDURAN  PERS.AD/SOYAD/İMZA </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr></tbody></table>✁...............................<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:20px; text-align:left; vertical-align:top; width:238px">TARİH:...../......./20......</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom; width:269px"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:20px; text-align:left; vertical-align:top">T.C.</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">ADI-SOYADI</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">DOĞ.YERİ VE TARİHİ</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">ADLİ VAKA MI?</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top">    □ EVET     □HAYIR</td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">PROTOKOL NO</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">ÖLÜM TARİH VE SAATİ</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">MORGA GİRİŞ TARİH VE SAATİ</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:40px; text-align:left; vertical-align:top; width:238px">SERVİSİ /DOLDURAN  PERS.AD/SOYAD/İMZA </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr></tbody></table>✁............................... <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:20px; text-align:left; vertical-align:top; width:238px">TARİH:...../......./20......</td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom; width:269px"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:20px; text-align:left; vertical-align:top">T.C.</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">ADI-SOYADI</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">DOĞ.YERİ VE TARİHİ</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">ADLİ VAKA MI?</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top">    □ EVET     □HAYIR</td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">PROTOKOL NO</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">ÖLÜM TARİH VE SAATİ</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:20px; text-align:left; vertical-align:top">MORGA GİRİŞ TARİH VE SAATİ</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; height:40px; text-align:left; vertical-align:top; width:238px">SERVİSİ /DOLDURAN  PERS.AD/SOYAD/İMZA </td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top"> </td></tr></tbody></table>✁...............................

Örnek Doküman

Yaşam Sonu Hizmetler - Yardımcı Doküman

YS.YD.002 - CENAZE KİMLİK KARTI

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