TRANSFÜZYON ÖNCESİ UYGUNLUK TESTLERİ FORMU

Örnek Doküman

TH.FR.017 - TRANSFÜZYON ÖNCESİ UYGUNLUK TESTLERİ FORMU

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Demo Hastanesi (Prokalite.Com) TRANSFÜZYON ÖNCESİ UYGUNLUK TESTLERİ FORMU

Doküman Kodu: TH.FR.017

Yayın Tarihi: 05.01.2012

Revizyon Tarihi: 08.11.2022

Revizyon No: 5

Sayfa: Otomatik

HASTANIN ADI SOYADI
KAN GRUBU
UYGULANAN TESTLER	SONUÇ
Hbs Ag
HCV
HIV
VDRL

HAZIRLANAN KANLARLA İLGİLİ BİLGİLER
VERİLEN KANIN ADI
SOYADI
KAN NOSU
ALINDIĞI TARİH
SON KULLANMA TARİHİ
KAN GRUBU
Hbs Ag
HCV
HIV
VDRL
MAJOR CROSS Hasta Serumu-Verici Eritrositi
MİNÖR CROSS Hasta Eritrositi-Verici Serumu

TARİH :………………

UYGUNLUK TESTLERİNİ YAPAN (İMZA KAŞE)

DİKKAT:
1.Uygunluk testi yapıldığını gösteren etiket torba üzerinde mutlaka bulunmalıdır. Etiketi bulunmayan kanı transfüzyonda kullanmayınız.
2.Tüm transfüzyon reaksiyonlarından Kan İstasyonunu haberdar ediniz.

<table style="border-collapse:collapse; width:882px" class=" cke_show_border" cellspacing="0"><tbody><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; vertical-align:middle; width:362px">HASTANIN ADI SOYADI</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:middle; width:341px"> </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; vertical-align:middle">KAN GRUBU</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"> </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; vertical-align:middle">UYGULANAN TESTLER</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle">SONUÇ</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; vertical-align:middle">Hbs Ag</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"> </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; vertical-align:middle">HCV</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"> </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; vertical-align:middle">HIV</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"> </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; vertical-align:middle">VDRL</td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"> </td></tr></tbody></table><table style="border-collapse:collapse; width:882px" class=" cke_show_border" cellspacing="0"><tbody><tr><td colspan="6" style="border-bottom:1px solid black; border-left:1px solid black; border-right:.7px solid black; border-top:1px solid black; height:20px; text-align:center; vertical-align:middle; width:789px">HAZIRLANAN KANLARLA İLGİLİ BİLGİLER</td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">VERİLEN KANIN ADI</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">SOYADI</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">KAN NOSU</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">ALINDIĞI TARİH</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">SON KULLANMA TARİHİ</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">KAN GRUBU</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">Hbs Ag</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">HCV</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">HIV</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">VDRL</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">MAJOR CROSS Hasta Serumu-Verici Eritrositi</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; height:20px; vertical-align:bottom; width:203px">MİNÖR CROSS Hasta Eritrositi-Verici Serumu</td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:122px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:120px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:125px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:150px"> </td><td style="border-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:bottom; width:138px"> </td></tr></tbody></table> TARİH :………………UYGUNLUK TESTLERİNİ YAPAN (İMZA KAŞE) DİKKAT: 1.Uygunluk testi yapıldığını gösteren etiket torba üzerinde mutlaka bulunmalıdır. Etiketi bulunmayan kanı transfüzyonda kullanmayınız. 2.Tüm transfüzyon reaksiyonlarından Kan İstasyonunu haberdar ediniz.

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Transfüzyon Hizmetleri - Form

TH.FR.017 - TRANSFÜZYON ÖNCESİ UYGUNLUK TESTLERİ FORMU

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