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Demo Hastanesi (Prokalite.Com) HASTA İZİN BELGESİ

Doküman Kodu: HB.YD.007

Yayın Tarihi: 03.10.2011

Revizyon Tarihi: 17.11.2022

Revizyon No: 6

Sayfa: Otomatik

T.C. Sağlık Bakanlığı ....................... Hastanesi Hasta İzin Belgesi
Servisi:		Ayrılış Tarih Saat:
Adı Soyadı:		Dönüş Tarih Saat:
Baba Adı:		Hekimi:
Niçin Ayrıldığı:
(İmza ve Mühür) Baştabip ..../..../.......

✄.........................................

T.C. Sağlık Bakanlığı ....................... Hastanesi Hasta İzin Belgesi
Servisi:		Ayrılış Tarih Saat:
Adı Soyadı:		Dönüş Tarih Saat:
Baba Adı:		Hekimi:
Niçin Ayrıldığı:
(İmza ve Mühür) Baştabip ..../..../.......

✄.........................................

T.C. Sağlık Bakanlığı ....................... Hastanesi Hasta İzin Belgesi
Servisi:		Ayrılış Tarih Saat:
Adı Soyadı:		Dönüş Tarih Saat:
Baba Adı:		Hekimi:
Niçin Ayrıldığı:
(İmza ve Mühür) Baştabip ..../..../.......

<table style="border-collapse:collapse; width:882px" class=" cke_show_border" cellspacing="0"><tbody><tr><td colspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:56px; text-align:center; vertical-align:middle; width:616px">T.C. Sağlık Bakanlığı ....................... Hastanesi Hasta İzin Belgesi </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:93px">Servisi:</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:440px"> </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:124px">Ayrılış Tarih Saat:</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:211px"> </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:93px">Adı Soyadı:</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:440px"> </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:124px">Dönüş Tarih Saat:</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:211px"> </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:93px">Baba Adı:</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:440px"> </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:124px">Hekimi: </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:211px"> </td></tr><tr><td colspan="4" style="border-color:black; border-style:solid; border-width:1px; height:47px; text-align:left; vertical-align:top">Niçin Ayrıldığı:</td></tr><tr><td colspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:57px; text-align:center; vertical-align:bottom; width:616px">(İmza ve Mühür) Baştabip ..../..../.......</td></tr></tbody></table>✄.........................................<table style="border-collapse:collapse; width:882px" class=" cke_show_border" cellspacing="0"><tbody><tr><td colspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:56px; text-align:center; vertical-align:middle; width:616px">T.C. Sağlık Bakanlığı ....................... Hastanesi Hasta İzin Belgesi</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:93px">Servisi:</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:440px"> </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:124px">Ayrılış Tarih Saat:</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:211px"> </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:93px">Adı Soyadı:</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:440px"> </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:124px">Dönüş Tarih Saat:</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:211px"> </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:93px">Baba Adı:</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:440px"> </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:124px">Hekimi: </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:211px"> </td></tr><tr><td colspan="4" style="border-color:black; border-style:solid; border-width:1px; height:47px; text-align:left; vertical-align:top">Niçin Ayrıldığı:</td></tr><tr><td colspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:57px; text-align:center; vertical-align:bottom; width:616px">(İmza ve Mühür) Baştabip ..../..../.......</td></tr></tbody></table>✄.........................................<table style="border-collapse:collapse; width:882px" class=" cke_show_border" cellspacing="0"><tbody><tr><td colspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:56px; text-align:center; vertical-align:middle; width:616px">T.C. Sağlık Bakanlığı ....................... Hastanesi Hasta İzin Belgesi</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:93px">Servisi:</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:440px"> </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:124px">Ayrılış Tarih Saat:</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:211px"> </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:93px">Adı Soyadı:</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:440px"> </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:124px">Dönüş Tarih Saat:</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:211px"> </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:93px">Baba Adı:</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:440px"> </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:124px">Hekimi: </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:211px"> </td></tr><tr><td colspan="4" style="border-color:black; border-style:solid; border-width:1px; height:47px; text-align:left; vertical-align:top">Niçin Ayrıldığı:</td></tr><tr><td colspan="4" style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:57px; text-align:center; vertical-align:bottom; width:616px">(İmza ve Mühür) Baştabip ..../..../.......</td></tr></tbody></table>

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Hasta Bakımı - Yardımcı Doküman

HB.YD.007 - HASTA İZİN BELGESİ

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