PB.FR.004 - PALYATİF BAKIM SERVİSİ HASTA DEĞERLENDİRME FORMU

Doküman Kodu: PB.FR.004
Yayın Tarihi: 20.11.2017
Revizyon Tarihi: 12.04.2023
Revizyon No: 2
Paylaş:
DİKKAT! Buradaki bilgiler sağlık profesyonelleri için hazırlanmıştır. Arama motorları vs. ile bu sayfadaki bilgilere ulaştıysanız, sağlık profesyonellerine danışmadan, sadece buradaki bilgiler ile hareket etmeyiniz.
Doküman Önizlemesi

(Logonuz Burada)
Demo Hastanesi (Prokalite.Com) PALYATİF BAKIM SERVİSİ HASTA DEĞERLENDİRME FORMU
Doküman Kodu: PB.FR.004
Yayın Tarihi: 20.11.2017
Revizyon Tarihi: 12.04.2023
Revizyon No: 2
Sayfa: Otomatik
Adı:				Tanı:
Soyadı:				Kilo: Boy: Oda No:
TC:				Beslenme Tipi:
Yaş:				Apache 2:
TARİH
…./..../…...
GKS
Ağrı Skalası (1...10)
Bulantı (1...10)
Kusma (1...10)
İştah (1...10)
Halsizlik (1...10)
Dispne (1...10)
Ankisiyete (1...10)
Depresyon (1...10)
Kendini İyi His. (1...10)
Uyku Kalitesi (1...10)
Kabızlık (1...10)
İshal (1...10)
Kasıntı (1...10)
Palyatif Bakım Kliniği bölümündeki diğer form örnekleri

Tümünü gör (9)
PB.FR.002 PALYATİF SERVİSİ HASTA VE HASTA YAKINI EĞİTİM FORMU PB.FR.003 PALYATİF BAKIM SERVİSİ İNVAZİV ARAÇ SÜRVEYANSI YAPILAN SERVİSLER PAYDA GİRİŞ FORMU PB.FR.005 PALYATİF BAKIM SERVİSİ POZİSYON VE MOBİLİZASYON KAYIT FORMU PB.FR.006 PALYATİF BAKIM SERVİSİ KÜLTÜR ALINAN BÖLGE KAYIT FORMU PB.FR.007 PALYATİF BAKIM SERVİSİ KATETER BAKIM VE İZLEM FORMU PB.FR.008 PALYATİF BAKIM SERVİSİ GÜNLÜK HASTA BAKIM FORMU PB.FR.009 PALYATİF HASTA EDMONTON SEMPTOM TANILAMA ÖLÇEĞİ PB.FR.010 PALYATİF KARNOFSKY PERFORMANS SKALASI
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<p><br></p><table style="border-collapse: collapse; width: 1292px;" class=" cke_show_border" cellspacing="0"><tbody><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><span style="font-size:16px"><strong><span style="color:black">Adı:</span></strong></span></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Tanı:</span></strong></span></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><strong><span style="font-size:14px"><span style="color:black">Soyadı: </span></span></strong></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td colspan="5" style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Kilo: Boy: Oda No: </span></strong></span></td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><span style="font-size:16px"><strong><span style="color:black">TC:</span></strong></span></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td colspan="2" style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:middle"><span style="font-size:16px"><strong><span style="color:black">Beslenme Tipi:</span></strong></span><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td></tr><tr><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><strong><span style="font-size:14px"><span style="color:black">Yaş:</span></span></strong></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td colspan="2" style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><span style="font-size:16px"><strong><span style="color:black">Apache 2:</span></strong></span></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td></tr></tbody></table><table style="border-collapse: collapse; width: 1292px;" 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; vertical-align:middle"><span style="font-size:13px"><strong><span style="color:black">TARİH</span></strong></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; text-align:center; vertical-align:middle"><span style="font-size:10px"><em><span style="color:black">…./..../…...</span></em></span></td></tr><tr><td style="border-color: currentcolor black black; border-style: none solid solid; border-width: medium 1px 1px; vertical-align: middle; height: 25px;"><span style="font-size:16px"><span style="color:black">GKS</span></span></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td><td style="border-color: currentcolor black black currentcolor; border-style: none solid solid none; border-width: medium 1px 1px medium; vertical-align: middle; height: 25px;"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Ağrı Skalası (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Bulantı (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kusma (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">İştah (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Halsizlik (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Dispne (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Ankisiyete (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Depresyon (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:14px"><span style="color:black">Kendini İyi His. (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Uyku Kalitesi (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kabızlık (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">İshal (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:16px"><span style="color:black">Kasıntı (1...10)</span></span></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td></tr></tbody></table>