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Doküman Kodu: Dİ.FR.015

Yayın Tarihi: 14.05.2025

Revizyon Tarihi: -

Revizyon No: -

Sayfa: Otomatik

İLAÇ

.../01/20...

.../02/20...

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./04/20..

./05/20.

./06/20.

./07/20.

./08/20.

./09/20.

./10/20.

./11/20..

./12/20.

Sorumlu Uzman Adı ve Soyadı

İmza

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<meta charset="utf-8"/>
<table cellspacing="0" style="border-collapse:collapse; width:1292px">
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   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; height:32px; width:68px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">İLAÇ</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">.../01/20...</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">.../02/20...</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">.../03/20...</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">./04/20..</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">./05/20.</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">./06/20.</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">./07/20.</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">./08/20.</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">./09/20.</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">./10/20.</span></span></span></strong></p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">./11/20..</span></span></span></strong></p>
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   <td style="border-bottom:none; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:68px">
   <p style="text-align:center"><strong><span style="font-size:11pt"><span style="color:#000000"><span style="font-size:10pt">./12/20.</span></span></span></strong></p>
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   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; height:13px; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; height:13px; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; height:13px; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; height:13px; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; height:13px; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; height:13px; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p> </p>
   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:68px">
   <p> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; height:102px; vertical-align:top; width:68px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">Sorumlu Uzman Adı </span><span style="color:#000000">ve Soyadı</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:68px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:69px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:68px">
   <p style="text-align:left"><strong><span style="font-size:11pt"><span style="color:#000000">İmza</span></span></strong></p>
   </td>
  </tr>
 </tbody>
</table>