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Dİ.FR.022 - DİYALİZ HASTA KABUL FORMU

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Doküman Kodu: Dİ.FR.022

Yayın Tarihi: 14.05.2025

Revizyon Tarihi: -

Revizyon No: -

Sayfa: Otomatik


	DİYALİZAT TÜRÜ\|

*DİYALİZAT*		TİPİ		Na		K	Ca


DİYALİZER			TİPİ		Kuf	Metrekare)


Kan akim hiz\|

DİYALİZAT AKIM HIZ\|

Seans SÜRESİ

Uf MİKTARI

	HEPARİN UYGULAMASI

	DİYALİZ SIRASINDA UYGULANACAK TEDAVİ
	KULLANACAĞI İLAÇLAR

EK NOT

SORUMLU HEKİM

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   <p style="text-align:center"><strong><span style="font-size:14px"><u><span style="color:#000000">DİYALİZAT TÜRÜ|</span></u></span></strong></p>
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   <p style="text-align:left"><strong><span style="font-size:14px"><span style="color:#000000"><em>DİYALİZAT</em></span></span></strong></p>
   </td>
   <td colspan="2" style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:129px">
   <p style="text-align:center"><strong><span style="font-size:14px"><span style="color:#000000">TİPİ</span></span></strong></p>
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   <p style="text-align:center"><strong><span style="font-size:14px"><span style="color:#000000">Na</span></span></strong></p>
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   <p style="text-align:center"><strong><span style="font-size:14px"><span style="color:#000000">K</span></span></strong></p>
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   <p style="text-align:center"><strong><span style="font-size:14px"><span style="color:#000000">Ca</span></span></strong></p>
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   <p> </p>
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   <p> </p>
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   <p> </p>
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   <p style="text-align:left"><strong><span style="font-size:14px"><u><span style="color:#000000">DİYALİZER</span></u></span></strong></p>
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   <td colspan="2" style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:125px">
   <p style="text-align:center"><strong><span style="font-size:14px"><u><span style="color:#000000">TİPİ</span></u></span></strong></p>
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   <p style="text-align:center"><strong><span style="font-size:14px"><u><span style="color:#000000">Kuf</span></u></span></strong></p>
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   <td colspan="2" style="border-bottom:none; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:204px">
   <p style="text-align:center"><strong><span style="font-size:14px"><u><span style="color:#000000">Metrekare)</span></u></span></strong></p>
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   <p> </p>
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   <p> </p>
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   <p> </p>
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   <p style="text-align:left"><strong><span style="font-size:14px"><u><span style="color:#000000">Kan akim hiz|</span></u></span></strong></p>
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   <p style="text-align:left"><strong><span style="font-size:14px"><u><span style="color:#000000">DİYALİZAT </span><span style="color:#000000">AKIM HIZ|</span></u></span></strong></p>
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   <p style="text-align:left"><strong><span style="font-size:14px"><u><span style="color:#000000">Seans</span><span style="color:#000000"> SÜRESİ</span></u></span></strong></p>
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   <p> </p>
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   <p style="text-align:left"><strong><span style="font-size:14px"><u><span style="color:#000000">Uf</span><span style="color:#000000"> MİKTARI</span></u></span></strong></p>
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   </td>
   <td style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:140px">
   <p style="text-align:left"><strong><span style="font-size:14px"><span style="color:#000000">HEPARİN UYGULAMASI</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; vertical-align:top; width:11px">
   <p> </p>
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   <p> </p>
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   <td colspan="2" style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; width:165px">
   <p style="text-align:left"><strong><span style="font-size:14px"><span style="color:#000000">DİYALİZ SIRASINDA UYGULANACAK TEDAVİ</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:140px">
   <p style="text-align:left"><strong><span style="font-size:14px"><span style="color:#000000">KULLANACAĞI İLAÇLAR</span></span></strong></p>
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   <p> </p>
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   <p> </p>
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   <p style="text-align:center"><strong><span style="font-size:14px"><u><span style="color:#000000">EK NOT</span></u></span></strong></p>
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   <p> </p>
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   <p> </p>
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   <td colspan="3" style="border-bottom:none; border-left:1px solid #000000; border-right:none; border-top:1px solid #000000; height:5px; width:200px">
   <p style="text-align:left"><strong><span style="font-size:14px"><u><span style="color:#000000">SORUMLU HEKİM</span></u></span></strong></p>
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   <p> </p>
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