Prokalite | DİYALİZ ÜNİTESİ MORTALİTE ORANI VERİ TOPLAMA FORMU

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Demo Hastanesi (Prokalite.Com) DİYALİZ ÜNİTESİ MORTALİTE ORANI VERİ TOPLAMA FORMU

Doküman Kodu: Dİ.FR.077

Yayın Tarihi: 14.05.2025

Revizyon Tarihi: -

Revizyon No: -

Sayfa: Otomatik

AY /YIL:
Sıra No	Hastanın Adı-Soyadı	Yaşı	Cinsiyeti	Tanısı	Diyalize başlama Tarihi	Ölüm Nedeni	Ölüm Tarihi
1
2
3
4
5
6
7
8
9
10

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   <p><span style="color:#000000"><span style="font-size:12pt">AY /YIL:</span></span></p>
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   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; height:56px; width:38px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">Sıra No</span></span></p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; width:159px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">Hastanın Adı-Soyadı</span></span></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; width:116px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">Yaşı</span></span></p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; width:83px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">Cinsiyeti</span></span></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; width:124px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">Tanısı</span></span></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; width:159px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">Diyalize başlama Tarihi</span></span></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; width:136px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">Ölüm Nedeni</span></span></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; width:178px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">Ölüm Tarihi</span></span></p>
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   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">1</span></span></p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:116px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:83px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:124px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:136px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:178px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; height:28px; width:38px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">2</span></span></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:116px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:83px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:124px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:136px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:178px">
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   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; height:28px; width:38px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">3</span></span></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:116px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:83px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:124px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:136px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:178px">
   <p style="text-align:center"> </p>
   </td>
  </tr>
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   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; height:28px; width:38px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">4</span></span></p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
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   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:83px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:124px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:136px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:178px">
   <p style="text-align:center"> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; height:28px; width:38px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">5</span></span></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:116px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:83px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:124px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:136px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:178px">
   <p style="text-align:center"> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; height:28px; width:38px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">6</span></span></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:116px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:83px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:124px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:136px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:178px">
   <p style="text-align:center"> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; height:28px; width:38px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">7</span></span></p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:116px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:83px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:124px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:159px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:136px">
   <p style="text-align:center"> </p>
   </td>
   <td style="border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; width:178px">
   <p style="text-align:center"> </p>
   </td>
  </tr>
  <tr>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; height:28px; width:38px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">8</span></span></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:159px">
   <p style="text-align:center"> </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:116px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:83px">
   <p style="text-align:center"> </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:124px">
   <p style="text-align:center"> </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:159px">
   <p style="text-align:center"> </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:136px">
   <p style="text-align:center"> </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:178px">
   <p style="text-align:center"> </p>
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  </tr>
  <tr>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; height:28px; width:38px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">9</span></span></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:159px">
   <p style="text-align:center"> </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:116px">
   <p style="text-align:center"> </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:83px">
   <p style="text-align:center"> </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:124px">
   <p style="text-align:center"> </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:159px">
   <p style="text-align:center"> </p>
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   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; width:136px">
   <p style="text-align:center"> </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:178px">
   <p style="text-align:center"> </p>
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  </tr>
  <tr>
   <td style="border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; height:27px; width:38px">
   <p style="text-align:center"><span style="color:#000000"><span style="font-size:12pt">10</span></span></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:159px">
   <p style="text-align:center"> </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:116px">
   <p style="text-align:center"> </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:83px">
   <p style="text-align:center"> </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:124px">
   <p style="text-align:center"> </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:159px">
   <p style="text-align:center"> </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:136px">
   <p style="text-align:center"> </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:178px">
   <p style="text-align:center"> </p>
   </td>
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</table>