Prokalite | HASTA SON DURUM LİSTESİ FORMU

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Afet ve Acil Durum Yönetimi - Form

AD.FR.012 - HASTA SON DURUM LİSTESİ FORMU

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Demo Hastanesi (Prokalite.Com) HASTA SON DURUM LİSTESİ FORMU

Doküman Kodu: AD.FR.012

Yayın Tarihi: 08.12.2016

Revizyon Tarihi: 02.11.2021

Revizyon No: 1

Sayfa: Otomatik

Olay Adı:
Olay Başlangıç Tarih ve Saati - Olay Bitiş Tarih ve Saati:
Sıra No	Protokol No	Ad Soyad/Eşgal	TC Kimlik No	Cinsiyet	Yaş	Triyaj	İstanilen Tetkikler	Ameliyata Sevk Saati	Sonuç ve saati (Taburcu, Yatış, Sevk, Morg)	Açıklama
Sıra No	Protokol No	Ad Soyad/Eşgal	TC Kimlik No	(K/E)	Yaş	Kodu	(USG, CT, Anjio vb.)	Ameliyata Sevk Saati	Sonuç ve saati (Taburcu, Yatış, Sevk, Morg)	Açıklama
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DÜZENLEYEN AD SOYAD UNVAN			ONAYLAYAN AD SOYAD UNVAN
İMZA			İMZA

*Bu Form farklı birimler tarafından doldurulan Hasta Takip Listesi Formlarının birleştirilmesi ile oluşturulur. Hastane Olay İstatistik Formu ile uyumlu olmalıdır.

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<table style="border-collapse:collapse; height:459px; width:1292px" class=" cke_show_border" cellspacing="0"><tbody><tr><td colspan="3" style="border-color:black; border-style:double solid solid double; border-width:3px 1px 1px 3px; vertical-align:middle; width:296px"><span style="font-size:12px"><span style="color:red"><strong>Olay Adı:</strong></span></span></td><td colspan="8" style="border-color:black black black currentcolor; border-style:double double solid none; border-width:3px 3px 1px medium; vertical-align:middle; width:929px"><br></td></tr><tr><td colspan="3" style="border-color:black; border-style:solid solid solid double; border-width:1px 1px 1px 3px; vertical-align:middle; width:296px"><span style="font-size:12px"><span style="color:red"><strong>Olay Başlangıç Tarih ve Saati - Olay Bitiş Tarih ve Saati:</strong></span></span></td><td colspan="8" style="border-color:black black black currentcolor; border-style:solid double solid none; border-width:1px 3px 1px medium; vertical-align:middle; width:929px"><br></td></tr><tr><td rowspan="2" style="background-color:#c6c8ca; border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black"><strong>Sıra No</strong></span></span></td><td rowspan="2" style="background-color:#c6c8ca; border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; text-align:left; vertical-align:middle; width:74px"><span style="font-size:12px"><span style="color:black"><strong>Protokol No</strong></span></span></td><td rowspan="2" style="background-color:#c6c8ca; border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; text-align:left; vertical-align:middle; width:159px"><span style="font-size:12px"><span style="color:black"><strong>Ad Soyad/Eşgal</strong></span></span></td><td rowspan="2" style="background-color:#c6c8ca; border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; vertical-align:middle; width:142px"><span style="font-size:12px"><span style="color:black"><strong>TC Kimlik No</strong></span></span></td><td style="background-color:#c6c8ca; border-bottom:none; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:12px"><span style="color:black"><strong>Cinsiyet</strong></span></span></td><td rowspan="2" style="background-color:#c6c8ca; 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:12px"><span style="color:black"><strong>Yaş</strong></span></span></td><td style="background-color:#c6c8ca; border-bottom:none; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:12px"><span style="color:black"><strong>Triyaj </strong></span></span></td><td style="background-color:#c6c8ca; border-bottom:none; border-left:none; border-right:1px solid black; border-top:none; text-align:left; vertical-align:middle"><span style="font-size:12px"><span style="color:black"><strong>İstanilen Tetkikler</strong></span></span></td><td rowspan="2" style="background-color:#c6c8ca; border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; vertical-align:middle; width:75px"><span style="font-size:12px"><span style="color:black"><strong>Ameliyata Sevk Saati</strong></span></span></td><td rowspan="2" style="background-color:#c6c8ca; border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; text-align:center; vertical-align:middle; width:176px"><span style="font-size:12px"><span style="color:black"><strong>Sonuç ve saati (Taburcu, Yatış, Sevk, Morg)</strong></span></span></td><td rowspan="2" style="background-color:#c6c8ca; border-color:currentcolor black black; border-style:none double solid solid; border-width:medium 3px 1px 1px; text-align:left; vertical-align:middle; width:255px"><span style="font-size:12px"><span style="color:black"><strong>Açıklama</strong></span></span></td></tr><tr><td style="background-color:#c6c8ca; border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:12px"><span style="color:black"><strong>(K/E)</strong></span></span></td><td style="background-color:#c6c8ca; border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><span style="font-size:12px"><span style="color:black"><strong>Kodu</strong></span></span></td><td style="background-color:#c6c8ca; border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:left; vertical-align:middle"><span style="font-size:12px"><span style="color:black"><strong>(USG, CT, Anjio vb.)</strong></span></span></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">1</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">2</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">3</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">4</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">5</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">6</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">7</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">8</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">9</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">10</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">11</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">12</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">13</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:1px solid black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">14</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; width:74px"><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; width:159px"><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; width:142px"><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-color:currentcolor black black currentcolor; border-style:none solid solid none; border-width:medium 1px 1px medium; vertical-align:middle; width:75px"><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; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double solid none; border-width:medium 3px 1px medium; vertical-align:middle; width:255px"><br></td></tr><tr><td style="border-bottom:3px double black; border-left:3px double black; border-right:1px solid black; border-top:none; text-align:center; vertical-align:middle"><span style="font-size:12px"><span style="color:black">15</span></span></td><td style="border-color:currentcolor black black currentcolor; border-style:none solid double none; border-width:medium 1px 3px medium; vertical-align:middle; width:74px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none solid double none; border-width:medium 1px 3px medium; vertical-align:middle; width:159px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none solid double none; border-width:medium 1px 3px medium; vertical-align:middle; width:142px"><br></td><td style="border-bottom:3px double black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:3px double black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:3px double black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-bottom:3px double black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:middle"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none solid double none; border-width:medium 1px 3px medium; vertical-align:middle; width:75px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none solid double none; border-width:medium 1px 3px medium; vertical-align:middle; width:176px"><br></td><td style="border-color:currentcolor black black currentcolor; border-style:none double double none; border-width:medium 3px 3px medium; vertical-align:middle; width:255px"><br></td></tr></tbody></table><p><br></p><table style="border-collapse: collapse; width: 1292px;" class=" cke_show_border" cellspacing="0"><tbody><tr><td style="border-color:black; border-style:solid; border-width:1px; vertical-align:middle; width:201px"><span style="font-size:13px"><span style="color:black">DÜZENLEYEN AD SOYAD UNVAN</span></span></td><td style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:258px"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-color:black; border-style:solid; border-width:1px; vertical-align:middle; width:189px"><span style="font-size:13px"><span style="color:black">ONAYLAYAN AD SOYAD UNVAN</span></span></td><td style="border-color:black black black currentcolor; border-style:solid solid solid none; border-width:1px 1px 1px medium; vertical-align:middle; width:248px"><br></td></tr><tr><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; vertical-align:middle; width:201px"><span style="font-size:13px"><span style="color:black">İMZA</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; width:258px"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-color:currentcolor black black; border-style:none solid solid; border-width:medium 1px 1px; vertical-align:middle; width:189px"><span style="font-size:13px"><span style="color:black">İMZA</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; width:248px"><p><br></p></td></tr><tr><td style="border-color:currentcolor; border-style:none; border-width:medium; vertical-align:bottom; width:202px"><br></td><td style="border-color:currentcolor; border-style:none; border-width:medium; vertical-align:bottom; width:259px"><br></td><td style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:bottom"><br></td><td style="border-color:currentcolor; border-style:none; border-width:medium; vertical-align:bottom; width:190px"><br></td><td style="border-color:currentcolor; border-style:none; border-width:medium; vertical-align:bottom; width:248px"><br></td></tr><tr><td colspan="5" style="border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:middle"><span style="font-size:13px"><span style="color:black">*Bu Form farklı birimler tarafından doldurulan Hasta Takip Listesi Formlarının birleştirilmesi ile oluşturulur. Hastane Olay İstatistik Formu ile uyumlu olmalıdır.</span></span></td></tr></tbody></table><p><br></p>