<?xml version="1.0" encoding="utf-8" standalone="no"?>
<TfrxReport Version="5.2.12" DotMatrixReport="False" EngineOptions.TempDir="C:\Users\user\AppData\Local\Temp\" IniFile="\Software\Fast Reports" PreviewOptions.Buttons="4095" PreviewOptions.Zoom="1" PrintOptions.Printer="HP LaserJet Professional CP1020 Series" PrintOptions.PrintOnSheet="0" ReportOptions.CreateDate="43000,6106140046" ReportOptions.Description.Text="" ReportOptions.LastChange="43109,4616221991" ScriptLanguage="PascalScript" ScriptText.Text="begin&#13;&#10;&#13;&#10;end.">
  <Datasets>
    <item DataSet="frxdata1" DataSetName="data2"/>
    <item DataSet="frxdata2" DataSetName="data3"/>
  </Datasets>
  <TfrxDataPage Name="Data" Height="1000" Left="0" Top="0" Width="1000"/>
  <TfrxReportPage Name="Page1" PaperWidth="210" PaperHeight="297" PaperSize="9" LeftMargin="10" RightMargin="10" TopMargin="10" BottomMargin="10" ColumnWidth="0" ColumnPositions.Text="" HGuides.Text="" VGuides.Text="">
    <TfrxReportTitle Name="ReportTitle1" FillType="ftBrush" FillGap.Top="0" FillGap.Left="0" FillGap.Bottom="0" FillGap.Right="0" Font.Charset="1" Font.Color="0" Font.Height="-15" Font.Name="Arial" Font.Style="0" Height="151,1812" Left="0" ParentFont="False" Top="18,89765" Width="718,1107">
      <TfrxMemoView Name="Memo1" Left="37,7953" Top="3,77953" Width="668,97681" Height="18,89765" Font.Charset="1" Font.Color="-16777208" Font.Height="-15" Font.Name="Arial" Font.Style="1" HAlign="haCenter" ParentFont="False" Text="İZLEM/AŞI BİLDİRİM TUTANAĞI"/>
      <TfrxMemoView Name="Memo2" Left="11,33859" Top="30,23624" Width="695,43352" Height="117,16543" Font.Charset="1" Font.Color="-16777208" Font.Height="-15" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Aile Hekimliği Bilgi Sisteminde Kesin Kayıtlı olan T.C:[data3.&#34;TCKIMLIKNO&#34;] kimlik numaralı [&#60;data3.&#34;ADI&#34;&#62; ] [data3.&#34;SOYADI&#34;] isimli çocuğumun aşağıda yapılma tarihleri belirtilen aşılarının/izlemlerinin [data3.&#34;ASMADI&#34;] Aile Sağlığı Merkezi [data3.&#34;AHKODU&#34;] nolu aile hekimliği biriminde yaptıracağımı beyan ederim.. Aile hekimimize hangi tarihlerde gelmemiz gerektiği tarafıma tebliğ edilmiştir Aşağıda tarihleri belirtilen aşı/izlemlere çocuğumu getirmediğim zaman tüm sorumluluğu kabul ediyorum.Bu tutanağın bir nüshası tarafıma verilmiştir.">
        <Formats>
          <item/>
          <item/>
          <item/>
          <item/>
          <item/>
        </Formats>
      </TfrxMemoView>
    </TfrxReportTitle>
    <TfrxMasterData Name="MasterData1" FillType="ftBrush" FillGap.Top="0" FillGap.Left="0" FillGap.Bottom="0" FillGap.Right="0" Height="15,11812" Left="0" Top="306,14193" Width="718,1107" AllowSplit="True" ColumnWidth="0" ColumnGap="0" DataSet="frxdata1" DataSetName="data2" RowCount="0" Stretched="True">
      <TfrxMemoView Name="Memo7" Left="7,55906" Top="0" Width="498,89796" Height="15,11812" StretchMode="smMaxHeight" DataField="ISLEMADI" DataSet="frxdata1" DataSetName="data2" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" Frame.Typ="15" ParentFont="False" VAlign="vaCenter" Text="[data2.&#34;ISLEMADI&#34;]"/>
      <TfrxMemoView Name="Memo8" Left="506,45702" Top="0" Width="102,04731" Height="15,11812" StretchMode="smMaxHeight" DataField="ILKTARIH" DataSet="frxdata1" DataSetName="data2" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" Frame.Typ="15" ParentFont="False" VAlign="vaCenter" Text="[data2.&#34;ILKTARIH&#34;]"/>
      <TfrxMemoView Name="Memo9" Left="608,50433" Top="0" Width="102,04731" Height="15,11812" StretchMode="smMaxHeight" DataField="SONTARIH" DataSet="frxdata1" DataSetName="data2" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" Frame.Typ="15" ParentFont="False" VAlign="vaCenter" Text="[data2.&#34;SONTARIH&#34;]"/>
    </TfrxMasterData>
    <TfrxReportSummary Name="ReportSummary1" FillType="ftBrush" FillGap.Top="0" FillGap.Left="0" FillGap.Bottom="0" FillGap.Right="0" Height="197,31509" Left="0" Top="381,73253" Width="718,1107">
      <TfrxMemoView Name="Memo10" Left="3,77953" Top="0" Width="468,66172" Height="18,89765" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="Bu tutanak aşağıda isimleri yazılı kişilerce imza altına alınmıştır."/>
      <TfrxMemoView Name="Memo11" Left="11,33859" Top="29,23624" Width="120,94496" Height="15,11812" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="ASE (ebe)"/>
      <TfrxMemoView Name="Memo12" Left="11,33859" Top="47,91342" Width="120,94496" Height="11,33859" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Aile Hekimliği Birimi"/>
      <TfrxMemoView Name="Memo13" Left="11,33859" Top="62,25201" Width="117,16543" Height="11,33859" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Tarih "/>
      <TfrxMemoView Name="Memo14" Left="11,33859" Top="77,14966" Width="117,16543" Height="15,11812" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="İmza "/>
      <TfrxMemoView Name="Memo15" Left="355,27582" Top="30,01577" Width="120,94496" Height="15,11812" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Aile Hekimi "/>
      <TfrxMemoView Name="Memo16" Left="355,27582" Top="48,69295" Width="120,94496" Height="11,33859" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Aile Hekimliği Birimi"/>
      <TfrxMemoView Name="Memo17" Left="355,27582" Top="63,03154" Width="120,94496" Height="11,33859" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Tarih "/>
      <TfrxMemoView Name="Memo18" Left="355,27582" Top="77,92919" Width="120,94496" Height="15,11812" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="İmza "/>
      <TfrxMemoView Name="Memo19" Left="11,33859" Top="98,26778" Width="377,953" Height="18,8976378" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Kişinin Kendisi veya  veya Çocuğun Annesi/Babası/Vasisi "/>
      <TfrxMemoView Name="Memo20" Left="11,33859" Top="117,94496" Width="166,29932" Height="18,8976378" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Telefon Numarası "/>
      <TfrxMemoView Name="Memo21" Left="11,33859" Top="136,84261" Width="166,29932" Height="41,5748178" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Adres       "/>
      <TfrxMemoView Name="Memo22" Left="11,33859" Top="178,41744" Width="166,29932" Height="18,89765" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Tarih "/>
      <TfrxMemoView Name="data3ADRES" Left="177,63791" Top="136,84261" Width="529,1342" Height="41,5748178" DataField="ADRES" DataSet="frxdata2" DataSetName="data3" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data3.&#34;ADRES&#34;]"/>
      <TfrxMemoView Name="data3TELEFON" Left="177,63791" Top="117,94496" Width="302,3624" Height="18,8976378" DataSet="frxdata2" DataSetName="data3" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data3.&#34;TELEFON&#34;] [data3.&#34;CEPTEL&#34;]">
        <Formats>
          <item/>
          <item/>
        </Formats>
      </TfrxMemoView>
      <TfrxMemoView Name="data3ADI" Left="411,96877" Top="98,26778" Width="302,3624" Height="18,8976378" DataSet="frxdata2" DataSetName="data3" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data3.&#34;ANAADI&#34;] [data3.&#34;SOYADI&#34;]">
        <Formats>
          <item/>
          <item/>
        </Formats>
      </TfrxMemoView>
      <TfrxMemoView Name="Memo23" Left="177,63791" Top="178,41744" Width="238,11039" Height="18,89765" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="[Date] [Time]">
        <Formats>
          <item/>
          <item/>
        </Formats>
      </TfrxMemoView>
      <TfrxMemoView Name="DUZENLEYEN" Left="136,06308" Top="29,23624" Width="211,65368" Height="15,11812" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="[data3.&#34;ASEADISOYADI&#34;]"/>
      <TfrxMemoView Name="Memo25" Left="136,06308" Top="47,91342" Width="211,65368" Height="11,33859" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="[data3.&#34;AHKODU&#34;]"/>
      <TfrxMemoView Name="Memo26" Left="136,06308" Top="62,25201" Width="211,65368" Height="11,33859" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="[Date] [Time]"/>
      <TfrxMemoView Name="ONAYLAYAN" Left="479,00031" Top="30,01577" Width="226,7718" Height="15,11812" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="[data3.&#34;HEKIMADISOYADI&#34;]"/>
      <TfrxMemoView Name="Memo27" Left="479,00031" Top="48,69295" Width="226,7718" Height="11,33859" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="[data3.&#34;AHKODU&#34;]"/>
      <TfrxMemoView Name="Memo28" Left="479,00031" Top="63,03154" Width="226,7718" Height="11,33859" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="[Date] [Time]"/>
      <TfrxMemoView Name="Memo24" Left="136,06308" Top="77,70872" Width="211,65368" Height="15,11812" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="..............................."/>
      <TfrxMemoView Name="Memo29" Left="480,00031" Top="77,70872" Width="226,7718" Height="15,11812" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="..............................."/>
    </TfrxReportSummary>
    <TfrxGroupHeader Name="GroupHeader1" FillType="ftBrush" FillGap.Top="0" FillGap.Left="0" FillGap.Bottom="0" FillGap.Right="0" Height="52,91342" Left="0" Top="230,55133" Width="718,1107" Condition="&#60;data2.&#34;LISTE&#34;&#62;" KeepTogether="True">
      <TfrxMemoView Name="Memo4" Left="7,55906" Top="30,23624" Width="498,89796" Height="18,1417322834646" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" Frame.Typ="15" ParentFont="False" VAlign="vaCenter" Text="İZLEM NO"/>
      <TfrxMemoView Name="Memo5" Left="506,45702" Top="30,23624" Width="102,04731" Height="18,1417322834646" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" Frame.Typ="15" ParentFont="False" VAlign="vaCenter" Text="İLK TARİH"/>
      <TfrxMemoView Name="Memo6" Left="608,50433" Top="30,23624" Width="102,04731" Height="18,1417322834646" Font.Charset="1" Font.Color="-16777208" Font.Height="-12" Font.Name="Arial" Font.Style="0" Frame.Typ="15" ParentFont="False" VAlign="vaCenter" Text="SON TARİH"/>
      <TfrxSysMemoView Name="SysMemo1" Left="7,55906" Top="9,55906" Width="702,99258" Height="18,89765" Font.Charset="1" Font.Color="-16777208" Font.Height="-13" Font.Name="Arial" Font.Style="1" ParentFont="False" Text="[(&#60;data2.&#34;LISTE&#34;&#62;)]"/>
    </TfrxGroupHeader>
  </TfrxReportPage>
</TfrxReport>
