<?xml version="1.0" encoding="utf-8" standalone="no"?>
<TfrxReport Version="4.10.5" DotMatrixReport="False" IniFile="\Software\Fast Reports" PreviewOptions.Buttons="4095" PreviewOptions.Zoom="1" PrintOptions.Printer="Default" PrintOptions.PrintOnSheet="0" ReportOptions.CreateDate="39246,6896357755" ReportOptions.Description.Text="" ReportOptions.LastChange="40899,6629732986" ScriptLanguage="PascalScript" ScriptText.Text="begin&#13;&#10;&#13;&#10;end." PropData="044C65667403E00103546F7002080844617461736574730101062620446174615365743D22667278646174612220446174615365744E616D653D226461746131220001062720446174615365743D2266727864617461312220446174615365744E616D653D226461746132220000095661726961626C65730100055374796C650100">
  <TfrxDataPage Name="Data" Height="1000" Left="0" Top="0" Width="1000"/>
  <TfrxReportPage Name="Page1" PaperWidth="148" PaperHeight="210" PaperSize="11" LeftMargin="1" RightMargin="1" TopMargin="1" BottomMargin="1" ColumnWidth="0" ColumnPositions.Text="" HGuides.Text="" VGuides.Text="">
    <TfrxReportTitle Name="ReportTitle1" Font.Charset="1" Font.Color="0" Font.Height="-8" Font.Name="Arial" Font.Style="0" Height="336,14413037" Left="0" ParentFont="False" Top="18,89765" Width="551,81138">
      <TfrxMemoView Name="Memo45" Left="231,6078212" Top="167,37794787" Width="307,275590551181" Height="71,81102362" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="0" Frame.Typ="15" ParentFont="False" Text=""/>
      <TfrxMemoView Name="Memo88" Left="13,00136769" Top="239,52752" Width="525,35423795" Height="57,38962538" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="0" Frame.Typ="15" ParentFont="False" Text=""/>
      <TfrxMemoView Name="sicilno" Left="12,78089769" Top="167,37794787" Width="219,21258866" Height="71,81102362" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="0" Frame.Typ="15" ParentFont="False" Text=""/>
      <TfrxMemoView Name="hastaad" Left="13,22183769" Top="100,75778223" Width="525,35423795" Height="66,81431667" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="0" Frame.Typ="15" ParentFont="False" Text=""/>
      <TfrxMemoView Name="baslik" Left="13,01575291" Top="2,14764999" Width="525,35421843" Height="63,70521556" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Times New Roman" Font.Style="1" HAlign="haCenter" ParentFont="False" VAlign="vaBottom" Text="T.C.&#13;&#10;SAĞLIK BAKANLIĞI&#13;&#10;ANKARA İL SAĞLIK MÜDÜRLÜĞÜ&#13;&#10;ÇANKAYA TSM"/>
      <TfrxMemoView Name="Memo4" Left="31,5905585" Top="257,9448648" Width="74,54440846" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Hekim Tercihi"/>
      <TfrxMemoView Name="Memo5" Left="13,55675282" Top="115,85863778" Width="69,40419556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Adı Soyadı"/>
      <TfrxMemoView Name="Memo7" Left="13,22183769" Top="171,64517666" Width="214,81859444" Height="14,03653889" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="       KAYITLI OLDUĞU AİLE HEKİMİNİN"/>
      <TfrxMemoView Name="calistigikurum" Left="13,22183769" Top="100,41419333" Width="445,58962111" Height="14,03653889" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="       MÜRACAAT EDEN KİŞİYE AİT BİLGİLER"/>
      <TfrxMemoView Name="raportarihi" Left="442,70606684" Top="190,15790555" Width="91,12138827" Height="47,60935889" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="ONAY&#13;&#10;&#13;&#10;İMZA / KAŞE"/>
      <TfrxMemoView Name="Memo40" Left="13,01575291" Top="65,79055888" Width="525,35421843" Height="14,87863333" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="1" HAlign="haCenter" ParentFont="False" Text="AİLE HEKİMİ DEĞİŞTİRME TALEP DİLEKÇESİ"/>
      <TfrxMemoView Name="Memo1" Left="13,01575291" Top="83,44513447" Width="525,35421843" Height="16,19970111" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="arial" Font.Style="1" Frame.Typ="7" ParentFont="False" VAlign="vaCenter" Text="      A- BAŞVURU YAPACAK KİŞİ TARAFINDAN DOLDURULACAK"/>
      <TfrxMemoView Name="Memo13" Left="13,55675282" Top="132,04993834" Width="69,40419556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Ev Telefonu"/>
      <TfrxMemoView Name="Memo14" Left="13,55675282" Top="149,24123889" Width="69,40419556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Cep Telefonu"/>
      <TfrxMemoView Name="Memo17" Left="83,04273504" Top="115,85863778" Width="5,15218556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo18" Left="83,04273504" Top="132,04993834" Width="5,15218556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo19" Left="83,04273504" Top="149,24123889" Width="5,15218556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo20" Left="88,54273504" Top="115,85863778" Width="168,01530667" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data1.&#34;ADI&#34;] [data1.&#34;SOYADI&#34;]"/>
      <TfrxMemoView Name="Memo21" Left="88,54273504" Top="132,04993834" Width="168,01530667" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data1.&#34;MTELEFON&#34;]"/>
      <TfrxMemoView Name="Memo22" Left="88,54273504" Top="149,24123889" Width="168,01530667" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data1.&#34;MCEPTEL&#34;]"/>
      <TfrxMemoView Name="Memo23" Left="258,18162393" Top="116,10235" Width="88,30184556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="MAHALLE / KÖY"/>
      <TfrxMemoView Name="Memo24" Left="258,18162393" Top="132,29365056" Width="88,30184556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="CADDE / SOKAK"/>
      <TfrxMemoView Name="Memo25" Left="258,18162393" Top="149,48495111" Width="88,30184556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="APARTMAN"/>
      <TfrxMemoView Name="Memo26" Left="346,66760615" Top="116,10235" Width="8,93171556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo27" Left="346,66760615" Top="132,29365056" Width="8,93171556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo28" Left="346,66760615" Top="149,48495111" Width="8,93171556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo29" Left="356,16760615" Top="116,10235" Width="181,52906667" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data1.&#34;MAHALLEADI&#34;]"/>
      <TfrxMemoView Name="Memo30" Left="356,16760615" Top="132,29365056" Width="181,52906667" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data1.&#34;SOKAKADI&#34;]"/>
      <TfrxMemoView Name="Memo31" Left="356,02871726" Top="149,48495111" Width="110,99103334" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data1.&#34;MAPARTMAN&#34;]"/>
      <TfrxMemoView Name="Memo32" Left="467,98717948" Top="149,46346111" Width="23,47902556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="NO"/>
      <TfrxMemoView Name="Memo33" Left="492,9731617" Top="149,46346111" Width="8,93171556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo34" Left="503,94538392" Top="149,00675111" Width="34,22701556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data1.&#34;MNO&#34;]"/>
      <TfrxMemoView Name="Memo35" Left="13,55675282" Top="190,15790555" Width="69,40419556" Height="15,11811024" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Adı Soyadı"/>
      <TfrxMemoView Name="Memo36" Left="83,04273504" Top="190,15790555" Width="5,15218556" Height="15,11811024" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo37" Left="88,54273504" Top="190,15790555" Width="141,55859667" Height="15,11811024" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data1.&#34;KAYITLIOLDAHADI&#34;] [data1.&#34;KAYITLIOLDAHSOYADI&#34;]"/>
      <TfrxMemoView Name="Memo38" Left="13,55675282" Top="206,29679444" Width="69,40419556" Height="15,11811024" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Bölge Kodu"/>
      <TfrxMemoView Name="Memo39" Left="83,04273504" Top="206,29679444" Width="5,15218556" Height="15,11811024" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo41" Left="88,54273504" Top="206,29679444" Width="141,55859667" Height="15,11811024" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data1.&#34;KAYITLIOLDAHNO&#34;]"/>
      <TfrxMemoView Name="Memo42" Left="13,55675282" Top="222,43568333" Width="69,40419556" Height="15,11811024" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="İl / İlçe"/>
      <TfrxMemoView Name="Memo43" Left="83,04273504" Top="222,43568333" Width="5,15218556" Height="15,11811024" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo44" Left="88,54273504" Top="222,43568333" Width="141,55859667" Height="15,11811024" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="[data1.&#34;KAYITLIOLDAHIL&#34;] [data1.&#34;KAYITLIOLDAHILCE&#34;]"/>
      <TfrxMemoView Name="Memo46" Left="235,40384615" Top="171,64517666" Width="275,71535899" Height="14,03653889" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="      TERCİH EDİLEN AİLE HEKİMİNİN"/>
      <TfrxMemoView Name="Memo47" Left="238,47644254" Top="190,15790555" Width="61,84513556" Height="15,1181102362205" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Adı Soyadı"/>
      <TfrxMemoView Name="Memo48" Left="302,4731617" Top="190,15790555" Width="5,15218556" Height="15,1181102362205" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="doktoradi" Left="309,2231617" Top="190,15790555" Width="130,83462223" Height="15,11811024" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="CANSIN ARDA"/>
      <TfrxMemoView Name="Memo50" Left="238,44538393" Top="206,29679444" Width="62,61940889" Height="15,1181102362205" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Bölge Kodu"/>
      <TfrxMemoView Name="Memo51" Left="302,02170837" Top="206,29679444" Width="5,15218556" Height="15,1181102362205" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="ahkod" Left="309,59803282" Top="206,29679444" Width="130,83462223" Height="15,1181102362205" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="0607144"/>
      <TfrxMemoView Name="Memo53" Left="239,44538393" Top="222,43568333" Width="61,84513556" Height="15,1181102362205" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="İl / İlçe"/>
      <TfrxMemoView Name="Memo54" Left="302,91059726" Top="222,43568333" Width="5,15218556" Height="15,1181102362205" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="ililce" Left="310,37581059" Top="222,43568333" Width="130,83462223" Height="15,1181102362205" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="ANKARA/ÇANKAYA"/>
      <TfrxMemoView Name="Memo56" Left="13,22183769" Top="239,80978539" Width="525,35423795" Height="16,19970111" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="      AİLE HEKİMİ DEĞİŞTİRME NEDENİ"/>
      <TfrxCheckBoxView Name="cbhekimtercihi" Left="15,57483" Top="257,9448648" Width="15,11812" Height="15,11812" ShowHint="False" CheckColor="0" Checked="False" CheckStyle="csCheck" Frame.Typ="15"/>
      <TfrxMemoView Name="diger" Left="303,79253278" Top="275,26102462" Width="233,90833377" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="............................................................."/>
      <TfrxMemoView Name="Memo6" Left="37,61538462" Top="304,59352255" Width="168,20623278" Height="30,52483382" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" Frame.Typ="6" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="Aile Fertlerinin &#13;&#10;Adı Soyadı"/>
      <TfrxMemoView Name="Memo8" Left="206,38598443" Top="304,59352255" Width="49,13385339" Height="13,60882791" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" Frame.Typ="15" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="Cinsiyet"/>
      <TfrxMemoView Name="Memo10" Left="206,38598443" Top="318,75577246" Width="24,56692913" Height="17,38835791" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" Frame.Typ="2" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="E"/>
      <TfrxMemoView Name="Memo11" Left="230,52004824" Top="318,75233493" Width="24,5669291338583" Height="17,38835791" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" Frame.Typ="2" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="K"/>
      <TfrxMemoView Name="Memo12" Left="255,95930058" Top="304,59352255" Width="86,03203801" Height="30,52483382" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" Frame.Typ="6" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="TC KİMLİK NO"/>
      <TfrxMemoView Name="Memo15" Left="341,7536931" Top="304,59352255" Width="91,87026898" Height="30,52483382" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" Frame.Typ="6" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="DOĞUM TARİHİ"/>
      <TfrxMemoView Name="Memo16" Left="433,43382575" Top="304,59352255" Width="103,73644415" Height="30,52483382" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" Frame.Typ="6" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="ÖZELLİK (*)"/>
      <TfrxMemoView Name="Memo2" Left="14,45669291" Top="304,59352255" Width="22,53755931" Height="30,52483382" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" Frame.Typ="7" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="No."/>
      <TfrxMemoView Name="Memo9" Left="127,98258124" Top="257,9448648" Width="112,33970846" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Fiziksel Mekan Tercihi"/>
      <TfrxCheckBoxView Name="cbfizikselmekan" Left="112,62214" Top="257,9448648" Width="15,11812" Height="15,11812" ShowHint="False" CheckColor="0" Checked="False" CheckStyle="csCheck" Frame.Typ="15"/>
      <TfrxMemoView Name="Memo57" Left="260,82519124" Top="257,9448648" Width="82,10346846" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Ulaşım Güçlüğü"/>
      <TfrxCheckBoxView Name="cbulasimguclugu" Left="244,46475" Top="257,9448648" Width="15,11812" Height="15,11812" ShowHint="False" CheckColor="0" Checked="False" CheckStyle="csCheck" Frame.Typ="15"/>
      <TfrxMemoView Name="Memo59" Left="366,22686124" Top="257,9448648" Width="74,54440846" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Hiç Kaydı Yok"/>
      <TfrxCheckBoxView Name="cbhickaydiyok" Left="347,86642" Top="257,9448648" Width="15,11812" Height="15,11812" ShowHint="False" CheckColor="0" Checked="False" CheckStyle="csCheck" Frame.Typ="15"/>
      <TfrxMemoView Name="Memo87" Left="463,83323124" Top="257,9448648" Width="74,54440846" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="İl İçinde Göç"/>
      <TfrxCheckBoxView Name="cbilicigoc" Left="445,47279" Top="257,9448648" Width="15,11812" Height="15,11812" ShowHint="False" CheckColor="0" Checked="False" CheckStyle="csCheck" Frame.Typ="15"/>
      <TfrxMemoView Name="Memo58" Left="31,5905585" Top="275,26102462" Width="78,32393846" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="İl Dışından Göç"/>
      <TfrxCheckBoxView Name="cbildisigoc" Left="15,69292071" Top="275,26102462" Width="15,11812" Height="15,11812" ShowHint="False" CheckColor="0" Checked="False" CheckStyle="csCheck" Frame.Typ="15"/>
      <TfrxMemoView Name="Memo91" Left="128,32117124" Top="275,26102462" Width="63,20581846" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Hatalı Kayıt"/>
      <TfrxCheckBoxView Name="cbhatalikayit" Left="112,74803882" Top="275,26102462" Width="15,11812" Height="15,11812" ShowHint="False" CheckColor="0" Checked="False" CheckStyle="csCheck" Frame.Typ="15"/>
      <TfrxMemoView Name="Memo92" Left="260,85040102" Top="275,26102462" Width="36,74910846" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Diğer :"/>
      <TfrxCheckBoxView Name="cbdiger" Left="244,33071598" Top="275,26102462" Width="15,11812" Height="15,11812" ShowHint="False" CheckColor="0" Checked="False" CheckStyle="csCheck" Frame.Typ="15"/>
    </TfrxReportTitle>
    <TfrxFooter Name="Footer1" Font.Charset="1" Font.Color="0" Font.Height="-8" Font.Name="Arial" Font.Style="0" Height="59,54843357" Left="0" ParentFont="False" Top="453,5436" Width="551,81138">
      <TfrxMemoView Name="Memo66" Left="16,57506936" Top="1,00992556" Width="308,58847181" Height="27,01497871" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="Yazmış olduğum bilgilerin doğruluğunu onaylıyor ve bundan dolayı olabilecek sorumluluğu kabul ediyorum."/>
      <TfrxMemoView Name="Memo67" Left="425,79943968" Top="22,0787401600001" Width="106,94564145" Height="13,60629677" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="[data1.&#34;DILEKCETARIHI&#34;]"/>
      <TfrxMemoView Name="Memo68" Left="329,96360226" Top="43,36428556" Width="88,04799145" Height="13,60629677" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="İmza :"/>
      <TfrxMemoView Name="Memo69" Left="42,8897589" Top="43,45596265" Width="283,46429843" Height="13,60629677" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-8" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="  (*) Özellik bölümüne kişilerin bebek, gebe, özürlü vb. durumları yazılacaktır."/>
      <TfrxMemoView Name="Memo49" Left="425,82715" Top="3,18110235999995" Width="106,94564145" Height="13,60629677" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="[data1.&#34;DILEKCENO&#34;]"/>
      <TfrxMemoView Name="Memo52" Left="329,96360226" Top="22,23624" Width="88,04799145" Height="13,60629677" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="Başvuru Tarihi :"/>
      <TfrxMemoView Name="Memo55" Left="329,96360226" Top="3,18110235999995" Width="88,04799145" Height="13,60629677" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="Dilekçe No. :"/>
    </TfrxFooter>
    <TfrxMasterData Name="MasterData1" Font.Charset="1" Font.Color="0" Font.Height="-8" Font.Name="Arial" Font.Style="0" Height="15,5155219" Left="0" ParentFont="False" Top="415,7483" Width="551,81138" ColumnWidth="0" ColumnGap="0" DataSet="frxdata1" DataSetName="data2" RowCount="0">
      <TfrxMemoView Name="Memo61" Left="37,61538462" Top="0,10880808" Width="168,20623278" Height="15,40671382" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" Frame.Typ="14" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="[data2.&#34;ADI&#34;] [data2.&#34;SOYADI&#34;]"/>
      <TfrxMemoView Name="Memo62" Left="206,38598443" Top="0,10880808" Width="24,56692913" Height="15,40671382" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" Frame.Typ="14" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="[IIF(&#60;data2.&#34;CINSIYETI&#34;&#62;=1,'X','')]"/>
      <TfrxMemoView Name="Memo63" Left="230,52004824" Top="0,10880808" Width="24,5669291338583" Height="15,40671382" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" Frame.Typ="14" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="[IIF(&#60;data2.&#34;CINSIYETI&#34;&#62;=2,'X','')]"/>
      <TfrxMemoView Name="Memo64" Left="255,95930058" Top="0,10880808" Width="86,03203801" Height="15,40671382" ShowHint="False" DataField="AILEBIREYTCKNO" DataSet="frxdata1" DataSetName="data2" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" Frame.Typ="14" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="[data2.&#34;AILEBIREYTCKNO&#34;]"/>
      <TfrxMemoView Name="Memo65" Left="341,7536931" Top="0,10880808" Width="91,87026898" Height="15,40671382" ShowHint="False" DataField="DOGUMTARIHI" DataSet="frxdata1" DataSetName="data2" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" Frame.Typ="14" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="[data2.&#34;DOGUMTARIHI&#34;]"/>
      <TfrxMemoView Name="Memo89" Left="433,43382575" Top="0,10880808" Width="103,73644415" Height="15,40671382" ShowHint="False" DataField="OZELLIKYAZI" DataSet="frxdata1" DataSetName="data2" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" Frame.Typ="14" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="[data2.&#34;OZELLIKYAZI&#34;]"/>
      <TfrxMemoView Name="Memo90" Left="14,45669291" Top="0,108808080000017" Width="22,53755931" Height="15,40671382" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" Frame.Typ="15" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="[Line]"/>
    </TfrxMasterData>
    <TfrxPageFooter Name="PageFooter1" Font.Charset="1" Font.Color="0" Font.Height="-8" Font.Name="Arial" Font.Style="0" Height="254,31009111" Left="0" ParentFont="False" Top="574,48856" Width="551,81138">
      <TfrxMemoView Name="Memo3" Left="14,77953" Top="1,35436" Width="521,57468843" Height="208,95573111" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="arial" Font.Style="1" Frame.Typ="15" ParentFont="False" VAlign="vaCenter" Text=""/>
      <TfrxMemoView Name="Memo70" Left="17,53213839" Top="3,69295" Width="506,45656843" Height="12,42017111" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="      B - İLGİLİ İLÇE SAĞLIK MÜDÜRLÜĞÜ TARAFINFAN DOLDURULACAKTIR."/>
      <TfrxMemoView Name="Memo71" Left="18,22834646" Top="18,1445629" Width="113,80768218" Height="15,27431322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="Evrak Sıra No. "/>
      <TfrxMemoView Name="Memo72" Left="131,80135452" Top="18,1445629" Width="128,92580218" Height="15,27431322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text=": ......................"/>
      <TfrxMemoView Name="Memo74" Left="17,78486646" Top="122,21417613" Width="164,85039223" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-12" Font.Name="Arial" Font.Style="1" ParentFont="False" Text="      KAYIT GÖREVLİSİ"/>
      <TfrxMemoView Name="Memo76" Left="17,59131807" Top="173,75674807" Width="67,93748317" Height="14,41274838" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Tarih"/>
      <TfrxMemoView Name="Memo78" Left="18,21276184" Top="137,89763462" Width="65,62466556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Adı Soyadı"/>
      <TfrxMemoView Name="Memo79" Left="88,532301" Top="137,89763462" Width="8,93171556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo80" Left="98,282301" Top="137,89763462" Width="213,98428223" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="............................................................."/>
      <TfrxMemoView Name="Memo81" Left="18,18170323" Top="155,03652351" Width="66,39893889" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Ünvanı"/>
      <TfrxMemoView Name="Memo82" Left="88,532301" Top="155,53652351" Width="8,93171556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo83" Left="98,65717212" Top="155,53652351" Width="213,98428223" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="............................................................."/>
      <TfrxMemoView Name="Memo84" Left="19,18170323" Top="190,0730624" Width="65,62466556" Height="18,89765" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="İmza"/>
      <TfrxMemoView Name="toplumsagmer" Left="327,83488" Top="42,70872" Width="193,17781218" Height="30,39243322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="1" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text=""/>
      <TfrxMemoView Name="Memo93" Left="18,22834646" Top="56,82684" Width="189,39828218" Height="15,27431322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Tercih formunun teslim alınma tarihi"/>
      <TfrxMemoView Name="Memo94" Left="214,87401819" Top="56,82684" Width="98,68956218" Height="15,27431322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text=": ......../........./201...."/>
      <TfrxMemoView Name="Memo73" Left="18,33859" Top="75,50402" Width="189,39828218" Height="26,61290322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="Kişinin mevcut aile hekiminde 3 ayını doldurduğu tarih"/>
      <TfrxMemoView Name="Memo75" Left="215,06125806" Top="75,50402" Width="98,68956218" Height="22,83337322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text=": ......../........./201...."/>
      <TfrxMemoView Name="Memo77" Left="18,33859" Top="101,1862971" Width="189,39828218" Height="15,27431322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text="Kişinin tercih edilen hekime kayıt tarihi"/>
      <TfrxMemoView Name="Memo95" Left="214,87401819" Top="102,1862971" Width="98,68956218" Height="15,27431322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" VAlign="vaCenter" Text=": ......../........./201...."/>
      <TfrxMemoView Name="Memo96" Left="327,83488" Top="86,84261" Width="193,17781218" Height="30,39243322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="1" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="UYGUNDUR"/>
      <TfrxMemoView Name="Memo97" Left="327,83488" Top="117,07885" Width="193,17781218" Height="30,39243322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="1" HAlign="haCenter" ParentFont="False" VAlign="vaCenter" Text="......../........./201...."/>
      <TfrxMemoView Name="Memo98" Left="89,37013" Top="171,78757" Width="8,93171556" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="0" ParentFont="False" Text=":"/>
      <TfrxMemoView Name="Memo99" Left="99,49500112" Top="171,78757" Width="134,61415223" Height="15,11812" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-11" Font.Name="Arial" Font.Style="0" ParentFont="False" Text="......../........./201...."/>
      <TfrxMemoView Name="Memo85" Left="18,33859" Top="35,48825" Width="113,80768218" Height="15,27431322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text="Kayıt Tarihi"/>
      <TfrxMemoView Name="Memo86" Left="131,91159806" Top="35,48825" Width="128,92580218" Height="15,27431322" ShowHint="False" Font.Charset="1" Font.Color="0" Font.Height="-13" Font.Name="Arial" Font.Style="1" ParentFont="False" VAlign="vaCenter" Text=":  ......../........./201...."/>
    </TfrxPageFooter>
  </TfrxReportPage>
</TfrxReport>
