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H01^    <title>KN-%s
H03^-%s-
H08^%s
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H96^    <th width=25%> <a href="#"><img border="0" src="https://eqt.inhedo.com/Logo%sweb.png" align="left"></a>
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FICHA KINESICA CCPP EN DOMICILIO
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REPORTE<br>
H00^N<sup>o</sup> %s<br>
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		<th width=50% class="empresatit"><b>IDENTIFICACION DEL PACIENTE</th>
		<th width=50% class="empresatit"><b>IDENTIFICACION DEL PROFESIONAL</th>
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H03^		<th class="empresacont" style="vertical-align:center;">%s<br>
H04^%s<br<br></th>
H01^		<th class="empresacont" style="vertical-align:center;"><br>%s<br>
H02^%s<br><br></th>
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		<th class="empresatit" width=10%><b>EDAD</th>
		<th class="empresatit" width=50%><b>DIAGNOSTICO</th>
		<th class="empresatit" width=15%><b>SESION</th>
		<th class="empresatit" width=15%><b>FECHA VISITA</th>
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H05^		<th class="empresacont">%s</th>
H06^		<th class="empresacont" style="text-align:left; padding-left: 10px;">%s</th>
H07^		<th class="empresacont">%s</th>
H08^		<th class="empresacont">%s</th>
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  <th class="itemtitc" width=40%><b>NIVEL DE CONCIENCIA</th>
  <th class="itemtitc" width=60%><b>MOTIVO DE LA VISITA</th>
 </tr>
   <tr>
H10^  <th class="empresacont" style="text-align:left; padding-left: 10px;">%s</th>
H11^  <th class="empresacont" style="text-align:left; padding-left: 10px;">%s</th>
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<th class="empresa" style="text-align: center;"><b>EVALUACION<br></th></tr>
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<th class="empresa" style="text-align: left;"><b>I. DOLOR<br></th></tr>
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 <table width=700 cellspacing=0 style="border-collapse:collapse;">
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  <th class="itemtitc" width=70%><b>TIPO</b></th>
  <th class="itemtitc" width=30%><b>EVN</b></th>
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H12^  <th class="empresacont" span=2  style="text-align:left;padding-left:10px">%s</th>
H13^  <th class="empresacont" >&nbsp;%s</th>
</tr><tr>
H14^  <th class="empresacont" style="text-align:left;padding-left:10px">%s</th>
H15^  <th class="empresacont" >&nbsp;%s</th>
</tr><tr>
H16^  <th class="empresacont" style="text-align:left;padding-left:10px">%s</th>
H17^  <th class="empresacont" >&nbsp;%s</th>
</tr><tr>
H18^  <th class="empresacont" style="text-align:left;padding-left:10px">%s</th>
H19^  <th class="empresacont" >&nbsp;%s</th>
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<tr><th>&nbsp;</th></tr>
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 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr><th class="empresa" colspan=3 style="text-align: left;"><b>II. SIGNOS Y SINTOMAS RESPIRATORIOS</th></tr>
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  <th class="itemtitc" width=25% style="text-align:left; padding-left: 10px;"><b>SINTOMA</b></th>
  <th class="itemtitc" width=15%><b>EVALUACION</b></th>
  <th class="itemtitc" width=60%><b>OBSERVACIONES</b></th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">TOS</th>
H20^  <th class="empresacont">%s</th>
H21^  <th class="empresacont" style="text-align:left; padding-left: 10px;">%s</th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">HEMOPTISIS</th>
H22^  <th class="empresacont">%s</th>
H23^  <th class="empresacont" style="text-align:left; padding-left: 10px;">%s</th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">DISNEA</th>
H24^  <th class="empresacont">%s</th>
  <th class="empresacont"> </th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">SATURACION</th>
H26^  <th class="empresacont">%s</th>
  <th class="empresacont"> </th>
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<tr>
  <th colspan=3 class="itemtitc" width=100%><b>OBSERVACIONES</b></th></tr>
H25^  <tr><th colspan=3 class="empresacont" style="text-align:left; padding: 10px;">%s</th></tr>
<tr><td>&nbsp;</td></tr>
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<tr><th class="empresa" colspan=3 style="text-align: left;"><b>III. SIGNOS Y SINTOMAS MUSCULO ESQUELETICO</th></tr>
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  <th class="itemtitc" width=10%><b>APPLEY</b></th>
  <th class="itemtitc" width=60% style="text-align:left; padding-left: 10px;"><b>ACCION DESARROLLADA</b></th>
  <th class="itemtitc" width=15%><b>DERECHA</b></th>
  <th class="itemtitc" width=15%><b>IZQUIERDA</b></th>
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  <th rowspan=3 class="itemtitc"><b>MMSS</th>
  <th class="empresacont" style="text-align:left; padding-left: 10px;">MANO HOMBRO CONTRARIO</th>
H27^  <th class="empresacont">%s</th>
H28^  <th class="empresacont">%s</th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">MANO TOCA DETRAS DE LA CABEZA CON ROT EXT</th>
H29^  <th class="empresacont">%s</th>
H30^  <th class="empresacont">%s</th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">MANO TOCA ESPALDA CON ROT INT</th>
H31^  <th class="empresacont">%s</th>
H32^  <th class="empresacont">%s</th>
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  <th class="itemtitc"><b>MMII</th>
  <th class="empresacont" style="text-align:left; padding-left: 10px;">TRIPLE FLX/EXT</th>
H33^  <th class="empresacont">%s</th>
H34^  <th class="empresacont">%s</th>
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<tr><td>&nbsp;</td></tr>
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  <th class="itemtitc" width=10%><b>MUSC</b></th>
  <th class="itemtitc" width=40% style="text-align:left; padding-left: 10px;"><b>ARTICULACION</b></th>
  <th class="itemtitc" width=20%><b>FUERZA MUSCULAR</b></th>
  <th class="itemtitc" width=15%><b>DERECHA</b></th>
  <th class="itemtitc" width=15%><b>IZQUIERDA</b></th>
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<tr>
  <th rowspan=3 class="itemtitc"><b>MMSS</th>
  <th class="empresacont" style="text-align:left; padding-left: 10px;">HOMBRO</th>
H35^  <th class="empresacont">%s</th>
H36^  <th class="empresacont">%s</th>
H37^  <th class="empresacont">%s</th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">CODO</th>
H38^  <th class="empresacont">%s</th>
H39^  <th class="empresacont">%s</th>
H40^  <th class="empresacont">%s</th>
</tr><tr>
  <th class="empresacont" style="text-align:left; padding-left: 10px;">MU&Nacute;ECA Y DEDOS</th>
H41^  <th class="empresacont">%s</th>
H42^  <th class="empresacont">%s</th>
H43^  <th class="empresacont">%s</th>
</tr><tr>
  <th rowspan=3 class="itemtitc"><b>MMII</th>
  <th class="empresacont" style="text-align:left; padding-left: 10px;">CADERA</th>
H44^  <th class="empresacont">%s</th>
H45^  <th class="empresacont">%s</th>
H46^  <th class="empresacont">%s</th>
</tr><tr>
  <th class="empresacont" style="text-align:left; padding-left: 10px;">RODILLA</th>
H47^  <th class="empresacont">%s</th>
H48^  <th class="empresacont">%s</th>
H49^  <th class="empresacont">%s</th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">TOBILLO Y PIE</th>
H50^  <th class="empresacont">%s</th>
H51^  <th class="empresacont">%s</th>
H52^  <th class="empresacont">%s</th>
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<tr><td>&nbsp;</td></tr>
</table>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr><th class="empresa" colspan=3 style="text-align: left;"><b>IV. SIGNOS CIRCULATORIOS</th></tr>
<tr>
  <th rowspan=2 class="itemtitc" width=40% style="text-align:left; padding-left: 10px;"><b>TIPO DE EDEMA</b></th>
  <th class="itemtitc" colspan=2 width=30%><b>MMSS</b></th>
  <th class="itemtitc" colspan=2 width=30%><b>MMII</b></th>
</tr>
<tr>
  <th class="itemtitc" width=15%><b>DERECHA</b></th>
  <th class="itemtitc" width=15%><b>IZQUIERDA</b></th>
  <th class="itemtitc" width=15%><b>DERECHA</b></th>
  <th class="itemtitc" width=15%><b>IZQUIERDA</b></th>
</tr>
<tr>
  <th class="empresacont" style="text-align:left; padding-left: 10px;">LINFATICO</th>
H54^  <th class="empresacont"><input type="checkbox" %s></th>
H55^  <th class="empresacont"><input type="checkbox" %s></th>
H56^  <th class="empresacont"><input type="checkbox" %s></th>
H57^  <th class="empresacont"><input type="checkbox" %s></th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">VENOSO</th>
H58^  <th class="empresacont"><input type="checkbox" %s></th>
H59^  <th class="empresacont"><input type="checkbox" %s></th>
H60^  <th class="empresacont"><input type="checkbox" %s></th>
H61^  <th class="empresacont"><input type="checkbox" %s></th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">MIXTO</th>
H62^  <th class="empresacont"><input type="checkbox" %s></th>
H63^  <th class="empresacont"><input type="checkbox" %s></th>
H64^  <th class="empresacont"><input type="checkbox" %s></th>
H65^  <th class="empresacont"><input type="checkbox" %s></th>
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  <th class="empresacont" style="text-align:left; padding-left: 10px;">OTROS</th>
H66^  <th class="empresacont"><input type="checkbox" %s></th>
H67^  <th class="empresacont"><input type="checkbox" %s></th>
H68^  <th class="empresacont"><input type="checkbox" %s></th>
H69^  <th class="empresacont"><input type="checkbox" %s></th>
</tr>

<tr>
  <th class="empresacont" style="text-align:left; padding-left: 10px;">SIGNO: GODDET</th>
H70^  <th class="empresacont"><input type="checkbox" %s></th>
H71^  <th class="empresacont"><input type="checkbox" %s></th>
H72^  <th class="empresacont"><input type="checkbox" %s></th>
H73^  <th class="empresacont"><input type="checkbox" %s></th>
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<tr>
  <th class="empresacont" style="text-align:left; padding-left: 10px;">SIGNO: STEMMER</th>
H74^  <th class="empresacont"><input type="checkbox" %s></th>
H75^  <th class="empresacont"><input type="checkbox" %s></th>
H76^  <th class="empresacont"><input type="checkbox" %s></th>
H77^  <th class="empresacont"><input type="checkbox" %s></th>
</tr>

  <tr><th colspan=5 class="itemtitc" width=100%><b>OBSERVACIONES</b></th> </tr>
H78^  <tr><th colspan=5 class="empresacont" style="text-align:left; padding: 10px;">%s</th></tr>
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 <table width=700 cellspacing=0 style="border-collapse:collapse;">

<tr><td>&nbsp;</td></tr>
<tr><th class="empresa" style="text-align: left;"><b>V. SIGNOS Y SINTOMAS DIGESTIVOS</th></tr>
  <tr><th class="itemtitc" width=40%><b>ASCITIS</b></th>
  <th class="itemtitc" width=40%><b>ESTRE&Nacute;IMIENTO</b></th>
<tr>
H79^  <th class="empresacont">%s</th>
H80^  <th class="empresacont">%s</th>
</tr>
<tr>
  <th class="itemtitc" colspan=2 width=100%><b>OBSERVACIONES</b></th>
</tr>
H81^  <tr><th class="empresacont" colspan=2 style="text-align:left; padding: 10px;">%s</th></tr>
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 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr>
<tr><td>&nbsp;</td></tr>
<tr><th class="empresa" colspan=7 style="text-align: left;"><b>VI. ULCERAS POR DECUBITO: Escala de Norton</th></tr>
  <tr><th class="itemtitc" width=14%><b>CONDICION FISICA</b></th>
  <th class="itemtitc" width=13%><b>ESTADO MENTAL</b></th>
  <th class="itemtitc" width=20%><b>ACTIVIDAD</b></th>
  <th class="itemtitc" width=18%><b>MOVILIDAD</b></th>
  <th class="itemtitc" width=18%><b>CONTINENCIA</b></th>
  <th class="itemtitc" width=10%><b>PUNTUACION</b></th>
  <th class="itemtitc" width=10%><b>RIESGO</b></th></tr>
H82^  <th class="empresacont">%s</th>
H83^  <th class="empresacont">%s</th>
H84^  <th class="empresacont">%s</th>
H85^  <th class="empresacont">%s</th>
H86^  <th class="empresacont">%s</th>
H98^  <th class="empresacont">%s</th>
H99^  <th class="empresacont">%s</th>
</tr>
</table>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr><td>&nbsp;</td></tr>
<tr><th class="empresa" colspan=7 style="text-align: left;"><b>VII. EVALUACION FUNCIONAL DE LAS AVD: Indice de Katz modificado.</th></tr>
<tr>
  <th class="itemtitc" width=10% style="text-align: left; padding-letf: 10px"><b>ACTIVIDAD</b></th>
  <th class="itemtitc" width=10%><b>ESTADO</b></th>
  <th class="itemtitc" width=10% style="text-align: left; padding-letf: 10px"><b>ACTIVIDAD</b></th>
  <th class="itemtitc" width=10%><b>ESTADO</b></th>
  <th class="itemtitc" width=10% style="text-align: left; padding-letf: 10px"><b>ACTIVIDAD</b></th>
  <th class="itemtitc" width=10%><b>ESTADO</b></th>
</tr>
<tr>
  <th class="itemtitc" style="text-align: left; padding-letf: 10px">BA&Nacute;ARSE</th>
H87^  <th class="empresacont">%s</th>
  <th class="itemtitc" style="text-align: left; padding-letf: 10px;">VESTIRSE</th>
H88^  <th class="empresacont">%s</th>
  <th class="itemtitc" style="text-align: left; padding-letf: 10px">USO DEL INODORO</th>
H89^  <th class="empresacont">%s</th>
</tr>
<tr>
  <th class="itemtitc" style="text-align: left; padding-letf: 10px">TRASLADARSE</th>
H90^  <th class="empresacont">%s</th>
  <th class="itemtitc" style="text-align: left; padding-letf: 10px">CONTINENCIA</th>
H91^  <th class="empresacont">%s</th>
  <th class="itemtitc" style="text-align: left; padding-letf: 10px">ALIMENTARSE</th>
H92^  <th class="empresacont">%s</th>
</tr>
</table>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr><td>&nbsp;</td></tr>
<tr><th class="empresa" colspan=7 style="text-align: left;"><b>VIII. TERAPIA KINESICA</th></tr>
<tr>
  <th class="itemtitc" width=100%><b>ACTIVIDADES DE LA SESION</b></th>
</tr>
<tr>
H93^  <th class="empresacont" style="text-align:left; padding: 10px;">%s</th>
</tr>
<tr><th>&nbsp;</th></tr>
<tr><th>&nbsp;</th></tr>
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 <table width=700 cellspacing=0 style="border-collapse:collapse;">
  <th width=30%></th>
  <th class="itemtitc" width=20%><b>FECHA DE VISITA</b></th>
  <th class="itemtitc" width=20%><b>FECHA DE RECEPCION</b></th>
  <th width=30%></th>
</tr>
<tr>
<th></th>
H08^  <th class="empresacont">%s</th>
H94^  <th class="empresacont">%s</th>
</tr>
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	<tr>
H01^	<th style="font-size:12.0pt; font-family:Calibri, sans-serif;"><br><br><br><br>%s<br>
H02^%s<br><br></th>
	</tr>
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