<!DOCTYPE html>
<html lang="en">
<head>
	<meta charset="ISO-8859-1">
H01^    <title>TNS-%s
H03^-%s-
H08^%s
</title>


	<link rel="stylesheet" href="https://eqt.inhedo.com/css/ncot.css">
</head>
<body OnBlur=self.close()>
<center>
	<table width="670"> 
	<tr>
H66^    <th width=25%> <a href="#"><img border="0" src="https://eqt.inhedo.com/Logo%sweb.png" align="left"></a>
		<th width=45% class="empresa">
<center>
<b>
INFORME DE VISITA TENS
</th>
		<th width=30%>
			<table width=100% style="border-collapse: collapse;">
			<tr>
				<th width=1% class="numberh">&nbsp;</th>
				<th width=98% class="numberh">&nbsp;</th>
				<th width=1% class="numberh">&nbsp;</th>
			</tr>
			<tr>
				<th width=1% class="numberv">&nbsp;</th>
				<th width=98%> </th>
				<th width=1% class="numberv">&nbsp;</th>
			</tr>
			<tr>
				<th width=1% class="numberv">&nbsp;</th>
				<th width=98% style="text-align: center; color: red; font-size: 16px">
REPORTE<br>
H00^N<sup>o</sup> %s<br>
 </th>
				<th width=1% class="numberv">&nbsp;</th>
			</tr>
			<tr>
				<th width=1% class="numberv">&nbsp;</th>
				<th width=98%> </th>
				<th width=1% class="numberv">&nbsp;</th>
			</tr>
			<tr>
				<th width=1% class="numberh">&nbsp;</th>
				<th width=98% class="numberh">&nbsp;</th>
				<th width=1% class="numberh">&nbsp;</th>
			</tr>
			</table>
	</tr>
	</table>
	<table width="700">
	<tr>
		<th width=50% class="empresatit"><b>IDENTIFICACION DEL PACIENTE</th>
		<th width=50% class="empresatit"><b>IDENTIFICACION DEL PROFESIONAL</th>
	</tr>
	<tr>
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>
	</tr>

	</table>
<div class="empresa" style="text-align: center;"><br><b>I. DATOS DEL PACIENTE</div>
	<table width="700">
	<tr>
		<th class="empresatit" width=15%><b>EDAD</th>
		<th class="empresatit" width=65% style="text-align:left">&nbsp;<b>DIAGNOSTICO</th>
		<th class="empresatit" width=30%><b>FECHA DE LA VISITA</th>
	</tr>
	<tr>
H05^		<th class="empresacont">%s</th>
H06^		<th class="empresacont" style="text-align:left; padding-left: 10px;">%s</th>
H08^		<th class="empresacont" style="text-align:center;">%s</th>
	</tr>
	</table>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
   <tr>
  <th class="empresatit" width=60%><b>UBICACION VISITA</th>
  <th class="empresatit" width=20%><b>COMUNA</th>
  <th class="empresatit" width=20%><b>CIUDAD</th>
 </tr>
   <tr>
H10^  <th class="empresacont" style="text-align:left; padding-left: 10px;">%s</th>
H11^  <th class="empresacont" style="text-align:center;">%s</th>
H12^  <th class="empresacont" style="text-align:center;">%s</th>
 </tr>
</table>
<table width=700 cellspacing=0 style="border-collapse:collapse;">
   <tr>
  <th class="empresatit" width=60%><b>ESTADO CIVIL</th>
  <th class="empresatit" width=40%><b>ACTIVIDAD LABORAL</th>
</tr>
   <tr>
H13^  <th class="empresacont" style="text-align:left; padding-left: 10px;">%s</th>
H07^  <th class="empresacont" style="text-align:center;">%s</th>
 </tr>
<tr><th>&nbsp;</th></tr>
</table>
  
<div class="empresa" style="text-align: center;"><b>II. HISTORIA CLINICA</div>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr>
  <th class="empresatit" width=40%><b>PATOLOGIAS CRONICAS</b></th>
  <th class="empresatit" width=40%><b>ANTECEDENTES QUIRURGICOS</b></th>
  <th class="empresatit" width=20%><b>ALERGIAS</b></th>
</tr>
<tr>
H14^  <th class="empresacont" style="text-align:left; padding: 10px;">%s</th>
H15^  <th class="empresacont" style="text-align:left; padding: 10px;">%s</th>
H16^  <th class="empresacont" style="text-align:left; padding: 10px;">%s</th>
</tr>
</table>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr>
  <th class="empresatit" width=100%><b>MEDICAMENTOS ACTUALES</b></th>
</tr>
<tr>
H17^  <th class="empresacont" style="text-align:left; padding: 10px;">%s</th>
</tr>
</table>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr>
  <th class="empresatit" width=33%><b>ALIMENTACION</b></th>
  <th class="empresatit" width=34%><b>POSICION</b></th>
  <th class="empresatit" width=33%><b>ELIMINACION</b></th>
</tr>
<tr>
H18^  <th class="empresacont">%s</th>
H19^  <th class="empresacont">%s</th>
H20^  <th class="empresacont">%s</th>
</tr>

<tr><td>&nbsp;</td></tr>
<tr>
</table>
<div class="empresa" style="text-align: center;"><b>III. SIGNOS VITALES</div>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
</table>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr>
<th class="empresatit" width=20%><b>PRESION ARTERIAL</th>
<th class="empresatit" width=20%><b>FRECUENCIA CARDIACA</th>
<th class="empresatit" width=20%><b>SATURACION</th>
<th class="empresatit" width=20%><b>FRECUENCIA RESPIRATORIA</th>
<th class="empresatit" width=20%><b>TEMPERATURA</th>
</tr>
<tr>
H21^  <th class="empresacont">%s mmgh</th>
H22^  <th class="empresacont">%s lpm</th>
H23^  <th class="empresacont">%s%% fio2 al 21%%</th>
H24^  <th class="empresacont">%s rpm</th>
H25^  <th class="empresacont">%s &deg;C</th>
</tr>
<tr><th>&nbsp;</th></tr>
</table>
<div class="empresa" style="text-align: center;"><b>IV. EXAMEN FISICO</div>
<table width=700 cellspacing=0 style="border-collapse:collapse;">
</table>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr>
<th class="empresatit" width=20%><b>ESTADO GENERAL</th>
<th class="empresatit" width=20%><b>CONCIENCIA</th>
<th class="empresatit" width=20%><b>ESTADO NUTRICIONAL</th>
<th class="empresatit" width=20%><b>HIDRATACION</th>
<th class="empresatit" width=20%><b>COLORACION</th>
</tr>
<tr>
H26^  <th class="empresacont">%s</th>
H27^  <th class="empresacont">%s</th>
H28^  <th class="empresacont">%s</th>
H29^  <th class="empresacont">%s</th>
H30^  <th class="empresacont">%s</th>
</tr>
<tr>
<th class="empresatit" width=20%><b>HIGIENE</th>
<th class="empresatit" width=20%><b>LENGUAJE</th>
<th class="empresatit" width=20%><b>VISION</th>
<th class="empresatit" width=20%><b>AUDICION</th>
<th class="empresatit" width=20%><b>MOTRICIDAD</th>
</tr>
<tr>
H31^  <th class="empresacont">%s</th>
H32^  <th class="empresacont">%s</th>
H33^  <th class="empresacont">%s</th>
H34^  <th class="empresacont">%s</th>
H35^  <th class="empresacont">%s</th>
</tr>
<tr><th>&nbsp;</th></tr>
</table>

<div class="empresa" style="text-align: center;"><b>V. EXAMEN SEGMENTARIO</div>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
<tr>
<th class="empresatit" width=18%><b>SEGMENTO</th>
<th class="empresatit" width=16%><b>NORMAL</th>
<th class="empresatit" width=16%><b>ALTERADO</th>
<th class="empresatit" width=18%><b>SEGMENTO</th>
<th class="empresatit" width=16%><b>NORMAL</th>
<th class="empresatit" width=16%><b>ALTERADO</th>
</tr>
<tr>
  <th class="empresacont">CUERO CABELLUDO</th>
H36^  <th class="empresacont"><input type="checkbox" %s></th>
H37^  <th class="empresacont"><input type="checkbox" %s></th>
  <th class="empresacont">OJOS Y PARPADOS</th>
H38^  <th class="empresacont"><input type="checkbox" %s></th>
H39^  <th class="empresacont"><input type="checkbox" %s></th>
</tr>
<tr>
  <th class="empresacont">PUPILAS</th>
H40^  <th class="empresacont"><input type="checkbox" %s></th>
H41^  <th class="empresacont"><input type="checkbox" %s></th>
  <th class="empresacont">ESCLERAS</th>
H42^  <th class="empresacont"><input type="checkbox" %s></th>
H43^  <th class="empresacont"><input type="checkbox" %s></th>
</tr>
<tr>
  <th class="empresacont">NARIZ</th>
H44^  <th class="empresacont"><input type="checkbox" %s></th>
H45^  <th class="empresacont"><input type="checkbox" %s></th>
  <th class="empresacont">OIDOS</th>
H46^  <th class="empresacont"><input type="checkbox" %s></th>
H47^  <th class="empresacont"><input type="checkbox" %s></th>
</tr>
<tr>
  <th class="empresacont">BOCA</th>
H48^  <th class="empresacont"><input type="checkbox" %s></th>
H49^  <th class="empresacont"><input type="checkbox" %s></th>
  <th class="empresacont">DENTADURA</th>
H50^  <th class="empresacont"><input type="checkbox" %s></th>
H51^  <th class="empresacont"><input type="checkbox" %s></th>
</tr>
<tr>
  <th class="empresacont">CUELLO</th>
H52^  <th class="empresacont"><input type="checkbox" %s></th>
H53^  <th class="empresacont"><input type="checkbox" %s></th>
  <th class="empresacont">TORAX</th>
H54^  <th class="empresacont"><input type="checkbox" %s></th>
H55^  <th class="empresacont"><input type="checkbox" %s></th>
</tr>
<tr>
  <th class="empresacont">ABDOMEN</th>
H56^  <th class="empresacont"><input type="checkbox" %s></th>
H57^  <th class="empresacont"><input type="checkbox" %s></th>
  <th class="empresacont">EXTREMIDADES</th>
H58^  <th class="empresacont"><input type="checkbox" %s></th>
H59^  <th class="empresacont"><input type="checkbox" %s></th>
</tr>
<tr>
  <th class="empresacont">GENITALES</th>
H60^  <th class="empresacont"><input type="checkbox" %s></th>
H61^  <th class="empresacont"><input type="checkbox" %s></th>
  <th class="empresacont"></th>
  <th class="empresacont"></th>
  <th class="empresacont"></th>
</tr>
<tr><th>&nbsp;</th></tr>
</table>
<div class="empresa" style="text-align: center;"><b>VI. ACTIVIDADES DE TENS</div>
 <table width=700 cellspacing=0 style="border-collapse:collapse;">
  <tr><th class="empresatit" width=100%><b>ACTIVIDADES</b></th>
<tr>
H62^  <th class="empresacont" style="text-align:left; padding: 10px;">%s</th>
</tr>
  <tr><th class="empresatit" width=100%><b>INDICACIONES</b></th><tr>
H63^  <th class="empresacont" style="text-align:left; padding: 10px;">%s</th>
</tr>
<tr><th>&nbsp;</th></tr>
<tr><th>&nbsp;</th></tr>
</table>
 <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>
H64^  <th class="empresacont">%s</th>
</tr>
</table>

 <table width=700 cellspacing=0 style="border-collapse:collapse;">
	<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>
</table>



</body>
</html>

