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<b>
<span style=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif"'>
De:</span>
</b>
<spanstyle=3D'font-size:10.0pt;font-family:"Tahoma","sans-serif"'>
 Formularios deGoogle [mailto:forms-receipts-noreply@google.com] <br>
<b>
Enviado el:</b>
 mi=C3=A9rcoles, 13 de marzo de 2019 16:13<br>
<b>
Para:</b>
 franciscasalinas@telemed-chile.cl<br>
<b>
Asunto:</b>
 Registro de Atenci=C3=B3n Domiciliaria Oncovida<o:p>
</o:p>
</span>
</p>
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<p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
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<img id=3D"_x0000_i1025"  src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png"  alt=3D"Formularios de Google">
<o:p>
</o:p>
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<b>
<span style=3D'font-size:10.0pt;  color:#424242'>
Gracias por rellenar <a  href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link">
Registro  de Atenci=C3=B3n Domiciliaria Oncovida</a>
<o:p>
</o:p>
</span>
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Esto es lo que nos has enviado:<o:p>
</o:p>
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  <h1 style=3D'mso-margin-top-alt:8.05pt;margin-right:0cm;margin-bottom:8.05pt;  margin-left:0cm'>
Registro de Atenci=C3=B3n Domiciliaria Oncovida<o:p>
</o:p>
</h1>
  <div style=3D'margin-bottom:12.0pt;white-space:pre-wrap;word-wrap:break-word'>
  <p class=3DMsoNormal>
Este es el sistema de registro de atenciones domiciliarias  de Oncovida. Debe ser llenado por el prestador individual, y debe realizarse  un registro por cada visita domiciliaria. Si usted no es prestador de  Oncovida por favor no llene este formulario. A continuaci=C3=B3n indique su correo  electr=C3=B3nico.<o:p>
</o:p>
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<o:p>
&nbsp;</o:p>
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<b>
Direcci=C3=B3n de correo  electr=C3=B3nico <span class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
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  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
franciscasalinas@telemed-chile.cl<o:p>
</o:p>
</span>
</p>
  </div>
  </div>
  </div>
  </div>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <p class=3DMsoNormal align=3Dright style=3D'text-align:right;vertical-align:middle'>
<img  border=3D0 id=3D"_x0000_i1026"  src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ"  alt=3D"Imagen sin leyenda">
<o:p>
</o:p>
</p>
  </div>
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<o:p>
&nbsp;</o:p>
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  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
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Identificaci=C3=B3n del Prestador<o:p>
</o:p>
</h2>
  <div>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
Aqu=C3=AD debe ingresar sus datos  personales<o:p>
</o:p>
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<o:p>
&nbsp;</o:p>
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<b>
Primer Nombre y Apellido  Paterno <span class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
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<span  style=3D'color:#545454'>
Francisca Salinas<o:p>
</o:p>
</span>
</p>
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<o:p>
&nbsp;</o:p>
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  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
RUT <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'margin-top:1.2pt;margin-bottom:3.0pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<span style=3D'color:#666666'>
RUT  con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)<o:p>
</o:p>
</span>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
16765876-8<o:p>
</o:p>
</span>
</p>
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<o:p>
&nbsp;</o:p>
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<b>
Tipo <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
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<span style=3D'color:#666666'>
Si  asisten m=C3=A1s de 1 prestador simult=C3=A1neamente, cada uno debe hacer un registro  independiente<o:p>
</o:p>
</span>
</p>
  </div>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
[ENFERMERA/O&nbsp;\/] <o:p>
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<o:p>
&nbsp;</o:p>
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<img  border=3D0 id=3D"_x0000_i1027"  src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA"  alt=3D"Imagen sin leyenda">
<o:p>
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&nbsp;</o:p>
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Identificaci=C3=B3n del Paciente<o:p>
</o:p>
</h2>
  <div>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
En esta secci=C3=B3n debe  ingresar los datos del paciente visitado<o:p>
</o:p>
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<o:p>
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Datos Personales del Paciente<o:p>
</o:p>
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<o:p>
&nbsp;</o:p>
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  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Ingrese el Rut del  Paciente <span class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'margin-top:1.2pt;margin-bottom:3.0pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<span style=3D'color:#666666'>
RUT  con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)<o:p>
</o:p>
</span>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
4984072-1<o:p>
</o:p>
</span>
</p>
  </div>
  </div>
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  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
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  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Ingrese el Primer Nombre  y Apellido Paterno del Paciente <span class=3Dss-required-asterisk>
<span  style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
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  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
Santiago Hernaiz<o:p>
</o:p>
</span>
</p>
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  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
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<b>
Previsi=C3=B3n <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
[CONSALUD&nbsp;\/] <o:p>
</o:p>
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&nbsp;</o:p>
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  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Ciudad <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
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Chill=C3=A1n<o:p>
</o:p>
</span>
</p>
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<o:p>
&nbsp;</o:p>
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<b>
Comuna <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
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Chill=C3=A1n<o:p>
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<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <p class=3DMsoNormal align=3Dright style=3D'text-align:right;vertical-align:middle'>
<img  border=3D0 id=3D"_x0000_i1028"  src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ"  alt=3D"Imagen sin leyenda">
<o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <h2 style=3D'mso-margin-top-alt:24.0pt;margin-right:-4.8pt;margin-bottom:0cm;  margin-left:-4.8pt;margin-bottom:.0001pt;background:#EEEEEE;vertical-align:  middle'>
Registro de la Atenci=C3=B3n Domiciliaria<o:p>
</o:p>
</h2>
  <div>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
En esta secci=C3=B3n debe  ingresar los datos de la atenci=C3=B3n domiciliaria<o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Tipo de Atenci=C3=B3n <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l0 level1 lfo1;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
(X)</span>
 <span  class=3Dss-choice-label>
Domicilio</span>
 <o:p>
</o:p>
</p>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l0 level1 lfo1;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
(&nbsp;)</span>
  <span class=3Dss-choice-label>
Ambulatorio</span>
 <o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Fecha de la Atenci=C3=B3n <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div>
  <div style=3D'border:solid gainsboro 1.0pt;padding:0cm 0cm 0cm 2.0pt;  margin-left:2.25pt;margin-top:3.0pt;margin-right:2.25pt;margin-bottom:3.0pt;  min-height:32px;display:inline-block'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
[12&nbsp;\/] [marzo&nbsp;\/]  [2019&nbsp;\/] <o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Hora de la Atenci=C3=B3n <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div>
  <div style=3D'border:solid gainsboro 1.0pt;padding:0cm 0cm 0cm 2.0pt;  margin-left:2.25pt;margin-top:3.0pt;margin-right:2.25pt;margin-bottom:3.0pt;  min-height:32px;display:inline-block'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
[15&nbsp;\/] : [00&nbsp;\/] <o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Performance Status ECOG  del Paciente <span class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
[4&nbsp;\/] <o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt;overflow-x:auto'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Escala Dolor EVA Actual <o:p>
</o:p>
</b>
</p>
  </div>
  <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=3D0   id=3D"entry_1421689035">
   <tr>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
0<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
1<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
2<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
3<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
4<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
5<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
6<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
7<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
8<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
9<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
10<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
   </tr>
   <tr>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 0cm'>
</td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(X)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 0cm 6.0pt 3.0pt'>
</td>
   </tr>
  </table>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt;overflow-x:auto'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Escala Dolor EVA M=C3=A1ximo <o:p>
</o:p>
</b>
</p>
  </div>
  <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=3D0   id=3D"entry_1244707512">
   <tr>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
0<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
1<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
2<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
3<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
4<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
5<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
6<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
7<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
8<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
9<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
10<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
   </tr>
   <tr>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 0cm'>
</td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 0cm 6.0pt 3.0pt'>
</td>
   </tr>
  </table>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt;overflow-x:auto'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Escala Dolor EVA M=C3=ADnimo <o:p>
</o:p>
</b>
</p>
  </div>
  <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=3D0   id=3D"entry_853118630">
   <tr>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
0<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
1<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
2<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
3<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
4<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
5<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
6<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
7<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
8<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
9<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
10<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
   </tr>
   <tr>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 0cm'>
</td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 0cm 6.0pt 3.0pt'>
</td>
   </tr>
  </table>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Anamnesis/Evoluci=C3=B3n <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
PACIENTE EN REGULARES CONDICIONES GENERALES,  CONSCIENTE, L=C3=9ACIDO, ORIENTADO EN TIEMPO Y ESPACIO, CON DOLOR LEVE EN ZONA  LUMBO SACRA Y EN EXTREMIDAD INFERIOR IZQUIERDA (EVA DE 2 PUNTOS). SE  ENCUENTRA EN SU DORMITORIO, ENCAMADO EL 100% DEL D=C3=8DA, ACOMPA=C3=91ADO POR UNA  CUIDADORA Y SU ESPOSA. DE ACUERDO A LA EVALUACI=C3=93N DE SUS NECESIDADES B=C3=81SICAS,  SE APRECIA ALTERACI=C3=93N DEL PATR=C3=93N ALIMENTARIO, PRODUCTO DE SU OBSTRUCCI=C3=93N  INTESTINAL. PACIENTE SE ENCUENTRA COMIENDO CADA 2 HORAS EN PEQUE=C3=91AS  CANTIDADES Y ALIMENTOS DE CONSISTENCIA PAPILLA. NECESIDAD DE ELIMINACI=C3=93N  ALTERADA. PACIENTE SE ENCUENTRA CON SONDA FOLLEY IN SITU, PRESENTANDO  PROBLEMAS EN EL DRENAJE DE ESTA. ORINA CON MUCHO SEDIMENTO URINARIO QUE  IMPIDE EL DRENAJE FLUIDO DE ORINA, PRESENTANDO OBSTRUCCI=C3=93N TOTAL EN DOS  OCASIONES DURANTE LA SEMANA. COLOSTOM=C3=8DA EN BUENAS CONDICIONES, CON MATERIA  FECAL PRESENTE EN PEQUE=C3=91AS CANTIDADES. NECESIDAD DE MOVILIZARSE ALTERADA.  PACIENTE TODO EL D=C3=8DA EN CAMA. NO PUEDE DEAMBULAR. ES CAPAZ DE PASAR DE  POSICI=C3=93N DECUBITO A SENTADO. Escala de Glasgow: 15 puntos Escala de Dowton: 6  puntos Escala de Norton: 9 puntos <o:p>
</o:p>
</span>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Examen F=C3=ADsico <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
AL CONTROL DE SIGNOS VITALES, PACIENTE  HEMODINAMICAMENTE ESTABLE PA: 110/66 MMHG FC: 80 LPM SATURACI=C3=93N DE OXIGENO DE  96% CON FIO2 AMBIENTAL. PRESENCIA DE UPP EN ZONA SACRA EN PRIMER GRADO,  MANEJABLE CON MEDIDAS DOM=C3=89STICAS SONDA FOLLEY IN SITU EN BUENAS CONDICIONES.  BIEN INSTALADA Y BUENA HIGIENE COLOSTOM=C3=8DA EN BUENAS CONDICIONES. ESTOMA Y  PIEL CIRCUNDANTE SIN ALTERACIONES<o:p>
</o:p>
</span>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Diagn=C3=B3stico <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
CORDOMA EN SACRO CON METASTASIS PULMONAR<o:p>
</o:p>
</span>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Plan de Tratamiento e  Indicaciones <span class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
MAJECO UPP PRIMER GRADO EN ZONA SACRA PREVENCI=C3=93N DE  CA=C3=8DDAS REFORZAR INDICACIONES PARA ALIMENTACI=C3=93N PREVENCI=C3=93N DE CA=C3=8DDAS<o:p>
</o:p>
</span>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Medicamentos Indicados <o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
DEXAMETASONA 4 MG 1 EN LA MA=C3=91ANA EUTIROX 100 MCG LANSOPRAZOL  30 MG AMIODARONA 100 MG PARACETAMOL 500 MG PREGABALINA 150 MG NITROFURANTOINA  100 MG CADA 8 HORAS<o:p>
</o:p>
</span>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Fecha aproximada del  Pr=C3=B3ximo Control con usted <o:p>
</o:p>
</b>
</p>
  </div>
  <div>
  <div style=3D'border:solid gainsboro 1.0pt;padding:0cm 0cm 0cm 2.0pt;  margin-left:2.25pt;margin-top:3.0pt;margin-right:2.25pt;margin-bottom:3.0pt;  min-height:32px;display:inline-block'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
[19&nbsp;\/] [marzo&nbsp;\/]  [2019&nbsp;\/] <o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Tratamiento Realizado (si  corresponde) <o:p>
</o:p>
</b>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Derivaci=C3=B3n a otro  Prestador Domiciliario <o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'margin-top:1.2pt;margin-bottom:3.0pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<span style=3D'color:#666666'>
S=C3=B3lo  llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del  equipo<o:p>
</o:p>
</span>
</p>
  </div>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l1 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
[&nbsp;]</span>
  <span class=3Dss-choice-label>
ENFERMERA</span>
 <o:p>
</o:p>
</p>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l1 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
[&nbsp;]</span>
  <span class=3Dss-choice-label>
TENS</span>
 <o:p>
</o:p>
</p>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l1 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
[&nbsp;]</span>
  <span class=3Dss-choice-label>
NUTRICIONISTA</span>
 <o:p>
</o:p>
</p>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l1 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
[&nbsp;]</span>
  <span class=3Dss-choice-label>
KINESIOLOGO</span>
 <o:p>
</o:p>
</p>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l1 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
[&nbsp;]</span>
  <span class=3Dss-choice-label>
PSICOLOGO</span>
 <o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <p class=3DMsoNormal align=3Dright style=3D'text-align:right;vertical-align:middle'>
<img  border=3D0 id=3D"_x0000_i1029"  src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A"  alt=3D"Imagen sin leyenda">
<o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  </div>
  </div>
  </td>
 </tr>
 <tr>
  <td style=3D'padding:0cm 0cm 0cm 0cm'>
</td>
 </tr>
</table>
</div>
</div>
<div align=3Dcenter>
<table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=3D0 width=3D"100%" style=3D'width:100.0%'>
 <tr>
  <td style=3D'padding:0cm 0cm 0cm 0cm'>
</td>
 </tr>
 <tr>
  <td style=3D'padding:0cm 0cm 0cm 0cm'>
  <p class=3DMsoNormal>
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link">
<span  style=3D'font-size:10.0pt;color:#424242'>
Crea tu propio formulario de Google</span>
</a>
<o:p>
</o:p>
</p>
  </td>
 </tr>
</table>
</div>
<p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
</div>
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