<div dir=3D"ltr">
Registro Atenci=C3=B3n Mario Barrientos<br clear=3D"all">
<div>
<div dir=3D"ltr" class=3D"gmail_signature" data-smartmail=3D"gmail_signature">
<div dir=3D"ltr">
<div>
<div dir=3D"ltr">
<div>
<font size=3D"4">
<img src=3D"https://docs.google.com/uc?export=3Ddownload&amp;id=3D1CZ1y5ajpxZHYVQARdKi0pbNJ5IGsl93s&amp;revid=3D0B3qxlh9GeOnuelMreVgyS2s4Njl2YXJhY245SE9QbXA0SW5VPQ">
<br>
</font>
<br>
</div>
</div>
</div>
</div>
</div>
</div>
<div class=3D"gmail_quote">
Estimada:</div>
<div class=3D"gmail_quote">
Adjunto registro de atenci=C3=B3n de Maria Barrientos.</div>
<div class=3D"gmail_quote">
<br>
</div>
<div class=3D"gmail_quote">
Saluda Atte.</div>
<div class=3D"gmail_quote">
<br>
</div>
<div class=3D"gmail_quote">
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;margin:0;padding:0;height:100%;width:100%">
<table border=3D"0" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(38,4,154)" width=3D"100%">
<tbody>
<tr height=3D"64px">
<td style=3D"padding-left:24px">
<img alt=3D"Formularios de Google" height=3D"26px" style=3D"display:inline-block;margin:0;vertical-align:middle" width=3D"143px" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div style=3D"padding:24px;background-color:rgb(229,218,254)">
<div align=3D"center" style=3D"background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por llenar <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr height=3D"12px">
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242">
Estas son tus respuestas:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"m_-5993890120828478855ss-form-container">
<div class=3D"m_-5993890120828478855ss-form-heading">
<h1 class=3D"m_-5993890120828478855ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_-5993890120828478855ss-form-desc m_-5993890120828478855ss-no-ignore-whitespace" style=3D"font:inherit;width:99%;margin:0 0 1em;white-space:pre-wrap;word-wrap:break-word">
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.</div>
</div>
<div class=3D"m_-5993890120828478855ss-form">
<form method=3D"GET" id=3D"m_-5993890120828478855ss-form" target=3D"_blank">
<br>
<div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-text" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855emailAddress">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Direcci=C3=B3n de correo electr=C3=B3nico<label for=3D"m_-5993890120828478855emailAddress">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_-5993890120828478855ss-q-text m_-5993890120828478855ss-printable-text-line" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
<a href=3D"mailto:carolinaandrea.vsanchez@gmail.com" target=3D"_blank">
carolinaandrea.vsanchez@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-5993890120828478855ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-5993890120828478855ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_-5993890120828478855ss-page-description m_-5993890120828478855ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
Aqu=C3=AD debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-text" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_579114469">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-5993890120828478855ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Carolina Vargas</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-text" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_1276273985">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"m_-5993890120828478855ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
17528747-7</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-select" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_133691676">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
Si asisten m=C3=A1s de 1 prestador simult=C3=A1neamente, cada uno debe hacer un registro independiente</div>
</label>
<select name=3D"entry.133691676" disabled id=3D"m_-5993890120828478855entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled>
MEDICO</option>
 <option value=3D"ENFERMERA/O" disabled selected>
ENFERMERA/O</option>
 <option value=3D"TENS" disabled>
TENS</option>
 <option value=3D"KINESIOLOGA/O" disabled>
KINESIOLOGA/O</option>
 <option value=3D"PSICOLOGO" disabled>
PSICOLOGO</option>
 <option value==3D"NUTRICIONISTA" disabled>
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-5993890120828478855ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-5993890120828478855ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_-5993890120828478855ss-page-description m_-5993890120828478855ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
En esta secci=C3=B3n debe ingresar los datos del paciente visitado</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-5993890120828478855ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_-5993890120828478855ss-section-description m_-5993890120828478855ss-no-ignore-whitespace" style=3D"margin-top:0.5em;white-space:pre-wrap;word-wrap:break-word">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-text" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_823811303">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"m_-5993890120828478855ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
13967779-k</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-text" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_1959365839">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-5993890120828478855ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Mario Barrientos </div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-select" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_545002227">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<select name=3D"entry.545002227" disabled id=3D"m_-5993890120828478855entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled>
COLMENA</option>
 <option value=3D"CONSALUD" disabled selected>
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled>
CRUZ BLANCA</option>
 <option value=3D"DIPRECA" disabled>
DIPRECA</option>
 <option value=3D"FONASA" disabled>
FONASA</option>
 <option value=3D"FUNDACION" disabled>
FUNDACION</option>
 <option value=3D"ISAPRES DEL COBRE" disabled>
ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled>
NUEVA MASVIDA</option>
 <option value=3D"VIDATRES" disabled>
VIDATRES</option>
 <option value=3D"PARTICULAR" disabled>
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-text" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_1900161356">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-5993890120828478855ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Puerto Montt</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-text" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_1298871758">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-5993890120828478855ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Puerto Montt</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-5993890120828478855ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-5993890120828478855ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_-5993890120828478855ss-page-description m_-5993890120828478855ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
En esta secci=C3=B3n debe ingresar los datos de la atenci=C3=B3n domiciliaria</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-radio" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_2073233714">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_-5993890120828478855ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-5993890120828478855ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-5993890120828478855ss-choice-item-control m_-5993890120828478855goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_-5993890120828478855group_1222378237_1" class=3D"m_-5993890120828478855ss-q-radio">
</span>
<span class=3D"m_-5993890120828478855ss-choice-label">
Domicilio</span>
</label>
</li>
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<label>
<span class=3D"m_-5993890120828478855ss-choice-item-control m_-5993890120828478855goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_-5993890120828478855group_1222378237_2" class=3D"m_-5993890120828478855ss-q-radio">
</span>
<span class=3D"m_-5993890120828478855ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-date" style=3D"margin:12px 0">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_1705849412">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha de la Atenci=C3=B3n<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-5993890120828478855ss-q-date">
<div class=3D"m_-5993890120828478855ss-datetime-box m_-5993890120828478855goog-inline-block" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
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<option value==3D"">
Mes</option>
<option value=3D"1">
enero</option>
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febrero</option>
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marzo</option>
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abril</option>
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mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
</select>
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<option value=3D"">
D=C3=ADa</option>
<option value=3D"1">
1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
</select>
=20<select name=3D"entry.1705849412_year" disabled id=3D"m_-5993890120828478855entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
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1897</option>
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1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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1925</option>
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1926</option>
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1927</option>
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1928</option>
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1929</option>
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1930</option>
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1931</option>
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1932</option>
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1933</option>
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1934</option>
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1935</option>
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1936</option>
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1937</option>
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1938</option>
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1939</option>
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1940</option>
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1941</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
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1946</option>
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1947</option>
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1948</option>
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1949</option>
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1950</option>
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1951</option>
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1952</option>
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1953</option>
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1954</option>
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1955</option>
 <option value==3D"1956">
1956</option>
 <option value=3D"1957">
1957</option>
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1958</option>
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1959</option>
 <option value==3D"1960">
1960</option>
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1961</option>
 <option value==3D"1962">
1962</option>
 <option value=3D"1963">
1963</option>
 <option value==3D"1964">
1964</option>
 <option value=3D"1965">
1965</option>
 <option value==3D"1966">
1966</option>
 <option value=3D"1967">
1967</option>
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1968</option>
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1969</option>
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1970</option>
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1971</option>
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1972</option>
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1973</option>
 <option value==3D"1974">
1974</option>
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1975</option>
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1976</option>
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1977</option>
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1978</option>
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1979</option>
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1980</option>
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1981</option>
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1982</option>
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1983</option>
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1984</option>
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1985</option>
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1986</option>
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1987</option>
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1988</option>
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1989</option>
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1990</option>
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1991</option>
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1992</option>
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1993</option>
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1994</option>
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1995</option>
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1996</option>
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1997</option>
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1998</option>
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1999</option>
 <option value==3D"2000">
2000</option>
 <option value=3D"2001">
2001</option>
 <option value==3D"2002">
2002</option>
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2003</option>
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2004</option>
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2005</option>
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2006</option>
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2007</option>
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2008</option>
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2009</option>
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2010</option>
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2011</option>
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2012</option>
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2013</option>
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2014</option>
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2015</option>
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2016</option>
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2017</option>
 <option value==3D"2018">
2018</option>
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2019</option>
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2020</option>
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2021</option>
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2022</option>
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2023</option>
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2024</option>
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2025</option>
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2026</option>
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2027</option>
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2028</option>
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2029</option>
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2030</option>
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2031</option>
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2032</option>
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2033</option>
 <option value=3D"2034">
2034</option>
 <option value=3D"2035">
2035</option>
 <option value=3D"2036">
2036</option>
 <option value=3D"2037">
2037</option>
 <option value==3D"2038">
2038</option>
 <option value=3D"2039">
2039</option>
 <option value==3D"2040">
2040</option>
 <option value=3D"2041">
2041</option>
 <option value==3D"2042">
2042</option>
 <option value=3D"2043">
2043</option>
 <option value==3D"2044">
2044</option>
 <option value=3D"2045">
2045</option>
 <option value==3D"2046">
2046</option>
 <option value=3D"2047">
2047</option>
 <option value==3D"2048">
2048</option>
 <option value=3D"2049">
2049</option>
 <option value==3D"2050">
2050</option>
 <option value=3D"2051">
2051</option>
 <option value==3D"2052">
2052</option>
 <option value=3D"2053">
2053</option>
 <option value==3D"2054">
2054</option>
 <option value=3D"2055">
2055</option>
 <option value==3D"2056">
2056</option>
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2057</option>
 <option value==3D"2058">
2058</option>
 <option value=3D"2059">
2059</option>
 <option value==3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <option value==3D"2062">
2062</option>
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2063</option>
 <option value==3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
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2066</option>
 <option value=3D"2067">
2067</option>
 <option value==3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-item-required m_-5993890120828478855ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_206244955">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Hora de la Atenci=C3=B3n<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-5993890120828478855ss-q-time">
<div class=3D"m_-5993890120828478855ss-datetime-box m_-5993890120828478855goog-inline-block" dir=3D"ltr" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
<select name=3D"entry.206244955_hour" disabled id=3D"m_-5993890120828478855entry.206244955_hour">
<option value=3D"">
h</option>
<option value=3D"00">
00</option>
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01</option>
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02</option>
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03</option>
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04</option>
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05</option>
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06</option>
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07</option>
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08</option>
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09</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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.<select name=3D"entry.206244955_minute" disabled id=3D"m_-5993890120828478855entry.206244955_minute">
<option value=3D"">
min</option>
<option value=3D"00" selected>
00</option>
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01</option>
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02</option>
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39</option>
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49</option>
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<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
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<span class=3D"m_-5993890120828478855ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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0</option>
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1</option>
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2</option>
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3</option>
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4</option>
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<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_1716090865">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
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<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
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2</label>
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3</label>
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<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
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5</label>
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6</label>
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<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
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<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
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<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
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10</label>
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<br>
 <div class=3D"m_-5993890120828478855ss-form-question m_-5993890120828478855errorbox-good">
<div dir=3D"auto" class=3D"m_-5993890120828478855ss-item m_-5993890120828478855ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-5993890120828478855ss-q-item-label" for=3D"m_-5993890120828478855entry_2064050596">
<div class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA M=C3=A1ximo</div>
<div class=3D"m_-5993890120828478855ss-q-help m_-5993890120828478855ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
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<tbody>
<tr>
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</td>
<td class=3D"m_-5993890120828478855ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-5993890120828478855ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-5993890120828478855ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-5993890120828478855ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-5993890120828478855ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-5993890120828478855ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
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<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-5993890120828478855ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-5993890120828478855ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
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<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
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<label class=3D"m_-5993890120828478855ss-scalenumber" for=3D"m_-5993890120828478855group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-5993890120828478855ss-scalenumbers" style=3D"text-align:center">
</td>
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<tr>
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<div class==3D"m_-5993890120828478855aria-todo">
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</td>
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Escala Dolor EVA M=C3=ADnimo</div>
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0</label>
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1</label>
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2</label>
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3</label>
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4</label>
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5</label>
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6</label>
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7</label>
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8</label>
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9</label>
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10</label>
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</td>
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Anamnesis/Evoluci=C3=B3n<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
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*</span>
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</div>
</label>
<div class=3D"m_-5993890120828478855ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Se realiza visita domiciliaria en conjunto con m=C3=A9dico Dr. Gonzalez.Antecedentes: Cancer de cerebral (Glioblastoma multiforme grado IV) Diciembre 2016 con abordaje quir=C3=BArgico y ciclo de quimioterapia.Quimioterapia oral con temosolamida.Medicamentos:=20Carbamazepina 200 mg 1 comprimido al diaParacetamol 500 mg en caso de dolor.Ketorolaco 10 mg en caso de dolor.Nos recibe junto a su esposa e hijos.Paciente se encuentra realizando actividades de la universidad al momento de la visita, se encuentra en buenas condiciones generales, orientado en tiempo y espacio, ECOG 0, este a=C3=B1o inicio actividades acad=C3=A9micas a la cual acude todos los d=C3=ADas en la ma=C3=B1ana. Se mantiene en control con neurocirujano Dr. Carmona, ultimo en enero 2019, pr=C3=B3ximo control en junio 2019.En relaci=C3=B3n a las actividades de la vida diaria, paciente autovalente, pudiendo realizarlas sin mayores complicaciones.Manifiesta que ha presentado episodios de cefalea en zona fronto occipital, que no son recurrentes pero si mas frecuentes ahora que estudia, lo cual asocia al estres propio que conllevan sus nuevas actividades. Actualmente sin dolor, aunque cuando se presenta es moderado, EVA 6/10 que no ceden con 1 gr de paracetamol por lo que esposa administra  2 comprimidos fredol con el cual logra ceder. M=C3=A9dico tratante hab=C3=ADa indicado ketorolaco trometamol, pero por costo elevado no es su primera opci=C3=B3n.=20En lo emocional se encuentra estable, ha logrado mantener un equilibrio, estuvo en control con psic=C3=B3logo  junto a su pareja. Refiere motivaci=C3==B3n para realizar nuevas actividades.Alimentaci=C3=B3n variada bien tolerada por boca. No mantiene una alimentaci=C3=B3n saludable.Eliminaci=C3=B3n sin problemas.Patr=C3=B3n del sue=C3=B1o normal, logra conciliar y mantener el sue=C3=B1o durante toda la noche.Movilidad conservada, no realiza ning=C3=BAn tipo de actividad f=C3=ADsica.Signos vitales: Normotenso, eucardico, saturando dentro de rangos normales.PA: 130/93Pulso: 79Sat: 98%Solicita orden vacuna influenza.Dr. Indica control con ex=C3=A1menes. </div>
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Examen F=C3=ADsico<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
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*</span>
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</div>
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<div class=3D"m_-5993890120828478855ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Cicatriz zona parietal izquierda. Sin mayores hallazgos.</div>
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Cancer de cerebral (Glioblastoma multiforme grado IV) tratado</div>
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Plan de Tratamiento e Indicaciones<label for=3D"m_-5993890120828478855itemView.getDomIdToLabel()">
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Valorar el dolor=20Manejo del dolorManejo del estr=C3=A9sEducaci=C3=B3n de h=C3=A1bitos saludables</div>
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2060</option>
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2065</option>
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2066</option>
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Tratamiento Realizado (si corresponde)</div>
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Derivaci=C3=B3n a otro Prestador Domiciliario</div>
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S=C3=B3lo llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del equipo</div>
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ENFERMERA</span>
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</span>
<span class=3D"m_-5993890120828478855ss-choice-label">
TENS</span>
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NUTRICIONISTA</span>
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KINESIOLOGO</span>
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PSICOLOGO</span>
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<div class=3D"m_-5993890120828478855ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-5993890120828478855ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
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<div style=3D"text-align:right">
<img class=3D"m_-5993890120828478855ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
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<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link" style=3D"color:#424242;font-size:13px" target=3D"_blank">
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