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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>
 viernes, 19 de abril de 2019 0:58<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>
</b>
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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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  </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>
</p>
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  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
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  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<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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FRANCISCA SALINAS MEDINA<o:p>
</o:p>
</span>
</p>
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  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
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  <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>
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>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
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  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<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>
</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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<o:p>
&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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  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
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Datos Personales del Paciente<o:p>
</o:p>
</h2>
  </div>
  </div>
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  <p class=3DMsoNormal>
<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'>
5425186-6<o:p>
</o:p>
</span>
</p>
  </div>
  </div>
  </div>
  </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>
  </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'>
MIRELLA ALVEAR<o:p>
</o:p>
</span>
</p>
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  </div>
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  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
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  <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>
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'>
[FUNDACION&nbsp;\/] <o:p>
</o:p>
</p>
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  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
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  <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>
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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<span  style=3D'color:#545454'>
CHILL=C3=81N<o:p>
</o:p>
</span>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
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  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<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=81N<o:p>
</o:p>
</span>
</p>
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  <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_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:l1 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:l1 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'>
[18&nbsp;\/] [abril&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'>
[17&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'>
[1&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'>
(&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'>
(X)<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'>
(X)<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'>
(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 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, DEAMBULA  POR EL DEPARTAMENTO, SE APRECIA CON UNA ACTITUD MUY ANSIOSA, NERVIOSA,  CONSCIENTE, ORIENTADA EN TIEMPO Y ESPACIO, CON DOLOR INTENSO EN REGI=C3==93N  EPIG=C3=81STRICA (REFIERE 10 PUNTOS SEG=C3=9AN EVA). MANIFIESTA QUE A PESAR DE LA  MEDICACI=C3=93N QUE TOMA DIARIAMENTE, EL DOLOR NO AMINORA. - NUEVOS EXAMENES  TOMADOS EN LA CIUDAD DE SANTIAGO ARROJAN CANDIDIASIS ESOF=C3=81GICA. - NECESIDAD  DE ALIMENTAUCI=C3=93N: PACIENTE INGIERE POCAS CANTIDADES DE ALIMENTO, YA QUE  MANIFIESTA SENTIR MUCHO DOLOR ABDOMINAL. CONSUME POCOS L=C3=8DQUIDOS. - USUARIA  DEPENDIENTE, REQUIERE DE AYUDA PARA REALIZAR ACTIVIDADES Y SATISFACER SUS  NECESIDADES B=C3=81SICAS. IMPORTANTE ALTERACI=C3=93N DE LA MEMORIA A CORTO Y A LARGO  PLAZO. - ESCALA DE GLASGOW: 15 PUNTOS - ESCALA DE DOWTON: 4 PUNTOS - ESCALA  DE NORTON: 18 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 EXAMEN F=C3=8DSICO GENERAL, PACIENTE SE ENCUENTRA DE PIE,  DEAMBULANDO DE FORMA NORMAL, FACIE DE ANGUSTIA, ANSIEDAD, EN TODO MOMENTO CON  LAS MANOS UBICADAS EN LA REGI=C3=93N ABDOMINAL. ESTADO PSIQUICO: SE APRECIA UNA  IMPORTANTE P=C3=89RDIDA DE LA MEMORIA A CORTO PLAZO. NO RECUERDA NOMBRES NI LOS  MEDICAMENTOS QUE ESTA TOMANDO. SE LE EXPLIC=C3=93 EN MAS DE 4 OCASIONES AL MOMENTO  DE LA VISITA LOS D=C3=8DAS Y LAS DOSIS QUE DEB=C3=8DA INGERIR, PERO PASABAN UNOS  MINUTOS Y NO RECORDABA HABER RECIBIDO LA INDICACI=C3=93N. AL CONTROL DE SIGNOS  VITALES, USUARIA HEMODIN=C3=81MICAMENTE ESTABLE, CON UNA PA DE 124/66 MMHG, FC DE  78 LPM Y SATURANDO 99% CON FIO2 AMBIENTAL. AL EXAMEN F=C3=8DSICO SEGMENTARIO: -  PIEL DE ASPECTO NORMAL, ROSADA E HIDRATADA. - ABDOMEN DISTENDIDO, TIMP=C3=81NICO A  LA PERCUSI=C3=93N, DOLOR A LA PALPACI=C3=93N. - EDEMA EN EXTREMIDAD INFERIOR IZQUIERDA  (LINFEDEMA +++) EN TRATAMIENTO CON KINESI=C3=93LOGA.<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'>
CA VAGINA<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'>
- CONTROL EN UNA SEMANA MAS - REFORZAMIENTO MEDICACI=C3=93N:  SE DEJA PAUTA ESCRITA CON HORARIO Y DOSIS DE TODOS LOS MEDICAMENTOS QUE  CONSUME. - PREVENCI=C3=93N DE CA=C3=8DDAS Y ACCIDENTES EN EL HOGAR.<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'>
TRIMEBUTINA 300 MG 1 DESPU=C3=89S DE ALMUERZO FLUCONAZOL 150  MG 1 VEZ POR SEMANA ACUODE 300.000 UI 16 GOTAS 1 VEZ POR SEMANA FLAPEX 1  COMPRIMIDO 2 VECES AL D=C3=8DA ESOMEPRAZOL 40 MG 1 COMPRIMIO EN AYUNAS VIVERA 1  SOBRE CADA 12 HORAS LODIPRES 1/2 COMPRIMIDO 2 VECES AL D=C3=8DA ANTIAX 1  COMPRIMIDO DOS VECES AL D=C3=8DA BION TRANSIT 1 COMPRIMIDO AL D=C3=8DA DOMPERIDONA 1  COMPRIMIDO AL D=C3=8DA CLONAZEPAM 1 COMPRIMIDO EN LA NOCHE<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'>
[25&nbsp;\/] [abril&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:l0 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:l0 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:l0 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:l0 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:l0 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%'>
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<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>
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			<a href=3D"https://www.avast.com/antivirus">
				<img border=3D0 src=3D"http://static.avast.com/emails/avast-mail-stamp.png" alt=3D"Avast logo" />
			</a>
		</td>
		<td>
			<p style=3D'color:#3d4d5a; font-family:"Calibri","Verdana","Arial","Helvetica"; font-size:12pt;'>
				El software de antivirus Avast ha analizado este correo electr=C3=B3nico en busca de virus.				<br>
<a href=3D"https://www.avast.com/antivirus">
www.avast.com</a>
			</p>
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<a href=3D"#DAB4FAD8-2DD7-40BB-A1B8-4E2AA1F9FDF2" width=3D"1" height=3D"1">
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