<div dir=3D"auto">
</div>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
---------- Forwarded message ---------<br>
De:<strong class=3D"gmail_sendername" dir=3D"auto">
Formularios de Google</strong>
 <span dir=3D"ltr">
&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;</span>
<br>
Date: vie., 19 abr. 2019 0:23<br>
Subject: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href=3D"mailto:eveortegaa@gmail.com">
eveortegaa@gmail.com</a>
&gt;<br>
</div>
<br>
<br>
<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 rellenar <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank" rel=3D"noreferrer">
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">
Esto es lo que nos has enviado:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"m_6083855148940475859ss-form-container">
<div class=3D"m_6083855148940475859ss-form-heading">
<h1 class=3D"m_6083855148940475859ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_6083855148940475859ss-form-desc m_6083855148940475859ss-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_6083855148940475859ss-form">
<form method=3D"GET" id=3D"m_6083855148940475859ss-form" target=3D"_blank">
<br>
<div class=3D"m_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-text" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859emailAddress">
<div class=3D"m_6083855148940475859ss-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_6083855148940475859emailAddress">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_6083855148940475859ss-q-text m_6083855148940475859ss-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:eveortegaa@gmail.com" target=3D"_blank" rel=3D"noreferrer">
eveortegaa@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6083855148940475859ss-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_6083855148940475859ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6083855148940475859ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_6083855148940475859ss-page-description m_6083855148940475859ss-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_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-text" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_579114469">
<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6083855148940475859ss-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%">
Evelyn Ortega Aravena</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-text" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_1276273985">
<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-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_6083855148940475859ss-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%">
16273226-9</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-select" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_133691676">
<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-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_6083855148940475859entry_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_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6083855148940475859ss-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_6083855148940475859ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6083855148940475859ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_6083855148940475859ss-page-description m_6083855148940475859ss-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_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6083855148940475859ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_6083855148940475859ss-section-description m_6083855148940475859ss-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_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-text" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_823811303">
<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-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_6083855148940475859ss-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%">
6131208-0</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-text" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_1959365839">
<div class=3D"m_6083855148940475859ss-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_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6083855148940475859ss-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%">
Luis Soto</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-select" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_545002227">
<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-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_6083855148940475859entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled selected>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled>
COLMENA</option>
 <option value=3D"CONSALUD" disabled>
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_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-text" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_1900161356">
<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6083855148940475859ss-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%">
Talca</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-text" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_1298871758">
<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6083855148940475859ss-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%">
Talca</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6083855148940475859ss-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_6083855148940475859ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6083855148940475859ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_6083855148940475859ss-page-description m_6083855148940475859ss-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_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-radio" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_2073233714">
<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_6083855148940475859ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_6083855148940475859ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_6083855148940475859ss-choice-item-control m_6083855148940475859goog-inline-block" style=3D"display:inline-block">
<input type==3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_6083855148940475859group_1222378237_1" class=3D"m_6083855148940475859ss-q-radio">
</span>
<span class=3D"m_6083855148940475859ss-choice-label">
Domicilio</span>
</label>
</li>
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<label>
<span class=3D"m_6083855148940475859ss-choice-item-control m_6083855148940475859goog-inline-block" style=3D"display:inline-block">
<input type==3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_6083855148940475859group_1222378237_2" class=3D"m_6083855148940475859ss-q-radio">
</span>
<span class=3D"m_6083855148940475859ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-date" style=3D"margin:12px 0">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_1705849412">
<div class=3D"m_6083855148940475859ss-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_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6083855148940475859ss-q-date">
<div class=3D"m_6083855148940475859ss-datetime-box m_6083855148940475859goog-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">
 <select name=3D"entry.1705849412_day" disabled class=3D"m_6083855148940475859ss-day-dropdown" id=3D"m_6083855148940475859entry.1705849412_day">
<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>
 <option value==3D"17">
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>
 <option value=3D"31">
31</option>
</select>
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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>
 <option value=3D"12">
diciembre</option>
</select>
=20<select name=3D"entry.1705849412_year" disabled id=3D"m_6083855148940475859entry.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>
 <option value==3D"1932">
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>
 <option value==3D"1952">
1952</option>
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1953</option>
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1954</option>
 <option value=3D"1955">
1955</option>
 <option value==3D"1956">
1956</option>
 <option value=3D"1957">
1957</option>
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1958</option>
 <option value=3D"1959">
1959</option>
 <option value==3D"1960">
1960</option>
 <option value=3D"1961">
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>
 <option value==3D"1968">
1968</option>
 <option value=3D"1969">
1969</option>
 <option value==3D"1970">
1970</option>
 <option value=3D"1971">
1971</option>
 <option value==3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
 <option value==3D"1974">
1974</option>
 <option value=3D"1975">
1975</option>
 <option value==3D"1976">
1976</option>
 <option value=3D"1977">
1977</option>
 <option value==3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option value==3D"1980">
1980</option>
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1981</option>
 <option value==3D"1982">
1982</option>
 <option value=3D"1983">
1983</option>
 <option value==3D"1984">
1984</option>
 <option value=3D"1985">
1985</option>
 <option value==3D"1986">
1986</option>
 <option value=3D"1987">
1987</option>
 <option value==3D"1988">
1988</option>
 <option value=3D"1989">
1989</option>
 <option value==3D"1990">
1990</option>
 <option value=3D"1991">
1991</option>
 <option value==3D"1992">
1992</option>
 <option value=3D"1993">
1993</option>
 <option value==3D"1994">
1994</option>
 <option value=3D"1995">
1995</option>
 <option value==3D"1996">
1996</option>
 <option value=3D"1997">
1997</option>
 <option value==3D"1998">
1998</option>
 <option value=3D"1999">
1999</option>
 <option value==3D"2000">
2000</option>
 <option value=3D"2001">
2001</option>
 <option value==3D"2002">
2002</option>
 <option value=3D"2003">
2003</option>
 <option value==3D"2004">
2004</option>
 <option value=3D"2005">
2005</option>
 <option value==3D"2006">
2006</option>
 <option value=3D"2007">
2007</option>
 <option value==3D"2008">
2008</option>
 <option value=3D"2009">
2009</option>
 <option value==3D"2010">
2010</option>
 <option value=3D"2011">
2011</option>
 <option value==3D"2012">
2012</option>
 <option value=3D"2013">
2013</option>
 <option value==3D"2014">
2014</option>
 <option value=3D"2015">
2015</option>
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2016</option>
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2017</option>
 <option value==3D"2018">
2018</option>
 <option value=3D"2019" selected>
2019</option>
 <option value=3D"2020">
2020</option>
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2021</option>
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2022</option>
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2023</option>
 <option value=3D"2024">
2024</option>
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2025</option>
 <option value=3D"2026">
2026</option>
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2027</option>
 <option value=3D"2028">
2028</option>
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2029</option>
 <option value=3D"2030">
2030</option>
 <option value=3D"2031">
2031</option>
 <option value=3D"2032">
2032</option>
 <option value=3D"2033">
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>
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2051</option>
 <option value==3D"2052">
2052</option>
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2053</option>
 <option value==3D"2054">
2054</option>
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2055</option>
 <option value==3D"2056">
2056</option>
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2057</option>
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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>
 <option value=3D"2063">
2063</option>
 <option value==3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option value==3D"2066">
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_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-item-required m_6083855148940475859ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_206244955">
<div class=3D"m_6083855148940475859ss-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_6083855148940475859itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6083855148940475859ss-q-time">
<div class=3D"m_6083855148940475859ss-datetime-box m_6083855148940475859goog-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_6083855148940475859entry.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>
</select>
:<select name=3D"entry.206244955_minute" disabled id=3D"m_6083855148940475859entry.206244955_minute">
<option value=3D"">
min</option>
<option value=3D"00" selected>
00</option>
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01</option>
 <option value=3D"02">
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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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>
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32</option>
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33</option>
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34</option>
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35</option>
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36</option>
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37</option>
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38</option>
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39</option>
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40</option>
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41</option>
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42</option>
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43</option>
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44</option>
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45</option>
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46</option>
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47</option>
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48</option>
 <option value=3D"49">
49</option>
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50</option>
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51</option>
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52</option>
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53</option>
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54</option>
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55</option>
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56</option>
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57</option>
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58</option>
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59</option>
</select>
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</div>
</div>
</div>
</div>
</div>
</div>
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<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<label for=3D"m_6083855148940475859itemView.getDomIdToLabel()">
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<span class=3D"m_6083855148940475859ss-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>
</div>
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<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_1716090865">
<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
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</td>
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<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
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<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
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<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
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<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
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<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
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<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
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<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
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<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
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<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
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</div>
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</div>
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</div>
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</div>
</td>
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</td>
</tr>
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</div>
</div>
</div>
<br>
 <div class=3D"m_6083855148940475859ss-form-question m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_2064050596">
<div class=3D"m_6083855148940475859ss-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_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"m_6083855148940475859entry_1244707512">
<tr>
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</td>
<td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6083855148940475859ss-scalenumber" for=3D"m_6083855148940475859group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_6083855148940475859ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_6083855148940475859ss-scalerow m_6083855148940475859ss-leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class=3D"m_6083855148940475859aria-todo">
</div>
</td>
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</div>
</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>
</td>
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</td>
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</div>
</label>
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Paciente orientado en tiempo y espacio, en regulares condiciones generales, refiere que el d=C3=ADa de ayer 17/04/2019 acude al SAR La Florida, debido a que presentaba dificultad al respirar, el que presenta signos vitales P/A 116/48; T=C2=BA axilar 36.1; Pulso 77 x minuto; HGT: 157; Sat O2%: 92, lo nebulizan y le admnistran oxigeno, indicando tratamiento para la casa, Berodual  2 puff cada 4 horas x 7 d=C3=ADas. El d=C3=ADa de hoy se aprecia leve dificultad respiratoria, tos, dificultad para caminar, se cansa.Paciente hoy es visitado por profesiones de la salud del consultorio la Florida, al cual lo vacunan contra la influenza.Paciente no presenta nauseas ni v=C3=B3mitos, animo regular, refiere que por momentos su animo decae,picaz=C3=B3n (-)Sue=C3=B1o: Paciente duerme muchas horas en el d=C3=ADa y se levanta para almorzar y tomar onceDiuresis: (+),durante la noche despierta unas 4 a 5 veces para orinar, deposiciones (+) en ba=C3=B1o.</div>
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<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
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</div>
</label>
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Al control de signos vitales:P/A: 138/63FC: 66 x minutoT: 35.8Glicemia: 146 mg/dlPiel: sin lesiones, tibia al tacto.Torax: tonel=20Ingurgitacion (-)=20Abdomen: globoso, hernia para umbilical derechaExtremidades superiores: m=C3=B3vilesExtremidades inferiores: m=C3=B3viles, edema (-)</div>
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</div>
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Ca pulmon</div>
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Plan de Tratamiento e Indicaciones<label for=3D"m_6083855148940475859itemView.getDomIdToLabel()">
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<span class=3D"m_6083855148940475859ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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1.- Control en 5 d=C3=ADas2.-Reforzamiento educaci=C3=B3n insulinoterapia3.-Educaci=C3=B3n del uso correcto de inhalador (berodual)4.- Educaci=C3=B3n de los efectos secundarios de la vacuna contra la influenza.</div>
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Medicamentos Indicados</div>
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1.- Insulina lenta lenta 16u2.- Zeolita3.- Codeisol 5 gotas 3 veces al d=C3=ADa4.- Tramadol 16 gotas cada 6 horas5.- Clopidrogel6.- Metformina7.- 1/2 monopack - 1/2 bisoprolol8.- Aspirina9.- Inhalador berodual 2 puff cada 4 horas10.- Goteli , una capsula11.- Pregabalina 75 mg una vez al d=C3=ADa12.- Dolginal SOS13.- Metoclopramida=2014.- ciruelax15.- Oxigeno SOS 3 lts en la noche16.- Centrum hombre, 1 tableta</div>
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
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D=C3=ADa</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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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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31</option>
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Mes</option>
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enero</option>
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febrero</option>
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marzo</option>
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agosto</option>
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A=C3=B1o</option>
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1896</option>
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1897</option>
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1899</option>
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1900</option>
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1901</option>
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1906</option>
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1907</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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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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1923</option>
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1925</option>
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1926</option>
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1927</option>
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1929</option>
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1930</option>
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1932</option>
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1933</option>
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1935</option>
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1936</option>
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1940</option>
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1945</option>
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1946</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>
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1956</option>
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1957</option>
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1958</option>
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1959</option>
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1960</option>
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1961</option>
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1962</option>
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1963</option>
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1967</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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1977</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>
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2000</option>
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2001</option>
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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>
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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>
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2034</option>
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2035</option>
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2036</option>
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2037</option>
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2038</option>
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2039</option>
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2040</option>
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2041</option>
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2042</option>
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2043</option>
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2044</option>
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2045</option>
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2046</option>
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2047</option>
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2048</option>
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2049</option>
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2050</option>
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2051</option>
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2052</option>
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2053</option>
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2054</option>
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2055</option>
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2056</option>
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2057</option>
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2058</option>
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2059</option>
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2060</option>
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2061</option>
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2062</option>
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2063</option>
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2064</option>
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2065</option>
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2066</option>
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2067</option>
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2068</option>
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2069</option>
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<label class=3D"m_6083855148940475859ss-q-item-label" for=3D"m_6083855148940475859entry_74766472">
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Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6083855148940475859ss-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%">
</div>
</div>
</div>
</div>
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<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
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<div class=3D"m_6083855148940475859ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"m_6083855148940475859ss-q-help m_6083855148940475859ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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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<span class=3D"m_6083855148940475859ss-choice-label">
ENFERMERA</span>
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<label>
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<input type==3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"m_6083855148940475859group_503039759_2" class=3D"m_6083855148940475859ss-q-checkbox">
</span>
<span class=3D"m_6083855148940475859ss-choice-label">
TENS</span>
</label>
</li>
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<label>
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</span>
<span class=3D"m_6083855148940475859ss-choice-label">
NUTRICIONISTA</span>
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<label>
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KINESIOLOGO</span>
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PSICOLOGO</span>
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 <div class=3D"m_6083855148940475859errorbox-good">
<div dir=3D"auto" class=3D"m_6083855148940475859ss-item m_6083855148940475859ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_6083855148940475859ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6083855148940475859ss-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_6083855148940475859ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
</form>
</div>
</div>
</td>
</tr>
<tr height=3D"24px">
</tr>
</tbody>
</table>
</div>
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"max-width:672px;min-width:154px" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
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<tr>
<td>
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link" style=3D"color:#424242;font-size:13px" target=3D"_blank" rel=3D"noreferrer">
Crea tu propio formulario de Google</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
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