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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>
 lunes, 27 de mayo de 2019 21:31<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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<o:p>
&nbsp;</o:p>
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  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
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Identificaci=C3=B3n del Prestador<o:p>
</o:p>
</h2>
  <div>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
Aqu=C3=AD debe ingresar sus datos  personales<o:p>
</o:p>
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  </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>
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<o:p>
</o:p>
</span>
</p>
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  </div>
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<o:p>
&nbsp;</o:p>
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  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
RUT <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'margin-top:1.2pt;margin-bottom:3.0pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<span style=3D'color:#666666'>
RUT  con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)<o:p>
</o:p>
</span>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
16765876-8<o:p>
</o:p>
</span>
</p>
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  </div>
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  </div>
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<o:p>
&nbsp;</o:p>
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<b>
Tipo <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
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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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&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>
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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'>
7880060-7<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'>
GALVARINO AEDO<o:p>
</o:p>
</span>
</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>
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'>
[COLMENA&nbsp;\/] <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>
Ciudad <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
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CHILL=C3=81N<o:p>
</o:p>
</span>
</p>
  </div>
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  </div>
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<o:p>
&nbsp;</o:p>
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<b>
Comuna <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
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CHILL=C3=81N<o:p>
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&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <p class=3DMsoNormal align=3Dright style=3D'text-align:right;vertical-align:middle'>
<img  border=3D0 id=3D"_x0000_i1028"  src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ"  alt=3D"Imagen sin leyenda">
<o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <h2 style=3D'mso-margin-top-alt:24.0pt;margin-right:-4.8pt;margin-bottom:0cm;  margin-left:-4.8pt;margin-bottom:.0001pt;background:#EEEEEE;vertical-align:  middle'>
Registro de la Atenci=C3=B3n Domiciliaria<o:p>
</o:p>
</h2>
  <div>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
En esta secci=C3=B3n debe  ingresar los datos de la atenci=C3=B3n domiciliaria<o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Tipo de Atenci=C3=B3n <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l0 level1 lfo1;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
(X)</span>
 <span  class=3Dss-choice-label>
Domicilio</span>
 <o:p>
</o:p>
</p>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l0 level1 lfo1;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
(&nbsp;)</span>
  <span class=3Dss-choice-label>
Ambulatorio</span>
 <o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Fecha de la Atenci=C3=B3n <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div>
  <div style=3D'border:solid gainsboro 1.0pt;padding:0cm 0cm 0cm 2.0pt;  margin-left:2.25pt;margin-top:3.0pt;margin-right:2.25pt;margin-bottom:3.0pt;  min-height:32px;display:inline-block'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
[27&nbsp;\/] [mayo&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'>
[10&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'>
(X)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 0cm 6.0pt 3.0pt'>
</td>
   </tr>
  </table>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt;overflow-x:auto'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Escala Dolor EVA M=C3=A1ximo <o:p>
</o:p>
</b>
</p>
  </div>
  <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=3D0   id=3D"entry_1244707512">
   <tr>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
0<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
1<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
2<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
3<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
4<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
5<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
6<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
7<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
8<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
9<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
10<o:p>
</o:p>
</p>
    </td>
    <td style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
   </tr>
   <tr>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 0cm'>
</td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(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 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'>
(X)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.75pt 6.0pt 0cm'>
    <div>
    <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'>
<span    style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
    </div>
    </td>
    <td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 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 BUEN ESTADO GENERAL, CONSCIENTE, L=C3=9ACIDO,  ORIENTADO EN TIEMPO Y ESPACIO, SIN DOLOR AL MOMENTO DE LA EVALUACI=C3=93N (EVA DE  0 PUNTOS ). REFIERE QUE EL D=C3=8DA DE AYER PRESENT=C3=93 MOLESTIAS Y EDEMA EN CADERA  DERECHA, QUE SE HA ALIVIADO DE FORMA ESPONTANEA. HA ESTADO CON DOLOR  ABDOMINAL (REGI=C3=93N EPIG=C3=81STRICA) Y MOLESTIAS DORSALES LEVES E INTERMITENTES.  SENSACI=C3=93N DE FATIGA Y FALTA DE ENERG=C3=8DA - USUARIO SE ALIMENTA DE FORMA NORMAL.  HA AUMENTADO SU CONSUMO DE AGUA DURANTE EL D=C3=8DA. - SIN PROBLEMAS PARA ORINAR  NI DEFECAR. SIN NAUSEAS NI V=C3=93MITOS. - PACIENTE AUTOVALENTE, CAPAZ DE  DESEMPE=C3=91AR ACTIVIDADES COTIDIANAS Y SATISFACER SUS NECESIDADES B=C3==81SICAS. -  ESCALA DE GLASGOW: 15 PUNTOS - ESCALA DE NORTON: 20 PUNTOS . - ESCALA DE  DOWTON: 1 PUNTO <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 EN POSICI=C3=93N SENTADO,  FACIE TRANQUILA, RELAJADA, L=C3=9ACIDO, ORIENTADO EN TIEMPO Y ESPACIO, PIEL Y  ANEXOS NORMALES. AL CONTROL DE SIGNOS VITALES, PACIENTE HIPOTENSO (100/60  MMHG), CON TENDENCIA A LA BRADICARDIA (60 LPM), SATURANDO 95% CON FIO2  AMBIENTAL. AL EXAMEN F=C3=8DSICO SEGMENTARIO, NO SE DETECTAN ALTERACIONES <o:p>
</o:p>
</span>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Diagn=C3=B3stico <span  class=3Dss-required-asterisk>
<span style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;  max-width:90%;white-space:pre-wrap'>
  <p class=3DMsoNormal style=3D'background:#EEEEEE;vertical-align:middle'>
<span  style=3D'color:#545454'>
CA PANCREAS<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 - AUMENTAR INGESTA DE AGUA -  ACTIVIDAD F=C3=8DSICA SEG=C3=9AN TOLERANCIA - AUMENTAR PERIODOS DE DESCANSO. - H=C3=81BITOS  PARA MEJORAR LA CALIDAD DEL SUE=C3=91O - DETECCI=C3=93N Y MANEJO DE HIPOGLICEMIA -  DETECCI=C3=93N DE COMPLICACIONES ASOCIADAS A SU ENFERMEDAD QUE REQUIEREN DE  ASISTENCIA INMEDIATA<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'>
DAMAZOL 200 MG 1 COMPRIMIDO AL D=C3=8DA =C3=81CIDO TRANEX=C3=81MICO  650 MG 2 AL D=C3=8DA COTRIMOXAZOL FORTE 3 VECES A LA SEMANA<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'>
[31&nbsp;\/] [mayo&nbsp;\/] [2019&nbsp;\/]  <o:p>
</o:p>
</p>
  </div>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Tratamiento Realizado (si  corresponde) <o:p>
</o:p>
</b>
</p>
  </div>
  </div>
  </div>
  </div>
  <p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
  <div>
  <div style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
  <div style=3D'margin-bottom:18.0pt;max-width:100%'>
  <div style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<b>
Derivaci=C3=B3n a otro  Prestador Domiciliario <o:p>
</o:p>
</b>
</p>
  </div>
  <div style=3D'margin-top:1.2pt;margin-bottom:3.0pt'>
  <p class=3DMsoNormal style=3D'vertical-align:middle'>
<span style=3D'color:#666666'>
S=C3=B3lo  llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del  equipo<o:p>
</o:p>
</span>
</p>
  </div>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l1 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
[&nbsp;]</span>
  <span class=3Dss-choice-label>
ENFERMERA</span>
 <o:p>
</o:p>
</p>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l1 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
<![endif]>
<span class=3Dss-choice-item-control>
[&nbsp;]</span>
  <span class=3Dss-choice-label>
TENS</span>
 <o:p>
</o:p>
</p>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l1 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
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<span class=3Dss-choice-item-control>
[&nbsp;]</span>
  <span class=3Dss-choice-label>
NUTRICIONISTA</span>
 <o:p>
</o:p>
</p>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l1 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
<span style=3D'mso-list:Ignore'>
=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
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<span class=3Dss-choice-item-control>
[&nbsp;]</span>
  <span class=3Dss-choice-label>
KINESIOLOGO</span>
 <o:p>
</o:p>
</p>
  <p class=3DMsoNormal style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:  15.6pt;mso-list:l1 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span  style=3D'font-size:10.0pt;font-family:Symbol'>
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=C2=B7<span  style=3D'font:7.0pt "Times New Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  </span>
</span>
</span>
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<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>
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  <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%'>
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<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>
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  </td>
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 <tr>
  <td style=3D'padding:0cm 0cm 0cm 0cm'>
</td>
 </tr>
</table>
</div>
</div>
<div align=3Dcenter>
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 <tr>
  <td style=3D'padding:0cm 0cm 0cm 0cm'>
</td>
 </tr>
 <tr>
  <td style=3D'padding:0cm 0cm 0cm 0cm'>
  <p class=3DMsoNormal>
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link">
<span  style=3D'font-size:10.0pt;color:#424242'>
Crea tu propio formulario de Google</span>
</a>
<o:p>
</o:p>
</p>
  </td>
 </tr>
</table>
</div>
<p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
</div>
</div>
<div id=3D"DAB4FAD8-2DD7-40BB-A1B8-4E2AA1F9FDF2">
<br />
 <table style=3D"border-top: 1px solid #D3D4DE;">
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