<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: mi=C3=A9., 29 may. 2019 17:28<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_-3266203640391591897ss-form-container">
<div class=3D"m_-3266203640391591897ss-form-heading">
<h1 class=3D"m_-3266203640391591897ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_-3266203640391591897ss-form-desc m_-3266203640391591897ss-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_-3266203640391591897ss-form">
<form method=3D"GET" id=3D"m_-3266203640391591897ss-form" target=3D"_blank">
<br>
<div class=3D"m_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897emailAddress">
<div class=3D"m_-3266203640391591897ss-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_-3266203640391591897emailAddress">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_-3266203640391591897ss-q-text m_-3266203640391591897ss-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_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3266203640391591897ss-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_-3266203640391591897ss-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_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3266203640391591897ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_-3266203640391591897ss-page-description m_-3266203640391591897ss-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_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_579114469">
<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3266203640391591897ss-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</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_1276273985">
<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-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_-3266203640391591897ss-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_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-select" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_133691676">
<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-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_-3266203640391591897entry_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_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3266203640391591897ss-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_-3266203640391591897ss-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_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3266203640391591897ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_-3266203640391591897ss-page-description m_-3266203640391591897ss-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_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3266203640391591897ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_-3266203640391591897ss-section-description m_-3266203640391591897ss-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_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_823811303">
<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-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_-3266203640391591897ss-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%">
5946625-9</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_1959365839">
<div class=3D"m_-3266203640391591897ss-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_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3266203640391591897ss-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%">
Roberto Navarro</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-select" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_545002227">
<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-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_-3266203640391591897entry_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_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_1900161356">
<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3266203640391591897ss-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_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_1298871758">
<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3266203640391591897ss-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_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3266203640391591897ss-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_-3266203640391591897ss-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_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3266203640391591897ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_-3266203640391591897ss-page-description m_-3266203640391591897ss-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_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-radio" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_2073233714">
<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_-3266203640391591897ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-3266203640391591897ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-3266203640391591897ss-choice-item-control m_-3266203640391591897goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_-3266203640391591897group_1222378237_1" class=3D"m_-3266203640391591897ss-q-radio">
</span>
<span class=3D"m_-3266203640391591897ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_-3266203640391591897ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-3266203640391591897ss-choice-item-control m_-3266203640391591897goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_-3266203640391591897group_1222378237_2" class=3D"m_-3266203640391591897ss-q-radio">
</span>
<span class=3D"m_-3266203640391591897ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-date" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_1705849412">
<div class=3D"m_-3266203640391591897ss-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_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3266203640391591897ss-q-date">
<div class=3D"m_-3266203640391591897ss-datetime-box m_-3266203640391591897goog-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_-3266203640391591897ss-day-dropdown" id=3D"m_-3266203640391591897entry.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>
 <option value=3D"12">
12</option>
 <option value=3D"13">
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>
 <option value=3D"19">
19</option>
 <option value=3D"20">
20</option>
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21</option>
 <option value=3D"22">
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>
 <option value=3D"5" selected>
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_-3266203640391591897entry.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>
 <option value=3D"1903">
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>
 <option value=3D"1909">
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>
 <option value==3D"1924">
1924</option>
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1925</option>
 <option value==3D"1926">
1926</option>
 <option value=3D"1927">
1927</option>
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1928</option>
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1929</option>
 <option value==3D"1930">
1930</option>
 <option value=3D"1931">
1931</option>
 <option value==3D"1932">
1932</option>
 <option value=3D"1933">
1933</option>
 <option value==3D"1934">
1934</option>
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1935</option>
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1936</option>
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1937</option>
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1938</option>
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1939</option>
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1940</option>
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1941</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
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1946</option>
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1947</option>
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1948</option>
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1949</option>
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1950</option>
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1951</option>
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1952</option>
 <option value=3D"1953">
1953</option>
 <option value==3D"1954">
1954</option>
 <option value=3D"1955">
1955</option>
 <option value==3D"1956">
1956</option>
 <option value=3D"1957">
1957</option>
 <option value==3D"1958">
1958</option>
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1959</option>
 <option value==3D"1960">
1960</option>
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1961</option>
 <option value==3D"1962">
1962</option>
 <option value=3D"1963">
1963</option>
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1964</option>
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1965</option>
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1966</option>
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1967</option>
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1968</option>
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1969</option>
 <option value==3D"1970">
1970</option>
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1971</option>
 <option value==3D"1972">
1972</option>
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1973</option>
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1974</option>
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1975</option>
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1976</option>
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1977</option>
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1978</option>
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1979</option>
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1980</option>
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1981</option>
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1982</option>
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1983</option>
 <option value==3D"1984">
1984</option>
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1985</option>
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1986</option>
 <option value=3D"1987">
1987</option>
 <option value==3D"1988">
1988</option>
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1989</option>
 <option value==3D"1990">
1990</option>
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1991</option>
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1992</option>
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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>
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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>
 <option value==3D"2016">
2016</option>
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2017</option>
 <option value==3D"2018">
2018</option>
 <option value=3D"2019" selected>
2019</option>
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2020</option>
 <option value=3D"2021">
2021</option>
 <option value=3D"2022">
2022</option>
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2023</option>
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2024</option>
 <option value=3D"2025">
2025</option>
 <option value=3D"2026">
2026</option>
 <option value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
 <option value=3D"2029">
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>
 <option value=3D"2051">
2051</option>
 <option value==3D"2052">
2052</option>
 <option value=3D"2053">
2053</option>
 <option value==3D"2054">
2054</option>
 <option value=3D"2055">
2055</option>
 <option value==3D"2056">
2056</option>
 <option value=3D"2057">
2057</option>
 <option value==3D"2058">
2058</option>
 <option value=3D"2059">
2059</option>
 <option value==3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <option value==3D"2062">
2062</option>
 <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_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_206244955">
<div class=3D"m_-3266203640391591897ss-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_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3266203640391591897ss-q-time">
<div class=3D"m_-3266203640391591897ss-datetime-box m_-3266203640391591897goog-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_-3266203640391591897entry.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>
 <option value=3D"10">
10</option>
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11</option>
 <option value=3D"12">
12</option>
 <option value=3D"13">
13</option>
 <option value=3D"14">
14</option>
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15</option>
 <option value=3D"16">
16</option>
 <option value=3D"17">
17</option>
 <option value=3D"18" selected>
18</option>
 <option value=3D"19">
19</option>
 <option value=3D"20">
20</option>
 <option value=3D"21">
21</option>
 <option value==3D"22">
22</option>
 <option value=3D"23">
23</option>
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</div>
</div>
</div>
</div>
</div>
</div>
<br>
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<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-item-required m_-3266203640391591897ss-select" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-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_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
</label>
<select name=3D"entry.1747608258" disabled id=3D"m_-3266203640391591897entry_1747608258">
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</option>
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0</option>
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1</option>
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2</option>
 <option value=3D"3" disabled selected>
3</option>
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4</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_1716090865">
<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-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_-3266203640391591897entry_1421689035">
<tr>
<td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
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<div class==3D"m_-3266203640391591897aria-todo">
</div>
</td>
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</div>
</td>
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</div>
</td>
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<div class=3D"m_-3266203640391591897ss-scalerow-fieldcell">
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</div>
</td>
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<div class=3D"m_-3266203640391591897ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"3" id=3D"m_-3266203640391591897group_1421689035_4" class=3D"m_-3266203640391591897ss-q-radio">
</div>
</td>
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<div class=3D"m_-3266203640391591897ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"4" id=3D"m_-3266203640391591897group_1421689035_5" class=3D"m_-3266203640391591897ss-q-radio">
</div>
</td>
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<div class=3D"m_-3266203640391591897ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"5" id=3D"m_-3266203640391591897group_1421689035_6" class=3D"m_-3266203640391591897ss-q-radio">
</div>
</td>
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<div class=3D"m_-3266203640391591897ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"6" id=3D"m_-3266203640391591897group_1421689035_7" class=3D"m_-3266203640391591897ss-q-radio">
</div>
</td>
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<div class=3D"m_-3266203640391591897ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"7" id=3D"m_-3266203640391591897group_1421689035_8" class=3D"m_-3266203640391591897ss-q-radio">
</div>
</td>
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<div class=3D"m_-3266203640391591897ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"8" id=3D"m_-3266203640391591897group_1421689035_9" class=3D"m_-3266203640391591897ss-q-radio">
</div>
</td>
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<div class=3D"m_-3266203640391591897ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"9" id=3D"m_-3266203640391591897group_1421689035_10" class=3D"m_-3266203640391591897ss-q-radio">
</div>
</td>
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<div class=3D"m_-3266203640391591897ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"10" id=3D"m_-3266203640391591897group_1421689035_11" class=3D"m_-3266203640391591897ss-q-radio">
</div>
</td>
<td class=3D"m_-3266203640391591897ss-scalerow m_-3266203640391591897ss-rightlabel" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0">
</td>
</tr>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_2064050596">
<div class=3D"m_-3266203640391591897ss-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_-3266203640391591897ss-q-help m_-3266203640391591897ss-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_-3266203640391591897entry_1244707512">
<tr>
<td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3266203640391591897ss-scalenumber" for=3D"m_-3266203640391591897group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-3266203640391591897ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_-3266203640391591897ss-scalerow m_-3266203640391591897ss-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_-3266203640391591897aria-todo">
</div>
</td>
<td class=3D"m_-3266203640391591897ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-3266203640391591897ss-scalerow-fieldcell">
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Paciente de 72 a=C3=B1os de edad, activo, casado, vive con su esposa, sin antecedentes m=C3=B3rbidos ni quir=C3==BArgicos. Al=C3=A9rgico (-), tabaco (-) suspendido en 1991.A fines del mes de febrero 2019 consulta con medico general por dolor lumbar, diagnosticando un lumbago, dolor que no cede con analg=C3=A9sicos, se realizaron ex=C3==A1menes PSA el cual estaba alterado, se  consulta  a un urologo el cual solicita una eco vesical y pr=C3=B3stata la cual informa acentuada hidroureterononefrosis derecha asociado a una lesi=C3=B3n en uni=C3=B3n ureterovesical  ipsilateral. Esto pudiese representar lesi=C3=B3n urotelial difusa con compromiso de todo el  eje excretor. Una segunda lesi=C3=B3n posterolateral izquierda, de probable origen urotelial. Acentuado aumento de volumen prostatico.Se solicita PET el cual detalla neoplasia vesical etapificacion. Aumento del metabolismo en n=C3=B3dulos pulmonares, en numerosos adenopatias supra e infradiafragmaticas y en lesi=C3=B3n osteolitica de L3 compatible con localizaciones secundarias.Posible infiltraci=C3=B3n prostatica.Se realizo un TAC abdomen y pelvis indicando, neoplasia vesical avanzada, con importante engrosamiento parietal difuso de la vejiga presencia un prominente nodulo vesical izquierda (cabe destacar que parte de la vejiga se encuentra ubicada dentro de una hernia inguinal izquierda) Extenso compromiso secundario adenopatico retroperitoneal secundario oseo en los cuerpo  L3 y T11 n=C3=B3dulo ureteral derecho que puede corresponder a un tumor sincr=C3=B3nico o a un compromiso secundario.Bolsa hidronefrotica derecha.Engrosamiento de la pared de la uni=C3=B3n gastroesofagica. Aspecto sospechoso que se siguiere evaluar con endoscopia. Presencia de adenopatias periesofagicas y retrocrurales. Diverticulos colonicos sin signos de complicaci==C3=B3n. Colelitiasis.Paciente se realiza en electrocardiograma  en reposo informando:Ritmo sinusalFC de 79 lpmEje el=C3=A9ctrico normalconducci=C3=B3n AV normal (PR 160 ms)Conduccion IV normal (QRS 100ms)Alteraciones inespecificas de la repolarizacion QT normal.El dia 15 de mayo se realiza RTU en Cl=C3=ADnica Davila, la cual no tuvo complicaciones , se realiza reseccion nedoscopica de tumor vesical extenso multifocal, logrando reduccion de volumen tumoral, dos dias despues de la intervencion se diagnostico HDA, presento vomitos, deposiciones oscuras, se dejo en regimen cero,no requirio transfusiones pese a que su hematrocrito bajo, se retiro sonda, orinando de forma espontanea, fue dado de alta  sabado 25 de mayo con diagnostico: Ca vejiga, ulcera peptica de sitio no especificado, cronica o no especificada con hemorragia digestiva alta, hiperplasia de la prostataEl dia 20 de mayo se realiza  endoscopia en clinica Davila el cual concluye ulcera esofagica extensa no sangrante, hernia hiatal, ulceras duodenales.Actualmente en cama, con dificultada para movilizarse, refiere dolor de rodilla, refiere buen apetito, nauseas y vomitos (-) sue=C3=B1o: reparador, diuresis (+) en pato, o pa=C3=B1al, deposiciones (-) hace una semana, antes realizar la visita presenta melena. Paciente hace 20 dias mas menos que esta en su cama,no deambula, O2: (-), tos (+) con flemas blancas.</div>
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<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Examen F=C3=ADsico<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
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*</span>
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Al control de signos vitales: =20P/A: 111/60FC: 72T=C2=BA: 35.9Sat: 96FR: 18Piel: palidez cut=C3=A1nea, sin lesionesExt sup: m=C3=B3vilesExt. inf: m=C3=B3viles, edema (-)Abdomen: blando, depresible  no doloroso a la palpaci=C3=B3n</div>
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<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Diagn=C3=B3stico<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
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<span class=3D"m_-3266203640391591897ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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Ca vejiga metastasico</div>
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Plan de Tratamiento e Indicaciones<label for=3D"m_-3266203640391591897itemView.getDomIdToLabel()">
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*</span>
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1.- Control en 7 d=C3=ADas2.- Educaci=C3=B3n prevenci=C3=B3n upp3.- Educaci=C3=B3n prevenci=C3=B3n Cambios de posici=C3=B3n en cama4.- Reforzamiento farmacol=C3=B3gico</div>
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Medicamentos Indicados</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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1.- Transtec  1 parche cada 3 dias2.- Xumadol 1 gr cada 8 horas3.- Morfina Sulfato al 2% 6 gotas SOS4.- Lactulosa 20 cccada 8 horas5.- Domperidona 10 mg cada 8 horas6.- Esomeprazol7.- Duodat 0.5 a 1 cada 24 hrs</div>
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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<div class=3D"m_-3266203640391591897ss-q-date">
<div class=3D"m_-3266203640391591897ss-datetime-box m_-3266203640391591897goog-inline-block" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
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<option value=3D"">
D==C3=ADa</option>
<option value=3D"1">
1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
 <option value=3D"25">
25</option>
 <option value=3D"26">
26</option>
 <option value=3D"27">
27</option>
 <option value=3D"28">
28</option>
 <option value=3D"29">
29</option>
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30</option>
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31</option>
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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>
 <option value=3D"4">
abril</option>
 <option value=3D"5">
mayo</option>
 <option value=3D"6" selected>
junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
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=20<select name=3D"entry.2063615873_year" disabled id=3D"m_-3266203640391591897entry.2063615873_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
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1897</option>
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1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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1925</option>
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1926</option>
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1927</option>
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1928</option>
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1929</option>
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1930</option>
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1931</option>
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1932</option>
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1933</option>
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1934</option>
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1935</option>
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1936</option>
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1937</option>
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1938</option>
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1939</option>
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1940</option>
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1941</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
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1946</option>
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1947</option>
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1948</option>
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1949</option>
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1950</option>
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1951</option>
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1952</option>
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1953</option>
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1954</option>
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1955</option>
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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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1964</option>
 <option value=3D"1965">
1965</option>
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1966</option>
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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>
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1975</option>
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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>
 <option value=3D"1981">
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>
 <option value==3D"2016">
2016</option>
 <option value=3D"2017">
2017</option>
 <option value==3D"2018">
2018</option>
 <option value=3D"2019" selected>
2019</option>
 <option value=3D"2020">
2020</option>
 <option value=3D"2021">
2021</option>
 <option value=3D"2022">
2022</option>
 <option value=3D"2023">
2023</option>
 <option value=3D"2024">
2024</option>
 <option value=3D"2025">
2025</option>
 <option value=3D"2026">
2026</option>
 <option value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
 <option value=3D"2029">
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>
 <option value=3D"2051">
2051</option>
 <option value==3D"2052">
2052</option>
 <option value=3D"2053">
2053</option>
 <option value==3D"2054">
2054</option>
 <option value=3D"2055">
2055</option>
 <option value==3D"2056">
2056</option>
 <option value=3D"2057">
2057</option>
 <option value==3D"2058">
2058</option>
 <option value=3D"2059">
2059</option>
 <option value==3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <option value==3D"2062">
2062</option>
 <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_-3266203640391591897ss-form-question m_-3266203640391591897errorbox-good">
<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_74766472">
<div class=3D"m_-3266203640391591897ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_-3266203640391591897ss-q-help m_-3266203640391591897ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3266203640391591897ss-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>
<br>
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<div dir=3D"auto" class=3D"m_-3266203640391591897ss-item m_-3266203640391591897ss-checkbox" style=3D"margin:12px 0">
<div class=3D"m_-3266203640391591897ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3266203640391591897ss-q-item-label" for=3D"m_-3266203640391591897entry_1219705969">
<div class=3D"m_-3266203640391591897ss-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_-3266203640391591897ss-q-help m_-3266203640391591897ss-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>
</label>
<ul class=3D"m_-3266203640391591897ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-3266203640391591897ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
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