<div dir=3D"ltr">
Saludos<br>
<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">
Google Forms</strong>
 <span dir=3D"auto">
&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;</span>
<br>
Date: jue., 20 jun. 2019 a las 12:30<br>
Subject: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href=3D"mailto:k7albarran@gmail.com">
k7albarran@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"Google Forms" 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">
Thanks for filling out <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr height=3D"12px">
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242">
Here&#39;s what we got from you:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"m_-4466410383292731945ss-form-container">
<div class=3D"m_-4466410383292731945ss-form-heading">
<h1 class=3D"m_-4466410383292731945ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_-4466410383292731945ss-form-desc m_-4466410383292731945ss-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_-4466410383292731945ss-form">
<form method=3D"GET" id=3D"m_-4466410383292731945ss-form" target=3D"_blank">
<br>
<div class=3D"m_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-item-required m_-4466410383292731945ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4466410383292731945ss-q-item-label" for=3D"m_-4466410383292731945emailAddress">
<div class=3D"m_-4466410383292731945ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Email address<label for=3D"m_-4466410383292731945emailAddress">
</label>
<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_-4466410383292731945ss-q-text m_-4466410383292731945ss-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:k7albarran@gmail.com" target=3D"_blank">
k7albarran@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4466410383292731945ss-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_-4466410383292731945ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width:78px;outline:none" alt=3D"Captionless Image">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4466410383292731945ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_-4466410383292731945ss-page-description m_-4466410383292731945ss-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_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-item-required m_-4466410383292731945ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4466410383292731945ss-q-item-label" for=3D"m_-4466410383292731945entry_579114469">
<div class=3D"m_-4466410383292731945ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4466410383292731945ss-q-help m_-4466410383292731945ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4466410383292731945ss-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%">
Kattia Albarr=C3=A1n</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-item-required m_-4466410383292731945ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4466410383292731945ss-q-item-label" for=3D"m_-4466410383292731945entry_1276273985">
<div class=3D"m_-4466410383292731945ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4466410383292731945ss-q-help m_-4466410383292731945ss-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_-4466410383292731945ss-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%">
16152053-5</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-item-required m_-4466410383292731945ss-select" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4466410383292731945ss-q-item-label" for=3D"m_-4466410383292731945entry_133691676">
<div class=3D"m_-4466410383292731945ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4466410383292731945ss-q-help m_-4466410383292731945ss-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_-4466410383292731945entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled selected>
MEDICO</option>
 <option value=3D"ENFERMERA/O" disabled>
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_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4466410383292731945ss-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_-4466410383292731945ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width:78px;outline:none" alt=3D"Captionless Image">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4466410383292731945ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_-4466410383292731945ss-page-description m_-4466410383292731945ss-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_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4466410383292731945ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_-4466410383292731945ss-section-description m_-4466410383292731945ss-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_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-item-required m_-4466410383292731945ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4466410383292731945ss-q-item-label" for=3D"m_-4466410383292731945entry_823811303">
<div class=3D"m_-4466410383292731945ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4466410383292731945ss-q-help m_-4466410383292731945ss-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_-4466410383292731945ss-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%">
12187778-3</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-item-required m_-4466410383292731945ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4466410383292731945ss-q-item-label" for=3D"m_-4466410383292731945entry_1959365839">
<div class=3D"m_-4466410383292731945ss-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_-4466410383292731945itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4466410383292731945ss-q-help m_-4466410383292731945ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4466410383292731945ss-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%">
Andr=C3=A9s Bello </div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-item-required m_-4466410383292731945ss-select" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4466410383292731945ss-q-item-label" for=3D"m_-4466410383292731945entry_545002227">
<div class=3D"m_-4466410383292731945ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4466410383292731945ss-q-help m_-4466410383292731945ss-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_-4466410383292731945entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled>
COLMENA</option>
 <option value=3D"CONSALUD" disabled>
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 selected>
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_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-item-required m_-4466410383292731945ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4466410383292731945ss-q-item-label" for=3D"m_-4466410383292731945entry_1900161356">
<div class=3D"m_-4466410383292731945ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4466410383292731945ss-q-help m_-4466410383292731945ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4466410383292731945ss-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%">
San pedro de la Paz</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-item-required m_-4466410383292731945ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4466410383292731945ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4466410383292731945ss-q-item-label" for=3D"m_-4466410383292731945entry_1298871758">
<div class=3D"m_-4466410383292731945ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4466410383292731945ss-q-help m_-4466410383292731945ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
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San Pedro de la Paz</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
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<h2 class=3D"m_-4466410383292731945ss-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_-4466410383292731945ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;outline:none" alt=3D"Captionless Image">
</div>
</div>
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<h2 class=3D"m_-4466410383292731945ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_-4466410383292731945ss-page-description m_-4466410383292731945ss-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>
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</div>
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<br>
 <div class=3D"m_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
<div dir=3D"auto" class=3D"m_-4466410383292731945ss-item m_-4466410383292731945ss-item-required m_-4466410383292731945ss-radio" style=3D"margin:12px 0">
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Tipo de Atenci=C3=B3n<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
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<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
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<ul class=3D"m_-4466410383292731945ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
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<label>
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<span class=3D"m_-4466410383292731945ss-choice-label">
Domicilio</span>
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<label>
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<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_-4466410383292731945group_1222378237_2" class=3D"m_-4466410383292731945ss-q-radio">
</span>
<span class=3D"m_-4466410383292731945ss-choice-label">
Ambulatorio</span>
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</li>
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</div>
</div>
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<br>
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<div class=3D"m_-4466410383292731945ss-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_-4466410383292731945itemView.getDomIdToLabel()">
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<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
</label>
<div class=3D"m_-4466410383292731945ss-q-date">
<div class=3D"m_-4466410383292731945ss-datetime-box m_-4466410383292731945goog-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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Month</option>
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January</option>
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February</option>
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April</option>
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May</option>
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July</option>
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August</option>
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September</option>
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November</option>
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December</option>
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Day</option>
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1</option>
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2</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
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Year</option>
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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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1908</option>
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1911</option>
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1912</option>
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1914</option>
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1915</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1923</option>
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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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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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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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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>
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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>
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1970</option>
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1971</option>
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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>
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1984</option>
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1985</option>
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1986</option>
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1987</option>
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1988</option>
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1989</option>
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1990</option>
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1991</option>
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1992</option>
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1993</option>
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1994</option>
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1995</option>
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1996</option>
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1997</option>
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1998</option>
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1999</option>
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2000</option>
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2001</option>
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2002</option>
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2004</option>
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2005</option>
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2006</option>
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2007</option>
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2008</option>
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2009</option>
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2010</option>
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2011</option>
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2012</option>
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2013</option>
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2014</option>
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2015</option>
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2016</option>
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2017</option>
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2018</option>
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2020</option>
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2021</option>
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2022</option>
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2023</option>
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2024</option>
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2025</option>
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2026</option>
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2027</option>
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2028</option>
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2029</option>
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2030</option>
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2031</option>
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2032</option>
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2033</option>
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2034</option>
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2035</option>
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2036</option>
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2037</option>
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2038</option>
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2039</option>
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2040</option>
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2041</option>
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2042</option>
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2043</option>
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2044</option>
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2045</option>
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2046</option>
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2047</option>
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2048</option>
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2049</option>
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2050</option>
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2051</option>
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2052</option>
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2053</option>
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2054</option>
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2055</option>
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2056</option>
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2057</option>
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2058</option>
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2059</option>
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2060</option>
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2061</option>
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2062</option>
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2063</option>
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2064</option>
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2065</option>
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2066</option>
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2067</option>
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2068</option>
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2069</option>
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</div>
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<br>
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<div class=3D"m_-4466410383292731945ss-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_-4466410383292731945itemView.getDomIdToLabel()">
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<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
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<div class=3D"m_-4466410383292731945ss-q-time">
<div class=3D"m_-4466410383292731945ss-datetime-box m_-4466410383292731945goog-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">
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Hr</option>
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01</option>
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03</option>
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04</option>
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05</option>
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06</option>
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07</option>
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08</option>
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09</option>
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10</option>
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11</option>
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12</option>
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Min</option>
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00</option>
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02</option>
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03</option>
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04</option>
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06</option>
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07</option>
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09</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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30</option>
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31</option>
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32</option>
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33</option>
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34</option>
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35</option>
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36</option>
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37</option>
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38</option>
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39</option>
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40</option>
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41</option>
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42</option>
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43</option>
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44</option>
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45</option>
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46</option>
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47</option>
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48</option>
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49</option>
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50</option>
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51</option>
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Performance Status ECOG del Paciente<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
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<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
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Escala Dolor EVA Actual</div>
<div class=3D"m_-4466410383292731945ss-q-help m_-4466410383292731945ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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0</label>
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3</label>
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<label class=3D"m_-4466410383292731945ss-scalenumber" for=3D"m_-4466410383292731945group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
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5</label>
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<label class=3D"m_-4466410383292731945ss-scalenumber" for=3D"m_-4466410383292731945group_1421689035_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
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9</label>
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10</label>
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Escala Dolor EVA M=C3=A1ximo</div>
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</td>
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<label class=3D"m_-4466410383292731945ss-scalenumber" for=3D"m_-4466410383292731945group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
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<label class=3D"m_-4466410383292731945ss-scalenumber" for=3D"m_-4466410383292731945group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
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<label class=3D"m_-4466410383292731945ss-scalenumber" for=3D"m_-4466410383292731945group_1244707512_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
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3</label>
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<label class=3D"m_-4466410383292731945ss-scalenumber" for=3D"m_-4466410383292731945group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
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<label class=3D"m_-4466410383292731945ss-scalenumber" for=3D"m_-4466410383292731945group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
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<label class=3D"m_-4466410383292731945ss-scalenumber" for=3D"m_-4466410383292731945group_1244707512_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
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<label class=3D"m_-4466410383292731945ss-scalenumber" for=3D"m_-4466410383292731945group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
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8</label>
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9</label>
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10</label>
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<td class=3D"m_-4466410383292731945ss-scalenumbers" style=3D"text-align:center">
</td>
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<tr>
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Escala Dolor EVA M=C3=ADnimo</div>
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0</label>
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3</label>
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5</label>
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10</label>
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Anamnesis/Evoluci=C3=B3n<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
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*</span>
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Paciente no refiere dolor (EVA 0/10) desde que fue dado de alta hace 25 d=C3=ADas. Drenaje duodenal no productivo desde el lunes que se realiz=C3=B3 el cambio de recolector. 	Colostom=C3==ADa con deposiciones normales, sin molestias. L a semana pasada se realiz==C3=B3 cambio de ap=C3=B3sito y curaciones de laparotom=C3=ADa media, tiene pendiente extracci=C3=B3n de corchetes por parte de su cirujano tratante para el d=C3=ADa viernes. Con menos ansiedad, se nota mucho m=C3=A1s tranquilo y menos temeroso con respecto a su enfermedad. Ha tenido orinas normales y muy buen apetito, adem=C3=A1s de realizar m=C3=A1s actividad f=C3=ADsica. </div>
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<div class=3D"m_-4466410383292731945ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Examen F=C3=ADsico<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4466410383292731945ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
</label>
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Facie tranquila, dec=C3=BAbito supino, activo, indiferente. =20signos vitales:=20Pa: 100/60 mmhgT: 36.4Pulso: 88 por minSat: 99%Fr:17Conciente, orientado temporo-espacialmente.Cabeza y cuello: escleras blancas, conjuntivas p=C3=A1lidas, no palpo adenopat=C3=ADas.=20T=C3=B3rax: de conformaci=C3=B3n normal,=20Cardiaco: Rr2t sin soplosPulmonar: mp+ sraAbdomen: cicatriz media supra e infraumbilical, con corchetes quir=C3=BArgicos en zona media, leve eritema en cicatriz, con tejido en v=C3=ADas de granulaci=C3=B3n, exudado seroso escaso. Drenajeduodenal insitu, con exposici==C3=B3n escasa de epitelio abdominal mucoso. Colostom=C3=ADa sin alteraciones. Abdomen blando, depresible, indoloro. RHA+ sin signos de irritaci=C3=B3n peritonealEEII: edema - bilateral pulsos normales bilateral sin signos de tvp</div>
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<div class=3D"m_-4466410383292731945ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Diagn=C3=B3stico<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
</label>
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*</span>
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C=C3=A1ncer de Colon metast=C3=A1sico</div>
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Plan de Tratamiento e Indicaciones<label for=3D"m_-4466410383292731945itemView.getDomIdToLabel()">
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*</span>
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En espera de evaluaci=C3=B3n cirujano, retiro de corchetes el viernesContinuar con evaluaciones m=C3=A9dicas, enfermer=C3=ADa y nutricionista.==20Regimen blando a toleranciaAumentar ingesta h=C3=ADdrica a 1lts/d=C3=ADaAumentar actividad f=C3=ADsica a tolerancia </div>
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Medicamentos Indicados</div>
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1.	Omeprazol 20mg por d=C3=ADa2.	Vertiotexina 10 mg 1 por d=C3=ADa=203.	Clonex CD, 2mg 1-14.	Prestat 150mg/noche=205.	Obs. Signos de alarma a urgencias.</div>
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<label class=3D"m_-4466410383292731945ss-q-item-label" for=3D"m_-4466410383292731945entry_2063615873">
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
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Month</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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31</option>
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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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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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1923</option>
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1924</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>
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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>
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1970</option>
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1971</option>
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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>
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1984</option>
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1985</option>
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1986</option>
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1987</option>
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1988</option>
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1989</option>
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1990</option>
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1991</option>
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1992</option>
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1993</option>
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1994</option>
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1995</option>
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1996</option>
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1997</option>
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1998</option>
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1999</option>
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2000</option>
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2001</option>
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2002</option>
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2003</option>
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2004</option>
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2005</option>
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2006</option>
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2007</option>
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2008</option>
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2009</option>
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2010</option>
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2011</option>
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2012</option>
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2013</option>
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2014</option>
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2015</option>
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2016</option>
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2017</option>
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2018</option>
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2019</option>
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2020</option>
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2021</option>
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2022</option>
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2023</option>
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2024</option>
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2025</option>
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2026</option>
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2027</option>
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2028</option>
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2029</option>
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2030</option>
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2031</option>
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2032</option>
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2033</option>
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2034</option>
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2035</option>
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2036</option>
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2037</option>
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2038</option>
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2039</option>
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2040</option>
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2041</option>
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2042</option>
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2043</option>
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2044</option>
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2045</option>
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2046</option>
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2047</option>
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2048</option>
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2049</option>
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2050</option>
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2051</option>
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2052</option>
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2053</option>
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2054</option>
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2055</option>
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2056</option>
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2057</option>
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2058</option>
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2059</option>
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2060</option>
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2061</option>
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2062</option>
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2063</option>
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2064</option>
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2065</option>
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2066</option>
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2067</option>
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2068</option>
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2069</option>
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</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4466410383292731945ss-form-question m_-4466410383292731945errorbox-good">
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Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_-4466410383292731945ss-q-help m_-4466410383292731945ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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<div class=3D"m_-4466410383292731945ss-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%">
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Derivaci=C3=B3n a otro Prestador Domiciliario</div>
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S=C3=B3lo llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del equipo</div>
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<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"ENFERMERA" id=3D"m_-4466410383292731945group_503039759_1" class=3D"m_-4466410383292731945ss-q-checkbox">
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ENFERMERA</span>
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<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"m_-4466410383292731945group_503039759_2" class=3D"m_-4466410383292731945ss-q-checkbox">
</span>
<span class=3D"m_-4466410383292731945ss-choice-label">
TENS</span>
</label>
</li>
 <li class=3D"m_-4466410383292731945ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
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<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"NUTRICIONISTA" id=3D"m_-4466410383292731945group_503039759_3" class=3D"m_-4466410383292731945ss-q-checkbox">
</span>
<span class=3D"m_-4466410383292731945ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
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<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"KINESIOLOGO" id=3D"m_-4466410383292731945group_503039759_4" class=3D"m_-4466410383292731945ss-q-checkbox">
</span>
<span class=3D"m_-4466410383292731945ss-choice-label">
KINESIOLOGO</span>
</label>
</li>
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<span class=3D"m_-4466410383292731945ss-choice-item-control m_-4466410383292731945goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"PSICOLOGO" id=3D"m_-4466410383292731945group_503039759_5" class=3D"m_-4466410383292731945ss-q-checkbox">
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<span class=3D"m_-4466410383292731945ss-choice-label">
PSICOLOGO</span>
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