<div dir=3D"ltr">
<div class=3D"gmail_default" style=3D"font-family:verdana,sans-serif;font-size:small;color:#20124d">
<br>
</div>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
---------- Forwarded message ---------<br>
De: <b class=3D"gmail_sendername" dir=3D"auto">
Google Forms</b>
 <span dir=3D"auto">
&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;</span>
<br>
Date: lun., 1 jul. 2019 a las 12:50<br>
Subject: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href=3D"mailto:luisa.yeomans@gmail.com">
luisa.yeomans@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 style=3D"background-color:rgb(38,4,154)" width=3D"100%" cellspacing=3D"0" cellpadding=3D"0" border=3D"0">
<tbody>
<tr height=3D"64px">
<td style=3D"padding-left:24px">
<img alt=3D"Google Forms" style=3D"display:inline-block;margin:0;vertical-align:middle" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png" width=3D"143px" height=3D"26px">
</td>
</tr>
</tbody>
</table>
<div style=3D"padding:24px;background-color:rgb(229,218,254)">
<div style=3D"background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px" align=3D"center">
<table style=3D"background-color:#fff" width=3D"100%" cellspacing=3D"0" cellpadding==3D"0" align=3D"center">
<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_1989158549512722575ss-form-container">
<div class=3D"m_1989158549512722575ss-form-heading">
<h1 class=3D"m_1989158549512722575ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_1989158549512722575ss-form-desc m_1989158549512722575ss-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_1989158549512722575ss-form">
<form method=3D"GET" id=3D"m_1989158549512722575ss-form" target=3D"_blank">
<br>
<div class=3D"m_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-text" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575emailAddress">
<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Email address<label for=3D"m_1989158549512722575emailAddress">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_1989158549512722575ss-q-text m_1989158549512722575ss-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:luisa.yeomans@gmail.com" target=3D"_blank">
luisa.yeomans@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1989158549512722575ss-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_1989158549512722575ss-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_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1989158549512722575ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_1989158549512722575ss-page-description m_1989158549512722575ss-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_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-text" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_579114469">
<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1989158549512722575ss-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%">
luisa yeomans</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-text" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_1276273985">
<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-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_1989158549512722575ss-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%">
17634251-k</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-select" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_133691676">
<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-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_1989158549512722575entry_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_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1989158549512722575ss-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_1989158549512722575ss-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_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1989158549512722575ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_1989158549512722575ss-page-description m_1989158549512722575ss-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_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1989158549512722575ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_1989158549512722575ss-section-description m_1989158549512722575ss-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_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-text" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_823811303">
<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-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_1989158549512722575ss-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%">
8629417-6</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-text" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_1959365839">
<div class=3D"m_1989158549512722575ss-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_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1989158549512722575ss-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%">
maria aguilera</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-select" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_545002227">
<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-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_1989158549512722575entry_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 selected>
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_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-text" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_1900161356">
<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1989158549512722575ss-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%">
el melon</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-text" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_1298871758">
<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1989158549512722575ss-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%">
nogales</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1989158549512722575ss-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_1989158549512722575ss-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>
</div>
</div>
<br>
 <div class=3D"m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1989158549512722575ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_1989158549512722575ss-page-description m_1989158549512722575ss-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_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-radio" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_2073233714">
<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_1989158549512722575ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_1989158549512722575ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_1989158549512722575ss-choice-item-control m_1989158549512722575goog-inline-block" style=3D"display:inline-block">
<input name==3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_1989158549512722575group_1222378237_1" class=3D"m_1989158549512722575ss-q-radio" type=3D"radio">
</span>
<span class=3D"m_1989158549512722575ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_1989158549512722575ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_1989158549512722575ss-choice-item-control m_1989158549512722575goog-inline-block" style=3D"display:inline-block">
<input name==3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_1989158549512722575group_1222378237_2" class=3D"m_1989158549512722575ss-q-radio" type=3D"radio">
</span>
<span class=3D"m_1989158549512722575ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-date" style=3D"margin:12px 0">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_1705849412">
<div class=3D"m_1989158549512722575ss-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_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1989158549512722575ss-q-date">
<div class=3D"m_1989158549512722575ss-datetime-box m_1989158549512722575goog-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_month" disabled class=3D"m_1989158549512722575ss-month-dropdown" id=3D"m_1989158549512722575entry.1705849412_month">
<option value=3D"">
Month</option>
<option value=3D"1" selected>
January</option>
 <option value=3D"2">
February</option>
 <option value=3D"3">
March</option>
 <option value=3D"4">
April</option>
 <option value=3D"5">
May</option>
 <option value=3D"6">
June</option>
 <option value=3D"7">
July</option>
 <option value=3D"8">
August</option>
 <option value=3D"9">
September</option>
 <option value=3D"10">
October</option>
 <option value=3D"11">
November</option>
 <option value=3D"12">
December</option>
</select>
   <select name=3D"entry.1705849412_day" disabled class=3D"m_1989158549512722575ss-day-dropdown" id=3D"m_1989158549512722575entry.1705849412_day">
<option value=3D"">
Day</option>
<option value=3D"1">
1</option>
 <option value=3D"2">
2</option>
 <option value=3D"3">
3</option>
 <option value=3D"4">
4</option>
 <option value=3D"5">
5</option>
 <option value=3D"6">
6</option>
 <option value=3D"7" selected>
7</option>
 <option value=3D"8">
8</option>
 <option value=3D"9">
9</option>
 <option value=3D"10">
10</option>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12</option>
 <option value=3D"13">
13</option>
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14</option>
 <option value=3D"15">
15</option>
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16</option>
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17</option>
 <option value=3D"18">
18</option>
 <option value==3D"19">
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>
 <option value=3D"30">
30</option>
 <option value=3D"31">
31</option>
</select>
=20<select name=3D"entry.1705849412_year" disabled id=3D"m_1989158549512722575entry.1705849412_year">
<option value=3D"">
Year</option>
<option value=3D"1896">
1896</option>
 <option value=3D"1897">
1897</option>
 <option value=3D"1898">
1898</option>
 <option value=3D"1899">
1899</option>
 <option value=3D"1900">
1900</option>
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1901</option>
 <option value=3D"1902">
1902</option>
 <option value=3D"1903">
1903</option>
 <option value=3D"1904">
1904</option>
 <option value=3D"1905">
1905</option>
 <option value=3D"1906">
1906</option>
 <option value=3D"1907">
1907</option>
 <option value=3D"1908">
1908</option>
 <option value=3D"1909">
1909</option>
 <option value=3D"1910">
1910</option>
 <option value=3D"1911">
1911</option>
 <option value=3D"1912">
1912</option>
 <option value=3D"1913">
1913</option>
 <option value=3D"1914">
1914</option>
 <option value=3D"1915">
1915</option>
 <option value=3D"1916">
1916</option>
 <option value=3D"1917">
1917</option>
 <option value=3D"1918">
1918</option>
 <option value=3D"1919">
1919</option>
 <option value=3D"1920">
1920</option>
 <option value=3D"1921">
1921</option>
 <option value=3D"1922">
1922</option>
 <option value=3D"1923">
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>
 <option value==3D"1928">
1928</option>
 <option value=3D"1929">
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>
 <option value=3D"1935">
1935</option>
 <option value==3D"1936">
1936</option>
 <option value=3D"1937">
1937</option>
 <option value==3D"1938">
1938</option>
 <option value=3D"1939">
1939</option>
 <option value==3D"1940">
1940</option>
 <option value=3D"1941">
1941</option>
 <option value==3D"1942">
1942</option>
 <option value=3D"1943">
1943</option>
 <option value==3D"1944">
1944</option>
 <option value=3D"1945">
1945</option>
 <option value==3D"1946">
1946</option>
 <option value=3D"1947">
1947</option>
 <option value==3D"1948">
1948</option>
 <option value=3D"1949">
1949</option>
 <option value==3D"1950">
1950</option>
 <option value=3D"1951">
1951</option>
 <option value==3D"1952">
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>
 <option value=3D"1959">
1959</option>
 <option value==3D"1960">
1960</option>
 <option value=3D"1961">
1961</option>
 <option value==3D"1962">
1962</option>
 <option value=3D"1963">
1963</option>
 <option value==3D"1964">
1964</option>
 <option value=3D"1965">
1965</option>
 <option value==3D"1966">
1966</option>
 <option value=3D"1967">
1967</option>
 <option value==3D"1968">
1968</option>
 <option value=3D"1969">
1969</option>
 <option value==3D"1970">
1970</option>
 <option value=3D"1971">
1971</option>
 <option value==3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
 <option value==3D"1974">
1974</option>
 <option value=3D"1975">
1975</option>
 <option value==3D"1976">
1976</option>
 <option value=3D"1977">
1977</option>
 <option value==3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option value==3D"1980">
1980</option>
 <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_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-item-required m_1989158549512722575ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_1989158549512722575ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1989158549512722575ss-q-item-label" for=3D"m_1989158549512722575entry_206244955">
<div class=3D"m_1989158549512722575ss-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_1989158549512722575itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1989158549512722575ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1989158549512722575ss-q-time">
<div class=3D"m_1989158549512722575ss-datetime-box m_1989158549512722575goog-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_1989158549512722575entry.206244955_hour">
<option value=3D"">
Hr</option>
<option value=3D"01">
01</option>
 <option value=3D"02">
02</option>
 <option value=3D"03">
03</option>
 <option value=3D"04" selected>
04</option>
 <option value=3D"05">
05</option>
 <option value=3D"06">
06</option>
 <option value=3D"07">
07</option>
 <option value=3D"08">
08</option>
 <option value=3D"09">
09</option>
 <option value=3D"10">
10</option>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12</option>
</select>
:<select name=3D"entry.206244955_minute" disabled id=3D"m_1989158549512722575entry.206244955_minute">
<option value=3D"">
Min</option>
<option value=3D"00" selected>
00</option>
 <option value=3D"01">
01</option>
 <option value=3D"02">
02</option>
 <option value=3D"03">
03</option>
 <option value=3D"04">
04</option>
 <option value=3D"05">
05</option>
 <option value=3D"06">
06</option>
 <option value=3D"07">
07</option>
 <option value=3D"08">
08</option>
 <option value=3D"09">
09</option>
 <option value=3D"10">
10</option>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12</option>
 <option value=3D"13">
13</option>
 <option value=3D"14">
14</option>
 <option value=3D"15">
15</option>
 <option value=3D"16">
16</option>
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Escala Dolor EVA Actual</div>
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3</label>
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8</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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0</label>
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3</label>
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4</label>
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5</label>
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6</label>
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7</label>
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8</label>
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9</label>
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10</label>
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VISITA REALIZADA 28/6SISTEMA NO PERMITE INCORPORARpaciente en buenas condiciones, se queja de que persiste con tos (tos propia de cuadro repsiratorio reciente). sin flema, sin tos, de buen animo. quedo muy cansada con Visita de hijamantiene buen apetito y deposiciones diarias, habitualmente mas ed 1 al diarefiere dolor hipogastrico, si disuria, sin poliaquiuria, afebril., sin cambios en orina.prox lunes 1/7 se realizar=C3=A1 TAC TAP para evaluacion de progreso de terapiasviernes 5/7 sera evaluado en reunion clinica medicaprox sesion de inmunoterapia (5=C2=AA) ser=C3=ADa dia 17/7se plantea realizar educacion sobre sus patolgias (con el objetivo de llegar a hablar de su patologia cancerosa). le interesa saber sobre insulinorresistencia, lo que ser=C3=A1 tratado en prox visita.=20</div>
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</label>
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se manteinen indicacionesse educa que es normal persistir co tos leve hasta 2 semnas posterior a cuadro respiratorio=20prox sesion educacion insulinorresitenciainmunoterapia 5=C2=AA sesion 17/7lunes 1 tac tapviernes 5/5 reunion medica para ev de evolucion con terapias y TAC TAP</div>
</div>
</div>
</div>
<br>
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<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class=3D"m_1989158549512722575ss-q-help m_1989158549512722575ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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<br>
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
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Month</option>
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1918</option>
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1920</option>
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1930</option>
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1940</option>
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1986</option>
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1989</option>
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1990</option>
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1991</option>
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1998</option>
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2011</option>
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2012</option>
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2021</option>
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2022</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>
</div>
<br>
 <div class=3D"m_1989158549512722575ss-form-question m_1989158549512722575errorbox-good">
<div dir=3D"auto" class=3D"m_1989158549512722575ss-item m_1989158549512722575ss-text" style=3D"margin:12px 0">
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<div class=3D"m_1989158549512722575ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tratamiento Realizado (si corresponde)</div>
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</label>
<div class=3D"m_1989158549512722575ss-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>
</label>
<ul class=3D"m_1989158549512722575ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
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<span class=3D"m_1989158549512722575ss-choice-label">
ENFERMERA</span>
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</li>
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<label>
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<span class=3D"m_1989158549512722575ss-choice-label">
TENS</span>
</label>
</li>
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<input name==3D"entry.503039759" disabled value=3D"NUTRICIONISTA" id=3D"m_1989158549512722575group_503039759_3" class=3D"m_1989158549512722575ss-q-checkbox" type==3D"checkbox">
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<span class=3D"m_1989158549512722575ss-choice-label">
NUTRICIONISTA</span>
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</li>
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<input name==3D"entry.503039759" disabled value=3D"KINESIOLOGO" id=3D"m_1989158549512722575group_503039759_4" class=3D"m_1989158549512722575ss-q-checkbox" type=3D"checkbox">
</span>
<span class=3D"m_1989158549512722575ss-choice-label">
KINESIOLOGO</span>
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</li>
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<span class=3D"m_1989158549512722575ss-choice-item-control m_1989158549512722575goog-inline-block" style=3D"display:inline-block">
<input name==3D"entry.503039759" disabled value=3D"PSICOLOGO" id=3D"m_1989158549512722575group_503039759_5" class=3D"m_1989158549512722575ss-q-checkbox" type=3D"checkbox">
</span>
<span class=3D"m_1989158549512722575ss-choice-label">
PSICOLOGO</span>
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</li>
</ul>
</div>
</div>
</div>
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LUISA YEOMANS CABRERA</font>
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MEDICO CIRUJANO</font>
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MEDICO CONTRALOR=C2=A0</font>
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DESAM NOGALES</font>
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TEL: +569 68427169</font>
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