<div dir=3D"ltr">
<div dir=3D"ltr">
<br>
</div>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
El mi=C3=A9., 10 de jul. de 2019 a la(s) 18:02, Formularios de Google (<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
) escribi=C3=B3:<br>
</div>
<blockquote class=3D"gmail_quote" style=3D"margin:0px 0px 0px 0.8ex;border-left-width:1px;border-left-color:rgb(204,204,204);border-left-style:solid;padding-left:1ex">
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;margin:0px;padding:0px;height:100%;width:100%">
<table border=3D"0" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(38,4,154)" width=3D"100%">
<tbody>
<tr height=3D"64px">
<td style=3D"padding-left:24px">
<img alt=3D"Formularios de Google" height=3D"26px" style=3D"display: inline-block; margin: 0px; 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"border-bottom-width:1px;border-bottom-style:solid;border-bottom-color:rgb(224,224,224);margin:0px auto;max-width:624px;min-width:154px;padding:0px 24px;background-color:rgb(255,255,255)">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(255,255,255)" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:rgb(66,66,66);font-weight:700">
Gracias por llenar <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:rgb(66,66,66)">
Estas son tus respuestas:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"gmail-m_-7818194019284236801ss-form-container">
<div class=3D"gmail-m_-7818194019284236801ss-form-heading">
<h1 class=3D"gmail-m_-7818194019284236801ss-form-title" dir=3D"ltr" style==3D"margin:0.67em 0px">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"gmail-m_-7818194019284236801ss-form-desc gmail-m_-7818194019284236801ss-no-ignore-whitespace" style=3D"font-style:inherit;font-variant:inherit;font-weight:inherit;font-stretch:inherit;font-size:inherit;line-height:inherit;font-family:inherit;width:99%;margin:0px 0px 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"gmail-m_-7818194019284236801ss-form">
<form method=3D"GET" id==3D"gmail-m_-7818194019284236801ss-form">
<br>
<div class=3D"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801emailAddress">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Direcci=C3=B3n de correo electr=C3==B3nico<label for=3D"m_-7818194019284236801emailAddress">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
</label>
<div class=3D"gmail-m_-7818194019284236801ss-q-text gmail-m_-7818194019284236801ss-printable-text-line" dir=3D"auto" style=3D"max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%;background-color:rgb(238,238,238)">
<a href=3D"mailto:nutricionistavale.gd@gmail.com" target=3D"_blank">
nutricionistavale.gd@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-embeddable-object-container" style=3D"margin:12px 0px;max-width:100%">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"gmail-m_-7818194019284236801ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width: 78px; outline: none;" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-page-break" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_-7818194019284236801ss-page-title" style=3D"padding:0.4em;background-color:rgb(238,238,238)">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"gmail-m_-7818194019284236801ss-page-description gmail-m_-7818194019284236801ss-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"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_579114469">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_-7818194019284236801ss-q-text" dir=3D"auto" style=3D"max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%;background-color:rgb(238,238,238)">
Valeska Gallardo </div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_1276273985">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
RUT<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"gmail-m_-7818194019284236801ss-q-text" dir=3D"auto" style=3D"max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%;background-color:rgb(238,238,238)">
17964660-9</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-select" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_133691676">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tipo<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
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"gmail-m_-7818194019284236801entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled>
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 selected>
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-embeddable-object-container" style=3D"margin:12px 0px;max-width:100%">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"gmail-m_-7818194019284236801ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width: 78px; outline: none;" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-page-break" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_-7818194019284236801ss-page-title" style=3D"padding:0.4em;background-color:rgb(238,238,238)">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"gmail-m_-7818194019284236801ss-page-description gmail-m_-7818194019284236801ss-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"gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-section-header" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_-7818194019284236801ss-section-title" style=3D"padding:0.4em;background-color:rgb(238,238,238)">
Datos Personales del Paciente</h2>
<div class=3D"gmail-m_-7818194019284236801ss-section-description gmail-m_-7818194019284236801ss-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"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_823811303">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ingrese el Rut del Paciente<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"gmail-m_-7818194019284236801ss-q-text" dir=3D"auto" style=3D"max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%;background-color:rgb(238,238,238)">
3739429-7</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_1959365839">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_-7818194019284236801ss-q-text" dir=3D"auto" style=3D"max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%;background-color:rgb(238,238,238)">
Marta Zuco </div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-select" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_545002227">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Previsi=C3=B3n<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<select name=3D"entry.545002227" disabled id=3D"gmail-m_-7818194019284236801entry_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 selected>
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"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_1900161356">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ciudad<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_-7818194019284236801ss-q-text" dir=3D"auto" style=3D"max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%;background-color:rgb(238,238,238)">
Vi==C3=B1a del Mar</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_1298871758">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Comuna<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_-7818194019284236801ss-q-text" dir=3D"auto" style=3D"max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%;background-color:rgb(238,238,238)">
Vi==C3=B1a del Mar</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-embeddable-object-container" style=3D"margin:12px 0px;max-width:100%">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"gmail-m_-7818194019284236801ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width: 78px; outline: none;" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-page-break" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_-7818194019284236801ss-page-title" style=3D"padding:0.4em;background-color:rgb(238,238,238)">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"gmail-m_-7818194019284236801ss-page-description gmail-m_-7818194019284236801ss-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"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-radio" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_2073233714">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<ul class=3D"gmail-m_-7818194019284236801ss-choices" style=3D"list-style:none;padding:0px;margin:0.5em 0px 0px">
<li class=3D"gmail-m_-7818194019284236801ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-7818194019284236801ss-choice-item-control gmail-m_-7818194019284236801goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"gmail-m_-7818194019284236801group_1222378237_1" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</span>
<span class=3D"gmail-m_-7818194019284236801ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"gmail-m_-7818194019284236801ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-7818194019284236801ss-choice-item-control gmail-m_-7818194019284236801goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"gmail-m_-7818194019284236801group_1222378237_2" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</span>
<span class=3D"gmail-m_-7818194019284236801ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-date" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_1705849412">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Fecha de la Atenci=C3=B3n<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-7818194019284236801ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_-7818194019284236801ss-q-date">
<div class=3D"gmail-m_-7818194019284236801ss-datetime-box gmail-m_-7818194019284236801goog-inline-block" style=3D"border:1px solid rgb(220,220,220);min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name=3D"entry.1705849412_month" disabled class=3D"gmail-m_-7818194019284236801ss-month-dropdown" id=3D"gmail-m_-7818194019284236801entry.1705849412_month">
<option value=3D"">
Mes</option>
<option value=3D"1">
enero</option>
 <option value=3D"2">
febrero</option>
 <option value=3D"3">
marzo</option>
 <option value=3D"4">
abril</option>
 <option value=3D"5">
mayo</option>
 <option value=3D"6">
junio</option>
 <option value==3D"7" selected>
julio</option>
 <option value=3D"8">
agosto</option>
 <option value=3D"9">
septiembre</option>
 <option value=3D"10">
octubre</option>
 <option value=3D"11">
noviembre</option>
 <option value=3D"12">
diciembre</option>
</select>
   <select name=3D"entry.1705849412_day" disabled class=3D"gmail-m_-7818194019284236801ss-day-dropdown" id=3D"gmail-m_-7818194019284236801entry.1705849412_day">
<option value=3D"">
D=C3=ADa</option>
<option value=3D"1">
1</option>
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2</option>
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3</option>
 <option value=3D"4">
4</option>
 <option value=3D"5">
5</option>
 <option value=3D"6">
6</option>
 <option value=3D"7">
7</option>
 <option value=3D"8">
8</option>
 <option value=3D"9" selected>
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>
 <option value=3D"14">
14</option>
 <option value=3D"15">
15</option>
 <option value=3D"16">
16</option>
 <option value=3D"17">
17</option>
 <option value=3D"18">
18</option>
 <option value==3D"19">
19</option>
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20</option>
 <option value=3D"21">
21</option>
 <option value=3D"22">
22</option>
 <option value=3D"23">
23</option>
 <option value=3D"24">
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"gmail-m_-7818194019284236801entry.1705849412_year">
<option value=3D"">
A=C3=B1o</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>
 <option value=3D"1901">
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>
 <option value=3D"1925">
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>
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1991</option>
 <option value==3D"1992">
1992</option>
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1993</option>
 <option value==3D"1994">
1994</option>
 <option value=3D"1995">
1995</option>
 <option value==3D"1996">
1996</option>
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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>
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2012</option>
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2013</option>
 <option value==3D"2014">
2014</option>
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2015</option>
 <option value==3D"2016">
2016</option>
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2017</option>
 <option value==3D"2018">
2018</option>
 <option value=3D"2019" selected>
2019</option>
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2020</option>
 <option value=3D"2021">
2021</option>
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2022</option>
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2023</option>
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2024</option>
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2025</option>
 <option value=3D"2026">
2026</option>
 <option value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
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2029</option>
 <option value=3D"2030">
2030</option>
 <option value=3D"2031">
2031</option>
 <option value=3D"2032">
2032</option>
 <option value=3D"2033">
2033</option>
 <option value=3D"2034">
2034</option>
 <option value=3D"2035">
2035</option>
 <option value=3D"2036">
2036</option>
 <option value=3D"2037">
2037</option>
 <option value==3D"2038">
2038</option>
 <option value=3D"2039">
2039</option>
 <option value==3D"2040">
2040</option>
 <option value=3D"2041">
2041</option>
 <option value==3D"2042">
2042</option>
 <option value=3D"2043">
2043</option>
 <option value==3D"2044">
2044</option>
 <option value=3D"2045">
2045</option>
 <option value==3D"2046">
2046</option>
 <option value=3D"2047">
2047</option>
 <option value==3D"2048">
2048</option>
 <option value=3D"2049">
2049</option>
 <option value==3D"2050">
2050</option>
 <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"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-item-required gmail-m_-7818194019284236801ss-time" style=3D"margin:12px 0px;font-style:inherit;font-variant:inherit;font-weight:inherit;font-stretch:inherit;font-size:inherit;line-height:inherit;font-family:inherit">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
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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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<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Escala Dolor EVA M=C3=A1ximo</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"gmail-m_-7818194019284236801entry_1244707512">
<tbody>
<tr>
<td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for==3D"m_-7818194019284236801group_1244707512_1" style=3D"display:block;padding:0.5em 0px">
0</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_1244707512_2" style=3D"display:block;padding:0.5em 0px">
1</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_1244707512_3" style=3D"display:block;padding:0.5em 0px">
2</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_1244707512_4" style=3D"display:block;padding:0.5em 0px">
3</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_1244707512_5" style=3D"display:block;padding:0.5em 0px">
4</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_1244707512_6" style=3D"display:block;padding:0.5em 0px">
5</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_1244707512_7" style=3D"display:block;padding:0.5em 0px">
6</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_1244707512_8" style=3D"display:block;padding:0.5em 0px">
7</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_1244707512_9" style=3D"display:block;padding:0.5em 0px">
8</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_1244707512_10" style=3D"display:block;padding:0.5em 0px">
9</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_1244707512_11" style=3D"display:block;padding:0.5em 0px">
10</label>
</td>
<td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"gmail-m_-7818194019284236801ss-scalerow gmail-m_-7818194019284236801ss-leftlabel" style=3D"text-align:right;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em 0.5em 0px">
<div class=3D"gmail-m_-7818194019284236801aria-todo">
</div>
</td>
<td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type==3D"radio" name=3D"entry.1244707512" disabled value=3D"0" id=3D"gmail-m_-7818194019284236801group_1244707512_1" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value==3D"1" id=3D"gmail-m_-7818194019284236801group_1244707512_2" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"2" id=3D"gmail-m_-7818194019284236801group_1244707512_3" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"3" id=3D"gmail-m_-7818194019284236801group_1244707512_4" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
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<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"4" id=3D"gmail-m_-7818194019284236801group_1244707512_5" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
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<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"5" id=3D"gmail-m_-7818194019284236801group_1244707512_6" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
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<input type=3D"radio" name==3D"entry.1244707512" disabled value=3D"6" id=3D"gmail-m_-7818194019284236801group_1244707512_7" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"7" id=3D"gmail-m_-7818194019284236801group_1244707512_8" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"8" id=3D"gmail-m_-7818194019284236801group_1244707512_9" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"9" id=3D"gmail-m_-7818194019284236801group_1244707512_10" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type==3D"radio" name=3D"entry.1244707512" disabled value=3D"10" id=3D"gmail-m_-7818194019284236801group_1244707512_11" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
<td class=3D"gmail-m_-7818194019284236801ss-scalerow gmail-m_-7818194019284236801ss-rightlabel" style=3D"text-align:left;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0px 0.5em 0.25em">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-scale" style=3D"margin:12px 0px;overflow-x:auto">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_2000523015">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Escala Dolor EVA M=C3=ADnimo</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"gmail-m_-7818194019284236801entry_853118630">
<tbody>
<tr>
<td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for==3D"m_-7818194019284236801group_853118630_1" style=3D"display:block;padding:0.5em 0px">
0</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_853118630_2" style=3D"display:block;padding:0.5em 0px">
1</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_853118630_3" style=3D"display:block;padding:0.5em 0px">
2</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_853118630_4" style=3D"display:block;padding:0.5em 0px">
3</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_853118630_5" style=3D"display:block;padding:0.5em 0px">
4</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_853118630_6" style=3D"display:block;padding:0.5em 0px">
5</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_853118630_7" style=3D"display:block;padding:0.5em 0px">
6</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_853118630_8" style=3D"display:block;padding:0.5em 0px">
7</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_853118630_9" style=3D"display:block;padding:0.5em 0px">
8</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style==3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_853118630_10" style=3D"display:block;padding:0.5em 0px">
9</label>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-7818194019284236801ss-scalenumber" for=3D"m_-7818194019284236801group_853118630_11" style=3D"display:block;padding:0.5em 0px">
10</label>
</td>
<td class=3D"gmail-m_-7818194019284236801ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"gmail-m_-7818194019284236801ss-scalerow gmail-m_-7818194019284236801ss-leftlabel" style=3D"text-align:right;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em 0.5em 0px">
<div class=3D"gmail-m_-7818194019284236801aria-todo">
</div>
</td>
<td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type==3D"radio" name=3D"entry.853118630" disabled value=3D"0" id=3D"gmail-m_-7818194019284236801group_853118630_1" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"1" id=3D"gmail-m_-7818194019284236801group_853118630_2" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-7818194019284236801ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_-7818194019284236801ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"2" id=3D"gmail-m_-7818194019284236801group_853118630_3" class=3D"gmail-m_-7818194019284236801ss-q-radio">
</div>
</td>
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Anamnesis/Evoluci=C3=B3n<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
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*</span>
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Paciente femenina de 96 a=C3=B1os con antecedentes de c=C3=A1ncer de pulm=C3=B3n, hipertensa y diab=C3=A9tica controlada, usa protesis dental, no presenta molestias para masticar ni tragar,deposiciones normales, orina normal, baja ingesta de agua, paciente se encuentra estable despues de sufrir un ACV, con buen apetito. Se realiz=C3=B3 pesaje semanal y seguimiento nutricional</div>
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<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_824006088">
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Peso: 68.2 %grasa corporal: 39.1 IMC: 28 %masa muscular: 26.3 visceral: 11</div>
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Normo peso segun IMC adulto mayor con aumento del compartimento graso </div>
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Plan de Tratamiento e Indicaciones<label for=3D"m_-7818194019284236801itemView.getDomIdToLabel()">
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R=C3=A9gimen normocalorico, normoproteico, normoglucidico con seleccion de hidratos de carbono complejos, normolipidico con seleccion de lipidos mono y poli insaturados, hiposodico </div>
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<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_1648939075">
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Medicamentos Indicados</div>
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
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<div class=3D"gmail-m_-7818194019284236801ss-q-date">
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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"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_74766472">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tratamiento Realizado (si corresponde)</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_-7818194019284236801ss-q-text" dir=3D"auto" style=3D"max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%;background-color:rgb(238,238,238)">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801ss-form-question gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-checkbox" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_-7818194019284236801ss-q-item-label" for=3D"m_-7818194019284236801entry_1219705969">
<div class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"gmail-m_-7818194019284236801ss-q-help gmail-m_-7818194019284236801ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
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"gmail-m_-7818194019284236801ss-choices" style=3D"list-style:none;padding:0px;margin:0.5em 0px 0px">
<li class=3D"gmail-m_-7818194019284236801ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-7818194019284236801ss-choice-item-control gmail-m_-7818194019284236801goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"ENFERMERA" id=3D"gmail-m_-7818194019284236801group_503039759_1" class=3D"gmail-m_-7818194019284236801ss-q-checkbox">
</span>
<span class=3D"gmail-m_-7818194019284236801ss-choice-label">
ENFERMERA</span>
</label>
</li>
 <li class=3D"gmail-m_-7818194019284236801ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-7818194019284236801ss-choice-item-control gmail-m_-7818194019284236801goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"gmail-m_-7818194019284236801group_503039759_2" class=3D"gmail-m_-7818194019284236801ss-q-checkbox">
</span>
<span class=3D"gmail-m_-7818194019284236801ss-choice-label">
TENS</span>
</label>
</li>
 <li class=3D"gmail-m_-7818194019284236801ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-7818194019284236801ss-choice-item-control gmail-m_-7818194019284236801goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"NUTRICIONISTA" id=3D"gmail-m_-7818194019284236801group_503039759_3" class=3D"gmail-m_-7818194019284236801ss-q-checkbox">
</span>
<span class=3D"gmail-m_-7818194019284236801ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
 <li class=3D"gmail-m_-7818194019284236801ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-7818194019284236801ss-choice-item-control gmail-m_-7818194019284236801goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"KINESIOLOGO" id=3D"gmail-m_-7818194019284236801group_503039759_4" class=3D"gmail-m_-7818194019284236801ss-q-checkbox">
</span>
<span class=3D"gmail-m_-7818194019284236801ss-choice-label">
KINESIOLOGO</span>
</label>
</li>
 <li class=3D"gmail-m_-7818194019284236801ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-7818194019284236801ss-choice-item-control gmail-m_-7818194019284236801goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"PSICOLOGO" id=3D"gmail-m_-7818194019284236801group_503039759_5" class=3D"gmail-m_-7818194019284236801ss-q-checkbox">
</span>
<span class=3D"gmail-m_-7818194019284236801ss-choice-label">
PSICOLOGO</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-7818194019284236801errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-7818194019284236801ss-item gmail-m_-7818194019284236801ss-embeddable-object-container" style=3D"margin:12px 0px;max-width:100%">
<div class=3D"gmail-m_-7818194019284236801ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_-7818194019284236801ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"gmail-m_-7818194019284236801ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width: 78px; outline: none;" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
</form>
</div>
</div>
</td>
</tr>
<tr height=3D"24px">
</tr>
</tbody>
</table>
</div>
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"max-width:672px;min-width:154px" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link" style=3D"color:rgb(66,66,66);font-size:13px" target=3D"_blank">
Crear tu propio Formulario de Google</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</blockquote>
</div>
</div>
--0000000000000e8ee9058d5ae0ef--