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EU B=C3=A1rbara Hueich=C3=A1n </div>
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---------- Forwarded message ----------<br>
From: "<b class=3D"gmail_sendername">
Formularios de Google</b>
" <span dir==3D"ltr">
&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;</span>
<br>
Date: Thu, Aug 1, 2019 at 12:01 AM -0400<br>
Subject: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To: <span dir=3D"ltr">
&lt;<a href=3D"mailto:barbarahueichan@telemed-chile.cl">
barbarahueichan@telemed-chile.cl</a>
&gt;</span>
<br>
<br>
<br>
<div dir=3D"3D&quot;ltr&quot;">
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<td style=3D"padding-left: 24px">
<img alt=3D"Formularios de Google" height=3D"26px" style=3D"display: inline-block; margin: 0; vertical-align: middle;" width=3D"143px" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
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<div style=3D"padding: 24px; background-color:rgb(229,218,254)">
<div align=3D"center" style=3D"background-color: #fff; border-bottom: 1px solid #e0e0e0; margin: 0 auto; max-width: 624px; min-width: 154px; padding: 0 24px;">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color: #fff;" width=3D"100%" role=3D"presentation">
<tbody>
<tr height=3D"24px">
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</td>
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<tr>
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<div style=3D"font-size: 13px; line-height: 18px; color: #424242; font-weight: 700">
Gracias por rellenar <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
</div>
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<tr height=3D"12px">
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<tr>
<td>
<div style=3D"font-size: 13px; line-height: 18px; color: #424242;">
Esto es lo que nos has enviado:</div>
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<td>
<div class=3D"ss-form-container" style=3D"">
<div class=3D"ss-form-heading" style=3D"">
<h1 class=3D"ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0;">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"ss-form-desc ss-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>
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<label class=3D"ss-q-item-label" for=3D"emailAddress" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Direcci=C3=B3n de correo electr=C3=B3nico<label for=3D"emailAddress" aria-label=3D"(Campo obligatorio)" style=3D"">
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*</span>
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barbarahueichan@telemed-chile.cl</div>
</div>
</div>
</div>
<div class=3D"errorbox-good" role=3D"listitem" style=3D"">
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</h2>
<div style=3D"text-align: right;">
<img class=3D"ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/00-FWRRIiJNpjLIXj1QrTLVceHhiPxWpIN-K4cI0enEtAvmFFnvOHRJTMz5Lq8yFpMHz7WvBnNdiNVchE6Snklpxxc7gIx3OoqTfn_sB2_iSp_6sx7Sr2pww-0pD" style=3D"width: 78px;outline:none;" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"errorbox-good" role=3D"listitem" style=3D"">
<div dir=3D"auto" class=3D"ss-item  ss-page-break" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ss-page-title" style=3D"margin:2em -0.4em 0;padding:0.4em;background-color:#eee;">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"ss-page-description ss-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"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-text" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_579114469" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Primer Nombre y Apellido Paterno<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
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</div>
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Barbara Hueichan</div>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-text" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_1276273985" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
RUT<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-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"ss-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%;">
18492447-1</div>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-select" style=3D"margin:12px 0;">
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<label class=3D"ss-q-item-label" for=3D"entry_133691676" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Tipo<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
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<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-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"entry_133691676" aria-label=3D"Tipo Si asisten m=C3=A1s de 1 prestador simult=C3=A1neamente, cada uno debe hacer un registro independiente " aria-required=3D"true" style=3D"">
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</option>
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MEDICO</option>
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ENFERMERA/O</option>
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TENS</option>
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KINESIOLOGA/O</option>
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PSICOLOGO</option>
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NUTRICIONISTA</option>
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<br>
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</h2>
<div style=3D"text-align: right;">
<img class=3D"ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/mRJInQVKRU12r9blREv2jmlzETLT9JfIHWC0FaeXYfPraPFE9ebBRX8P_hmpfiBP6BNpOgjPBYU0zwBxYxgoLvjQ7EjfjoRTJ2_-8flTaiU_wC008XC8LpcEJ_Yp" style=3D"width: 78px;outline:none;" alt=3D"Imagen sin leyenda">
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<div dir=3D"auto" class=3D"ss-item  ss-page-break" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ss-page-title" style=3D"margin:2em -0.4em 0;padding:0.4em;background-color:#eee;">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"ss-page-description ss-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"errorbox-good" role=3D"listitem" style=3D"">
<div dir=3D"auto" class=3D"ss-item  ss-section-header" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ss-section-title" style=3D"background-color:#eee;padding:0.4em;margin:2em -0.4em 0;">
Datos Personales del Paciente</h2>
<div class=3D"ss-section-description ss-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"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-text" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_823811303" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Ingrese el Rut del Paciente<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-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"ss-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%;">
8699860-2</div>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-text" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_1959365839" style=3D"">
<div class=3D"ss-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"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ss-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%;">
Viola Ojeda</div>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-select" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_545002227" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Previsi=C3=B3n<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-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"entry_545002227" aria-label=3D"Previsi=C3=B3n  " aria-required=3D"true" style=3D"">
<option value=3D"" style=3D"">
</option>
<option value=3D"BANMEDICA" disabled style=3D"">
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled style=3D"">
CAPREDENA</option>
 <option value=3D"COLMENA" disabled style=3D"">
COLMENA</option>
 <option value=3D"CONSALUD" disabled selected style=3D"">
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled style=3D"">
CRUZ BLANCA</option>
 <option value=3D"DIPRECA" disabled style=3D"">
DIPRECA</option>
 <option value=3D"FONASA" disabled style=3D"">
FONASA</option>
 <option value=3D"FUNDACION" disabled style=3D"">
FUNDACION</option>
 <option value=3D"ISAPRES DEL COBRE" disabled style=3D"">
ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled style=3D"">
NUEVA MASVIDA</option>
 <option value=3D"VIDATRES" disabled style=3D"">
VIDATRES</option>
 <option value=3D"PARTICULAR" disabled style=3D"">
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-text" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_1900161356" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Ciudad<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ss-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%;">
Osorno</div>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-text" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_1298871758" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Comuna<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ss-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%;">
Osorno</div>
</div>
</div>
</div>
<br>
 <div class=3D"errorbox-good" role=3D"listitem" style=3D"">
<div dir=3D"auto" class=3D"ss-item  ss-embeddable-object-container" style==3D"margin:12px 0;max-width:100%;position:relative;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ss-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"ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/URytM0QWRGW_JEL0xQxvOLvwPRJIHyqlnKOm6ky9DRBfzvYVPaAngXV35GNHnaVG-dm9Orno4lr8sy8E-KB9tMrmIhFbVQiOPWy3vUclqRKAJ51dvLdhjBKgXdLO" style=3D"width: 78px;outline:none;" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"errorbox-good" role=3D"listitem" style=3D"">
<div dir=3D"auto" class=3D"ss-item  ss-page-break" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ss-page-title" style=3D"margin:2em -0.4em 0;padding:0.4em;background-color:#eee;">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"ss-page-description ss-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"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-radio" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_2073233714" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Tipo de Atenci=C3=B3n<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<ul class=3D"ss-choices" role=3D"radiogroup" aria-label=3D"Tipo de Atenci==C3=B3n  " style=3D"list-style:none;padding:0;margin:.5em 0 0;">
<li class==3D"ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em;">
<label>
<span class=3D"ss-choice-item-control goog-inline-block" style=3D"position:relative;display:inline-block;">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"group_1222378237_1" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"Domicilio" aria-required==3D"true" style=3D"">
</span>
<span class=3D"ss-choice-label" style=3D"">
Domicilio</span>
</label>
</li>
 <li class=3D"ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em;">
<label>
<span class=3D"ss-choice-item-control goog-inline-block" style=3D"position:relative;display:inline-block;">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"group_1222378237_2" role==3D"radio" class=3D"ss-q-radio" aria-label=3D"Ambulatorio" aria-required=3D"true" style=3D"">
</span>
<span class=3D"ss-choice-label" style=3D"">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-date" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_1705849412" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Fecha de la Atenci=C3=B3n<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ss-q-date" role=3D"group" aria-label=3D"Fecha de la Atenci=C3=B3n  " style=3D"">
<div class=3D"ss-datetime-box goog-inline-block" role=3D"group" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;position:relative;display:inline-block;">
 <select name=3D"entry.1705849412_day" disabled class==3D"ss-day-dropdown" id=3D"entry.1705849412_day" aria-label=3D"D=C3=ADa del mes" aria-required=3D"true" style=3D"">
<option value=3D"" style=3D"">
D=C3==ADa</option>
<option value=3D"1" style=3D"">
1</option>
 <option value=3D"2" style=3D"">
2</option>
 <option value=3D"3" style=3D"">
3</option>
 <option value=3D"4" style=3D"">
4</option>
 <option value=3D"5" style=3D"">
5</option>
 <option value==3D"6" style=3D"">
6</option>
 <option value=3D"7" style=3D"">
7</option>
 <option value=3D"8" style=3D"">
8</option>
 <option value=3D"9" style=3D"">
9</option>
 <option value=3D"10" style=3D"">
10</option>
 <option value=3D"11" style=3D"">
11</option>
 <option value=3D"12" style=3D"">
12</option>
 <option value=3D"13" style=3D"">
13</option>
 <option value=3D"14" style=3D"">
14</option>
 <option value=3D"15" style=3D"">
15</option>
 <option value=3D"16" style=3D"">
16</option>
 <option value=3D"17" style=3D"">
17</option>
 <option value=3D"18" style=3D"">
18</option>
 <option value=3D"19" style=3D"">
19</option>
 <option value=3D"20" style=3D"">
20</option>
 <option value=3D"21" style=3D"">
21</option>
 <option value=3D"22" style=3D"">
22</option>
 <option value=3D"23" style=3D"">
23</option>
 <option value=3D"24" style=3D"">
24</option>
 <option value=3D"25" style=3D"">
25</option>
 <option value=3D"26" style=3D"">
26</option>
 <option value=3D"27" style=3D"">
27</option>
 <option value=3D"28" style==3D"">
28</option>
 <option value=3D"29" style=3D"">
29</option>
 <option value=3D"30" style=3D"">
30</option>
 <option value=3D"31" selected style=3D"">
31</option>
</select>
   <select name=3D"entry.1705849412_month" disabled class==3D"ss-month-dropdown" id=3D"entry.1705849412_month" aria-label=3D"Mes" aria-required=3D"true" style=3D"">
<option value=3D"" style=3D"">
Mes</option>
<option value=3D"1" style=3D"">
enero</option>
 <option value=3D"2" style=3D"">
febrero</option>
 <option value=3D"3" style=3D"">
marzo</option>
 <option value=3D"4" style=3D"">
abril</option>
 <option value=3D"5" style=3D"">
mayo</option>
 <option value=3D"6" style=3D"">
junio</option>
 <option value=3D"7" selected style=3D"">
julio</option>
 <option value=3D"8" style=3D"">
agosto</option>
 <option value=3D"9" style=3D"">
septiembre</option>
 <option value=3D"10" style=3D"">
octubre</option>
 <option value=3D"11" style=3D"">
noviembre</option>
 <option value=3D"12" style=3D"">
diciembre</option>
</select>
=20<select name=3D"entry.1705849412_year" disabled id=3D"entry.1705849412_year" aria-label=3D"A=C3=B1o" aria-required=3D"true" style=3D"">
<option value==3D"" style=3D"">
A=C3=B1o</option>
<option value=3D"1896" style=3D"">
1896</option>
 <option value=3D"1897" style=3D"">
1897</option>
 <option value=3D"1898" style=3D"">
1898</option>
 <option value=3D"1899" style=3D"">
1899</option>
 <option value=3D"1900" style=3D"">
1900</option>
 <option value=3D"1901" style=3D"">
1901</option>
 <option value=3D"1902" style=3D"">
1902</option>
 <option value=3D"1903" style=3D"">
1903</option>
 <option value=3D"1904" style=3D"">
1904</option>
 <option value=3D"1905" style=3D"">
1905</option>
 <option value=3D"1906" style=3D"">
1906</option>
 <option value=3D"1907" style=3D"">
1907</option>
 <option value=3D"1908" style=3D"">
1908</option>
 <option value=3D"1909" style=3D"">
1909</option>
 <option value=3D"1910" style=3D"">
1910</option>
 <option value=3D"1911" style==3D"">
1911</option>
 <option value=3D"1912" style=3D"">
1912</option>
 <option value=3D"1913" style=3D"">
1913</option>
 <option value=3D"1914" style=3D"">
1914</option>
 <option value=3D"1915" style=3D"">
1915</option>
 <option value=3D"1916" style=3D"">
1916</option>
 <option value=3D"1917" style=3D"">
1917</option>
 <option value=3D"1918" style=3D"">
1918</option>
 <option value=3D"1919" style=3D"">
1919</option>
 <option value=3D"1920" style=3D"">
1920</option>
 <option value=3D"1921" style=3D"">
1921</option>
 <option value=3D"1922" style=3D"">
1922</option>
 <option value=3D"1923" style=3D"">
1923</option>
 <option value=3D"1924" style=3D"">
1924</option>
 <option value=3D"1925" style=3D"">
1925</option>
 <option value=3D"1926" style=3D"">
1926</option>
 <option value=3D"1927" style=3D"">
1927</option>
 <option value=3D"1928" style=3D"">
1928</option>
 <option value=3D"1929" style=3D"">
1929</option>
 <option value=3D"1930" style=3D"">
1930</option>
 <option value=3D"1931" style=3D"">
1931</option>
 <option value=3D"1932" style=3D"">
1932</option>
 <option value=3D"1933" style=3D"">
1933</option>
 <option value=3D"1934" style=3D"">
1934</option>
 <option value=3D"1935" style=3D"">
1935</option>
 <option value=3D"1936" style=3D"">
1936</option>
 <option value=3D"1937" style=3D"">
1937</option>
 <option value=3D"1938" style=3D"">
1938</option>
 <option value=3D"1939" style=3D"">
1939</option>
 <option value=3D"1940" style=3D"">
1940</option>
 <option value=3D"1941" style=3D"">
1941</option>
 <option value=3D"1942" style=3D"">
1942</option>
 <option value=3D"1943" style=3D"">
1943</option>
 <option value=3D"1944" style=3D"">
1944</option>
 <option value=3D"1945" style=3D"">
1945</option>
 <option value=3D"1946" style=3D"">
1946</option>
 <option value=3D"1947" style=3D"">
1947</option>
 <option value=3D"1948" style=3D"">
1948</option>
 <option value=3D"1949" style=3D"">
1949</option>
 <option value=3D"1950" style=3D"">
1950</option>
 <option value=3D"1951" style=3D"">
1951</option>
 <option value=3D"1952" style=3D"">
1952</option>
 <option value=3D"1953" style=3D"">
1953</option>
 <option value=3D"1954" style=3D"">
1954</option>
 <option value=3D"1955" style=3D"">
1955</option>
 <option value=3D"1956" style=3D"">
1956</option>
 <option value=3D"1957" style=3D"">
1957</option>
 <option value=3D"1958" style=3D"">
1958</option>
 <option value=3D"1959" style=3D"">
1959</option>
 <option value=3D"1960" style=3D"">
1960</option>
 <option value=3D"1961" style=3D"">
1961</option>
 <option value=3D"1962" style=3D"">
1962</option>
 <option value=3D"1963" style=3D"">
1963</option>
 <option value=3D"1964" style=3D"">
1964</option>
 <option value=3D"1965" style=3D"">
1965</option>
 <option value=3D"1966" style=3D"">
1966</option>
 <option value=3D"1967" style=3D"">
1967</option>
 <option value=3D"1968" style=3D"">
1968</option>
 <option value=3D"1969" style=3D"">
1969</option>
 <option value=3D"1970" style=3D"">
1970</option>
 <option value=3D"1971" style=3D"">
1971</option>
 <option value=3D"1972" style=3D"">
1972</option>
 <option value=3D"1973" style=3D"">
1973</option>
 <option value=3D"1974" style=3D"">
1974</option>
 <option value=3D"1975" style=3D"">
1975</option>
 <option value=3D"1976" style=3D"">
1976</option>
 <option value=3D"1977" style=3D"">
1977</option>
 <option value=3D"1978" style=3D"">
1978</option>
 <option value=3D"1979" style=3D"">
1979</option>
 <option value=3D"1980" style=3D"">
1980</option>
 <option value=3D"1981" style=3D"">
1981</option>
 <option value=3D"1982" style=3D"">
1982</option>
 <option value=3D"1983" style=3D"">
1983</option>
 <option value=3D"1984" style=3D"">
1984</option>
 <option value=3D"1985" style=3D"">
1985</option>
 <option value=3D"1986" style=3D"">
1986</option>
 <option value=3D"1987" style=3D"">
1987</option>
 <option value=3D"1988" style=3D"">
1988</option>
 <option value=3D"1989" style=3D"">
1989</option>
 <option value=3D"1990" style=3D"">
1990</option>
 <option value=3D"1991" style=3D"">
1991</option>
 <option value=3D"1992" style=3D"">
1992</option>
 <option value=3D"1993" style=3D"">
1993</option>
 <option value=3D"1994" style=3D"">
1994</option>
 <option value=3D"1995" style=3D"">
1995</option>
 <option value=3D"1996" style=3D"">
1996</option>
 <option value=3D"1997" style=3D"">
1997</option>
 <option value=3D"1998" style=3D"">
1998</option>
 <option value=3D"1999" style=3D"">
1999</option>
 <option value=3D"2000" style=3D"">
2000</option>
 <option value=3D"2001" style=3D"">
2001</option>
 <option value=3D"2002" style=3D"">
2002</option>
 <option value=3D"2003" style=3D"">
2003</option>
 <option value=3D"2004" style=3D"">
2004</option>
 <option value=3D"2005" style=3D"">
2005</option>
 <option value=3D"2006" style=3D"">
2006</option>
 <option value=3D"2007" style=3D"">
2007</option>
 <option value=3D"2008" style=3D"">
2008</option>
 <option value=3D"2009" style=3D"">
2009</option>
 <option value=3D"2010" style=3D"">
2010</option>
 <option value=3D"2011" style=3D"">
2011</option>
 <option value=3D"2012" style=3D"">
2012</option>
 <option value=3D"2013" style=3D"">
2013</option>
 <option value=3D"2014" style=3D"">
2014</option>
 <option value=3D"2015" style=3D"">
2015</option>
 <option value=3D"2016" style=3D"">
2016</option>
 <option value=3D"2017" style=3D"">
2017</option>
 <option value=3D"2018" style=3D"">
2018</option>
 <option value=3D"2019" selected style=3D"">
2019</option>
 <option value=3D"2020" style=3D"">
2020</option>
 <option value=3D"2021" style=3D"">
2021</option>
 <option value=3D"2022" style=3D"">
2022</option>
 <option value=3D"2023" style=3D"">
2023</option>
 <option value=3D"2024" style=3D"">
2024</option>
 <option value=3D"2025" style=3D"">
2025</option>
 <option value=3D"2026" style=3D"">
2026</option>
 <option value=3D"2027" style=3D"">
2027</option>
 <option value=3D"2028" style=3D"">
2028</option>
 <option value=3D"2029" style=3D"">
2029</option>
 <option value=3D"2030" style=3D"">
2030</option>
 <option value=3D"2031" style=3D"">
2031</option>
 <option value=3D"2032" style=3D"">
2032</option>
 <option value=3D"2033" style=3D"">
2033</option>
 <option value=3D"2034" style=3D"">
2034</option>
 <option value=3D"2035" style=3D"">
2035</option>
 <option value=3D"2036" style=3D"">
2036</option>
 <option value=3D"2037" style=3D"">
2037</option>
 <option value=3D"2038" style=3D"">
2038</option>
 <option value=3D"2039" style=3D"">
2039</option>
 <option value=3D"2040" style=3D"">
2040</option>
 <option value=3D"2041" style=3D"">
2041</option>
 <option value=3D"2042" style=3D"">
2042</option>
 <option value=3D"2043" style=3D"">
2043</option>
 <option value=3D"2044" style=3D"">
2044</option>
 <option value=3D"2045" style=3D"">
2045</option>
 <option value=3D"2046" style=3D"">
2046</option>
 <option value=3D"2047" style=3D"">
2047</option>
 <option value=3D"2048" style=3D"">
2048</option>
 <option value=3D"2049" style=3D"">
2049</option>
 <option value=3D"2050" style=3D"">
2050</option>
 <option value=3D"2051" style=3D"">
2051</option>
 <option value=3D"2052" style=3D"">
2052</option>
 <option value=3D"2053" style=3D"">
2053</option>
 <option value=3D"2054" style=3D"">
2054</option>
 <option value=3D"2055" style=3D"">
2055</option>
 <option value=3D"2056" style=3D"">
2056</option>
 <option value=3D"2057" style=3D"">
2057</option>
 <option value=3D"2058" style=3D"">
2058</option>
 <option value=3D"2059" style=3D"">
2059</option>
 <option value=3D"2060" style=3D"">
2060</option>
 <option value=3D"2061" style=3D"">
2061</option>
 <option value=3D"2062" style=3D"">
2062</option>
 <option value=3D"2063" style=3D"">
2063</option>
 <option value=3D"2064" style=3D"">
2064</option>
 <option value=3D"2065" style=3D"">
2065</option>
 <option value=3D"2066" style=3D"">
2066</option>
 <option value=3D"2067" style=3D"">
2067</option>
 <option value=3D"2068" style=3D"">
2068</option>
 <option value=3D"2069" style=3D"">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-time" style=3D"margin:12px 0;font:inherit;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_206244955" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Hora de la Atenci=C3=B3n<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ss-q-time" style=3D"">
<div class=3D"ss-datetime-box goog-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;position:relative;display:inline-block;">
<select name=3D"entry.206244955_hour" disabled id=3D"entry.206244955_hour" aria-label=3D"Hora" aria-required=3D"true" style=3D"">
<option value=3D"" style=3D"">
h</option>
<option value=3D"00" style=3D"">
00</option>
 <option value=3D"01" style=3D"">
01</option>
 <option value=3D"02" style=3D"">
02</option>
 <option value=3D"03" style=3D"">
03</option>
 <option value=3D"04" style=3D"">
04</option>
 <option value=3D"05" style=3D"">
05</option>
 <option value=3D"06" style=3D"">
06</option>
 <option value=3D"07" style=3D"">
07</option>
 <option value=3D"08" style=3D"">
08</option>
 <option value=3D"09" style=3D"">
09</option>
 <option value=3D"10" style=3D"">
10</option>
 <option value=3D"11" style=3D"">
11</option>
 <option value=3D"12" style=3D"">
12</option>
 <option value=3D"13" style==3D"">
13</option>
 <option value=3D"14" style=3D"">
14</option>
 <option value=3D"15" style=3D"">
15</option>
 <option value=3D"16" style=3D"">
16</option>
 <option value=3D"17" selected style=3D"">
17</option>
 <option value=3D"18" style=3D"">
18</option>
 <option value=3D"19" style=3D"">
19</option>
 <option value=3D"20" style=3D"">
20</option>
 <option value=3D"21" style=3D"">
21</option>
 <option value=3D"22" style=3D"">
22</option>
 <option value=3D"23" style==3D"">
23</option>
</select>
:<select name=3D"entry.206244955_minute" disabled id=3D"entry.206244955_minute" aria-label=3D"Minuto" aria-required=3D"true" style=3D"">
<option value==3D"" style=3D"">
min</option>
<option value=3D"00" style=3D"">
00</option>
 <option value=3D"01" style=3D"">
01</option>
 <option value=3D"02" style=3D"">
02</option>
 <option value=3D"03" style=3D"">
03</option>
 <option value=3D"04" style=3D"">
04</option>
 <option value=3D"05" style=3D"">
05</option>
 <option value=3D"06" style=3D"">
06</option>
 <option value=3D"07" style=3D"">
07</option>
 <option value=3D"08" style=3D"">
08</option>
 <option value=3D"09" style=3D"">
09</option>
 <option value=3D"10" style=3D"">
10</option>
 <option value=3D"11" style=3D"">
11</option>
 <option value=3D"12" style=3D"">
12</option>
 <option value=3D"13" style==3D"">
13</option>
 <option value=3D"14" style=3D"">
14</option>
 <option value=3D"15" style=3D"">
15</option>
 <option value=3D"16" style=3D"">
16</option>
 <option value=3D"17" style=3D"">
17</option>
 <option value=3D"18" style=3D"">
18</option>
 <option value=3D"19" style=3D"">
19</option>
 <option value=3D"20" style=3D"">
20</option>
 <option value=3D"21" style=3D"">
21</option>
 <option value=3D"22" style=3D"">
22</option>
 <option value=3D"23" style=3D"">
23</option>
 <option value=3D"24" style=3D"">
24</option>
 <option value=3D"25" style=3D"">
25</option>
 <option value=3D"26" style=3D"">
26</option>
 <option value=3D"27" style=3D"">
27</option>
 <option value=3D"28" style=3D"">
28</option>
 <option value=3D"29" style=3D"">
29</option>
 <option value=3D"30" selected style=3D"">
30</option>
 <option value=3D"31" style=3D"">
31</option>
 <option value=3D"32" style=3D"">
32</option>
 <option value=3D"33" style=3D"">
33</option>
 <option value=3D"34" style=3D"">
34</option>
 <option value=3D"35" style=3D"">
35</option>
 <option value=3D"36" style=3D"">
36</option>
 <option value=3D"37" style=3D"">
37</option>
 <option value=3D"38" style=3D"">
38</option>
 <option value=3D"39" style=3D"">
39</option>
 <option value=3D"40" style=3D"">
40</option>
 <option value=3D"41" style=3D"">
41</option>
 <option value=3D"42" style=3D"">
42</option>
 <option value=3D"43" style=3D"">
43</option>
 <option value=3D"44" style=3D"">
44</option>
 <option value=3D"45" style=3D"">
45</option>
 <option value=3D"46" style=3D"">
46</option>
 <option value=3D"47" style=3D"">
47</option>
 <option value=3D"48" style=3D"">
48</option>
 <option value=3D"49" style=3D"">
49</option>
 <option value=3D"50" style=3D"">
50</option>
 <option value=3D"51" style=3D"">
51</option>
 <option value=3D"52" style=3D"">
52</option>
 <option value=3D"53" style=3D"">
53</option>
 <option value=3D"54" style=3D"">
54</option>
 <option value=3D"55" style=3D"">
55</option>
 <option value=3D"56" style=3D"">
56</option>
 <option value=3D"57" style=3D"">
57</option>
 <option value=3D"58" style=3D"">
58</option>
 <option value=3D"59" style=3D"">
59</option>
</select>
<div class=3D"ss-datetime-box-spacer goog-inline-block" style=3D"height:32px;vertical-align:middle;position:relative;display:inline-block;">
</div>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item ss-item-required ss-select" style=3D"margin:12px 0;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_1747608258" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Performance Status ECOG del Paciente<label for=3D"itemView.getDomIdToLabel()" aria-label=3D"(Campo obligatorio)" style=3D"">
</label>
<span class=3D"ss-required-asterisk" aria-hidden=3D"true" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
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<select name=3D"entry.1747608258" disabled id=3D"entry_1747608258" aria-label=3D"Performance Status ECOG del Paciente  " aria-required=3D"true" style==3D"">
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</option>
<option value=3D"0" disabled style=3D"">
0</option>
 <option value=3D"1" disabled style=3D"">
1</option>
 <option value=3D"2" disabled selected style=3D"">
2</option>
 <option value=3D"3" disabled style=3D"">
3</option>
 <option value=3D"4" disabled style=3D"">
4</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item  ss-scale" style=3D"margin:12px 0;overflow-x:auto;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_1716090865" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Escala Dolor EVA Actual</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"entry_1421689035" style=3D"">
<tbody>
<tr aria-hidden=3D"true" style=3D"">
<td class=3D"ss-scalenumbers" style=3D"text-align:center;">
</td>
<td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em;">
0</label>
</td>
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<label class=3D"ss-scalenumber" for=3D"group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em;">
1</label>
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<label class=3D"ss-scalenumber" for=3D"group_1421689035_3" style=3D"display:block;padding:0.5em 0 .5em;">
2</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em;">
3</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em;">
4</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em;">
5</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1421689035_7" style=3D"display:block;padding:0.5em 0 .5em;">
6</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em;">
7</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em;">
8</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em;">
9</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em;">
10</label>
</td>
<td class=3D"ss-scalenumbers" style=3D"text-align:center;">
</td>
</tr>
<tr role=3D"radiogroup" aria-label=3D"Escala Dolor EVA Actual  Selecciona un valor en el intervalo de 0 a 10 ." style=3D"">
<td class=3D"ss-scalerow ss-leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0;">
<div aria-hidden=3D"true" class=3D"aria-todo" style=3D"">
</div>
</td>
<td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class==3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"0" id=3D"group_1421689035_1" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"0" style=3D"">
</div>
</td>
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<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"1" id=3D"group_1421689035_2" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"1" style=3D"">
</div>
</td>
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<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"2" id=3D"group_1421689035_3" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"2" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"3" id=3D"group_1421689035_4" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"3" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name==3D"entry.1421689035" disabled checked value=3D"4" id=3D"group_1421689035_5" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"4" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"5" id=3D"group_1421689035_6" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"5" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"6" id=3D"group_1421689035_7" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"6" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"7" id=3D"group_1421689035_8" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"7" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"8" id=3D"group_1421689035_9" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"8" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name==3D"entry.1421689035" disabled value=3D"9" id=3D"group_1421689035_10" role==3D"radio" class=3D"ss-q-radio" aria-label=3D"9" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"10" id=3D"group_1421689035_11" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"10" style=3D"">
</div>
</td>
<td class=3D"ss-scalerow ss-rightlabel" aria-hidden=3D"true" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0;">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item  ss-scale" style=3D"margin:12px 0;overflow-x:auto;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_2064050596" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Escala Dolor EVA M=C3=A1ximo</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"entry_1244707512" style=3D"">
<tbody>
<tr aria-hidden=3D"true" style=3D"">
<td class=3D"ss-scalenumbers" style=3D"text-align:center;">
</td>
<td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em;">
0</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em;">
1</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_3" style=3D"display:block;padding:0.5em 0 .5em;">
2</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em;">
3</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em;">
4</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em;">
5</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_7" style=3D"display:block;padding:0.5em 0 .5em;">
6</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em;">
7</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em;">
8</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em;">
9</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em;">
10</label>
</td>
<td class=3D"ss-scalenumbers" style=3D"text-align:center;">
</td>
</tr>
<tr role=3D"radiogroup" aria-label=3D"Escala Dolor EVA M=C3=A1ximo  Selecciona un valor en el intervalo de 0 a 10 ." style=3D"">
<td class=3D"ss-scalerow ss-leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0;">
<div aria-hidden=3D"true" class=3D"aria-todo" style=3D"">
</div>
</td>
<td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class==3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"0" id=3D"group_1244707512_1" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"0" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"1" id=3D"group_1244707512_2" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"1" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style==3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"2" id=3D"group_1244707512_3" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"2" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"3" id=3D"group_1244707512_4" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"3" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name==3D"entry.1244707512" disabled value=3D"4" id=3D"group_1244707512_5" role==3D"radio" class=3D"ss-q-radio" aria-label=3D"4" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"5" id=3D"group_1244707512_6" role=3D"radio" class==3D"ss-q-radio" aria-label=3D"5" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"6" id=3D"group_1244707512_7" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"6" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"7" id=3D"group_1244707512_8" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"7" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1244707512" disabled checked value=3D"8" id=3D"group_1244707512_9" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"8" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"9" id=3D"group_1244707512_10" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"9" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"10" id=3D"group_1244707512_11" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"10" style=3D"">
</div>
</td>
<td class=3D"ss-scalerow ss-rightlabel" aria-hidden=3D"true" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0;">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"ss-form-question errorbox-good" role=3D"listitem" style==3D"">
<div dir=3D"auto" class=3D"ss-item  ss-scale" style=3D"margin:12px 0;overflow-x:auto;">
<div class=3D"ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ss-q-item-label" for=3D"entry_2000523015" style=3D"">
<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Escala Dolor EVA M=C3=ADnimo</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"entry_853118630" style=3D"">
<tbody>
<tr aria-hidden=3D"true" style=3D"">
<td class=3D"ss-scalenumbers" style=3D"text-align:center;">
</td>
<td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_1" style=3D"display:block;padding:0.5em 0 .5em;">
0</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_2" style=3D"display:block;padding:0.5em 0 .5em;">
1</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_3" style=3D"display:block;padding:0.5em 0 .5em;">
2</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_4" style=3D"display:block;padding:0.5em 0 .5em;">
3</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_5" style=3D"display:block;padding:0.5em 0 .5em;">
4</label>
</td>
 <td class==3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_6" style=3D"display:block;padding:0.5em 0 .5em;">
5</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_7" style=3D"display:block;padding:0.5em 0 .5em;">
6</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_8" style=3D"display:block;padding:0.5em 0 .5em;">
7</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_9" style=3D"display:block;padding:0.5em 0 .5em;">
8</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_10" style=3D"display:block;padding:0.5em 0 .5em;">
9</label>
</td>
 <td class=3D"ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ss-scalenumber" for=3D"group_853118630_11" style=3D"display:block;padding:0.5em 0 .5em;">
10</label>
</td>
<td class=3D"ss-scalenumbers" style=3D"text-align:center;">
</td>
</tr>
<tr role=3D"radiogroup" aria-label=3D"Escala Dolor EVA M=C3=ADnimo  Selecciona un valor en el intervalo de 0 a 10 ." style=3D"">
<td class=3D"ss-scalerow ss-leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0;">
<div aria-hidden=3D"true" class=3D"aria-todo" style=3D"">
</div>
</td>
<td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class==3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"0" id=3D"group_853118630_1" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"0" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"1" id=3D"group_853118630_2" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"1" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"2" id=3D"group_853118630_3" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"2" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"3" id=3D"group_853118630_4" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"3" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class==3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.853118630" disabled checked value=3D"4" id=3D"group_853118630_5" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"4" style=3D"">
</div>
</td>
 <td class==3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"5" id=3D"group_853118630_6" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"5" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"6" id=3D"group_853118630_7" role=3D"radio" class=3D"ss-q-radio" aria-label==3D"6" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"7" id=3D"group_853118630_8" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"7" style=3D"">
</div>
</td>
 <td class=3D"ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ss-scalerow-fieldcell" style=3D"">
<input type=3D"radio" name==3D"entry.853118630" disabled value=3D"8" id=3D"group_853118630_9" role=3D"radio" class=3D"ss-q-radio" aria-label=3D"8" style=3D"">
</div>
</td>
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<div class=3D"ss-scalerow-fieldcell" style=3D"">
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Se realiza atenci=C3=B3n en conjunto con medico tratante en presencia de cuidador a paciente con antecedentes de Ca Ves=C3=ADcula Biliar en etapa IV.Paciente se encuentra en cama durante evaluaci=C3=B3n cooperadora con buen estado de =C3=A1nimo.Hijo refiere ingreso a unidad oncolog=C3=ADa de hospital base Osorno en el cual se indican modificaciones a tratamiento farmacol=C3=B3gico as=C3=AD como evaluaci=C3=B3n por psic=C3=B3logo en domicilio por desconocimiento de situaci=C3=B3n de salud actual, situaci=C3=B3n para la cual refiere no estar lista la familia por miedo a que su madre decaiga an=C3=ADmicamente. </div>
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CONTROL DE SIGNOS VITALES: hipertensa sintom=C3=A1tica (cefalea); euc=C3=A1rdica; eupneica; afebril. P/A: 172/60 mmHg; FC: 72 lpm; FR: 18 rpm; T=C2=BAax: 36,3=C2=BAc. EVALUACI=C3=93N DOLOR: Dolor moderador-severo. EVA actual: 4 puntos; EVA minimo: 4 puntos; EVA max: 8 puntos. EVALUACI=C3=93N NUTRICIONAL: eutr=C3=B3fica. EXAMEN F=C3=8DSICO GENERAL: Paciente consciente OTE, cooperadora y conversadora, en buenas condiciones generales. R=C3=A9gimen blando liviano fraccionado sin nauseas ni v=C3=B3mitos, buen apetito. Movilizaci=C3=B3n dentro del hogar sin ayuda, sin ca=C3=ADdas. Sue=C3=B1o interrumpido por molestias abdominales. Refiere encontrarse en mejores  condiciones en relaci=C3=B3n a vista anterior. EXAMEN FISICO SEGMENTARIO: CABEZA: escleras con mayor tinte ict=C3=A9rico, conjuntivas p=C3=A1lidas, sequedad en mucosa oral, sin lesiones ni disfagia. TORAX: refiere disnea, MP (+) sin ruidos adventicios. signo pliegue (clavicular) 2 segundos.  ABDOMEN: distendido, sensible a la palpaci=C3=B3n de regi=C3=B3n epig=C3=A1strica, con dolor irradiado a hemiabdomen derecho y regi=C3=B3n lumbar D=C2=AA de car=C3=A1cter punzante, continuo, EVA 8 a la palpaci=C3=B3n, que alivia con posici=C3=B3n anti=C3=A1lgica (lateral izquierdo), con n=C3=A1useas y v=C3=B3mitos ocasionales; hepatomegalia 4 dedos bajo reborde costal; RHA aumentados, Masas palpables en hemiabdomen superior. Piel caliente al tacto. Ascitis. EESS: sim=C3=A9tricas, movimientos en rango normal, llene apilar 2 segundos. Piel caliente al tacto, sequedad sin descamaci=C3=B3n, edema (-). EEII: asim=C3=A9tricas, movimientos limitados, piel con descamaci=C3==B3n, caliente al tacto, edema (+++/++++) bilaterial con f=C3=B3vea en cara dorsal de miembro derecho, distensi=C3=B3n venosa. GENITALES: no evaluado. ZONA SACRA: piel indemne. DIURERSIS: positiva en ba=C3=B1o, no medidas, polaquiuria, sin episodios de incontinencia, coluria. DEPOSICIONES: refiere presencia de sangre fresca desde hace 3 d=C3=ADas con deposiciones formadas en ba=C3=B1o, sin acolia, frecuencia de 3-4 veces al d=C3=ADa, con esfuerzo. Control de esf=C3=ADnter (+). se observa presencia de hemorroides externas, sin dolor.TRATAMIENTO FARMACOL=C3=93GICO ACTUAL: Paracetamol 1gr/d=C3=ADa o cada 12 horas seg=C3=BAn dolor; Metoclopramida (10mg) 1 comprimido 30 minutos antes de las comidas; Suspender Quetiapina (25 mg);  Zopiclona (7,5 mg) 1 comprimido VO noche; Losartan (50 mg) 1 comp. AM - 1 comp. PM; Tramadol 5 gotas C/8 horas, SOS; Furosemida (40mg) 1/2 comprimido cada 12 horas; Proctogel (uso T=C3=B3pico) 3 veces al d=C3=ADa por 7 d=C3=ADas =20ESCALAS APLICADAS: Dowton: 6puntos (alto riesgo de ca=C3=ADda); Escala de Braden: 22 puntos (Sin riesgo UPP); ECOG: 2; Yesavage: 7 puntos (Depresi=C3==B3n Leve); Escala autoadministrada de Insomnio: 19 puntos (Insomnio Leve) Escala ESAS: dolor 4 pts. (moderado); cansancio 5 pts. (moderado); n=C3=A1useas 4 pts (moderado); depresi=C3=B3n 0 pts. (nada-nulo); ansiedad 6 pts. (moderado); somnolencia 5 pts. (moderado); apetito: 0 pts. (buen apetito); Bienestar: 5 pts. (moderado); Falta de aire: 4 pts (moderado); Dificultad para respirar: 7 pts (severo)=20NECESIDADES VH ALTERADAS PRIORIZADAS: Seguridad, comer y beber, eliminaci==C3=B3n ; Sue=C3=B1o y reposo, comunicaci=C3=B3n.</div>
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1.-Dolor cr=C3=B3nico r/c proceso oncol=C3=B3gico m/p EVA moderado, sensibilidad a la palpaci=C3=B3n de hemiabdomen derecho irradiado a regi=C3=B3n lumbar derecha. 2. Exceso de volumen de l=C3=ADquidos r/c compromiso de mecanismos reguladores m/p edema bilateral de extremidades inferiores y ascitis. 3. Riesgo de estre=C3=B1imiento r/c presencia de hemorroides externas. 4.- Patr=C3=B3n del sue=C3=B1o alterado r/c interrupci=C3=B3n del sue=C3=B1o m/p insomnio moderado, nicturia, EVA moderado. 5.- Riesgo de ca=C3=ADdas r/c dowton 6 puntos, nicturia. molestias abdominales al realizar cambios de posici=C3=B3n. 6.- Afrontamiento defensivo r/c miedo a las repercusiones en salud materna m/p verbalizaci=C3=B3n de temor por asimilaci=C3=B3n de diagnostico de salud tras ocultarlo por tiempo prolongado, depresi=C3=B3n leve.</div>
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1.- Refuerzo indicaciones m=C3=A9dicas, y tratamiento farmacol=C3=B3gico (dosis y horarios indicados), enfatizando en la importancia para la prevenci=C3=B3n de sintomatolog=C3=ADa asociada como el no suspender tratamiento sin previa indicaci=C3=B3n m=C3=A9dica. 2- R=C3=A9gimen blando liviano en horarios y porciones fraccionados; se refuerzan indicaciones nutricionales. 3.-Evaluar progresi=C3=B3n de hemorroides externas, aumento/disminuci=C3=B3n de sangrado y Prevenci=C3=B3n estre=C3=B1imiento: Ingesta de l=C3=ADquidos (1,5 lts/d=C3=ADa), ofrecer peque=C3=B1os sorbos, aumento consumo frutas en la ma=C3=B1ana y en la noche, antes de dormir. 4.Auto monitoreo de s=C3=ADntomas: nauseas, v=C3=B3mitos, constipaci=C3=B3n, ansiedad, disnea y acompa=C3=B1ar de medidas no farmacol=C3=B3gicas. 5.- Manejo del dolor: medidas no farmacol=C3=B3gicas y administraci=C3=B3n de analgesia SOS evaluando eficacia. Aplicaci=C3=B3n de calor observando signos de irritaci=C3=B3n cut=C3=A1nea. 6.- Observar signos de incontinencia-urgencia urinaria o infecci=C3=B3n urinaria. 7.- Refuerzo higiene del sue=C3=B1o; disminuci=C3=B3n de factores estresantes y n=C3=BAmero de siestas durante el d=C3==ADa. 8.- Cuidados de la piel y lubricaci=C3=B3n al menos 3 veces al d=C3==ADa de extremidades superiores e inferiores con o sin ayuda. Mantener EEII en alto para disminuir edema as=C3=AD como evaluaci=C3=B3n de disminuci=C3=B3n/aumento de este; Observar sitios de compresi=C3=B3n =C3=B3sea y eritema.  9.-Refuerzo Prevenci=C3=B3n de ca=C3=ADdas en el hogar. 10.- Deambulaci=C3=B3n frecuente seg=C3=BAn tolerancia. 11.- Prevenci=C3=B3n de enfermedades respiratorias. 12.- Incentivo actividades recreativas a tolerancia. 13.- Refuerzo medidas preventivas de sobrecarga en cuidador. 14.- Solicito se converse como familia la incorporaci=C3=B3n de Psic=C3=B3logo al equipo de salud. 15.- Atenci=C3=B3n por Medico-Enfermera SOS durante la semana. 16.- Informar a la brevedad indicaciones realizadas por psic=C3=B3logo (visita 02.08.2019). 17.- Pr=C3=B3ximo control oncologia HBSJO: 29.08.1918.- Solicitar evaluaci=C3=B3n por internista (evaluaci=C3=B3n de soplo card=C3=ADaco y solicitud ex=C3=A1menes).</div>
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1930</option>
 <option value=3D"1931" style=3D"">
1931</option>
 <option value=3D"1932" style=3D"">
1932</option>
 <option value=3D"1933" style=3D"">
1933</option>
 <option value=3D"1934" style=3D"">
1934</option>
 <option value=3D"1935" style=3D"">
1935</option>
 <option value=3D"1936" style=3D"">
1936</option>
 <option value=3D"1937" style=3D"">
1937</option>
 <option value=3D"1938" style=3D"">
1938</option>
 <option value=3D"1939" style=3D"">
1939</option>
 <option value=3D"1940" style=3D"">
1940</option>
 <option value=3D"1941" style=3D"">
1941</option>
 <option value=3D"1942" style=3D"">
1942</option>
 <option value=3D"1943" style=3D"">
1943</option>
 <option value=3D"1944" style=3D"">
1944</option>
 <option value=3D"1945" style=3D"">
1945</option>
 <option value=3D"1946" style=3D"">
1946</option>
 <option value=3D"1947" style=3D"">
1947</option>
 <option value=3D"1948" style=3D"">
1948</option>
 <option value=3D"1949" style=3D"">
1949</option>
 <option value=3D"1950" style=3D"">
1950</option>
 <option value=3D"1951" style=3D"">
1951</option>
 <option value=3D"1952" style=3D"">
1952</option>
 <option value=3D"1953" style=3D"">
1953</option>
 <option value=3D"1954" style=3D"">
1954</option>
 <option value=3D"1955" style=3D"">
1955</option>
 <option value=3D"1956" style=3D"">
1956</option>
 <option value=3D"1957" style=3D"">
1957</option>
 <option value=3D"1958" style=3D"">
1958</option>
 <option value=3D"1959" style=3D"">
1959</option>
 <option value=3D"1960" style=3D"">
1960</option>
 <option value=3D"1961" style=3D"">
1961</option>
 <option value=3D"1962" style=3D"">
1962</option>
 <option value=3D"1963" style=3D"">
1963</option>
 <option value=3D"1964" style=3D"">
1964</option>
 <option value=3D"1965" style=3D"">
1965</option>
 <option value=3D"1966" style=3D"">
1966</option>
 <option value=3D"1967" style=3D"">
1967</option>
 <option value=3D"1968" style=3D"">
1968</option>
 <option value=3D"1969" style=3D"">
1969</option>
 <option value=3D"1970" style=3D"">
1970</option>
 <option value=3D"1971" style=3D"">
1971</option>
 <option value=3D"1972" style=3D"">
1972</option>
 <option value=3D"1973" style=3D"">
1973</option>
 <option value=3D"1974" style=3D"">
1974</option>
 <option value=3D"1975" style=3D"">
1975</option>
 <option value=3D"1976" style=3D"">
1976</option>
 <option value=3D"1977" style=3D"">
1977</option>
 <option value=3D"1978" style=3D"">
1978</option>
 <option value=3D"1979" style=3D"">
1979</option>
 <option value=3D"1980" style=3D"">
1980</option>
 <option value=3D"1981" style=3D"">
1981</option>
 <option value=3D"1982" style=3D"">
1982</option>
 <option value=3D"1983" style=3D"">
1983</option>
 <option value=3D"1984" style=3D"">
1984</option>
 <option value=3D"1985" style=3D"">
1985</option>
 <option value=3D"1986" style=3D"">
1986</option>
 <option value=3D"1987" style=3D"">
1987</option>
 <option value=3D"1988" style=3D"">
1988</option>
 <option value=3D"1989" style=3D"">
1989</option>
 <option value=3D"1990" style=3D"">
1990</option>
 <option value=3D"1991" style=3D"">
1991</option>
 <option value=3D"1992" style=3D"">
1992</option>
 <option value=3D"1993" style=3D"">
1993</option>
 <option value=3D"1994" style=3D"">
1994</option>
 <option value=3D"1995" style=3D"">
1995</option>
 <option value=3D"1996" style=3D"">
1996</option>
 <option value=3D"1997" style=3D"">
1997</option>
 <option value=3D"1998" style=3D"">
1998</option>
 <option value=3D"1999" style=3D"">
1999</option>
 <option value=3D"2000" style=3D"">
2000</option>
 <option value=3D"2001" style=3D"">
2001</option>
 <option value=3D"2002" style=3D"">
2002</option>
 <option value=3D"2003" style=3D"">
2003</option>
 <option value=3D"2004" style=3D"">
2004</option>
 <option value=3D"2005" style=3D"">
2005</option>
 <option value=3D"2006" style=3D"">
2006</option>
 <option value=3D"2007" style=3D"">
2007</option>
 <option value=3D"2008" style=3D"">
2008</option>
 <option value=3D"2009" style=3D"">
2009</option>
 <option value=3D"2010" style=3D"">
2010</option>
 <option value=3D"2011" style=3D"">
2011</option>
 <option value=3D"2012" style=3D"">
2012</option>
 <option value=3D"2013" style=3D"">
2013</option>
 <option value=3D"2014" style=3D"">
2014</option>
 <option value=3D"2015" style=3D"">
2015</option>
 <option value=3D"2016" style=3D"">
2016</option>
 <option value=3D"2017" style=3D"">
2017</option>
 <option value=3D"2018" style=3D"">
2018</option>
 <option value=3D"2019" selected style=3D"">
2019</option>
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2020</option>
 <option value=3D"2021" style=3D"">
2021</option>
 <option value=3D"2022" style=3D"">
2022</option>
 <option value=3D"2023" style=3D"">
2023</option>
 <option value=3D"2024" style=3D"">
2024</option>
 <option value=3D"2025" style=3D"">
2025</option>
 <option value=3D"2026" style=3D"">
2026</option>
 <option value=3D"2027" style=3D"">
2027</option>
 <option value=3D"2028" style=3D"">
2028</option>
 <option value=3D"2029" style=3D"">
2029</option>
 <option value=3D"2030" style=3D"">
2030</option>
 <option value=3D"2031" style=3D"">
2031</option>
 <option value=3D"2032" style=3D"">
2032</option>
 <option value=3D"2033" style=3D"">
2033</option>
 <option value=3D"2034" style=3D"">
2034</option>
 <option value=3D"2035" style=3D"">
2035</option>
 <option value=3D"2036" style=3D"">
2036</option>
 <option value=3D"2037" style=3D"">
2037</option>
 <option value=3D"2038" style=3D"">
2038</option>
 <option value=3D"2039" style=3D"">
2039</option>
 <option value=3D"2040" style=3D"">
2040</option>
 <option value=3D"2041" style=3D"">
2041</option>
 <option value=3D"2042" style=3D"">
2042</option>
 <option value=3D"2043" style=3D"">
2043</option>
 <option value=3D"2044" style=3D"">
2044</option>
 <option value=3D"2045" style=3D"">
2045</option>
 <option value=3D"2046" style=3D"">
2046</option>
 <option value=3D"2047" style=3D"">
2047</option>
 <option value=3D"2048" style=3D"">
2048</option>
 <option value=3D"2049" style=3D"">
2049</option>
 <option value=3D"2050" style=3D"">
2050</option>
 <option value=3D"2051" style=3D"">
2051</option>
 <option value=3D"2052" style=3D"">
2052</option>
 <option value=3D"2053" style=3D"">
2053</option>
 <option value=3D"2054" style=3D"">
2054</option>
 <option value=3D"2055" style=3D"">
2055</option>
 <option value=3D"2056" style=3D"">
2056</option>
 <option value=3D"2057" style=3D"">
2057</option>
 <option value=3D"2058" style=3D"">
2058</option>
 <option value=3D"2059" style=3D"">
2059</option>
 <option value=3D"2060" style=3D"">
2060</option>
 <option value=3D"2061" style=3D"">
2061</option>
 <option value=3D"2062" style=3D"">
2062</option>
 <option value=3D"2063" style=3D"">
2063</option>
 <option value=3D"2064" style=3D"">
2064</option>
 <option value=3D"2065" style=3D"">
2065</option>
 <option value=3D"2066" style=3D"">
2066</option>
 <option value=3D"2067" style=3D"">
2067</option>
 <option value=3D"2068" style=3D"">
2068</option>
 <option value=3D"2069" style=3D"">
2069</option>
</select>
</div>
</div>
</div>
</div>
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<br>
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Tratamiento Realizado (si corresponde)</div>
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<div class=3D"ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"ss-q-help ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
S=C3=B3lo llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del equipo</div>
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<ul class=3D"ss-choices" role=3D"group" aria-label=3D"Derivaci=C3=B3n a otro Prestador Domiciliario S=C3=B3lo llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del equipo " style=3D"list-style:none;padding:0;margin:.5em 0 0;">
<li class=3D"ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em;">
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ENFERMERA</span>
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TENS</span>
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NUTRICIONISTA</span>
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 <li class=3D"ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em;">
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KINESIOLOGO</span>
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PSICOLOGO</span>
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