<div dir=3D"auto">
</div>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
---------- Forwarded message ---------<br>
De: <strong class=3D"gmail_sendername" dir=3D"auto">
Formularios de Google</strong>
 <span dir=3D"auto">
&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;</span>
<br>
Date: mar., 6 ago. 2019 23:05<br>
Subject: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href=3D"mailto:eveortegaa@gmail.com">
eveortegaa@gmail.com</a>
&gt;<br>
</div>
<br>
<br>
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;margin:0;padding:0;height:100%;width:100%">
<table border=3D"0" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(38,4,154)" width=3D"100%">
<tbody>
<tr height=3D"64px">
<td style=3D"padding-left:24px">
<img alt=3D"Formularios de Google" height=3D"26px" style=3D"display:inline-block;margin:0;vertical-align:middle" width=3D"143px" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div style=3D"padding:24px;background-color:rgb(229,218,254)">
<div align=3D"center" style=3D"background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por llenar <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank" rel=3D"noreferrer">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr height=3D"12px">
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242">
Estas son tus respuestas:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"m_-7045369394462466167ss-form-container">
<div class=3D"m_-7045369394462466167ss-form-heading">
<h1 class=3D"m_-7045369394462466167ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci==C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_-7045369394462466167ss-form-desc m_-7045369394462466167ss-no-ignore-whitespace" style=3D"font:inherit;width:99%;margin:0 0 1em;white-space:pre-wrap;word-wrap:break-word">
Este es el sistema de registro de atenciones domiciliarias de Oncovida.   Debe ser llenado por el prestador individual, y debe realizarse un registro por cada visita domiciliaria.   Si usted no es prestador de Oncovida por favor no llene este formulario.   A continuaci=C3=B3n indique su correo electr=C3=B3nico.</div>
</div>
<div class=3D"m_-7045369394462466167ss-form">
<form method=3D"GET" id=3D"m_-7045369394462466167ss-form" target=3D"_blank">
<br>
<div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-text" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167emailAddress">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Direcci=C3=B3n de correo electr=C3=B3nico<label for=3D"m_-7045369394462466167emailAddress">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_-7045369394462466167ss-q-text m_-7045369394462466167ss-printable-text-line" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
<a href=3D"mailto:eveortegaa@gmail.com" target=3D"_blank" rel=3D"noreferrer">
eveortegaa@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-7045369394462466167ss-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 t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-7045369394462466167ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_-7045369394462466167ss-page-description m_-7045369394462466167ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
Aqu=C3=AD debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-text" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_579114469">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-7045369394462466167ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Evelyn Ortega</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-text" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_1276273985">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"m_-7045369394462466167ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
16273226-9</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-select" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_133691676">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
Si asisten m=C3=A1s de 1 prestador simult=C3=A1neamente, cada uno debe hacer un registro independiente</div>
</label>
<select name=3D"entry.133691676" disabled id=3D"m_-7045369394462466167entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled>
MEDICO</option>
 <option value=3D"ENFERMERA/O" disabled selected>
ENFERMERA/O</option>
 <option value=3D"TENS" disabled>
TENS</option>
 <option value=3D"KINESIOLOGA/O" disabled>
KINESIOLOGA/O</option>
 <option value=3D"PSICOLOGO" disabled>
PSICOLOGO</option>
 <option value==3D"NUTRICIONISTA" disabled>
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-7045369394462466167ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/mRJInQVKRU12r9blREv2jmlzETLT9JfIHWC0FaeXYfPraPFE9ebBRX8P_hmpfiBP6BNpOgjPBYU0zwBxYxgoLvjQ7EjfjoRTJ2_-8flTaiU_wC008XC8LpcEJ_Yp" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-7045369394462466167ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_-7045369394462466167ss-page-description m_-7045369394462466167ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
En esta secci=C3=B3n debe ingresar los datos del paciente visitado</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-7045369394462466167ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_-7045369394462466167ss-section-description m_-7045369394462466167ss-no-ignore-whitespace" style=3D"margin-top:0.5em;white-space:pre-wrap;word-wrap:break-word">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-text" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_823811303">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"m_-7045369394462466167ss-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%">
7558632-9</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-text" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_1959365839">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-7045369394462466167ss-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%">
Isabel General</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-select" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_545002227">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<select name=3D"entry.545002227" disabled id=3D"m_-7045369394462466167entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled>
COLMENA</option>
 <option value=3D"CONSALUD" disabled selected>
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled>
CRUZ BLANCA</option>
 <option value=3D"DIPRECA" disabled>
DIPRECA</option>
 <option value=3D"FONASA" disabled>
FONASA</option>
 <option value=3D"FUNDACION" disabled>
FUNDACION</option>
 <option value=3D"ISAPRES DEL COBRE" disabled>
ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled>
NUEVA MASVIDA</option>
 <option value=3D"VIDATRES" disabled>
VIDATRES</option>
 <option value=3D"PARTICULAR" disabled>
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-text" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_1900161356">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-7045369394462466167ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Talca</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-text" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_1298871758">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-7045369394462466167ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Talca</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-7045369394462466167ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/URytM0QWRGW_JEL0xQxvOLvwPRJIHyqlnKOm6ky9DRBfzvYVPaAngXV35GNHnaVG-dm9Orno4lr8sy8E-KB9tMrmIhFbVQiOPWy3vUclqRKAJ51dvLdhjBKgXdLO" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-7045369394462466167ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_-7045369394462466167ss-page-description m_-7045369394462466167ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
En esta secci=C3=B3n debe ingresar los datos de la atenci=C3=B3n domiciliaria</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-radio" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_2073233714">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_-7045369394462466167ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-7045369394462466167ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-7045369394462466167ss-choice-item-control m_-7045369394462466167goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_-7045369394462466167group_1222378237_1" class=3D"m_-7045369394462466167ss-q-radio">
</span>
<span class=3D"m_-7045369394462466167ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_-7045369394462466167ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-7045369394462466167ss-choice-item-control m_-7045369394462466167goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_-7045369394462466167group_1222378237_2" class=3D"m_-7045369394462466167ss-q-radio">
</span>
<span class=3D"m_-7045369394462466167ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-date" style=3D"margin:12px 0">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_1705849412">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha de la Atenci=C3=B3n<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-7045369394462466167ss-q-date">
<div class=3D"m_-7045369394462466167ss-datetime-box m_-7045369394462466167goog-inline-block" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
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Mes</option>
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enero</option>
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febrero</option>
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marzo</option>
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abril</option>
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mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
</select>
   <select name=3D"entry.1705849412_day" disabled class=3D"m_-7045369394462466167ss-day-dropdown" id=3D"m_-7045369394462466167entry.1705849412_day">
<option value=3D"">
D=C3=ADa</option>
<option value=3D"1">
1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
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=20<select name=3D"entry.1705849412_year" disabled id=3D"m_-7045369394462466167entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
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1897</option>
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1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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1925</option>
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1926</option>
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1927</option>
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1928</option>
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1929</option>
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1930</option>
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1931</option>
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1932</option>
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1933</option>
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1934</option>
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1935</option>
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1936</option>
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1937</option>
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1938</option>
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1939</option>
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1940</option>
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1941</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
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1946</option>
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1947</option>
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1948</option>
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1949</option>
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1950</option>
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1951</option>
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1952</option>
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1953</option>
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1954</option>
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1955</option>
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1956</option>
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1957</option>
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1958</option>
 <option value=3D"1959">
1959</option>
 <option value==3D"1960">
1960</option>
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1961</option>
 <option value==3D"1962">
1962</option>
 <option value=3D"1963">
1963</option>
 <option value==3D"1964">
1964</option>
 <option value=3D"1965">
1965</option>
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1966</option>
 <option value=3D"1967">
1967</option>
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1968</option>
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1969</option>
 <option value==3D"1970">
1970</option>
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1971</option>
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1972</option>
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1973</option>
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1974</option>
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1975</option>
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1976</option>
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1977</option>
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1978</option>
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1979</option>
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1980</option>
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1981</option>
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1982</option>
 <option value=3D"1983">
1983</option>
 <option value==3D"1984">
1984</option>
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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>
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1992</option>
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1993</option>
 <option value==3D"1994">
1994</option>
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1995</option>
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1996</option>
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1997</option>
 <option value==3D"1998">
1998</option>
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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>
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2005</option>
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2006</option>
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2007</option>
 <option value==3D"2008">
2008</option>
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2009</option>
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2010</option>
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2011</option>
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2012</option>
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2013</option>
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2014</option>
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2015</option>
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2016</option>
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2017</option>
 <option value==3D"2018">
2018</option>
 <option value=3D"2019" selected>
2019</option>
 <option value=3D"2020">
2020</option>
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2021</option>
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2022</option>
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2023</option>
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2024</option>
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2025</option>
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2026</option>
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2027</option>
 <option value=3D"2028">
2028</option>
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2029</option>
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2030</option>
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2031</option>
 <option value=3D"2032">
2032</option>
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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>
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2063</option>
 <option value==3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option value==3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option value==3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-item-required m_-7045369394462466167ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_206244955">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Hora de la Atenci=C3=B3n<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-7045369394462466167ss-q-time">
<div class=3D"m_-7045369394462466167ss-datetime-box m_-7045369394462466167goog-inline-block" dir=3D"ltr" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
<select name=3D"entry.206244955_hour" disabled id=3D"m_-7045369394462466167entry.206244955_hour">
<option value=3D"">
h</option>
<option value=3D"00">
00</option>
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01</option>
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02</option>
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03</option>
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04</option>
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05</option>
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06</option>
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07</option>
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08</option>
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09</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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.<select name=3D"entry.206244955_minute" disabled id=3D"m_-7045369394462466167entry.206244955_minute">
<option value=3D"">
min</option>
<option value=3D"00">
00</option>
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01</option>
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02</option>
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03</option>
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04</option>
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09</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
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32</option>
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33</option>
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34</option>
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35</option>
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36</option>
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38</option>
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39</option>
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40</option>
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42</option>
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43</option>
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44</option>
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45</option>
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46</option>
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47</option>
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48</option>
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49</option>
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50</option>
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51</option>
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52</option>
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53</option>
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54</option>
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55</option>
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56</option>
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57</option>
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58</option>
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59</option>
</select>
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</div>
</div>
</div>
</div>
</div>
</div>
<br>
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<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
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<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
</label>
<select name=3D"entry.1747608258" disabled id=3D"m_-7045369394462466167entry_1747608258">
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</option>
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0</option>
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1</option>
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2</option>
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3</option>
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4</option>
</select>
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</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_1716090865">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"m_-7045369394462466167entry_1421689035">
<tr>
<td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
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<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
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<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
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<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
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<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
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<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
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<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
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<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
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<div class=3D"m_-7045369394462466167ss-scalerow-fieldcell">
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</div>
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</td>
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</div>
</div>
</div>
<br>
 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
<div dir=3D"auto" class=3D"m_-7045369394462466167ss-item m_-7045369394462466167ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_2064050596">
<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA M=C3=A1ximo</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"m_-7045369394462466167entry_1244707512">
<tr>
<td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-7045369394462466167ss-scalenumber" for=3D"m_-7045369394462466167group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-7045369394462466167ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_-7045369394462466167ss-scalerow m_-7045369394462466167ss-leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class==3D"m_-7045369394462466167aria-todo">
</div>
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<td class=3D"m_-7045369394462466167ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
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</div>
</td>
 <td class=3D"m_-7045369394462466167ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-7045369394462466167ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled checked value=3D"1" id=3D"m_-7045369394462466167group_1244707512_2" class=3D"m_-7045369394462466167ss-q-radio">
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Escala Dolor EVA M=C3=ADnimo</div>
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0</label>
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1</label>
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3</label>
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6</label>
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8</label>
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9</label>
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10</label>
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Paciente en buenas condiciones generales, de buen animo, refiriendo  haber presentado dolor EVA1/10 durante la semana no presenta dolor al momento de la visita, orientada en tiempo y espacio, deambula lento, refiriendo que esta semana ha caminado mas, no necesitando ayuda de su hija para movilizarse.Apetito: BuenoNauseas: (+) un episodioVomitos: (+) un episodioSue=C3=B1o: Duerme sin dificultadPicazon: (+) refiere picazon en las manosDiuresis: (+)Deposiciones: (+) diariasSangrado rectal: (-)Colicos/dolor abdominal: (-)Debilidad/cansancio: (-)Estre=C3=B1imiento: (-)Meteorismo: (+)Tos: (-)Dificultad respiratoria:(-)Paciente se realizo quimioterapia el dia 26 de julio :=20- OXALIPLATINO 150.0-ACIDO FOLINICO 700.0- FLUOROURACILO 700.0- FLUOROURACILO INFUSION  CONTINUA: 4300.0 MGPaciente consulto urgencia en Clinica Lircay el dia  1 de agosto con motivo de consulta arritimia cardiaca no especificada, se realiza un electrocardiograma , ritmo sinusual, conduccion av normal extrasistoles ventriculares monomorfod con acomplamiento fijo, complejos normotopicos normales, la doc residente de UPC indica al no tener compromiso hemodinamico ni signos de alarma  debe ser evaluada por oncologo tratante para estudio de eventual efecto cardiotoxico.</div>
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</div>
</label>
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Al control de signos vitales:=20P/A:149/96FC: 72T: 36.5Sat: 99Piel: indemne, tibia al tacto, hidratadaCabeza: normocraneo, cabello cano, corto bien implantadoTorax: simetricoAbdomen: blando, depresible no doloroso a la palpacionExt superiores: moviles, refiere que tuvo un episodio de dolor de brazo izquierdo.Ext inferiores: moviles, edema (+)</div>
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</div>
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Ca colon</div>
</div>
</div>
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Plan de Tratamiento e Indicaciones<label for=3D"m_-7045369394462466167itemView.getDomIdToLabel()">
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<span class=3D"m_-7045369394462466167ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
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1.- Control en una semana2.- Refuerzo escala del dolor3.- Refuerzo farmacologico</div>
</div>
</div>
</div>
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 <div class=3D"m_-7045369394462466167ss-form-question m_-7045369394462466167errorbox-good">
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<div class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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1.- Carbamazepina2.- Lantus3.- Novorapid4.- Tramal 5 gotas  en caso de dolor5.- Omeprazol 20mg cada 12 horas via oral6.- Paracetamol 1gr cada 8 horas en caso de dolor7.- Buprenorfina 5mcg/cada 7 dias8.- Losartan 2 al dia9.- insulina tresiba 24 u10.- Neurobionta</div>
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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Mes</option>
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enero</option>
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febrero</option>
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marzo</option>
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abril</option>
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mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
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D=C3=ADa</option>
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1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
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A=C3=B1o</option>
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1896</option>
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1897</option>
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1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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1925</option>
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1926</option>
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1927</option>
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1928</option>
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1929</option>
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1930</option>
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1931</option>
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1932</option>
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1933</option>
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1934</option>
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1935</option>
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1936</option>
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1937</option>
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1938</option>
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1939</option>
 <option value==3D"1940">
1940</option>
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1941</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
 <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>
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1951</option>
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1952</option>
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1953</option>
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1954</option>
 <option value=3D"1955">
1955</option>
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1956</option>
 <option value=3D"1957">
1957</option>
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1958</option>
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1959</option>
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1960</option>
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1961</option>
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1962</option>
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1963</option>
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1964</option>
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1965</option>
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1966</option>
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1967</option>
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1968</option>
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1969</option>
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1970</option>
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1971</option>
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1972</option>
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1973</option>
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1974</option>
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1975</option>
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1976</option>
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1977</option>
 <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>
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1983</option>
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1984</option>
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1985</option>
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1986</option>
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1987</option>
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1988</option>
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1989</option>
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1990</option>
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1991</option>
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1992</option>
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1993</option>
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1994</option>
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1995</option>
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1996</option>
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1997</option>
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1998</option>
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1999</option>
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2000</option>
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2001</option>
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2002</option>
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2003</option>
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2004</option>
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2005</option>
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2006</option>
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2007</option>
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2008</option>
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2009</option>
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2010</option>
 <option value=3D"2011">
2011</option>
 <option value==3D"2012">
2012</option>
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2013</option>
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2014</option>
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2015</option>
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2016</option>
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2017</option>
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2018</option>
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2019</option>
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2020</option>
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2021</option>
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2022</option>
 <option value=3D"2023">
2023</option>
 <option value=3D"2024">
2024</option>
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2025</option>
 <option value=3D"2026">
2026</option>
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2027</option>
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2028</option>
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2029</option>
 <option value=3D"2030">
2030</option>
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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>
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2037</option>
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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>
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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>
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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>
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<br>
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Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-7045369394462466167ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
</div>
</div>
</div>
</div>
<br>
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<label class=3D"m_-7045369394462466167ss-q-item-label" for=3D"m_-7045369394462466167entry_1219705969">
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Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"m_-7045369394462466167ss-q-help m_-7045369394462466167ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
S=C3=B3lo llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del equipo</div>
</label>
<ul class=3D"m_-7045369394462466167ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
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<label>
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<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"ENFERMERA" id=3D"m_-7045369394462466167group_503039759_1" class=3D"m_-7045369394462466167ss-q-checkbox">
</span>
<span class=3D"m_-7045369394462466167ss-choice-label">
ENFERMERA</span>
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<label>
<span class=3D"m_-7045369394462466167ss-choice-item-control m_-7045369394462466167goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"m_-7045369394462466167group_503039759_2" class=3D"m_-7045369394462466167ss-q-checkbox">
</span>
<span class=3D"m_-7045369394462466167ss-choice-label">
TENS</span>
</label>
</li>
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<label>
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<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"NUTRICIONISTA" id==3D"m_-7045369394462466167group_503039759_3" class=3D"m_-7045369394462466167ss-q-checkbox">
</span>
<span class=3D"m_-7045369394462466167ss-choice-label">
NUTRICIONISTA</span>
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<label>
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<span class=3D"m_-7045369394462466167ss-choice-label">
KINESIOLOGO</span>
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<label>
<span class=3D"m_-7045369394462466167ss-choice-item-control m_-7045369394462466167goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"PSICOLOGO" id=3D"m_-7045369394462466167group_503039759_5" class=3D"m_-7045369394462466167ss-q-checkbox">
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<span class=3D"m_-7045369394462466167ss-choice-label">
PSICOLOGO</span>
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<br>
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<div class=3D"m_-7045369394462466167ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-7045369394462466167ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-7045369394462466167ss-image" title=3D"" src=3D"https://lh5.googleusercontent.com/Bpur5zPteyG-bXtM-WNRuiLwTi8myvetX7lBkdjzbnQyqUlGcuv84zmWyU3x0Ua2-_WXX9PiJ2cMBOO0zhG2nHX7tXXPHH6_X8UTG8MZzIBwxETkF0a8JyZtuxSL" 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:#424242;font-size:13px" target=3D"_blank" rel=3D"noreferrer">
Crear tu propio Formulario de Google</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
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