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Estimado adjunto correo a jefatura no veo el tema de pagos<br>
 Saludos </p>
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--<br>
 Sandra Maulen Angel<br>
 Enfermera <br>
 Coordinadora<br>
 Telemed-chile</p>
</div>
-------- Mensaje reenviado --------De: roberto troncoso <a href="mailto:ntroncoso3@gmail.com">
ntroncoso3@gmail.com</a>
Para: <a href="mailto:coordinadora@telemed-chile.cl">
coordinadora@telemed-chile.cl</a>
Fecha: martes, 19 marzo 2019, 08:58p. m. -03:00Asunto: Fwd: Registro de Atención Domiciliaria Oncovida<br>
<br>
<blockquote id="mail-app-auto-quote" cite="15530399890000001570" style="border-left:1px solid #FC2C38; margin:0px 0px 0px 10px; padding:0px 0px 0px 10px;">
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<div>
VISITA PACIENTE DE CURACAVI JOHN MC VEY.</div>
<div>
<br>
</div>
<div>
JUNTO CON SALUDAR</div>
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<br>
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envio correo con visita realizada el dia 19 de marzo del presente a paciente de curacavi. </div>
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<br>
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<div>
en anexo consulta por como es el procedemiento para el pago por las visitas realizadas es este mes para hacer boletas o en que fecha para que me puedas indicar el proceso</div>
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<br>
</div>
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quedo atento a tus comentarios </div>
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<br>
</div>
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se despide </div>
<div>
roberto <br>
<br>
</div>
<div class="gmail_quote_mailru_css_attribute_postfix">
<div class="gmail_attr_mailru_css_attribute_postfix" dir="ltr">
---------- Forwarded message ---------<br>
From: <strong class="gmail_sendername_mailru_css_attribute_postfix" dir="auto">
Formularios de Google</strong>
 <span dir="ltr">
<<a href="mailto:forms-receipts-noreply@google.com" target="_blank"  rel=" noopener noreferrer" >
forms-receipts-noreply@google.com</a>
>
</span>
<br>
Date: mar., 19 mar. 2019 a las 20:56<br>
Subject: Registro de Atención Domiciliaria Oncovida<br>
To:  <<a href="mailto:ntroncoso3@gmail.com" target="_blank"  rel=" noopener noreferrer" >
ntroncoso3@gmail.com</a>
>
<br>
</div>
<br>
<br>
<div style="font-family:Roboto,Helvetica,Arial,sans-serif;margin:0;padding:0;height:100%;width:100%">
<table width="100%" style="background-color:rgb(38,4,154)" border="0" cellspacing="0" cellpadding="0">
<tbody>
<tr height="64">
<td style="padding-left:24px">
<img width="143" height="26" style="display:inline-block;margin:0;vertical-align:middle" alt="Formularios de Google" src="https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div style="padding:24px;background-color:rgb(229,218,254)">
<div align="center" style="background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table width="100%" align="center" style="background-color:#fff" cellspacing="0" cellpadding="0">
<tbody>
<tr height="24">
<td>
</td>
</tr>
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<td>
<div style="font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por rellenar <a href="https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=mail_form_link" target="_blank" rel=" noopener noreferrer" >
Registro de Atención Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr height="12">
</tr>
<tr>
<td>
<div style="font-size:13px;line-height:18px;color:#424242">
Esto es lo que nos has enviado:</div>
</td>
</tr>
<tr>
<td>
<div class="m_-8443529824146446958ss-form-container_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-form-heading_mailru_css_attribute_postfix">
<h1 class="m_-8443529824146446958ss-form-title_mailru_css_attribute_postfix" style="margin:.67em 0" dir="ltr">
Registro de Atención Domiciliaria Oncovida</h1>
<div class="m_-8443529824146446958ss-form-desc_mailru_css_attribute_postfix m_-8443529824146446958ss-no-ignore-whitespace_mailru_css_attribute_postfix" style="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 continuación indique su correo electrónico.</div>
</div>
<div class="m_-8443529824146446958ss-form_mailru_css_attribute_postfix">
<form id="m_-8443529824146446958ss-form_mailru_css_attribute_postfix" target="_blank" action="#" method="POST" onsubmit="return false"  rel=" noopener noreferrer" >
<br>
<div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Dirección de correo electrónico<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix m_-8443529824146446958ss-printable-text-line_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
<a href="mailto:ntroncoso3@gmail.com" target="_blank" rel=" noopener noreferrer" >
ntroncoso3@gmail.com</a>
</div>
</div>
</div>
</div>
<div class="m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style="text-align:right">
<img title="" class="m_-8443529824146446958ss-image_mailru_css_attribute_postfix" style="width:78px;outline:none" alt="Imagen sin leyenda" src="https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ">
</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-page-break_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-8443529824146446958ss-page-title_mailru_css_attribute_postfix" style="padding:0.4em;background-color:#eee">
Identificación del Prestador</h2>
<div class="m_-8443529824146446958ss-page-description_mailru_css_attribute_postfix m_-8443529824146446958ss-no-ignore-whitespace_mailru_css_attribute_postfix" style="white-space:pre-wrap;word-wrap:break-word" dir="auto">
Aquí debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
roberto troncoso</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
RUT con Guión y Dígito Verificador, sin puntos ( Ej: 5632200-k)</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
18292536-5</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-select_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
Si asisten más de 1 prestador simultáneamente, cada uno debe hacer un registro independiente</div>
<select name="entry.133691676" id="m_-8443529824146446958entry_133691676_mailru_css_attribute_postfix">
<option value="">
</option>
<option value="MEDICO">
MEDICO</option>
 <option value="ENFERMERA/O" >
ENFERMERA/O</option>
 <option value="TENS">
TENS</option>
 <option value="KINESIOLOGA/O">
KINESIOLOGA/O</option>
 <option value="PSICOLOGO">
PSICOLOGO</option>
 <option value="NUTRICIONISTA">
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style="text-align:right">
<img title="" class="m_-8443529824146446958ss-image_mailru_css_attribute_postfix" style="width:78px;outline:none" alt="Imagen sin leyenda" src="https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA">
</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-page-break_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-8443529824146446958ss-page-title_mailru_css_attribute_postfix" style="padding:0.4em;background-color:#eee">
Identificación del Paciente</h2>
<div class="m_-8443529824146446958ss-page-description_mailru_css_attribute_postfix m_-8443529824146446958ss-no-ignore-whitespace_mailru_css_attribute_postfix" style="white-space:pre-wrap;word-wrap:break-word" dir="auto">
En esta sección debe ingresar los datos del paciente visitado</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-section-header_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-8443529824146446958ss-section-title_mailru_css_attribute_postfix" style="background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class="m_-8443529824146446958ss-section-description_mailru_css_attribute_postfix m_-8443529824146446958ss-no-ignore-whitespace_mailru_css_attribute_postfix" style="margin-top:0.5em;white-space:pre-wrap;word-wrap:break-word">
</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
RUT con Guión y Dígito Verificador, sin puntos ( Ej: 5632200-k)</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
7986475-7</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
JOHN MC VEY</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-select_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsión<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<select name="entry.545002227" id="m_-8443529824146446958entry_545002227_mailru_css_attribute_postfix">
<option value="">
</option>
<option value="BANMEDICA">
BANMEDICA</option>
 <option value="CAPREDENA">
CAPREDENA</option>
 <option value="COLMENA">
COLMENA</option>
 <option value="CONSALUD">
CONSALUD</option>
 <option value="CRUZ BLANCA">
CRUZ BLANCA</option>
 <option value="DIPRECA">
DIPRECA</option>
 <option value="FONASA">
FONASA</option>
 <option value="FUNDACION">
FUNDACION</option>
 <option value="ISAPRES DEL COBRE">
ISAPRES DEL COBRE</option>
 <option value="NUEVA MASVIDA" >
NUEVA MASVIDA</option>
 <option value="VIDATRES">
VIDATRES</option>
 <option value="PARTICULAR">
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
curacavi</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
curacavi</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style="text-align:right">
<img title="" class="m_-8443529824146446958ss-image_mailru_css_attribute_postfix" style="width:78px;outline:none" alt="Imagen sin leyenda" src="https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ">
</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-page-break_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-8443529824146446958ss-page-title_mailru_css_attribute_postfix" style="padding:0.4em;background-color:#eee">
Registro de la Atención Domiciliaria</h2>
<div class="m_-8443529824146446958ss-page-description_mailru_css_attribute_postfix m_-8443529824146446958ss-no-ignore-whitespace_mailru_css_attribute_postfix" style="white-space:pre-wrap;word-wrap:break-word" dir="auto">
En esta sección debe ingresar los datos de la atención domiciliaria</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-radio_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atención<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<ul class="m_-8443529824146446958ss-choices_mailru_css_attribute_postfix" style="list-style:none;padding:0;margin:.5em 0 0">
<li class="m_-8443529824146446958ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-8443529824146446958ss-choice-item-control_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input name="entry.1222378237" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1222378237_1_mailru_css_attribute_postfix" type="radio" value="Domicilio">
</span>
<span class="m_-8443529824146446958ss-choice-label_mailru_css_attribute_postfix">
Domicilio</span>
</li>
 <li class="m_-8443529824146446958ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-8443529824146446958ss-choice-item-control_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input name="entry.1222378237" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1222378237_2_mailru_css_attribute_postfix" type="radio" value="Ambulatorio">
</span>
<span class="m_-8443529824146446958ss-choice-label_mailru_css_attribute_postfix">
Ambulatorio</span>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-date_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha de la Atención<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-date_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-datetime-box_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name="entry.1705849412_day" class="m_-8443529824146446958ss-day-dropdown_mailru_css_attribute_postfix" >
<option value="">
Día</option>
<option value="1">
1</option>
 <option value="2">
2</option>
 <option value="3">
3</option>
 <option value="4">
4</option>
 <option value="5">
5</option>
 <option value="6">
6</option>
 <option value="7">
7</option>
 <option value="8">
8</option>
 <option value="9">
9</option>
 <option value="10">
10</option>
 <option value="11">
11</option>
 <option value="12">
12</option>
 <option value="13">
13</option>
 <option value="14">
14</option>
 <option value="15">
15</option>
 <option value="16">
16</option>
 <option value="17">
17</option>
 <option value="18">
18</option>
 <option value="19" >
19</option>
 <option value="20">
20</option>
 <option value="21">
21</option>
 <option value="22">
22</option>
 <option value="23">
23</option>
 <option value="24">
24</option>
 <option value="25">
25</option>
 <option value="26">
26</option>
 <option value="27">
27</option>
 <option value="28">
28</option>
 <option value="29">
29</option>
 <option value="30">
30</option>
 <option value="31">
31</option>
</select>
   <select name="entry.1705849412_month" class="m_-8443529824146446958ss-month-dropdown_mailru_css_attribute_postfix" >
<option value="">
Mes</option>
<option value="1">
enero</option>
 <option value="2">
febrero</option>
 <option value="3" >
marzo</option>
 <option value="4">
abril</option>
 <option value="5">
mayo</option>
 <option value="6">
junio</option>
 <option value="7">
julio</option>
 <option value="8">
agosto</option>
 <option value="9">
septiembre</option>
 <option value="10">
octubre</option>
 <option value="11">
noviembre</option>
 <option value="12">
diciembre</option>
</select>
 <select name="entry.1705849412_year" >
<option value="">
Año</option>
<option value="1896">
1896</option>
 <option value="1897">
1897</option>
 <option value="1898">
1898</option>
 <option value="1899">
1899</option>
 <option value="1900">
1900</option>
 <option value="1901">
1901</option>
 <option value="1902">
1902</option>
 <option value="1903">
1903</option>
 <option value="1904">
1904</option>
 <option value="1905">
1905</option>
 <option value="1906">
1906</option>
 <option value="1907">
1907</option>
 <option value="1908">
1908</option>
 <option value="1909">
1909</option>
 <option value="1910">
1910</option>
 <option value="1911">
1911</option>
 <option value="1912">
1912</option>
 <option value="1913">
1913</option>
 <option value="1914">
1914</option>
 <option value="1915">
1915</option>
 <option value="1916">
1916</option>
 <option value="1917">
1917</option>
 <option value="1918">
1918</option>
 <option value="1919">
1919</option>
 <option value="1920">
1920</option>
 <option value="1921">
1921</option>
 <option value="1922">
1922</option>
 <option value="1923">
1923</option>
 <option value="1924">
1924</option>
 <option value="1925">
1925</option>
 <option value="1926">
1926</option>
 <option value="1927">
1927</option>
 <option value="1928">
1928</option>
 <option value="1929">
1929</option>
 <option value="1930">
1930</option>
 <option value="1931">
1931</option>
 <option value="1932">
1932</option>
 <option value="1933">
1933</option>
 <option value="1934">
1934</option>
 <option value="1935">
1935</option>
 <option value="1936">
1936</option>
 <option value="1937">
1937</option>
 <option value="1938">
1938</option>
 <option value="1939">
1939</option>
 <option value="1940">
1940</option>
 <option value="1941">
1941</option>
 <option value="1942">
1942</option>
 <option value="1943">
1943</option>
 <option value="1944">
1944</option>
 <option value="1945">
1945</option>
 <option value="1946">
1946</option>
 <option value="1947">
1947</option>
 <option value="1948">
1948</option>
 <option value="1949">
1949</option>
 <option value="1950">
1950</option>
 <option value="1951">
1951</option>
 <option value="1952">
1952</option>
 <option value="1953">
1953</option>
 <option value="1954">
1954</option>
 <option value="1955">
1955</option>
 <option value="1956">
1956</option>
 <option value="1957">
1957</option>
 <option value="1958">
1958</option>
 <option value="1959">
1959</option>
 <option value="1960">
1960</option>
 <option value="1961">
1961</option>
 <option value="1962">
1962</option>
 <option value="1963">
1963</option>
 <option value="1964">
1964</option>
 <option value="1965">
1965</option>
 <option value="1966">
1966</option>
 <option value="1967">
1967</option>
 <option value="1968">
1968</option>
 <option value="1969">
1969</option>
 <option value="1970">
1970</option>
 <option value="1971">
1971</option>
 <option value="1972">
1972</option>
 <option value="1973">
1973</option>
 <option value="1974">
1974</option>
 <option value="1975">
1975</option>
 <option value="1976">
1976</option>
 <option value="1977">
1977</option>
 <option value="1978">
1978</option>
 <option value="1979">
1979</option>
 <option value="1980">
1980</option>
 <option value="1981">
1981</option>
 <option value="1982">
1982</option>
 <option value="1983">
1983</option>
 <option value="1984">
1984</option>
 <option value="1985">
1985</option>
 <option value="1986">
1986</option>
 <option value="1987">
1987</option>
 <option value="1988">
1988</option>
 <option value="1989">
1989</option>
 <option value="1990">
1990</option>
 <option value="1991">
1991</option>
 <option value="1992">
1992</option>
 <option value="1993">
1993</option>
 <option value="1994">
1994</option>
 <option value="1995">
1995</option>
 <option value="1996">
1996</option>
 <option value="1997">
1997</option>
 <option value="1998">
1998</option>
 <option value="1999">
1999</option>
 <option value="2000">
2000</option>
 <option value="2001">
2001</option>
 <option value="2002">
2002</option>
 <option value="2003">
2003</option>
 <option value="2004">
2004</option>
 <option value="2005">
2005</option>
 <option value="2006">
2006</option>
 <option value="2007">
2007</option>
 <option value="2008">
2008</option>
 <option value="2009">
2009</option>
 <option value="2010">
2010</option>
 <option value="2011">
2011</option>
 <option value="2012">
2012</option>
 <option value="2013">
2013</option>
 <option value="2014">
2014</option>
 <option value="2015">
2015</option>
 <option value="2016">
2016</option>
 <option value="2017">
2017</option>
 <option value="2018">
2018</option>
 <option value="2019" >
2019</option>
 <option value="2020">
2020</option>
 <option value="2021">
2021</option>
 <option value="2022">
2022</option>
 <option value="2023">
2023</option>
 <option value="2024">
2024</option>
 <option value="2025">
2025</option>
 <option value="2026">
2026</option>
 <option value="2027">
2027</option>
 <option value="2028">
2028</option>
 <option value="2029">
2029</option>
 <option value="2030">
2030</option>
 <option value="2031">
2031</option>
 <option value="2032">
2032</option>
 <option value="2033">
2033</option>
 <option value="2034">
2034</option>
 <option value="2035">
2035</option>
 <option value="2036">
2036</option>
 <option value="2037">
2037</option>
 <option value="2038">
2038</option>
 <option value="2039">
2039</option>
 <option value="2040">
2040</option>
 <option value="2041">
2041</option>
 <option value="2042">
2042</option>
 <option value="2043">
2043</option>
 <option value="2044">
2044</option>
 <option value="2045">
2045</option>
 <option value="2046">
2046</option>
 <option value="2047">
2047</option>
 <option value="2048">
2048</option>
 <option value="2049">
2049</option>
 <option value="2050">
2050</option>
 <option value="2051">
2051</option>
 <option value="2052">
2052</option>
 <option value="2053">
2053</option>
 <option value="2054">
2054</option>
 <option value="2055">
2055</option>
 <option value="2056">
2056</option>
 <option value="2057">
2057</option>
 <option value="2058">
2058</option>
 <option value="2059">
2059</option>
 <option value="2060">
2060</option>
 <option value="2061">
2061</option>
 <option value="2062">
2062</option>
 <option value="2063">
2063</option>
 <option value="2064">
2064</option>
 <option value="2065">
2065</option>
 <option value="2066">
2066</option>
 <option value="2067">
2067</option>
 <option value="2068">
2068</option>
 <option value="2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-time_mailru_css_attribute_postfix" style="margin:12px 0;font:inherit" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Hora de la Atención<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-time_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-datetime-box_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block" dir="ltr">
<select name="entry.206244955_hour" >
<option value="">
h</option>
<option value="00">
00</option>
 <option value="01">
01</option>
 <option value="02">
02</option>
 <option value="03">
03</option>
 <option value="04">
04</option>
 <option value="05">
05</option>
 <option value="06">
06</option>
 <option value="07">
07</option>
 <option value="08">
08</option>
 <option value="09">
09</option>
 <option value="10">
10</option>
 <option value="11">
11</option>
 <option value="12">
12</option>
 <option value="13">
13</option>
 <option value="14">
14</option>
 <option value="15">
15</option>
 <option value="16">
16</option>
 <option value="17">
17</option>
 <option value="18">
18</option>
 <option value="19" >
19</option>
 <option value="20">
20</option>
 <option value="21">
21</option>
 <option value="22">
22</option>
 <option value="23">
23</option>
</select>
:<select name="entry.206244955_minute" >
<option value="">
min</option>
<option value="00" >
00</option>
 <option value="01">
01</option>
 <option value="02">
02</option>
 <option value="03">
03</option>
 <option value="04">
04</option>
 <option value="05">
05</option>
 <option value="06">
06</option>
 <option value="07">
07</option>
 <option value="08">
08</option>
 <option value="09">
09</option>
 <option value="10">
10</option>
 <option value="11">
11</option>
 <option value="12">
12</option>
 <option value="13">
13</option>
 <option value="14">
14</option>
 <option value="15">
15</option>
 <option value="16">
16</option>
 <option value="17">
17</option>
 <option value="18">
18</option>
 <option value="19">
19</option>
 <option value="20">
20</option>
 <option value="21">
21</option>
 <option value="22">
22</option>
 <option value="23">
23</option>
 <option value="24">
24</option>
 <option value="25">
25</option>
 <option value="26">
26</option>
 <option value="27">
27</option>
 <option value="28">
28</option>
 <option value="29">
29</option>
 <option value="30">
30</option>
 <option value="31">
31</option>
 <option value="32">
32</option>
 <option value="33">
33</option>
 <option value="34">
34</option>
 <option value="35">
35</option>
 <option value="36">
36</option>
 <option value="37">
37</option>
 <option value="38">
38</option>
 <option value="39">
39</option>
 <option value="40">
40</option>
 <option value="41">
41</option>
 <option value="42">
42</option>
 <option value="43">
43</option>
 <option value="44">
44</option>
 <option value="45">
45</option>
 <option value="46">
46</option>
 <option value="47">
47</option>
 <option value="48">
48</option>
 <option value="49">
49</option>
 <option value="50">
50</option>
 <option value="51">
51</option>
 <option value="52">
52</option>
 <option value="53">
53</option>
 <option value="54">
54</option>
 <option value="55">
55</option>
 <option value="56">
56</option>
 <option value="57">
57</option>
 <option value="58">
58</option>
 <option value="59">
59</option>
</select>
<div class="m_-8443529824146446958ss-datetime-box-spacer_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="height:32px;vertical-align:middle;display:inline-block">
</div>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-select_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<select name="entry.1747608258" id="m_-8443529824146446958entry_1747608258_mailru_css_attribute_postfix">
<option value="">
</option>
<option value="0">
0</option>
 <option value="1" >
1</option>
 <option value="2">
2</option>
 <option value="3">
3</option>
 <option value="4">
4</option>
</select>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-scale_mailru_css_attribute_postfix" style="margin:12px 0;overflow-x:auto" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<table id="m_-8443529824146446958entry_1421689035_mailru_css_attribute_postfix" border="0" cellspacing="0" cellpadding="5">
<tbody>
<tr>
<td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
<td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
0</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
1</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
2</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
3</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
4</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
5</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
6</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
7</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
8</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
9</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
10</td>
<td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
</tr>
<tr>
<td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix m_-8443529824146446958ss-leftlabel_mailru_css_attribute_postfix" style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class="m_-8443529824146446958aria-todo_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_1_mailru_css_attribute_postfix" type="radio" value="0">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_2_mailru_css_attribute_postfix" type="radio" value="1">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_3_mailru_css_attribute_postfix" type="radio" value="2">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_4_mailru_css_attribute_postfix" type="radio" value="3">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_5_mailru_css_attribute_postfix" type="radio" value="4">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_6_mailru_css_attribute_postfix" type="radio" value="5">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_7_mailru_css_attribute_postfix" type="radio" value="6">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_8_mailru_css_attribute_postfix" type="radio" value="7">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_9_mailru_css_attribute_postfix" type="radio" value="8">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_10_mailru_css_attribute_postfix" type="radio" value="9">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1421689035" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1421689035_11_mailru_css_attribute_postfix" type="radio" value="10">
</div>
</td>
<td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix m_-8443529824146446958ss-rightlabel_mailru_css_attribute_postfix" style="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="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-scale_mailru_css_attribute_postfix" style="margin:12px 0;overflow-x:auto" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Máximo</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<table id="m_-8443529824146446958entry_1244707512_mailru_css_attribute_postfix" border="0" cellspacing="0" cellpadding="5">
<tbody>
<tr>
<td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
<td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
0</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
1</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
2</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
3</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
4</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
5</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
6</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
7</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
8</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
9</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
10</td>
<td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
</tr>
<tr>
<td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix m_-8443529824146446958ss-leftlabel_mailru_css_attribute_postfix" style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class="m_-8443529824146446958aria-todo_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_1_mailru_css_attribute_postfix" type="radio" value="0">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_2_mailru_css_attribute_postfix" type="radio" value="1">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_3_mailru_css_attribute_postfix" type="radio" value="2">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_4_mailru_css_attribute_postfix" type="radio" value="3">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_5_mailru_css_attribute_postfix" type="radio" value="4">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_6_mailru_css_attribute_postfix" type="radio" value="5">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_7_mailru_css_attribute_postfix" type="radio" value="6">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_8_mailru_css_attribute_postfix" type="radio" value="7">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_9_mailru_css_attribute_postfix" type="radio" value="8">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_10_mailru_css_attribute_postfix" type="radio" value="9">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.1244707512" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_1244707512_11_mailru_css_attribute_postfix" type="radio" value="10">
</div>
</td>
<td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix m_-8443529824146446958ss-rightlabel_mailru_css_attribute_postfix" style="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="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-scale_mailru_css_attribute_postfix" style="margin:12px 0;overflow-x:auto" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Mínimo</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<table id="m_-8443529824146446958entry_853118630_mailru_css_attribute_postfix" border="0" cellspacing="0" cellpadding="5">
<tbody>
<tr>
<td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
<td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
0</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
1</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
2</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
3</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
4</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
5</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
6</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
7</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
8</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
9</td>
 <td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
10</td>
<td class="m_-8443529824146446958ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
</tr>
<tr>
<td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix m_-8443529824146446958ss-leftlabel_mailru_css_attribute_postfix" style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class="m_-8443529824146446958aria-todo_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_1_mailru_css_attribute_postfix" type="radio" value="0">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_2_mailru_css_attribute_postfix" type="radio" value="1">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_3_mailru_css_attribute_postfix" type="radio" value="2">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_4_mailru_css_attribute_postfix" type="radio" value="3">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_5_mailru_css_attribute_postfix" type="radio" value="4">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_6_mailru_css_attribute_postfix" type="radio" value="5">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_7_mailru_css_attribute_postfix" type="radio" value="6">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_8_mailru_css_attribute_postfix" type="radio" value="7">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_9_mailru_css_attribute_postfix" type="radio" value="8">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_10_mailru_css_attribute_postfix" type="radio" value="9">
</div>
</td>
 <td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-8443529824146446958ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input name="entry.853118630" class="m_-8443529824146446958ss-q-radio_mailru_css_attribute_postfix" id="m_-8443529824146446958group_853118630_11_mailru_css_attribute_postfix" type="radio" value="10">
</div>
</td>
<td class="m_-8443529824146446958ss-scalerow_mailru_css_attribute_postfix m_-8443529824146446958ss-rightlabel_mailru_css_attribute_postfix" style="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="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-paragraph-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Anamnesis/Evolución<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
paciente de 49 años  sin antecedentes de enfermedades crónicas,  con diagnostico de cáncer gástrico  (marzo 2017), con FOLFOX de 6 ciclos  entre abril - marzo 2017, radioterapia y quimioterapia  entre febrero y marzo 2018. paciente evoluciona con metástasis  hepáticas, pulmonares, peritoneales. ultimo ciclo de 18/12/18 con reducción de MTT hepáticas y pulmonares.paciente en visita domiciliaria. Paciente con antecedes descritos, en Glascow 15 con pupilas isoricas , reactivas, conectado con el medio participa activamente de la visita, logra comunicar sus necesidades, hoy visita con medico tratante, el cual por indicación medico solicita control con scanner para conducta terapéutica a seguir, es por esto que se ve paciente con animo bajo post control medico, control jueves o viernes de esta semana post toma de scanner. con signo vitales:Presión arterial 98/78FC: 91sat 99% ambiental T°: 36.7EVA: 1 al momento de visitapeso: 55 con alimentación oral bien tolerado, régimen terapéutico de forma adecuada( sin efectos secundarios .eliminación: diuresis conservada, deposiciones  hace dos días. se insiste que familia refiere   que tenga visita por parte de equipo de psicología, se indica a familia que medico al realizar visita debe emitir informe para la visita de psicólogose informa además que  es la ultima visita por parte de enfermero del mes autorizada por parte de isapre por ende en próxima visita de medico se debe gestionar nuevo informe para solicitud de visita de enfermería.se indica a paciente y familia que es la ultima visita por parte de mi, que ONCOVIDA gestionara la visita por parte de otro profesional enfermero. </div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-paragraph-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Examen Físico<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
normo cráneotórax simétrico sin lesión.abdomen blando depresible indoloro, con apósito  pasado con contenido seroso ( no se realiza curaciones dado que no están dentro de la prestación según correo por parte de encargada de curaciones)moviliza 4 extremidades sin dificultad. sin lesión de piel. </div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Diagnóstico<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
Cancer  gástrico metastasico </div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-item-required_mailru_css_attribute_postfix m_-8443529824146446958ss-paragraph-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Plan de Tratamiento e Indicaciones<span class="m_-8443529824146446958ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
Reposo relativoRégimen 1500 kcal y 90 gramos de proteínaControl oncología post toma de scanner abdominalcontrol con cuidados paliativos</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-paragraph-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
Fármacos:-Metadona 7 mg  cada 8 hrs -Paracetamol 500 mg 2 comp  cada 8 hrs -Celebra 200 mg  1 comp cada 12 hrs-Omeprazol 20 mg 1 cada 24 hrs-Domperidona 10 mg 1 comp cada 8 hrs -Dulcolax   2 perlas  ( sos)-Clonazepam 2 mg  cada 24 hrs-Acido ursodeoxicolico 1 comp  cada 12 hrs </div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-date_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha aproximada del Próximo Control con usted</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-date_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-datetime-box_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name="entry.2063615873_day" class="m_-8443529824146446958ss-day-dropdown_mailru_css_attribute_postfix" >
<option value="">
Día</option>
<option value="1" >
1</option>
 <option value="2">
2</option>
 <option value="3">
3</option>
 <option value="4">
4</option>
 <option value="5">
5</option>
 <option value="6">
6</option>
 <option value="7">
7</option>
 <option value="8">
8</option>
 <option value="9">
9</option>
 <option value="10">
10</option>
 <option value="11">
11</option>
 <option value="12">
12</option>
 <option value="13">
13</option>
 <option value="14">
14</option>
 <option value="15">
15</option>
 <option value="16">
16</option>
 <option value="17">
17</option>
 <option value="18">
18</option>
 <option value="19">
19</option>
 <option value="20">
20</option>
 <option value="21">
21</option>
 <option value="22">
22</option>
 <option value="23">
23</option>
 <option value="24">
24</option>
 <option value="25">
25</option>
 <option value="26">
26</option>
 <option value="27">
27</option>
 <option value="28">
28</option>
 <option value="29">
29</option>
 <option value="30">
30</option>
 <option value="31">
31</option>
</select>
   <select name="entry.2063615873_month" class="m_-8443529824146446958ss-month-dropdown_mailru_css_attribute_postfix" >
<option value="">
Mes</option>
<option value="1">
enero</option>
 <option value="2">
febrero</option>
 <option value="3">
marzo</option>
 <option value="4" >
abril</option>
 <option value="5">
mayo</option>
 <option value="6">
junio</option>
 <option value="7">
julio</option>
 <option value="8">
agosto</option>
 <option value="9">
septiembre</option>
 <option value="10">
octubre</option>
 <option value="11">
noviembre</option>
 <option value="12">
diciembre</option>
</select>
 <select name="entry.2063615873_year" >
<option value="">
Año</option>
<option value="1896">
1896</option>
 <option value="1897">
1897</option>
 <option value="1898">
1898</option>
 <option value="1899">
1899</option>
 <option value="1900">
1900</option>
 <option value="1901">
1901</option>
 <option value="1902">
1902</option>
 <option value="1903">
1903</option>
 <option value="1904">
1904</option>
 <option value="1905">
1905</option>
 <option value="1906">
1906</option>
 <option value="1907">
1907</option>
 <option value="1908">
1908</option>
 <option value="1909">
1909</option>
 <option value="1910">
1910</option>
 <option value="1911">
1911</option>
 <option value="1912">
1912</option>
 <option value="1913">
1913</option>
 <option value="1914">
1914</option>
 <option value="1915">
1915</option>
 <option value="1916">
1916</option>
 <option value="1917">
1917</option>
 <option value="1918">
1918</option>
 <option value="1919">
1919</option>
 <option value="1920">
1920</option>
 <option value="1921">
1921</option>
 <option value="1922">
1922</option>
 <option value="1923">
1923</option>
 <option value="1924">
1924</option>
 <option value="1925">
1925</option>
 <option value="1926">
1926</option>
 <option value="1927">
1927</option>
 <option value="1928">
1928</option>
 <option value="1929">
1929</option>
 <option value="1930">
1930</option>
 <option value="1931">
1931</option>
 <option value="1932">
1932</option>
 <option value="1933">
1933</option>
 <option value="1934">
1934</option>
 <option value="1935">
1935</option>
 <option value="1936">
1936</option>
 <option value="1937">
1937</option>
 <option value="1938">
1938</option>
 <option value="1939">
1939</option>
 <option value="1940">
1940</option>
 <option value="1941">
1941</option>
 <option value="1942">
1942</option>
 <option value="1943">
1943</option>
 <option value="1944">
1944</option>
 <option value="1945">
1945</option>
 <option value="1946">
1946</option>
 <option value="1947">
1947</option>
 <option value="1948">
1948</option>
 <option value="1949">
1949</option>
 <option value="1950">
1950</option>
 <option value="1951">
1951</option>
 <option value="1952">
1952</option>
 <option value="1953">
1953</option>
 <option value="1954">
1954</option>
 <option value="1955">
1955</option>
 <option value="1956">
1956</option>
 <option value="1957">
1957</option>
 <option value="1958">
1958</option>
 <option value="1959">
1959</option>
 <option value="1960">
1960</option>
 <option value="1961">
1961</option>
 <option value="1962">
1962</option>
 <option value="1963">
1963</option>
 <option value="1964">
1964</option>
 <option value="1965">
1965</option>
 <option value="1966">
1966</option>
 <option value="1967">
1967</option>
 <option value="1968">
1968</option>
 <option value="1969">
1969</option>
 <option value="1970">
1970</option>
 <option value="1971">
1971</option>
 <option value="1972">
1972</option>
 <option value="1973">
1973</option>
 <option value="1974">
1974</option>
 <option value="1975">
1975</option>
 <option value="1976">
1976</option>
 <option value="1977">
1977</option>
 <option value="1978">
1978</option>
 <option value="1979">
1979</option>
 <option value="1980">
1980</option>
 <option value="1981">
1981</option>
 <option value="1982">
1982</option>
 <option value="1983">
1983</option>
 <option value="1984">
1984</option>
 <option value="1985">
1985</option>
 <option value="1986">
1986</option>
 <option value="1987">
1987</option>
 <option value="1988">
1988</option>
 <option value="1989">
1989</option>
 <option value="1990">
1990</option>
 <option value="1991">
1991</option>
 <option value="1992">
1992</option>
 <option value="1993">
1993</option>
 <option value="1994">
1994</option>
 <option value="1995">
1995</option>
 <option value="1996">
1996</option>
 <option value="1997">
1997</option>
 <option value="1998">
1998</option>
 <option value="1999">
1999</option>
 <option value="2000">
2000</option>
 <option value="2001">
2001</option>
 <option value="2002">
2002</option>
 <option value="2003">
2003</option>
 <option value="2004">
2004</option>
 <option value="2005">
2005</option>
 <option value="2006">
2006</option>
 <option value="2007">
2007</option>
 <option value="2008">
2008</option>
 <option value="2009">
2009</option>
 <option value="2010">
2010</option>
 <option value="2011">
2011</option>
 <option value="2012">
2012</option>
 <option value="2013">
2013</option>
 <option value="2014">
2014</option>
 <option value="2015">
2015</option>
 <option value="2016">
2016</option>
 <option value="2017">
2017</option>
 <option value="2018">
2018</option>
 <option value="2019" >
2019</option>
 <option value="2020">
2020</option>
 <option value="2021">
2021</option>
 <option value="2022">
2022</option>
 <option value="2023">
2023</option>
 <option value="2024">
2024</option>
 <option value="2025">
2025</option>
 <option value="2026">
2026</option>
 <option value="2027">
2027</option>
 <option value="2028">
2028</option>
 <option value="2029">
2029</option>
 <option value="2030">
2030</option>
 <option value="2031">
2031</option>
 <option value="2032">
2032</option>
 <option value="2033">
2033</option>
 <option value="2034">
2034</option>
 <option value="2035">
2035</option>
 <option value="2036">
2036</option>
 <option value="2037">
2037</option>
 <option value="2038">
2038</option>
 <option value="2039">
2039</option>
 <option value="2040">
2040</option>
 <option value="2041">
2041</option>
 <option value="2042">
2042</option>
 <option value="2043">
2043</option>
 <option value="2044">
2044</option>
 <option value="2045">
2045</option>
 <option value="2046">
2046</option>
 <option value="2047">
2047</option>
 <option value="2048">
2048</option>
 <option value="2049">
2049</option>
 <option value="2050">
2050</option>
 <option value="2051">
2051</option>
 <option value="2052">
2052</option>
 <option value="2053">
2053</option>
 <option value="2054">
2054</option>
 <option value="2055">
2055</option>
 <option value="2056">
2056</option>
 <option value="2057">
2057</option>
 <option value="2058">
2058</option>
 <option value="2059">
2059</option>
 <option value="2060">
2060</option>
 <option value="2061">
2061</option>
 <option value="2062">
2062</option>
 <option value="2063">
2063</option>
 <option value="2064">
2064</option>
 <option value="2065">
2065</option>
 <option value="2066">
2066</option>
 <option value="2067">
2067</option>
 <option value="2068">
2068</option>
 <option value="2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-text_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tratamiento Realizado (si corresponde)</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
</div>
<div class="m_-8443529824146446958ss-q-text_mailru_css_attribute_postfix" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%" dir="auto">
N/A</div>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958ss-form-question_mailru_css_attribute_postfix m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-checkbox_mailru_css_attribute_postfix" style="margin:12px 0" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Derivación a otro Prestador Domiciliario</div>
<div class="m_-8443529824146446958ss-q-help_mailru_css_attribute_postfix m_-8443529824146446958ss-secondary-text_mailru_css_attribute_postfix" style="display:block;margin:.1em 0 .25em 0;color:#666" dir="auto">
Sólo llene esta sección si es médico y solicita la visita de otro prestador del equipo</div>
<ul class="m_-8443529824146446958ss-choices_mailru_css_attribute_postfix" style="list-style:none;padding:0;margin:.5em 0 0">
<li class="m_-8443529824146446958ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-8443529824146446958ss-choice-item-control_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input name="entry.503039759" class="m_-8443529824146446958ss-q-checkbox_mailru_css_attribute_postfix" id="m_-8443529824146446958group_503039759_1_mailru_css_attribute_postfix" type="checkbox" value="ENFERMERA">
</span>
<span class="m_-8443529824146446958ss-choice-label_mailru_css_attribute_postfix">
ENFERMERA</span>
</li>
 <li class="m_-8443529824146446958ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-8443529824146446958ss-choice-item-control_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input name="entry.503039759" class="m_-8443529824146446958ss-q-checkbox_mailru_css_attribute_postfix" id="m_-8443529824146446958group_503039759_2_mailru_css_attribute_postfix" type="checkbox" value="TENS">
</span>
<span class="m_-8443529824146446958ss-choice-label_mailru_css_attribute_postfix">
TENS</span>
</li>
 <li class="m_-8443529824146446958ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-8443529824146446958ss-choice-item-control_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input name="entry.503039759" class="m_-8443529824146446958ss-q-checkbox_mailru_css_attribute_postfix" id="m_-8443529824146446958group_503039759_3_mailru_css_attribute_postfix" type="checkbox" value="NUTRICIONISTA">
</span>
<span class="m_-8443529824146446958ss-choice-label_mailru_css_attribute_postfix">
NUTRICIONISTA</span>
</li>
 <li class="m_-8443529824146446958ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-8443529824146446958ss-choice-item-control_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input name="entry.503039759" class="m_-8443529824146446958ss-q-checkbox_mailru_css_attribute_postfix" id="m_-8443529824146446958group_503039759_4_mailru_css_attribute_postfix" type="checkbox" value="KINESIOLOGO">
</span>
<span class="m_-8443529824146446958ss-choice-label_mailru_css_attribute_postfix">
KINESIOLOGO</span>
</li>
 <li class="m_-8443529824146446958ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-8443529824146446958ss-choice-item-control_mailru_css_attribute_postfix m_-8443529824146446958goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input name="entry.503039759" class="m_-8443529824146446958ss-q-checkbox_mailru_css_attribute_postfix" id="m_-8443529824146446958group_503039759_5_mailru_css_attribute_postfix" type="checkbox" value="PSICOLOGO">
</span>
<span class="m_-8443529824146446958ss-choice-label_mailru_css_attribute_postfix">
PSICOLOGO</span>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class="m_-8443529824146446958errorbox-good_mailru_css_attribute_postfix">
<div class="m_-8443529824146446958ss-item_mailru_css_attribute_postfix m_-8443529824146446958ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%" dir="auto">
<div class="m_-8443529824146446958ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-8443529824146446958ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style="text-align:right">
<img title="" class="m_-8443529824146446958ss-image_mailru_css_attribute_postfix" style="width:78px;outline:none" alt="Imagen sin leyenda" src="https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A">
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<a style="color:#424242;font-size:13px" href="https://docs.google.com/forms?usp=mail_form_link" target="_blank" rel=" noopener noreferrer" >
Crea tu propio formulario de Google</a>
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<div style="text-align:left">
Roberto Nicolás Troncoso Troncoso</div>
<div style="text-align:left">
Enfermero Universitario.</div>
<div style="text-align:left">
Curacaví.</div>
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