<div dir=3D"ltr">
<br>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class==3D"gmail_attr">
<br>
</div>
Atentamente,<br>
<br>
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;margin:0;padding:0;height:100%;width:100%">
<table border=3D"0" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(38,4,154)" width=3D"100%">
<tbody>
<tr height=3D"64px">
<td style=3D"padding-left:24px">
<img alt=3D"Formularios de Google" height=3D"26px" style=3D"display:inline-block;margin:0;vertical-align:middle" width=3D"143px" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div style=3D"padding:24px;background-color:rgb(229,218,254)">
<div align=3D"center" style=3D"background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por rellenar <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr height=3D"12px">
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242">
Esto es lo que nos has enviado:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-container">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-heading">
<h1 class=3D"m_-1960584645049150073m_270674263807561848ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-desc m_-1960584645049150073m_270674263807561848ss-no-ignore-whitespace" style=3D"font:inherit;width:99%;margin:0 0 1em;white-space:pre-wrap;word-wrap:break-word">
Este es el sistema de registro de atenciones domiciliarias de Oncovida.   Debe ser llenado por el prestador individual, y debe realizarse un registro por cada visita domiciliaria.   Si usted no es prestador de Oncovida por favor no llene este formulario.   A continuaci=C3=B3n indique su correo electr=C3=B3nico.</div>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form">
<form method=3D"GET" id=3D"m_-1960584645049150073m_270674263807561848ss-form" target==3D"_blank">
<br>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-text" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848emailAddress">
<div class==3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Direcci=C3=B3n de correo electr=C3=B3nico<label for=3D"m_-1960584645049150073m_270674263807561848emailAddress">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text m_-1960584645049150073m_270674263807561848ss-printable-text-line" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
<a href=3D"mailto:pcarrascogodoy@gmail.com" target=3D"_blank">
pcarrascogodoy@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-1960584645049150073m_270674263807561848ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-1960584645049150073m_270674263807561848ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-page-description m_-1960584645049150073m_270674263807561848ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
Aqu=C3=AD debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-text" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_579114469">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Paulina</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-text" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_1276273985">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
15929130-8</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-select" style=3D"margin:12px 0">
<div class==3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_133691676">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
Si asisten m=C3=A1s de 1 prestador simult=C3=A1neamente, cada uno debe hacer un registro independiente</div>
</label>
<select name=3D"entry.133691676" disabled id=3D"m_-1960584645049150073m_270674263807561848entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled selected>
MEDICO</option>
 <option value=3D"ENFERMERA/O" disabled>
ENFERMERA/O</option>
 <option value=3D"TENS" disabled>
TENS</option>
 <option value=3D"KINESIOLOGA/O" disabled>
KINESIOLOGA/O</option>
 <option value=3D"PSICOLOGO" disabled>
PSICOLOGO</option>
 <option value==3D"NUTRICIONISTA" disabled>
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-1960584645049150073m_270674263807561848ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-1960584645049150073m_270674263807561848ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-page-description m_-1960584645049150073m_270674263807561848ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
En esta secci=C3==B3n debe ingresar los datos del paciente visitado</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-1960584645049150073m_270674263807561848ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-section-description m_-1960584645049150073m_270674263807561848ss-no-ignore-whitespace" style=3D"margin-top:0.5em;white-space:pre-wrap;word-wrap:break-word">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-text" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_823811303">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
10614396-k</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-text" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_1959365839">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Michel Espinoza</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-select" style=3D"margin:12px 0">
<div class==3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_545002227">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<select name=3D"entry.545002227" disabled id=3D"m_-1960584645049150073m_270674263807561848entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled>
COLMENA</option>
 <option value=3D"CONSALUD" disabled selected>
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled>
CRUZ BLANCA</option>
 <option value=3D"DIPRECA" disabled>
DIPRECA</option>
 <option value=3D"FONASA" disabled>
FONASA</option>
 <option value=3D"FUNDACION" disabled>
FUNDACION</option>
 <option value=3D"ISAPRES DEL COBRE" disabled>
ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled>
NUEVA MASVIDA</option>
 <option value=3D"VIDATRES" disabled>
VIDATRES</option>
 <option value=3D"PARTICULAR" disabled>
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-text" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_1900161356">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Talcahuano</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-text" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_1298871758">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Talcahuano</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-1960584645049150073m_270674263807561848ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-1960584645049150073m_270674263807561848ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-page-description m_-1960584645049150073m_270674263807561848ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
En esta secci=C3==B3n debe ingresar los datos de la atenci=C3=B3n domiciliaria</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-radio" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_2073233714">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_-1960584645049150073m_270674263807561848ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-1960584645049150073m_270674263807561848ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-choice-item-control m_-1960584645049150073m_270674263807561848goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_-1960584645049150073m_270674263807561848group_1222378237_1" class=3D"m_-1960584645049150073m_270674263807561848ss-q-radio">
</span>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_-1960584645049150073m_270674263807561848ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-choice-item-control m_-1960584645049150073m_270674263807561848goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_-1960584645049150073m_270674263807561848group_1222378237_2" class=3D"m_-1960584645049150073m_270674263807561848ss-q-radio">
</span>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-date" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_1705849412">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha de la Atenci=C3=B3n<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-date">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-datetime-box m_-1960584645049150073m_270674263807561848goog-inline-block" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name=3D"entry.1705849412_day" disabled class=3D"m_-1960584645049150073m_270674263807561848ss-day-dropdown" id=3D"m_-1960584645049150073m_270674263807561848entry.1705849412_day">
<option value=3D"">
D=C3=ADa</option>
<option value=3D"1">
1</option>
 <option value=3D"2">
2</option>
 <option value=3D"3">
3</option>
 <option value=3D"4">
4</option>
 <option value=3D"5">
5</option>
 <option value=3D"6">
6</option>
 <option value=3D"7">
7</option>
 <option value=3D"8">
8</option>
 <option value=3D"9">
9</option>
 <option value=3D"10">
10</option>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12</option>
 <option value=3D"13">
13</option>
 <option value=3D"14">
14</option>
 <option value=3D"15">
15</option>
 <option value=3D"16">
16</option>
 <option value==3D"17">
17</option>
 <option value=3D"18">
18</option>
 <option value=3D"19">
19</option>
 <option value=3D"20">
20</option>
 <option value=3D"21">
21</option>
 <option value=3D"22">
22</option>
 <option value=3D"23">
23</option>
 <option value=3D"24">
24</option>
 <option value=3D"25">
25</option>
 <option value=3D"26" selected>
26</option>
 <option value=3D"27">
27</option>
 <option value=3D"28">
28</option>
 <option value=3D"29">
29</option>
 <option value=3D"30">
30</option>
 <option value=3D"31">
31</option>
</select>
   <select name=3D"entry.1705849412_month" disabled class=3D"m_-1960584645049150073m_270674263807561848ss-month-dropdown" id=3D"m_-1960584645049150073m_270674263807561848entry.1705849412_month">
<option value=3D"">
Mes</option>
<option value=3D"1">
enero</option>
 <option value=3D"2">
febrero</option>
 <option value=3D"3" selected>
marzo</option>
 <option value=3D"4">
abril</option>
 <option value=3D"5">
mayo</option>
 <option value=3D"6">
junio</option>
 <option value=3D"7">
julio</option>
 <option value=3D"8">
agosto</option>
 <option value=3D"9">
septiembre</option>
 <option value=3D"10">
octubre</option>
 <option value=3D"11">
noviembre</option>
 <option value=3D"12">
diciembre</option>
</select>
=20<select name=3D"entry.1705849412_year" disabled id=3D"m_-1960584645049150073m_270674263807561848entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
 <option value=3D"1897">
1897</option>
 <option value=3D"1898">
1898</option>
 <option value=3D"1899">
1899</option>
 <option value=3D"1900">
1900</option>
 <option value=3D"1901">
1901</option>
 <option value=3D"1902">
1902</option>
 <option value=3D"1903">
1903</option>
 <option value=3D"1904">
1904</option>
 <option value=3D"1905">
1905</option>
 <option value=3D"1906">
1906</option>
 <option value=3D"1907">
1907</option>
 <option value=3D"1908">
1908</option>
 <option value=3D"1909">
1909</option>
 <option value=3D"1910">
1910</option>
 <option value=3D"1911">
1911</option>
 <option value=3D"1912">
1912</option>
 <option value=3D"1913">
1913</option>
 <option value=3D"1914">
1914</option>
 <option value=3D"1915">
1915</option>
 <option value=3D"1916">
1916</option>
 <option value=3D"1917">
1917</option>
 <option value=3D"1918">
1918</option>
 <option value=3D"1919">
1919</option>
 <option value=3D"1920">
1920</option>
 <option value=3D"1921">
1921</option>
 <option value=3D"1922">
1922</option>
 <option value=3D"1923">
1923</option>
 <option value==3D"1924">
1924</option>
 <option value=3D"1925">
1925</option>
 <option value==3D"1926">
1926</option>
 <option value=3D"1927">
1927</option>
 <option value==3D"1928">
1928</option>
 <option value=3D"1929">
1929</option>
 <option value==3D"1930">
1930</option>
 <option value=3D"1931">
1931</option>
 <option value==3D"1932">
1932</option>
 <option value=3D"1933">
1933</option>
 <option value==3D"1934">
1934</option>
 <option value=3D"1935">
1935</option>
 <option value==3D"1936">
1936</option>
 <option value=3D"1937">
1937</option>
 <option value==3D"1938">
1938</option>
 <option value=3D"1939">
1939</option>
 <option value==3D"1940">
1940</option>
 <option value=3D"1941">
1941</option>
 <option value==3D"1942">
1942</option>
 <option value=3D"1943">
1943</option>
 <option value==3D"1944">
1944</option>
 <option value=3D"1945">
1945</option>
 <option value==3D"1946">
1946</option>
 <option value=3D"1947">
1947</option>
 <option value==3D"1948">
1948</option>
 <option value=3D"1949">
1949</option>
 <option value==3D"1950">
1950</option>
 <option value=3D"1951">
1951</option>
 <option value==3D"1952">
1952</option>
 <option value=3D"1953">
1953</option>
 <option value==3D"1954">
1954</option>
 <option value=3D"1955">
1955</option>
 <option value==3D"1956">
1956</option>
 <option value=3D"1957">
1957</option>
 <option value==3D"1958">
1958</option>
 <option value=3D"1959">
1959</option>
 <option value==3D"1960">
1960</option>
 <option value=3D"1961">
1961</option>
 <option value==3D"1962">
1962</option>
 <option value=3D"1963">
1963</option>
 <option value==3D"1964">
1964</option>
 <option value=3D"1965">
1965</option>
 <option value==3D"1966">
1966</option>
 <option value=3D"1967">
1967</option>
 <option value==3D"1968">
1968</option>
 <option value=3D"1969">
1969</option>
 <option value==3D"1970">
1970</option>
 <option value=3D"1971">
1971</option>
 <option value==3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
 <option value==3D"1974">
1974</option>
 <option value=3D"1975">
1975</option>
 <option value==3D"1976">
1976</option>
 <option value=3D"1977">
1977</option>
 <option value==3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option value==3D"1980">
1980</option>
 <option value=3D"1981">
1981</option>
 <option value==3D"1982">
1982</option>
 <option value=3D"1983">
1983</option>
 <option value==3D"1984">
1984</option>
 <option value=3D"1985">
1985</option>
 <option value==3D"1986">
1986</option>
 <option value=3D"1987">
1987</option>
 <option value==3D"1988">
1988</option>
 <option value=3D"1989">
1989</option>
 <option value==3D"1990">
1990</option>
 <option value=3D"1991">
1991</option>
 <option value==3D"1992">
1992</option>
 <option value=3D"1993">
1993</option>
 <option value==3D"1994">
1994</option>
 <option value=3D"1995">
1995</option>
 <option value==3D"1996">
1996</option>
 <option value=3D"1997">
1997</option>
 <option value==3D"1998">
1998</option>
 <option value=3D"1999">
1999</option>
 <option value==3D"2000">
2000</option>
 <option value=3D"2001">
2001</option>
 <option value==3D"2002">
2002</option>
 <option value=3D"2003">
2003</option>
 <option value==3D"2004">
2004</option>
 <option value=3D"2005">
2005</option>
 <option value==3D"2006">
2006</option>
 <option value=3D"2007">
2007</option>
 <option value==3D"2008">
2008</option>
 <option value=3D"2009">
2009</option>
 <option value==3D"2010">
2010</option>
 <option value=3D"2011">
2011</option>
 <option value==3D"2012">
2012</option>
 <option value=3D"2013">
2013</option>
 <option value==3D"2014">
2014</option>
 <option value=3D"2015">
2015</option>
 <option value==3D"2016">
2016</option>
 <option value=3D"2017">
2017</option>
 <option value==3D"2018">
2018</option>
 <option value=3D"2019" selected>
2019</option>
 <option value=3D"2020">
2020</option>
 <option value=3D"2021">
2021</option>
 <option value=3D"2022">
2022</option>
 <option value=3D"2023">
2023</option>
 <option value=3D"2024">
2024</option>
 <option value=3D"2025">
2025</option>
 <option value=3D"2026">
2026</option>
 <option value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
 <option value=3D"2029">
2029</option>
 <option value=3D"2030">
2030</option>
 <option value=3D"2031">
2031</option>
 <option value=3D"2032">
2032</option>
 <option value=3D"2033">
2033</option>
 <option value=3D"2034">
2034</option>
 <option value=3D"2035">
2035</option>
 <option value=3D"2036">
2036</option>
 <option value=3D"2037">
2037</option>
 <option value==3D"2038">
2038</option>
 <option value=3D"2039">
2039</option>
 <option value==3D"2040">
2040</option>
 <option value=3D"2041">
2041</option>
 <option value==3D"2042">
2042</option>
 <option value=3D"2043">
2043</option>
 <option value==3D"2044">
2044</option>
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2067</option>
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Hora de la Atenci=C3=B3n<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
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</div>
</div>
</div>
<br>
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Performance Status ECOG del Paciente<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
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*</span>
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1</option>
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2</option>
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3</option>
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4</option>
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<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
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Escala Dolor EVA Actual</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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0</label>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
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2</label>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_1421689035_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
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8</label>
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10</label>
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<div class=3D"m_-1960584645049150073m_270674263807561848aria-todo">
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Escala Dolor EVA M=C3=A1ximo</div>
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0</label>
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1</label>
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2</label>
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3</label>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
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5</label>
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6</label>
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7</label>
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8</label>
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9</label>
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10</label>
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</td>
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<div class=3D"m_-1960584645049150073m_270674263807561848aria-todo">
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</div>
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</div>
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</div>
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<div class=3D"m_-1960584645049150073m_270674263807561848ss-scalerow-fieldcell">
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</div>
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</td>
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<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
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<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
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<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA M=C3=ADnimo</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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<tbody>
<tr>
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</td>
<td class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_853118630_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_853118630_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_853118630_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_853118630_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_853118630_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_853118630_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_853118630_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_853118630_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumber" for=3D"m_-1960584645049150073m_270674263807561848group_853118630_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
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9</label>
</td>
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10</label>
</td>
<td class=3D"m_-1960584645049150073m_270674263807561848ss-scalenumbers" style=3D"text-align:center">
</td>
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<tr>
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<div class=3D"m_-1960584645049150073m_270674263807561848aria-todo">
</div>
</td>
<td class=3D"m_-1960584645049150073m_270674263807561848ss-scalerow" style==3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_2140974612">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Anamnesis/Evoluci=C3=B3n<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
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<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Paciente de 50 a==C3=B1os, actualmente con c=C3=A1ncer de colon, pronto iniciar=C3=A1 quimioterapia (en pr=C3=B3ximo control con onc=C3=B3logo  se fijar=C3=A1 la fecha), actualmente usando paracetamol y tramadol, usuario de colostomia hace 2,5 a=C3=B1os, sonda foley y cateter subcut=C3=A1neo en torax desde el 2018. El 2018 le extirparon ganglios metast=C3=A1sicos presentes en ingle izquierda. Presenta mayor dolor durante las noches, con dificultad para dormir. Apetito disminuido. presenta tenesmo vesical. Refiere adem=C3=A1s dolor tipo quemante en zona perineal EVA 7, persistente, con respuesta parcial a tramadol y paracetamol. Con dificultad para caminar y estar sentado.</div>
</div>
</div>
</div>
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<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-item-required m_-1960584645049150073m_270674263807561848ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_824006088">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Examen F=C3==ADsico<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
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</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
L=C3=BAcido, cooperador, bien hidratado. faringe eritematosa, dentadura en mal estado. MP +, sibilancia escasas bilaterales, Cardiaco RR2t, no ausculto siplo, abdomen con RHA levemente aumentados, indoloro, sin masas, colostomia en buenas condiciones. Sonda Foley con orina. Cateter sc bien.pulsos pedios presentes, sin edema de piernas. u=C3=B1as engrosadas.</div>
</div>
</div>
</div>
<br>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_1690694733">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Diagn=C3=B3stico<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
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</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
GES-4, Dolor, trastorno del sue=C3=B1o.</div>
</div>
</div>
</div>
<br>
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<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_1255665248">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Plan de Tratamiento e Indicaciones<label for=3D"m_-1960584645049150073m_270674263807561848itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-1960584645049150073m_270674263807561848ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
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</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Analgesia, F=C3==A1rmacos, Educaci=C3=B3n, Medicina f=C3=ADsica-rehabilitaci=C3=B3n f=C3=ADsica, podolog=C3=ADa, kinesioterapia respiratoria, asistencia por t=C3=A9cnico param=C3=A9dico, psic=C3=B3loga y enfermer=C3=ADa, el resto de indicaciones se mantienen.</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_1648939075">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Morfina 1 gr sc al dia o sos por 1 mes, tramadol 10-20 gts c/6-8hrs vo al dia o sos, paracetamol 1 cp c/6 hrs v.o, Metamizol 300 mg 1-2 cp c/6-8 hrs al dia o sos, diclofenaco 75 mg im al dia sos, ondanvitae 1 cp al dia por 3 dias, ondansentron 1 ampolla im al dia por 7 d=C3=ADas, domperidona 10 gts al dia sos, salbutamol 2 puff c/6 hrs por 7 dias con aeroc=C3=A1mara, amoxicilina 500 mg c/8 hrs por 7 dias, bilidren 1 cp al d=C3=ADa por 1 mes, prednisona 20 mg, 1,5 cp al d=C3=ADa en ayuno por 5 d=C3=ADas, esencia de lavanda ambiental mientras haya dolor (difusor), infor pro 3 , 1 cp al dia por 1 mes, vitamina c 1 cp al d=C3=ADa por 1 mes, neurobionta 1 ampolla im a la semana por 3 semasnas, memorex 1 caps c/12 hrs por 1 mes, ensure clinical 250 ml al d=C3=ADa, 3-4 veces a la semana por 1 mes,melipas 1 c/12 hrs por 1 mes, amitriptilina 25 mg al dormir por 1 mes, zopiclona 7,5 ml al dia por 1 mes, crema eucerin ph 5, uso diario en todo el cuperpo por 1 mes, aceite de cal=C3=A9ndula 1 vez al d=C3=ADa en todo el cuerpo por 1 mes, vacuna de la influenza, capsulas de maqui 1 c/12 hrs por 1 mes, c=C3=A1psulas de aloe vera 1 al dia por 1 mes, entrenamiento + reacondicionamiento fisico-asistir a gimnasio 3-4veces a la semana-fitnes, podolog=C3=ADa, kinesioterapia respiratoria, asistencia de t=C3=A9cnico param=C3=A9dico, asistencia de enfermer=C3=ADa, psicologa (solicitado por enfermero)</div>
</div>
</div>
</div>
<br>
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<div dir=3D"auto" class=3D"m_-1960584645049150073m_270674263807561848ss-item m_-1960584645049150073m_270674263807561848ss-date" style=3D"margin:12px 0">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-1960584645049150073m_270674263807561848ss-q-item-label" for=3D"m_-1960584645049150073m_270674263807561848entry_2063615873">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-date">
<div class=3D"m_-1960584645049150073m_270674263807561848ss-datetime-box m_-1960584645049150073m_270674263807561848goog-inline-block" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
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<option value=3D"">
D=C3=ADa</option>
<option value=3D"1">
1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
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<option value=3D"">
Mes</option>
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enero</option>
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febrero</option>
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marzo</option>
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abril</option>
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mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
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<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
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1897</option>
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1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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1925</option>
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1926</option>
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1927</option>
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1928</option>
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1929</option>
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1930</option>
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1931</option>
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1932</option>
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1933</option>
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1934</option>
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1935</option>
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1936</option>
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1937</option>
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1938</option>
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1939</option>
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1940</option>
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1941</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
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1946</option>
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1947</option>
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1948</option>
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1949</option>
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1950</option>
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1951</option>
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1952</option>
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1953</option>
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1954</option>
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1955</option>
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1956</option>
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1957</option>
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1958</option>
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1959</option>
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1960</option>
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1961</option>
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1962</option>
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1963</option>
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1964</option>
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1965</option>
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1966</option>
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1967</option>
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1968</option>
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1969</option>
 <option value==3D"1970">
1970</option>
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1971</option>
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1972</option>
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1973</option>
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1974</option>
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1975</option>
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1976</option>
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1977</option>
 <option value==3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option value==3D"1980">
1980</option>
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1981</option>
 <option value==3D"1982">
1982</option>
 <option value=3D"1983">
1983</option>
 <option value==3D"1984">
1984</option>
 <option value=3D"1985">
1985</option>
 <option value==3D"1986">
1986</option>
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1987</option>
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1988</option>
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1989</option>
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1990</option>
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1991</option>
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1992</option>
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1993</option>
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1994</option>
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1995</option>
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1996</option>
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1997</option>
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1998</option>
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1999</option>
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2000</option>
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2001</option>
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2002</option>
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2003</option>
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2004</option>
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2005</option>
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2006</option>
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2007</option>
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2008</option>
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2009</option>
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2010</option>
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2011</option>
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2012</option>
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2013</option>
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2014</option>
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2015</option>
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2016</option>
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2017</option>
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2018</option>
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2019</option>
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2020</option>
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2021</option>
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2022</option>
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2023</option>
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2024</option>
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2025</option>
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2026</option>
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2027</option>
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2028</option>
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2029</option>
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2030</option>
 <option value=3D"2031">
2031</option>
 <option value=3D"2032">
2032</option>
 <option value=3D"2033">
2033</option>
 <option value=3D"2034">
2034</option>
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2035</option>
 <option value=3D"2036">
2036</option>
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2037</option>
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2038</option>
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2039</option>
 <option value==3D"2040">
2040</option>
 <option value=3D"2041">
2041</option>
 <option value==3D"2042">
2042</option>
 <option value=3D"2043">
2043</option>
 <option value==3D"2044">
2044</option>
 <option value=3D"2045">
2045</option>
 <option value==3D"2046">
2046</option>
 <option value=3D"2047">
2047</option>
 <option value==3D"2048">
2048</option>
 <option value=3D"2049">
2049</option>
 <option value==3D"2050">
2050</option>
 <option value=3D"2051">
2051</option>
 <option value==3D"2052">
2052</option>
 <option value=3D"2053">
2053</option>
 <option value==3D"2054">
2054</option>
 <option value=3D"2055">
2055</option>
 <option value==3D"2056">
2056</option>
 <option value=3D"2057">
2057</option>
 <option value==3D"2058">
2058</option>
 <option value=3D"2059">
2059</option>
 <option value==3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <option value==3D"2062">
2062</option>
 <option value=3D"2063">
2063</option>
 <option value==3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option value==3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option value==3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-1960584645049150073m_270674263807561848ss-form-question m_-1960584645049150073m_270674263807561848errorbox-good">
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Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_-1960584645049150073m_270674263807561848ss-q-help m_-1960584645049150073m_270674263807561848ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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Aplicaci=C3=B3n de esencia oleo 31 swis just</div>
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Derivaci=C3==B3n a otro Prestador Domiciliario</div>
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S=C3=B3lo llene esta secci==C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del equipo</div>
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ENFERMERA</span>
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TENS</span>
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<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"NUTRICIONISTA" id=3D"m_-1960584645049150073m_270674263807561848group_503039759_3" class=3D"m_-1960584645049150073m_270674263807561848ss-q-checkbox">
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<span class=3D"m_-1960584645049150073m_270674263807561848ss-choice-label">
NUTRICIONISTA</span>
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<span class=3D"m_-1960584645049150073m_270674263807561848ss-choice-item-control m_-1960584645049150073m_270674263807561848goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"KINESIOLOGO" id=3D"m_-1960584645049150073m_270674263807561848group_503039759_4" class=3D"m_-1960584645049150073m_270674263807561848ss-q-checkbox">
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KINESIOLOGO</span>
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<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"PSICOLOGO" id=3D"m_-1960584645049150073m_270674263807561848group_503039759_5" class=3D"m_-1960584645049150073m_270674263807561848ss-q-checkbox">
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PSICOLOGO</span>
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<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link" style=3D"color:#424242;font-size:13px" target=3D"_blank">
Crea tu propio formulario de Google</a>
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=C2=A0 =C2=A0 Dra. Paulina Carrasco Godoy</i>
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pcarrascogodoy@gmail.com</a>
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--000000000000beb59c0585129a74--