<div dir=3D"ltr">
Buenas noches, adjunto registro de atencion domiciliaria, 1ra visita.<div>
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</div>
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<br>
</div>
<div>
EU Francheska C=C3=A1ceres B.</div>
<div>
<br>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
---------- Forwarded message ---------<br>
De: <strong class=3D"gmail_sendername" dir=3D"auto">
Formularios de Google</strong>
 <span dir=3D"ltr">
&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;</span>
<br>
Date: vie., 29 mar. 2019 a las 22:59<br>
Subject: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href=3D"mailto:francheskacaceres@gmail.com">
francheskacaceres@gmail.com</a>
&gt;<br>
</div>
<br>
<br>
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;margin:0;padding:0;height:100%;width:100%">
<table border=3D"0" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(38,4,154)" width=3D"100%">
<tbody>
<tr height=3D"64px">
<td style=3D"padding-left:24px">
<img alt=3D"Formularios de Google" height=3D"26px" style=3D"display:inline-block;margin:0;vertical-align:middle" width=3D"143px" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div style=3D"padding:24px;background-color:rgb(229,218,254)">
<div align=3D"center" style=3D"background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por llenar <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
</div>
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</tr>
<tr height=3D"12px">
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<div style=3D"font-size:13px;line-height:18px;color:#424242">
Estas son tus respuestas:</div>
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</tr>
<tr>
<td>
<div class=3D"m_2829126789147193361ss-form-container">
<div class=3D"m_2829126789147193361ss-form-heading">
<h1 class=3D"m_2829126789147193361ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_2829126789147193361ss-form-desc m_2829126789147193361ss-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_2829126789147193361ss-form">
<form method=3D"GET" id=3D"m_2829126789147193361ss-form" target=3D"_blank">
<br>
<div class=3D"m_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-text" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361emailAddress">
<div class=3D"m_2829126789147193361ss-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_2829126789147193361emailAddress">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_2829126789147193361ss-q-text m_2829126789147193361ss-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:francheskacaceres@gmail.com" target=3D"_blank">
francheskacaceres@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_2829126789147193361ss-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_2829126789147193361ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_2829126789147193361ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_2829126789147193361ss-page-description m_2829126789147193361ss-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_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-text" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_579114469">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_2829126789147193361ss-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%">
Francheska C=C3=A1ceres</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-text" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_1276273985">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-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_2829126789147193361ss-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%">
18588339-6</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-select" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_133691676">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-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_2829126789147193361entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled>
MEDICO</option>
 <option value=3D"ENFERMERA/O" disabled selected>
ENFERMERA/O</option>
 <option value=3D"TENS" disabled>
TENS</option>
 <option value=3D"KINESIOLOGA/O" disabled>
KINESIOLOGA/O</option>
 <option value=3D"PSICOLOGO" disabled>
PSICOLOGO</option>
 <option value==3D"NUTRICIONISTA" disabled>
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_2829126789147193361ss-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_2829126789147193361ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_2829126789147193361ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_2829126789147193361ss-page-description m_2829126789147193361ss-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_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_2829126789147193361ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_2829126789147193361ss-section-description m_2829126789147193361ss-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_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-text" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_823811303">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-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_2829126789147193361ss-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%">
6214541-2</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-text" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_1959365839">
<div class=3D"m_2829126789147193361ss-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_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_2829126789147193361ss-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%">
Arturo Castro</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-select" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_545002227">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-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_2829126789147193361entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled selected>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled>
COLMENA</option>
 <option value=3D"CONSALUD" disabled>
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled>
CRUZ BLANCA</option>
 <option value=3D"DIPRECA" disabled>
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>
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VIDATRES</option>
 <option value=3D"PARTICULAR" disabled>
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-text" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_1900161356">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_2829126789147193361ss-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%">
Huala=C3=B1e</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-text" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_1298871758">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_2829126789147193361ss-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%">
Huala=C3=B1e</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_2829126789147193361ss-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_2829126789147193361ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_2829126789147193361ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_2829126789147193361ss-page-description m_2829126789147193361ss-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_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-radio" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_2073233714">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_2829126789147193361ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_2829126789147193361ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_2829126789147193361ss-choice-item-control m_2829126789147193361goog-inline-block" style=3D"display:inline-block">
<input type==3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_2829126789147193361group_1222378237_1" class=3D"m_2829126789147193361ss-q-radio">
</span>
<span class=3D"m_2829126789147193361ss-choice-label">
Domicilio</span>
</label>
</li>
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<label>
<span class=3D"m_2829126789147193361ss-choice-item-control m_2829126789147193361goog-inline-block" style=3D"display:inline-block">
<input type==3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_2829126789147193361group_1222378237_2" class=3D"m_2829126789147193361ss-q-radio">
</span>
<span class=3D"m_2829126789147193361ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-date" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_1705849412">
<div class=3D"m_2829126789147193361ss-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_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_2829126789147193361ss-q-date">
<div class=3D"m_2829126789147193361ss-datetime-box m_2829126789147193361goog-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"">
Mes</option>
<option value=3D"1">
enero</option>
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febrero</option>
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marzo</option>
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abril</option>
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mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
</select>
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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>
</select>
=20<select name=3D"entry.1705849412_year" disabled id=3D"m_2829126789147193361entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
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1897</option>
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1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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1925</option>
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1926</option>
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1927</option>
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1928</option>
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1929</option>
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1930</option>
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1931</option>
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1932</option>
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1933</option>
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1934</option>
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1935</option>
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1936</option>
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1937</option>
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1938</option>
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1939</option>
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1940</option>
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1941</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
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1946</option>
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1947</option>
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1948</option>
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1949</option>
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1950</option>
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1951</option>
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1952</option>
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1953</option>
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1954</option>
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1955</option>
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1956</option>
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1957</option>
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1958</option>
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1959</option>
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1960</option>
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1961</option>
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1962</option>
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1963</option>
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1964</option>
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1965</option>
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1966</option>
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1967</option>
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1968</option>
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1969</option>
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1970</option>
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1971</option>
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1972</option>
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1973</option>
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1974</option>
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1975</option>
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1976</option>
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1977</option>
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1978</option>
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1979</option>
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1980</option>
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1981</option>
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1982</option>
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1983</option>
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1984</option>
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1985</option>
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1986</option>
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1987</option>
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1988</option>
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1989</option>
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1990</option>
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1991</option>
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1992</option>
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1993</option>
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1994</option>
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1995</option>
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1996</option>
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1997</option>
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1998</option>
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1999</option>
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2000</option>
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2001</option>
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2002</option>
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2003</option>
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2004</option>
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2005</option>
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2006</option>
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2007</option>
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2008</option>
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2009</option>
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2010</option>
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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>
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2031</option>
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2032</option>
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2033</option>
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2034</option>
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2035</option>
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2036</option>
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2037</option>
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2038</option>
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2039</option>
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2040</option>
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2041</option>
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2042</option>
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2043</option>
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2044</option>
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2045</option>
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2046</option>
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2047</option>
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2048</option>
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2049</option>
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2050</option>
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2051</option>
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2052</option>
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2053</option>
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2054</option>
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2055</option>
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2056</option>
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2057</option>
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2058</option>
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2059</option>
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2060</option>
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2061</option>
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2062</option>
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2063</option>
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2064</option>
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2065</option>
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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_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_206244955">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Hora de la Atenci=C3=B3n<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
</label>
<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_2829126789147193361ss-q-time">
<div class=3D"m_2829126789147193361ss-datetime-box m_2829126789147193361goog-inline-block" dir=3D"ltr" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
<select name=3D"entry.206244955_hour" disabled id=3D"m_2829126789147193361entry.206244955_hour">
<option value=3D"">
h</option>
<option value=3D"00">
00</option>
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01</option>
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02</option>
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03</option>
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04</option>
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05</option>
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06</option>
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07</option>
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08</option>
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09</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
</select>
.<select name=3D"entry.206244955_minute" disabled id=3D"m_2829126789147193361entry.206244955_minute">
<option value=3D"">
min</option>
<option value=3D"00" selected>
00</option>
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01</option>
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02</option>
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03</option>
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04</option>
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05</option>
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06</option>
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07</option>
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08</option>
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09</option>
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10</option>
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11</option>
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12</option>
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13</option>
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28</option>
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29</option>
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32</option>
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33</option>
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35</option>
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36</option>
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38</option>
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39</option>
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40</option>
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47</option>
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48</option>
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49</option>
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50</option>
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53</option>
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54</option>
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55</option>
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56</option>
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57</option>
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58</option>
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59</option>
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</div>
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Performance Status ECOG del Paciente<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
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<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</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_2829126789147193361ss-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_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-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_2829126789147193361ss-scalenumber" for=3D"m_2829126789147193361group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
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2</label>
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3</label>
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<label class=3D"m_2829126789147193361ss-scalenumber" for=3D"m_2829126789147193361group_1421689035_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 class=3D"m_2829126789147193361ss-scalenumbers" style=3D"text-align:center">
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<br>
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<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA M=C3=A1ximo</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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<tr>
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</td>
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<label class=3D"m_2829126789147193361ss-scalenumber" for=3D"m_2829126789147193361group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_2829126789147193361ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_2829126789147193361ss-scalenumber" for=3D"m_2829126789147193361group_1244707512_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_2829126789147193361ss-scalenumber" for=3D"m_2829126789147193361group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
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<label class=3D"m_2829126789147193361ss-scalenumber" for=3D"m_2829126789147193361group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
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<label class=3D"m_2829126789147193361ss-scalenumber" for=3D"m_2829126789147193361group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
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<label class=3D"m_2829126789147193361ss-scalenumber" for=3D"m_2829126789147193361group_1244707512_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
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<label class=3D"m_2829126789147193361ss-scalenumber" for=3D"m_2829126789147193361group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
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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Escala Dolor EVA M=C3=ADnimo</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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4</label>
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5</label>
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6</label>
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8</label>
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9</label>
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10</label>
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</td>
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Anamnesis/Evoluci=C3=B3n<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
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Paciente adulto mayor, 67 a=C3=B1os, vive con su esposa (Rosa) e hijo (Jans), trabajaba como profesor en escuela del sector, ces=C3=B3 su trabajo hace 2 semanas aproximadamente debido a su estado actual de salud. Al ingreso al domicilio me recibe su esposa, se dirige al dormitorio donde se encuentra el paciente, Don Arturo, el cual se observa en regulares condiciones generales, dec=C3=BAbito supino sobre su cama, con leve elevaci=C3=B3n de piernas. Refiere sentirse deca=C3=ADdo, inapetente hace aprox. 2 semanas, adem=C3=A1s de &quot;ardor&quot; y leve dolor (EVA 2/10) en zona abdominal derecha, que cede a la analgesia y masajes. Ademas describe cefaleas (EVA 5/10) que ceden de manera espont=C3=A1nea. =C3=9Altimo control con m=C3=A9dico tratante 20/03/19.Signos vitales 29/03/19P/A: 104/43mmHgFC: 76x&#39;FR: 16x&#39;EVA: 0/10Antecedentes m=C3=B3rbidos:=20-Laparostom=C3=ADa exploratoria por accidente automovil=C3=ADstico (hace m==C3=A1s de 30 a=C3=B1os)=20-Diabetes (Dg 2015 aprox.)-OH cr=C3=B3nico (actualmente suspendido), Tabaco (-)-Hemorragia variceal que amerit=C3=B3 ligadura de v=C3=A1rices esof=C3=A1gicas (07/16), posteriormente evolucionando con anasarca, ascitis moderada y encefalopat=C3=ADa grado II-III, presentando mejor=C3=ADa satisfactoria, pero con persistencia de encefalopat=C3=ADa, con periodos de desorientaci=C3==B3n y somnolencia, por lo cual se indico evaluaci=C3=B3n para incapacitaci=C3=B3n.-Cirrosis hep=C3=A1tica desde hace 6 a=C3=B1os aprox.=20Ex=C3=A1menes:-TAC muestra signos de Da=C3=B1o Hep=C3=A1tico cr=C3=B3nico, tumor de 49mm, de bordes mal definidos, en seg. 2 y 3 del h=C3=ADgado, esplenomegalia, leve ascitis, colelitiasis, colecistitis cr.-RNM (21/06/2018) Da=C3=B1o hep=C3=A1tico cr=C3=B3nico, signos de hipertensi=C3=B3n portal esplenomegalia y ascitis, 4 lesiones focales ambos l=C3=B3bulos 75mm, 37mm, 73mm y 32mm.-Ex. lab. alterado (16/03/2019):Bilirrubina total 11.8 mg/dLBilirrubina indirecta 10.59 mg/dLBilirrubina directa 1.21mg/dLTransaminasa GOT/AST 72 U/LTransaminasa GPT/ALT 52 U/LGAM. GLUT. Transpeptid: GGT 108 U/LFosfatasa alcalina 204 U/LINR 1.5Eritrocitos 3.27mill/mm3Hematocrito 35%Hemoglobina 11.95 gr/dLVCM 107 flHCM 36.54 pgPlaquetas 74000 mm3VHS 112 mm/hrTratamiento farmacol=C3=B3gico actual=20(indicado por Dr F=C3=A9lix Gonz=C3=A1lez, Gastroenter=C3=B3logo. 20/03/19):- Furokal (Acido ursodeoxicolico 500mg) 3 veces al d=C3=ADa-Konakion (fitomenadiona 10mg/ml)-Contumax polvo (Macrogol 3350) c/12hr-Ciprofloxacino 500mg-Normix (rifaximina 200mg) 2 c/8hrs-Zoltum (Pantoprazol 40mg) 1 al d=C3=ADa en ayuna-Quetiapina 25mg noche-Cheltin FC 1 diario-Probiotix-Lertus 150mg-Centum=20-Espironolactona 25mg-Furosemida 40mg (1/2 diaria)-Carvedilol 6.25mg 1/2  2 veces al d=C3=ADa</div>
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Examen F=C3=ADsico<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
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<div class=3D"m_2829126789147193361ss-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%">
Examen f=C3=ADsico general:Paciente en regulares condiciones generales de salud, orientado en tiempo y espacio, cooperador, fascie tranquila. Dec=C3=BAbito supino, contextura mesom=C3=B3rfica. Deambula sin ayuda, realiza actividades de la vida diaria sin dificultad, su sra. de igual forma lo asiste.Examen f=C3=ADsico segmentario:Piel tibia al tacto, indemne, destaca coloraci=C3=B3n icterica generalizada. Normocr=C3=A1neo, pupilas isoc=C3=B3ricas, reactivas a la luz, destaca ictericia escler=C3=B3tica, mucosas hidratadas, p=C3=A1lidas. Cuello m=C3=B3vil, t=C3=B3rax sim=C3=A9trico, abdomen distendido, EVA 2/10 en Hipocondrio derecho, a la palpaci=C3=B3n zona poco depresible, destaca cicatriz laparotom=C3=ADa. Hernia umbilical no reductible, con lesiones costrosas. Columna alineada. Extremidades superiores m=C3=B3viles, sim=C3=A9tricas. Extremidades inferiores m=C3=B3viles, sim=C3=A9tricas, sin edema, hiperqueratosis plantar, onicomicosis. Genitales masculinos, destaca test=C3=ADculo derecho inflamado, sensible a la palpaci=C3=B3n. Diuresis (+), nicturia. Deposiciones (+) 1 vez al d=C3=ADa, escasas, dificultosas.</div>
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<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Diagn=C3=B3stico<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
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<span class=3D"m_2829126789147193361ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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Ca Hep=C3=A1tico</div>
</div>
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<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-item-required m_2829126789147193361ss-paragraph-text" style=3D"margin:12px 0">
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Plan de Tratamiento e Indicaciones<label for=3D"m_2829126789147193361itemView.getDomIdToLabel()">
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*</span>
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<div class=3D"m_2829126789147193361ss-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%">
-Control de signos vitales-Mantener tratamiento indicado por m=C3=A9dico tratante-Alimentaci=C3=B3n hipos=C3=B3dica, hipograsa.-Educaci=C3=B3n sobre patolog=C3=ADa=20-Educaci=C3=B3n sobre correcta toma de P/A y valores normales-Consulta urgencia S.O.S.-Pr=C3=B3xima visita a coordinar</div>
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<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-paragraph-text" style=3D"margin:12px 0">
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<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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Mes</option>
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D=C3=ADa</option>
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A=C3=B1o</option>
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1914</option>
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1918</option>
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1920</option>
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1970</option>
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1972</option>
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1985</option>
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1992</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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2005</option>
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2006</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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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>
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2031</option>
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2032</option>
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2033</option>
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2034</option>
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2035</option>
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2036</option>
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2037</option>
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2038</option>
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2039</option>
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2040</option>
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2041</option>
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2042</option>
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2043</option>
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2044</option>
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2045</option>
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2046</option>
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2047</option>
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2048</option>
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2049</option>
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2050</option>
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2051</option>
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2052</option>
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2053</option>
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2054</option>
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2055</option>
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2056</option>
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2057</option>
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2058</option>
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2059</option>
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2060</option>
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2061</option>
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2062</option>
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2063</option>
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2064</option>
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2065</option>
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2066</option>
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2067</option>
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2068</option>
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2069</option>
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<br>
 <div class=3D"m_2829126789147193361ss-form-question m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-text" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_74766472">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_2829126789147193361ss-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%">
-Control de signos vitales, educaci=C3=B3n sobre correcta toma de presi=C3=B3n arterial</div>
</div>
</div>
</div>
<br>
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<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-checkbox" style=3D"margin:12px 0">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_2829126789147193361ss-q-item-label" for=3D"m_2829126789147193361entry_1219705969">
<div class=3D"m_2829126789147193361ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"m_2829126789147193361ss-q-help m_2829126789147193361ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
S=C3=B3lo llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del equipo</div>
</label>
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<label>
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<input type==3D"checkbox" name=3D"entry.503039759" disabled value=3D"ENFERMERA" id=3D"m_2829126789147193361group_503039759_1" class=3D"m_2829126789147193361ss-q-checkbox">
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<span class=3D"m_2829126789147193361ss-choice-label">
ENFERMERA</span>
</label>
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<label>
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<input type==3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"m_2829126789147193361group_503039759_2" class=3D"m_2829126789147193361ss-q-checkbox">
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<span class=3D"m_2829126789147193361ss-choice-label">
TENS</span>
</label>
</li>
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<label>
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<input type==3D"checkbox" name=3D"entry.503039759" disabled value=3D"NUTRICIONISTA" id==3D"m_2829126789147193361group_503039759_3" class=3D"m_2829126789147193361ss-q-checkbox">
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<span class=3D"m_2829126789147193361ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
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<label>
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<span class=3D"m_2829126789147193361ss-choice-label">
KINESIOLOGO</span>
</label>
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 <li class=3D"m_2829126789147193361ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_2829126789147193361ss-choice-item-control m_2829126789147193361goog-inline-block" style=3D"display:inline-block">
<input type==3D"checkbox" name=3D"entry.503039759" disabled value=3D"PSICOLOGO" id=3D"m_2829126789147193361group_503039759_5" class=3D"m_2829126789147193361ss-q-checkbox">
</span>
<span class=3D"m_2829126789147193361ss-choice-label">
PSICOLOGO</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_2829126789147193361errorbox-good">
<div dir=3D"auto" class=3D"m_2829126789147193361ss-item m_2829126789147193361ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_2829126789147193361ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_2829126789147193361ss-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_2829126789147193361ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
</form>
</div>
</div>
</td>
</tr>
<tr height=3D"24px">
</tr>
</tbody>
</table>
</div>
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"max-width:672px;min-width:154px" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link" style=3D"color:#424242;font-size:13px" target=3D"_blank">
Crear tu propio Formulario de Google</a>
</td>
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</tbody>
</table>
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</div>
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<br clear=3D"all">
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-- <br>
<div dir=3D"ltr" class=3D"gmail_signature" data-smartmail=3D"gmail_signature">
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<font face=3D"trebuchet ms, sans-serif" color=3D"#073763">
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Francheska C==C3=A1ceres Bustamante</b>
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Enfermera</b>
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<b style=3D"background-color:rgb(255,255,255)">
Universidad Cat=C3=B3lica del Maule</b>
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