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<span =style=3D'font-size:11.0pt;font-family:"Calibri",sans-serif;color:#1F497D;=mso-fareast-language:EN-US'>
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<div>
<div =style=3D'border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0cm =0cm 0cm'>
<p class=3DMsoNormal>
<b>
<span lang=3DES =style=3D'font-size:11.0pt;font-family:"Calibri",sans-serif'>
De:</span>
</b=>
<span lang=3DES =style=3D'font-size:11.0pt;font-family:"Calibri",sans-serif'>
 Formularios =de Google [mailto:forms-receipts-noreply@google.com] <br>
<b>
Enviado =el:</b>
 martes, 2 de abril de 2019 22:00<br>
<b>
Para:</b>
 =carolinazagal@telemed-chile.cl<br>
<b>
Asunto:</b>
 Registro de =Atenci=C3=B3n Domiciliaria Oncovida<o:p>
</o:p>
</span>
</p>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<table class=3DMsoNormalTable =border=3D0 cellspacing=3D0 cellpadding=3D0 width=3D"100%" =style=3D'width:100.0%;background:#26049A'>
<tr>
<td style=3D'padding:0cm =0cm 0cm 18.0pt'>
<p class=3DMsoNormal>
<img id=3D"_x0000_i1025" =src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_=2x.png" alt=3D"Formularios de =Google">
<o:p>
</o:p>
</p>
</td>
</tr>
</table>
<div>
<div =style=3D'border:none;border-bottom:solid #E0E0E0 1.0pt;padding:0cm 0cm =0cm 0cm;max-width:100%'>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center;background:white'>
<span =style=3D'font-family:"Helvetica",sans-serif;display:none'>
<o:p>
&nbsp;</o:=p>
</span>
</p>
<div align=3Dcenter>
<table class=3DMsoNormalTable =border=3D0 cellspacing=3D0 cellpadding=3D0 width=3D"100%" =style=3D'width:100.0%;background:white'>
<tr>
<td style=3D'padding:0cm 0cm =0cm 0cm'>
</td>
</tr>
<tr>
<td style=3D'padding:0cm 0cm 0cm 0cm'>
<div>
<p =class=3DMsoNormal style=3D'line-height:13.5pt'>
<b>
<span =style=3D'font-size:10.0pt;color:#424242'>
Gracias por llenar <a =href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKM=wg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link">
Registro de =Atenci=C3=B3n Domiciliaria =Oncovida</a>
<o:p>
</o:p>
</span>
</b>
</p>
</div>
</td>
</tr>
<tr>
<td =style=3D'padding:0cm 0cm 0cm 0cm'>
</td>
</tr>
<tr>
<td style=3D'padding:0cm =0cm 0cm 0cm'>
<div>
<p class=3DMsoNormal =style=3D'line-height:13.5pt'>
<span =style=3D'font-size:10.0pt;color:#424242'>
Estas son tus =respuestas:<o:p>
</o:p>
</span>
</p>
</div>
</td>
</tr>
<tr>
<td =style=3D'padding:0cm 0cm 0cm 0cm'>
<div>
<div>
<h1 =style=3D'mso-margin-top-alt:8.05pt;margin-right:0cm;margin-bottom:8.05pt;=margin-left:0cm'>
Registro de Atenci=C3=B3n Domiciliaria =Oncovida<o:p>
</o:p>
</h1>
<div =style=3D'margin-bottom:12.0pt;white-space:pre-wrap;word-wrap:break-word'>
=<p class=3DMsoNormal>
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.<o:p>
</o:p>
</p>
</div>
</div>
<div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Direcci=C3=B3n de correo =electr=C3=B3nico <span class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
<a =href=3D"mailto:carolinazagal@telemed-chile.cl">
carolinazagal@telemed-chil=e.cl</a>
<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div>
</div>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<p class=3DMsoNormal =align=3Dright style=3D'text-align:right;vertical-align:middle'>
<img =border=3D0 id=3D"_x0000_i1026" =src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN3=7sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" alt=3D"Imagen sin =t=C3=ADtulo">
<o:p>
</o:p>
</p>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<h2 =style=3D'mso-margin-top-alt:24.0pt;margin-right:-4.8pt;margin-bottom:0cm;=margin-left:-4.8pt;margin-bottom:.0001pt;background:#EEEEEE;vertical-alig=n:middle'>
Identificaci=C3=B3n del Prestador<o:p>
</o:p>
</h2>
<div>
<p =class=3DMsoNormal style=3D'vertical-align:middle'>
Aqu=C3=AD debe =ingresar sus datos personales<o:p>
</o:p>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Primer Nombre y Apellido Paterno =<span class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
Carolina =Zagal<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
RUT <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'margin-top:1.2pt;margin-bottom:3.0pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<span style=3D'color:#666666'>
RUT con =Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: =5632200-k)<o:p>
</o:p>
</span>
</p>
</div>
<div style=3D'border:solid silver =1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
16938426-6<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div=>
</div>
<p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Tipo <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'margin-top:1.2pt;margin-bottom:3.0pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<span style=3D'color:#666666'>
Si asisten =m=C3=A1s de 1 prestador simult=C3=A1neamente, cada uno debe hacer un =registro independiente<o:p>
</o:p>
</span>
</p>
</div>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
[ENFERMERA/O&nbsp;\/] =<o:p>
</o:p>
</p>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<p class=3DMsoNormal =align=3Dright style=3D'text-align:right;vertical-align:middle'>
<img =border=3D0 id=3D"_x0000_i1027" =src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5=mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" alt=3D"Imagen sin =t=C3=ADtulo">
<o:p>
</o:p>
</p>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<h2 =style=3D'mso-margin-top-alt:24.0pt;margin-right:-4.8pt;margin-bottom:0cm;=margin-left:-4.8pt;margin-bottom:.0001pt;background:#EEEEEE;vertical-alig=n:middle'>
Identificaci=C3=B3n del Paciente<o:p>
</o:p>
</h2>
<div>
<p =class=3DMsoNormal style=3D'vertical-align:middle'>
En esta secci=C3=B3n =debe ingresar los datos del paciente =visitado<o:p>
</o:p>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<h2 =style=3D'mso-margin-top-alt:24.0pt;margin-right:-4.8pt;margin-bottom:0cm;=margin-left:-4.8pt;margin-bottom:.0001pt;background:#EEEEEE;vertical-alig=n:middle'>
Datos Personales del =Paciente<o:p>
</o:p>
</h2>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Ingrese el Rut del Paciente <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'margin-top:1.2pt;margin-bottom:3.0pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<span style=3D'color:#666666'>
RUT con =Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: =5632200-k)<o:p>
</o:p>
</span>
</p>
</div>
<div style=3D'border:solid silver =1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
9015729-9<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div>
=</div>
<p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Ingrese el Primer Nombre y Apellido =Paterno del Paciente <span class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
Marco =Villalobos<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Previsi=C3=B3n <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<p =class=3DMsoNormal style=3D'vertical-align:middle'>
[COLMENA&nbsp;\/] =<o:p>
</o:p>
</p>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Ciudad <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
Arica<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div>
</di=v>
<p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Comuna <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
Arica<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div>
</di=v>
<p class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<p class=3DMsoNormal =align=3Dright style=3D'text-align:right;vertical-align:middle'>
<img =border=3D0 id=3D"_x0000_i1028" =src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Of=zul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" alt=3D"Imagen sin =t=C3=ADtulo">
<o:p>
</o:p>
</p>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<h2 =style=3D'mso-margin-top-alt:24.0pt;margin-right:-4.8pt;margin-bottom:0cm;=margin-left:-4.8pt;margin-bottom:.0001pt;background:#EEEEEE;vertical-alig=n:middle'>
Registro de la Atenci=C3=B3n =Domiciliaria<o:p>
</o:p>
</h2>
<div>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
En esta secci=C3=B3n debe ingresar los =datos de la atenci=C3=B3n =domiciliaria<o:p>
</o:p>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Tipo de Atenci=C3=B3n <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<p =class=3DMsoNormal =style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:=l1 level1 lfo1;vertical-align:middle'>
<![if !supportLists]>
<span =style=3D'font-size:10.0pt;font-family:Symbol'>
<span =style=3D'mso-list:Ignore'>
=C2=B7<span style=3D'font:7.0pt "Times New =Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =</span>
</span>
</span>
<![endif]>
<span =class=3Dss-choice-item-control>
(X)</span>
 <span =class=3Dss-choice-label>
Domicilio</span>
 <o:p>
</o:p>
</p>
<p =class=3DMsoNormal =style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:=l1 level1 lfo1;vertical-align:middle'>
<![if !supportLists]>
<span =style=3D'font-size:10.0pt;font-family:Symbol'>
<span =style=3D'mso-list:Ignore'>
=C2=B7<span style=3D'font:7.0pt "Times New =Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =</span>
</span>
</span>
<![endif]>
<span =class=3Dss-choice-item-control>
(&nbsp;)</span>
 <span =class=3Dss-choice-label>
Ambulatorio</span>
 =<o:p>
</o:p>
</p>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Fecha de la Atenci=C3=B3n <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div>
<div= style=3D'border:solid gainsboro 1.0pt;padding:0cm 0cm 0cm =2.0pt;margin-left:2.25pt;margin-top:3.0pt;margin-right:2.25pt;margin-bott=om:3.0pt;min-height:32px;display:inline-block'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
[abril&nbsp;\/] [2&nbsp;\/] =[2019&nbsp;\/] <o:p>
</o:p>
</p>
</div>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Hora de la Atenci=C3=B3n <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div>
<div= style=3D'border:solid gainsboro 1.0pt;padding:0cm 0cm 0cm =2.0pt;margin-left:2.25pt;margin-top:3.0pt;margin-right:2.25pt;margin-bott=om:3.0pt;min-height:32px;display:inline-block'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
[11&nbsp;\/] . [00&nbsp;\/] =<o:p>
</o:p>
</p>
</div>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Performance Status ECOG del Paciente =<span class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<p =class=3DMsoNormal style=3D'vertical-align:middle'>
[0&nbsp;\/] =<o:p>
</o:p>
</p>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt;overflow-x:auto'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Escala Dolor EVA Actual =<o:p>
</o:p>
</b>
</p>
</div>
<table class=3DMsoNormalTable border=3D0 =cellspacing=3D0 cellpadding=3D0 id=3D"entry_1421689035">
<tr>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
0<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
1<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
2<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
3<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
4<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
5<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
6<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
7<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
8<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
9<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
10<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
</tr>
<tr>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =0cm'>
</td>
<td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt =6.0pt 3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(X)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 0cm 6.0pt =3.0pt'>
</td>
</tr>
</table>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Escala Dolor EVA M=C3=A1ximo =<o:p>
</o:p>
</b>
</p>
</div>
<table class=3DMsoNormalTable border=3D0 =cellspacing=3D0 cellpadding=3D0 id=3D"entry_1244707512">
<tr>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
0<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
1<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
2<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
3<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
4<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
5<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
6<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
7<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
8<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
9<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
10<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
</tr>
<tr>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =0cm'>
</td>
<td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt =6.0pt 3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(X)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 0cm 6.0pt =3.0pt'>
</td>
</tr>
</table>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt;overflow-x:auto'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Escala Dolor EVA M=C3=ADnimo =<o:p>
</o:p>
</b>
</p>
</div>
<table class=3DMsoNormalTable border=3D0 =cellspacing=3D0 cellpadding=3D0 id=3D"entry_853118630">
<tr>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
0<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
1<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
2<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
3<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
4<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
5<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
6<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
7<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
8<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
9<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
<p class=3DMsoNormal =align=3Dcenter style=3D'text-align:center'>
10<o:p>
</o:p>
</p>
</td>
<td =style=3D'padding:3.75pt 3.75pt 3.75pt 3.75pt'>
</td>
</tr>
<tr>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =0cm'>
</td>
<td style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt =6.0pt 3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(X)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt =3.0pt'>
<div>
<p class=3DMsoNormal align=3Dcenter =style=3D'text-align:center'>
<span =style=3D'color:#666666'>
(&nbsp;)<o:p>
</o:p>
</span>
</p>
</div>
</td>
<td =style=3D'border:solid #D3D8D3 1.0pt;padding:6.0pt 0cm 6.0pt =3.0pt'>
</td>
</tr>
</table>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Anamnesis/Evoluci=C3=B3n <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
Paciente en buenas condiciones generales, sin =dolor EVA 0/10, actualmente no consume ning=C3=BAn medicamento =paliativo. Refiere bajo estado an=C3=ADmico luego de control con =otorrinolaringologo, por lo que acepta atenci=C3=B3n por parte de =psic=C3=B3logo.<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Examen F=C3=ADsico <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
Paciente sin variaciones e su estado de =salud.<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Diagn=C3=B3stico <span =class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
Carcinoma escamoso de amigdala =izquierda<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Plan de Tratamiento e Indicaciones =<span class=3Dss-required-asterisk>
<span =style=3D'color:#C43B1D'>
*</span>
</span>
<o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt =4.0pt;max-width:90%;white-space:pre-wrap'>
<p class=3DMsoNormal =style=3D'background:#EEEEEE;vertical-align:middle'>
<span =style=3D'color:#545454'>
Se solicita evaluaci=C3=B3n por psic=C3=B3logo y =nutricionista lo antes =posible.<o:p>
</o:p>
</span>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Medicamentos Indicados =<o:p>
</o:p>
</b>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Fecha aproximada del Pr=C3=B3ximo =Control con usted <o:p>
</o:p>
</b>
</p>
</div>
<div>
<div =style=3D'border:solid gainsboro 1.0pt;padding:0cm 0cm 0cm =2.0pt;margin-left:2.25pt;margin-top:3.0pt;margin-right:2.25pt;margin-bott=om:3.0pt;min-height:32px;display:inline-block'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
[abril&nbsp;\/] [8&nbsp;\/] =[2019&nbsp;\/] <o:p>
</o:p>
</p>
</div>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Tratamiento Realizado (si =corresponde) <o:p>
</o:p>
</b>
</p>
</div>
</div>
</div>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<div =style=3D'margin-top:9.95pt;margin-bottom:9.95pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<b>
Derivaci=C3=B3n a otro Prestador =Domiciliario <o:p>
</o:p>
</b>
</p>
</div>
<div =style=3D'margin-top:1.2pt;margin-bottom:3.0pt'>
<p class=3DMsoNormal =style=3D'vertical-align:middle'>
<span style=3D'color:#666666'>
S=C3=B3lo =llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro =prestador del equipo<o:p>
</o:p>
</span>
</p>
</div>
<p class=3DMsoNormal =style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:=l0 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span =style=3D'font-size:10.0pt;font-family:Symbol'>
<span =style=3D'mso-list:Ignore'>
=C2=B7<span style=3D'font:7.0pt "Times New =Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =</span>
</span>
</span>
<![endif]>
<span =class=3Dss-choice-item-control>
[&nbsp;]</span>
 <span =class=3Dss-choice-label>
ENFERMERA</span>
 <o:p>
</o:p>
</p>
<p =class=3DMsoNormal =style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:=l0 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span =style=3D'font-size:10.0pt;font-family:Symbol'>
<span =style=3D'mso-list:Ignore'>
=C2=B7<span style=3D'font:7.0pt "Times New =Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =</span>
</span>
</span>
<![endif]>
<span =class=3Dss-choice-item-control>
[&nbsp;]</span>
 <span =class=3Dss-choice-label>
TENS</span>
 <o:p>
</o:p>
</p>
<p class=3DMsoNormal =style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:=l0 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span =style=3D'font-size:10.0pt;font-family:Symbol'>
<span =style=3D'mso-list:Ignore'>
=C2=B7<span style=3D'font:7.0pt "Times New =Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =</span>
</span>
</span>
<![endif]>
<span =class=3Dss-choice-item-control>
[X]</span>
 <span =class=3Dss-choice-label>
NUTRICIONISTA</span>
 <o:p>
</o:p>
</p>
<p =class=3DMsoNormal =style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:=l0 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span =style=3D'font-size:10.0pt;font-family:Symbol'>
<span =style=3D'mso-list:Ignore'>
=C2=B7<span style=3D'font:7.0pt "Times New =Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =</span>
</span>
</span>
<![endif]>
<span =class=3Dss-choice-item-control>
[&nbsp;]</span>
 <span =class=3Dss-choice-label>
KINESIOLOGO</span>
 <o:p>
</o:p>
</p>
<p =class=3DMsoNormal =style=3D'margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:=l0 level1 lfo2;vertical-align:middle'>
<![if !supportLists]>
<span =style=3D'font-size:10.0pt;font-family:Symbol'>
<span =style=3D'mso-list:Ignore'>
=C2=B7<span style=3D'font:7.0pt "Times New =Roman"'>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; =</span>
</span>
</span>
<![endif]>
<span =class=3Dss-choice-item-control>
[X]</span>
 <span =class=3Dss-choice-label>
PSICOLOGO</span>
 =<o:p>
</o:p>
</p>
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<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
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<div>
<div =style=3D'margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%'>
<div =style=3D'margin-bottom:18.0pt;max-width:100%'>
<p class=3DMsoNormal =align=3Dright style=3D'text-align:right;vertical-align:middle'>
<img =border=3D0 id=3D"_x0000_i1029" =src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmY=QL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" alt=3D"Imagen sin =t=C3=ADtulo">
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</td>
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<tr>
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</td>
</tr>
<tr>
<td style=3D'padding:0cm =0cm 0cm 0cm'>
<p class=3DMsoNormal>
<a =href=3D"https://docs.google.com/forms?usp=3Dmail_form_link">
<span =style=3D'font-size:10.0pt;color:#424242'>
Crear tu propio Formulario de =Google</span>
</a>
<o:p>
</o:p>
</p>
</td>
</tr>
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