X-AntiAbuse: Primary Hostname - ns1.hostnow.clX-AntiAbuse: Original Domain - telemed-chile.clX-AntiAbuse: Originator/Caller UID/GID - [47 12] / [47 12]X-AntiAbuse: Sender Address Domain - gmail.comX-Get-Message-Sender-Via: ns1.hostnow.cl: redirect/forwarder owner informeges@telemed-chile.cl ->
 informeges@inhedo.comX-Authenticated-Sender: ns1.hostnow.cl: informeges@telemed-chile.clX-Source: X-Source-Args: X-Source-Dir: X-Spam-Status: Yes, score=5.6X-Spam-Score: 56X-Spam-Bar: +++++X-Spam-Report: Spam detection software, running on the system "host213.hostmonster.com", has identified this incoming email as possible spam.  The original message has been attached to this so you can view it or label similar future email.  If you have any questions, see root\@localhost for details.  Content preview:  Enviado desde mi HUAWEI Mate 20 lite -------- Mensaje original    -------- Asunto: Registro de Atención Domiciliaria Oncovida De: Formularios    de Google Para: Gracias por rellenar Registro de Atención  Content analysis details:   (5.6 points, 5.0 required)   pts rule name              description ---- ---------------------- --------------------------------------------------  0.0 URIBL_BLOCKED          ADMINISTRATOR NOTICE: The query to URIBL was blocked.                             See                             http://wiki.apache.org/spamassassin/DnsBlocklists#dnsbl-block                              for more information.                             [URIs: docs.google.com]  1.0 SPF_SOFTFAIL           SPF: sender does not match SPF record (softfail)  0.5 FREEMAIL_FROM          Sender email is commonly abused enduser mail provider                             (sandramaulenangel[at]gmail.com)  1.1 MIME_HTML_ONLY         BODY: Message only has text/html MIME parts  2.4 HTML_OBFUSCATE_20_30   BODY: Message is 20% to 30% HTML obfuscation  0.0 HTML_MESSAGE           BODY: HTML included in message -0.1 DKIM_VALID             Message has at least one valid DKIM or DK signature -0.1 DKIM_VALID_AU          Message has a valid DKIM or DK signature from author's                             domain  0.1 DKIM_SIGNED            Message has a DKIM or DK signature, not necessarily valid  0.6 HTML_MIME_NO_HTML_TAG  HTML-only message, but there is no HTML tagX-Spam-Flag: NO<br>
<br>
Enviado desde mi HUAWEI Mate 20 lite<div style="line-height:1.5">
<br>
<br>
-------- Mensaje original --------<br>
Asunto: Registro de Atención Domiciliaria Oncovida<br>
De: Formularios de Google <forms-receipts-noreply@google.com>
<br>
Para: SANDRAMAULENANGEL@GMAIL.COM<br>
CC: <br>
<br>
<blockquote style="margin:0 0 0 0.8ex;border-left:1px #ccc solid;padding-left:1ex">
<blockquote class="quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex">
<div style="font-family:&#39;roboto&#39; , &#39;helvetica&#39; , &#39;arial&#39; , sans-serif;margin:0;padding:0;height:100%;width:100%">
<table border="0" cellpadding="0" cellspacing="0" style="background-color:rgb( 38 , 4 , 154 )" width="100%">
<tbody>
<tr>
<td style="padding-left:24px">
<img alt="Formularios de Google" height="26px" style="display:inline-block;margin:0;vertical-align:middle" width="143px" src="https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png" />
</td>
</tr>
</tbody>
</table>
<div style="padding:24px;background-color:rgb( 229 , 218 , 254 )">
<div align="center" style="background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table align="center" cellpadding="0" cellspacing="0" style="background-color:#fff" width="100%">
<tbody>
<tr>
<td>
</td>
</tr>
<tr>
<td>
<div style="font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por rellenar <a href="https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp&#61;mail_form_link">
Registro de Atención Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr>
</tr>
<tr>
<td>
<div style="font-size:13px;line-height:18px;color:#424242">
Esto es lo que nos has enviado:</div>
</td>
</tr>
<tr>
<td>
<div>
<div>
<h1 dir="ltr" style="margin:0.67em 0">
Registro de Atención Domiciliaria Oncovida</h1>

<div style="font:inherit;width:99%;margin:0 0 1em;white-space:pre-wrap;word-wrap:break-word">
Este es el sistema de registro de atenciones domiciliarias de Oncovida.   Debe ser llenado por el prestador individual, y debe realizarse un registro por cada visita domiciliaria.   Si usted no es prestador de Oncovida por favor no llene este formulario.   A continuación indique su correo electrónico.</div>

</div>

<div>
<form action="" method="GET">
<br />

<div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Dirección de correo electrónico
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
SANDRAMAULENANGEL&#64;GMAIL.COM</div>



</div>
</div>
</div>

<div>

<div dir="auto" style="margin:12px 0;max-width:100%">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<h2 style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>

<div style="text-align:right">
<img src="https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style="width:78px;outline:none" alt="Imagen sin leyenda" />
</div>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<h2 style="margin:2em 0;padding:0.4em;background-color:#eee">
Identificación del Prestador</h2>

<div dir="auto" style="white-space:pre-wrap;word-wrap:break-word">
Aquí debe ingresar sus datos personales</div>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Primer Nombre y Apellido Paterno
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
SANDRA MAULEN</div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
RUT
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
RUT con Guión y Dígito Verificador, sin puntos ( Ej: 5632200-k)</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
16621429-7</div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tipo
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
Si asisten más de 1 prestador simultáneamente, cada uno debe hacer un registro independiente</div>


<select name="entry.133691676" disabled="disabled">
<option value="">
</option>
<option value="MEDICO" disabled="disabled">
MEDICO</option>
<option value="ENFERMERA/O" disabled="disabled" selected="selected">
ENFERMERA/O</option>
<option value="TENS" disabled="disabled">
TENS</option>
<option value="KINESIOLOGA/O" disabled="disabled">
KINESIOLOGA/O</option>
<option value="PSICOLOGO" disabled="disabled">
PSICOLOGO</option>
<option value="NUTRICIONISTA" disabled="disabled">
NUTRICIONISTA</option>
</select>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0;max-width:100%">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<h2 style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>

<div style="text-align:right">
<img src="https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style="width:78px;outline:none" alt="Imagen sin leyenda" />
</div>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<h2 style="margin:2em 0;padding:0.4em;background-color:#eee">
Identificación del Paciente</h2>

<div dir="auto" style="white-space:pre-wrap;word-wrap:break-word">
En esta sección debe ingresar los datos del paciente visitado</div>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<h2 style="background-color:#eee;padding:0.4em;margin:2em 0">
Datos Personales del Paciente</h2>

<div style="margin-top:0.5em;white-space:pre-wrap;word-wrap:break-word">
</div>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ingrese el Rut del Paciente
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
RUT con Guión y Dígito Verificador, sin puntos ( Ej: 5632200-k)</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
3843642-2</div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
ALAMIRO PACHECO</div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Previsión
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<select name="entry.545002227" disabled="disabled">
<option value="">
</option>
<option value="BANMEDICA" disabled="disabled" selected="selected">
BANMEDICA</option>
<option value="CAPREDENA" disabled="disabled">
CAPREDENA</option>
<option value="COLMENA" disabled="disabled">
COLMENA</option>
<option value="CONSALUD" disabled="disabled">
CONSALUD</option>
<option value="CRUZ BLANCA" disabled="disabled">
CRUZ BLANCA</option>
<option value="DIPRECA" disabled="disabled">
DIPRECA</option>
<option value="FONASA" disabled="disabled">
FONASA</option>
<option value="FUNDACION" disabled="disabled">
FUNDACION</option>
<option value="ISAPRES DEL COBRE" disabled="disabled">
ISAPRES DEL COBRE</option>
<option value="NUEVA MASVIDA" disabled="disabled">
NUEVA MASVIDA</option>
<option value="VIDATRES" disabled="disabled">
VIDATRES</option>
<option value="PARTICULAR" disabled="disabled">
PARTICULAR</option>
</select>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ciudad
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
VIÑA DEL MAR </div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Comuna
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
VIÑA DEL MAR </div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0;max-width:100%">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<h2 style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>

<div style="text-align:right">
<img src="https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style="width:78px;outline:none" alt="Imagen sin leyenda" />
</div>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<h2 style="margin:2em 0;padding:0.4em;background-color:#eee">
Registro de la Atención Domiciliaria</h2>

<div dir="auto" style="white-space:pre-wrap;word-wrap:break-word">
En esta sección debe ingresar los datos de la atención domiciliaria</div>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tipo de Atención
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>



<ul style="list-style:none;padding:0;margin:0.5em 0 0">
<li style="margin:0;line-height:1.3em;padding-bottom:0.5em">

<label>
<span style="display:inline-block">
<input type="radio" name="entry.1222378237" disabled="disabled" checked="checked" value="Domicilio" />
</span>

Domicilio
</label>
</li>
<li style="margin:0;line-height:1.3em;padding-bottom:0.5em">

<label>
<span style="display:inline-block">
<input type="radio" name="entry.1222378237" disabled="disabled" value="Ambulatorio" />
</span>

Ambulatorio
</label>
</li>
</ul>


</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Fecha de la Atención
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div>
<div style="border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name="entry.1705849412_day" disabled="disabled">
<option value="">
Día</option>
<option value="1" selected="selected">
1</option>
<option value="2">
2</option>
<option value="3">
3</option>
<option value="4">
4</option>
<option value="5">
5</option>
<option value="6">
6</option>
<option value="7">
7</option>
<option value="8">
8</option>
<option value="9">
9</option>
<option value="10">
10</option>
<option value="11">
11</option>
<option value="12">
12</option>
<option value="13">
13</option>
<option value="14">
14</option>
<option value="15">
15</option>
<option value="16">
16</option>
<option value="17">
17</option>
<option value="18">
18</option>
<option value="19">
19</option>
<option value="20">
20</option>
<option value="21">
21</option>
<option value="22">
22</option>
<option value="23">
23</option>
<option value="24">
24</option>
<option value="25">
25</option>
<option value="26">
26</option>
<option value="27">
27</option>
<option value="28">
28</option>
<option value="29">
29</option>
<option value="30">
30</option>
<option value="31">
31</option>
</select>
   <select name="entry.1705849412_month" disabled="disabled">
<option value="">
Mes</option>
<option value="1">
enero</option>
<option value="2">
febrero</option>
<option value="3">
marzo</option>
<option value="4" selected="selected">
abril</option>
<option value="5">
mayo</option>
<option value="6">
junio</option>
<option value="7">
julio</option>
<option value="8">
agosto</option>
<option value="9">
septiembre</option>
<option value="10">
octubre</option>
<option value="11">
noviembre</option>
<option value="12">
diciembre</option>
</select>
 
<select name="entry.1705849412_year" disabled="disabled">
<option value="">
Año</option>
<option value="1896">
1896</option>
<option value="1897">
1897</option>
<option value="1898">
1898</option>
<option value="1899">
1899</option>
<option value="1900">
1900</option>
<option value="1901">
1901</option>
<option value="1902">
1902</option>
<option value="1903">
1903</option>
<option value="1904">
1904</option>
<option value="1905">
1905</option>
<option value="1906">
1906</option>
<option value="1907">
1907</option>
<option value="1908">
1908</option>
<option value="1909">
1909</option>
<option value="1910">
1910</option>
<option value="1911">
1911</option>
<option value="1912">
1912</option>
<option value="1913">
1913</option>
<option value="1914">
1914</option>
<option value="1915">
1915</option>
<option value="1916">
1916</option>
<option value="1917">
1917</option>
<option value="1918">
1918</option>
<option value="1919">
1919</option>
<option value="1920">
1920</option>
<option value="1921">
1921</option>
<option value="1922">
1922</option>
<option value="1923">
1923</option>
<option value="1924">
1924</option>
<option value="1925">
1925</option>
<option value="1926">
1926</option>
<option value="1927">
1927</option>
<option value="1928">
1928</option>
<option value="1929">
1929</option>
<option value="1930">
1930</option>
<option value="1931">
1931</option>
<option value="1932">
1932</option>
<option value="1933">
1933</option>
<option value="1934">
1934</option>
<option value="1935">
1935</option>
<option value="1936">
1936</option>
<option value="1937">
1937</option>
<option value="1938">
1938</option>
<option value="1939">
1939</option>
<option value="1940">
1940</option>
<option value="1941">
1941</option>
<option value="1942">
1942</option>
<option value="1943">
1943</option>
<option value="1944">
1944</option>
<option value="1945">
1945</option>
<option value="1946">
1946</option>
<option value="1947">
1947</option>
<option value="1948">
1948</option>
<option value="1949">
1949</option>
<option value="1950">
1950</option>
<option value="1951">
1951</option>
<option value="1952">
1952</option>
<option value="1953">
1953</option>
<option value="1954">
1954</option>
<option value="1955">
1955</option>
<option value="1956">
1956</option>
<option value="1957">
1957</option>
<option value="1958">
1958</option>
<option value="1959">
1959</option>
<option value="1960">
1960</option>
<option value="1961">
1961</option>
<option value="1962">
1962</option>
<option value="1963">
1963</option>
<option value="1964">
1964</option>
<option value="1965">
1965</option>
<option value="1966">
1966</option>
<option value="1967">
1967</option>
<option value="1968">
1968</option>
<option value="1969">
1969</option>
<option value="1970">
1970</option>
<option value="1971">
1971</option>
<option value="1972">
1972</option>
<option value="1973">
1973</option>
<option value="1974">
1974</option>
<option value="1975">
1975</option>
<option value="1976">
1976</option>
<option value="1977">
1977</option>
<option value="1978">
1978</option>
<option value="1979">
1979</option>
<option value="1980">
1980</option>
<option value="1981">
1981</option>
<option value="1982">
1982</option>
<option value="1983">
1983</option>
<option value="1984">
1984</option>
<option value="1985">
1985</option>
<option value="1986">
1986</option>
<option value="1987">
1987</option>
<option value="1988">
1988</option>
<option value="1989">
1989</option>
<option value="1990">
1990</option>
<option value="1991">
1991</option>
<option value="1992">
1992</option>
<option value="1993">
1993</option>
<option value="1994">
1994</option>
<option value="1995">
1995</option>
<option value="1996">
1996</option>
<option value="1997">
1997</option>
<option value="1998">
1998</option>
<option value="1999">
1999</option>
<option value="2000">
2000</option>
<option value="2001">
2001</option>
<option value="2002">
2002</option>
<option value="2003">
2003</option>
<option value="2004">
2004</option>
<option value="2005">
2005</option>
<option value="2006">
2006</option>
<option value="2007">
2007</option>
<option value="2008">
2008</option>
<option value="2009">
2009</option>
<option value="2010">
2010</option>
<option value="2011">
2011</option>
<option value="2012">
2012</option>
<option value="2013">
2013</option>
<option value="2014">
2014</option>
<option value="2015">
2015</option>
<option value="2016">
2016</option>
<option value="2017">
2017</option>
<option value="2018">
2018</option>
<option value="2019" selected="selected">
2019</option>
<option value="2020">
2020</option>
<option value="2021">
2021</option>
<option value="2022">
2022</option>
<option value="2023">
2023</option>
<option value="2024">
2024</option>
<option value="2025">
2025</option>
<option value="2026">
2026</option>
<option value="2027">
2027</option>
<option value="2028">
2028</option>
<option value="2029">
2029</option>
<option value="2030">
2030</option>
<option value="2031">
2031</option>
<option value="2032">
2032</option>
<option value="2033">
2033</option>
<option value="2034">
2034</option>
<option value="2035">
2035</option>
<option value="2036">
2036</option>
<option value="2037">
2037</option>
<option value="2038">
2038</option>
<option value="2039">
2039</option>
<option value="2040">
2040</option>
<option value="2041">
2041</option>
<option value="2042">
2042</option>
<option value="2043">
2043</option>
<option value="2044">
2044</option>
<option value="2045">
2045</option>
<option value="2046">
2046</option>
<option value="2047">
2047</option>
<option value="2048">
2048</option>
<option value="2049">
2049</option>
<option value="2050">
2050</option>
<option value="2051">
2051</option>
<option value="2052">
2052</option>
<option value="2053">
2053</option>
<option value="2054">
2054</option>
<option value="2055">
2055</option>
<option value="2056">
2056</option>
<option value="2057">
2057</option>
<option value="2058">
2058</option>
<option value="2059">
2059</option>
<option value="2060">
2060</option>
<option value="2061">
2061</option>
<option value="2062">
2062</option>
<option value="2063">
2063</option>
<option value="2064">
2064</option>
<option value="2065">
2065</option>
<option value="2066">
2066</option>
<option value="2067">
2067</option>
<option value="2068">
2068</option>
<option value="2069">
2069</option>
</select>

</div>

</div>
</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0;font:inherit">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Hora de la Atención
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div>
<div dir="ltr" style="border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
<select name="entry.206244955_hour" disabled="disabled">
<option value="">
h</option>
<option value="00">
00</option>
<option value="01">
01</option>
<option value="02">
02</option>
<option value="03">
03</option>
<option value="04">
04</option>
<option value="05">
05</option>
<option value="06">
06</option>
<option value="07">
07</option>
<option value="08">
08</option>
<option value="09">
09</option>
<option value="10">
10</option>
<option value="11">
11</option>
<option value="12">
12</option>
<option value="13">
13</option>
<option value="14">
14</option>
<option value="15">
15</option>
<option value="16">
16</option>
<option value="17">
17</option>
<option value="18">
18</option>
<option value="19" selected="selected">
19</option>
<option value="20">
20</option>
<option value="21">
21</option>
<option value="22">
22</option>
<option value="23">
23</option>
</select>

:
<select name="entry.206244955_minute" disabled="disabled">
<option value="">
min</option>
<option value="00" selected="selected">
00</option>
<option value="01">
01</option>
<option value="02">
02</option>
<option value="03">
03</option>
<option value="04">
04</option>
<option value="05">
05</option>
<option value="06">
06</option>
<option value="07">
07</option>
<option value="08">
08</option>
<option value="09">
09</option>
<option value="10">
10</option>
<option value="11">
11</option>
<option value="12">
12</option>
<option value="13">
13</option>
<option value="14">
14</option>
<option value="15">
15</option>
<option value="16">
16</option>
<option value="17">
17</option>
<option value="18">
18</option>
<option value="19">
19</option>
<option value="20">
20</option>
<option value="21">
21</option>
<option value="22">
22</option>
<option value="23">
23</option>
<option value="24">
24</option>
<option value="25">
25</option>
<option value="26">
26</option>
<option value="27">
27</option>
<option value="28">
28</option>
<option value="29">
29</option>
<option value="30">
30</option>
<option value="31">
31</option>
<option value="32">
32</option>
<option value="33">
33</option>
<option value="34">
34</option>
<option value="35">
35</option>
<option value="36">
36</option>
<option value="37">
37</option>
<option value="38">
38</option>
<option value="39">
39</option>
<option value="40">
40</option>
<option value="41">
41</option>
<option value="42">
42</option>
<option value="43">
43</option>
<option value="44">
44</option>
<option value="45">
45</option>
<option value="46">
46</option>
<option value="47">
47</option>
<option value="48">
48</option>
<option value="49">
49</option>
<option value="50">
50</option>
<option value="51">
51</option>
<option value="52">
52</option>
<option value="53">
53</option>
<option value="54">
54</option>
<option value="55">
55</option>
<option value="56">
56</option>
<option value="57">
57</option>
<option value="58">
58</option>
<option value="59">
59</option>
</select>



<div style="height:32px;vertical-align:middle;display:inline-block">
</div>
</div>
</div>
</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Performance Status ECOG del Paciente
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<select name="entry.1747608258" disabled="disabled">
<option value="">
</option>
<option value="0" disabled="disabled">
0</option>
<option value="1" disabled="disabled">
1</option>
<option value="2" disabled="disabled">
2</option>
<option value="3" disabled="disabled">
3</option>
<option value="4" disabled="disabled" selected="selected">
4</option>
</select>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Escala Dolor EVA Actual
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>



<table border="0" cellpadding="5" cellspacing="0">
<tr>
<td style="text-align:center">
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
0</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
1</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
2</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
3</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
4</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
5</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
6</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
7</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
8</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
9</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
10</label>
</td>
<td style="text-align:center">
</td>
</tr>
<tr>
<td style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em;padding-left:0">
<div>
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="0" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="1" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="2" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="3" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="4" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="5" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="6" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="7" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="8" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="9" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" checked="checked" value="10" />
</div>
</td>
<td style="text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em;padding-right:0">
</td>
</tr>
</table>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Escala Dolor EVA Máximo
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>



<table border="0" cellpadding="5" cellspacing="0">
<tr>
<td style="text-align:center">
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
0</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
1</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
2</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
3</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
4</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
5</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
6</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
7</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
8</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
9</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
10</label>
</td>
<td style="text-align:center">
</td>
</tr>
<tr>
<td style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em;padding-left:0">
<div>
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="0" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="1" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="2" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="3" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="4" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="5" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="6" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="7" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="8" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="9" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" checked="checked" value="10" />
</div>
</td>
<td style="text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em;padding-right:0">
</td>
</tr>
</table>

</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Escala Dolor EVA Mínimo
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>



<table border="0" cellpadding="5" cellspacing="0">
<tr>
<td style="text-align:center">
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
0</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
1</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
2</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
3</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
4</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
5</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
6</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
7</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
8</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
9</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
10</label>
</td>
<td style="text-align:center">
</td>
</tr>
<tr>
<td style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em;padding-left:0">
<div>
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" value="0" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" value="1" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" value="2" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" value="3" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" checked="checked" value="4" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" value="5" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" value="6" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" value="7" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" value="8" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" value="9" />
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.853118630" disabled="disabled" value="10" />
</div>
</td>
<td style="text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em;padding-right:0">
</td>
</tr>
</table>

</div>
</div>
</div>

<br />
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<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Anamnesis/Evolución
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
PACIENTE CON TORPIDA EVOLUCION DE EVOLUCION PASADA SE ENCUENTRA CON MUCHO DOLOR, POR LO CUAL VIA TELEFONICA ME COMUNICO CON DRA CORREA E INDICA CAMBIO DE TTO. 1/2 TRANSTEC CON CAMBIO CADA 72 HORAS Y SUSPENSION DE PARACETAMOL COMPRIMIDO.
LAS 24/7 ENCAMADO
CON MALA TOLERANCIA A LA ALIMENTACION TOLERA MUCHO MEJOR COMIDAS LIQUIDAS ENSURE O LICUADO 
REPOSO Y SUEÑO MAL TOLERADO 
</div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Examen Físico
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
PACIENTE CON HEMODINAMIA ESTABLE NORMOTENSO 120/88 AFEBRIL 36,7 SATURACION OPTIMAS CON 1,5 LITROS DE OXIGENO CON BIGOTERA, DESNEA LEVE AL MINIMO ESFUERZO, SATURACION DE 93%.
PIEL SECA POCO HIDRATADA SE SUGIERE HIDRATACION Y CAMBIOS DE POSICION, SE REALIZA CURACION DE LESION SACRA, HDA GRADO II, SE LAVA CON ABUNDANTE SUERO FISIOLOGICO PINCELO CON CLOREXIDINA LO BORDES AREA CENTRA Y SATELITAL LESIONES CON TEJIDO GRANULATORIO SIN ESFACELO A LA VISTA DEJO GASA PARAFINADA CON CURIOSIN, BORDES APLICO CAVILON SELLO CON GASA Y FIJO CON TEGADERM.
EXTREMIDADES BIEN PEREFUNDIDAS SIN LESIONES PULSOS OK SIN EDEMA
DIURESIS NORMALES DEBITOS ESCASOS POR BAJO INGESTA ORAL DE AGUA 
DEPO DIARIAS TIPO MELANA OBS
</div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Diagnóstico
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
CANCER DE COLON CON METASTASIS PULMONAR </div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Plan de Tratamiento e Indicaciones
<label>
</label>

<span style="color:#c43b1d">
*</span>
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
- MANEJO DEL DOLOR MANEJO DE RESCATE
- APOYO EMOCIONAL PARA FAMILIA 
- APOYO KINESICO 3 VECES POR SEMANA INDICADO POR DRA CORREA
- APOYO NUTRICIONAL SEMANAL 
- PENDIENTE EVALUACION POR CONVATEC PARA VER HERIDA </div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Medicamentos Indicados
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
- 1/2 PARCHE DE TRANSTEC CAMBIO CADA 72 HORAS
- PARACETAMOL 1GR CADA 8 HORAS EN SOS 
- SI NO CEDE DOLOR DE 5 A 10 GOTAS DE TRAMADOL CADA 12 HORAS O EN SOS COMUNICARSE CON ENFERMERA A CARGO</div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Fecha aproximada del Próximo Control con usted
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div>
<div style="border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name="entry.2063615873_day" disabled="disabled">
<option value="">
Día</option>
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1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
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Mes</option>
<option value="1">
enero</option>
<option value="2">
febrero</option>
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marzo</option>
<option value="4" selected="selected">
abril</option>
<option value="5">
mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
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Año</option>
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1896</option>
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1897</option>
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1898</option>
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1899</option>
<option value="1900">
1900</option>
<option value="1901">
1901</option>
<option value="1902">
1902</option>
<option value="1903">
1903</option>
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1904</option>
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1905</option>
<option value="1906">
1906</option>
<option value="1907">
1907</option>
<option value="1908">
1908</option>
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1909</option>
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1910</option>
<option value="1911">
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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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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1948</option>
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1949</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>
<option value="1979">
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>
<option value="1985">
1985</option>
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1986</option>
<option value="1987">
1987</option>
<option value="1988">
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>
<option value="2033">
2033</option>
<option value="2034">
2034</option>
<option value="2035">
2035</option>
<option value="2036">
2036</option>
<option value="2037">
2037</option>
<option value="2038">
2038</option>
<option value="2039">
2039</option>
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2040</option>
<option value="2041">
2041</option>
<option value="2042">
2042</option>
<option value="2043">
2043</option>
<option value="2044">
2044</option>
<option value="2045">
2045</option>
<option value="2046">
2046</option>
<option value="2047">
2047</option>
<option value="2048">
2048</option>
<option value="2049">
2049</option>
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2050</option>
<option value="2051">
2051</option>
<option value="2052">
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>
<option value="2069">
2069</option>
</select>

</div>

</div>
</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tratamiento Realizado (si corresponde)
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>


<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
</div>



</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<label>
</label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Derivación a otro Prestador Domiciliario
</div>

<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
Sólo llene esta sección si es médico y solicita la visita de otro prestador del equipo</div>



<ul style="list-style:none;padding:0;margin:0.5em 0 0">
<li style="margin:0;line-height:1.3em;padding-bottom:0.5em">

<label>
<span style="display:inline-block">
<input type="checkbox" name="entry.503039759" disabled="disabled" value="ENFERMERA" />
</span>

ENFERMERA
</label>
</li>
<li style="margin:0;line-height:1.3em;padding-bottom:0.5em">

<label>
<span style="display:inline-block">
<input type="checkbox" name="entry.503039759" disabled="disabled" value="TENS" />
</span>

TENS
</label>
</li>
<li style="margin:0;line-height:1.3em;padding-bottom:0.5em">

<label>
<span style="display:inline-block">
<input type="checkbox" name="entry.503039759" disabled="disabled" value="NUTRICIONISTA" />
</span>

NUTRICIONISTA
</label>
</li>
<li style="margin:0;line-height:1.3em;padding-bottom:0.5em">

<label>
<span style="display:inline-block">
<input type="checkbox" name="entry.503039759" disabled="disabled" value="KINESIOLOGO" />
</span>

KINESIOLOGO
</label>
</li>
<li style="margin:0;line-height:1.3em;padding-bottom:0.5em">

<label>
<span style="display:inline-block">
<input type="checkbox" name="entry.503039759" disabled="disabled" value="PSICOLOGO" />
</span>

PSICOLOGO
</label>
</li>
</ul>


</div>
</div>
</div>

<br />
 <div>

<div dir="auto" style="margin:12px 0;max-width:100%">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">

<h2 style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>

<div style="text-align:right">
<img src="https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style="width:78px;outline:none" alt="Imagen sin leyenda" />
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</td>
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<tr>
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</tbody>
</table>
</div>
<table align="center" cellpadding="0" cellspacing="0" style="max-width:672px;min-width:154px" width="100%">
<tbody>
<tr>
<td>
</td>
</tr>
<tr>
<td>
<a href="https://docs.google.com/forms?usp&#61;mail_form_link" style="color:#424242;font-size:13px">
Crea tu propio formulario de Google</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</blockquote>
</div>
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