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<p class=3DMsoNormal>
<span =style=3D'font-size:12.0pt;font-family:"Arial",sans-serif;color:#222222;ba=ckground:white'>
Estimados,</span>
<o:p>
</o:p>
</p>
<p class=3DMsoNormal =style=3D'background:white'>
<span =style=3D'font-size:12.0pt;font-family:"Arial",sans-serif;color:#222222'>
J=unto con saludar, env=C3=ADo informe de visita domiciliaria realizada al =paciente John McVey&nbsp; el d=C3=ADa de hoy 11 de abril del =2019.<o:p>
</o:p>
</span>
</p>
<p class=3DMsoNormal =style=3D'background:white'>
<span =style=3D'font-size:12.0pt;font-family:"Arial",sans-serif;color:#222222'>
<=o:p>
&nbsp;</o:p>
</span>
</p>
<p class=3DMsoNormal =style=3D'background:white'>
<span =style=3D'font-size:12.0pt;font-family:"Arial",sans-serif;color:#222222'>
S=aludos cordiales<o:p>
</o:p>
</span>
</p>
<p class=3DMsoNormal>
<span =style=3D'mso-fareast-language:EN-US'>
<o:p>
&nbsp;</o:p>
</span>
</p>
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<span =style=3D'mso-fareast-language:EN-US'>
<o:p>
&nbsp;</o:p>
</span>
</p>
<div>
<p =class=3DMsoNormal>
<b>
<i>
<span style=3D'color:#1F4E79'>
Muriel Su=C3=A1rez =S.<o:p>
</o:p>
</span>
</i>
</b>
</p>
<p class=3DMsoNormal>
<b>
<i>
<span =style=3D'color:#1F4E79'>
Enfermera<o:p>
</o:p>
</span>
</i>
</b>
</p>
<p =class=3DMsoNormal>
<img width=3D93 height=3D62 =style=3D'width:.9687in;height:.6458in' id=3D"Imagen_x0020_1" =src=3D"cid:image001.jpg@01D4F092.49285B20" =alt=3Dimage003>
<o:p>
</o:p>
</p>
</div>
<p class=3DMsoNormal>
<span =style=3D'mso-fareast-language:EN-US'>
<o:p>
&nbsp;</o:p>
</span>
</p>
<div>
<di=v style=3D'border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0cm =0cm 0cm'>
<p class=3DMsoNormal>
<b>
De:</b>
 Formularios de Google =&lt;forms-receipts-noreply@google.com&gt; <br>
<b>
Enviado el:</b>
 jueves, =11 de abril de 2019 17:54<br>
<b>
Para:</b>
 =murielsuarez@telemed-chile.cl<br>
<b>
Asunto:</b>
 Registro de =Atenci=C3=B3n Domiciliaria Oncovida<o:p>
</o:p>
</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>
<span style=3D'color:white =!msorm'>
<span style=3D'color:windowtext;border:solid windowtext =1.0pt;padding:0cm'>
<img width=3D100 height=3D100 =style=3D'width:1.0416in;height:1.0416in' id=3D"_x0000_i1025" =src=3D"cid:~WRD000.jpg" alt=3D"Imagen quitada por el remitente. =Formularios de Google">
</span>
</span>
<span =style=3D'color:windowtext'>
<span =style=3D'color:white'>
<o:p>
</o:p>
</span>
</span>
</p>
</td>
</tr>
</table>
<div=>
<div style=3D'border:none;border-bottom:solid #E0E0E0 1.0pt;padding:0cm =0cm 0cm 0cm;min-width: 154px'>
<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 rellenar <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'>
Esto es lo que nos has =enviado:<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'>
murielsuarez@telemed-chile.cl<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'>
<span =style=3D'border:solid windowtext 1.0pt;padding:0cm'>
<img border=3D0 =width=3D100 height=3D100 style=3D'width:1.0416in;height:1.0416in' =id=3D"_x0000_i1026" src=3D"cid:~WRD000.jpg" alt=3D"Imagen quitada por el =remitente. Imagen sin =leyenda">
</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%'>
<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'>
Muriel =Su=C3=A1rez<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'>
18955696-9<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>
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'>
<span =style=3D'border:solid windowtext 1.0pt;padding:0cm'>
<img border=3D0 =width=3D100 height=3D100 style=3D'width:1.0416in;height:1.0416in' =id=3D"_x0000_i1027" src=3D"cid:~WRD000.jpg" alt=3D"Imagen quitada por el =remitente. Imagen sin =leyenda">
</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%'>
<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'>
7986475-7<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'>
John =McVey<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'>
[NUEVA =MASVIDA&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'>
Curacavi<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>
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'>
Curacavi<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;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'>
<span =style=3D'border:solid windowtext 1.0pt;padding:0cm'>
<img border=3D0 =width=3D100 height=3D100 style=3D'width:1.0416in;height:1.0416in' =id=3D"_x0000_i1028" src=3D"cid:~WRD000.jpg" alt=3D"Imagen quitada por el =remitente. Imagen sin =leyenda">
</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%'>
<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=3Dss-choice-item =style=3D'margin:0cm;margin-bottom:.0001pt;text-indent:-18.0pt;line-height=:15.6pt;mso-list:l0 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=3Dss-choice-item =style=3D'margin:0cm;margin-bottom:.0001pt;text-indent:-18.0pt;line-height=:15.6pt;mso-list:l0 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'>
[11&nbsp;\/] [abril&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'>
[14&nbsp;\/] : [30&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'>
[2&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;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=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'>
(&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'>
(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 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'>
Realizo visita domiciliara a Don John Mac Vey, =paciente sin antecedentes m=C3=B3rbidos previos con diagn=C3=B3stico de =cancer g=C3=A1strico metast=C3=A1sico (Marzo/2017), recibiendo =tratamiento con FOLFOX de 6 ciclos (Abril =E2=80=93 diciembre 2017), =radioterapia + quimioterapia (Febrero- Marzo 2018). Paciente evoluciona =con met=C3=A1stasis hep=C3=A1tica, pulmonar y peritoneal (agosto 2018). =Recibe un s=C3=A9ptimo ciclo de quimioterapia el 18/12/18, logrando =reducir met=C3=A1stasis pulmonares y hep=C3=A1ticas. Paciente presenta =colestasia en enero 2019, evolucionando favorablemente mediante el uso =de un drenaje biliar percut=C3=A1neo, el cual se encuentra actualmente =insitu y sellado. Tomograf=C3=ADa marzo/2019: aumento de met=C3=A1stasis =pulmonar y hep=C3=A1tica y progresi=C3=B3n de signos de carsinomatosis =peritoneal. Comenz=C3=B3 nuevo ciclo de quimioterapia el 29/03/2019. =Paciente al momento de la visita se encuentra acompa=C3=B1ado por =esposa, con buena disposici=C3=B3n, se observa con mejor facie y mayor ==C3=A1nimo, refiere que durante la =C3=BAltima semana pudo disfrutar =m=C3=A1s que en otras ocasiones las reuniones familiares, sin embargo, =menciona que de manera intermitente no se siente emocionalmente bien =para compartir con ellos. Durante la semana refiere encontrarse en =buenas condiciones, buena tolerancia a quimioterapia, ultima realizada =el pasado viernes. Paciente menciona sentir debilidad en el cuerpo, =principalmente en las piernas y esto lo relaciona al inicio del =tratamiento con quimioterapia. El pasado martes sufre ca=C3=ADda =mientras caminaba, refiriendo que no tuvo la fuerza para mantener el =equilibrio, adem=C3=A1s de la necesidad de ayuda para poder levantarse, =debido a esto presenta herida en palma de la mano derecha de 2 x 2 cm en =proceso de cicatrizaci=C3=B3n. Actividades cotidianas bien toleradas. =Presenta dificultad para dormir, despert=C3=A1ndose 2 veces en la noche, =durante el d=C3=ADa duerme alrededor de 2 horas. Ha presentado menor =nivel de dolor que semanas anteriores, sin embargo, mantiene dolor en la =espalda a nivel lumbar, informa que se encuentra usando Buprenorfina en =parche, el cual fue recetado por m=C3=A9dico. Respecto a la =alimentaci=C3=B3n, mantiene r=C3=A9gimen oral liviano, bien tolerado, =con menor rechazo a las comidas. Referente a la eliminaci=C3=B3n, =diuresis normal, con dificultad para realizar deposiciones (=C3=BAltimas =del d=C3=ADa de ayer), presenta dolor en zona abdominal baja al defecar, =necesitando consumir viadil para reducir el dolor. =<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'>
Al control de signos vitales, normoc=C3=A1rdico =(88 ppm), eupneico (15 rpm), normotenso (94/68 mmHg), temperatura de =36,5=C2=BA, sin dolor. Al examen f=C3=ADsico Glasgow 15, pupilas =isocoricas y reactivas, piel p=C3=A1lida levemente seca, mucosas =hidratadas. A la auscultaci=C3=B3n pulmonar MP (+), sin ruidos =agregados. Abdomen con RHA (+), blando, depresible e indoloro, paciente =refiere dolor ocasional difuso en el abdomen. En flanco derecho, sonda =biliar percut=C3=A1nea insitu, se realiza curaci=C3=B3n, se observa =contenido bilioso solidificado y escaso contenido viscoso amarillo =p=C3=A1lido. El =C3=A1rea circundante de un di=C3=A1metro de 2 x 2 cm se =encuentra eritematosa. Paciente refiere no tener dolor permanente en la =zona ni tampoco a la palpaci=C3=B3n. Al presionar la herida, no sale =ning=C3=BAn tipo de secreci=C3=B3n. Se deja con ap=C3=B3sito limpio y =seco. Extremidades m=C3=B3viles y sanas, zonas de apoyo =indemnes.<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'>
Ca G=C3=A1strico =Metast=C3=A1sico<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'>
Manejo del dolor, reposo relativo, r=C3=A9gimen =liviano<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'>
[18&nbsp;\/] [abril&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 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 realiza curaci=C3=B3n de drenaje biliar =percutaneo. <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>
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=3Dss-choice-item =style=3D'margin:0cm;margin-bottom:.0001pt;text-indent:-18.0pt;line-height=:15.6pt;mso-list:l1 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=3Dss-choice-item =style=3D'margin:0cm;margin-bottom:.0001pt;text-indent:-18.0pt;line-height=:15.6pt;mso-list:l1 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=3Dss-choice-item =style=3D'margin:0cm;margin-bottom:.0001pt;text-indent:-18.0pt;line-height=:15.6pt;mso-list:l1 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>
NUTRICIONISTA</span>
 <o:p>
</o:p>
</p>
<p =class=3Dss-choice-item =style=3D'margin:0cm;margin-bottom:.0001pt;text-indent:-18.0pt;line-height=:15.6pt;mso-list:l1 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=3Dss-choice-item =style=3D'margin:0cm;margin-bottom:.0001pt;text-indent:-18.0pt;line-height=:15.6pt;mso-list:l1 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>
PSICOLOGO</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;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'>
<span =style=3D'border:solid windowtext 1.0pt;padding:0cm'>
<img border=3D0 =width=3D100 height=3D100 style=3D'width:1.0416in;height:1.0416in' =id=3D"_x0000_i1029" src=3D"cid:~WRD000.jpg" alt=3D"Imagen quitada por el =remitente. Imagen sin =leyenda">
</span>
<o:p>
</o:p>
</p>
</div>
</div>
</div>
</div>
</div>
</td>
</tr>
<t=r>
<td style=3D'padding:0cm 0cm 0cm =0cm'>
</td>
</tr>
</table>
</div>
</div>
<div align=3Dcenter>
<table =class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=3D0 =style=3D'max-width:504.0pt'>
<tr>
<td style=3D'padding:0cm 0cm 0cm =0cm'>
</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'>
Crea tu propio formulario de =Google</span>
</a>
<o:p>
</o:p>
</p>
</td>
</tr>
</table>
</div>
<p =class=3DMsoNormal>
<o:p>
&nbsp;</o:p>
</p>
</div>
</div>
</body>
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