<div dir=3D"ltr">
Hago envio de la atencion realizada el dia de ayer<br>
<br>
Saludos cordiales<div>
<br>
</div>
<div>
<br clear=3D"all">
<div>
<div dir=3D"ltr" class=3D"gmail_signature" data-smartmail=3D"gmail_signature">
<div dir=3D"ltr">
<div>
<div dir=3D"ltr">
<div dir=3D"ltr">
<div dir=3D"ltr">
<div dir=3D"ltr">
<div dir=3D"ltr">
<div dir=3D"ltr">
<div style=3D"text-align:left">
<span style=3D"color:rgb(0,0,0)">
Bastian Droguett Figueroa</span>
</div>
<font color=3D"#000000">
<div style=3D"text-align:left">
<br>
</div>
<div style=3D"text-align:left">
<a value=3D"+56966117402">
<br>
</a>
</div>
</font>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<br>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
---------- Forwarded message ---------<br>
De: <strong class=3D"gmail_sendername" dir=3D"auto">
Formularios de Google</strong>
 <span dir=3D"ltr">
&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;</span>
<br>
Date: s==C3=A1b., 25 may. 2019 a las 15:30<br>
Subject: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href=3D"mailto:b.droguettfi@gmail.com">
b.droguettfi@gmail.com</a>
&gt;<br>
</div>
<br>
<br>
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;margin:0;padding:0;height:100%;width:100%">
<table border=3D"0" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(38,4,154)" width=3D"100%">
<tbody>
<tr height=3D"64px">
<td style==3D"padding-left:24px">
<img alt=3D"Formularios de Google" height=3D"26px" style=3D"display:inline-block;margin:0;vertical-align:middle" width=3D"143px" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div style=3D"padding:24px;background-color:rgb(229,218,254)">
<div align=3D"center" style=3D"background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por rellenar <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr height=3D"12px">
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242">
Esto es lo que nos has enviado:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"m_-6583714140650391081ss-form-container">
<div class=3D"m_-6583714140650391081ss-form-heading">
<h1 class=3D"m_-6583714140650391081ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_-6583714140650391081ss-form-desc m_-6583714140650391081ss-no-ignore-whitespace" style=3D"font:inherit;width:99%;margin:0 0 1em;white-space:pre-wrap;word-wrap:break-word">
Este es el sistema de registro de atenciones domiciliarias de Oncovida.   Debe ser llenado por el prestador individual, y debe realizarse un registro por cada visita domiciliaria.   Si usted no es prestador de Oncovida por favor no llene este formulario.   A continuaci=C3=B3n indique su correo electr=C3=B3nico.</div>
</div>
<div class=3D"m_-6583714140650391081ss-form">
<form method=3D"GET" id=3D"m_-6583714140650391081ss-form" target=3D"_blank">
<br>
<div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-text" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081emailAddress">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Direcci=C3=B3n de correo electr=C3=B3nico<label for=3D"m_-6583714140650391081emailAddress">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_-6583714140650391081ss-q-text m_-6583714140650391081ss-printable-text-line" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
<a href=3D"mailto:b.droguettfi@gmail.com" target=3D"_blank">
b.droguettfi@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-6583714140650391081ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-6583714140650391081ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_-6583714140650391081ss-page-description m_-6583714140650391081ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
Aqu=C3=AD debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-text" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_579114469">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-6583714140650391081ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Bastian Droguett</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-text" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_1276273985">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"m_-6583714140650391081ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
20899385-2</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-select" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_133691676">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
Si asisten m=C3=A1s de 1 prestador simult=C3=A1neamente, cada uno debe hacer un registro independiente</div>
</label>
<select name=3D"entry.133691676" disabled id=3D"m_-6583714140650391081entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled selected>
MEDICO</option>
 <option value=3D"ENFERMERA/O" disabled>
ENFERMERA/O</option>
 <option value=3D"TENS" disabled>
TENS</option>
 <option value=3D"KINESIOLOGA/O" disabled>
KINESIOLOGA/O</option>
 <option value=3D"PSICOLOGO" disabled>
PSICOLOGO</option>
 <option value==3D"NUTRICIONISTA" disabled>
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-6583714140650391081ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-6583714140650391081ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_-6583714140650391081ss-page-description m_-6583714140650391081ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
En esta secci=C3=B3n debe ingresar los datos del paciente visitado</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-6583714140650391081ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_-6583714140650391081ss-section-description m_-6583714140650391081ss-no-ignore-whitespace" style=3D"margin-top:0.5em;white-space:pre-wrap;word-wrap:break-word">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-text" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_823811303">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"m_-6583714140650391081ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
7644924-4</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-text" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_1959365839">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-6583714140650391081ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Leontina Rojas P=C3=A9rez</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-select" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_545002227">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<select name=3D"entry.545002227" disabled id=3D"m_-6583714140650391081entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled>
COLMENA</option>
 <option value=3D"CONSALUD" disabled>
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled>
CRUZ BLANCA</option>
 <option value=3D"DIPRECA" disabled>
DIPRECA</option>
 <option value=3D"FONASA" disabled>
FONASA</option>
 <option value=3D"FUNDACION" disabled>
FUNDACION</option>
 <option value==3D"ISAPRES DEL COBRE" disabled>
ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled selected>
NUEVA MASVIDA</option>
 <option value=3D"VIDATRES" disabled>
VIDATRES</option>
 <option value=3D"PARTICULAR" disabled>
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-text" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_1900161356">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-6583714140650391081ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Lo miranda</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-text" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_1298871758">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-6583714140650391081ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Donihue</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-6583714140650391081ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-6583714140650391081ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_-6583714140650391081ss-page-description m_-6583714140650391081ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
En esta secci=C3=B3n debe ingresar los datos de la atenci=C3=B3n domiciliaria</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-radio" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_2073233714">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_-6583714140650391081ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-6583714140650391081ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-6583714140650391081ss-choice-item-control m_-6583714140650391081goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_-6583714140650391081group_1222378237_1" class=3D"m_-6583714140650391081ss-q-radio">
</span>
<span class=3D"m_-6583714140650391081ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_-6583714140650391081ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-6583714140650391081ss-choice-item-control m_-6583714140650391081goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_-6583714140650391081group_1222378237_2" class=3D"m_-6583714140650391081ss-q-radio">
</span>
<span class=3D"m_-6583714140650391081ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-date" style=3D"margin:12px 0">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_1705849412">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha de la Atenci=C3=B3n<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-6583714140650391081ss-q-date">
<div class=3D"m_-6583714140650391081ss-datetime-box m_-6583714140650391081goog-inline-block" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name=3D"entry.1705849412_day" disabled class=3D"m_-6583714140650391081ss-day-dropdown" id=3D"m_-6583714140650391081entry.1705849412_day">
<option value=3D"">
D==C3=ADa</option>
<option value=3D"1">
1</option>
 <option value=3D"2">
2</option>
 <option value=3D"3">
3</option>
 <option value=3D"4">
4</option>
 <option value=3D"5">
5</option>
 <option value=3D"6">
6</option>
 <option value=3D"7">
7</option>
 <option value=3D"8">
8</option>
 <option value=3D"9">
9</option>
 <option value=3D"10">
10</option>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12</option>
 <option value=3D"13">
13</option>
 <option value=3D"14">
14</option>
 <option value=3D"15">
15</option>
 <option value=3D"16">
16</option>
 <option value==3D"17">
17</option>
 <option value=3D"18">
18</option>
 <option value=3D"19">
19</option>
 <option value=3D"20">
20</option>
 <option value=3D"21">
21</option>
 <option value=3D"22">
22</option>
 <option value=3D"23">
23</option>
 <option value=3D"24" selected>
24</option>
 <option value=3D"25">
25</option>
 <option value=3D"26">
26</option>
 <option value=3D"27">
27</option>
 <option value=3D"28">
28</option>
 <option value=3D"29">
29</option>
 <option value=3D"30">
30</option>
 <option value=3D"31">
31</option>
</select>
   <select name=3D"entry.1705849412_month" disabled class=3D"m_-6583714140650391081ss-month-dropdown" id=3D"m_-6583714140650391081entry.1705849412_month">
<option value=3D"">
Mes</option>
<option value=3D"1">
enero</option>
 <option value=3D"2">
febrero</option>
 <option value=3D"3">
marzo</option>
 <option value=3D"4">
abril</option>
 <option value=3D"5" selected>
mayo</option>
 <option value=3D"6">
junio</option>
 <option value=3D"7">
julio</option>
 <option value=3D"8">
agosto</option>
 <option value=3D"9">
septiembre</option>
 <option value=3D"10">
octubre</option>
 <option value=3D"11">
noviembre</option>
 <option value=3D"12">
diciembre</option>
</select>
=20<select name=3D"entry.1705849412_year" disabled id=3D"m_-6583714140650391081entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
 <option value=3D"1897">
1897</option>
 <option value=3D"1898">
1898</option>
 <option value=3D"1899">
1899</option>
 <option value=3D"1900">
1900</option>
 <option value=3D"1901">
1901</option>
 <option value=3D"1902">
1902</option>
 <option value=3D"1903">
1903</option>
 <option value=3D"1904">
1904</option>
 <option value=3D"1905">
1905</option>
 <option value=3D"1906">
1906</option>
 <option value=3D"1907">
1907</option>
 <option value=3D"1908">
1908</option>
 <option value=3D"1909">
1909</option>
 <option value=3D"1910">
1910</option>
 <option value=3D"1911">
1911</option>
 <option value=3D"1912">
1912</option>
 <option value=3D"1913">
1913</option>
 <option value=3D"1914">
1914</option>
 <option value=3D"1915">
1915</option>
 <option value=3D"1916">
1916</option>
 <option value=3D"1917">
1917</option>
 <option value=3D"1918">
1918</option>
 <option value=3D"1919">
1919</option>
 <option value=3D"1920">
1920</option>
 <option value=3D"1921">
1921</option>
 <option value=3D"1922">
1922</option>
 <option value=3D"1923">
1923</option>
 <option value==3D"1924">
1924</option>
 <option value=3D"1925">
1925</option>
 <option value==3D"1926">
1926</option>
 <option value=3D"1927">
1927</option>
 <option value==3D"1928">
1928</option>
 <option value=3D"1929">
1929</option>
 <option value==3D"1930">
1930</option>
 <option value=3D"1931">
1931</option>
 <option value==3D"1932">
1932</option>
 <option value=3D"1933">
1933</option>
 <option value==3D"1934">
1934</option>
 <option value=3D"1935">
1935</option>
 <option value==3D"1936">
1936</option>
 <option value=3D"1937">
1937</option>
 <option value==3D"1938">
1938</option>
 <option value=3D"1939">
1939</option>
 <option value==3D"1940">
1940</option>
 <option value=3D"1941">
1941</option>
 <option value==3D"1942">
1942</option>
 <option value=3D"1943">
1943</option>
 <option value==3D"1944">
1944</option>
 <option value=3D"1945">
1945</option>
 <option value==3D"1946">
1946</option>
 <option value=3D"1947">
1947</option>
 <option value==3D"1948">
1948</option>
 <option value=3D"1949">
1949</option>
 <option value==3D"1950">
1950</option>
 <option value=3D"1951">
1951</option>
 <option value==3D"1952">
1952</option>
 <option value=3D"1953">
1953</option>
 <option value==3D"1954">
1954</option>
 <option value=3D"1955">
1955</option>
 <option value==3D"1956">
1956</option>
 <option value=3D"1957">
1957</option>
 <option value==3D"1958">
1958</option>
 <option value=3D"1959">
1959</option>
 <option value==3D"1960">
1960</option>
 <option value=3D"1961">
1961</option>
 <option value==3D"1962">
1962</option>
 <option value=3D"1963">
1963</option>
 <option value==3D"1964">
1964</option>
 <option value=3D"1965">
1965</option>
 <option value==3D"1966">
1966</option>
 <option value=3D"1967">
1967</option>
 <option value==3D"1968">
1968</option>
 <option value=3D"1969">
1969</option>
 <option value==3D"1970">
1970</option>
 <option value=3D"1971">
1971</option>
 <option value==3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
 <option value==3D"1974">
1974</option>
 <option value=3D"1975">
1975</option>
 <option value==3D"1976">
1976</option>
 <option value=3D"1977">
1977</option>
 <option value==3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option value==3D"1980">
1980</option>
 <option value=3D"1981">
1981</option>
 <option value==3D"1982">
1982</option>
 <option value=3D"1983">
1983</option>
 <option value==3D"1984">
1984</option>
 <option value=3D"1985">
1985</option>
 <option value==3D"1986">
1986</option>
 <option value=3D"1987">
1987</option>
 <option value==3D"1988">
1988</option>
 <option value=3D"1989">
1989</option>
 <option value==3D"1990">
1990</option>
 <option value=3D"1991">
1991</option>
 <option value==3D"1992">
1992</option>
 <option value=3D"1993">
1993</option>
 <option value==3D"1994">
1994</option>
 <option value=3D"1995">
1995</option>
 <option value==3D"1996">
1996</option>
 <option value=3D"1997">
1997</option>
 <option value==3D"1998">
1998</option>
 <option value=3D"1999">
1999</option>
 <option value==3D"2000">
2000</option>
 <option value=3D"2001">
2001</option>
 <option value==3D"2002">
2002</option>
 <option value=3D"2003">
2003</option>
 <option value==3D"2004">
2004</option>
 <option value=3D"2005">
2005</option>
 <option value==3D"2006">
2006</option>
 <option value=3D"2007">
2007</option>
 <option value==3D"2008">
2008</option>
 <option value=3D"2009">
2009</option>
 <option value==3D"2010">
2010</option>
 <option value=3D"2011">
2011</option>
 <option value==3D"2012">
2012</option>
 <option value=3D"2013">
2013</option>
 <option value==3D"2014">
2014</option>
 <option value=3D"2015">
2015</option>
 <option value==3D"2016">
2016</option>
 <option value=3D"2017">
2017</option>
 <option value==3D"2018">
2018</option>
 <option value=3D"2019" selected>
2019</option>
 <option value=3D"2020">
2020</option>
 <option value=3D"2021">
2021</option>
 <option value=3D"2022">
2022</option>
 <option value=3D"2023">
2023</option>
 <option value=3D"2024">
2024</option>
 <option value=3D"2025">
2025</option>
 <option value=3D"2026">
2026</option>
 <option value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
 <option value=3D"2029">
2029</option>
 <option value=3D"2030">
2030</option>
 <option value=3D"2031">
2031</option>
 <option value=3D"2032">
2032</option>
 <option value=3D"2033">
2033</option>
 <option value=3D"2034">
2034</option>
 <option value=3D"2035">
2035</option>
 <option value=3D"2036">
2036</option>
 <option value=3D"2037">
2037</option>
 <option value==3D"2038">
2038</option>
 <option value=3D"2039">
2039</option>
 <option value==3D"2040">
2040</option>
 <option value=3D"2041">
2041</option>
 <option value==3D"2042">
2042</option>
 <option value=3D"2043">
2043</option>
 <option value==3D"2044">
2044</option>
 <option value=3D"2045">
2045</option>
 <option value==3D"2046">
2046</option>
 <option value=3D"2047">
2047</option>
 <option value==3D"2048">
2048</option>
 <option value=3D"2049">
2049</option>
 <option value==3D"2050">
2050</option>
 <option value=3D"2051">
2051</option>
 <option value==3D"2052">
2052</option>
 <option value=3D"2053">
2053</option>
 <option value==3D"2054">
2054</option>
 <option value=3D"2055">
2055</option>
 <option value==3D"2056">
2056</option>
 <option value=3D"2057">
2057</option>
 <option value==3D"2058">
2058</option>
 <option value=3D"2059">
2059</option>
 <option value==3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <option value==3D"2062">
2062</option>
 <option value=3D"2063">
2063</option>
 <option value==3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option value==3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option value==3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_206244955">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Hora de la Atenci=C3=B3n<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-6583714140650391081ss-q-time">
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</div>
</div>
</div>
</div>
</div>
</div>
<br>
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<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-item-required m_-6583714140650391081ss-select" style=3D"margin:12px 0">
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<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
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<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
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</option>
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0</option>
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1</option>
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2</option>
 <option value=3D"3" disabled>
3</option>
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4</option>
</select>
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</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_1716090865">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
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</td>
<td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
</td>
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<tr>
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<div class==3D"m_-6583714140650391081aria-todo">
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</div>
</td>
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<div class=3D"m_-6583714140650391081ss-scalerow-fieldcell">
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</div>
</td>
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</div>
</td>
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</div>
</td>
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</div>
</td>
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</div>
</td>
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<div class=3D"m_-6583714140650391081ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"9" id=3D"m_-6583714140650391081group_1421689035_10" class=3D"m_-6583714140650391081ss-q-radio">
</div>
</td>
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<div class=3D"m_-6583714140650391081ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"10" id=3D"m_-6583714140650391081group_1421689035_11" class=3D"m_-6583714140650391081ss-q-radio">
</div>
</td>
<td class=3D"m_-6583714140650391081ss-scalerow m_-6583714140650391081ss-rightlabel" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081ss-form-question m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-6583714140650391081ss-q-item-label" for=3D"m_-6583714140650391081entry_2064050596">
<div class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA M=C3=A1ximo</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"m_-6583714140650391081entry_1244707512">
<tbody>
<tr>
<td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-6583714140650391081ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-6583714140650391081ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
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<label class=3D"m_-6583714140650391081ss-scalenumber" for=3D"m_-6583714140650391081group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
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</td>
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</div>
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Escala Dolor EVA M=C3=ADnimo</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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0</label>
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1</label>
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2</label>
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3</label>
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4</label>
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5</label>
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6</label>
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7</label>
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8</label>
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9</label>
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10</label>
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</td>
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<div class==3D"m_-6583714140650391081aria-todo">
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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Anamnesis/Evoluci=C3=B3n<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-6583714140650391081ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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Paciente femenina con antecedentes  de Cancer de mama derecha en etapa IV, actualmente en tratamiento de quimioterapia mensual, en su cuarto ciclo, en  Hospital Cl=C3=ADnico FUSAT.La paciente se encuentra al cuidado de su hijo mayor y esposo regularmente, pero al momento de la visita se encuentra sola en su casa sin invonvenientes y de buen estado animico.Actualmente la paciente se encuentra sin grandes molestas, de buen animo y activa. Refiere buen apetito y sin inconvenientes a la ingesta de alimentos, sin vomitos ni nauseas, sin diarreas. No refiere nueva perdida de peso, ni fiebre ni sudoracion profusa.Menciona que nota cambios favorables en cuanto a  su lesion tumoral en la mama derecha, refiriendo que lo siente m=C3=A1s peque=C3=B1o y menos adherido, sin mayor dolor, con mejor=C3=ADa en cuanto a la herida superficial previa, con menor zona de enrojecimiento en comparacion a consulta anterior, sin secrecion, sin calor local.De su tratamiento analgesico, La paciente refiere estar actualmente usando paracetamol 500 mg. 1 c/8h, con refuerzos de tramadol en gotitas ante dolor articular y &quot;oseo&quot;, que se relaciona con los ciclos de quimioterapia, segun ella.Durante la entrevista la paciente se muestra con estado animico estable, con buena vision de futuro y contenta ante el acercamiento espiritual personal. No se encuentran signos de patologia ansiosa o estado de animo depresivo.=20</div>
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Examen F=C3=ADsico<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
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Signos vitales estables, eupneico, normocardico, saturacion normal, EVA actual 2 de 10.Buen estado general, sin signos de complicaci=C3=B3n.Facie no caracteristica, indiferente.Piel levemente palida, sin alteracionesBien hidratadaCabeza normal sin adenopatiasmucosa palpebral rosada, levemente palidaFaringe rosadaSin adenopatias cervicalesRR2TSS sin soplo carotideoMP presente sin ruidos agregadosMama izquierda sin alteracionesMama derecha con lesion tumoral de =C3=BAnica, multilobulada, irregular, de app 10 a 11cm de diametro mayor, de consisitencia dura a gomosa, no adherida a planos profundos, sin signos de infeccion ni inflamacion. En relacion con ulcera de 5 mm en regresion , sin signos de inflamacion ni infeccion. No palpo adenopatias axilares.Abdomen blando depresible e indoloro, RHA normales, sin masas ni blumberg. PP negativoGenitales sin alteracionesEEII con pulsos presentes simetricos, sin edema, sin signos de TVP.Neurologico sin alteraciones</div>
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Diagn=C3=B3stico<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
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C=C3=A1ncer de mama derecha Etapa IV en tto Quimoterapia</div>
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Plan de Tratamiento e Indicaciones<label for=3D"m_-6583714140650391081itemView.getDomIdToLabel()">
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Mantengo farmacos segun uso habitualSe Educa en cuanto a signos de alarma y control SOSSe insta a mantener terapia quimioterapica y buen control de su patolog=C3==ADa</div>
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Medicamentos Indicados</div>
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Xumadol 1 gr. c/8hrs.x 30 d=C3=ADasTramadol gotas  6 gotas al d=C3=ADa S.O.S.Ondasentron 8mg. 1 C/12 hrs. x 30 d=C3=ADasEsomeprazol 40 mg. 1 c/12 hrs. x 30 dias=20Paracetamol 500 mg. 1C/8 hrs. s.o.s.</div>
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
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D==C3=ADa</option>
<option value=3D"1">
1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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14</option>
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18</option>
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21</option>
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22</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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31</option>
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Mes</option>
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enero</option>
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febrero</option>
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marzo</option>
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abril</option>
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mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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A=C3=B1o</option>
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1896</option>
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1899</option>
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1900</option>
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1911</option>
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1914</option>
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1918</option>
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1920</option>
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1985</option>
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1987</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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2024</option>
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2026</option>
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2027</option>
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2029</option>
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2030</option>
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2033</option>
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2034</option>
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2035</option>
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2036</option>
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2037</option>
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2038</option>
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2039</option>
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2040</option>
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2041</option>
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2042</option>
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2043</option>
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2044</option>
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2045</option>
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2046</option>
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2047</option>
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2048</option>
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2049</option>
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2050</option>
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2051</option>
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2052</option>
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2053</option>
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2054</option>
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2055</option>
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2056</option>
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2057</option>
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2058</option>
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2059</option>
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2060</option>
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2061</option>
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2062</option>
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2063</option>
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2064</option>
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2065</option>
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2066</option>
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2067</option>
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2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
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Tratamiento Realizado (si corresponde)</div>
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.</div>
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Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"m_-6583714140650391081ss-q-help m_-6583714140650391081ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
S=C3=B3lo llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del equipo</div>
</label>
<ul class=3D"m_-6583714140650391081ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-6583714140650391081ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-6583714140650391081ss-choice-item-control m_-6583714140650391081goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"ENFERMERA" id=3D"m_-6583714140650391081group_503039759_1" class=3D"m_-6583714140650391081ss-q-checkbox">
</span>
<span class=3D"m_-6583714140650391081ss-choice-label">
ENFERMERA</span>
</label>
</li>
 <li class=3D"m_-6583714140650391081ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-6583714140650391081ss-choice-item-control m_-6583714140650391081goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"m_-6583714140650391081group_503039759_2" class=3D"m_-6583714140650391081ss-q-checkbox">
</span>
<span class=3D"m_-6583714140650391081ss-choice-label">
TENS</span>
</label>
</li>
 <li class=3D"m_-6583714140650391081ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-6583714140650391081ss-choice-item-control m_-6583714140650391081goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"NUTRICIONISTA" id==3D"m_-6583714140650391081group_503039759_3" class=3D"m_-6583714140650391081ss-q-checkbox">
</span>
<span class=3D"m_-6583714140650391081ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
 <li class=3D"m_-6583714140650391081ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-6583714140650391081ss-choice-item-control m_-6583714140650391081goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"KINESIOLOGO" id=3D"m_-6583714140650391081group_503039759_4" class=3D"m_-6583714140650391081ss-q-checkbox">
</span>
<span class=3D"m_-6583714140650391081ss-choice-label">
KINESIOLOGO</span>
</label>
</li>
 <li class=3D"m_-6583714140650391081ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-6583714140650391081ss-choice-item-control m_-6583714140650391081goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"PSICOLOGO" id=3D"m_-6583714140650391081group_503039759_5" class=3D"m_-6583714140650391081ss-q-checkbox">
</span>
<span class=3D"m_-6583714140650391081ss-choice-label">
PSICOLOGO</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-6583714140650391081errorbox-good">
<div dir=3D"auto" class=3D"m_-6583714140650391081ss-item m_-6583714140650391081ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-6583714140650391081ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-6583714140650391081ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-6583714140650391081ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
</form>
</div>
</div>
</td>
</tr>
<tr height=3D"24px">
</tr>
</tbody>
</table>
</div>
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"max-width:672px;min-width:154px" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link" style=3D"color:#424242;font-size:13px" target=3D"_blank">
Crea tu propio formulario de Google</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
</div>
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