<div dir=3D"ltr">
<br>
felipe suazo dra garcia nilqger talca. visista domingo 2 de junio<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
---------- Forwarded message ---------<br>
From: <strong class=3D"gmail_sendername" dir=3D"auto">
Formularios de Google</strong>
 <span dir=3D"auto">
&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;</span>
<br>
Date: Mon, Jun 3, 2019 at 8:37 PM<br>
Subject: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href==3D"mailto:nilqgergarcia@gmail.com">
nilqgergarcia@gmail.com</a>
&gt;<br>
</div>
<br>
<br>
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;margin:0;padding:0;height:100%;width:100%">
<table border=3D"0" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(38,4,154)" width=3D"100%">
<tbody>
<tr height=3D"64px">
<td style=3D"padding-left:24px">
<img alt=3D"Formularios de Google" height=3D"26px" style=3D"display:inline-block;margin:0;vertical-align:middle" width=3D"143px" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div style=3D"padding:24px;background-color:rgb(229,218,254)">
<div align=3D"center" style=3D"background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por llenar <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr height=3D"12px">
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242">
Estas son tus respuestas:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"m_-3826752434918214841ss-form-container">
<div class=3D"m_-3826752434918214841ss-form-heading">
<h1 class=3D"m_-3826752434918214841ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_-3826752434918214841ss-form-desc m_-3826752434918214841ss-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_-3826752434918214841ss-form">
<form method=3D"GET" id=3D"m_-3826752434918214841ss-form" target=3D"_blank">
<br>
<div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841emailAddress">
<div class=3D"m_-3826752434918214841ss-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_-3826752434918214841emailAddress">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_-3826752434918214841ss-q-text m_-3826752434918214841ss-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:nilqgergarcia@gmail.com" target=3D"_blank">
nilqgergarcia@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3826752434918214841ss-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_-3826752434918214841ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3826752434918214841ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_-3826752434918214841ss-page-description m_-3826752434918214841ss-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_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_579114469">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3826752434918214841ss-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%">
NILQGER GARCIA</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_1276273985">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-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_-3826752434918214841ss-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%">
25742995-4</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-select" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_133691676">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-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_-3826752434918214841entry_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_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3826752434918214841ss-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_-3826752434918214841ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3826752434918214841ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_-3826752434918214841ss-page-description m_-3826752434918214841ss-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_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3826752434918214841ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_-3826752434918214841ss-section-description m_-3826752434918214841ss-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_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_823811303">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-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_-3826752434918214841ss-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%">
17448922-k</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_1959365839">
<div class=3D"m_-3826752434918214841ss-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_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3826752434918214841ss-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%">
felipe suazo bastias</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-select" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_545002227">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-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_-3826752434918214841entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled selected>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled>
COLMENA</option>
 <option value=3D"CONSALUD" disabled>
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled>
CRUZ BLANCA</option>
 <option value=3D"DIPRECA" disabled>
DIPRECA</option>
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FONASA</option>
 <option value=3D"FUNDACION" disabled>
FUNDACION</option>
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ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled>
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_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_1900161356">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3826752434918214841ss-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%">
LINARES</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_1298871758">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3826752434918214841ss-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%">
LINARES</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3826752434918214841ss-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_-3826752434918214841ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-3826752434918214841ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_-3826752434918214841ss-page-description m_-3826752434918214841ss-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_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-radio" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_2073233714">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_-3826752434918214841ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-3826752434918214841ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-3826752434918214841ss-choice-item-control m_-3826752434918214841goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_-3826752434918214841group_1222378237_1" class=3D"m_-3826752434918214841ss-q-radio">
</span>
<span class=3D"m_-3826752434918214841ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_-3826752434918214841ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-3826752434918214841ss-choice-item-control m_-3826752434918214841goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_-3826752434918214841group_1222378237_2" class=3D"m_-3826752434918214841ss-q-radio">
</span>
<span class=3D"m_-3826752434918214841ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-date" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_1705849412">
<div class=3D"m_-3826752434918214841ss-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_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3826752434918214841ss-q-date">
<div class=3D"m_-3826752434918214841ss-datetime-box m_-3826752434918214841goog-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_month" disabled class=3D"m_-3826752434918214841ss-month-dropdown" id=3D"m_-3826752434918214841entry.1705849412_month">
<option value==3D"">
Mes</option>
<option value=3D"1">
enero</option>
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febrero</option>
 <option value=3D"3">
marzo</option>
 <option value=3D"4">
abril</option>
 <option value=3D"5">
mayo</option>
 <option value=3D"6" selected>
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>
   <select name=3D"entry.1705849412_day" disabled class=3D"m_-3826752434918214841ss-day-dropdown" id=3D"m_-3826752434918214841entry.1705849412_day">
<option value=3D"">
D=C3=ADa</option>
<option value=3D"1">
1</option>
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2</option>
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3</option>
 <option value=3D"4">
4</option>
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5</option>
 <option value=3D"6">
6</option>
 <option value=3D"7">
7</option>
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8</option>
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9</option>
 <option value=3D"10">
10</option>
 <option value=3D"11">
11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
 <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>
=20<select name=3D"entry.1705849412_year" disabled id=3D"m_-3826752434918214841entry.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>
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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>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
 <option value=3D"1920">
1920</option>
 <option value=3D"1921">
1921</option>
 <option value=3D"1922">
1922</option>
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1923</option>
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1924</option>
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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>
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1937</option>
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1938</option>
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1939</option>
 <option value==3D"1940">
1940</option>
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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_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_206244955">
<div class=3D"m_-3826752434918214841ss-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_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3826752434918214841ss-q-time">
<div class=3D"m_-3826752434918214841ss-datetime-box m_-3826752434918214841goog-inline-block" dir=3D"ltr" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
<select name=3D"entry.206244955_hour" disabled id=3D"m_-3826752434918214841entry.206244955_hour">
<option value=3D"">
h</option>
<option value=3D"00">
00</option>
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01</option>
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02</option>
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03</option>
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04</option>
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05</option>
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06</option>
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07</option>
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08</option>
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09</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
 <option value=3D"18">
18</option>
 <option value=3D"19">
19</option>
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20</option>
 <option value=3D"21">
21</option>
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22</option>
 <option value=3D"23">
23</option>
</select>
.<select name=3D"entry.206244955_minute" disabled id=3D"m_-3826752434918214841entry.206244955_minute">
<option value=3D"">
min</option>
<option value=3D"00" selected>
00</option>
 <option value=3D"01">
01</option>
 <option value=3D"02">
02</option>
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13</option>
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14</option>
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17</option>
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18</option>
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19</option>
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22</option>
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26</option>
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27</option>
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29</option>
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31</option>
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32</option>
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33</option>
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34</option>
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35</option>
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36</option>
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37</option>
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38</option>
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39</option>
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40</option>
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42</option>
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45</option>
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46</option>
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47</option>
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48</option>
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49</option>
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50</option>
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51</option>
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52</option>
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53</option>
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54</option>
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55</option>
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56</option>
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57</option>
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58</option>
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59</option>
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</div>
</div>
</div>
</div>
</div>
</div>
<br>
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<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-select" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
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<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<label for=3D"m_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
</label>
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0</option>
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1</option>
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2</option>
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3</option>
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4</option>
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</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_1716090865">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-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_-3826752434918214841entry_1421689035">
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<tr>
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</td>
<td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
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<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
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<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
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<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
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<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
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<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
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<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
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<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
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<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
</td>
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<tr>
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<div class==3D"m_-3826752434918214841aria-todo">
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<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"4" id=3D"m_-3826752434918214841group_1421689035_5" class=3D"m_-3826752434918214841ss-q-radio">
</div>
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</div>
</td>
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<div class=3D"m_-3826752434918214841ss-scalerow-fieldcell">
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<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"7" id=3D"m_-3826752434918214841group_1421689035_8" class=3D"m_-3826752434918214841ss-q-radio">
</div>
</td>
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<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"8" id=3D"m_-3826752434918214841group_1421689035_9" class=3D"m_-3826752434918214841ss-q-radio">
</div>
</td>
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<div class=3D"m_-3826752434918214841ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"9" id=3D"m_-3826752434918214841group_1421689035_10" class=3D"m_-3826752434918214841ss-q-radio">
</div>
</td>
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<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"10" id=3D"m_-3826752434918214841group_1421689035_11" class=3D"m_-3826752434918214841ss-q-radio">
</div>
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</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_2064050596">
<div class=3D"m_-3826752434918214841ss-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_-3826752434918214841ss-q-help m_-3826752434918214841ss-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_-3826752434918214841entry_1244707512">
<tbody>
<tr>
<td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-3826752434918214841ss-scalenumber" for=3D"m_-3826752434918214841group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-3826752434918214841ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_-3826752434918214841ss-scalerow m_-3826752434918214841ss-leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class==3D"m_-3826752434918214841aria-todo">
</div>
</td>
<td class=3D"m_-3826752434918214841ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
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</div>
</td>
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<div class=3D"m_-3826752434918214841ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"1" id=3D"m_-3826752434918214841group_1244707512_2" class=3D"m_-3826752434918214841ss-q-radio">
</div>
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Escala Dolor EVA M=C3=ADnimo</div>
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pac. sin antecedentes m=C3=B3rbido que comienza inicio de enfermedad en marzo 2019, con disartria y par=C3=A1lisis en hemicara derecha y convulsiones parciales sin perdida de consciencia, se realiza tac que reporta glioma frontal izq..se busca el primario y en tac pulmonar reporta lesi=C3=B3n tumoral pulmonar a nivel inferior derecho y medio. lesiones mediast=C3=ADnicas, suprarenales,derrame peric=C3=A1rdico leve, ganglios presentes mediastino y cervicales. se realiza biopsia q reporrtan adenocarcinoma pulmonar metast=C3=A1sico. realiza trombosis venosa en extremidad <a href=3D"http://inferior.se" target=3D"_blank">
inferior.se</a>
 planifica tto de radiocirug=C3=ADa cerebral y quimioterapia oral con alectinib 600mg dos veces al d=C3=ADa,no hay buena respuesta se cambia por  ceritinib 450 mg por d=C3=ADa. actualmente toma leviteracetam 1000mg, cotrimoxaol 3 veces por semana,acenocumarol 4mg. al interrogatorio refiere mejor=C3=ADa de condiciones generales ,no ha convulsionado, persiste paresia facial en hemicara derecha,nauseas no apetito conservado tos seca no productiva, animo bien evacuaciones bien,apetito conservado.niega prurito. mejor=C3=ADa de trombosis venosa.niega cefalea. ma=C3=B1ana va a santiago de chile a control con oncologo medico.ACTUALMENTE  toma dexametasona 12 mg dia por 20 dias con poilirea, polidipaia y perdia de peso. se indica realizar laboratorios para descartar debut de diabetes post medicamentosa.pendiente control con internista y escaner</div>
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134/87, fc 93 satO2 99, temp 34,8.pacte estable consciente orientado en TEP, con mejoria de hemiparesia en hemicara derecha. sin d=C3=A9ficit motor en miembros superiores ni inferiores, discreta disartria. niega convulsiones recientes. pulmonar murmullo vesicular presente en ambos campos pulmonares discretamente disminuido en ambas bases, roncus en ambas bases. cv. ruidos card=C3=ADacos r=C3=ADtmicos regulares,sin soplos.abdomen blando depresible no doloroso.pulsos perif=C3=A9ricos presentes. acne en cara</div>
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<div class=3D"m_-3826752434918214841ss-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%">
cancer pulmonar metastasico cerebral</div>
</div>
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<br>
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<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-item-required m_-3826752434918214841ss-paragraph-text" style=3D"margin:12px 0">
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<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Plan de Tratamiento e Indicaciones<label for=3D"m_-3826752434918214841itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-3826752434918214841ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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<div class=3D"m_-3826752434918214841ss-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%">
ceritinib 450 mg por d=C3=ADa. actualmente toma leviteracetam 1000mg, cotrimoxaol 3 veces por semana,acenocumarol 4mg.ipatropio 2 puf cada 8 horas y budesonida cada 12 horas sos.ipatropio cada 8 horas un puff y budesonida cada 12 horas un puff SOS. este corresponde a 2do control medico, enfermera, kinesiologo. psic=C3=B3logo.control internista para tACO, control neurologo y oncologo, control broncopulmonar. control con internista para descartar diabetes . se indican laboratorios</div>
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<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
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<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
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ninguno</div>
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</div>
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<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-date" style=3D"margin:12px 0">
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
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<div class=3D"m_-3826752434918214841ss-q-date">
<div class=3D"m_-3826752434918214841ss-datetime-box m_-3826752434918214841goog-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.2063615873_month" disabled class=3D"m_-3826752434918214841ss-month-dropdown" id=3D"m_-3826752434918214841entry.2063615873_month">
<option value==3D"">
Mes</option>
<option value=3D"1">
enero</option>
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febrero</option>
 <option value=3D"3">
marzo</option>
 <option value=3D"4">
abril</option>
 <option value=3D"5">
mayo</option>
 <option value=3D"6" selected>
junio</option>
 <option value=3D"7">
julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
</select>
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D=C3=ADa</option>
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1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
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A=C3=B1o</option>
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1896</option>
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1897</option>
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1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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1927</option>
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1929</option>
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1930</option>
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1932</option>
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1933</option>
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1934</option>
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1935</option>
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1936</option>
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1937</option>
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1938</option>
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1939</option>
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1940</option>
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1941</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
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1946</option>
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1947</option>
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1948</option>
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1949</option>
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1950</option>
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1951</option>
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1952</option>
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1953</option>
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1954</option>
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1955</option>
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1956</option>
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1957</option>
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1958</option>
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1959</option>
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1960</option>
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1961</option>
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1962</option>
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1963</option>
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1964</option>
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1965</option>
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1966</option>
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1967</option>
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1968</option>
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1969</option>
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1970</option>
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1971</option>
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1972</option>
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1973</option>
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1974</option>
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1975</option>
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1976</option>
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1977</option>
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1978</option>
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1979</option>
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1980</option>
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1981</option>
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1982</option>
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1983</option>
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1984</option>
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1985</option>
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1986</option>
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1987</option>
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1988</option>
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1989</option>
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1990</option>
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1991</option>
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1992</option>
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1993</option>
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1994</option>
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1995</option>
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1996</option>
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1997</option>
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1998</option>
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1999</option>
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2000</option>
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2001</option>
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2002</option>
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2003</option>
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2004</option>
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2005</option>
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2006</option>
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2007</option>
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2008</option>
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2009</option>
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2010</option>
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2011</option>
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2012</option>
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2013</option>
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2014</option>
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2015</option>
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2016</option>
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2017</option>
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2018</option>
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2019</option>
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2020</option>
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2021</option>
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2022</option>
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2023</option>
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2024</option>
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2025</option>
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2026</option>
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2027</option>
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2028</option>
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2029</option>
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2030</option>
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2031</option>
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2032</option>
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2033</option>
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2034</option>
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2035</option>
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2036</option>
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2037</option>
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2038</option>
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2039</option>
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2040</option>
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2041</option>
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2042</option>
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2043</option>
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2044</option>
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2045</option>
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2046</option>
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2047</option>
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2048</option>
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2049</option>
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2050</option>
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2051</option>
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2052</option>
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2053</option>
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2054</option>
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2055</option>
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2056</option>
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2057</option>
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2058</option>
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2059</option>
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2060</option>
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2061</option>
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2062</option>
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2063</option>
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2064</option>
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2065</option>
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2066</option>
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2067</option>
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2068</option>
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2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-text" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_74766472">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-3826752434918214841ss-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%">
no</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-3826752434918214841ss-form-question m_-3826752434918214841errorbox-good">
<div dir=3D"auto" class=3D"m_-3826752434918214841ss-item m_-3826752434918214841ss-checkbox" style=3D"margin:12px 0">
<div class=3D"m_-3826752434918214841ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-3826752434918214841ss-q-item-label" for=3D"m_-3826752434918214841entry_1219705969">
<div class=3D"m_-3826752434918214841ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"m_-3826752434918214841ss-q-help m_-3826752434918214841ss-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_-3826752434918214841ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-3826752434918214841ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-3826752434918214841ss-choice-item-control m_-3826752434918214841goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"ENFERMERA" id=3D"m_-3826752434918214841group_503039759_1" class=3D"m_-3826752434918214841ss-q-checkbox">
</span>
<span class=3D"m_-3826752434918214841ss-choice-label">
ENFERMERA</span>
</label>
</li>
 <li class=3D"m_-3826752434918214841ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-3826752434918214841ss-choice-item-control m_-3826752434918214841goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"m_-3826752434918214841group_503039759_2" class=3D"m_-3826752434918214841ss-q-checkbox">
</span>
<span class=3D"m_-3826752434918214841ss-choice-label">
TENS</span>
</label>
</li>
 <li class=3D"m_-3826752434918214841ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-3826752434918214841ss-choice-item-control m_-3826752434918214841goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"NUTRICIONISTA" id=3D"m_-3826752434918214841group_503039759_3" class=3D"m_-3826752434918214841ss-q-checkbox">
</span>
<span class=3D"m_-3826752434918214841ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
 <li class=3D"m_-3826752434918214841ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-3826752434918214841ss-choice-item-control m_-3826752434918214841goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"KINESIOLOGO" id=3D"m_-3826752434918214841group_503039759_4" class=3D"m_-3826752434918214841ss-q-checkbox">
</span>
<span class=3D"m_-3826752434918214841ss-choice-label">
KINESIOLOGO</span>
</label>
</li>
 <li class=3D"m_-3826752434918214841ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-3826752434918214841ss-choice-item-control m_-3826752434918214841goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"PSICOLOGO" id=3D"m_-3826752434918214841group_503039759_5" class=3D"m_-3826752434918214841ss-q-checkbox">
</span>
<span class=3D"m_-3826752434918214841ss-choice-label">
PSICOLOGO</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
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<img class=3D"m_-3826752434918214841ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
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