<div>
<div dir=3D"auto">
Estimada, junto con saludar, env=C3=ADo formulario de atenci=C3=B3n kin=C3=A9sica a domicilio de la paciente Leonila Sep=C3=BAlveda el d=C3=ADa viernes 21 de junio.</div>
</div>
<div dir=3D"auto">
Esperando que tenga un buen d=C3=ADa=C2=A0</div>
<div dir=3D"auto">
<br>
</div>
<div dir=3D"auto">
Saludos</div>
<div>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
----------=C2=A0Mensaje reenviado=C2=A0---------<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>
Fecha: El s=C3==A1b, 22 de jun. de 2019 a las 12:27<br>
Asunto: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
Para:  &lt;<a href=3D"mailto:fallendes.o@gmail.com">
fallendes.o@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_1140176941836946767ss-form-container">
<div class=3D"m_1140176941836946767ss-form-heading">
<h1 class=3D"m_1140176941836946767ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_1140176941836946767ss-form-desc m_1140176941836946767ss-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_1140176941836946767ss-form">
<form method=3D"GET" id=3D"m_1140176941836946767ss-form" target=3D"_blank">
<br>
<div class=3D"m_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-text" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767emailAddress">
<div class=3D"m_1140176941836946767ss-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_1140176941836946767emailAddress">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_1140176941836946767ss-q-text m_1140176941836946767ss-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:fallendes.o@gmail.com" target=3D"_blank">
fallendes.o@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1140176941836946767ss-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_1140176941836946767ss-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_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1140176941836946767ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_1140176941836946767ss-page-description m_1140176941836946767ss-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_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-text" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_579114469">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1140176941836946767ss-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%">
Fernando Allendes</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-text" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_1276273985">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-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_1140176941836946767ss-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%">
17885100-4</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-select" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_133691676">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-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_1140176941836946767entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled>
MEDICO</option>
 <option value=3D"ENFERMERA/O" disabled>
ENFERMERA/O</option>
 <option value=3D"TENS" disabled>
TENS</option>
 <option value=3D"KINESIOLOGA/O" disabled selected>
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_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1140176941836946767ss-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_1140176941836946767ss-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_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1140176941836946767ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_1140176941836946767ss-page-description m_1140176941836946767ss-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_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1140176941836946767ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_1140176941836946767ss-section-description m_1140176941836946767ss-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_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-text" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_823811303">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-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_1140176941836946767ss-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%">
6213811-4</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-text" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_1959365839">
<div class=3D"m_1140176941836946767ss-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_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1140176941836946767ss-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%">
Leonila Sep=C3=BAlveda</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-select" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_545002227">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-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_1140176941836946767entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled selected>
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>
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_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-text" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_1900161356">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1140176941836946767ss-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%">
Talca</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-text" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_1298871758">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1140176941836946767ss-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%">
Talca</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1140176941836946767ss-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_1140176941836946767ss-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_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_1140176941836946767ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_1140176941836946767ss-page-description m_1140176941836946767ss-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_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-radio" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_2073233714">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_1140176941836946767ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_1140176941836946767ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_1140176941836946767ss-choice-item-control m_1140176941836946767goog-inline-block" style=3D"display:inline-block">
<input type==3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_1140176941836946767group_1222378237_1" class=3D"m_1140176941836946767ss-q-radio">
</span>
<span class=3D"m_1140176941836946767ss-choice-label">
Domicilio</span>
</label>
</li>
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<label>
<span class=3D"m_1140176941836946767ss-choice-item-control m_1140176941836946767goog-inline-block" style=3D"display:inline-block">
<input type==3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_1140176941836946767group_1222378237_2" class=3D"m_1140176941836946767ss-q-radio">
</span>
<span class=3D"m_1140176941836946767ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-date" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_1705849412">
<div class=3D"m_1140176941836946767ss-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_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1140176941836946767ss-q-date">
<div class=3D"m_1140176941836946767ss-datetime-box m_1140176941836946767goog-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">
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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>
</select>
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<option value=3D"">
Mes</option>
<option value=3D"1">
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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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
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=20<select name=3D"entry.1705849412_year" disabled id=3D"m_1140176941836946767entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
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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1925</option>
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1926</option>
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1927</option>
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1928</option>
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1929</option>
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1930</option>
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1931</option>
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1932</option>
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1933</option>
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1934</option>
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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_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_206244955">
<div class=3D"m_1140176941836946767ss-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_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_1140176941836946767ss-q-time">
<div class=3D"m_1140176941836946767ss-datetime-box m_1140176941836946767goog-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_1140176941836946767entry.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>
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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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05</option>
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06</option>
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10</option>
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11</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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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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35</option>
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37</option>
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40</option>
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41</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>
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<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
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<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
</label>
<select name=3D"entry.1747608258" disabled id=3D"m_1140176941836946767entry_1747608258">
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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>
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 <div class=3D"m_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_1716090865">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-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_1140176941836946767entry_1421689035">
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<tr>
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</td>
<td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
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<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
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<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
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<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
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<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
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<div class=3D"m_1140176941836946767aria-todo">
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</td>
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</td>
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</div>
</td>
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</div>
</td>
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</div>
</td>
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</div>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
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</div>
</td>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"6" id=3D"m_1140176941836946767group_1421689035_7" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"7" id=3D"m_1140176941836946767group_1421689035_8" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"8" id=3D"m_1140176941836946767group_1421689035_9" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"9" id=3D"m_1140176941836946767group_1421689035_10" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<div class==3D"m_1140176941836946767ss-scalerow-fieldcell">
<input type=3D"radio" name==3D"entry.1421689035" disabled value=3D"10" id=3D"m_1140176941836946767group_1421689035_11" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
<td class=3D"m_1140176941836946767ss-scalerow m_1140176941836946767ss-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_1140176941836946767ss-form-question m_1140176941836946767errorbox-good">
<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_2064050596">
<div class=3D"m_1140176941836946767ss-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_1140176941836946767ss-q-help m_1140176941836946767ss-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_1140176941836946767entry_1244707512">
<tbody>
<tr>
<td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_1140176941836946767ss-scalerow m_1140176941836946767ss-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_1140176941836946767aria-todo">
</div>
</td>
<td class=3D"m_1140176941836946767ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"0" id=3D"m_1140176941836946767group_1244707512_1" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
 <td class=3D"m_1140176941836946767ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
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</div>
</td>
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</div>
</td>
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<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"3" id=3D"m_1140176941836946767group_1244707512_4" class==3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
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</div>
</td>
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</div>
</td>
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</div>
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</div>
</td>
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</div>
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<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"9" id=3D"m_1140176941836946767group_1244707512_10" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<input type=3D"radio" name==3D"entry.1244707512" disabled value=3D"10" id=3D"m_1140176941836946767group_1244707512_11" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
<td class=3D"m_1140176941836946767ss-scalerow m_1140176941836946767ss-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>
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<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_2000523015">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA M=C3=ADnimo</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-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_1140176941836946767entry_853118630">
<tbody>
<tr>
<td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_853118630_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for==3D"m_1140176941836946767group_853118630_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
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<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_853118630_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
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<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_853118630_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class==3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_853118630_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
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<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_853118630_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_853118630_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_853118630_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
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<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_853118630_9" style==3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
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<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_853118630_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
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<label class=3D"m_1140176941836946767ss-scalenumber" for=3D"m_1140176941836946767group_853118630_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_1140176941836946767ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_1140176941836946767ss-scalerow m_1140176941836946767ss-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_1140176941836946767aria-todo">
</div>
</td>
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<input type=3D"radio" name=3D"entry.853118630" disabled checked value=3D"0" id=3D"m_1140176941836946767group_853118630_1" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
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</div>
</td>
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<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"2" id=3D"m_1140176941836946767group_853118630_3" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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</div>
</td>
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</div>
</td>
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<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"5" id=3D"m_1140176941836946767group_853118630_6" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"6" id=3D"m_1140176941836946767group_853118630_7" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"7" id=3D"m_1140176941836946767group_853118630_8" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"8" id=3D"m_1140176941836946767group_853118630_9" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<div class=3D"m_1140176941836946767ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"9" id=3D"m_1140176941836946767group_853118630_10" class=3D"m_1140176941836946767ss-q-radio">
</div>
</td>
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<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"10" id=3D"m_1140176941836946767group_853118630_11" class==3D"m_1140176941836946767ss-q-radio">
</div>
</td>
<td class=3D"m_1140176941836946767ss-scalerow m_1140176941836946767ss-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>
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</tbody>
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<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_2140974612">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Anamnesis/Evoluci=C3=B3n<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
</label>
<div class=3D"m_1140176941836946767ss-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%">
Paciente de antecedentes conocidos. Refiere que se ha sentido mejor, capaz de desenvolverse mejor en su vida diaria, con menos cansancio, sin embargo ha tenido episodios de dolores estomacales que han provocado v=C3=B3mitos, episodios que se desarrollan aproximadamente d=C3=ADa por medio. =C3=9Altima visita de la nutricionista se realiza el d=C3=ADa previo de visita por Kinesi=C3=B3logo, por lo que se est=C3==A1 a la espera de efectos de nuevas indicaciones nutricionales.</div>
</div>
</div>
</div>
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<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_824006088">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Examen F=C3=ADsico<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
</label>
<div class=3D"m_1140176941836946767ss-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%">
Paciente se encuentra despierta, orientada en BCG. FC: 109; FR: 32cpm; SatO2: 99% FiO2 ambiente. Borg 2/10 basal. Patr=C3=B3n de respiraci=C3=B3n tor=C3=A1cico. MP (+) disminuido en pulm==C3=B3n derecho. Se realiza sesi=C3=B3n de ejercicios bien tolerados.</div>
</div>
</div>
</div>
<br>
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<div dir=3D"auto" class=3D"m_1140176941836946767ss-item m_1140176941836946767ss-item-required m_1140176941836946767ss-text" style=3D"margin:12px 0">
<div class=3D"m_1140176941836946767ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_1690694733">
<div class=3D"m_1140176941836946767ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Diagn=C3=B3stico<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
</label>
<span class=3D"m_1140176941836946767ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
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</div>
</label>
<div class=3D"m_1140176941836946767ss-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%">
Disfunci=C3=B3n caracterizada por baja tolerancia al esfuerzo, dolor leve, fatiga, mp alterado, asociado a componente cardiopulmonar</div>
</div>
</div>
</div>
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Plan de Tratamiento e Indicaciones<label for=3D"m_1140176941836946767itemView.getDomIdToLabel()">
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Mejorar volumen corriente, mejorar tolerancia al esfuerzo, fortalecimiento muscular.</div>
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Medicamentos Indicados</div>
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
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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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5</option>
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6</option>
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7</option>
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14</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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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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1914</option>
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1918</option>
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1920</option>
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1932</option>
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1933</option>
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1935</option>
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1936</option>
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1939</option>
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1940</option>
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1941</option>
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1945</option>
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1951</option>
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1952</option>
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1953</option>
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1956</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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1991</option>
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1992</option>
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1993</option>
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1994</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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2004</option>
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2005</option>
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2006</option>
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2007</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>
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Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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</label>
<div class=3D"m_1140176941836946767ss-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%">
Localizaci=C3=B3n diafragm=C3=A1tica, manejo ventilaci=C3=B3n pulm=C3=B3n derecho, mtb activo con resistencia EE.SS, velocidad de marcha, marcha est=C3=A1tica y fortalecimiento de cu=C3=A1driceps.</div>
</div>
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<label class=3D"m_1140176941836946767ss-q-item-label" for=3D"m_1140176941836946767entry_1219705969">
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Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"m_1140176941836946767ss-q-help m_1140176941836946767ss-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>
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ENFERMERA</span>
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TENS</span>
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NUTRICIONISTA</span>
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KINESIOLOGO</span>
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</h2>
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<img class=3D"m_1140176941836946767ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width:78px;outline:none" alt=3D"Imagen sin leyenda">
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<br>
</form>
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</td>
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<tr height=3D"24px">
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<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">
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</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>
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</tbody>
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Fernando Alberto=C2=A0</i>
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Allendes Osorio</i>
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Kinesi=C3=B3logo</font>
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Lic. en Kinesiolog=C3=ADa</font>
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+56994184501</font>
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