<html>
<head>
<meta http-equiv=3D"Content-Type" content=3D"text/html; charset=3DWindows-1252">
</head>
<body>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
De: Formularios de Google<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
Enviado: martes, 9 de julio 5:57 a. m.<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
Asunto: Registro de Atenci=F3n Domiciliaria Oncovida<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
Para: vcornejorozas@live.cl<br>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Gracias por rellenar</table>
<a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link">
</a>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Registro de Atenci=F3n Domiciliaria Oncovida</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Esto es lo que nos has enviado:</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<b>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Registro de Atenci=F3n Domiciliaria Oncovida</table>
</b>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
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=F3n indique su correo electr=F3nico.</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Direcci=F3n de correo electr=F3nico *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
vcornejorozas@live.cl</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<b>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Identificaci=F3n del Prestador</table>
</b>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Aqu=ED debe ingresar sus datos personales</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Primer Nombre y Apellido Paterno *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Valentina Cornejo</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
RUT *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
RUT con Gui=F3n y D=EDgito Verificador, sin puntos ( Ej: 5632200-k)</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
17972298-4</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Tipo *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Si asisten m=E1s de 1 prestador simult=E1neamente, cada uno debe hacer un registro independiente</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
MEDICO ENFERMERA/OTENS KINESIOLOGA/OPSICOLOGONUTRICIONISTA</table>
<br>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<b>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Identificaci=F3n del Paciente</table>
</b>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
En esta secci=F3n debe ingresar los datos del paciente visitado</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<b>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Datos Personales del Paciente</table>
</b>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Ingrese el Rut del Paciente *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
RUT con Gui=F3n y D=EDgito Verificador, sin puntos ( Ej: 5632200-k)</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
5176028-k</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Ingrese el Primer Nombre y Apellido Paterno del Paciente *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Eliana Allendes</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Previsi=F3n *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
BANMEDICACAPREDENA COLMENACONSALUD CRUZ BLANCADIPRECAFONASA FUNDACIONISAPRES DEL COBRE NUEVA MASVIDAVIDATRES PARTICULAR</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Ciudad *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
San Felipe</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Comuna *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
San Felipe</table>
<br>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<b>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Registro de la Atenci=F3n Domiciliaria</table>
</b>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
En esta secci=F3n debe ingresar los datos de la atenci=F3n domiciliaria</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Tipo de Atenci=F3n *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Domicilio Ambulatorio</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Fecha de la Atenci=F3n *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
D=EDa1234 56 7891011 121314 15161718 192021 22232425 262728 293031 Mesenero febreromarzo abrilmayo juniojulio agostoseptiembre octubrenoviembre diciembre A=F1o1896 18971898 18991900 19011902 19031904 19051906 19071908 19091910 19111912 19131914 19151916 19171918 19191920 19211922 19231924 19251926 19271928 19291930 19311932 19331934 19351936 19371938 19391940 19411942 19431944 19451946 19471948 19491950 19511952 19531954 19551956 19571958 19591960 19611962 19631964 19651966 19671968 19691970 19711972 19731974 19751976 19771978 19791980 19811982 19831984 19851986 19871988 19891990 19911992 19931994 19951996 19971998 19992000 20012002 20032004 20052006 20072008 20092010 20112012 20132014 20152016 20172018 20192020 20212022 20232024 20252026 20272028 20292030 20312032 20332034 20352036 20372038 20392040 20412042 20432044 20452046 20472048 20492050 20512052 20532054 20552056 20572058 20592060 20612062 20632064 20652066 20672068 2069</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Hora de la Atenci=F3n *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
h0001 02030405 060708 09101112 131415 16 171819 20212223 : min00 010203 04050607 080910 11121314 151617 18192021 222324 25262728 293031 32333435 363738 39404142 434445 46474849 505152 53545556 575859</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Performance Status ECOG del Paciente *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
0 12 34</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Escala Dolor EVA Actual</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
0</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
1</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
2</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
3</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
4</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
5</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
6</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
7</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
8</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
9</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
10</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Escala Dolor EVA M=E1ximo</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
0</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
1</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
2</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
3</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
4</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
5</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
6</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
7</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
8</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
9</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
10</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Escala Dolor EVA M=EDnimo</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
0</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
1</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
2</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
3</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
4</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
5</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
6</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
7</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
8</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
9</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
10</table>
<table id=3D"entry_853118630" border=3D"0" cellpadding=3D"5" cellspacing=3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Anamnesis/Evoluci=F3n *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Paciente adulto mayor, sexo femenino, en buenas condiciones generales, al momento de la visita a su domicilio se encuentra sentada en el living de su casa acompa=F1ada de su esposo y cuidadora. Paciente CLOTE, Glasgow 15, EVA 0/10, normotensa, normocardica, eupneica, afebril, Sat O2 97% FiO2 21%, sin apremio respiratorio, usuaria refiere llevar aproximadamente una semana con tos productiva. Paciente no refiere alergias, los medicamentos de uso actual son Amlodipino 10 mg una vez al d=EDa, Eutirox 100 mg una vez al d=EDa, un comprimido vitamina D una vez al d=EDa, Lactulosa 20 ml cada 8 hrs, Metoclopramida 10 mg cada 8 hrs, Tramal Long 50 mg cada 12 horas, tramal gotas en SOS, Paracetamol 500 mg cada 8 horas, Pregavalina 150 mg una vez al dia, Furosemida 40 mg una vez al d=EDa, Neurobionta 1 comprimido al d=EDa, Bion 3 una vez al d=EDa, Revil B-12 60 ml una vez al d=EDa, Col=E1geno 1 vez al d=EDa. Doloten 1 comprimido cada 8 hrs, Celecoxib 200 mg cada 12 hrs. Paciente con antecedentes m=F3rbidos de HTA, Prolapso de =FAtero, C=E1ncer bronquial con met=E1stasis =F3sea, C=E1ncer renal grado 4. En enero 2019 fue sometida a cirug=EDa de Humero derecho por met=E1stasis, En mayo 2019 fue sometida a cirug=EDa por Fx de cadera. Otros antecedentes: Tabaquismo (-), OH (-). En cuanto a la alimentaci=F3n el apetito se encuentra aumentado, tres comidas durante el d=EDa, r=E9gimen hiposodico, 800 cc de agua diariamente. En cuanto a la eliminaci=F3n presenta no presenta episodios de incontinencia urinaria, no presenta disuria, el color de la orina es cristalino con arom=E1tica d=E9bil, adem=E1s de presentar deposiciones diariamente. Paciente requiere ayuda para realizar actividades de la vida diaria, paciente camina con bast=F3n sin dificultad.</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Examen F=EDsico *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Examen F=EDsico General: Paciente mantiene postura activa, se desplaza con ayuda de bast=F3n, mantiene buenas condiciones higi=E9nicas, en cuanto aseo general de piel y cabello, u=F1as limpias. Se encuentra vigil. Piel sana, sin lesiones. Facie relajada. Sus signos vitales al momento de la visita son: Frecuencia cardiaca: 83 lpm, frecuencia respiratoria: 19 rpm, temperatura: 36,7 C=BA axilar, presi=F3n arterial: 130/80mmHg, Sat O2: 97% FiO2 21%. Examen F=EDsico Segmentario. Cabeza =95 Cr=E1neo: Normocr=E1neo. =95 Pelo: Distribuci=F3n homog=E9nea, buena higiene. =95 Ojos: Sim=E9tricos, conjuntivas rosadas, escleras blancas, sin presencia de secreci=F3n, pupilas reactivas a la luz, isocoria. =95 O=EDdos: Permeables sin presencia de secreciones. =95 Boca: Mucosas sanas, sin lesiones, hidratadas, sin cianosis peribucal. =95 Dientes: Sin uso de pr=F3tesis. =95 Nariz: Sim=E9trica, sin presencia de secreciones, sin signos de dificultad respiratoria, mucosas sanas. Cuello: Sin presencia de adenopat=EDas, sim=E9trico, movilidad normal. Tr=E1quea: En posici=F3n anat=F3mica. T=F3rax y Dorso: Sim=E9trico, sin retracciones, sin signos de dificultad respiratoria. Sin lesiones, piel sana. Abdomen: Blando, depresible e indoloro. Espalda: Columna vertebral sim=E9trica. Piel sana sin lesiones. Extremidades =95 Superiores: EESS D=B0 m=F3vil. Piel sana sin lesiones, sin presencia de cianosis distal tampoco ungueal, pulso radial y braquial presentes. =95 Inferiores: EEII derecha m=F3vil, sim=E9trica, pulsos pedios y tibial posterior presentes y sim=E9tricos, sin presencia de cianosis distal tampoco ungueal. EEII pulsos pedios y tibial posterior presentes y sim=E9tricos, sin presencia de cianosis distal tampoco ungueal. Pies sanos, sin lesiones. Ambas EEII presentan edema (&#43;). =95 Zona genital/anal: Se observa prolapso de =FAtero.</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Diagn=F3stico *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
C=E1ncer bronquial con met=E1stasis osea</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Plan de Tratamiento e Indicaciones *</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
=95 Se educa a paciente sobre efectos adversos de medicamentos de uso actual, adem=E1s de conocer la importancia sobre conocer los medicamentos indicados juntos sus dosis, y la no automedicaci=F3n. =95 Se educa a paciente sobre riesgo de ca=EDdas, al interior de domicilio se observan peligros (alfombras, objetos tirados en el suelo). =95 Se educa a paciente sobre los alimentos en alto contenido en sodio como: alimentos enlatados, embutidos, precocinados. =95 Se educa a paciente sobre cambios de posici=F3n, cuidados de puntos de apoyo, hidrataci=F3n de la piel. =95 Se incentiva a paciente a aumentar consumo de vitamiva C y proteinas. =95 Se educa sobre los cuidados de los pies</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Medicamentos Indicados</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Fecha aproximada del Pr=F3ximo Control con usted</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
D=EDa1234 56789 101112 13 141516 17181920 212223 24252627 282930 31 Mesenero febreromarzo abrilmayo juniojulio agostoseptiembre octubrenoviembre diciembre A=F1o1896 18971898 18991900 19011902 19031904 19051906 19071908 19091910 19111912 19131914 19151916 19171918 19191920 19211922 19231924 19251926 19271928 19291930 19311932 19331934 19351936 19371938 19391940 19411942 19431944 19451946 19471948 19491950 19511952 19531954 19551956 19571958 19591960 19611962 19631964 19651966 19671968 19691970 19711972 19731974 19751976 19771978 19791980 19811982 19831984 19851986 19871988 19891990 19911992 19931994 19951996 19971998 19992000 20012002 20032004 20052006 20072008 20092010 20112012 20132014 20152016 20172018 20192020 20212022 20232024 20252026 20272028 20292030 20312032 20332034 20352036 20372038 20392040 20412042 20432044 20452046 20472048 20492050 20512052 20532054 20552056 20572058 20592060 20612062 20632064 20652066 20672068 2069</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Tratamiento Realizado (si corresponde)</table>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Derivaci=F3n a otro Prestador Domiciliario</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
S=F3lo llene esta secci=F3n si es m=E9dico y solicita la visita de otro prestador del equipo</table>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
ENFERMERA TENS NUTRICIONISTA KINESIOLOGO PSICOLOGO</table>
<br>
<br>
<br>
</div>
<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link">
</a>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"max-width:672px; min-width:154px">
Crea tu propio formulario de Google</table>
<br>
<br>
<br>
</div>
</body>
</html>
--_000_DM6PR07MB69081F340C92E2085BCB3171BEF10DM6PR07MB6908namp_--