<div dir=3D"ltr">
<br clear=3D"all">
<div>
<div dir=3D"ltr" class=3D"gmail_signature" data-smartmail=3D"gmail_signature">
<div dir=3D"ltr">
<div style=3D"text-align:center">
Saludos Cordiales=C2=A0</div>
<div style=3D"text-align:center">
Graciela Fuentes Vel=C3=A1squez</div>
<div style=3D"text-align:center">
Licenciada en Psicolog=C3=ADa</div>
<div style=3D"text-align:center">
<b>
Psic=C3=B3loga=C2=A0</b>
</div>
</div>
</div>
</div>
<br>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
---------- Forwarded message ---------<br>
De: <strong class=3D"gmail_sendername" dir=3D"auto">
Formularios de Google</strong>
 <span dir=3D"auto">
&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;</span>
<br>
Date: mi=C3=A9., 10 de jul. de 2019 a la(s) 10:44<br>
Subject: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href=3D"mailto:gracielafuentes.psico@gmail.com">
gracielafuentes.psico@gmail.com</a>
&gt;<br>
</div>
<br>
<br>
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;margin:0;padding:0;height:100%;width:100%">
<table border=3D"0" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(38,4,154)" width=3D"100%">
<tbody>
<tr height=3D"64px">
<td style=3D"padding-left:24px">
<img alt=3D"Formularios de Google" height=3D"26px" style=3D"display:inline-block;margin:0;vertical-align:middle" width=3D"143px" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div style=3D"padding:24px;background-color:rgb(229,218,254)">
<div align=3D"center" style==3D"background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por llenar <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr height=3D"12px">
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242">
Estas son tus respuestas:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"m_6049113069736236086ss-form-container">
<div class=3D"m_6049113069736236086ss-form-heading">
<h1 class=3D"m_6049113069736236086ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_6049113069736236086ss-form-desc m_6049113069736236086ss-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_6049113069736236086ss-form">
<form method=3D"GET" id=3D"m_6049113069736236086ss-form" target=3D"_blank">
<br>
<div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086emailAddress">
<div class=3D"m_6049113069736236086ss-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_6049113069736236086emailAddress">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_6049113069736236086ss-q-text m_6049113069736236086ss-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:gracielafuentes.psico@gmail.com" target=3D"_blank">
gracielafuentes.psico@gmail.com</a>
</div>
</div>
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</div>
<div class=3D"m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6049113069736236086ss-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_6049113069736236086ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6049113069736236086ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_6049113069736236086ss-page-description m_6049113069736236086ss-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_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_579114469">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-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%">
Graciela Fuentes</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_1276273985">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-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_6049113069736236086ss-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%">
18789468-9</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-select" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_133691676">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-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_6049113069736236086entry_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>
KINESIOLOGA/O</option>
 <option value=3D"PSICOLOGO" disabled selected>
PSICOLOGO</option>
 <option value==3D"NUTRICIONISTA" disabled>
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6049113069736236086ss-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_6049113069736236086ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6049113069736236086ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_6049113069736236086ss-page-description m_6049113069736236086ss-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_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6049113069736236086ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_6049113069736236086ss-section-description m_6049113069736236086ss-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_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_823811303">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-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_6049113069736236086ss-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%">
7880060-7</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_1959365839">
<div class=3D"m_6049113069736236086ss-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_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-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%">
Galvarino Aedo</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-select" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_545002227">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-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_6049113069736236086entry_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_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_1900161356">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-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%">
Chill=C3=A1n</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_1298871758">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-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%">
Chill=C3=A1n</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6049113069736236086ss-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_6049113069736236086ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6049113069736236086ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_6049113069736236086ss-page-description m_6049113069736236086ss-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_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-radio" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_2073233714">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_6049113069736236086ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_6049113069736236086ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_6049113069736236086ss-choice-item-control m_6049113069736236086goog-inline-block" style=3D"display:inline-block">
<input type==3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_6049113069736236086group_1222378237_1" class=3D"m_6049113069736236086ss-q-radio">
</span>
<span class=3D"m_6049113069736236086ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_6049113069736236086ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_6049113069736236086ss-choice-item-control m_6049113069736236086goog-inline-block" style=3D"display:inline-block">
<input type==3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_6049113069736236086group_1222378237_2" class=3D"m_6049113069736236086ss-q-radio">
</span>
<span class=3D"m_6049113069736236086ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-date" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_1705849412">
<div class=3D"m_6049113069736236086ss-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_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-q-date">
<div class=3D"m_6049113069736236086ss-datetime-box m_6049113069736236086goog-inline-block" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name=3D"entry.1705849412_month" disabled class=3D"m_6049113069736236086ss-month-dropdown" id=3D"m_6049113069736236086entry.1705849412_month">
<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>
 <option value=3D"6">
junio</option>
 <option value==3D"7" selected>
julio</option>
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agosto</option>
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septiembre</option>
 <option value=3D"10">
octubre</option>
 <option value=3D"11">
noviembre</option>
 <option value=3D"12">
diciembre</option>
</select>
   <select name=3D"entry.1705849412_day" disabled class=3D"m_6049113069736236086ss-day-dropdown" id=3D"m_6049113069736236086entry.1705849412_day">
<option value=3D"">
D=C3=ADa</option>
<option value=3D"1">
1</option>
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2</option>
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3</option>
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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>
 <option value=3D"9" selected>
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>
 <option value==3D"19">
19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
 <option value=3D"26">
26</option>
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27</option>
 <option value=3D"28">
28</option>
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29</option>
 <option value=3D"30">
30</option>
 <option value=3D"31">
31</option>
</select>
=20<select name=3D"entry.1705849412_year" disabled id=3D"m_6049113069736236086entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
 <option value=3D"1897">
1897</option>
 <option value=3D"1898">
1898</option>
 <option value=3D"1899">
1899</option>
 <option value=3D"1900">
1900</option>
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1901</option>
 <option value=3D"1902">
1902</option>
 <option value=3D"1903">
1903</option>
 <option value=3D"1904">
1904</option>
 <option value=3D"1905">
1905</option>
 <option value=3D"1906">
1906</option>
 <option value=3D"1907">
1907</option>
 <option value=3D"1908">
1908</option>
 <option value=3D"1909">
1909</option>
 <option value=3D"1910">
1910</option>
 <option value=3D"1911">
1911</option>
 <option value=3D"1912">
1912</option>
 <option value=3D"1913">
1913</option>
 <option value=3D"1914">
1914</option>
 <option value=3D"1915">
1915</option>
 <option value=3D"1916">
1916</option>
 <option value=3D"1917">
1917</option>
 <option value=3D"1918">
1918</option>
 <option value=3D"1919">
1919</option>
 <option value=3D"1920">
1920</option>
 <option value=3D"1921">
1921</option>
 <option value=3D"1922">
1922</option>
 <option value=3D"1923">
1923</option>
 <option value==3D"1924">
1924</option>
 <option value=3D"1925">
1925</option>
 <option value==3D"1926">
1926</option>
 <option value=3D"1927">
1927</option>
 <option value==3D"1928">
1928</option>
 <option value=3D"1929">
1929</option>
 <option value==3D"1930">
1930</option>
 <option value=3D"1931">
1931</option>
 <option value==3D"1932">
1932</option>
 <option value=3D"1933">
1933</option>
 <option value==3D"1934">
1934</option>
 <option value=3D"1935">
1935</option>
 <option value==3D"1936">
1936</option>
 <option value=3D"1937">
1937</option>
 <option value==3D"1938">
1938</option>
 <option value=3D"1939">
1939</option>
 <option value==3D"1940">
1940</option>
 <option value=3D"1941">
1941</option>
 <option value==3D"1942">
1942</option>
 <option value=3D"1943">
1943</option>
 <option value==3D"1944">
1944</option>
 <option value=3D"1945">
1945</option>
 <option value==3D"1946">
1946</option>
 <option value=3D"1947">
1947</option>
 <option value==3D"1948">
1948</option>
 <option value=3D"1949">
1949</option>
 <option value==3D"1950">
1950</option>
 <option value=3D"1951">
1951</option>
 <option value==3D"1952">
1952</option>
 <option value=3D"1953">
1953</option>
 <option value==3D"1954">
1954</option>
 <option value=3D"1955">
1955</option>
 <option value==3D"1956">
1956</option>
 <option value=3D"1957">
1957</option>
 <option value==3D"1958">
1958</option>
 <option value=3D"1959">
1959</option>
 <option value==3D"1960">
1960</option>
 <option value=3D"1961">
1961</option>
 <option value==3D"1962">
1962</option>
 <option value=3D"1963">
1963</option>
 <option value==3D"1964">
1964</option>
 <option value=3D"1965">
1965</option>
 <option value==3D"1966">
1966</option>
 <option value=3D"1967">
1967</option>
 <option value==3D"1968">
1968</option>
 <option value=3D"1969">
1969</option>
 <option value==3D"1970">
1970</option>
 <option value=3D"1971">
1971</option>
 <option value==3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
 <option value==3D"1974">
1974</option>
 <option value=3D"1975">
1975</option>
 <option value==3D"1976">
1976</option>
 <option value=3D"1977">
1977</option>
 <option value==3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option value==3D"1980">
1980</option>
 <option value=3D"1981">
1981</option>
 <option value==3D"1982">
1982</option>
 <option value=3D"1983">
1983</option>
 <option value==3D"1984">
1984</option>
 <option value=3D"1985">
1985</option>
 <option value==3D"1986">
1986</option>
 <option value=3D"1987">
1987</option>
 <option value==3D"1988">
1988</option>
 <option value=3D"1989">
1989</option>
 <option value==3D"1990">
1990</option>
 <option value=3D"1991">
1991</option>
 <option value==3D"1992">
1992</option>
 <option value=3D"1993">
1993</option>
 <option value==3D"1994">
1994</option>
 <option value=3D"1995">
1995</option>
 <option value==3D"1996">
1996</option>
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1997</option>
 <option value==3D"1998">
1998</option>
 <option value=3D"1999">
1999</option>
 <option value==3D"2000">
2000</option>
 <option value=3D"2001">
2001</option>
 <option value==3D"2002">
2002</option>
 <option value=3D"2003">
2003</option>
 <option value==3D"2004">
2004</option>
 <option value=3D"2005">
2005</option>
 <option value==3D"2006">
2006</option>
 <option value=3D"2007">
2007</option>
 <option value==3D"2008">
2008</option>
 <option value=3D"2009">
2009</option>
 <option value==3D"2010">
2010</option>
 <option value=3D"2011">
2011</option>
 <option value==3D"2012">
2012</option>
 <option value=3D"2013">
2013</option>
 <option value==3D"2014">
2014</option>
 <option value=3D"2015">
2015</option>
 <option value==3D"2016">
2016</option>
 <option value=3D"2017">
2017</option>
 <option value==3D"2018">
2018</option>
 <option value=3D"2019" selected>
2019</option>
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2020</option>
 <option value=3D"2021">
2021</option>
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2022</option>
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2023</option>
 <option value=3D"2024">
2024</option>
 <option value=3D"2025">
2025</option>
 <option value=3D"2026">
2026</option>
 <option value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
 <option value=3D"2029">
2029</option>
 <option value=3D"2030">
2030</option>
 <option value=3D"2031">
2031</option>
 <option value=3D"2032">
2032</option>
 <option value=3D"2033">
2033</option>
 <option value=3D"2034">
2034</option>
 <option value=3D"2035">
2035</option>
 <option value=3D"2036">
2036</option>
 <option value=3D"2037">
2037</option>
 <option value==3D"2038">
2038</option>
 <option value=3D"2039">
2039</option>
 <option value==3D"2040">
2040</option>
 <option value=3D"2041">
2041</option>
 <option value==3D"2042">
2042</option>
 <option value=3D"2043">
2043</option>
 <option value==3D"2044">
2044</option>
 <option value=3D"2045">
2045</option>
 <option value==3D"2046">
2046</option>
 <option value=3D"2047">
2047</option>
 <option value==3D"2048">
2048</option>
 <option value=3D"2049">
2049</option>
 <option value==3D"2050">
2050</option>
 <option value=3D"2051">
2051</option>
 <option value==3D"2052">
2052</option>
 <option value=3D"2053">
2053</option>
 <option value==3D"2054">
2054</option>
 <option value=3D"2055">
2055</option>
 <option value==3D"2056">
2056</option>
 <option value=3D"2057">
2057</option>
 <option value==3D"2058">
2058</option>
 <option value=3D"2059">
2059</option>
 <option value==3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <option value==3D"2062">
2062</option>
 <option value=3D"2063">
2063</option>
 <option value==3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option value==3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option value==3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_206244955">
<div class=3D"m_6049113069736236086ss-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_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-q-time">
<div class=3D"m_6049113069736236086ss-datetime-box m_6049113069736236086goog-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_6049113069736236086entry.206244955_hour">
<option value=3D"">
h</option>
<option value=3D"00">
00</option>
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01</option>
 <option value=3D"02">
02</option>
 <option value=3D"03">
03</option>
 <option value=3D"04">
04</option>
 <option value=3D"05">
05</option>
 <option value=3D"06">
06</option>
 <option value=3D"07">
07</option>
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22</option>
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23</option>
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.<select name=3D"entry.206244955_minute" disabled id=3D"m_6049113069736236086entry.206244955_minute">
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00</option>
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01</option>
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11</option>
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38</option>
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41</option>
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42</option>
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53</option>
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56</option>
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57</option>
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58</option>
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59</option>
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</div>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-select" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
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<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
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</div>
</label>
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</option>
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0</option>
 <option value=3D"1" disabled selected>
1</option>
 <option value=3D"2" disabled>
2</option>
 <option value=3D"3" disabled>
3</option>
 <option value=3D"4" disabled>
4</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_1716090865">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-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_6049113069736236086entry_1421689035">
<tbody>
<tr>
<td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_6049113069736236086ss-scalerow m_6049113069736236086ss-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_6049113069736236086aria-todo">
</div>
</td>
<td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled checked value=3D"0" id=3D"m_6049113069736236086group_1421689035_1" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value==3D"1" id=3D"m_6049113069736236086group_1421689035_2" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"2" id=3D"m_6049113069736236086group_1421689035_3" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"3" id=3D"m_6049113069736236086group_1421689035_4" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"4" id=3D"m_6049113069736236086group_1421689035_5" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"5" id=3D"m_6049113069736236086group_1421689035_6" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"6" id=3D"m_6049113069736236086group_1421689035_7" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"7" id=3D"m_6049113069736236086group_1421689035_8" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"8" id=3D"m_6049113069736236086group_1421689035_9" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"9" id=3D"m_6049113069736236086group_1421689035_10" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name==3D"entry.1421689035" disabled value=3D"10" id=3D"m_6049113069736236086group_1421689035_11" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
<td class=3D"m_6049113069736236086ss-scalerow m_6049113069736236086ss-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_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_2064050596">
<div class=3D"m_6049113069736236086ss-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_6049113069736236086ss-q-help m_6049113069736236086ss-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_6049113069736236086entry_1244707512">
<tbody>
<tr>
<td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_6049113069736236086ss-scalerow m_6049113069736236086ss-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_6049113069736236086aria-todo">
</div>
</td>
<td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
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</div>
</td>
 <td class=3D"m_6049113069736236086ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
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</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"2" id=3D"m_6049113069736236086group_1244707512_3" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"3" id=3D"m_6049113069736236086group_1244707512_4" class==3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"4" id=3D"m_6049113069736236086group_1244707512_5" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"5" id=3D"m_6049113069736236086group_1244707512_6" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
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</div>
</td>
 <td class=3D"m_6049113069736236086ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
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</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
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</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"9" id=3D"m_6049113069736236086group_1244707512_10" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"10" id=3D"m_6049113069736236086group_1244707512_11" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
<td class=3D"m_6049113069736236086ss-scalerow m_6049113069736236086ss-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_6049113069736236086ss-item m_6049113069736236086ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_2000523015">
<div class=3D"m_6049113069736236086ss-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_6049113069736236086ss-q-help m_6049113069736236086ss-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_6049113069736236086entry_853118630">
<tbody>
<tr>
<td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_853118630_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for==3D"m_6049113069736236086group_853118630_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_853118630_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_853118630_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class==3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_853118630_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_853118630_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_853118630_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_853118630_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_853118630_9" style==3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_853118630_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_6049113069736236086ss-scalenumber" for=3D"m_6049113069736236086group_853118630_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_6049113069736236086ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_6049113069736236086ss-scalerow m_6049113069736236086ss-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_6049113069736236086aria-todo">
</div>
</td>
<td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"0" id=3D"m_6049113069736236086group_853118630_1" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"1" id=3D"m_6049113069736236086group_853118630_2" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value==3D"2" id=3D"m_6049113069736236086group_853118630_3" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"3" id=3D"m_6049113069736236086group_853118630_4" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled checked value=3D"4" id=3D"m_6049113069736236086group_853118630_5" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"5" id=3D"m_6049113069736236086group_853118630_6" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type==3D"radio" name=3D"entry.853118630" disabled value=3D"6" id=3D"m_6049113069736236086group_853118630_7" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"7" id=3D"m_6049113069736236086group_853118630_8" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"8" id=3D"m_6049113069736236086group_853118630_9" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"9" id=3D"m_6049113069736236086group_853118630_10" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
 <td class=3D"m_6049113069736236086ss-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_6049113069736236086ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"10" id=3D"m_6049113069736236086group_853118630_11" class=3D"m_6049113069736236086ss-q-radio">
</div>
</td>
<td class=3D"m_6049113069736236086ss-scalerow m_6049113069736236086ss-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>
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<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Anamnesis/Evoluci=C3=B3n<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-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%">
Don Galvarino presenta una rigidez de pensamiento respecto a sus creencias, es decir, que a pesar de presentar mas posibilidades para un hecho persevera en su pensamiento.=20Por otro lado se encuentra mas tranquilo ya que su esposa Rosa esta volviendo a hacer la cosas de manera paulatina, lo que le ha permitido realizar ejercicio.=20Respecto a situaci=C3=B3n familiar se mantienen los mismos problemas ya que don Galvarino no afronta los problemas sino que los sigue evitando.Es importante mencionar que su hijo Gabriel se encontraba con un ataque de epilepsia al momento de la visita. </div>
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</div>
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<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_824006088">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Examen F=C3=ADsico<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-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 no presentaba molestias el d==C3=ADa de la visita, sin embargo durante la semana pasada tuvo molestias en el estomago.</div>
</div>
</div>
</div>
<br>
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<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_1690694733">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Diagn=C3=B3stico<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-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%">
Trastorno de la Personalidad Obsesivo Compulsivo (TPOC)</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-item-required m_6049113069736236086ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_1255665248">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Plan de Tratamiento e Indicaciones<label for=3D"m_6049113069736236086itemView.getDomIdToLabel()">
</label>
<span class=3D"m_6049113069736236086ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-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%">
Se le brinda contenci=C3=B3n en problemas familiares, adem=C3=A1s se persiste en entregar herramientas para afrontar situaci=C3=B3n familiar</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_1648939075">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-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%">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-date" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_2063615873">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-q-date">
<div class=3D"m_6049113069736236086ss-datetime-box m_6049113069736236086goog-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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<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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<option value=3D"">
D=C3=ADa</option>
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1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
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<option value=3D"">
A=C3=B1o</option>
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1896</option>
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1897</option>
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1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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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_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-text" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_74766472">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_6049113069736236086ss-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%">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086ss-form-question m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-checkbox" style=3D"margin:12px 0">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_6049113069736236086ss-q-item-label" for=3D"m_6049113069736236086entry_1219705969">
<div class=3D"m_6049113069736236086ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"m_6049113069736236086ss-q-help m_6049113069736236086ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
S=C3=B3lo llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del equipo</div>
</label>
<ul class=3D"m_6049113069736236086ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_6049113069736236086ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
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<input type==3D"checkbox" name=3D"entry.503039759" disabled value=3D"ENFERMERA" id=3D"m_6049113069736236086group_503039759_1" class=3D"m_6049113069736236086ss-q-checkbox">
</span>
<span class=3D"m_6049113069736236086ss-choice-label">
ENFERMERA</span>
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</li>
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<label>
<span class=3D"m_6049113069736236086ss-choice-item-control m_6049113069736236086goog-inline-block" style=3D"display:inline-block">
<input type==3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"m_6049113069736236086group_503039759_2" class=3D"m_6049113069736236086ss-q-checkbox">
</span>
<span class=3D"m_6049113069736236086ss-choice-label">
TENS</span>
</label>
</li>
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<label>
<span class=3D"m_6049113069736236086ss-choice-item-control m_6049113069736236086goog-inline-block" style=3D"display:inline-block">
<input type==3D"checkbox" name=3D"entry.503039759" disabled value=3D"NUTRICIONISTA" id==3D"m_6049113069736236086group_503039759_3" class=3D"m_6049113069736236086ss-q-checkbox">
</span>
<span class=3D"m_6049113069736236086ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
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<label>
<span class=3D"m_6049113069736236086ss-choice-item-control m_6049113069736236086goog-inline-block" style=3D"display:inline-block">
<input type==3D"checkbox" name=3D"entry.503039759" disabled value=3D"KINESIOLOGO" id=3D"m_6049113069736236086group_503039759_4" class=3D"m_6049113069736236086ss-q-checkbox">
</span>
<span class=3D"m_6049113069736236086ss-choice-label">
KINESIOLOGO</span>
</label>
</li>
 <li class=3D"m_6049113069736236086ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_6049113069736236086ss-choice-item-control m_6049113069736236086goog-inline-block" style=3D"display:inline-block">
<input type==3D"checkbox" name=3D"entry.503039759" disabled value=3D"PSICOLOGO" id=3D"m_6049113069736236086group_503039759_5" class=3D"m_6049113069736236086ss-q-checkbox">
</span>
<span class=3D"m_6049113069736236086ss-choice-label">
PSICOLOGO</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_6049113069736236086errorbox-good">
<div dir=3D"auto" class=3D"m_6049113069736236086ss-item m_6049113069736236086ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_6049113069736236086ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_6049113069736236086ss-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_6049113069736236086ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width:78px;outline:none" alt=3D"Imagen sin t=C3=ADtulo">
</div>
</div>
</div>
</div>
<br>
</form>
</div>
</div>
</td>
</tr>
<tr height=3D"24px">
</tr>
</tbody>
</table>
</div>
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"max-width:672px;min-width:154px" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link" style=3D"color:#424242;font-size:13px" target=3D"_blank">
Crear tu propio Formulario de Google</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
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