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Enviado desde mi iPhone</div>
<div dir=3D"ltr">
<br>
Inicio del mensaje r=eenviado:<br>
<br>
</div>
<blockquote type=3D"cite">
<div dir=3D"ltr">
<b>
De:</b>
= christian galleguillos &lt;<a href=3D"mailto:galleguillos.arredondo.16@gmai=l.com">
galleguillos.arredondo.16@gmail.com</a>
&gt;<br>
<b>
Fecha:</b>
 9 de jul=io de 2019, 01:54:28 CLT<br>
<b>
Para:</b>
 <a href=3D"mailto:coordinadora@tele=med-chile.cl">
coordinadora@telemed-chile.cl</a>
, <a href=3D"mailto:informege=s@telemed-chile.cl">
informeges@telemed-chile.cl</a>
<br>
<b>
Asunto:</b>
 <b>
RV:==E2=81=A8 Registro de Atenci=C3=B3n Domiciliaria Oncovida=E2=81=A9</b>
<br>
<b=r>
</div>
</blockquote>
<blockquote type=3D"cite">
<div dir=3D"ltr">
<div dir=3D"=ltr">
<br>
buenas noches, adjunto reporte<div>
sin otro particular Christian Ga=lleguillos<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_att=r">
---------- Forwarded message ---------<br>
De: <strong class=3D"gmail_send=ername" dir=3D"auto">
Formularios de Google</strong>
 <span dir=3D"auto">
&lt;<=a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@g=oogle.com</a>
&gt;</span>
<br>
Date: mar., 9 jul. 2019 a las 1:43<br>
Subject: R=egistro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href=3D"mailto=:galleguillos.arredondo.16@gmail.com">
galleguillos.arredondo.16@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" cellpa=dding=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 al=t=3D"Formularios de Google" height=3D"26px" style=3D"display:inline-block;ma=rgin:0;vertical-align:middle" width=3D"143px" src=3D"https://ci6.googleuserc=ontent.com/proxy/t1Vv3qXKt68KP1AzCe5Kkb21psRLWijHOvT3wLOSDVX8sW979L6toyGSYUZ=CkzrF63TJybR0oyToPbzNjZ4I09e8x2pEkzjZX9Xsx2izR7S-7LRSvZAARwttrg=3Ds0-d-e1-ft=#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-botto=m:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 2=4px">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"ba=ckground-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-we=ight:700">
Gracias por rellenar <a href=3D"https://docs.google.com/forms/d/e/=1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail=_form_link" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria Oncovid=a</a>
</div>
</td>
</tr>
<tr height=3D"12px">
</tr>
<tr>
<td>
<div style=3D"font-siz=e:13px;line-height:18px;color:#424242">
Esto es lo que nos has enviado:</div>
=</td>
</tr>
<tr>
<td>
<div class=3D"m_3095786363977802670ss-form-container">
<div= class=3D"m_3095786363977802670ss-form-heading">
<h1 class=3D"m_3095786363977=802670ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci==C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_3095786363977802670ss-form-desc m_3095786363977802670ss-no-i=gnore-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 p=restador de Oncovida por favor no llene este formulario.   A continuaci=C3=B3=n indique su correo electr=C3=B3nico.</div>
</div>
<div class=3D"m_3095786363977802670ss-form">
<form method=3D"GET" id=3D"m_309=5786363977802670ss-form" target=3D"_blank">
<br>
<div class=3D"m_3095786363977802670ss-form-question m_3095786363977802670err=orbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-text" style=3D"margin:12px 0">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class==3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977802670emailA=ddress">
<div class=3D"m_3095786363977802670ss-q-title" style=3D"display:bloc=k;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Direcci=C3=B3n de c=orreo electr=C3=B3nico<label for=3D"m_3095786363977802670emailAddress">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
</label>
<div class=3D"m_3095786363977802670ss-q-text m_3095786363977802670ss-printab=le-text-line" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;bord=er:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70=%">
<a href=3D"mailto:galleguillos.arredondo.16@gmail.com" target=3D"_blank">
=galleguillos.arredondo.16@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_3095786363977802670errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_3095786363977802670ss-q-title" style=3D"display:block;font-we=ight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_3095786363977802670ss-image"= title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8Yp=wJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width:78px;out=line:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_3095786363977802670s=s-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left=:0;margin-top:0;max-width:100%">
<h2 class=3D"m_3095786363977802670ss-page-title" style=3D"padding:0.4em;back=ground-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_3095786363977802670ss-page-description m_3095786363977802670=ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wra=p:break-word">
Aqu=C3=AD debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-text" style=3D"margin:12px 0">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_579114469">
<div class=3D"m_3095786363977802670ss-q-title" style=3D="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer= Nombre y Apellido Paterno<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
</div>
</label>
<div class=3D"m_3095786363977802670ss-q-text" dir=3D"auto" style=3D"backgrou=nd-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space=:pre-wrap;color:#545454;width:70%">
Christian Galleguillos</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-text" style=3D"margin:12px 0">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_1276273985">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT=<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)=</div>
</label>
<div class=3D"m_3095786363977802670ss-q-text" dir=3D"auto" style=3D"backgrou=nd-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space=:pre-wrap;color:#545454;width:70%">
15065811-K</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-select" style=3D"margin:12px 0">
<d=iv class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em=;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_133691676">
<div class=3D"m_3095786363977802670ss-q-title" style=3D="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
Si asisten m=C3=A1s de 1 prestador simult=C3=A1neamente, cada uno debe ha=cer un registro independiente</div>
</label>
<select name=3D"entry.133691676" disabled=3D"" id=3D"m_3095786363977802670en=try_133691676">
<option value=3D"">
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<option value=3D"MEDICO" disabled=3D"">
MEDICO</option>
 <option value=3D"ENFE=RMERA/O" disabled=3D"" selected=3D"">
ENFERMERA/O</option>
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TENS</option>
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KINESIOLOGA/O</option>
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PSICOLOG=O</option>
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NUTRICIONISTA</opti=on>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_3095786363977802670ss-q-title" style=3D"display:block;font-we=ight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_3095786363977802670ss-image"= title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57=PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width:78px;out=line:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_3095786363977802670s=s-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left=:0;margin-top:0;max-width:100%">
<h2 class=3D"m_3095786363977802670ss-page-title" style=3D"padding:0.4em;back=ground-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_3095786363977802670ss-page-description m_3095786363977802670=ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wra=p:break-word">
En esta secci=C3=B3n debe ingresar los datos del paciente visi=tado</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_3095786363977802=670ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-=left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_3095786363977802670ss-section-title" style=3D"background-colo=r:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_3095786363977802670ss-section-description m_3095786363977802=670ss-no-ignore-whitespace" style=3D"margin-top:0.5em;white-space:pre-wrap;w=ord-wrap:break-word">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-text" style=3D"margin:12px 0">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_823811303">
<div class=3D"m_3095786363977802670ss-q-title" style=3D="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingres=e el Rut del Paciente<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)=</div>
</label>
<div class=3D"m_3095786363977802670ss-q-text" dir=3D"auto" style=3D"backgrou=nd-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space=:pre-wrap;color:#545454;width:70%">
14442247-3</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-text" style=3D"margin:12px 0">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_1959365839">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ing=rese el Primer Nombre y Apellido Paterno del Paciente<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
</div>
</label>
<div class=3D"m_3095786363977802670ss-q-text" dir=3D"auto" style=3D"backgrou=nd-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space=:pre-wrap;color:#545454;width:70%">
Thomas Franziskus</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-select" style=3D"margin:12px 0">
<d=iv class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em=;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_545002227">
<div class=3D"m_3095786363977802670ss-q-title" style=3D="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previs=i=C3=B3n<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
</div>
</label>
<select name=3D"entry.545002227" disabled=3D"" id=3D"m_3095786363977802670en=try_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled=3D"">
BANMEDICA</option>
 <option value=3D="CAPREDENA" disabled=3D"">
CAPREDENA</option>
 <option value=3D"COLMENA" disab=led=3D"">
COLMENA</option>
 <option value=3D"CONSALUD" disabled=3D"" selected=3D="">
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled=3D"">
CRUZ BLANCA=</option>
 <option value=3D"DIPRECA" disabled=3D"">
DIPRECA</option>
 <option v=alue=3D"FONASA" disabled=3D"">
FONASA</option>
 <option value=3D"FUNDACION" di=sabled=3D"">
FUNDACION</option>
 <option value=3D"ISAPRES DEL COBRE" disabled=3D="">
ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled=3D"">
=NUEVA MASVIDA</option>
 <option value=3D"VIDATRES" disabled=3D"">
VIDATRES</op=tion>
 <option value=3D"PARTICULAR" disabled=3D"">
PARTICULAR</option>
</select=>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-text" style=3D"margin:12px 0">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_1900161356">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciu=dad<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
</div>
</label>
<div class=3D"m_3095786363977802670ss-q-text" dir=3D"auto" style=3D"backgrou=nd-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space=:pre-wrap;color:#545454;width:70%">
valparaiso</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-text" style=3D"margin:12px 0">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_1298871758">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Com=una<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
</div>
</label>
<div class=3D"m_3095786363977802670ss-q-text" dir=3D"auto" style=3D"backgrou=nd-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space=:pre-wrap;color:#545454;width:70%">
valparaiso</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_3095786363977802670ss-q-title" style=3D"display:block;font-we=ight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_3095786363977802670ss-image"= title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBW=w-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;out=line:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_3095786363977802670s=s-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left=:0;margin-top:0;max-width:100%">
<h2 class=3D"m_3095786363977802670ss-page-title" style=3D"padding:0.4em;back=ground-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_3095786363977802670ss-page-description m_3095786363977802670=ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wra=p:break-word">
En esta secci=C3=B3n debe ingresar los datos de la atenci=C3=B3=n domiciliaria</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-radio" style=3D"margin:12px 0">
<di=v class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;=vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_2073233714">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tip=o de Atenci=C3=B3n<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
</div>
</label>
<ul class=3D"m_3095786363977802670ss-choices" style=3D"list-style:none;paddi=ng:0;margin:.5em 0 0">
<li class=3D"m_3095786363977802670ss-choice-item" styl=e=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_3095786363977802670ss-choice-item-control m_30957863=63977802670goog-inline-block" style=3D"display:inline-block">
<input type=3D"=radio" name=3D"entry.1222378237" disabled=3D"" checked=3D"" value=3D"Domicil=io" id=3D"m_3095786363977802670group_1222378237_1" class=3D"m_30957863639778=02670ss-q-radio">
</span>
<span class=3D"m_3095786363977802670ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_3095786363977802670ss-choice-item" style=3D"mar=gin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_3095786363977802670ss-choice-item-control m_30957863=63977802670goog-inline-block" style=3D"display:inline-block">
<input type=3D"=radio" name=3D"entry.1222378237" disabled=3D"" value=3D"Ambulatorio" id=3D"m=_3095786363977802670group_1222378237_2" class=3D"m_3095786363977802670ss-q-r=adio">
</span>
<span class=3D"m_3095786363977802670ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-date" style=3D"margin:12px 0">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_1705849412">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fec=ha de la Atenci=C3=B3n<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
</div>
</label>
<div class=3D"m_3095786363977802670ss-q-date">
<div class=3D"m_30957863639778=02670ss-datetime-box m_3095786363977802670goog-inline-block" style=3D"border=:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertica=l-align:middle;margin:4px 3px;display:inline-block">
 <select name=3D"entry.1=705849412_day" disabled=3D"" class=3D"m_3095786363977802670ss-day-dropdown" i=d=3D"m_3095786363977802670entry.1705849412_day">
<option value=3D"">
D=C3=ADa<=/option>
<option value=3D"1">
1</option>
 <option value=3D"2">
2</option>
 <option value=3D="3">
3</option>
 <option value=3D"4">
4</option>
 <option value=3D"5">
5</option>
= <option value=3D"6">
6</option>
 <option value=3D"7">
7</option>
 <option value==3D"8" selected=3D"">
8</option>
 <option value=3D"9">
9</option>
 <option value==3D"10">
10</option>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12=</option>
 <option value=3D"13">
13</option>
 <option value=3D"14">
14</option>
 <=option value=3D"15">
15</option>
 <option value=3D"16">
16</option>
 <option val=ue=3D"17">
17</option>
 <option value=3D"18">
18</option>
 <option value=3D"19">
=19</option>
 <option value=3D"20">
20</option>
 <option value=3D"21">
21</option=>
 <option value=3D"22">
22</option>
 <option value=3D"23">
23</option>
 <option v=alue=3D"24">
24</option>
 <option value=3D"25">
25</option>
 <option value=3D"26=">
26</option>
 <option value=3D"27">
27</option>
 <option value=3D"28">
28</opti=on>
 <option value=3D"29">
29</option>
 <option value=3D"30">
30</option>
 <optio=n value=3D"31">
31</option>
</select>
   <select name=3D"entry.1705849412_month=" disabled=3D"" class=3D"m_3095786363977802670ss-month-dropdown" id=3D"m_309=5786363977802670entry.1705849412_month">
<option value=3D"">
Mes</option>
<option value=3D"1">
enero</option>
 <option value=3D"2">
febrero</option>
 <opt=ion value=3D"3">
marzo</option>
 <option value=3D"4">
abril</option>
 <option va=lue=3D"5">
mayo</option>
 <option value=3D"6">
junio</option>
 <option value=3D"=7" selected=3D"">
julio</option>
 <option value=3D"8">
agosto</option>
 <option v=alue=3D"9">
septiembre</option>
 <option value=3D"10">
octubre</option>
 <option= value=3D"11">
noviembre</option>
 <option value=3D"12">
diciembre</option>
</se=lect>
=20<select name=3D"entry.1705849412_year" disabled=3D"" id=3D"m_309578636397780=2670entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
 <option value=3D"1897">
1897</option>
 <o=ption value=3D"1898">
1898</option>
 <option value=3D"1899">
1899</option>
 <opt=ion value=3D"1900">
1900</option>
 <option value=3D"1901">
1901</option>
 <optio=n value=3D"1902">
1902</option>
 <option value=3D"1903">
1903</option>
 <option v=alue=3D"1904">
1904</option>
 <option value=3D"1905">
1905</option>
 <option val=ue=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"1=912">
1912</option>
 <option value=3D"1913">
1913</option>
 <option value=3D"191=4">
1914</option>
 <option value=3D"1915">
1915</option>
 <option value=3D"1916"=>
1916</option>
 <option value=3D"1917">
1917</option>
 <option value=3D"1918">
1=918</option>
 <option value=3D"1919">
1919</option>
 <option value=3D"1920">
192=0</option>
 <option value=3D"1921">
1921</option>
 <option value=3D"1922">
1922<=/option>
 <option value=3D"1923">
1923</option>
 <option value=3D"1924">
1924</o=ption>
 <option value=3D"1925">
1925</option>
 <option value=3D"1926">
1926</opt=ion>
 <option value=3D"1927">
1927</option>
 <option value=3D"1928">
1928</optio=n>
 <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>
 <op=tion value=3D"1935">
1935</option>
 <option value=3D"1936">
1936</option>
 <opti=on value=3D"1937">
1937</option>
 <option value=3D"1938">
1938</option>
 <option= value=3D"1939">
1939</option>
 <option value=3D"1940">
1940</option>
 <option v=alue=3D"1941">
1941</option>
 <option value=3D"1942">
1942</option>
 <option val=ue=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"1=949">
1949</option>
 <option value=3D"1950">
1950</option>
 <option value=3D"195=1">
1951</option>
 <option value=3D"1952">
1952</option>
 <option value=3D"1953"=>
1953</option>
 <option value=3D"1954">
1954</option>
 <option value=3D"1955">
1=955</option>
 <option value=3D"1956">
1956</option>
 <option value=3D"1957">
195=7</option>
 <option value=3D"1958">
1958</option>
 <option value=3D"1959">
1959<=/option>
 <option value=3D"1960">
1960</option>
 <option value=3D"1961">
1961</o=ption>
 <option value=3D"1962">
1962</option>
 <option value=3D"1963">
1963</opt=ion>
 <option value=3D"1964">
1964</option>
 <option value=3D"1965">
1965</optio=n>
 <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>
 <op=tion value=3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
 <opti=on value=3D"1974">
1974</option>
 <option value=3D"1975">
1975</option>
 <option= value=3D"1976">
1976</option>
 <option value=3D"1977">
1977</option>
 <option v=alue=3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option val=ue=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"1=986">
1986</option>
 <option value=3D"1987">
1987</option>
 <option value=3D"198=8">
1988</option>
 <option value=3D"1989">
1989</option>
 <option value=3D"1990"=>
1990</option>
 <option value=3D"1991">
1991</option>
 <option value=3D"1992">
1=992</option>
 <option value=3D"1993">
1993</option>
 <option value=3D"1994">
199=4</option>
 <option value=3D"1995">
1995</option>
 <option value=3D"1996">
1996<=/option>
 <option value=3D"1997">
1997</option>
 <option value=3D"1998">
1998</o=ption>
 <option value=3D"1999">
1999</option>
 <option value=3D"2000">
2000</opt=ion>
 <option value=3D"2001">
2001</option>
 <option value=3D"2002">
2002</optio=n>
 <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>
 <op=tion value=3D"2009">
2009</option>
 <option value=3D"2010">
2010</option>
 <opti=on value=3D"2011">
2011</option>
 <option value=3D"2012">
2012</option>
 <option= value=3D"2013">
2013</option>
 <option value=3D"2014">
2014</option>
 <option v=alue=3D"2015">
2015</option>
 <option value=3D"2016">
2016</option>
 <option val=ue=3D"2017">
2017</option>
 <option value=3D"2018">
2018</option>
 <option value==3D"2019" selected=3D"">
2019</option>
 <option value=3D"2020">
2020</option>
 <=option value=3D"2021">
2021</option>
 <option value=3D"2022">
2022</option>
 <op=tion value=3D"2023">
2023</option>
 <option value=3D"2024">
2024</option>
 <opti=on value=3D"2025">
2025</option>
 <option value=3D"2026">
2026</option>
 <option= value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
 <option v=alue=3D"2029">
2029</option>
 <option value=3D"2030">
2030</option>
 <option val=ue=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"2=037">
2037</option>
 <option value=3D"2038">
2038</option>
 <option value=3D"203=9">
2039</option>
 <option value=3D"2040">
2040</option>
 <option value=3D"2041"=>
2041</option>
 <option value=3D"2042">
2042</option>
 <option value=3D"2043">
2=043</option>
 <option value=3D"2044">
2044</option>
 <option value=3D"2045">
204=5</option>
 <option value=3D"2046">
2046</option>
 <option value=3D"2047">
2047<=/option>
 <option value=3D"2048">
2048</option>
 <option value=3D"2049">
2049</o=ption>
 <option value=3D"2050">
2050</option>
 <option value=3D"2051">
2051</opt=ion>
 <option value=3D"2052">
2052</option>
 <option value=3D"2053">
2053</optio=n>
 <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">
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<div class=3D"m_309578636=3977802670ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;=margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_1716090865">
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Esc=ala Dolor EVA Actual</div>
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</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"m_309578636397=7802670entry_1421689035">
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<tr>
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</td>
<td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align:cente=r">
<label class=3D"m_3095786363977802670ss-scalenumber" for=3D"m_30957863639=77802670group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</=label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text=-align:center">
<label class=3D"m_3095786363977802670ss-scalenumber" for=3D"m=_3095786363977802670group_1421689035_2" style=3D"display:block;padding:0.5em= 0 .5em">
1</label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" s=tyle=3D"text-align:center">
<label class=3D"m_3095786363977802670ss-scalenumb=er" for=3D"m_3095786363977802670group_1421689035_3" style=3D"display:block;p=adding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_3095786363977802670ss-sca=lenumbers" style=3D"text-align:center">
<label class=3D"m_3095786363977802670=ss-scalenumber" for=3D"m_3095786363977802670group_1421689035_4" style=3D"dis=play:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_3095786363977=802670ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_3095786=363977802670ss-scalenumber" for=3D"m_3095786363977802670group_1421689035_5" s=tyle=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_30=95786363977802670ss-scalenumbers" style=3D"text-align:center">
<label class=3D="m_3095786363977802670ss-scalenumber" for=3D"m_3095786363977802670group_1421=689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td cl=ass=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align:center">
<la=bel class=3D"m_3095786363977802670ss-scalenumber" for=3D"m_30957863639778026=70group_1421689035_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
=</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align=:center">
<label class=3D"m_3095786363977802670ss-scalenumber" for=3D"m_30957=86363977802670group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5e=m">
7</label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" style=3D="text-align:center">
<label class=3D"m_3095786363977802670ss-scalenumber" for==3D"m_3095786363977802670group_1421689035_9" style=3D"display:block;padding:=0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbe=rs" style=3D"text-align:center">
<label class=3D"m_3095786363977802670ss-scal=enumber" for=3D"m_3095786363977802670group_1421689035_10" style=3D"display:b=lock;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_3095786363977802670=ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_3095786363977=802670ss-scalenumber" for=3D"m_3095786363977802670group_1421689035_11" style==3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align:cente=r">
</td>
</tr>
<tr>
<td class=3D"m_3095786363977802670ss-scalerow m_3095786363977802670ss-le=ftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;borde=r-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class=3D"m_3=095786363977802670aria-todo">
</div>
</td>
<td class=3D"m_3095786363977802670ss-scalerow" style=3D"text-align:center;co=lor:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .=25em">
<div class=3D"m_3095786363977802670ss-scalerow-fieldcell">
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</div>
</td>
 <td class=3D"m_3095786363977802670ss-scalerow" style=3D"=text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-r=ight:0;padding:.5em .25em">
<div class=3D"m_3095786363977802670ss-scalerow-fi=eldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled=3D"" value==3D"1" id=3D"m_3095786363977802670group_1421689035_2" class=3D"m_30957863639=77802670ss-q-radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-scalero=w" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-lef=t:0;border-right:0;padding:.5em .25em">
<div class=3D"m_3095786363977802670ss=-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disable=d=3D"" value=3D"2" id=3D"m_3095786363977802670group_1421689035_3" class=3D"m=_3095786363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_30957863639778026=70ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d=3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_309578636=3977802670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689=035" disabled=3D"" value=3D"3" id=3D"m_3095786363977802670group_1421689035_4=" class=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_30957=86363977802670ss-scalerow" style=3D"text-align:center;color:#666;border:1px s=olid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"=m_3095786363977802670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"en=try.1421689035" disabled=3D"" value=3D"4" id=3D"m_3095786363977802670group_1=421689035_5" class=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
 <td class==3D"m_3095786363977802670ss-scalerow" style=3D"text-align:center;color:#666;=border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<d=iv class=3D"m_3095786363977802670ss-scalerow-fieldcell">
<input type=3D"radio=" name=3D"entry.1421689035" disabled=3D"" value=3D"5" id=3D"m_30957863639778=02670group_1421689035_6" class=3D"m_3095786363977802670ss-q-radio">
</div>
</t=d>
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<div class=3D"m_3095786363977802670ss-scalerow-fieldcell">
<input t=ype=3D"radio" name=3D"entry.1421689035" disabled=3D"" value=3D"6" id=3D"m_30=95786363977802670group_1421689035_7" class=3D"m_3095786363977802670ss-q-radi=o">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-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_3095786363977802670ss-scalerow-fieldce=ll">
<input type=3D"radio" name=3D"entry.1421689035" disabled=3D"" value=3D"7=" id=3D"m_3095786363977802670group_1421689035_8" class=3D"m_3095786363977802=670ss-q-radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-scalerow" st=yle=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;b=order-right:0;padding:.5em .25em">
<div class=3D"m_3095786363977802670ss-scal=erow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled=3D"=" value=3D"8" id=3D"m_3095786363977802670group_1421689035_9" class=3D"m_3095=786363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-=scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;bor=der-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_30957863639778=02670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" d=isabled=3D"" value=3D"9" id=3D"m_3095786363977802670group_1421689035_10" cla=ss=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_3095786363=977802670ss-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_30=95786363977802670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.=1421689035" disabled=3D"" value=3D"10" id=3D"m_3095786363977802670group_1421=689035_11" class=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
<td class=3D"m_3095786363977802670ss-scalerow m_3095786363977802670ss-rightl=abel" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-le=ft:0;border-right:0;padding:.5em .25em;padding-right:0">
</td>
</tr>
</tbody>
</=table>
</div>
</div>
</div>
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 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_309578636=3977802670ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;=margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_2064050596">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Esc=ala Dolor EVA M=C3=A1ximo</div>
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</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"m_309578636397=7802670entry_1244707512">
<tbody>
<tr>
<td class=3D"m_3095786363977802670ss-sca=lenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align:cente=r">
<label class=3D"m_3095786363977802670ss-scalenumber" for=3D"m_30957863639=77802670group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</=label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text=-align:center">
<label class=3D"m_3095786363977802670ss-scalenumber" for=3D"m=_3095786363977802670group_1244707512_2" style=3D"display:block;padding:0.5em= 0 .5em">
1</label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" s=tyle=3D"text-align:center">
<label class=3D"m_3095786363977802670ss-scalenumb=er" for=3D"m_3095786363977802670group_1244707512_3" style=3D"display:block;p=adding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_3095786363977802670ss-sca=lenumbers" style=3D"text-align:center">
<label class=3D"m_3095786363977802670=ss-scalenumber" for=3D"m_3095786363977802670group_1244707512_4" style=3D"dis=play:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_3095786363977=802670ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_3095786=363977802670ss-scalenumber" for=3D"m_3095786363977802670group_1244707512_5" s=tyle=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_30=95786363977802670ss-scalenumbers" style=3D"text-align:center">
<label class=3D="m_3095786363977802670ss-scalenumber" for=3D"m_3095786363977802670group_1244=707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td cl=ass=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align:center">
<la=bel class=3D"m_3095786363977802670ss-scalenumber" for=3D"m_30957863639778026=70group_1244707512_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
=</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align=:center">
<label class=3D"m_3095786363977802670ss-scalenumber" for=3D"m_30957=86363977802670group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5e=m">
7</label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" style=3D="text-align:center">
<label class=3D"m_3095786363977802670ss-scalenumber" for==3D"m_3095786363977802670group_1244707512_9" style=3D"display:block;padding:=0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbe=rs" style=3D"text-align:center">
<label class=3D"m_3095786363977802670ss-scal=enumber" for=3D"m_3095786363977802670group_1244707512_10" style=3D"display:b=lock;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_3095786363977802670=ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_3095786363977=802670ss-scalenumber" for=3D"m_3095786363977802670group_1244707512_11" style==3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align:cente=r">
</td>
</tr>
<tr>
<td class=3D"m_3095786363977802670ss-scalerow m_3095786363977802670ss-le=ftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;borde=r-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class=3D"m_3=095786363977802670aria-todo">
</div>
</td>
<td class=3D"m_3095786363977802670ss-scalerow" style=3D"text-align:center;co=lor:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .=25em">
<div class=3D"m_3095786363977802670ss-scalerow-fieldcell">
<input type=3D="radio" name=3D"entry.1244707512" disabled=3D"" value=3D"0" id=3D"m_30957863=63977802670group_1244707512_1" class=3D"m_3095786363977802670ss-q-radio">
</d=iv>
</td>
 <td class=3D"m_3095786363977802670ss-scalerow" style=3D"text-align:=center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padd=ing:.5em .25em">
<div class=3D"m_3095786363977802670ss-scalerow-fieldcell">
<i=nput type=3D"radio" name=3D"entry.1244707512" disabled=3D"" value=3D"1" id=3D="m_3095786363977802670group_1244707512_2" class=3D"m_3095786363977802670ss-q=-radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-scalerow" style=3D"=text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-r=ight:0;padding:.5em .25em">
<div class=3D"m_3095786363977802670ss-scalerow-fi=eldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled=3D"" value==3D"2" id=3D"m_3095786363977802670group_1244707512_3" class=3D"m_30957863639=77802670ss-q-radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-scalero=w" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-lef=t:0;border-right:0;padding:.5em .25em">
<div class=3D"m_3095786363977802670ss=-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disable=d=3D"" value=3D"3" id=3D"m_3095786363977802670group_1244707512_4" class=3D"m=_3095786363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_30957863639778026=70ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d=3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_309578636=3977802670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707=512" disabled=3D"" value=3D"4" id=3D"m_3095786363977802670group_1244707512_5=" class=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_30957=86363977802670ss-scalerow" style=3D"text-align:center;color:#666;border:1px s=olid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"=m_3095786363977802670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"en=try.1244707512" disabled=3D"" value=3D"5" id=3D"m_3095786363977802670group_1=244707512_6" class=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
 <td class==3D"m_3095786363977802670ss-scalerow" style=3D"text-align:center;color:#666;=border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<d=iv class=3D"m_3095786363977802670ss-scalerow-fieldcell">
<input type=3D"radio=" name=3D"entry.1244707512" disabled=3D"" checked=3D"" value=3D"6" id=3D"m_3=095786363977802670group_1244707512_7" class=3D"m_3095786363977802670ss-q-rad=io">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-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_3095786363977802670ss-scalerow-fieldc=ell">
<input type=3D"radio" name=3D"entry.1244707512" disabled=3D"" value=3D"=7" id=3D"m_3095786363977802670group_1244707512_8" class=3D"m_309578636397780=2670ss-q-radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-scalerow" s=tyle=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;=border-right:0;padding:.5em .25em">
<div class=3D"m_3095786363977802670ss-sca=lerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled=3D="" value=3D"8" id=3D"m_3095786363977802670group_1244707512_9" class=3D"m_309=5786363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss=-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;bo=rder-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_3095786363977=802670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512"= disabled=3D"" value=3D"9" id=3D"m_3095786363977802670group_1244707512_10" c=lass=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_30957863=63977802670ss-scalerow" style=3D"text-align:center;color:#666;border:1px sol=id #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_=3095786363977802670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entr=y.1244707512" disabled=3D"" value=3D"10" id=3D"m_3095786363977802670group_12=44707512_11" class=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
<td class=3D"m_3095786363977802670ss-scalerow m_3095786363977802670ss-rightl=abel" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-le=ft:0;border-right:0;padding:.5em .25em;padding-right:0">
</td>
</tr>
</tbody>
</=table>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_309578636=3977802670ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;=margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_2000523015">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Esc=ala Dolor EVA M=C3=ADnimo</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"m_309578636397=7802670entry_853118630">
<tbody>
<tr>
<td class=3D"m_3095786363977802670ss-scal=enumbers" style=3D"text-align:center">
</td>
<td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align:cente=r">
<label class=3D"m_3095786363977802670ss-scalenumber" for=3D"m_30957863639=77802670group_853118630_1" style=3D"display:block;padding:0.5em 0 .5em">
0</l=abel>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-=align:center">
<label class=3D"m_3095786363977802670ss-scalenumber" for=3D"m_=3095786363977802670group_853118630_2" style=3D"display:block;padding:0.5em 0= .5em">
1</label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" sty=le=3D"text-align:center">
<label class=3D"m_3095786363977802670ss-scalenumber=" for=3D"m_3095786363977802670group_853118630_3" style=3D"display:block;padd=ing:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_3095786363977802670ss-scalen=umbers" style=3D"text-align:center">
<label class=3D"m_3095786363977802670ss-=scalenumber" for=3D"m_3095786363977802670group_853118630_4" style=3D"display=:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_30957863639778026=70ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_30957863639=77802670ss-scalenumber" for=3D"m_3095786363977802670group_853118630_5" style==3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_309578=6363977802670ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_=3095786363977802670ss-scalenumber" for=3D"m_3095786363977802670group_8531186=30_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D="m_3095786363977802670ss-scalenumbers" style=3D"text-align:center">
<label cl=ass=3D"m_3095786363977802670ss-scalenumber" for=3D"m_3095786363977802670grou=p_853118630_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <=td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align:center=">
<label class=3D"m_3095786363977802670ss-scalenumber" for=3D"m_309578636397=7802670group_853118630_8" style=3D"display:block;padding:0.5em 0 .5em">
7</la=bel>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-a=lign:center">
<label class=3D"m_3095786363977802670ss-scalenumber" for=3D"m_3=095786363977802670group_853118630_9" style=3D"display:block;padding:0.5em 0 .=5em">
8</label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_3095786363977802670ss-scalenumber" f=or=3D"m_3095786363977802670group_853118630_10" style=3D"display:block;paddin=g:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_3095786363977802670ss-scalenum=bers" style=3D"text-align:center">
<label class=3D"m_3095786363977802670ss-sc=alenumber" for=3D"m_3095786363977802670group_853118630_11" style=3D"display:=block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_3095786363977802670ss-scalenumbers" style=3D"text-align:cente=r">
</td>
</tr>
<tr>
<td class=3D"m_3095786363977802670ss-scalerow m_3095786363977802670ss-le=ftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;borde=r-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class=3D"m_3=095786363977802670aria-todo">
</div>
</td>
<td class=3D"m_3095786363977802670ss-scalerow" style=3D"text-align:center;co=lor:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .=25em">
<div class=3D"m_3095786363977802670ss-scalerow-fieldcell">
<input type=3D="radio" name=3D"entry.853118630" disabled=3D"" checked=3D"" value=3D"0" id=3D="m_3095786363977802670group_853118630_1" class=3D"m_3095786363977802670ss-q-=radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-scalerow" style=3D"t=ext-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-ri=ght:0;padding:.5em .25em">
<div class=3D"m_3095786363977802670ss-scalerow-fie=ldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D="1" id=3D"m_3095786363977802670group_853118630_2" class=3D"m_309578636397780=2670ss-q-radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-scalerow" s=tyle=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;=border-right:0;padding:.5em .25em">
<div class=3D"m_3095786363977802670ss-sca=lerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"=" value=3D"2" id=3D"m_3095786363977802670group_853118630_3" class=3D"m_30957=86363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-s=calerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;bord=er-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_309578636397780=2670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" di=sabled=3D"" value=3D"3" id=3D"m_3095786363977802670group_853118630_4" class=3D="m_3095786363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_309578636397780=2670ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d=8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_3095786=363977802670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.85311=8630" disabled=3D"" value=3D"4" id=3D"m_3095786363977802670group_853118630_5=" class=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
 <td class=3D"m_30957=86363977802670ss-scalerow" style=3D"text-align:center;color:#666;border:1px s=olid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"=m_3095786363977802670ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"en=try.853118630" disabled=3D"" value=3D"5" id=3D"m_3095786363977802670group_85=3118630_6" class=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
 <td class=3D="m_3095786363977802670ss-scalerow" style=3D"text-align:center;color:#666;bor=der:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div c=lass=3D"m_3095786363977802670ss-scalerow-fieldcell">
<input type=3D"radio" na=me=3D"entry.853118630" disabled=3D"" value=3D"6" id=3D"m_3095786363977802670=group_853118630_7" class=3D"m_3095786363977802670ss-q-radio">
</div>
</td>
 <td= class=3D"m_3095786363977802670ss-scalerow" style=3D"text-align:center;color=:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25=em">
<div class=3D"m_3095786363977802670ss-scalerow-fieldcell">
<input type=3D="radio" name=3D"entry.853118630" disabled=3D"" value=3D"7" id=3D"m_309578636=3977802670group_853118630_8" class=3D"m_3095786363977802670ss-q-radio">
</div=>
</td>
 <td class=3D"m_3095786363977802670ss-scalerow" style=3D"text-align:ce=nter;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;paddin=g:.5em .25em">
<div class=3D"m_3095786363977802670ss-scalerow-fieldcell">
<inp=ut type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"8" id=3D"m=_3095786363977802670group_853118630_9" class=3D"m_3095786363977802670ss-q-ra=dio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-scalerow" style=3D"tex=t-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-righ=t:0;padding:.5em .25em">
<div class=3D"m_3095786363977802670ss-scalerow-field=cell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"=9" id=3D"m_3095786363977802670group_853118630_10" class=3D"m_309578636397780=2670ss-q-radio">
</div>
</td>
 <td class=3D"m_3095786363977802670ss-scalerow" s=tyle=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;=border-right:0;padding:.5em .25em">
<div class=3D"m_3095786363977802670ss-sca=lerow-fieldcell">
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<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_2140974612">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ana=mnesis/Evoluci=C3=B3n<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
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<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
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</div>
</label>
<div class=3D"m_3095786363977802670ss-q-text" dir=3D"auto" style=3D"backgrou=nd-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space=:pre-wrap;color:#545454;width:70%">
Usuario antecedentes de Ca Prostatico, de= buen aspecto general, refiere sentirse bien, con buen afrontamiento de su s=ituaci=C3=B3n de salud actual, su esposa esta preocupada por el desenlace qu=e este pueda tener, se siente angustiada, llanto f=C3=A1cil. Usuario mantien=e actividades de la vida diaria, aunque dejo de realizar actividades pesadas=. comprende y maneja su tratamiento medico, rechazando quimioterapia. refier=e buena tolerancia a tratamiento farmacol=C3=B3gico, nauseas (-), buena adhe=rencia, EVA 0. Refiere haber bajado de peso no cuantificada, el apetito a di=sminuido un poco, eliminaci=C3=B3n urinaria (+), sin incontinencia, deposici=ones (+) presenta cambios en el patr=C3=B3n de sue=C3=B1o, le cuesta concili=ar el sue=C3=B1o durante la noche.</div>
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<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_824006088">
<div class=3D"m_3095786363977802670ss-q-title" style=3D="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Examen= F=C3=ADsico<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
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Usuario vigil, orientado en tiempo y espa=cio, piel y mucosas sanas e hidratadas, pupilas iguales, reactivas a la luz,= yugulares planas, t=C3=B3rax sim=C3=A9trico, Mp (+)AcPs, sin ruidos agregad=os, ABD BDI, sin masas palpables, RHA (+), extremidades sanas, pulsos perif=C3==A9ricos +/+</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-text" style=3D"margin:12px 0">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_1690694733">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Dia=gn=C3=B3stico<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
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Afrontamiento familiar ineficiente, Deseq=uilibrio nutricional, relecionado con disminuci=C3=B3n del apetito, </div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-item-required m_3095786363977802670ss-paragraph-text" style=3D"margin:12=px 0">
<div class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bott=om:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_1255665248">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Pla=n de Tratamiento e Indicaciones<label for=3D"m_3095786363977802670itemView.getDomIdToLabel()">
</label>
<span class=3D"m_3095786363977802670ss-required-asterisk" style=3D"color:#c4=3b1d">
*</span>
</div>
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Fomentar afrontamiento, apoyo emocional-e=spiritual, monitoreo nutricional y evaluaci=C3=B3n por nutricionista, manten=er tratamiento farmacol=C3=B3gico, control por enfermero en SOS</div>
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<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_1648939075">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Med=icamentos Indicados</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
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</div>
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<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-date" style=3D"margin:12px 0">
<div class=3D"m_3095786363977802670ss-form=-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;mar=gin-top:0;max-width:100%">
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<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fec=ha aproximada del Pr=C3=B3ximo Control con usted</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
</div>
</label>
<div class=3D"m_3095786363977802670ss-q-date">
<div class=3D"m_30957863639778=02670ss-datetime-box m_3095786363977802670goog-inline-block" style=3D"border=:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertica=l-align:middle;margin:4px 3px;display:inline-block">
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<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>
= <option value=3D"6">
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</op=tion>
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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</o=ption>
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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"">
Mes</option>
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enero</option>
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febrero</option>
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marzo</option>
 <option value=3D"4">
abril</option>
 <option va=lue=3D"5">
mayo</option>
 <option value=3D"6">
junio</option>
 <option value=3D"=7">
julio</option>
 <option value=3D"8">
agosto</option>
 <option value=3D"9">
se=ptiembre</option>
 <option value=3D"10">
octubre</option>
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noviembre</option>
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diciembre</option>
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=20<select name=3D"entry.2063615873_year" disabled=3D"" id=3D"m_309578636397780=2670entry.2063615873_year">
<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>
 <option value=3D"1903">
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>
 <option value=3D"1915">
1915</option>
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1916</option>
 <option value=3D"1917">
1917</option>
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1=918</option>
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1919</option>
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192=0</option>
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1921</option>
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1922<=/option>
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1923</option>
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1924</o=ption>
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1925</option>
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1926</opt=ion>
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1927</option>
 <option value=3D"1928">
1928</optio=n>
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1929</option>
 <option value=3D"1930">
1930</option>
= <option value=3D"1931">
1931</option>
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1932</option>
 <=option value=3D"1933">
1933</option>
 <option value=3D"1934">
1934</option>
 <op=tion value=3D"1935">
1935</option>
 <option value=3D"1936">
1936</option>
 <opti=on value=3D"1937">
1937</option>
 <option value=3D"1938">
1938</option>
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1939</option>
 <option value=3D"1940">
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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1=955</option>
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1956</option>
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195=7</option>
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1958</option>
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1959<=/option>
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1960</option>
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1961</o=ption>
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1962</option>
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1963</opt=ion>
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1964</option>
 <option value=3D"1965">
1965</optio=n>
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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>
 <op=tion value=3D"1972">
1972</option>
 <option value=3D"1973">
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>
 <option value=3D"1983">
1983</option>
 <option value=3D="1984">
1984</option>
 <option value=3D"1985">
1985</option>
 <option value=3D"1=986">
1986</option>
 <option value=3D"1987">
1987</option>
 <option value=3D"198=8">
1988</option>
 <option value=3D"1989">
1989</option>
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1990</option>
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1991</option>
 <option value=3D"1992">
1=992</option>
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1993</option>
 <option value=3D"1994">
199=4</option>
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1995</option>
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1996<=/option>
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1997</option>
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1998</o=ption>
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1999</option>
 <option value=3D"2000">
2000</opt=ion>
 <option value=3D"2001">
2001</option>
 <option value=3D"2002">
2002</optio=n>
 <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>
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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>
 <option v=alue=3D"2015">
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>
 <option value=3D"2020">
2020</option>
 <=option value=3D"2021">
2021</option>
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2022</option>
 <op=tion value=3D"2023">
2023</option>
 <option value=3D"2024">
2024</option>
 <opti=on value=3D"2025">
2025</option>
 <option value=3D"2026">
2026</option>
 <option= value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
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2029</option>
 <option value=3D"2030">
2030</option>
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2031</option>
 <option value=3D"2032">
2032</option>
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2033</option>
 <option value=3D"2034">
2034</option>
 <option value=3D="2035">
2035</option>
 <option value=3D"2036">
2036</option>
 <option value=3D"2=037">
2037</option>
 <option value=3D"2038">
2038</option>
 <option value=3D"203=9">
2039</option>
 <option value=3D"2040">
2040</option>
 <option value=3D"2041"=>
2041</option>
 <option value=3D"2042">
2042</option>
 <option value=3D"2043">
2=043</option>
 <option value=3D"2044">
2044</option>
 <option value=3D"2045">
204=5</option>
 <option value=3D"2046">
2046</option>
 <option value=3D"2047">
2047<=/option>
 <option value=3D"2048">
2048</option>
 <option value=3D"2049">
2049</o=ption>
 <option value=3D"2050">
2050</option>
 <option value=3D"2051">
2051</opt=ion>
 <option value=3D"2052">
2052</option>
 <option value=3D"2053">
2053</optio=n>
 <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>
 <op=tion value=3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <opti=on value=3D"2062">
2062</option>
 <option value=3D"2063">
2063</option>
 <option= value=3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option v=alue=3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option val=ue=3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-text" style=3D"margin:12px 0">
<div class=3D"m_3095786363977802670ss-form=-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;mar=gin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_74766472">
<div class=3D"m_3095786363977802670ss-q-title" style=3D="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tratam=iento Realizado (si corresponde)</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
</div>
</label>
<div class=3D"m_3095786363977802670ss-q-text" dir=3D"auto" style=3D"backgrou=nd-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_3095786363977802670ss-form-question m_30957863639778026=70errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-checkbox" style=3D"margin:12px 0">
<div class=3D"m_3095786363977802670ss-=form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0=;margin-top:0;max-width:100%">
<label class=3D"m_3095786363977802670ss-q-item-label" for=3D"m_3095786363977=802670entry_1219705969">
<div class=3D"m_3095786363977802670ss-q-title" style==3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Der=ivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"m_3095786363977802670ss-q-help m_3095786363977802670ss-seconda=ry-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#66=6">
S=C3=B3lo llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita d=e otro prestador del equipo</div>
</label>
<ul class=3D"m_3095786363977802670ss-choices" style=3D"list-style:none;paddi=ng:0;margin:.5em 0 0">
<li class=3D"m_3095786363977802670ss-choice-item" styl=e=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_3095786363977802670ss-choice-item-control m_30957863=63977802670goog-inline-block" style=3D"display:inline-block">
<input type=3D"=checkbox" name=3D"entry.503039759" disabled=3D"" value=3D"ENFERMERA" id=3D"m=_3095786363977802670group_503039759_1" class=3D"m_3095786363977802670ss-q-ch=eckbox">
</span>
<span class=3D"m_3095786363977802670ss-choice-label">
ENFERMERA</span>
</label>
</li>
 <li class=3D"m_3095786363977802670ss-choice-item" style=3D"mar=gin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_3095786363977802670ss-choice-item-control m_30957863=63977802670goog-inline-block" style=3D"display:inline-block">
<input type=3D"=checkbox" name=3D"entry.503039759" disabled=3D"" value=3D"TENS" id=3D"m_3095=786363977802670group_503039759_2" class=3D"m_3095786363977802670ss-q-checkbo=x">
</span>
<span class=3D"m_3095786363977802670ss-choice-label">
TENS</span>
</label>
</li>
 <li class=3D"m_3095786363977802670ss-choice-item" style=3D"mar=gin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_3095786363977802670ss-choice-item-control m_30957863=63977802670goog-inline-block" style=3D"display:inline-block">
<input type=3D"=checkbox" name=3D"entry.503039759" disabled=3D"" value=3D"NUTRICIONISTA" id=3D="m_3095786363977802670group_503039759_3" class=3D"m_3095786363977802670ss-q-=checkbox">
</span>
<span class=3D"m_3095786363977802670ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
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<label>
<span class=3D"m_3095786363977802670ss-choice-item-control m_30957863=63977802670goog-inline-block" style=3D"display:inline-block">
<input type=3D"=checkbox" name=3D"entry.503039759" disabled=3D"" value=3D"KINESIOLOGO" id=3D="m_3095786363977802670group_503039759_4" class=3D"m_3095786363977802670ss-q-=checkbox">
</span>
<span class=3D"m_3095786363977802670ss-choice-label">
KINESIOLOGO</span>
</label>
</li>
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<label>
<span class=3D"m_3095786363977802670ss-choice-item-control m_30957863=63977802670goog-inline-block" style=3D"display:inline-block">
<input type=3D"=checkbox" name=3D"entry.503039759" disabled=3D"" value=3D"PSICOLOGO" id=3D"m=_3095786363977802670group_503039759_5" class=3D"m_3095786363977802670ss-q-ch=eckbox">
</span>
<span class=3D"m_3095786363977802670ss-choice-label">
PSICOLOGO</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_3095786363977802670errorbox-good">
<div dir=3D"auto" class=3D"m_3095786363977802670ss-item m_309578636397780267=0ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div= class=3D"m_3095786363977802670ss-form-entry" style=3D"margin-bottom:1.5em;v=ertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_3095786363977802670ss-q-title" style=3D"display:block;font-we=ight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_3095786363977802670ss-image"= title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hr=FRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width:78px;out=line:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
</form>
</div>
</div>
</td>
</tr>
<tr height=3D"24px">
</tr>
</tbody>
</table>
</=div>
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"max=-width:672px;min-width:154px" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
=</td>
</tr>
<tr>
<td>
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_l=ink" style=3D"color:#424242;font-size:13px" target=3D"_blank">
Crea tu propio= formulario de Google</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<=/div>
</div>
</blockquote>
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