X-AntiAbuse: Primary Hostname - ns1.hostnow.clX-AntiAbuse: Original Domain - telemed-chile.clX-AntiAbuse: Originator/Caller UID/GID - [47 12] / [47 12]X-AntiAbuse: Sender Address Domain - telemed-chile.clX-Get-Message-Sender-Via: ns1.hostnow.cl: authenticated_id: claritamamani@telemed-chile.clX-Authenticated-Sender: ns1.hostnow.cl: claritamamani@telemed-chile.clX-Source: X-Source-Args: X-Source-Dir: X-Spam-Status: Yes, score=5.7X-Spam-Score: 57X-Spam-Bar: +++++X-Spam-Report: Spam detection software, running on the system "host213.hostmonster.com", has identified this incoming email as possible spam.  The original message has been attached to this so you can view it or label similar future email.  If you have any questions, see root\@localhost for details.  Content preview:  Estimados envió registro de atención realizada al paciente    Saludos cordiales Atentamente Clara Mamani   Content analysis details:   (5.7 points, 5.0 required)   pts rule name              description ---- ---------------------- --------------------------------------------------  0.0 URIBL_BLOCKED          ADMINISTRATOR NOTICE: The query to URIBL was                             blocked.  See                             http://wiki.apache.org/spamassassin/DnsBlocklists#dnsbl-block                              for more information.                             [URIs: docs.google.com] -0.5 SPF_PASS               SPF: sender matches SPF record  1.5 SUBJ_ALL_CAPS          Subject is all capitals  0.9 SPF_HELO_SOFTFAIL      SPF: HELO does not match SPF record (softfail)  2.4 HTML_OBFUSCATE_20_30   BODY: Message is 20% to 30% HTML                             obfuscation  0.0 HTML_MESSAGE           BODY: HTML included in message  0.1 MIME_HTML_ONLY         BODY: Message only has text/html MIME parts -0.1 DKIM_VALID_EF          Message has a valid DKIM or DK signature from                             envelope-from domain  0.1 DKIM_SIGNED            Message has a DKIM or DK signature, not necessarily                             valid -0.1 DKIM_VALID_AU          Message has a valid DKIM or DK signature from                             author's domain -0.1 DKIM_VALID             Message has at least one valid DKIM or DK signature  1.8 MISSING_MIMEOLE        Message has X-MSMail-Priority, but no X-MimeOLE  0.6 HTML_MIME_NO_HTML_TAG  HTML-only message, but there is no HTML                             tag -1.1 AWL                    AWL: Adjusted score from AWL reputation of From: addressX-Spam-Flag: NO<div dir='auto'>
<div>
Estimados envió registro de atención realizada al paciente<div dir="auto">
Saludos cordiales&nbsp;</div>
<div dir="auto">
Atentamente&nbsp;</div>
<div dir="auto">
Clara Mamani&nbsp;</div>
<div dir="auto">
Enfermera&nbsp;</div>
<br>
<div class="gmail_quote">
---------- Mensaje reenviado ----------<br>
De: Formularios de Google &lt;forms-receipts-noreply@google.com&gt;<br>
Fecha: 01-08-2019 09:15<br>
Asunto: Registro de Atención Domiciliaria Oncovida<br>
Para: claritamamani@telemed-chile.cl<br>
Cc: <br>
<br type="attribution">
<blockquote class="quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex">
<div style="font-family:'roboto' , 'helvetica' , 'arial' , sans-serif;margin:0;padding:0;height:100%;width:100%">
<table border="0" cellpadding="0" cellspacing="0" style="background-color:rgb( 38 , 4 , 154 )" width="100%">
<tbody>
<tr>
<td style="padding-left:24px">
<img alt="Formularios de Google" height="26px" style="display:inline-block;margin:0;vertical-align:middle" width="143px" src="https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div style="padding:24px;background-color:rgb( 229 , 218 , 254 )">
<div align="center" style="background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table align="center" cellpadding="0" cellspacing="0" style="background-color:#fff" width="100%">
<tbody>
<tr>
<td>
</td>
</tr>
<tr>
<td>
<div style="font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por llenar <a href="https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=mail_form_link">
Registro de Atención Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr>
</tr>
<tr>
<td>
<div style="font-size:13px;line-height:18px;color:#424242">
Estas son tus respuestas:</div>
</td>
</tr>
<tr>
<td>
<div>
<div>
<h1 dir="ltr" style="margin:0.67em 0">
Registro de Atención Domiciliaria Oncovida</h1>
<div style="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 continuación indique su correo electrónico.</div>
</div>
<div>
<form action="" method="GET">
<br>
<div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Dirección de correo electrónico<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
</label>
<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
claritamamani@telemed-chile.cl</div>
</div>
</div>
</div>
<div>
<div dir="auto" style="margin:12px 0;max-width:100%">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>
<div style="text-align:right">
<img src="https://lh3.googleusercontent.com/00-FWRRIiJNpjLIXj1QrTLVceHhiPxWpIN-K4cI0enEtAvmFFnvOHRJTMz5Lq8yFpMHz7WvBnNdiNVchE6Snklpxxc7gIx3OoqTfn_sB2_iSp_6sx7Sr2pww-0pD" style="width:78px;outline:none" alt="Imagen sin título">
</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 style="margin:2em 0;padding:0.4em;background-color:#eee">
Identificación del Prestador</h2>
<div dir="auto" style="white-space:pre-wrap;word-wrap:break-word">
Aquí debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Primer Nombre y Apellido Paterno<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
CLARA MAMANI</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
RUT<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
RUT con Guión y Dígito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
18787490-4</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tipo<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
Si asisten más de 1 prestador simultáneamente, cada uno debe hacer un registro independiente</div>
</label>
<select name="entry.133691676" disabled="disabled">
<option value="">
</option>
<option value="MEDICO" disabled="disabled">
MEDICO</option>
<option value="ENFERMERA/O" disabled="disabled" selected="selected">
ENFERMERA/O</option>
<option value="TENS" disabled="disabled">
TENS</option>
<option value="KINESIOLOGA/O" disabled="disabled">
KINESIOLOGA/O</option>
<option value="PSICOLOGO" disabled="disabled">
PSICOLOGO</option>
<option value="NUTRICIONISTA" disabled="disabled">
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0;max-width:100%">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>
<div style="text-align:right">
<img src="https://lh3.googleusercontent.com/mRJInQVKRU12r9blREv2jmlzETLT9JfIHWC0FaeXYfPraPFE9ebBRX8P_hmpfiBP6BNpOgjPBYU0zwBxYxgoLvjQ7EjfjoRTJ2_-8flTaiU_wC008XC8LpcEJ_Yp" style="width:78px;outline:none" alt="Imagen sin título">
</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 style="margin:2em 0;padding:0.4em;background-color:#eee">
Identificación del Paciente</h2>
<div dir="auto" style="white-space:pre-wrap;word-wrap:break-word">
En esta sección debe ingresar los datos del paciente visitado</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 style="background-color:#eee;padding:0.4em;margin:2em 0">
Datos Personales del Paciente</h2>
<div style="margin-top:0.5em;white-space:pre-wrap;word-wrap:break-word">
</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ingrese el Rut del Paciente<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
RUT con Guión y Dígito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
9015729-9</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
MARCO VILLALOBOS</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Previsión<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<select name="entry.545002227" disabled="disabled">
<option value="">
</option>
<option value="BANMEDICA" disabled="disabled">
BANMEDICA</option>
<option value="CAPREDENA" disabled="disabled">
CAPREDENA</option>
<option value="COLMENA" disabled="disabled" selected="selected">
COLMENA</option>
<option value="CONSALUD" disabled="disabled">
CONSALUD</option>
<option value="CRUZ BLANCA" disabled="disabled">
CRUZ BLANCA</option>
<option value="DIPRECA" disabled="disabled">
DIPRECA</option>
<option value="FONASA" disabled="disabled">
FONASA</option>
<option value="FUNDACION" disabled="disabled">
FUNDACION</option>
<option value="ISAPRES DEL COBRE" disabled="disabled">
ISAPRES DEL COBRE</option>
<option value="NUEVA MASVIDA" disabled="disabled">
NUEVA MASVIDA</option>
<option value="VIDATRES" disabled="disabled">
VIDATRES</option>
<option value="PARTICULAR" disabled="disabled">
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ciudad<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
ARICA</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Comuna<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
ARICA</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0;max-width:100%">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>
<div style="text-align:right">
<img src="https://lh6.googleusercontent.com/URytM0QWRGW_JEL0xQxvOLvwPRJIHyqlnKOm6ky9DRBfzvYVPaAngXV35GNHnaVG-dm9Orno4lr8sy8E-KB9tMrmIhFbVQiOPWy3vUclqRKAJ51dvLdhjBKgXdLO" style="width:78px;outline:none" alt="Imagen sin título">
</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 style="margin:2em 0;padding:0.4em;background-color:#eee">
Registro de la Atención Domiciliaria</h2>
<div dir="auto" style="white-space:pre-wrap;word-wrap:break-word">
En esta sección debe ingresar los datos de la atención domiciliaria</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tipo de Atención<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<ul style="list-style:none;padding:0;margin:0.5em 0 0">
<li style="margin:0;line-height:1.3em;padding-bottom:0.5em">
<label>
<span style="display:inline-block">
<input type="radio" name="entry.1222378237" disabled="disabled" checked="checked" value="Domicilio">
</span>
Domicilio</label>
</li>
<li style="margin:0;line-height:1.3em;padding-bottom:0.5em">
<label>
<span style="display:inline-block">
<input type="radio" name="entry.1222378237" disabled="disabled" value="Ambulatorio">
</span>
Ambulatorio</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Fecha de la Atención<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<div>
<div style="border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name="entry.1705849412_month" disabled="disabled">
<option value="">
Mes</option>
<option value="1">
enero</option>
<option value="2">
febrero</option>
<option value="3">
marzo</option>
<option value="4">
abril</option>
<option value="5">
mayo</option>
<option value="6">
junio</option>
<option value="7" selected="selected">
julio</option>
<option value="8">
agosto</option>
<option value="9">
septiembre</option>
<option value="10">
octubre</option>
<option value="11">
noviembre</option>
<option value="12">
diciembre</option>
</select>
   <select name="entry.1705849412_day" disabled="disabled">
<option value="">
Día</option>
<option value="1">
1</option>
<option value="2">
2</option>
<option value="3">
3</option>
<option value="4">
4</option>
<option value="5">
5</option>
<option value="6">
6</option>
<option value="7">
7</option>
<option value="8">
8</option>
<option value="9">
9</option>
<option value="10">
10</option>
<option value="11">
11</option>
<option value="12">
12</option>
<option value="13">
13</option>
<option value="14">
14</option>
<option value="15">
15</option>
<option value="16">
16</option>
<option value="17">
17</option>
<option value="18">
18</option>
<option value="19">
19</option>
<option value="20">
20</option>
<option value="21">
21</option>
<option value="22">
22</option>
<option value="23">
23</option>
<option value="24">
24</option>
<option value="25">
25</option>
<option value="26">
26</option>
<option value="27">
27</option>
<option value="28">
28</option>
<option value="29">
29</option>
<option value="30">
30</option>
<option value="31" selected="selected">
31</option>
</select>
 <select name="entry.1705849412_year" disabled="disabled">
<option value="">
Año</option>
<option value="1896">
1896</option>
<option value="1897">
1897</option>
<option value="1898">
1898</option>
<option value="1899">
1899</option>
<option value="1900">
1900</option>
<option value="1901">
1901</option>
<option value="1902">
1902</option>
<option value="1903">
1903</option>
<option value="1904">
1904</option>
<option value="1905">
1905</option>
<option value="1906">
1906</option>
<option value="1907">
1907</option>
<option value="1908">
1908</option>
<option value="1909">
1909</option>
<option value="1910">
1910</option>
<option value="1911">
1911</option>
<option value="1912">
1912</option>
<option value="1913">
1913</option>
<option value="1914">
1914</option>
<option value="1915">
1915</option>
<option value="1916">
1916</option>
<option value="1917">
1917</option>
<option value="1918">
1918</option>
<option value="1919">
1919</option>
<option value="1920">
1920</option>
<option value="1921">
1921</option>
<option value="1922">
1922</option>
<option value="1923">
1923</option>
<option value="1924">
1924</option>
<option value="1925">
1925</option>
<option value="1926">
1926</option>
<option value="1927">
1927</option>
<option value="1928">
1928</option>
<option value="1929">
1929</option>
<option value="1930">
1930</option>
<option value="1931">
1931</option>
<option value="1932">
1932</option>
<option value="1933">
1933</option>
<option value="1934">
1934</option>
<option value="1935">
1935</option>
<option value="1936">
1936</option>
<option value="1937">
1937</option>
<option value="1938">
1938</option>
<option value="1939">
1939</option>
<option value="1940">
1940</option>
<option value="1941">
1941</option>
<option value="1942">
1942</option>
<option value="1943">
1943</option>
<option value="1944">
1944</option>
<option value="1945">
1945</option>
<option value="1946">
1946</option>
<option value="1947">
1947</option>
<option value="1948">
1948</option>
<option value="1949">
1949</option>
<option value="1950">
1950</option>
<option value="1951">
1951</option>
<option value="1952">
1952</option>
<option value="1953">
1953</option>
<option value="1954">
1954</option>
<option value="1955">
1955</option>
<option value="1956">
1956</option>
<option value="1957">
1957</option>
<option value="1958">
1958</option>
<option value="1959">
1959</option>
<option value="1960">
1960</option>
<option value="1961">
1961</option>
<option value="1962">
1962</option>
<option value="1963">
1963</option>
<option value="1964">
1964</option>
<option value="1965">
1965</option>
<option value="1966">
1966</option>
<option value="1967">
1967</option>
<option value="1968">
1968</option>
<option value="1969">
1969</option>
<option value="1970">
1970</option>
<option value="1971">
1971</option>
<option value="1972">
1972</option>
<option value="1973">
1973</option>
<option value="1974">
1974</option>
<option value="1975">
1975</option>
<option value="1976">
1976</option>
<option value="1977">
1977</option>
<option value="1978">
1978</option>
<option value="1979">
1979</option>
<option value="1980">
1980</option>
<option value="1981">
1981</option>
<option value="1982">
1982</option>
<option value="1983">
1983</option>
<option value="1984">
1984</option>
<option value="1985">
1985</option>
<option value="1986">
1986</option>
<option value="1987">
1987</option>
<option value="1988">
1988</option>
<option value="1989">
1989</option>
<option value="1990">
1990</option>
<option value="1991">
1991</option>
<option value="1992">
1992</option>
<option value="1993">
1993</option>
<option value="1994">
1994</option>
<option value="1995">
1995</option>
<option value="1996">
1996</option>
<option value="1997">
1997</option>
<option value="1998">
1998</option>
<option value="1999">
1999</option>
<option value="2000">
2000</option>
<option value="2001">
2001</option>
<option value="2002">
2002</option>
<option value="2003">
2003</option>
<option value="2004">
2004</option>
<option value="2005">
2005</option>
<option value="2006">
2006</option>
<option value="2007">
2007</option>
<option value="2008">
2008</option>
<option value="2009">
2009</option>
<option value="2010">
2010</option>
<option value="2011">
2011</option>
<option value="2012">
2012</option>
<option value="2013">
2013</option>
<option value="2014">
2014</option>
<option value="2015">
2015</option>
<option value="2016">
2016</option>
<option value="2017">
2017</option>
<option value="2018">
2018</option>
<option value="2019" selected="selected">
2019</option>
<option value="2020">
2020</option>
<option value="2021">
2021</option>
<option value="2022">
2022</option>
<option value="2023">
2023</option>
<option value="2024">
2024</option>
<option value="2025">
2025</option>
<option value="2026">
2026</option>
<option value="2027">
2027</option>
<option value="2028">
2028</option>
<option value="2029">
2029</option>
<option value="2030">
2030</option>
<option value="2031">
2031</option>
<option value="2032">
2032</option>
<option value="2033">
2033</option>
<option value="2034">
2034</option>
<option value="2035">
2035</option>
<option value="2036">
2036</option>
<option value="2037">
2037</option>
<option value="2038">
2038</option>
<option value="2039">
2039</option>
<option value="2040">
2040</option>
<option value="2041">
2041</option>
<option value="2042">
2042</option>
<option value="2043">
2043</option>
<option value="2044">
2044</option>
<option value="2045">
2045</option>
<option value="2046">
2046</option>
<option value="2047">
2047</option>
<option value="2048">
2048</option>
<option value="2049">
2049</option>
<option value="2050">
2050</option>
<option value="2051">
2051</option>
<option value="2052">
2052</option>
<option value="2053">
2053</option>
<option value="2054">
2054</option>
<option value="2055">
2055</option>
<option value="2056">
2056</option>
<option value="2057">
2057</option>
<option value="2058">
2058</option>
<option value="2059">
2059</option>
<option value="2060">
2060</option>
<option value="2061">
2061</option>
<option value="2062">
2062</option>
<option value="2063">
2063</option>
<option value="2064">
2064</option>
<option value="2065">
2065</option>
<option value="2066">
2066</option>
<option value="2067">
2067</option>
<option value="2068">
2068</option>
<option value="2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0;font:inherit">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Hora de la Atención<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<div>
<div dir="ltr" style="border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
<select name="entry.206244955_hour" disabled="disabled">
<option value="">
h</option>
<option value="00">
00</option>
<option value="01">
01</option>
<option value="02">
02</option>
<option value="03">
03</option>
<option value="04">
04</option>
<option value="05">
05</option>
<option value="06">
06</option>
<option value="07">
07</option>
<option value="08">
08</option>
<option value="09" selected="selected">
09</option>
<option value="10">
10</option>
<option value="11">
11</option>
<option value="12">
12</option>
<option value="13">
13</option>
<option value="14">
14</option>
<option value="15">
15</option>
<option value="16">
16</option>
<option value="17">
17</option>
<option value="18">
18</option>
<option value="19">
19</option>
<option value="20">
20</option>
<option value="21">
21</option>
<option value="22">
22</option>
<option value="23">
23</option>
</select>
.<select name="entry.206244955_minute" disabled="disabled">
<option value="">
min</option>
<option value="00">
00</option>
<option value="01">
01</option>
<option value="02">
02</option>
<option value="03">
03</option>
<option value="04">
04</option>
<option value="05">
05</option>
<option value="06">
06</option>
<option value="07">
07</option>
<option value="08">
08</option>
<option value="09">
09</option>
<option value="10">
10</option>
<option value="11">
11</option>
<option value="12">
12</option>
<option value="13">
13</option>
<option value="14">
14</option>
<option value="15">
15</option>
<option value="16">
16</option>
<option value="17">
17</option>
<option value="18">
18</option>
<option value="19">
19</option>
<option value="20">
20</option>
<option value="21">
21</option>
<option value="22">
22</option>
<option value="23">
23</option>
<option value="24">
24</option>
<option value="25">
25</option>
<option value="26">
26</option>
<option value="27">
27</option>
<option value="28">
28</option>
<option value="29">
29</option>
<option value="30" selected="selected">
30</option>
<option value="31">
31</option>
<option value="32">
32</option>
<option value="33">
33</option>
<option value="34">
34</option>
<option value="35">
35</option>
<option value="36">
36</option>
<option value="37">
37</option>
<option value="38">
38</option>
<option value="39">
39</option>
<option value="40">
40</option>
<option value="41">
41</option>
<option value="42">
42</option>
<option value="43">
43</option>
<option value="44">
44</option>
<option value="45">
45</option>
<option value="46">
46</option>
<option value="47">
47</option>
<option value="48">
48</option>
<option value="49">
49</option>
<option value="50">
50</option>
<option value="51">
51</option>
<option value="52">
52</option>
<option value="53">
53</option>
<option value="54">
54</option>
<option value="55">
55</option>
<option value="56">
56</option>
<option value="57">
57</option>
<option value="58">
58</option>
<option value="59">
59</option>
</select>
<div style="height:32px;vertical-align:middle;display:inline-block">
</div>
</div>
</div>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Performance Status ECOG del Paciente<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<select name="entry.1747608258" disabled="disabled">
<option value="">
</option>
<option value="0" disabled="disabled" selected="selected">
0</option>
<option value="1" disabled="disabled">
1</option>
<option value="2" disabled="disabled">
2</option>
<option value="3" disabled="disabled">
3</option>
<option value="4" disabled="disabled">
4</option>
</select>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Escala Dolor EVA Actual</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<table border="0" cellpadding="5" cellspacing="0">
<tbody>
<tr>
<td style="text-align:center">
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
0</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
1</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
2</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
3</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
4</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
5</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
6</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
7</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
8</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
9</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
10</label>
</td>
<td style="text-align:center">
</td>
</tr>
<tr>
<td style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em;padding-left:0">
<div>
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" checked="checked" value="0">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="1">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="2">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="3">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="4">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="5">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="6">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="7">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="8">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="9">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1421689035" disabled="disabled" value="10">
</div>
</td>
<td style="text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em;padding-right:0">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Escala Dolor EVA Máximo</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<table border="0" cellpadding="5" cellspacing="0">
<tbody>
<tr>
<td style="text-align:center">
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
0</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
1</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
2</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
3</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
4</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
5</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
6</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
7</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
8</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
9</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
10</label>
</td>
<td style="text-align:center">
</td>
</tr>
<tr>
<td style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em;padding-left:0">
<div>
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="0">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="1">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="2">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" checked="checked" value="3">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="4">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="5">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="6">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="7">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="8">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="9">
</div>
</td>
<td style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em">
<div>
<input type="radio" name="entry.1244707512" disabled="disabled" value="10">
</div>
</td>
<td style="text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:0.5em 0.25em;padding-right:0">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div>
<div dir="auto" style="margin:12px 0">
<div style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label>
<div style="display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Escala Dolor EVA Mínimo</div>
<div dir="auto" style="display:block;margin:0.1em 0 0.25em 0;color:#666">
</div>
</label>
<table border="0" cellpadding="5" cellspacing="0">
<tbody>
<tr>
<td style="text-align:center">
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
0</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
1</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
2</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
3</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
4</label>
</td>
<td style="text-align:center">
<label style="display:block;padding:0.5em 0 0.5em">
5</label>
</td>
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10</label>
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Anamnesis/Evolución<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
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</label>
<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Paciente consciente, lucido, orientado en tiempo espacio y persona, glasgow 15 pts. en buenas condiciones generales, P/A:114/80 mm/hg FC: 58 x' , Sat: 98% EVA 0/10, paciente refiere en ocasiones dolor abdominal que se alivia con medidas fisicas, continúa con acidez estomacal la cual alivia con esomeprazol 1 al día.  se mantiene con escasa salivacion y xerostomia la cual se agudiza con ciertos alimentos. Buen estado de ánimo, patrón del sueño conservado, buen apetito.</div>
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Examen Físico<label>
</label>
<span style="color:#c43b1d">
*</span>
</div>
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</div>
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<div dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Cabeza: normocraneo, simetrico, cuero cabelludo no presenta lesiones, ni descamaciones, higiene conservada, cabello canoso y delgado. • Oidos: simétricos, sin lesiones y sin presencia de secreciones. •Cara: simetrica, piel indemne e hidratada; cejas simétricas, parpadeo espontáneo; conjuntivas y lagrimal rosados e hidratados, sin secreciones; esclera limpia, pupilas isocóricas, oscuras y fotorreactivas. • Boca: mucosas hidratadas, refiere escasa producir de saliva. lengua   de blanca coloración • Cuello: simétrico, sin dolor a la palpación, piel seca e hiperpigmentada. Hacia posterior, bajo la prominencia de la vértebra c7, presenta un lipoma. • Extremidades Superiores: movilidad conservada, piel hidratada e indemne pulsos radial y braquial (+). • Tórax anterior: simétrico, ruidos pulmonares normales, no presenta lesiones en piel. • Abdomen: blando, depresible e indoloro, RHA (+). Herida quirugia de precedimiento laparoscopico sin signos de infección • Extremidades inferiores: – Pierna derecha: movilidad conservada, piel indemne, sin lesiones, pulsos popliteo, tibial y pedio (+) – Pierna Izquierda: movilidad conservada, piel indemne, presencia de cicatrices en la rótula, por cirugía anterior de meniscos. pulsos popliteo, tibial y pedio (+) • Genitales: masculinos. • Diuresis: Sin cambios en su patron de eliminacion. • Deposiciones: Refiere que sus deposiciones diarias, sin dificultad.</div>
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Diagnóstico<label>
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<span style="color:#c43b1d">
*</span>
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Cáncer Escamoso de amígdala izquierda</div>
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Plan de Tratamiento e Indicaciones<label>
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*</span>
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se realiza educacion con respecto a: - mantener uso de protector solar, crema hidratante en area del cuello y uso de balsamo labial en caso necesario. - uso de medicacion para el dolor SOS - signos y sintomas de alarma acudir al servicio de urgencia - higiene oral - continuar con consumo de colaciones y pauta de nutricionista- precauciones standard</div>
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Medicamentos Indicados</div>
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Esomeprazol 1 al diaViadil 20 gotas c/8 hrs sosParacetamol 500 mg 1 c/8 hrs sos </div>
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Fecha aproximada del Próximo Control con usted</div>
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Tratamiento Realizado (si corresponde)</div>
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Derivación a otro Prestador Domiciliario</div>
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Sólo llene esta sección si es médico y solicita la visita de otro prestador del equipo</div>
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</h2>
<div style="text-align:right">
<img src="https://lh5.googleusercontent.com/Bpur5zPteyG-bXtM-WNRuiLwTi8myvetX7lBkdjzbnQyqUlGcuv84zmWyU3x0Ua2-_WXX9PiJ2cMBOO0zhG2nHX7tXXPHH6_X8UTG8MZzIBwxETkF0a8JyZtuxSL" style="width:78px;outline:none" alt="Imagen sin título">
</div>
</div>
</div>
</div>
<br>
</form>
</div>
</div>
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
</div>
<table align="center" cellpadding="0" cellspacing="0" style="max-width:672px;min-width:154px" width="100%">
<tbody>
<tr>
<td>
</td>
</tr>
<tr>
<td>
<a href="https://docs.google.com/forms?usp=mail_form_link" style="color:#424242;font-size:13px">
Crear tu propio Formulario de Google</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</blockquote>
</div>
<br>
</div>
</div>
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