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--<br>
 Sandra Maulen Angel<br>
 Enfermera <br>
 Coordinadora<br>
 Telemed-chile</p>
</div>
-------- Mensaje reenviado --------De: Gonzalo Sanchez <a href="mailto:gsanchez.sotelo.gs@gmail.com">
gsanchez.sotelo.gs@gmail.com</a>
Para: <a href="mailto:coordinadora@telemed-chile.cl">
coordinadora@telemed-chile.cl</a>
Fecha: sábado, 30 marzo 2019, 11:05a. m. -03:00Asunto: Fwd: Registro de Atención Domiciliaria Oncovida<br>
<br>
<blockquote id="mail-app-auto-quote" cite="15539547080000001868" style="border-left:1px solid #FC2C38; margin:0px 0px 0px 10px; padding:0px 0px 0px 10px;">
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---------- Forwarded message ---------<br>
From: <strong class="gmail_sendername_mailru_css_attribute_postfix" dir="auto">
Formularios de Google</strong>
 <span dir="ltr">
<<a href="mailto:forms-receipts-noreply@google.com" target="_blank"  rel=" noopener noreferrer" >
forms-receipts-noreply@google.com</a>
>
</span>
<br>
Date: mié., 30 de ene. de 2019 23:43<br>
Subject: Registro de Atención Domiciliaria Oncovida<br>
To:  <<a href="mailto:gsanchez.sotelo.gs@gmail.com" target="_blank"  rel=" noopener noreferrer" >
gsanchez.sotelo.gs@gmail.com</a>
>
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<table border="0" cellpadding="0" cellspacing="0" style="background-color:rgb(38,4,154)" width="100%">
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<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">
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<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">
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<div style="font-size:13px;line-height:18px;color:#424242;font-weight:700">
Gracias por rellenar <a href="https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=mail_form_link" target="_blank" rel=" noopener noreferrer" >
Registro de Atención Domiciliaria Oncovida</a>
</div>
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<div style="font-size:13px;line-height:18px;color:#424242">
Esto es lo que nos has enviado:</div>
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<div class="m_-1441598801993523635m_-7315385751086384981ss-form-container_mailru_css_attribute_postfix">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-heading_mailru_css_attribute_postfix">
<h1 class="m_-1441598801993523635m_-7315385751086384981ss-form-title_mailru_css_attribute_postfix" dir="ltr" style="margin:.67em 0">
Registro de Atención Domiciliaria Oncovida</h1>
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-desc_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-no-ignore-whitespace_mailru_css_attribute_postfix" 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 class="m_-1441598801993523635m_-7315385751086384981ss-form_mailru_css_attribute_postfix">
<form id="m_-1441598801993523635m_-7315385751086384981ss-form_mailru_css_attribute_postfix" target="_blank" action="#" method="POST" onsubmit="return false"  rel=" noopener noreferrer" >
<br>
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Dirección de correo electrónico<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-text_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-printable-text-line_mailru_css_attribute_postfix" dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
<a href="mailto:gsanchez.sotelo.gs@gmail.com" target="_blank" rel=" noopener noreferrer" >
gsanchez.sotelo.gs@gmail.com</a>
</div>
</div>
</div>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style="text-align:right">
<img class="m_-1441598801993523635m_-7315385751086384981ss-image_mailru_css_attribute_postfix" title="" src="https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style="width:78px;outline:none" alt="Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-page-break_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-1441598801993523635m_-7315385751086384981ss-page-title_mailru_css_attribute_postfix" style="padding:0.4em;background-color:#eee">
Identificación del Prestador</h2>
<div class="m_-1441598801993523635m_-7315385751086384981ss-page-description_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-no-ignore-whitespace_mailru_css_attribute_postfix" dir="auto" style="white-space:pre-wrap;word-wrap:break-word">
Aquí debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-text_mailru_css_attribute_postfix" dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Lidio Gonzalo Sánchez Sotelo</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Guión y Dígito Verificador, sin puntos ( Ej: 5632200-k)</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-text_mailru_css_attribute_postfix" dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
12694478-0</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-select_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
Si asisten más de 1 prestador simultáneamente, cada uno debe hacer un registro independiente</div>
<select name="entry.133691676" id="m_-1441598801993523635m_-7315385751086384981entry_133691676_mailru_css_attribute_postfix">
<option value="">
</option>
<option value="MEDICO" >
MEDICO</option>
 <option value="ENFERMERA/O" >
ENFERMERA/O</option>
 <option value="TENS" >
TENS</option>
 <option value="KINESIOLOGA/O" >
KINESIOLOGA/O</option>
 <option value="PSICOLOGO" >
PSICOLOGO</option>
 <option value="NUTRICIONISTA" >
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style="text-align:right">
<img class="m_-1441598801993523635m_-7315385751086384981ss-image_mailru_css_attribute_postfix" title="" src="https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style="width:78px;outline:none" alt="Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-page-break_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-1441598801993523635m_-7315385751086384981ss-page-title_mailru_css_attribute_postfix" style="padding:0.4em;background-color:#eee">
Identificación del Paciente</h2>
<div class="m_-1441598801993523635m_-7315385751086384981ss-page-description_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-no-ignore-whitespace_mailru_css_attribute_postfix" 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 class="m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-section-header_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-1441598801993523635m_-7315385751086384981ss-section-title_mailru_css_attribute_postfix" style="background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class="m_-1441598801993523635m_-7315385751086384981ss-section-description_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-no-ignore-whitespace_mailru_css_attribute_postfix" style="margin-top:0.5em;white-space:pre-wrap;word-wrap:break-word">
</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Guión y Dígito Verificador, sin puntos ( Ej: 5632200-k)</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-text_mailru_css_attribute_postfix" dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
4921999-7</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-text_mailru_css_attribute_postfix" dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Manuel Olea Cornejo</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-select_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsión<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<select name="entry.545002227" id="m_-1441598801993523635m_-7315385751086384981entry_545002227_mailru_css_attribute_postfix">
<option value="">
</option>
<option value="BANMEDICA" >
BANMEDICA</option>
 <option value="CAPREDENA" >
CAPREDENA</option>
 <option value="COLMENA" >
COLMENA</option>
 <option value="CONSALUD" >
CONSALUD</option>
 <option value="CRUZ BLANCA" >
CRUZ BLANCA</option>
 <option value="DIPRECA" >
DIPRECA</option>
 <option value="FONASA" >
FONASA</option>
 <option value="FUNDACION" >
FUNDACION</option>
 <option value="ISAPRES DEL COBRE" >
ISAPRES DEL COBRE</option>
 <option value="NUEVA MASVIDA" >
NUEVA MASVIDA</option>
 <option value="VIDATRES" >
VIDATRES</option>
 <option value="PARTICULAR" >
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-text_mailru_css_attribute_postfix" dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Rancagua</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-text_mailru_css_attribute_postfix" dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
coltauco</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style="text-align:right">
<img class="m_-1441598801993523635m_-7315385751086384981ss-image_mailru_css_attribute_postfix" title="" src="https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style="width:78px;outline:none" alt="Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-page-break_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class="m_-1441598801993523635m_-7315385751086384981ss-page-title_mailru_css_attribute_postfix" style="padding:0.4em;background-color:#eee">
Registro de la Atención Domiciliaria</h2>
<div class="m_-1441598801993523635m_-7315385751086384981ss-page-description_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-no-ignore-whitespace_mailru_css_attribute_postfix" 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 class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-radio_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atención<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<ul class="m_-1441598801993523635m_-7315385751086384981ss-choices_mailru_css_attribute_postfix" style="list-style:none;padding:0;margin:.5em 0 0">
<li class="m_-1441598801993523635m_-7315385751086384981ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-item-control_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="radio" name="entry.1222378237" value="Domicilio" id="m_-1441598801993523635m_-7315385751086384981group_1222378237_1_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</span>
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-label_mailru_css_attribute_postfix">
Domicilio</span>
</li>
 <li class="m_-1441598801993523635m_-7315385751086384981ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-item-control_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="radio" name="entry.1222378237" value="Ambulatorio" id="m_-1441598801993523635m_-7315385751086384981group_1222378237_2_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</span>
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-label_mailru_css_attribute_postfix">
Ambulatorio</span>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-date_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha de la Atención<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-date_mailru_css_attribute_postfix">
<div class="m_-1441598801993523635m_-7315385751086384981ss-datetime-box_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" 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_day" class="m_-1441598801993523635m_-7315385751086384981ss-day-dropdown_mailru_css_attribute_postfix" >
<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">
31</option>
</select>
   <select name="entry.1705849412_month" class="m_-1441598801993523635m_-7315385751086384981ss-month-dropdown_mailru_css_attribute_postfix" >
<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">
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_year" >
<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" >
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 class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-time_mailru_css_attribute_postfix" style="margin:12px 0;font:inherit">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Hora de la Atención<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-time_mailru_css_attribute_postfix">
<div class="m_-1441598801993523635m_-7315385751086384981ss-datetime-box_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" 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" >
<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">
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" >
<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">
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 class="m_-1441598801993523635m_-7315385751086384981ss-datetime-box-spacer_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" style="height:32px;vertical-align:middle;display:inline-block">
</div>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-select_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<select name="entry.1747608258" id="m_-1441598801993523635m_-7315385751086384981entry_1747608258_mailru_css_attribute_postfix">
<option value="">
</option>
<option value="0" >
0</option>
 <option value="1" >
1</option>
 <option value="2" >
2</option>
 <option value="3" >
3</option>
 <option value="4" >
4</option>
</select>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-scale_mailru_css_attribute_postfix" style="margin:12px 0;overflow-x:auto">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<table border="0" cellpadding="5" cellspacing="0" id="m_-1441598801993523635m_-7315385751086384981entry_1421689035_mailru_css_attribute_postfix">
<tbody>
<tr>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
0</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
1</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
2</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
3</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
4</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
5</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
6</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
7</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
8</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
9</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
10</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
</tr>
<tr>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-leftlabel_mailru_css_attribute_postfix" style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class="m_-1441598801993523635m_-7315385751086384981aria-todo_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="0" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_1_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="1" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_2_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="2" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_3_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="3" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_4_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="4" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_5_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="5" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_6_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="6" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_7_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="7" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_8_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="8" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_9_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="9" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_10_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1421689035" value="10" id="m_-1441598801993523635m_-7315385751086384981group_1421689035_11_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-rightlabel_mailru_css_attribute_postfix" style="text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-scale_mailru_css_attribute_postfix" style="margin:12px 0;overflow-x:auto">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Máximo</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<table border="0" cellpadding="5" cellspacing="0" id="m_-1441598801993523635m_-7315385751086384981entry_1244707512_mailru_css_attribute_postfix">
<tbody>
<tr>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
0</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
1</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
2</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
3</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
4</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
5</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
6</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
7</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
8</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
9</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
10</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
</tr>
<tr>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-leftlabel_mailru_css_attribute_postfix" style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class="m_-1441598801993523635m_-7315385751086384981aria-todo_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="0" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_1_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="1" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_2_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="2" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_3_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="3" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_4_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="4" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_5_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="5" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_6_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="6" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_7_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="7" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_8_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="8" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_9_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="9" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_10_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.1244707512" value="10" id="m_-1441598801993523635m_-7315385751086384981group_1244707512_11_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-rightlabel_mailru_css_attribute_postfix" style="text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-scale_mailru_css_attribute_postfix" style="margin:12px 0;overflow-x:auto">
<div class="m_-1441598801993523635m_-7315385751086384981ss-form-entry_mailru_css_attribute_postfix" style="margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Mínimo</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<table border="0" cellpadding="5" cellspacing="0" id="m_-1441598801993523635m_-7315385751086384981entry_853118630_mailru_css_attribute_postfix">
<tbody>
<tr>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
0</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
1</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
2</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
3</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
4</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
5</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
6</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
7</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
8</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
9</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
10</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
</tr>
<tr>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-leftlabel_mailru_css_attribute_postfix" style="text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class="m_-1441598801993523635m_-7315385751086384981aria-todo_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="0" id="m_-1441598801993523635m_-7315385751086384981group_853118630_1_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="1" id="m_-1441598801993523635m_-7315385751086384981group_853118630_2_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="2" id="m_-1441598801993523635m_-7315385751086384981group_853118630_3_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="3" id="m_-1441598801993523635m_-7315385751086384981group_853118630_4_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="4" id="m_-1441598801993523635m_-7315385751086384981group_853118630_5_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="5" id="m_-1441598801993523635m_-7315385751086384981group_853118630_6_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="6" id="m_-1441598801993523635m_-7315385751086384981group_853118630_7_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="7" id="m_-1441598801993523635m_-7315385751086384981group_853118630_8_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="8" id="m_-1441598801993523635m_-7315385751086384981group_853118630_9_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="9" id="m_-1441598801993523635m_-7315385751086384981group_853118630_10_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class="m_-1441598801993523635m_-7315385751086384981ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="10" id="m_-1441598801993523635m_-7315385751086384981group_853118630_11_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-1441598801993523635m_-7315385751086384981ss-scalerow_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-rightlabel_mailru_css_attribute_postfix" style="text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-1441598801993523635m_-7315385751086384981ss-item_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-item-required_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-paragraph-text_mailru_css_attribute_postfix" style="margin:12px 0">
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Anamnesis/Evolución<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
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<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
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Paciente ,Hemodinamicamente estable , se encuentra al cuidado de familiares,especialmente de esposa e hijo, durante la visita y entrevista  se aprecia desorientación en tiempo y espacio, pero que en ocasiones obedece ordenes verbales.  familiares refieren , que durante la noche esta desorientación aumenta otro punto a destacar es que Don Manuel presenta,Hemoptisis ocasional. otro punto a destacar es la  perdida de la movilidad en el lado derecho de su cuerpo, extremidades superiores e inferiores.(Hemiplejia).Don Manuel Durante la visita  se evalúan sus signos vitales P/A110/70FR: 18x´ , sat:94%,FC: 100 X´, T° Ax 36,8°.</div>
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Examen Físico<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
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Cabeza Normalojos : pupilas ,PiRRL ,escleras pálidas leve ictericiaOídos: Pabellón auricular permeableNariz . levemente congestiva Facie: pálida Boca: permeable labios pálidoscuello: sin adenopatias  palpables, en sector de entre cuello y clavícula se observa catéter de tto. Torax: Simetricocolumna : se observa normal si lesiones de l zona de piel Extremidades superiores: perdidad de la funcionalidad motora en EESDAbdomnen BDIzona : pelvica normal móvil sin dolorzona genital: no presenta alteraciones zona sacra : se observa leve lesión por presión de 1° grado extesion de -0,5 cm.Extremidades inferiores : Levemente dolorosas :obs artrosis de Rodillas Se observa perdida de funcionalidad Motora de la Extremidad inferior DerechaPies: sanos Móviles excepción pie derecho.Piel  y foráneos : sana pálida húmeda, tibiaOrina: Normal : aveces episodios de incontinenciaDeposiciones : presenta constipación.( apoyado con lactulosa)</div>
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Diagnóstico<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
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</div>
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Ca. Pulmonar en etapa terminal obs. ACV Secuelado</div>
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Plan de Tratamiento e Indicaciones<span class="m_-1441598801993523635m_-7315385751086384981ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
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1. Educación y prevención de LPP. 2. uso obligatorio  de colchón Anti escaras ( corrección de presión de aire y Otros).3. Educación respecto a los cuidados Nocturnos por problemas de desorientación Nocturna posibles caídas.4. Mantener alimentación según condición actual.5. observar todas las zonas posible de padecer Lpp.6. Aplicar cremas humectantes en toda la piel.7. se indica baño diario y lubrican de piel8.Mantener TTo. Medico actual según lo indicado9. Evaluar oxigenación con oximetro de pulso, para posible oxigeno terapia a futuro.</div>
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<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
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1. Cavilón Spray como protector Cutáneo2. Apósitos Hidrocolides  para evitar LPP. en zona sacra3. Cojín antiescaras de uso obligatorio en Silla de Ruedas u otra superficie</div>
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Fecha aproximada del Próximo Control con usted</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-date_mailru_css_attribute_postfix">
<div class="m_-1441598801993523635m_-7315385751086384981ss-datetime-box_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" style="border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
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<option value="">
Mes</option>
<option value="1">
enero</option>
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febrero</option>
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marzo</option>
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abril</option>
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mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
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<option value="1896">
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2069</option>
</select>
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 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
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<div class="m_-1441598801993523635m_-7315385751086384981ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tratamiento Realizado (si corresponde)</div>
<div class="m_-1441598801993523635m_-7315385751086384981ss-q-help_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
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<div class="m_-1441598801993523635m_-7315385751086384981ss-q-text_mailru_css_attribute_postfix" dir="auto" style="background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Prevencion de UPP.</div>
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<br>
 <div class="m_-1441598801993523635m_-7315385751086384981ss-form-question_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981errorbox-good_mailru_css_attribute_postfix">
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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>
<ul class="m_-1441598801993523635m_-7315385751086384981ss-choices_mailru_css_attribute_postfix" style="list-style:none;padding:0;margin:.5em 0 0">
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<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-item-control_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
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</span>
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-label_mailru_css_attribute_postfix">
ENFERMERA</span>
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 <li class="m_-1441598801993523635m_-7315385751086384981ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-item-control_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="checkbox" name="entry.503039759" value="TENS" id="m_-1441598801993523635m_-7315385751086384981group_503039759_2_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-checkbox_mailru_css_attribute_postfix">
</span>
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-label_mailru_css_attribute_postfix">
TENS</span>
</li>
 <li class="m_-1441598801993523635m_-7315385751086384981ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-item-control_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="checkbox" name="entry.503039759" value="NUTRICIONISTA" id="m_-1441598801993523635m_-7315385751086384981group_503039759_3_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-checkbox_mailru_css_attribute_postfix">
</span>
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-label_mailru_css_attribute_postfix">
NUTRICIONISTA</span>
</li>
 <li class="m_-1441598801993523635m_-7315385751086384981ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-item-control_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="checkbox" name="entry.503039759" value="KINESIOLOGO" id="m_-1441598801993523635m_-7315385751086384981group_503039759_4_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-checkbox_mailru_css_attribute_postfix">
</span>
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-label_mailru_css_attribute_postfix">
KINESIOLOGO</span>
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<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-item-control_mailru_css_attribute_postfix m_-1441598801993523635m_-7315385751086384981goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="checkbox" name="entry.503039759" value="PSICOLOGO" id="m_-1441598801993523635m_-7315385751086384981group_503039759_5_mailru_css_attribute_postfix" class="m_-1441598801993523635m_-7315385751086384981ss-q-checkbox_mailru_css_attribute_postfix">
</span>
<span class="m_-1441598801993523635m_-7315385751086384981ss-choice-label_mailru_css_attribute_postfix">
PSICOLOGO</span>
</li>
</ul>
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</h2>
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<img class="m_-1441598801993523635m_-7315385751086384981ss-image_mailru_css_attribute_postfix" title="" src="https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style="width:78px;outline:none" alt="Imagen sin leyenda">
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<a href="https://docs.google.com/forms?usp=mail_form_link" style="color:#424242;font-size:13px" target="_blank" rel=" noopener noreferrer" >
Crea tu propio formulario de Google</a>
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