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--<br>
 Sandra Maulen Angel<br>
 Enfermera <br>
 Coordinadora<br>
 Telemed-chile</p>
</div>
-------- Mensaje reenviado --------De: Rafael Richard <a href="mailto:rafaelrichardc@gmail.com">
rafaelrichardc@gmail.com</a>
Para: <a href="mailto:coordinadora@telemed-chile.cl">
coordinadora@telemed-chile.cl</a>
Fecha: domingo, 21 abril 2019, 05:01p. m. -04:00Asunto: Fwd: Registro de Atención Domiciliaria Oncovida<br>
<br>
<blockquote id="mail-app-auto-quote" cite="15558804670000002515" style="border-left:1px solid #FC2C38; margin:0px 0px 0px 10px; padding:0px 0px 0px 10px;">
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Estimada,<div>
<br>
</div>
<div>
Reenvío Formulario correspondiente a atención del 27/02/2019.</div>
<div>
Hoy enviaré Formularios faltantes de actualizar hasta atención más reciente.</div>
<div>
<br>
</div>
<div>
Saludos cordiales,<br>
<br>
<div class="gmail_quote_mailru_css_attribute_postfix">
<div dir="ltr" class="gmail_attr_mailru_css_attribute_postfix">
---------- Forwarded message ---------<br>
De: <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., 27 feb. 2019 a las 14:01<br>
Subject: Registro de Atención Domiciliaria Oncovida<br>
To:  <<a href="mailto:rafaelrichardc@gmail.com" target="_blank"  rel=" noopener noreferrer" >
rafaelrichardc@gmail.com</a>
>
<br>
</div>
<br>
<br>
<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 height="64px">
<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 height="24px">
<td>
</td>
</tr>
<tr>
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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>
</td>
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<td>
<div class="m_-2082590125090564369ss-form-container_mailru_css_attribute_postfix">
<div class="m_-2082590125090564369ss-form-heading_mailru_css_attribute_postfix">
<h1 class="m_-2082590125090564369ss-form-title_mailru_css_attribute_postfix" dir="ltr" style="margin:.67em 0">
Registro de Atención Domiciliaria Oncovida</h1>
<div class="m_-2082590125090564369ss-form-desc_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369ss-form_mailru_css_attribute_postfix">
<form id="m_-2082590125090564369ss-form_mailru_css_attribute_postfix" target="_blank" action="#" method="POST" onsubmit="return false"  rel=" noopener noreferrer" >
<br>
<div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-text_mailru_css_attribute_postfix m_-2082590125090564369ss-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:rafaelrichardc@gmail.com" target="_blank" rel=" noopener noreferrer" >
rafaelrichardc@gmail.com</a>
</div>
</div>
</div>
</div>
<div class="m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-page-break_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-page-title_mailru_css_attribute_postfix" style="padding:0.4em;background-color:#eee">
Identificación del Prestador</h2>
<div class="m_-2082590125090564369ss-page-description_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-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%">
Rafael Richard </div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<span class="m_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369ss-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%">
17082479-2</div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-select_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<span class="m_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369entry_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_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-page-break_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-page-title_mailru_css_attribute_postfix" style="padding:0.4em;background-color:#eee">
Identificación del Paciente</h2>
<div class="m_-2082590125090564369ss-page-description_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-section-header_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-section-title_mailru_css_attribute_postfix" style="background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class="m_-2082590125090564369ss-section-description_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369ss-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%">
7986475-7</div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-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%">
John McVey</div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-select_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsión<span class="m_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369entry_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_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<span class="m_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-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%">
Curacaví</div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<span class="m_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-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%">
Curacaví</div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-page-break_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-page-title_mailru_css_attribute_postfix" style="padding:0.4em;background-color:#eee">
Registro de la Atención Domiciliaria</h2>
<div class="m_-2082590125090564369ss-page-description_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-radio_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atención<span class="m_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<ul class="m_-2082590125090564369ss-choices_mailru_css_attribute_postfix" style="list-style:none;padding:0;margin:.5em 0 0">
<li class="m_-2082590125090564369ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-2082590125090564369ss-choice-item-control_mailru_css_attribute_postfix m_-2082590125090564369goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="radio" name="entry.1222378237" value="Domicilio" id="m_-2082590125090564369group_1222378237_1_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</span>
<span class="m_-2082590125090564369ss-choice-label_mailru_css_attribute_postfix">
Domicilio</span>
</li>
 <li class="m_-2082590125090564369ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-2082590125090564369ss-choice-item-control_mailru_css_attribute_postfix m_-2082590125090564369goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="radio" name="entry.1222378237" value="Ambulatorio" id="m_-2082590125090564369group_1222378237_2_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</span>
<span class="m_-2082590125090564369ss-choice-label_mailru_css_attribute_postfix">
Ambulatorio</span>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-date_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-q-date_mailru_css_attribute_postfix">
<div class="m_-2082590125090564369ss-datetime-box_mailru_css_attribute_postfix m_-2082590125090564369goog-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_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-time_mailru_css_attribute_postfix" style="margin:12px 0;font:inherit">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-q-time_mailru_css_attribute_postfix">
<div class="m_-2082590125090564369ss-datetime-box_mailru_css_attribute_postfix m_-2082590125090564369goog-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_-2082590125090564369ss-datetime-box-spacer_mailru_css_attribute_postfix m_-2082590125090564369goog-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_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
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 <td class="m_-2082590125090564369ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
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 <td class="m_-2082590125090564369ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
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 <td class="m_-2082590125090564369ss-scalerow_mailru_css_attribute_postfix" style="text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
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 <td class="m_-2082590125090564369ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
4</td>
 <td class="m_-2082590125090564369ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
5</td>
 <td class="m_-2082590125090564369ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
6</td>
 <td class="m_-2082590125090564369ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
7</td>
 <td class="m_-2082590125090564369ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
8</td>
 <td class="m_-2082590125090564369ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
9</td>
 <td class="m_-2082590125090564369ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
10</td>
<td class="m_-2082590125090564369ss-scalenumbers_mailru_css_attribute_postfix" style="text-align:center">
</td>
</tr>
<tr>
<td class="m_-2082590125090564369ss-scalerow_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369aria-todo_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="0" id="m_-2082590125090564369group_853118630_1_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="1" id="m_-2082590125090564369group_853118630_2_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="2" id="m_-2082590125090564369group_853118630_3_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="3" id="m_-2082590125090564369group_853118630_4_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="4" id="m_-2082590125090564369group_853118630_5_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="5" id="m_-2082590125090564369group_853118630_6_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="6" id="m_-2082590125090564369group_853118630_7_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="7" id="m_-2082590125090564369group_853118630_8_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="8" id="m_-2082590125090564369group_853118630_9_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="9" id="m_-2082590125090564369group_853118630_10_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
 <td class="m_-2082590125090564369ss-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_-2082590125090564369ss-scalerow-fieldcell_mailru_css_attribute_postfix">
<input type="radio" name="entry.853118630" value="10" id="m_-2082590125090564369group_853118630_11_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-radio_mailru_css_attribute_postfix">
</div>
</td>
<td class="m_-2082590125090564369ss-scalerow_mailru_css_attribute_postfix m_-2082590125090564369ss-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_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-paragraph-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Anamnesis/Evolución<span class="m_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-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%">
Segunda visita por GES4, paciente en fase ajuste de medicación, presentó aumento de dolor con metadona cada 12h, por lo que se reinicia cada 8h, con buena respuesta clínica. Actualmente con transgresión alimentaria y dolor abdominal, sin otras molestias. </div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-paragraph-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Examen Físico<span class="m_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-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%">
Hidratado, lúcido, MP (+), SRA. RR2T, NAS. Abd: BD, sensible difuso, sin signos irritación peritoneal.</div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Diagnóstico<span class="m_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-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%">
Cáncer Gastrico Metastásico</div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-item-required_mailru_css_attribute_postfix m_-2082590125090564369ss-paragraph-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Plan de Tratamiento e Indicaciones<span class="m_-2082590125090564369ss-required-asterisk_mailru_css_attribute_postfix" style="color:#c43b1d">
*</span>
</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-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%">
Domperidona SOS en gotas, régimen liviano a tolerancia, hidratación abundante.</div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-paragraph-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-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%">
Celecoxib, Omeprazol, paracetamol, ursofalk, dulcolax SOS, Domperidona.</div>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-date_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha aproximada del Próximo Control con usted</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-q-date_mailru_css_attribute_postfix">
<div class="m_-2082590125090564369ss-datetime-box_mailru_css_attribute_postfix m_-2082590125090564369goog-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.2063615873_day" class="m_-2082590125090564369ss-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.2063615873_month" class="m_-2082590125090564369ss-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.2063615873_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_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-text_mailru_css_attribute_postfix" style="margin:12px 0">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
</div>
<div class="m_-2082590125090564369ss-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%">
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<br>
 <div class="m_-2082590125090564369ss-form-question_mailru_css_attribute_postfix m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
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<div class="m_-2082590125090564369ss-q-title_mailru_css_attribute_postfix" style="display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Derivación a otro Prestador Domiciliario</div>
<div class="m_-2082590125090564369ss-q-help_mailru_css_attribute_postfix m_-2082590125090564369ss-secondary-text_mailru_css_attribute_postfix" dir="auto" style="display:block;margin:.1em 0 .25em 0;color:#666">
Sólo llene esta sección si es médico y solicita la visita de otro prestador del equipo</div>
<ul class="m_-2082590125090564369ss-choices_mailru_css_attribute_postfix" style="list-style:none;padding:0;margin:.5em 0 0">
<li class="m_-2082590125090564369ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-2082590125090564369ss-choice-item-control_mailru_css_attribute_postfix m_-2082590125090564369goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="checkbox" name="entry.503039759" value="ENFERMERA" id="m_-2082590125090564369group_503039759_1_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-checkbox_mailru_css_attribute_postfix">
</span>
<span class="m_-2082590125090564369ss-choice-label_mailru_css_attribute_postfix">
ENFERMERA</span>
</li>
 <li class="m_-2082590125090564369ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-2082590125090564369ss-choice-item-control_mailru_css_attribute_postfix m_-2082590125090564369goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="checkbox" name="entry.503039759" value="TENS" id="m_-2082590125090564369group_503039759_2_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-checkbox_mailru_css_attribute_postfix">
</span>
<span class="m_-2082590125090564369ss-choice-label_mailru_css_attribute_postfix">
TENS</span>
</li>
 <li class="m_-2082590125090564369ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-2082590125090564369ss-choice-item-control_mailru_css_attribute_postfix m_-2082590125090564369goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="checkbox" name="entry.503039759" value="NUTRICIONISTA" id="m_-2082590125090564369group_503039759_3_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-checkbox_mailru_css_attribute_postfix">
</span>
<span class="m_-2082590125090564369ss-choice-label_mailru_css_attribute_postfix">
NUTRICIONISTA</span>
</li>
 <li class="m_-2082590125090564369ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-2082590125090564369ss-choice-item-control_mailru_css_attribute_postfix m_-2082590125090564369goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="checkbox" name="entry.503039759" value="KINESIOLOGO" id="m_-2082590125090564369group_503039759_4_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-checkbox_mailru_css_attribute_postfix">
</span>
<span class="m_-2082590125090564369ss-choice-label_mailru_css_attribute_postfix">
KINESIOLOGO</span>
</li>
 <li class="m_-2082590125090564369ss-choice-item_mailru_css_attribute_postfix" style="margin:0;line-height:1.3em;padding-bottom:.5em">
<span class="m_-2082590125090564369ss-choice-item-control_mailru_css_attribute_postfix m_-2082590125090564369goog-inline-block_mailru_css_attribute_postfix" style="display:inline-block">
<input type="checkbox" name="entry.503039759" value="PSICOLOGO" id="m_-2082590125090564369group_503039759_5_mailru_css_attribute_postfix" class="m_-2082590125090564369ss-q-checkbox_mailru_css_attribute_postfix">
</span>
<span class="m_-2082590125090564369ss-choice-label_mailru_css_attribute_postfix">
PSICOLOGO</span>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class="m_-2082590125090564369errorbox-good_mailru_css_attribute_postfix">
<div dir="auto" class="m_-2082590125090564369ss-item_mailru_css_attribute_postfix m_-2082590125090564369ss-embeddable-object-container_mailru_css_attribute_postfix" style="margin:12px 0;max-width:100%">
<div class="m_-2082590125090564369ss-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_-2082590125090564369ss-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_-2082590125090564369ss-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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-- <br>
<div dir="ltr" class="gmail_signature_mailru_css_attribute_postfix" >
<div dir="ltr">
<div>
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Rafael Richard C.<div>
Médico</div>
<div>
Universidad de Chile</div>
<div>
Celular: <span class="js-phone-number">
8-9049047</span>
</div>
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