<div dir=3D"ltr">
<div>
<br>
</div>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
El s=C3=A1b., 27 abr. 2019 a las 17:47, Google Forms (&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;) escribi=C3=B3:<br>
</div>
<blockquote class=3D"gmail_quote" style=3D"margin:0px 0px 0px 0.8ex;border-left:1px solid rgb(204,204,204);padding-left:1ex">
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;margin:0px;padding:0px;height:100%;width:100%">
<table border==3D"0" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(38,4,154)" width=3D"100%">
<tbody>
<tr height=3D"64px">
<td style=3D"padding-left:24px">
<img alt=3D"Google Forms" height=3D"26px" style=3D"display: inline-block; margin: 0px; vertical-align: middle;" width=3D"143px" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div style=3D"padding:24px;background-color:rgb(229,218,254)">
<div align=3D"center" style=3D"background-color:rgb(255,255,255);border-bottom:1px solid rgb(224,224,224);margin:0px auto;max-width:624px;min-width:154px;padding:0px 24px">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(255,255,255)" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:rgb(66,66,66);font-weight:700">
Thanks for filling out <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
</div>
</td>
</tr>
<tr height=3D"12px">
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:rgb(66,66,66)">
Here&#39;s what we got from you:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"gmail-m_7087727798560844915ss-form-container">
<div class=3D"gmail-m_7087727798560844915ss-form-heading">
<h1 class=3D"gmail-m_7087727798560844915ss-form-title" dir=3D"ltr" style=3D"margin:0.67em 0px">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"gmail-m_7087727798560844915ss-form-desc gmail-m_7087727798560844915ss-no-ignore-whitespace" style=3D"font:inherit;width:99%;margin:0px 0px 1em;white-space:pre-wrap">
Este es el sistema de registro de atenciones domiciliarias de Oncovida.   Debe ser llenado por el prestador individual, y debe realizarse un registro por cada visita domiciliaria.   Si usted no es prestador de Oncovida por favor no llene este formulario.   A continuaci==C3=B3n indique su correo electr=C3=B3nico.</div>
</div>
<div class=3D"gmail-m_7087727798560844915ss-form">
<form method=3D"GET" id==3D"gmail-m_7087727798560844915ss-form">
<br>
<div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915emailAddress">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Email address<label for=3D"m_7087727798560844915emailAddress">
</label>
<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
</label>
<div class=3D"gmail-m_7087727798560844915ss-q-text gmail-m_7087727798560844915ss-printable-text-line" dir=3D"auto" style=3D"background-color:rgb(238,238,238);max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%">
<a href=3D"mailto:gbarkerm@gmail.com" target=3D"_blank">
gbarkerm@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-embeddable-object-container" style=3D"margin:12px 0px;max-width:100%">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style==3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"gmail-m_7087727798560844915ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width: 78px; outline: none;" alt=3D"Captionless Image">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-page-break" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_7087727798560844915ss-page-title" style=3D"padding:0.4em;background-color:rgb(238,238,238)">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"gmail-m_7087727798560844915ss-page-description gmail-m_7087727798560844915ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap">
Aqu=C3=AD debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_579114469">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_7087727798560844915itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_7087727798560844915ss-q-text" dir=3D"auto" style=3D"background-color:rgb(238,238,238);max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%">
Guillermo Barker</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_1276273985">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
RUT<label for=3D"m_7087727798560844915itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"gmail-m_7087727798560844915ss-q-text" dir=3D"auto" style=3D"background-color:rgb(238,238,238);max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%">
16608219-6</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-select" style==3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_133691676">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tipo<label for=3D"m_7087727798560844915itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
Si asisten m=C3=A1s de 1 prestador simult=C3=A1neamente, cada uno debe hacer un registro independiente</div>
</label>
<select name=3D"entry.133691676" disabled id=3D"gmail-m_7087727798560844915entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled selected>
MEDICO</option>
 <option value=3D"ENFERMERA/O" disabled>
ENFERMERA/O</option>
 <option value=3D"TENS" disabled>
TENS</option>
 <option value=3D"KINESIOLOGA/O" disabled>
KINESIOLOGA/O</option>
 <option value=3D"PSICOLOGO" disabled>
PSICOLOGO</option>
 <option value==3D"NUTRICIONISTA" disabled>
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-embeddable-object-container" style=3D"margin:12px 0px;max-width:100%">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style==3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"gmail-m_7087727798560844915ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width: 78px; outline: none;" alt=3D"Captionless Image">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-page-break" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_7087727798560844915ss-page-title" style=3D"padding:0.4em;background-color:rgb(238,238,238)">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"gmail-m_7087727798560844915ss-page-description gmail-m_7087727798560844915ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap">
En esta secci=C3=B3n debe ingresar los datos del paciente visitado</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-section-header" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_7087727798560844915ss-section-title" style=3D"background-color:rgb(238,238,238);padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"gmail-m_7087727798560844915ss-section-description gmail-m_7087727798560844915ss-no-ignore-whitespace" style=3D"margin-top:0.5em;white-space:pre-wrap">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_823811303">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ingrese el Rut del Paciente<label for=3D"m_7087727798560844915itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"gmail-m_7087727798560844915ss-q-text" dir=3D"auto" style=3D"background-color:rgb(238,238,238);max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%">
5681099-4</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_1959365839">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<label for=3D"m_7087727798560844915itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_7087727798560844915ss-q-text" dir=3D"auto" style=3D"background-color:rgb(238,238,238);max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%">
Jorge Reyes</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-select" style==3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_545002227">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Previsi=C3=B3n<label for=3D"m_7087727798560844915itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<select name=3D"entry.545002227" disabled id=3D"gmail-m_7087727798560844915entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled>
COLMENA</option>
 <option value=3D"CONSALUD" disabled>
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled>
CRUZ BLANCA</option>
 <option value=3D"DIPRECA" disabled>
DIPRECA</option>
 <option value=3D"FONASA" disabled>
FONASA</option>
 <option value=3D"FUNDACION" disabled selected>
FUNDACION</option>
 <option value=3D"ISAPRES DEL COBRE" disabled>
ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled>
NUEVA MASVIDA</option>
 <option value=3D"VIDATRES" disabled>
VIDATRES</option>
 <option value=3D"PARTICULAR" disabled>
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_1900161356">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ciudad<label for=3D"m_7087727798560844915itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_7087727798560844915ss-q-text" dir=3D"auto" style=3D"background-color:rgb(238,238,238);max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%">
Frutillar</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_1298871758">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Comuna<label for=3D"m_7087727798560844915itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
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<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_7087727798560844915ss-q-text" dir=3D"auto" style=3D"background-color:rgb(238,238,238);max-width:90%;border:1px solid rgb(192,192,192);padding:5px;white-space:pre-wrap;color:rgb(84,84,84);width:70%">
Frutillar</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915errorbox-good">
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<div class=3D"gmail-m_7087727798560844915ss-form-entry" style==3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"gmail-m_7087727798560844915ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width: 78px; outline: none;" alt=3D"Captionless Image">
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</div>
</div>
</div>
<br>
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<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-page-break" style=3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<h2 class=3D"gmail-m_7087727798560844915ss-page-title" style=3D"padding:0.4em;background-color:rgb(238,238,238)">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"gmail-m_7087727798560844915ss-page-description gmail-m_7087727798560844915ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap">
En esta secci=C3=B3n debe ingresar los datos de la atenci=C3=B3n domiciliaria</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-radio" style==3D"margin:12px 0px">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_2073233714">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_7087727798560844915itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<ul class=3D"gmail-m_7087727798560844915ss-choices" style=3D"list-style:none;padding:0px;margin:0.5em 0px 0px">
<li class=3D"gmail-m_7087727798560844915ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_7087727798560844915ss-choice-item-control gmail-m_7087727798560844915goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"gmail-m_7087727798560844915group_1222378237_1" class=3D"gmail-m_7087727798560844915ss-q-radio">
</span>
<span class=3D"gmail-m_7087727798560844915ss-choice-label">
Domicilio</span>
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</li>
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<label>
<span class=3D"gmail-m_7087727798560844915ss-choice-item-control gmail-m_7087727798560844915goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"gmail-m_7087727798560844915group_1222378237_2" class=3D"gmail-m_7087727798560844915ss-q-radio">
</span>
<span class=3D"gmail-m_7087727798560844915ss-choice-label">
Ambulatorio</span>
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<br>
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<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_1705849412">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Fecha de la Atenci=C3=B3n<label for=3D"m_7087727798560844915itemView.getDomIdToLabel()">
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<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
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</div>
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<div class=3D"gmail-m_7087727798560844915ss-q-date">
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Month</option>
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January</option>
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February</option>
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March</option>
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April</option>
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May</option>
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June</option>
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July</option>
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August</option>
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September</option>
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October</option>
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November</option>
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December</option>
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Day</option>
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1</option>
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2</option>
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5</option>
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6</option>
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7</option>
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8</option>
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10</option>
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11</option>
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15</option>
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17</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
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Year</option>
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1896</option>
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1897</option>
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1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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1925</option>
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1926</option>
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1927</option>
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1928</option>
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1929</option>
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1930</option>
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1932</option>
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1933</option>
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1939</option>
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1940</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
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1946</option>
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1947</option>
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1948</option>
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1949</option>
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1950</option>
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1951</option>
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1952</option>
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1953</option>
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1955</option>
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1956</option>
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1957</option>
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1960</option>
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1961</option>
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1962</option>
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1963</option>
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1964</option>
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1965</option>
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1966</option>
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1967</option>
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1968</option>
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1969</option>
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1970</option>
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1971</option>
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1972</option>
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1973</option>
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1974</option>
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1975</option>
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1976</option>
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1977</option>
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1978</option>
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1979</option>
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1980</option>
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1981</option>
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1982</option>
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1983</option>
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1984</option>
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1985</option>
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1986</option>
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1987</option>
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1988</option>
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1989</option>
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1990</option>
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1991</option>
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1992</option>
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1993</option>
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1994</option>
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1995</option>
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1996</option>
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1997</option>
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1998</option>
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1999</option>
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2000</option>
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2001</option>
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2002</option>
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2003</option>
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2004</option>
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2005</option>
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2006</option>
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2007</option>
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2008</option>
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2009</option>
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2010</option>
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2011</option>
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2012</option>
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2013</option>
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2014</option>
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2015</option>
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2016</option>
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2017</option>
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2018</option>
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2019</option>
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2020</option>
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2021</option>
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2022</option>
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2023</option>
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2024</option>
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2025</option>
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2026</option>
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2027</option>
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2028</option>
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2029</option>
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2030</option>
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2031</option>
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2032</option>
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2033</option>
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2034</option>
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2035</option>
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2036</option>
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2037</option>
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2038</option>
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2039</option>
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2040</option>
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2041</option>
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2042</option>
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2043</option>
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2044</option>
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2045</option>
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2046</option>
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2047</option>
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2048</option>
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2049</option>
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2050</option>
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2051</option>
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2052</option>
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2053</option>
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2054</option>
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2055</option>
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2056</option>
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2057</option>
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2058</option>
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2059</option>
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2060</option>
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2061</option>
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2062</option>
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2063</option>
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2064</option>
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2065</option>
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2066</option>
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2067</option>
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2068</option>
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2069</option>
</select>
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</div>
</div>
</div>
</div>
<br>
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<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-item-required gmail-m_7087727798560844915ss-time" style=3D"margin:12px 0px;font:inherit">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
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<span class=3D"gmail-m_7087727798560844915ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
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<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<div class=3D"gmail-m_7087727798560844915ss-q-time">
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0</label>
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3</label>
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4</label>
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5</label>
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6</label>
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7</label>
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8</label>
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9</label>
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Escala Dolor EVA M=C3=A1ximo</div>
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<td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
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0</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_1244707512_2" style=3D"display:block;padding:0.5em 0px">
1</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_1244707512_3" style=3D"display:block;padding:0.5em 0px">
2</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_1244707512_4" style=3D"display:block;padding:0.5em 0px">
3</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_1244707512_5" style=3D"display:block;padding:0.5em 0px">
4</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_1244707512_6" style=3D"display:block;padding:0.5em 0px">
5</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_1244707512_7" style=3D"display:block;padding:0.5em 0px">
6</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_1244707512_8" style=3D"display:block;padding:0.5em 0px">
7</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_1244707512_9" style=3D"display:block;padding:0.5em 0px">
8</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_1244707512_10" style=3D"display:block;padding:0.5em 0px">
9</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_1244707512_11" style=3D"display:block;padding:0.5em 0px">
10</label>
</td>
<td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"gmail-m_7087727798560844915ss-scalerow gmail-m_7087727798560844915ss-leftlabel" style=3D"text-align:right;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em 0.5em 0px">
<div class=3D"gmail-m_7087727798560844915aria-todo">
</div>
</td>
<td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"0" id=3D"gmail-m_7087727798560844915group_1244707512_1" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"1" id=3D"gmail-m_7087727798560844915group_1244707512_2" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"2" id=3D"gmail-m_7087727798560844915group_1244707512_3" class==3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"3" id=3D"gmail-m_7087727798560844915group_1244707512_4" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"4" id=3D"gmail-m_7087727798560844915group_1244707512_5" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style==3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"5" id==3D"gmail-m_7087727798560844915group_1244707512_6" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled checked value=3D"6" id=3D"gmail-m_7087727798560844915group_1244707512_7" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name==3D"entry.1244707512" disabled value=3D"7" id=3D"gmail-m_7087727798560844915group_1244707512_8" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"8" id=3D"gmail-m_7087727798560844915group_1244707512_9" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"9" id=3D"gmail-m_7087727798560844915group_1244707512_10" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"10" id=3D"gmail-m_7087727798560844915group_1244707512_11" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
<td class=3D"gmail-m_7087727798560844915ss-scalerow gmail-m_7087727798560844915ss-rightlabel" style=3D"text-align:left;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0px 0.5em 0.25em">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-scale" style=3D"margin:12px 0px;overflow-x:auto">
<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
<label class=3D"gmail-m_7087727798560844915ss-q-item-label" for=3D"m_7087727798560844915entry_2000523015">
<div class=3D"gmail-m_7087727798560844915ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Escala Dolor EVA M=C3=ADnimo</div>
<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"gmail-m_7087727798560844915entry_853118630">
<tbody>
<tr>
<td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_1" style=3D"display:block;padding:0.5em 0px">
0</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_2" style=3D"display:block;padding:0.5em 0px">
1</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_3" style=3D"display:block;padding:0.5em 0px">
2</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_4" style=3D"display:block;padding:0.5em 0px">
3</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_5" style=3D"display:block;padding:0.5em 0px">
4</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_6" style=3D"display:block;padding:0.5em 0px">
5</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_7" style=3D"display:block;padding:0.5em 0px">
6</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style==3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_8" style=3D"display:block;padding:0.5em 0px">
7</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_9" style=3D"display:block;padding:0.5em 0px">
8</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_10" style=3D"display:block;padding:0.5em 0px">
9</label>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_7087727798560844915ss-scalenumber" for=3D"m_7087727798560844915group_853118630_11" style=3D"display:block;padding:0.5em 0px">
10</label>
</td>
<td class=3D"gmail-m_7087727798560844915ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"gmail-m_7087727798560844915ss-scalerow gmail-m_7087727798560844915ss-leftlabel" style=3D"text-align:right;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em 0.5em 0px">
<div class=3D"gmail-m_7087727798560844915aria-todo">
</div>
</td>
<td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"0" id=3D"gmail-m_7087727798560844915group_853118630_1" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style==3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"1" id==3D"gmail-m_7087727798560844915group_853118630_2" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"2" id=3D"gmail-m_7087727798560844915group_853118630_3" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled checked value=3D"3" id=3D"gmail-m_7087727798560844915group_853118630_4" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_7087727798560844915ss-scalerow" style=3D"text-align:center;color:rgb(102,102,102);border-width:1px 0px;border-top-style:solid;border-bottom-style:solid;border-top-color:rgb(211,216,211);border-bottom-color:rgb(211,216,211);border-left-style:initial;border-left-color:initial;border-right-style:initial;border-right-color:initial;padding:0.5em 0.25em">
<div class=3D"gmail-m_7087727798560844915ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"4" id=3D"gmail-m_7087727798560844915group_853118630_5" class=3D"gmail-m_7087727798560844915ss-q-radio">
</div>
</td>
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Paciente con antecedentes descritos, 2 esquemas de 12 ciclos de QMT terminados con buena tolerancia. Iniciando un 3 esquema de QT de 4 ciclos (segundo completado). Antecedente de NAC en noviembre de 2018, que requiri=C3=B3 de hospitalizaci=C3=B3n.=20El d=C3=ADa 26 de diciembre paciente presenta episodio de lumbalgia muy intenso irradiado a extremidades inferiores. Por refractaridad de dolor a analgesia (AINES, paracetamol, morfina) paciente decide consultar en servicio de urgencias, donde se requiere de morfina EV (10 mg) para manejo del dolor con alivio parcial. Se realiza scanner donde se informa extenso compromiso metast=C3=A1sico nodular pulmonar bilateral y hep=C3=A1tico en LD con cambios morfol=C3=B3gicos asociados de este =C3=BAltimo =C3=B3rgano y dilataci==C3=B3n de la v=C3=ADa biliar intrahep=C3=A1tica derecha, compromiso de aspecto neopl=C3=A1sico secundario en columna lumbar. Tambi=C3=A9n se realiza scanner de cerebro donde se describe leves cambios involutivos encef=C3=A1licos difusos asociados a ligeros signos de microangiopatia de la sustancia blanca supratentorial.=20Present=C3=B3 nueva crisis de dolor el 31 de diciembre y el 1 de enero que requiere de morfina para yugular el dolor.=20Con scanner obtenido en servicio de urgencias Cl=C3=ADnica Puerto Varas, se realiza an=C3=A1lisis comparativo con scanner de octubre, donde se vio aumento de n=C3=B3dulos pulmonares significativa, aumento de masa hep=C3=A1tica de 2,8 a 3,5 cm; sin cambios evidentes en met=C3=A1stasis lumbar.=20Por progresi=C3=B3n de enfermedad, equipo de oncolog=C3=ADa decide reinicio de QMT esquema FOLFOX. Se inicia esquema de 4 ciclos el martes 29 de enero. Primer ciclo muy mal tolerado, paciente evoluciona 7 d=C3=ADas con rechazo alimentario (no ingiere alimentos primeros 3 d=C3=ADas), diarrea profusa, alzas t=C3=A9rmicas hasta 40=C2=BAC, y mucho dolor (EVA 10/10). Se realiza ajuste de quimio, completandose el 2=C2=BA ciclo 6 semanas despu=C3=A9s (5/3/2019) con mucha mejor tolerancia. 3=C2=BA ciclo de quimio tambi=C3=A9n bien tolerado. Pendiente 4 ciclo (que debi=C3=B3 iniciarse el 4 de abril)Se realiza evaluaci=C3=B3n por odontolog=C3=ADa, pendiente emisi=C3=B3n de certificado que autoriza uso de pamidronato.=20El 17 de diciembre, en relaci=C3=B3n a retraso en cambio de parches, paciente presenta episodio de dolor progresivo hasta EVA 10/10 y diarrea. Es llevado a servicio de urgencias de cl=C3=ADnica puerto varas donde ingresa en regulares condiciones generales, somnolientas, tendencia a la hipotension y subfebriles. Se hospitaliza para estabilizaci=C3=B3n, siendo dado de alta el 20 de diciembre.=20Al momento de la evaluaci=C3=B3n, paciente con escala ECOG 3. Utilizando oxicodona 30 mg cada 12 hrs. Afebril. Con esquema actual de analgesia, paciente necesita estar en cama m=C3=A1s de la mitad del d=C3=ADa por la presencia de s=C3=ADntomas. Necesita ayuda para la mayor=C3=ADa de las actividades de la vida diaria. Tambi=C3=A9n requiere de m=C3=BAltiples visitas SOS por m=C3=A9dico por dolor. Por creciente requerimiento de analgesia y opiaceos, insisto en beneficio de radioterapia paliativa en L4-L5. Pendiente inicio de Durogesic.=20Desde el punto de vista afectivo, paciente refiere =C3=A1nimo bajo la mayor parte del tiempo e ideas de muerte (sin ideacion suicida activa y sin alucinaciones). Hija refiere gran labilidad emocional e irritabilidad. En el contexto de esto, presenta relaci=C3=B3n conflictiva con parte del equipo tratante</div>
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PA: 155/87 FC: 101 FR: 18 T=C2=B0: 36=C2=B0C SatO2: 97%=20Estable. En cama por dolor. Bien hidratado y perfundido. Piel sana. Sin adenopat=C3=ADas palpables. RR2TNAS MP (+) SRA actuales. Abd. BDI RHA (+). Sin masas ni visceromegalias palpables. Sensibilidad a palpaci=C3=B3n de musculatura paravertebral lumbar y cuerpos vertebrales muy marcada a nivel de L4-L5. Sin cambios inflamatorios cut=C3=A1neos. EEII sin edemas ni signos de TVP. Tepe y lasegue dudosos. Examen neurol=C3=B3gico normal. Sin evidencias de UPP</div>
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C=C3==A1ncer de colon metast=C3=A1sico, Met=C3=A1stasis lumbar, Trastorno del animo -&gt; Obs trastorno depresivo mayor, Lumbociatica, DM2 IR, HTA</div>
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-Por lumbalgia persistente en contexto de metastasis lumbar, insisto en evaluaci=C3=B3n de radioterapia=20-Refuerzo importancia de apoyo por equipo de salud mental. Mantengo indicaci=C3=B3n de evaluaci=C3=B2n por psicolog=C3=ADa.-Visitas por enfermer=C3=ADa SOS en caso de dolor (1-2 por semana)=20-R=C3=A9gimen hipos=C3=B3dico e hipogluc=C3=ADdico (200 gr de hidratos de carbono)-Durogesic 50 mcg/d; 1 de parche cada 3 d=C3=ADas. Rotar de posicion. -&gt; lunes (ma=C3=B1ana)/jueves (tarde)=20-Oxicodona 30 mg cada 12 hrs via oral-Paracetamol 500 mg, 2 como cada 8 hrs via oral =20-Oramorph 20mg/20ml; 20 gotas SOS en caso de dolor=20-Paracetamol 1gr EV, 1 amp en caso de dolor=20-Ketorolaco 30 mg EV SOS=20-Dacam Rapilento 1 amp IM SOS en caso de dolor m=C3=A1ximo cada 2 semanas ==20 -Ondasentron 4 mg SOS en caso de nauseas y vomitos=20-Lactulosa 20 cc SOS en caso de constipacion=20-Pamidronato 90 mg EV lento mensual por 6 meses (reevaluar seg=C3=BAn tolerancia y monitorizando efectos adversos -&gt; explico)=20-Terapia kinesica motora por lumbociatica =20-Por dificultad en manejo del dolor y trastorno de =C3=A1nimo, indico evaluaci=C3=B3n m=C3=A9dica 3 veces por semana=20-Sin cambios en tratamiento cr=C3=B3nico </div>
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-Por lumbalgia persistente en contexto de metastasis lumbar, insisto en evaluaci=C3=B3n de radioterapia=20-Refuerzo importancia de apoyo por equipo de salud mental. Mantengo indicaci=C3=B3n de evaluaci=C3=B2n por psicolog=C3=ADa.-Visitas por enfermer=C3=ADa SOS en caso de dolor (1-2 por semana)=20-R=C3=A9gimen hipos=C3=B3dico e hipogluc=C3=ADdico (200 gr de hidratos de carbono)-Durogesic 50 mcg/d; 1 de parche cada 3 d=C3=ADas. Rotar de posicion. -&gt; lunes (ma=C3=B1ana)/jueves (tarde)=20-Oxicodona 30 mg cada 12 hrs via oral-Paracetamol 500 mg, 2 como cada 8 hrs via oral =20-Oramorph 20mg/20ml; 20 gotas SOS en caso de dolor=20-Paracetamol 1gr EV, 1 amp en caso de dolor=20-Ketorolaco 30 mg EV SOS=20-Dacam Rapilento 1 amp IM SOS en caso de dolor m=C3=A1ximo cada 2 semanas ==20 -Ondasentron 4 mg SOS en caso de nauseas y vomitos=20-Lactulosa 20 cc SOS en caso de constipacion=20-Pamidronato 90 mg EV lento mensual por 6 meses (reevaluar seg=C3=BAn tolerancia y monitorizando efectos adversos -&gt; explico)=20-Terapia kinesica motora por lumbociatica =20-Por dificultad en manejo del dolor y trastorno de =C3=A1nimo, indico evaluaci=C3=B3n m=C3=A9dica 3 veces por semana=20-Sin cambios en tratamiento cr=C3=B3nico </div>
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Day</option>
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1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
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15</option>
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16</option>
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17</option>
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18</option>
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19</option>
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20</option>
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21</option>
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22</option>
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23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
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1896</option>
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1897</option>
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1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
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1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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1925</option>
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1926</option>
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1927</option>
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1928</option>
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1929</option>
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1930</option>
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1931</option>
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1932</option>
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1933</option>
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1934</option>
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1935</option>
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1936</option>
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1937</option>
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1938</option>
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1939</option>
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1940</option>
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1941</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
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1946</option>
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1947</option>
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1948</option>
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1949</option>
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1950</option>
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1951</option>
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1952</option>
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1953</option>
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1954</option>
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1955</option>
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1956</option>
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1957</option>
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1958</option>
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1959</option>
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1960</option>
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1961</option>
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1962</option>
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1963</option>
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1964</option>
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1965</option>
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1966</option>
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1967</option>
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1968</option>
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1969</option>
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1970</option>
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1971</option>
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1972</option>
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1973</option>
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1974</option>
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1975</option>
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1976</option>
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1977</option>
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1978</option>
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1979</option>
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1980</option>
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1981</option>
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1982</option>
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1983</option>
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1984</option>
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1985</option>
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1986</option>
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1987</option>
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1988</option>
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1989</option>
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1990</option>
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1991</option>
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1992</option>
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1993</option>
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1994</option>
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1995</option>
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1996</option>
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1997</option>
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1998</option>
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1999</option>
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2000</option>
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2001</option>
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2002</option>
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2003</option>
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2004</option>
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2005</option>
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2006</option>
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2007</option>
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2008</option>
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2009</option>
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2010</option>
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2011</option>
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2012</option>
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2013</option>
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2014</option>
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2015</option>
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2016</option>
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2017</option>
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2018</option>
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2019</option>
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2020</option>
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2021</option>
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2022</option>
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2023</option>
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2024</option>
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2025</option>
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2026</option>
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2027</option>
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2028</option>
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2029</option>
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2030</option>
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2031</option>
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2032</option>
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2033</option>
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2034</option>
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2035</option>
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2036</option>
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2037</option>
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2038</option>
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2039</option>
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2040</option>
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2041</option>
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2042</option>
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2043</option>
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2044</option>
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2045</option>
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2046</option>
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2047</option>
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2048</option>
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2049</option>
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2050</option>
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2051</option>
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2052</option>
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2053</option>
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2054</option>
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2055</option>
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2056</option>
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2057</option>
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2058</option>
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2059</option>
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2060</option>
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2061</option>
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2062</option>
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2063</option>
 <option value==3D"2064">
2064</option>
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2065</option>
 <option value==3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option value==3D"2068">
2068</option>
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2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_7087727798560844915ss-item gmail-m_7087727798560844915ss-text" style=3D"margin:12px 0px">
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 <div class=3D"gmail-m_7087727798560844915ss-form-question gmail-m_7087727798560844915errorbox-good">
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<div class=3D"gmail-m_7087727798560844915ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
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Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"gmail-m_7087727798560844915ss-q-help gmail-m_7087727798560844915ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
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--00000000000069a06605878a101a--