<div dir=3D"ltr">
<div dir=3D"ltr">
<br>
</div>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
El lun., 29 abr. 2019 a las 18:11, Formularios de Google (&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"Formularios de Google" 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">
Gracias por rellenar <a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria 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)">
Esto es lo que nos has enviado:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"gmail-m_-3617145350424434293ss-form-container">
<div class=3D"gmail-m_-3617145350424434293ss-form-heading">
<h1 class=3D"gmail-m_-3617145350424434293ss-form-title" dir=3D"ltr" style=3D"margin:0.67em 0px">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"gmail-m_-3617145350424434293ss-form-desc gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-form">
<form method=3D"GET" id==3D"gmail-m_-3617145350424434293ss-form">
<br>
<div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293emailAddress">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Direcci=C3=B3n de correo electr=C3==B3nico<label for=3D"m_-3617145350424434293emailAddress">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
</label>
<div class=3D"gmail-m_-3617145350424434293ss-q-text gmail-m_-3617145350424434293ss-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:kine.claudiovargas@gmail.com" target=3D"_blank">
kine.claudiovargas@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-embeddable-object-container" style=3D"margin:12px 0px;max-width:100%">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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_-3617145350424434293ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width: 78px; outline: none;" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-page-break" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-page-title" style=3D"padding:0.4em;background-color:rgb(238,238,238)">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"gmail-m_-3617145350424434293ss-page-description gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_579114469">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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%">
Claudio Vargas</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_1276273985">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
RUT<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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%">
18680109-1</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-select" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_133691676">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tipo<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled>
MEDICO</option>
 <option value=3D"ENFERMERA/O" disabled>
ENFERMERA/O</option>
 <option value=3D"TENS" disabled>
TENS</option>
 <option value=3D"KINESIOLOGA/O" disabled selected>
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_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-embeddable-object-container" style=3D"margin:12px 0px;max-width:100%">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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_-3617145350424434293ss-image" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width: 78px; outline: none;" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-page-break" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-page-title" style=3D"padding:0.4em;background-color:rgb(238,238,238)">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"gmail-m_-3617145350424434293ss-page-description gmail-m_-3617145350424434293ss-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_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-section-header" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-section-title" style=3D"background-color:rgb(238,238,238);padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"gmail-m_-3617145350424434293ss-section-description gmail-m_-3617145350424434293ss-no-ignore-whitespace" style=3D"margin-top:0.5em;white-space:pre-wrap">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_823811303">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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%">
9447529-5</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_1959365839">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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%">
Monica Lopez</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-select" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_545002227">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Previsi=C3=B3n<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled selected>
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>
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_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_1900161356">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Ciudad<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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%">
Los Andes</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_1298871758">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Comuna<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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%">
Los Andes</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-embeddable-object-container" style=3D"margin:12px 0px;max-width:100%">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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_-3617145350424434293ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width: 78px; outline: none;" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-page-break" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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_-3617145350424434293ss-page-description gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-radio" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_2073233714">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-choices" style=3D"list-style:none;padding:0px;margin:0.5em 0px 0px">
<li class=3D"gmail-m_-3617145350424434293ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-3617145350424434293ss-choice-item-control gmail-m_-3617145350424434293goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"gmail-m_-3617145350424434293group_1222378237_1" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</span>
<span class=3D"gmail-m_-3617145350424434293ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"gmail-m_-3617145350424434293ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-3617145350424434293ss-choice-item-control gmail-m_-3617145350424434293goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"gmail-m_-3617145350424434293group_1222378237_2" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</span>
<span class=3D"gmail-m_-3617145350424434293ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-date" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_1705849412">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-date">
<div class=3D"gmail-m_-3617145350424434293ss-datetime-box gmail-m_-3617145350424434293goog-inline-block" style=3D"border:1px solid rgb(220,220,220);min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name=3D"entry.1705849412_day" disabled class=3D"gmail-m_-3617145350424434293ss-day-dropdown" id=3D"gmail-m_-3617145350424434293entry.1705849412_day">
<option value=3D"">
D=C3=ADa</option>
<option value=3D"1">
1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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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>
 <option value=3D"14">
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>
 <option value=3D"31">
31</option>
</select>
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<option value=3D"">
Mes</option>
<option value=3D"1">
enero</option>
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febrero</option>
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marzo</option>
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abril</option>
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mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
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=20<select name=3D"entry.1705849412_year" disabled id=3D"gmail-m_-3617145350424434293entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
 <option value=3D"1897">
1897</option>
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1898</option>
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1899</option>
 <option value=3D"1900">
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>
 <option value=3D"1922">
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>
 <option value==3D"1996">
1996</option>
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1997</option>
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1998</option>
 <option value=3D"1999">
1999</option>
 <option value==3D"2000">
2000</option>
 <option value=3D"2001">
2001</option>
 <option value==3D"2002">
2002</option>
 <option value=3D"2003">
2003</option>
 <option value==3D"2004">
2004</option>
 <option value=3D"2005">
2005</option>
 <option value==3D"2006">
2006</option>
 <option value=3D"2007">
2007</option>
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2008</option>
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2009</option>
 <option value==3D"2010">
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>
 <option value==3D"2018">
2018</option>
 <option value=3D"2019" selected>
2019</option>
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2020</option>
 <option value=3D"2021">
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>
 <option value=3D"2026">
2026</option>
 <option value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
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2029</option>
 <option value=3D"2030">
2030</option>
 <option value=3D"2031">
2031</option>
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2032</option>
 <option value=3D"2033">
2033</option>
 <option value=3D"2034">
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>
 <option value==3D"2040">
2040</option>
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2041</option>
 <option value==3D"2042">
2042</option>
 <option value=3D"2043">
2043</option>
 <option value==3D"2044">
2044</option>
 <option value=3D"2045">
2045</option>
 <option value==3D"2046">
2046</option>
 <option value=3D"2047">
2047</option>
 <option value==3D"2048">
2048</option>
 <option value=3D"2049">
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>
 <option value==3D"2056">
2056</option>
 <option value=3D"2057">
2057</option>
 <option value==3D"2058">
2058</option>
 <option value=3D"2059">
2059</option>
 <option value==3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <option value==3D"2062">
2062</option>
 <option value=3D"2063">
2063</option>
 <option value==3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option value==3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option value==3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-item-required gmail-m_-3617145350424434293ss-time" style=3D"margin:12px 0px;font:inherit">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_206244955">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Hora de la Atenci=C3=B3n<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
</label>
<span class=3D"gmail-m_-3617145350424434293ss-required-asterisk" style=3D"color:rgb(196,59,29)">
*</span>
</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
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<div class=3D"gmail-m_-3617145350424434293ss-q-time">
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</div>
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</div>
</div>
</div>
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Performance Status ECOG del Paciente<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
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Escala Dolor EVA Actual</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
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0</label>
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1</label>
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2</label>
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<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1421689035_4" style=3D"display:block;padding:0.5em 0px">
3</label>
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<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1421689035_5" style=3D"display:block;padding:0.5em 0px">
4</label>
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<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1421689035_6" style=3D"display:block;padding:0.5em 0px">
5</label>
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<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1421689035_7" style=3D"display:block;padding:0.5em 0px">
6</label>
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7</label>
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8</label>
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9</label>
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<div class=3D"gmail-m_-3617145350424434293aria-todo">
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<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-scale" style=3D"margin:12px 0px;overflow-x:auto">
<div class=3D"gmail-m_-3617145350424434293ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0px;margin-top:0px;max-width:100%">
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Escala Dolor EVA M=C3=A1ximo</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
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</td>
<td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for==3D"m_-3617145350424434293group_1244707512_1" style=3D"display:block;padding:0.5em 0px">
0</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1244707512_2" style=3D"display:block;padding:0.5em 0px">
1</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1244707512_3" style=3D"display:block;padding:0.5em 0px">
2</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1244707512_4" style=3D"display:block;padding:0.5em 0px">
3</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1244707512_5" style=3D"display:block;padding:0.5em 0px">
4</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1244707512_6" style=3D"display:block;padding:0.5em 0px">
5</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1244707512_7" style=3D"display:block;padding:0.5em 0px">
6</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1244707512_8" style=3D"display:block;padding:0.5em 0px">
7</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1244707512_9" style=3D"display:block;padding:0.5em 0px">
8</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1244707512_10" style=3D"display:block;padding:0.5em 0px">
9</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_1244707512_11" style=3D"display:block;padding:0.5em 0px">
10</label>
</td>
<td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"gmail-m_-3617145350424434293ss-scalerow gmail-m_-3617145350424434293ss-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_-3617145350424434293aria-todo">
</div>
</td>
<td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type==3D"radio" name=3D"entry.1244707512" disabled value=3D"0" id=3D"gmail-m_-3617145350424434293group_1244707512_1" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value==3D"1" id=3D"gmail-m_-3617145350424434293group_1244707512_2" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"2" id=3D"gmail-m_-3617145350424434293group_1244707512_3" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"3" id=3D"gmail-m_-3617145350424434293group_1244707512_4" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"4" id=3D"gmail-m_-3617145350424434293group_1244707512_5" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled checked value=3D"5" id=3D"gmail-m_-3617145350424434293group_1244707512_6" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"6" id=3D"gmail-m_-3617145350424434293group_1244707512_7" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"7" id=3D"gmail-m_-3617145350424434293group_1244707512_8" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"8" id=3D"gmail-m_-3617145350424434293group_1244707512_9" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name==3D"entry.1244707512" disabled value=3D"9" id=3D"gmail-m_-3617145350424434293group_1244707512_10" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"10" id=3D"gmail-m_-3617145350424434293group_1244707512_11" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
<td class=3D"gmail-m_-3617145350424434293ss-scalerow gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-scale" style=3D"margin:12px 0px;overflow-x:auto">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_2000523015">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293entry_853118630">
<tbody>
<tr>
<td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for==3D"m_-3617145350424434293group_853118630_1" style=3D"display:block;padding:0.5em 0px">
0</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_853118630_2" style=3D"display:block;padding:0.5em 0px">
1</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_853118630_3" style=3D"display:block;padding:0.5em 0px">
2</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_853118630_4" style=3D"display:block;padding:0.5em 0px">
3</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_853118630_5" style=3D"display:block;padding:0.5em 0px">
4</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_853118630_6" style=3D"display:block;padding:0.5em 0px">
5</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_853118630_7" style=3D"display:block;padding:0.5em 0px">
6</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_853118630_8" style=3D"display:block;padding:0.5em 0px">
7</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_853118630_9" style=3D"display:block;padding:0.5em 0px">
8</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style==3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_853118630_10" style=3D"display:block;padding:0.5em 0px">
9</label>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
<label class=3D"gmail-m_-3617145350424434293ss-scalenumber" for=3D"m_-3617145350424434293group_853118630_11" style=3D"display:block;padding:0.5em 0px">
10</label>
</td>
<td class=3D"gmail-m_-3617145350424434293ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"gmail-m_-3617145350424434293ss-scalerow gmail-m_-3617145350424434293ss-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_-3617145350424434293aria-todo">
</div>
</td>
<td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type==3D"radio" name=3D"entry.853118630" disabled value=3D"0" id=3D"gmail-m_-3617145350424434293group_853118630_1" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"1" id=3D"gmail-m_-3617145350424434293group_853118630_2" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled checked value=3D"2" id=3D"gmail-m_-3617145350424434293group_853118630_3" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"3" id=3D"gmail-m_-3617145350424434293group_853118630_4" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"4" id==3D"gmail-m_-3617145350424434293group_853118630_5" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
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</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"6" id=3D"gmail-m_-3617145350424434293group_853118630_7" class=3D"gmail-m_-3617145350424434293ss-q-radio">
</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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">
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<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"7" id=3D"gmail-m_-3617145350424434293group_853118630_8" class=3D"gmail-m_-3617145350424434293ss-q-radio">
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</td>
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</div>
</td>
 <td class=3D"gmail-m_-3617145350424434293ss-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">
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</div>
</td>
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</td>
<td class=3D"gmail-m_-3617145350424434293ss-scalerow gmail-m_-3617145350424434293ss-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>
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</tbody>
</table>
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<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_2140974612">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Anamnesis/Evoluci=C3=B3n<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
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</div>
</label>
<div class=3D"gmail-m_-3617145350424434293ss-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%">
Usuaria relata que el a=C3=B1o pasado cuando le realizaron biopsia para ver el estado de su c=C3=A1ncer comenz=C3=B3 con dolor en la zona abdominal oblicua izquierda, que comenz=C3=B3 a irradiarse hacia la zona lumbar y el MMII por anterior hasta el dorso del pie. Este dolor le impida realizar marcha sin ayudas t=C3=A9cnicas y adoptar posici=C3=B3n de sedente, supino y prono. La mayor parte del d=C3=ADa lo pasa en su cama decubito lateral derecho, ya que en esa posici=C3=B3n el dolor es un EVA 2. </div>
</div>
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<label class=3D"gmail-m_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_824006088">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Examen F=C3=ADsico<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
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</div>
</label>
<div class=3D"gmail-m_-3617145350424434293ss-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%">
Usuaria en decubito lateral derecho en su cama, se evidencia fuerza en M2 a la extensi=C3=B3n de rodilla izquierda, resto del MMII en M3 (no se pudo evaluar contra la gravedad, debido al dolor que ocasiona en ella adoptar distintas posiciones. Marcha se realiza con andador solamente en desplazamientos desde su dormitorio a su ba=C3=B1o y viceversa.</div>
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<label class=3D"gmail-m_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_1690694733">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Diagn=C3=B3stico<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
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*</span>
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C=C3=A1ncer endometrio </div>
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<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_1255665248">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Plan de Tratamiento e Indicaciones<label for=3D"m_-3617145350424434293itemView.getDomIdToLabel()">
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</div>
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<div class=3D"gmail-m_-3617145350424434293ss-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%">
Se entrega pauta de ejercicios para realizar en su hogar.</div>
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<label class=3D"gmail-m_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_1648939075">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Medicamentos Indicados</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
</div>
</label>
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</div>
</div>
</div>
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<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-date" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_2063615873">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-date">
<div class=3D"gmail-m_-3617145350424434293ss-datetime-box gmail-m_-3617145350424434293goog-inline-block" style=3D"border:1px solid rgb(220,220,220);min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
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D=C3=ADa</option>
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1</option>
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<option value=3D"">
Mes</option>
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enero</option>
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marzo</option>
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abril</option>
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mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
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octubre</option>
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noviembre</option>
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diciembre</option>
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=20<select name=3D"entry.2063615873_year" disabled id=3D"gmail-m_-3617145350424434293entry.2063615873_year">
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1896</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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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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1935</option>
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1936</option>
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1937</option>
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1938</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>
 <option value==3D"1982">
1982</option>
 <option value=3D"1983">
1983</option>
 <option value==3D"1984">
1984</option>
 <option value=3D"1985">
1985</option>
 <option value==3D"1986">
1986</option>
 <option value=3D"1987">
1987</option>
 <option value==3D"1988">
1988</option>
 <option value=3D"1989">
1989</option>
 <option value==3D"1990">
1990</option>
 <option value=3D"1991">
1991</option>
 <option value==3D"1992">
1992</option>
 <option value=3D"1993">
1993</option>
 <option value==3D"1994">
1994</option>
 <option value=3D"1995">
1995</option>
 <option value==3D"1996">
1996</option>
 <option value=3D"1997">
1997</option>
 <option value==3D"1998">
1998</option>
 <option value=3D"1999">
1999</option>
 <option value==3D"2000">
2000</option>
 <option value=3D"2001">
2001</option>
 <option value==3D"2002">
2002</option>
 <option value=3D"2003">
2003</option>
 <option value==3D"2004">
2004</option>
 <option value=3D"2005">
2005</option>
 <option value==3D"2006">
2006</option>
 <option value=3D"2007">
2007</option>
 <option value==3D"2008">
2008</option>
 <option value=3D"2009">
2009</option>
 <option value==3D"2010">
2010</option>
 <option value=3D"2011">
2011</option>
 <option value==3D"2012">
2012</option>
 <option value=3D"2013">
2013</option>
 <option value==3D"2014">
2014</option>
 <option value=3D"2015">
2015</option>
 <option value==3D"2016">
2016</option>
 <option value=3D"2017">
2017</option>
 <option value==3D"2018">
2018</option>
 <option value=3D"2019" selected>
2019</option>
 <option value=3D"2020">
2020</option>
 <option value=3D"2021">
2021</option>
 <option value=3D"2022">
2022</option>
 <option value=3D"2023">
2023</option>
 <option value=3D"2024">
2024</option>
 <option value=3D"2025">
2025</option>
 <option value=3D"2026">
2026</option>
 <option value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
 <option value=3D"2029">
2029</option>
 <option value=3D"2030">
2030</option>
 <option value=3D"2031">
2031</option>
 <option value=3D"2032">
2032</option>
 <option value=3D"2033">
2033</option>
 <option value=3D"2034">
2034</option>
 <option value=3D"2035">
2035</option>
 <option value=3D"2036">
2036</option>
 <option value=3D"2037">
2037</option>
 <option value==3D"2038">
2038</option>
 <option value=3D"2039">
2039</option>
 <option value==3D"2040">
2040</option>
 <option value=3D"2041">
2041</option>
 <option value==3D"2042">
2042</option>
 <option value=3D"2043">
2043</option>
 <option value==3D"2044">
2044</option>
 <option value=3D"2045">
2045</option>
 <option value==3D"2046">
2046</option>
 <option value=3D"2047">
2047</option>
 <option value==3D"2048">
2048</option>
 <option value=3D"2049">
2049</option>
 <option value==3D"2050">
2050</option>
 <option value=3D"2051">
2051</option>
 <option value==3D"2052">
2052</option>
 <option value=3D"2053">
2053</option>
 <option value==3D"2054">
2054</option>
 <option value=3D"2055">
2055</option>
 <option value==3D"2056">
2056</option>
 <option value=3D"2057">
2057</option>
 <option value==3D"2058">
2058</option>
 <option value=3D"2059">
2059</option>
 <option value==3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <option value==3D"2062">
2062</option>
 <option value=3D"2063">
2063</option>
 <option value==3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option value==3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option value==3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-text" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_74766472">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Tratamiento Realizado (si corresponde)</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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%">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293ss-form-question gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-checkbox" style=3D"margin:12px 0px">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-q-item-label" for=3D"m_-3617145350424434293entry_1219705969">
<div class=3D"gmail-m_-3617145350424434293ss-q-title" style=3D"display:block;font-weight:bold;margin-top:0.83em;margin-bottom:0.83em">
Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"gmail-m_-3617145350424434293ss-q-help gmail-m_-3617145350424434293ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:0.1em 0px 0.25em;color:rgb(102,102,102)">
S=C3=B3lo llene esta secci=C3=B3n si es m==C3=A9dico y solicita la visita de otro prestador del equipo</div>
</label>
<ul class=3D"gmail-m_-3617145350424434293ss-choices" style=3D"list-style:none;padding:0px;margin:0.5em 0px 0px">
<li class=3D"gmail-m_-3617145350424434293ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-3617145350424434293ss-choice-item-control gmail-m_-3617145350424434293goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"ENFERMERA" id=3D"gmail-m_-3617145350424434293group_503039759_1" class=3D"gmail-m_-3617145350424434293ss-q-checkbox">
</span>
<span class=3D"gmail-m_-3617145350424434293ss-choice-label">
ENFERMERA</span>
</label>
</li>
 <li class=3D"gmail-m_-3617145350424434293ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-3617145350424434293ss-choice-item-control gmail-m_-3617145350424434293goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"gmail-m_-3617145350424434293group_503039759_2" class=3D"gmail-m_-3617145350424434293ss-q-checkbox">
</span>
<span class=3D"gmail-m_-3617145350424434293ss-choice-label">
TENS</span>
</label>
</li>
 <li class=3D"gmail-m_-3617145350424434293ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-3617145350424434293ss-choice-item-control gmail-m_-3617145350424434293goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"NUTRICIONISTA" id=3D"gmail-m_-3617145350424434293group_503039759_3" class=3D"gmail-m_-3617145350424434293ss-q-checkbox">
</span>
<span class=3D"gmail-m_-3617145350424434293ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
 <li class=3D"gmail-m_-3617145350424434293ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-3617145350424434293ss-choice-item-control gmail-m_-3617145350424434293goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value==3D"KINESIOLOGO" id=3D"gmail-m_-3617145350424434293group_503039759_4" class=3D"gmail-m_-3617145350424434293ss-q-checkbox">
</span>
<span class=3D"gmail-m_-3617145350424434293ss-choice-label">
KINESIOLOGO</span>
</label>
</li>
 <li class=3D"gmail-m_-3617145350424434293ss-choice-item" style=3D"margin:0px;line-height:1.3em;padding-bottom:0.5em">
<label>
<span class=3D"gmail-m_-3617145350424434293ss-choice-item-control gmail-m_-3617145350424434293goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"PSICOLOGO" id=3D"gmail-m_-3617145350424434293group_503039759_5" class=3D"gmail-m_-3617145350424434293ss-q-checkbox">
</span>
<span class=3D"gmail-m_-3617145350424434293ss-choice-label">
PSICOLOGO</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"gmail-m_-3617145350424434293errorbox-good">
<div dir=3D"auto" class=3D"gmail-m_-3617145350424434293ss-item gmail-m_-3617145350424434293ss-embeddable-object-container" style=3D"margin:12px 0px;max-width:100%">
<div class=3D"gmail-m_-3617145350424434293ss-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_-3617145350424434293ss-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_-3617145350424434293ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width: 78px; outline: none;" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
</form>
</div>
</div>
</td>
</tr>
<tr height=3D"24px">
</tr>
</tbody>
</table>
</div>
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"max-width:672px;min-width:154px" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_link" style=3D"color:rgb(66,66,66);font-size:13px" target=3D"_blank">
Crea tu propio formulario de Google</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</blockquote>
</div>
</div>
<div id=3D"DAB4FAD8-2DD7-40BB-A1B8-4E2AA1F9FDF2">
<br>
 <table style=3D"border-top:1px solid #d3d4de">
	<tr>
      <td style=3D"width:55px;padding-top:18px">
<a href=3D"https://www.avast.com/sig-email?utm_medium=3Demail&amp;utm_source=3Dlink&amp;utm_campaign==3Dsig-email&amp;utm_content=3Dwebmail" target=3D"_blank">
<img src=3D"https://ipmcdn.avast.com/images/icons/icon-envelope-tick-round-orange-animated-no-repeat-v1.gif" alt=3D"" width=3D"46" height=3D"29" style=3D"width: 46px; height: 29px;">
</a>
</td>
		<td style=3D"width:470px;padding-top:17px;color:#41424e;font-size:13px;font-family:Arial,Helvetica,sans-serif;line-height:18px">
Libre de virus. <a href=3D"https://www.avast.com/sig-email?utm_medium=3Demail&amp;utm_source=3Dlink&amp;utm_campaign=3Dsig-email&amp;utm_content=3Dwebmail" target=3D"_blank" style=3D"color:#4453ea">
www.avast.com</a>
 		</td>
	</tr>
</table>
<a href=3D"#DAB4FAD8-2DD7-40BB-A1B8-4E2AA1F9FDF2" width=3D"1" height=3D"1">
</a>
</div>
--00000000000087be5c0587b295d9--