<div dir=3D"ltr">
<div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
<br>
</div>
Estimados/as:</div>
<div class=3D"gmail_quote">
Adjunto registro atenci=C3=B3n Mar=C3=ADa Romero Pino 15 mayo 2019</div>
<div class=3D"gmail_quote">
Paciente se encontraba con insuficiencia card=C3=ADaca descompensada, estaba en espera de evaluaci=C3=B3n por servicio de ambulancia particular. Con medidas generales al momento de nuestra despedida en buen estado general.</div>
<div class=3D"gmail_quote">
<br>
</div>
<div class=3D"gmail_quote">
Saludos</div>
<div class=3D"gmail_quote">
<br>
</div>
<div class=3D"gmail_quote">
Viviana Moraga Montes</div>
<div class=3D"gmail_quote">
M=C3=A9dica Cirujana=C2=A0<br>
<br>
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;margin:0;padding:0;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:0;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:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
</td>
</tr>
<tr>
<td>
<div style=3D"font-size:13px;line-height:18px;color:#424242;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:#424242">
Here&#39;s what we got from you:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"m_-4019192868782884930ss-form-container">
<div class=3D"m_-4019192868782884930ss-form-heading">
<h1 class=3D"m_-4019192868782884930ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_-4019192868782884930ss-form-desc m_-4019192868782884930ss-no-ignore-whitespace" style=3D"font:inherit;width:99%;margin:0 0 1em;white-space:pre-wrap;word-wrap:break-word">
Este es el sistema de registro de atenciones domiciliarias de Oncovida.   Debe ser llenado por el prestador individual, y debe realizarse un registro por cada visita domiciliaria.   Si usted no es prestador de Oncovida por favor no llene este formulario.   A continuaci=C3=B3n indique su correo electr=C3=B3nico.</div>
</div>
<div class=3D"m_-4019192868782884930ss-form">
<form method=3D"GET" id=3D"m_-4019192868782884930ss-form" target=3D"_blank">
<br>
<div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930emailAddress">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Email address<label for=3D"m_-4019192868782884930emailAddress">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text m_-4019192868782884930ss-printable-text-line" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
<a href=3D"mailto:vivimoragam@gmail.com" target=3D"_blank">
vivimoragam@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-4019192868782884930ss-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"m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4019192868782884930ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_-4019192868782884930ss-page-description m_-4019192868782884930ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
Aqu=C3=AD debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_579114469">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Viviana Moraga Montes</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1276273985">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
18121502-K</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-select" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_133691676">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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"m_-4019192868782884930entry_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"m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-4019192868782884930ss-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"m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4019192868782884930ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_-4019192868782884930ss-page-description m_-4019192868782884930ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
En esta secci=C3=B3n debe ingresar los datos del paciente visitado</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4019192868782884930ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_-4019192868782884930ss-section-description m_-4019192868782884930ss-no-ignore-whitespace" style=3D"margin-top:0.5em;white-space:pre-wrap;word-wrap:break-word">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_823811303">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
RUT con Gui=C3=B3n y D=C3=ADgito Verificador, sin puntos ( Ej: 5632200-k)</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
3602556-5</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1959365839">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Mar=C3=ADa Romero</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-select" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_545002227">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<select name=3D"entry.545002227" disabled id=3D"m_-4019192868782884930entry_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 selected>
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"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1900161356">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Concepci=C3=B3n</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1298871758">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Concepci=C3=B3n</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-4019192868782884930ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;outline:none" alt=3D"Captionless Image">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4019192868782884930ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_-4019192868782884930ss-page-description m_-4019192868782884930ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-wrap:break-word">
En esta secci=C3=B3n debe ingresar los datos de la atenci=C3=B3n domiciliaria</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-radio" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_2073233714">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_-4019192868782884930ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-4019192868782884930ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4019192868782884930ss-choice-item-control m_-4019192868782884930goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_-4019192868782884930group_1222378237_1" class=3D"m_-4019192868782884930ss-q-radio">
</span>
<span class=3D"m_-4019192868782884930ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_-4019192868782884930ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4019192868782884930ss-choice-item-control m_-4019192868782884930goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_-4019192868782884930group_1222378237_2" class=3D"m_-4019192868782884930ss-q-radio">
</span>
<span class=3D"m_-4019192868782884930ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-date" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1705849412">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha de la Atenci=C3=B3n<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-date">
<div class=3D"m_-4019192868782884930ss-datetime-box m_-4019192868782884930goog-inline-block" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name=3D"entry.1705849412_month" disabled class=3D"m_-4019192868782884930ss-month-dropdown" id=3D"m_-4019192868782884930entry.1705849412_month">
<option value==3D"">
Month</option>
<option value=3D"1">
January</option>
 <option value=3D"2">
February</option>
 <option value=3D"3">
March</option>
 <option value=3D"4">
April</option>
 <option value=3D"5" selected>
May</option>
 <option value=3D"6">
June</option>
 <option value=3D"7">
July</option>
 <option value=3D"8">
August</option>
 <option value=3D"9">
September</option>
 <option value=3D"10">
October</option>
 <option value=3D"11">
November</option>
 <option value=3D"12">
December</option>
</select>
   <select name=3D"entry.1705849412_day" disabled class=3D"m_-4019192868782884930ss-day-dropdown" id=3D"m_-4019192868782884930entry.1705849412_day">
<option value=3D"">
Day</option>
<option value=3D"1">
1</option>
 <option value=3D"2">
2</option>
 <option value=3D"3">
3</option>
 <option value=3D"4">
4</option>
 <option value=3D"5">
5</option>
 <option value=3D"6">
6</option>
 <option value=3D"7">
7</option>
 <option value=3D"8">
8</option>
 <option value=3D"9">
9</option>
 <option value=3D"10">
10</option>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12</option>
 <option value=3D"13">
13</option>
 <option value=3D"14">
14</option>
 <option value=3D"15" selected>
15</option>
 <option value=3D"16">
16</option>
 <option value=3D"17">
17</option>
 <option value=3D"18">
18</option>
 <option value==3D"19">
19</option>
 <option value=3D"20">
20</option>
 <option value=3D"21">
21</option>
 <option value=3D"22">
22</option>
 <option value=3D"23">
23</option>
 <option value=3D"24">
24</option>
 <option value=3D"25">
25</option>
 <option value=3D"26">
26</option>
 <option value=3D"27">
27</option>
 <option value=3D"28">
28</option>
 <option value=3D"29">
29</option>
 <option value=3D"30">
30</option>
 <option value=3D"31">
31</option>
</select>
=20<select name=3D"entry.1705849412_year" disabled id=3D"m_-4019192868782884930entry.1705849412_year">
<option value=3D"">
Year</option>
<option value=3D"1896">
1896</option>
 <option value=3D"1897">
1897</option>
 <option value=3D"1898">
1898</option>
 <option value=3D"1899">
1899</option>
 <option value=3D"1900">
1900</option>
 <option value=3D"1901">
1901</option>
 <option value=3D"1902">
1902</option>
 <option value=3D"1903">
1903</option>
 <option value=3D"1904">
1904</option>
 <option value=3D"1905">
1905</option>
 <option value=3D"1906">
1906</option>
 <option value=3D"1907">
1907</option>
 <option value=3D"1908">
1908</option>
 <option value=3D"1909">
1909</option>
 <option value=3D"1910">
1910</option>
 <option value=3D"1911">
1911</option>
 <option value=3D"1912">
1912</option>
 <option value=3D"1913">
1913</option>
 <option value=3D"1914">
1914</option>
 <option value=3D"1915">
1915</option>
 <option value=3D"1916">
1916</option>
 <option value=3D"1917">
1917</option>
 <option value=3D"1918">
1918</option>
 <option value=3D"1919">
1919</option>
 <option value=3D"1920">
1920</option>
 <option value=3D"1921">
1921</option>
 <option value=3D"1922">
1922</option>
 <option value=3D"1923">
1923</option>
 <option value==3D"1924">
1924</option>
 <option value=3D"1925">
1925</option>
 <option value==3D"1926">
1926</option>
 <option value=3D"1927">
1927</option>
 <option value==3D"1928">
1928</option>
 <option value=3D"1929">
1929</option>
 <option value==3D"1930">
1930</option>
 <option value=3D"1931">
1931</option>
 <option value==3D"1932">
1932</option>
 <option value=3D"1933">
1933</option>
 <option value==3D"1934">
1934</option>
 <option value=3D"1935">
1935</option>
 <option value==3D"1936">
1936</option>
 <option value=3D"1937">
1937</option>
 <option value==3D"1938">
1938</option>
 <option value=3D"1939">
1939</option>
 <option value==3D"1940">
1940</option>
 <option value=3D"1941">
1941</option>
 <option value==3D"1942">
1942</option>
 <option value=3D"1943">
1943</option>
 <option value==3D"1944">
1944</option>
 <option value=3D"1945">
1945</option>
 <option value==3D"1946">
1946</option>
 <option value=3D"1947">
1947</option>
 <option value==3D"1948">
1948</option>
 <option value=3D"1949">
1949</option>
 <option value==3D"1950">
1950</option>
 <option value=3D"1951">
1951</option>
 <option value==3D"1952">
1952</option>
 <option value=3D"1953">
1953</option>
 <option value==3D"1954">
1954</option>
 <option value=3D"1955">
1955</option>
 <option value==3D"1956">
1956</option>
 <option value=3D"1957">
1957</option>
 <option value==3D"1958">
1958</option>
 <option value=3D"1959">
1959</option>
 <option value==3D"1960">
1960</option>
 <option value=3D"1961">
1961</option>
 <option value==3D"1962">
1962</option>
 <option value=3D"1963">
1963</option>
 <option value==3D"1964">
1964</option>
 <option value=3D"1965">
1965</option>
 <option value==3D"1966">
1966</option>
 <option value=3D"1967">
1967</option>
 <option value==3D"1968">
1968</option>
 <option value=3D"1969">
1969</option>
 <option value==3D"1970">
1970</option>
 <option value=3D"1971">
1971</option>
 <option value==3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
 <option value==3D"1974">
1974</option>
 <option value=3D"1975">
1975</option>
 <option value==3D"1976">
1976</option>
 <option value=3D"1977">
1977</option>
 <option value==3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option value==3D"1980">
1980</option>
 <option value=3D"1981">
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"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_206244955">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Hora de la Atenci=C3=B3n<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-time">
<div class=3D"m_-4019192868782884930ss-datetime-box m_-4019192868782884930goog-inline-block" dir=3D"ltr" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
<select name=3D"entry.206244955_hour" disabled id=3D"m_-4019192868782884930entry.206244955_hour">
<option value=3D"">
Hr</option>
<option value=3D"01">
01</option>
 <option value=3D"02" selected>
02</option>
 <option value=3D"03">
03</option>
 <option value=3D"04">
04</option>
 <option value=3D"05">
05</option>
 <option value=3D"06">
06</option>
 <option value=3D"07">
07</option>
 <option value=3D"08">
08</option>
 <option value=3D"09">
09</option>
 <option value=3D"10">
10</option>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12</option>
</select>
:<select name=3D"entry.206244955_minute" disabled id=3D"m_-4019192868782884930entry.206244955_minute">
<option value=3D"">
Min</option>
<option value=3D"00" selected>
00</option>
 <option value=3D"01">
01</option>
 <option value=3D"02">
02</option>
 <option value=3D"03">
03</option>
 <option value=3D"04">
04</option>
 <option value=3D"05">
05</option>
 <option value=3D"06">
06</option>
 <option value=3D"07">
07</option>
 <option value=3D"08">
08</option>
 <option value=3D"09">
09</option>
 <option value=3D"10">
10</option>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12</option>
 <option value=3D"13">
13</option>
 <option value=3D"14">
14</option>
 <option value=3D"15">
15</option>
 <option value=3D"16">
16</option>
 <option value=3D"17">
17</option>
 <option value=3D"18">
18</option>
 <option value=3D"19">
19</option>
 <option value=3D"20">
20</option>
 <option value=3D"21">
21</option>
 <option value==3D"22">
22</option>
 <option value=3D"23">
23</option>
 <option value=3D"24">
24</option>
 <option value=3D"25">
25</option>
 <option value=3D"26">
26</option>
 <option value=3D"27">
27</option>
 <option value=3D"28">
28</option>
 <option value=3D"29">
29</option>
 <option value=3D"30">
30</option>
 <option value=3D"31">
31</option>
 <option value=3D"32">
32</option>
 <option value=3D"33">
33</option>
 <option value=3D"34">
34</option>
 <option value=3D"35">
35</option>
 <option value=3D"36">
36</option>
 <option value=3D"37">
37</option>
 <option value=3D"38">
38</option>
 <option value=3D"39">
39</option>
 <option value=3D"40">
40</option>
 <option value=3D"41">
41</option>
 <option value=3D"42">
42</option>
 <option value=3D"43">
43</option>
 <option value=3D"44">
44</option>
 <option value=3D"45">
45</option>
 <option value=3D"46">
46</option>
 <option value=3D"47">
47</option>
 <option value=3D"48">
48</option>
 <option value=3D"49">
49</option>
 <option value=3D"50">
50</option>
 <option value=3D"51">
51</option>
 <option value=3D"52">
52</option>
 <option value=3D"53">
53</option>
 <option value=3D"54">
54</option>
 <option value=3D"55">
55</option>
 <option value=3D"56">
56</option>
 <option value=3D"57">
57</option>
 <option value=3D"58">
58</option>
 <option value=3D"59">
59</option>
</select>
<select name=3D"entry.206244955_ampm" disabled>
<option value=3D"AM">
AM</option>
<option value=3D"PM" selected>
PM</option>
</select>
<div class=3D"m_-4019192868782884930ss-datetime-box-spacer m_-4019192868782884930goog-inline-block" style=3D"height:32px;vertical-align:middle;display:inline-block">
</div>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-select" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1747608258">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<select name=3D"entry.1747608258" disabled id=3D"m_-4019192868782884930entry_1747608258">
<option value=3D"">
</option>
<option value=3D"0" disabled>
0</option>
 <option value=3D"1" disabled>
1</option>
 <option value=3D"2" disabled>
2</option>
 <option value=3D"3" disabled selected>
3</option>
 <option value=3D"4" disabled>
4</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1716090865">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"m_-4019192868782884930entry_1421689035">
<tbody>
<tr>
<td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_-4019192868782884930ss-scalerow m_-4019192868782884930ss-leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class==3D"m_-4019192868782884930aria-todo">
</div>
</td>
<td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled checked value=3D"0" id==3D"m_-4019192868782884930group_1421689035_1" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"1" id=3D"m_-4019192868782884930group_1421689035_2" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"2" id=3D"m_-4019192868782884930group_1421689035_3" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"3" id=3D"m_-4019192868782884930group_1421689035_4" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"4" id=3D"m_-4019192868782884930group_1421689035_5" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"5" id=3D"m_-4019192868782884930group_1421689035_6" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"6" id=3D"m_-4019192868782884930group_1421689035_7" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"7" id=3D"m_-4019192868782884930group_1421689035_8" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"8" id=3D"m_-4019192868782884930group_1421689035_9" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"9" id=3D"m_-4019192868782884930group_1421689035_10" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style==3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"10" id=3D"m_-4019192868782884930group_1421689035_11" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
<td class=3D"m_-4019192868782884930ss-scalerow m_-4019192868782884930ss-rightlabel" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_2064050596">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA M=C3=A1ximo</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"m_-4019192868782884930entry_1244707512">
<tbody>
<tr>
<td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_-4019192868782884930ss-scalerow m_-4019192868782884930ss-leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class==3D"m_-4019192868782884930aria-todo">
</div>
</td>
<td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"0" id=3D"m_-4019192868782884930group_1244707512_1" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"1" id=3D"m_-4019192868782884930group_1244707512_2" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"2" id=3D"m_-4019192868782884930group_1244707512_3" class==3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"3" id=3D"m_-4019192868782884930group_1244707512_4" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"4" id=3D"m_-4019192868782884930group_1244707512_5" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"5" id=3D"m_-4019192868782884930group_1244707512_6" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"6" id=3D"m_-4019192868782884930group_1244707512_7" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled checked value=3D"7" id=3D"m_-4019192868782884930group_1244707512_8" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"8" id=3D"m_-4019192868782884930group_1244707512_9" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"9" id=3D"m_-4019192868782884930group_1244707512_10" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style==3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"10" id=3D"m_-4019192868782884930group_1244707512_11" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
<td class=3D"m_-4019192868782884930ss-scalerow m_-4019192868782884930ss-rightlabel" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_2000523015">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA M=C3=ADnimo</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<table border=3D"0" cellpadding=3D"5" cellspacing=3D"0" id=3D"m_-4019192868782884930entry_853118630">
<tbody>
<tr>
<td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_853118630_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_853118630_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_853118630_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_853118630_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_853118630_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for==3D"m_-4019192868782884930group_853118630_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_853118630_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_853118630_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class==3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_853118630_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_853118630_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4019192868782884930ss-scalenumber" for=3D"m_-4019192868782884930group_853118630_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-4019192868782884930ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_-4019192868782884930ss-scalerow m_-4019192868782884930ss-leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class==3D"m_-4019192868782884930aria-todo">
</div>
</td>
<td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled checked value=3D"0" id=3D"m_-4019192868782884930group_853118630_1" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"1" id=3D"m_-4019192868782884930group_853118630_2" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"2" id=3D"m_-4019192868782884930group_853118630_3" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"3" id=3D"m_-4019192868782884930group_853118630_4" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class==3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"4" id=3D"m_-4019192868782884930group_853118630_5" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"5" id=3D"m_-4019192868782884930group_853118630_6" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value==3D"6" id=3D"m_-4019192868782884930group_853118630_7" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"7" id=3D"m_-4019192868782884930group_853118630_8" class==3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"8" id=3D"m_-4019192868782884930group_853118630_9" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class==3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"9" id=3D"m_-4019192868782884930group_853118630_10" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
 <td class=3D"m_-4019192868782884930ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4019192868782884930ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"10" id=3D"m_-4019192868782884930group_853118630_11" class=3D"m_-4019192868782884930ss-q-radio">
</div>
</td>
<td class=3D"m_-4019192868782884930ss-scalerow m_-4019192868782884930ss-rightlabel" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_2140974612">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Anamnesis/Evoluci=C3=B3n<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Paciente acompa=C3=B1ada por enfermera a cargo de instituci=C3=B3n y hermana, con disnea aguda desde hoy en la ma=C3=B1ana, se encuentra en cama semisentada, agitada, refiriendo dificultad respiratoria. Hasta el d=C3=ADa previo s=C3=B3lo con insomnio de conciliaci=C3=B3n, por lo que nuevamente EU encargada del centro decide realizar ajustes en terapia farmacol=C3=B3gica, agregando a zolpidem 12,5mg de quetiapina vo, sin buena respuesta. La paciente no refiere dolor tor=C3=A1cico, tos, expectoraci=C3=B3n ni sensaci=C3=B3n febril. Al d=C3=ADa le facilitan la ingesta de 1 litro de l=C3=ADquidos a tomar, adem=C3=A1s de sopas y otros tipos de l=C3=ADquidos que no consideran en la cuantificaci=C3=B3n del total de ingesta diaria. Adem=C3=A1s se consigna que se encuentran administrando furosemida 40 mg 1,5 comprimidos en una toma diaria, siendo que cardi=C3==B3logo particular indic=C3=B3 recientemente que su uso fuera 1 comprimido am y 0,5 comprimido pm.=20Fuera de esto, de buen =C3=A1nimo, levant=C3=A1ndose un par de veces al d==C3=ADa, apetito disminuido pero aliment=C3=A1ndose suficientemente en comedor com=C3=BAn del hogar, orinando y defecando sin dificultad. Sin episodios de dolor.Se revisan ex=C3=A1menes de control sugeridos a familiar, resultados del 10/05/19. Destacan: hiponatremia leve (131), anemia leve normoc=C3=ADtica normocr=C3=B3mica (Hb10), trombocitopenia (58.000), hipoalbuminemia leve (3,2), TSH 5,8 (dentro de lo normal para su edad, porque el limite superior de lo normal es mayor en adultos mayores), resto normal.EU del centro llam=C3=B3 a equipo m=C3=A9dico particular de asistencia de urgencias, quienes hasta el momento de nuestra despedida junto al EU de Cuidados Paliativos a=C3=BAn no se presentaban. </div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_824006088">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Examen F=C3=ADsico<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Regular estado general, PA 146/88, FC 98-112, FR 24, 35,8=C2=B0C axilar, SatO2 93-97% con ox=C3=ADgeno ambiental,  Estable hemodin=C3=A1micamente, afebril, ventilando con apremio, bien hidratada y perfundida, con llene capilar &lt;2&quot;. Mucosas semi p=C3=A1lidas, sin adenopat=C3=ADas cervicales ni supraclaviculares palpables. RI2T sin soplos audibles, yugulares ingurgitadas a 30=C2=BA, reflujo hepatoyugular +, discreta hepatomegalia palpable,  pulsos perif=C3=A9ricos sim=C3=A9tricos, edema de EEII sim=C3=A9trico. MP + SRA. Abdomen RHA +, indoloro a la palpaci=C3=B3n, sin masas palpables, sin signos de irritaci=C3=B3n peritoneal. Extremidades inferiores con extenso edema sim=C3=A9trico hasta muslos pero menor en relaci=C3=B3n a =C3=BAltima visita, sin signos de TVP.  Piel de dorso descubierta, se evidencian orificios externos de f=C3=ADstulas cut==C3=A1neas cerrados, sin aumento de volumen ni signos de infecci=C3=B3n. Sin nuevas equ=C3=ADmosis evidentes. </div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1690694733">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Diagn=C3=B3stico<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Tumor renal derecho, obs c=C3=A1 renal. Insuficiencia card=C3=ADaca descompensada. Fibrilaci=C3=B3n auricular con control de frecuencia. Hipertensi=C3=B3n arterial. Hipotiroidismo. Insomnio de conciliaci=C3=B3n. Hiponatremia leve (probablemente secundaria a insuficiencia card=C3=ADaca). Bicitopenia. </div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-item-required m_-4019192868782884930ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1255665248">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Plan de Tratamiento e Indicaciones<label for=3D"m_-4019192868782884930itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4019192868782884930ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
1) Cardiol=C3=B3gico: Debido a tipo de prestaci=C3=B3n que realizo, no puedo modificar tratamiento cr=C3=B3nico de patolog=C3=ADa card=C3=ADaca, lo que explico a paciente, hermana y EU del centro. Sin embargo hago hincapi=C3=A9 en indicaciones generales: mantener en reposo semisentada/sentada; restricci=C3=B3n h=C3=ADdrica m=C3=A1ximo 1 litro de ingesta h=C3=ADdrica TOTAL al d=C3=ADa; administrar furosemida 40 mg 1 comp am y 0,5 mg pm seg=C3=BAn indicaci=C3=B3n de cardi=C3=B3logo, con la que concuerdo. Si hubiese que realizar un nuevo ajuste de tratamiento para insuficiencia card=C3=ADaca/fibrilaci=C3=B3n auricular, debiesen consultar a m=C3=A9dico/a general, internista o solicitar control con cardi=C3==B3logo tratante a la brevedad. 2) Insomnio: mantener zolpidem, agregar quetiapina 25mg 1 comp/noche, m=C3=A1ximo 1,5 comp/noche si persiste insomnio. 3) Resto sin cambios. </div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1648939075">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
1)	Buprenorfina 35ug, =C2=BD parche cada 3,5 d=C3=ADas2)	Paracetamol 500mg/12hrs vo3)	Tramadol 10 gotas vo SOS=204)	Bisoprolol 2,5 mg/d=C3=ADa vo (dosis modificada por cardi=C3=B3logo tratante)5)	Olmesart=C3=A1n 20mg/d=C3=ADa vo (dosis modificada por cardi=C3=B3logo tratante)6)	Levotiroxina 25ug/d=C3=ADa vo (al menos media hr antes del desayuno)=207)	Escitalopran 10mg/d=C3=ADa vo=208)	Zolpidem 10mg/noche vo=209)	Furosemida 40mg am, 20 mg pm  vo (dosis modificada por cardi=C3=B3logo tratante) (insisto en esta indicaci=C3=B3n porque no la estaban administrando correctamente)10)	Vitamina C, 1 comp efervescente al d=C3=ADa vo=2011)	Centrum silver 1 comp/d=C3=ADa vo=2012)	Lactulosa jarabe, 10-30cc/6-8hrs, lo necesario para 2-3 deposiciones semiformadas al d=C3=ADa13) Metoclopramida 10mg vo con el desayuno y almuerzo14) Digoxina 0,25mg, 1/2 comprimido/d=C3=ADa vo (indicado por cardi=C3=B3logo tratante)15) Quetiapina 25mg, 1 comp/noche, m=C3=A1ximo 1,5 comp/noche si persiste insomnio conciliaci=C3=B3n</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-date" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_2063615873">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-date">
<div class=3D"m_-4019192868782884930ss-datetime-box m_-4019192868782884930goog-inline-block" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
 <select name=3D"entry.2063615873_month" disabled class=3D"m_-4019192868782884930ss-month-dropdown" id=3D"m_-4019192868782884930entry.2063615873_month">
<option value==3D"">
Month</option>
<option value=3D"1">
January</option>
 <option value=3D"2">
February</option>
 <option value=3D"3">
March</option>
 <option value=3D"4">
April</option>
 <option value=3D"5" selected>
May</option>
 <option value=3D"6">
June</option>
 <option value=3D"7">
July</option>
 <option value=3D"8">
August</option>
 <option value=3D"9">
September</option>
 <option value=3D"10">
October</option>
 <option value=3D"11">
November</option>
 <option value=3D"12">
December</option>
</select>
   <select name=3D"entry.2063615873_day" disabled class=3D"m_-4019192868782884930ss-day-dropdown" id=3D"m_-4019192868782884930entry.2063615873_day">
<option value=3D"">
Day</option>
<option value=3D"1">
1</option>
 <option value=3D"2">
2</option>
 <option value=3D"3">
3</option>
 <option value=3D"4">
4</option>
 <option value=3D"5">
5</option>
 <option value=3D"6">
6</option>
 <option value=3D"7">
7</option>
 <option value=3D"8">
8</option>
 <option value=3D"9">
9</option>
 <option value=3D"10">
10</option>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12</option>
 <option value=3D"13">
13</option>
 <option value=3D"14">
14</option>
 <option value=3D"15">
15</option>
 <option value=3D"16">
16</option>
 <option value==3D"17">
17</option>
 <option value=3D"18">
18</option>
 <option value=3D"19">
19</option>
 <option value=3D"20">
20</option>
 <option value=3D"21">
21</option>
 <option value=3D"22" selected>
22</option>
 <option value=3D"23">
23</option>
 <option value=3D"24">
24</option>
 <option value=3D"25">
25</option>
 <option value=3D"26">
26</option>
 <option value=3D"27">
27</option>
 <option value=3D"28">
28</option>
 <option value=3D"29">
29</option>
 <option value=3D"30">
30</option>
 <option value=3D"31">
31</option>
</select>
=20<select name=3D"entry.2063615873_year" disabled id=3D"m_-4019192868782884930entry.2063615873_year">
<option value=3D"">
Year</option>
<option value=3D"1896">
1896</option>
 <option value=3D"1897">
1897</option>
 <option value=3D"1898">
1898</option>
 <option value=3D"1899">
1899</option>
 <option value=3D"1900">
1900</option>
 <option value=3D"1901">
1901</option>
 <option value=3D"1902">
1902</option>
 <option value=3D"1903">
1903</option>
 <option value=3D"1904">
1904</option>
 <option value=3D"1905">
1905</option>
 <option value=3D"1906">
1906</option>
 <option value=3D"1907">
1907</option>
 <option value=3D"1908">
1908</option>
 <option value=3D"1909">
1909</option>
 <option value=3D"1910">
1910</option>
 <option value=3D"1911">
1911</option>
 <option value=3D"1912">
1912</option>
 <option value=3D"1913">
1913</option>
 <option value=3D"1914">
1914</option>
 <option value=3D"1915">
1915</option>
 <option value=3D"1916">
1916</option>
 <option value=3D"1917">
1917</option>
 <option value=3D"1918">
1918</option>
 <option value=3D"1919">
1919</option>
 <option value=3D"1920">
1920</option>
 <option value=3D"1921">
1921</option>
 <option value=3D"1922">
1922</option>
 <option value=3D"1923">
1923</option>
 <option value==3D"1924">
1924</option>
 <option value=3D"1925">
1925</option>
 <option value==3D"1926">
1926</option>
 <option value=3D"1927">
1927</option>
 <option value==3D"1928">
1928</option>
 <option value=3D"1929">
1929</option>
 <option value==3D"1930">
1930</option>
 <option value=3D"1931">
1931</option>
 <option value==3D"1932">
1932</option>
 <option value=3D"1933">
1933</option>
 <option value==3D"1934">
1934</option>
 <option value=3D"1935">
1935</option>
 <option value==3D"1936">
1936</option>
 <option value=3D"1937">
1937</option>
 <option value==3D"1938">
1938</option>
 <option value=3D"1939">
1939</option>
 <option value==3D"1940">
1940</option>
 <option value=3D"1941">
1941</option>
 <option value==3D"1942">
1942</option>
 <option value=3D"1943">
1943</option>
 <option value==3D"1944">
1944</option>
 <option value=3D"1945">
1945</option>
 <option value==3D"1946">
1946</option>
 <option value=3D"1947">
1947</option>
 <option value==3D"1948">
1948</option>
 <option value=3D"1949">
1949</option>
 <option value==3D"1950">
1950</option>
 <option value=3D"1951">
1951</option>
 <option value==3D"1952">
1952</option>
 <option value=3D"1953">
1953</option>
 <option value==3D"1954">
1954</option>
 <option value=3D"1955">
1955</option>
 <option value==3D"1956">
1956</option>
 <option value=3D"1957">
1957</option>
 <option value==3D"1958">
1958</option>
 <option value=3D"1959">
1959</option>
 <option value==3D"1960">
1960</option>
 <option value=3D"1961">
1961</option>
 <option value==3D"1962">
1962</option>
 <option value=3D"1963">
1963</option>
 <option value==3D"1964">
1964</option>
 <option value=3D"1965">
1965</option>
 <option value==3D"1966">
1966</option>
 <option value=3D"1967">
1967</option>
 <option value==3D"1968">
1968</option>
 <option value=3D"1969">
1969</option>
 <option value==3D"1970">
1970</option>
 <option value=3D"1971">
1971</option>
 <option value==3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
 <option value==3D"1974">
1974</option>
 <option value=3D"1975">
1975</option>
 <option value==3D"1976">
1976</option>
 <option value=3D"1977">
1977</option>
 <option value==3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option value==3D"1980">
1980</option>
 <option value=3D"1981">
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"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_74766472">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4019192868782884930ss-q-text" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%">
Se maneja con reposo semisentada, con lo que al momento de nuestra despedida (15 hrs aprox) se encuentra con FC 100 lpm irregular, sin dificultad respiratoria ni agitaci=C3=B3n. Educo a paciente, familiar y EU del centro respecto a necesidad de solicitar control con cardi=C3=B3logo a la brevedad de persistir la descompensaci=C3=B3n de patolog=C3=ADa card=C3=ADaca cr=C3=B3nica  </div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930ss-form-question m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-checkbox" style=3D"margin:12px 0">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4019192868782884930ss-q-item-label" for=3D"m_-4019192868782884930entry_1219705969">
<div class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"m_-4019192868782884930ss-q-help m_-4019192868782884930ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
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"m_-4019192868782884930ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-4019192868782884930ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4019192868782884930ss-choice-item-control m_-4019192868782884930goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"ENFERMERA" id=3D"m_-4019192868782884930group_503039759_1" class=3D"m_-4019192868782884930ss-q-checkbox">
</span>
<span class=3D"m_-4019192868782884930ss-choice-label">
ENFERMERA</span>
</label>
</li>
 <li class=3D"m_-4019192868782884930ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4019192868782884930ss-choice-item-control m_-4019192868782884930goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"m_-4019192868782884930group_503039759_2" class=3D"m_-4019192868782884930ss-q-checkbox">
</span>
<span class=3D"m_-4019192868782884930ss-choice-label">
TENS</span>
</label>
</li>
 <li class=3D"m_-4019192868782884930ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4019192868782884930ss-choice-item-control m_-4019192868782884930goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"NUTRICIONISTA" id=3D"m_-4019192868782884930group_503039759_3" class=3D"m_-4019192868782884930ss-q-checkbox">
</span>
<span class=3D"m_-4019192868782884930ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
 <li class=3D"m_-4019192868782884930ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4019192868782884930ss-choice-item-control m_-4019192868782884930goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"KINESIOLOGO" id=3D"m_-4019192868782884930group_503039759_4" class=3D"m_-4019192868782884930ss-q-checkbox">
</span>
<span class=3D"m_-4019192868782884930ss-choice-label">
KINESIOLOGO</span>
</label>
</li>
 <li class=3D"m_-4019192868782884930ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4019192868782884930ss-choice-item-control m_-4019192868782884930goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"PSICOLOGO" id=3D"m_-4019192868782884930group_503039759_5" class=3D"m_-4019192868782884930ss-q-checkbox">
</span>
<span class=3D"m_-4019192868782884930ss-choice-label">
PSICOLOGO</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4019192868782884930errorbox-good">
<div dir=3D"auto" class=3D"m_-4019192868782884930ss-item m_-4019192868782884930ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-4019192868782884930ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4019192868782884930ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-4019192868782884930ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width:78px;outline:none" alt=3D"Captionless Image">
</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:#424242;font-size:13px" target=3D"_blank">
Create your own Google Form</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
--0000000000006ffc850588f2c8a9--