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Obtener <a href=3D"https://aka.ms/ghei36">
Outlook para Android</a>
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De: Formularios de Google<br>
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Enviado: martes, 25 de junio 19:40<br>
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Asunto: Registro de Atenci=F3n Domiciliaria Oncovida<br>
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Para: abdul2508@hotmail.com<br>
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Gracias por rellenar</table>
<a href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link">
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Registro de Atenci=F3n Domiciliaria Oncovida</table>
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Esto es lo que nos has enviado:</table>
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Registro de Atenci=F3n Domiciliaria Oncovida</table>
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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=F3n indique su correo electr=F3nico.</table>
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Direcci=F3n de correo electr=F3nico *</table>
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abdul2508@hotmail.com</table>
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Identificaci=F3n del Prestador</table>
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Aqu=ED debe ingresar sus datos personales</table>
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Primer Nombre y Apellido Paterno *</table>
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Abdul sarria</table>
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RUT *</table>
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RUT con Gui=F3n y D=EDgito Verificador, sin puntos ( Ej: 5632200-k)</table>
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26743483-2</table>
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Tipo *</table>
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Si asisten m=E1s de 1 prestador simult=E1neamente, cada uno debe hacer un registro independiente</table>
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MEDICOENFERMERA/O TENSKINESIOLOGA/OPSICOLOGO NUTRICIONISTA</table>
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Identificaci=F3n del Paciente</table>
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En esta secci=F3n debe ingresar los datos del paciente visitado</table>
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Datos Personales del Paciente</table>
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Ingrese el Rut del Paciente *</table>
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RUT con Gui=F3n y D=EDgito Verificador, sin puntos ( Ej: 5632200-k)</table>
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7966839-7</table>
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Ingrese el Primer Nombre y Apellido Paterno del Paciente *</table>
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Jos=E9 leyva</table>
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Previsi=F3n *</table>
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BANMEDICA CAPREDENACOLMENA CONSALUDCRUZ BLANCADIPRECA FONASAFUNDACIONISAPRES DEL COBRENUEVA MASVIDA VIDATRESPARTICULAR</table>
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Ciudad *</table>
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Antofagasta</table>
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Comuna *</table>
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Antofagasta</table>
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Registro de la Atenci=F3n Domiciliaria</table>
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En esta secci=F3n debe ingresar los datos de la atenci=F3n domiciliaria</table>
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Tipo de Atenci=F3n *</table>
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Domicilio Ambulatorio</table>
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Fecha de la Atenci=F3n *</table>
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D=EDa1234 56789 101112 13141516 171819 20212223 242526 27282930 31 Mesenero febreromarzo abrilmayo juniojulio agostoseptiembre octubrenoviembre diciembre A=F1o1896 18971898 18991900 19011902 19031904 19051906 19071908 19091910 19111912 19131914 19151916 19171918 19191920 19211922 19231924 19251926 19271928 19291930 19311932 19331934 19351936 19371938 19391940 19411942 19431944 19451946 19471948 19491950 19511952 19531954 19551956 19571958 19591960 19611962 19631964 19651966 19671968 19691970 19711972 19731974 19751976 19771978 19791980 19811982 19831984 19851986 19871988 19891990 19911992 19931994 19951996 19971998 19992000 20012002 20032004 20052006 20072008 20092010 20112012 20132014 20152016 20172018 20192020 20212022 20232024 20252026 20272028 20292030 20312032 20332034 20352036 20372038 20392040 20412042 20432044 20452046 20472048 20492050 20512052 20532054 20552056 20572058 20592060 20612062 20632064 20652066 20672068 2069</table>
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Hora de la Atenci=F3n *</table>
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h0001 02030405 060708 09101112 131415 16171819 202122 23 : min00 010203 04050607 080910 11121314 151617 18192021 222324 25262728 293031 32333435 363738 39404142 434445 46474849 505152 53545556 575859</table>
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Performance Status ECOG del Paciente *</table>
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0 12 34</table>
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Escala Dolor EVA Actual</table>
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<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
0</table>
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<tbody>
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</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
1</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
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</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
2</table>
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<tbody>
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<td rowspan=3D"1" colspan=3D"1">
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</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
3</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
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4</table>
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<tbody>
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</tbody>
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<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
5</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
<tr>
<td rowspan=3D"1" colspan=3D"1">
</td>
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</tr>
</tbody>
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<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
6</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
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<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
7</table>
<table id=3D"entry_1421689035" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
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<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
8</table>
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<tbody>
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9</table>
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10</table>
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<tbody>
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Escala Dolor EVA M=E1ximo</table>
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<tbody>
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<td rowspan=3D"1" colspan=3D"1">
</td>
</tr>
<tr>
</tr>
</tbody>
</table>
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
0</table>
<table id=3D"entry_1244707512" border=3D"0" cellpadding=3D"5" cellspacing==3D"0">
<tbody>
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<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Escala Dolor EVA M=EDnimo</table>
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1</table>
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3</table>
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5</table>
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7</table>
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9</table>
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10</table>
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<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Anamnesis/Evoluci=F3n *</table>
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<div dir=3D"auto" style=3D"direction: ltr; margin: 0; padding: 0; font-family: sans-serif; font-size: 11pt; color: black; ">
<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
paciente de 62 a=F1os de edad, hipertenso controlado, diabetico controlado, con dx de base CA de pr=F3stata con met=E1stasis en pulm=F3n en tto con quimioterapia doxetacel 75mg ev hasta el momento 7 sesiones sin mayores efectos secundarios, funcional en sus actividades cotidianas, asintom=E1tico respiratorio, refiere ocasionalmente dolores generalizados de caracter=EDsticas musculares, adem=E1s constipacion en las ==FAltimas semanas exacerbada hace 3 d=EDas, y glicemias elevadas entre ellas una de 356 no refiere que d=EDa, niega s=EDntomas de alarma como fiebre, intolerancia a la v=EDa oral, perdida de peso, sudoraci=F3n nocturna, niega dolor tor=E1cico, niega otros s=EDntomas.</table>
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Examen F=EDsico *</table>
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<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
luce en buenas condiciones generales, sin signos de dificultad respiratoria, no luce agudo, asintomatico, svt ta:135/70 sto 97% fc 80 fr 18 t 36%, mucosas hidratadas, escleras anictericas, conjuntivas rosadas, cuello no doloroso y m=F3vil no se palpan adenopatias considerables, cavidad oral sin alteraciones, ruidos card=EDacos r=EDtmicos y regulares no se auscultan soplos, campos pulmonares bien ventilados sin sobre agregados, abdomen blando deprensible no doloroso no se palpan masas, parche traste zona escapulario derecha, lesiones en piel de las piernas tipo atrofia de piel con signos de rascado, m=E1cula hiperpigmentadas, extremidades sim=E9tricas m=F3viles sin edemas ni equimosis, glasgow 15/15.</table>
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Diagn=F3stico *</table>
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<table width=3D"100%" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff">
Ca de pr=F3stata</table>
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Plan de Tratamiento e Indicaciones *</table>
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Paciente con manejo del dolor controlado, se sigue igual esquema analg=E9sico. Adem=E1s constipacion se adiciona bisacodilo como laxante junto con recomendaciones dietarias, con sospecha de DMT2 no controlada por reporte de glicemias elevadas y lesiones de caracteristicas complicaciones dermatologicas en piel de las piernas por DM vs efecto adverso de la quimioterapia.</table>
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Medicamentos Indicados</table>
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Tramado 100mg gotas 30 SOS Xumadol SOS Bisacodilo 5mg cada ma=F1ana por 10 d=EDas Solicito hemoglobina glicosilada a evaluar control diabetico ( no se realiz=F3 control metab=F3lico en enero)</table>
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Fecha aproximada del Pr=F3ximo Control con usted</table>
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D=EDa1234 56789 101112 13141516 171819 20212223 242526 27 282930 31 Mesenero febreromarzo abrilmayo juniojulio agostoseptiembre octubrenoviembre diciembre A=F1o1896 18971898 18991900 19011902 19031904 19051906 19071908 19091910 19111912 19131914 19151916 19171918 19191920 19211922 19231924 19251926 19271928 19291930 19311932 19331934 19351936 19371938 19391940 19411942 19431944 19451946 19471948 19491950 19511952 19531954 19551956 19571958 19591960 19611962 19631964 19651966 19671968 19691970 19711972 19731974 19751976 19771978 19791980 19811982 19831984 19851986 19871988 19891990 19911992 19931994 19951996 19971998 19992000 20012002 20032004 20052006 20072008 20092010 20112012 20132014 20152016 20172018 20192020 20212022 20232024 20252026 20272028 20292030 20312032 20332034 20352036 20372038 20392040 20412042 20432044 20452046 20472048 20492050 20512052 20532054 20552056 20572058 20592060 20612062 20632064 20652066 20672068 2069</table>
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Tratamiento Realizado (si corresponde)</table>
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Derivaci=F3n a otro Prestador Domiciliario</table>
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S=F3lo llene esta secci=F3n si es m=E9dico y solicita la visita de otro prestador del equipo</table>
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ENFERMERA TENS NUTRICIONISTA KINESIOLOGO PSICOLOGO</table>
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Crea tu propio formulario de Google</table>
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