<div dir=3D"ltr">
<br>
<br>
<div class=3D"gmail_quote">
<div dir=3D"ltr" class==3D"gmail_attr">
---------- Forwarded message ---------<br>
De: <strong class=3D"gmail_sendername" dir=3D"auto">
Google Forms</strong>
 <span dir=3D"auto">
&lt;<a href=3D"mailto:forms-receipts-noreply@google.com">
forms-receipts-noreply@google.com</a>
&gt;</span>
<br>
Date: vie., 28 jun. 2019 a las 16:14<br>
Subject: Registro de Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href=3D"mailto:k7albarran@gmail.com">
k7albarran@gmail.com</a>
&gt;<br>
</div>
<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_-4785875261268570816ss-form-container">
<div class=3D"m_-4785875261268570816ss-form-heading">
<h1 class=3D"m_-4785875261268570816ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"m_-4785875261268570816ss-form-desc m_-4785875261268570816ss-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_-4785875261268570816ss-form">
<form method=3D"GET" id=3D"m_-4785875261268570816ss-form" target=3D"_blank">
<br>
<div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816emailAddress">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Email address<label for=3D"m_-4785875261268570816emailAddress">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
</label>
<div class=3D"m_-4785875261268570816ss-q-text m_-4785875261268570816ss-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:k7albarran@gmail.com" target=3D"_blank">
k7albarran@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-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_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4785875261268570816ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_-4785875261268570816ss-page-description m_-4785875261268570816ss-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_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_579114469">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Primer Nombre y Apellido Paterno<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-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%">
Kattia Albarr=C3=A1n</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1276273985">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
RUT<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-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_-4785875261268570816ss-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%">
16152053-5</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-select" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_133691676">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-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_-4785875261268570816entry_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_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-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_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4785875261268570816ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_-4785875261268570816ss-page-description m_-4785875261268570816ss-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_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4785875261268570816ss-section-title" style=3D"background-color:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_-4785875261268570816ss-section-description m_-4785875261268570816ss-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_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_823811303">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ingrese el Rut del Paciente<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-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_-4785875261268570816ss-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%">
7486326-4</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1959365839">
<div class=3D"m_-4785875261268570816ss-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_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-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%">
Irene Soto</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-select" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_545002227">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Previsi=C3=B3n<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-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_-4785875261268570816entry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled>
BANMEDICA</option>
 <option value=3D"CAPREDENA" disabled>
CAPREDENA</option>
 <option value=3D"COLMENA" disabled>
COLMENA</option>
 <option value=3D"CONSALUD" disabled>
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled>
CRUZ BLANCA</option>
 <option value=3D"DIPRECA" disabled>
DIPRECA</option>
 <option value=3D"FONASA" disabled>
FONASA</option>
 <option value=3D"FUNDACION" disabled>
FUNDACION</option>
 <option value==3D"ISAPRES DEL COBRE" disabled>
ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled selected>
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_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1900161356">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Ciudad<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1298871758">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Comuna<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-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_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-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_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4785875261268570816ss-page-title" style=3D"padding:0.4em;background-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_-4785875261268570816ss-page-description m_-4785875261268570816ss-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_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-radio" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_2073233714">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tipo de Atenci=C3=B3n<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<ul class=3D"m_-4785875261268570816ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-4785875261268570816ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4785875261268570816ss-choice-item-control m_-4785875261268570816goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled checked value=3D"Domicilio" id=3D"m_-4785875261268570816group_1222378237_1" class=3D"m_-4785875261268570816ss-q-radio">
</span>
<span class=3D"m_-4785875261268570816ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_-4785875261268570816ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4785875261268570816ss-choice-item-control m_-4785875261268570816goog-inline-block" style=3D"display:inline-block">
<input type=3D"radio" name=3D"entry.1222378237" disabled value=3D"Ambulatorio" id=3D"m_-4785875261268570816group_1222378237_2" class=3D"m_-4785875261268570816ss-q-radio">
</span>
<span class=3D"m_-4785875261268570816ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-date" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1705849412">
<div class=3D"m_-4785875261268570816ss-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_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-q-date">
<div class=3D"m_-4785875261268570816ss-datetime-box m_-4785875261268570816goog-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_-4785875261268570816ss-month-dropdown" id=3D"m_-4785875261268570816entry.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">
May</option>
 <option value=3D"6" selected>
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_-4785875261268570816ss-day-dropdown" id=3D"m_-4785875261268570816entry.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">
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" selected>
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_-4785875261268570816entry.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_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-time" style=3D"margin:12px 0;font:inherit">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_206244955">
<div class=3D"m_-4785875261268570816ss-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_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-q-time">
<div class=3D"m_-4785875261268570816ss-datetime-box m_-4785875261268570816goog-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_-4785875261268570816entry.206244955_hour">
<option value=3D"">
Hr</option>
<option value=3D"01">
01</option>
 <option value=3D"02">
02</option>
 <option value=3D"03">
03</option>
 <option value=3D"04" selected>
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_-4785875261268570816entry.206244955_minute">
<option value=3D"">
Min</option>
<option value=3D"00">
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" selected>
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_-4785875261268570816ss-datetime-box-spacer m_-4785875261268570816goog-inline-block" style=3D"height:32px;vertical-align:middle;display:inline-block">
</div>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-select" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1747608258">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Performance Status ECOG del Paciente<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-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_-4785875261268570816entry_1747608258">
<option value=3D"">
</option>
<option value=3D"0" disabled>
0</option>
 <option value=3D"1" disabled>
1</option>
 <option value=3D"2" disabled selected>
2</option>
 <option value=3D"3" disabled>
3</option>
 <option value=3D"4" disabled>
4</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1716090865">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Escala Dolor EVA Actual</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-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_-4785875261268570816entry_1421689035">
<tbody>
<tr>
<td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_-4785875261268570816ss-scalerow m_-4785875261268570816ss-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_-4785875261268570816aria-todo">
</div>
</td>
<td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled checked value=3D"0" id==3D"m_-4785875261268570816group_1421689035_1" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"1" id=3D"m_-4785875261268570816group_1421689035_2" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"2" id=3D"m_-4785875261268570816group_1421689035_3" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"3" id=3D"m_-4785875261268570816group_1421689035_4" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"4" id=3D"m_-4785875261268570816group_1421689035_5" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"5" id=3D"m_-4785875261268570816group_1421689035_6" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"6" id=3D"m_-4785875261268570816group_1421689035_7" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"7" id=3D"m_-4785875261268570816group_1421689035_8" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"8" id=3D"m_-4785875261268570816group_1421689035_9" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"9" id=3D"m_-4785875261268570816group_1421689035_10" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled value=3D"10" id=3D"m_-4785875261268570816group_1421689035_11" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
<td class=3D"m_-4785875261268570816ss-scalerow m_-4785875261268570816ss-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_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_2064050596">
<div class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-q-help m_-4785875261268570816ss-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_-4785875261268570816entry_1244707512">
<tbody>
<tr>
<td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_3" style==3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_7" style==3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_-4785875261268570816ss-scalerow m_-4785875261268570816ss-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_-4785875261268570816aria-todo">
</div>
</td>
<td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled checked value=3D"0" id==3D"m_-4785875261268570816group_1244707512_1" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"1" id=3D"m_-4785875261268570816group_1244707512_2" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"2" id=3D"m_-4785875261268570816group_1244707512_3" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"3" id=3D"m_-4785875261268570816group_1244707512_4" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"4" id=3D"m_-4785875261268570816group_1244707512_5" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"5" id=3D"m_-4785875261268570816group_1244707512_6" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"6" id=3D"m_-4785875261268570816group_1244707512_7" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"7" id=3D"m_-4785875261268570816group_1244707512_8" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"8" id=3D"m_-4785875261268570816group_1244707512_9" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"9" id=3D"m_-4785875261268570816group_1244707512_10" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled value=3D"10" id=3D"m_-4785875261268570816group_1244707512_11" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
<td class=3D"m_-4785875261268570816ss-scalerow m_-4785875261268570816ss-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_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_2000523015">
<div class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-q-help m_-4785875261268570816ss-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_-4785875261268570816entry_853118630">
<tbody>
<tr>
<td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_853118630_1" style=3D"display:block;padding:0.5em 0 .5em">
0</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style==3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_853118630_2" style=3D"display:block;padding:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_853118630_3" style=3D"display:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_853118630_4" style=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_853118630_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for==3D"m_-4785875261268570816group_853118630_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_853118630_7" style=3D"display:block;padding:0.5em 0 .5em">
6</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_853118630_8" style=3D"display:block;padding:0.5em 0 .5em">
7</label>
</td>
 <td class==3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_853118630_9" style=3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_853118630_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4785875261268570816ss-scalenumber" for=3D"m_-4785875261268570816group_853118630_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-4785875261268570816ss-scalenumbers" style=3D"text-align:center">
</td>
</tr>
<tr>
<td class=3D"m_-4785875261268570816ss-scalerow m_-4785875261268570816ss-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_-4785875261268570816aria-todo">
</div>
</td>
<td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled checked value=3D"0" id=3D"m_-4785875261268570816group_853118630_1" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"1" id=3D"m_-4785875261268570816group_853118630_2" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"2" id=3D"m_-4785875261268570816group_853118630_3" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"3" id=3D"m_-4785875261268570816group_853118630_4" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class==3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"4" id=3D"m_-4785875261268570816group_853118630_5" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"5" id=3D"m_-4785875261268570816group_853118630_6" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value==3D"6" id=3D"m_-4785875261268570816group_853118630_7" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"7" id=3D"m_-4785875261268570816group_853118630_8" class==3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"8" id=3D"m_-4785875261268570816group_853118630_9" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class==3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"9" id=3D"m_-4785875261268570816group_853118630_10" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
 <td class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled value=3D"10" id=3D"m_-4785875261268570816group_853118630_11" class=3D"m_-4785875261268570816ss-q-radio">
</div>
</td>
<td class=3D"m_-4785875261268570816ss-scalerow m_-4785875261268570816ss-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_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_2140974612">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Anamnesis/Evoluci=C3=B3n<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-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 fue hospitalizada por sugerencia nuestra para compensaci=C3=B3n de encefalopat=C3=ADa hep=C3=A1tica el d=C3=ADa 17.06.2019, ingresa con ictericia de piel y mucosas +++, caquexia, somnolencia. Durante el transcurso de los d=C3=ADas recibi=C3=B3 hidrataci=C3=B3n parenteral, adem=C3=A1s de que se instal=C3=B3 sonda nasog=C3=A1strica, la cual fue mal tolerada, y se decide retirar para alimentar por boca. Durante hospitalizaci=C3=B3n se mantiene sin dolor, deposiciones y micci==C3=B3n normales se toman ex=C3=A1menes de control que destacan bilirrubina total: 14,74, bilirrubina directa: 10,94, GOT: 157 GPT:69 GGT: 212 Alb=C3==BAmina: 2mg/dl. Se decidi=C3=B3 el alta el d=C3=ADa 27.06.2019 con indicaciones de transtec 35mcg 1 =C2=BD parches cada 72 hrs y aumentar la dosis de quetiapina a 100mg por noche. Hoy a la evaluaci=C3=B3n persiste con compromiso de conciencia y somnolencia, adem=C3=A1s de persistir con caquexia, cuidadora refiere que sigue aliment=C3=A1ndose en forma enteral de manera regular pero escasa. Con deposiciones + y orinas normales. No refiere dolor. </div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_824006088">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Examen F=C3=ADsico<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-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%">
Presi=C3=B3n: 88/56mmhgFc: 80 por minFr: 17 por minT=C2=B0: 36.5=C2=B0CSat O2: 99% fio2 ambientalSoporosa, Glasgow 12-13, no contesta preguntas sencillas. Con mayor bradipsiquia que semana pasada. sin asterixis.=20Cabeza y Cuello:Escleras ict=C3=A9ricas, piel ict=C3=A9rica, conjuntivas ict=C3=A9ricas, p==C3=A1lidas. No palpo masas ni adenopat=C3=ADas,yugulares planas a 30=C2=B0T=C3=B3rax: Conformaci=C3=B3n normal. Cardiaco: Ritmo regular en 2 tiempos sin soplosPulmonar: Murmullo pulmonar presente sin ruidos agregadosAbdominal: Abdomen globuloso, ruidos hidroa=C3=A9reos levemente aumentados, blando, depresible, sensible difuso m=C3=A1s periumbilical, con cicatriz media supraumbilcal y laterales. Circulaci=C3=B3n colateral++ , No palpo masas. Reborde hep=C3=A1tico palpable romo. Escasos signos de ascitis. (No hay matidez desplazable, sonoridad casi normal)EEII: Edema - pulsos presentes sim=C3=A9tricos disminuidos, sin signos de TVP.No se encuentran evidencias de escaras ni a nivel sacro ni en otras prominencias =C3=B3seas</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1690694733">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Diagn=C3=B3stico<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-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%">
Leiomiosarcoma vena cava inferior infiltrante</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-item-required m_-4785875261268570816ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1255665248">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Plan de Tratamiento e Indicaciones<label for=3D"m_-4785875261268570816itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4785875261268570816ss-required-asterisk" style=3D"color:#c43b1d">
*</span>
</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-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%">
Evaluaci=C3=B3n m=C3=A9dica 1 vez por semanaEvaluaci=C3=B3n por enfermer=C3=ADa 1 vez por semanaEvaluaci=C3=B3n kin=C3=A9sica motora 1 vez por semanaEvaluaci=C3=B3n nutricional 1 vez por semanaEvaluaci=C3=B3n psicol=C3=B3gica 1 vez por semanaAumentar ingesta h=C3=ADdrica a 1,5 lts por d=C3=ADaAumentar Actividad f=C3=ADsica</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1648939075">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Medicamentos Indicados</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-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%">
Morfina 10mg/ml 1=E2=81=842 ampolla SOSTranstec 35mcg 1 =C2=BD parche por 72 hrs.Espironolactina 25mg 1/2  por diaFurosemida 20mg 1=E2=81=842 por d=C3=ADaZoltium 20mg por d=C3=ADaMulcatel 10cc al almuerzo, 10cc a la cenaQuetiapina 100mg por nocheBurten 10mg sublingual SOSRevil 5 cc despu=C3=A9s del desayunoClonazepam 0,5 mg =C2=BD por noche=20Control en servicio de urgencias SOS</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-date" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_2063615873">
<div class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-q-date">
<div class=3D"m_-4785875261268570816ss-datetime-box m_-4785875261268570816goog-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_-4785875261268570816ss-month-dropdown" id=3D"m_-4785875261268570816entry.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">
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_-4785875261268570816ss-day-dropdown" id=3D"m_-4785875261268570816entry.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">
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_-4785875261268570816entry.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_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_74766472">
<div class=3D"m_-4785875261268570816ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tratamiento Realizado (si corresponde)</div>
<div class=3D"m_-4785875261268570816ss-q-help m_-4785875261268570816ss-secondary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#666">
</div>
</label>
<div class=3D"m_-4785875261268570816ss-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%">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816ss-form-question m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-checkbox" style=3D"margin:12px 0">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4785875261268570816ss-q-item-label" for=3D"m_-4785875261268570816entry_1219705969">
<div class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-q-help m_-4785875261268570816ss-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_-4785875261268570816ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0">
<li class=3D"m_-4785875261268570816ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4785875261268570816ss-choice-item-control m_-4785875261268570816goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"ENFERMERA" id=3D"m_-4785875261268570816group_503039759_1" class=3D"m_-4785875261268570816ss-q-checkbox">
</span>
<span class=3D"m_-4785875261268570816ss-choice-label">
ENFERMERA</span>
</label>
</li>
 <li class=3D"m_-4785875261268570816ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4785875261268570816ss-choice-item-control m_-4785875261268570816goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled value=3D"TENS" id=3D"m_-4785875261268570816group_503039759_2" class=3D"m_-4785875261268570816ss-q-checkbox">
</span>
<span class=3D"m_-4785875261268570816ss-choice-label">
TENS</span>
</label>
</li>
 <li class=3D"m_-4785875261268570816ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4785875261268570816ss-choice-item-control m_-4785875261268570816goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"NUTRICIONISTA" id=3D"m_-4785875261268570816group_503039759_3" class=3D"m_-4785875261268570816ss-q-checkbox">
</span>
<span class=3D"m_-4785875261268570816ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
 <li class=3D"m_-4785875261268570816ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4785875261268570816ss-choice-item-control m_-4785875261268570816goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"KINESIOLOGO" id=3D"m_-4785875261268570816group_503039759_4" class=3D"m_-4785875261268570816ss-q-checkbox">
</span>
<span class=3D"m_-4785875261268570816ss-choice-label">
KINESIOLOGO</span>
</label>
</li>
 <li class=3D"m_-4785875261268570816ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4785875261268570816ss-choice-item-control m_-4785875261268570816goog-inline-block" style=3D"display:inline-block">
<input type=3D"checkbox" name=3D"entry.503039759" disabled checked value=3D"PSICOLOGO" id=3D"m_-4785875261268570816group_503039759_5" class=3D"m_-4785875261268570816ss-q-checkbox">
</span>
<span class=3D"m_-4785875261268570816ss-choice-label">
PSICOLOGO</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4785875261268570816errorbox-good">
<div dir=3D"auto" class=3D"m_-4785875261268570816ss-item m_-4785875261268570816ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<div class=3D"m_-4785875261268570816ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4785875261268570816ss-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_-4785875261268570816ss-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>
<br clear=3D"all">
<div>
<br>
</div>
-- <br>
<div dir=3D"ltr" class=3D"gmail_signature" data-smartmail=3D"gmail_signature">
<div dir=3D"ltr">
<i>
<font face=3D"garamond, serif" size=3D"4" style=3D"background-color:rgb(255,255,153)" color=3D"#ff99ff">
Dra. Kattia Albarr=C3=A1n Cid<span>
</span>
<span>
</span>
</font>
</i>
<div>
<i>
<font face=3D"garamond, serif" size=3D"4" style=3D"background-color:rgb(255,255,153)" color=3D"#ff99ff">
=C2=A0 =C2=A0 =C2=A0M=C3=A9dico-Cirujano =C2=A0 =C2=A0 =C2=A0 =C2=A0</font>
</i>
</div>
</div>
</div>
</div>
--000000000000810f90058c67f282----000000000000810f93058c67f284Content-Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document; 	name="Irene Soto Mancilla 27.06.2019.docx"Content-Disposition: attachment; 	filename="Irene Soto Mancilla 27.06.2019.docx"Content-Transfer-Encoding: base64Content-ID: <f_jxgjd9d90>
X-Attachment-Id: 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