<html>
<head>
<meta http-equiv=3D"content-type" content=3D"text/html; charset=3D=utf-8">
</head>
<body dir=3D"auto">
Estimado informenes se deben subir hasta 24= hrs despu=C3=A9s de la atenci=C3=B3n.<div>
Porfavor cumplir con fechas estab=lecidas.<br>
<br>
<div id=3D"AppleMailSignature" dir=3D"ltr">
EU Sandra Maulen A=ngel<div>
Coordinadora</div>
<div>
Telemed-Chile</div>
</div>
<div dir=3D"ltr">
<b=r>
El 01-07-2019, a la(s) 16:39, Camilo Villanueva &lt;<a href=3D"mailto:cami=lo.villanuevacarrasco@gmail.com">
camilo.villanuevacarrasco@gmail.com</a>
&gt;= escribi=C3=B3:<br>
<br>
</div>
<blockquote type=3D"cite">
<div dir=3D"ltr">
<div= dir=3D"ltr">
Estimada:<div>
Env=C3=ADo informe de paciente Marta Lopez, Chimb=arongo, hecho el&nbsp; 12/06/19.</div>
<div>
<br>
</div>
<div>
Saludos</div>
<br>
<=div class=3D"gmail_quote">
<div dir=3D"ltr" class=3D"gmail_attr">
---------- Fo=rwarded message ---------<br>
De: <strong class=3D"gmail_sendername" dir=3D"a=uto">
Formularios de Google</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: mi=C3=A9., 12 jun. 2019 a las 18:17<br>
Subject: Registro d=e Atenci=C3=B3n Domiciliaria Oncovida<br>
To:  &lt;<a href=3D"mailto:camilo.v=illanuevacarrasco@gmail.com">
camilo.villanuevacarrasco@gmail.com</a>
&gt;<br>
=</div>
<br>
<br>
<div style=3D"font-family:Roboto,Helvetica,Arial,sans-serif;ma=rgin: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"Form=ularios de Google" height=3D"26px" style=3D"display:inline-block;margin:0;ve=rtical-align:middle" width=3D"143px" src=3D"https://www.gstatic.com/docs/for=ms/google_forms_logo_lockup_white_2x.png">
</td>
</tr>
</tbody>
</table>
<div sty=le=3D"padding:24px;background-color:rgb(229,218,254)">
<div align=3D"center" s=tyle=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" cell=padding=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">
Gracias por rellenar <a= href=3D"https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg=1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" target=3D"_blank">
Reg=istro 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:#424=242">
Esto es lo que nos has enviado:</div>
</td>
</tr>
<tr>
<td>
<div class=3D"m_=-4984042604611926884ss-form-container">
<div class=3D"m_-4984042604611926884s=s-form-heading">
<h1 class=3D"m_-4984042604611926884ss-form-title" dir=3D"ltr=" style=3D"margin:.67em 0">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</=h1>
<div class=3D"m_-4984042604611926884ss-form-desc m_-4984042604611926884ss-no=-ignore-whitespace" style=3D"font:inherit;width:99%;margin:0 0 1em;white-spa=ce:pre-wrap;word-wrap:break-word">
Este es el sistema de registro de atencion=es domiciliarias de Oncovida.   Debe ser llenado por el prestador individual=, y debe realizarse un registro por cada visita domiciliaria.   Si usted no e=s 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_-4984042604611926884ss-form">
<form method=3D"GET" id=3D"m_-4=984042604611926884ss-form" target=3D"_blank">
<br>
<div class=3D"m_-4984042604611926884ss-form-question m_-4984042604611926884e=rrorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-text" style=3D"margin:12px 0">
<=div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5=em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label c=lass=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-4984042604611926884=emailAddress">
<div class=3D"m_-4984042604611926884ss-q-title" style=3D"displ=ay:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Direcci=C3=B3=n de correo electr=C3=B3nico<label for=3D"m_-4984042604611926884emailAddress">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text m_-4984042604611926884ss-print=able-text-line" dir=3D"auto" style=3D"background-color:#eee;max-width:90%;bo=rder:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:=70%">
<a href=3D"mailto:camilo.villanuevacarrasco@gmail.com" target=3D"_blank=">
camilo.villanuevacarrasco@gmail.com</a>
</div>
</div>
</div>
</div>
<div class=3D"m_-4984042604611926884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<d=iv class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5e=m;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4984042604611926884ss-q-title" style=3D"display:block;font-w=eight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-4984042604611926884ss-image=" title=3D"" src=3D"https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8Y=pwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" style=3D"width:78px;ou=tline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-49840426046119268=84ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-l=eft:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4984042604611926884ss-page-title" style=3D"padding:0.4em;bac=kground-color:#eee">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"m_-4984042604611926884ss-page-description m_-49840426046119268=84ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-w=rap:break-word">
Aqu=C3=AD debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-text" style=3D"margin:12px 0">
<=div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5=em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_579114469">
<div class=3D"m_-4984042604611926884ss-q-title" sty=le=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
P=rimer Nombre y Apellido Paterno<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
camilo villanueva</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-text" style=3D"margin:12px 0">
<=div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5=em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1276273985">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=RUT<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-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_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
18721814-4</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-select" style=3D"margin:12px 0"=>
<div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1=.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_133691676">
<div class=3D"m_-4984042604611926884ss-q-title" sty=le=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
T=ipo<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-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 h=acer un registro independiente</div>
</label>
<select name=3D"entry.133691676" disabled=3D"" id=3D"m_-4984042604611926884e=ntry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled=3D"">
MEDICO</option>
 <option value=3D"ENFE=RMERA/O" disabled=3D"">
ENFERMERA/O</option>
 <option value=3D"TENS" disabled=3D="">
TENS</option>
 <option value=3D"KINESIOLOGA/O" disabled=3D"" selected=3D""=>
KINESIOLOGA/O</option>
 <option value=3D"PSICOLOGO" disabled=3D"">
PSICOLOGO<=/option>
 <option value=3D"NUTRICIONISTA" disabled=3D"">
NUTRICIONISTA</option=>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<d=iv class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5e=m;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4984042604611926884ss-q-title" style=3D"display:block;font-w=eight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-4984042604611926884ss-image=" title=3D"" src=3D"https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B5=7PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" style=3D"width:78px;ou=tline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-49840426046119268=84ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-l=eft:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4984042604611926884ss-page-title" style=3D"padding:0.4em;bac=kground-color:#eee">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"m_-4984042604611926884ss-page-description m_-49840426046119268=84ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-w=rap:break-word">
En esta secci=C3=B3n debe ingresar los datos del paciente vi=sitado</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-section-header" style=3D"margin:12px 0">
<div class=3D"m_-4984042604611=926884ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;marg=in-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4984042604611926884ss-section-title" style=3D"background-col=or:#eee;padding:0.4em">
Datos Personales del Paciente</h2>
<div class=3D"m_-4984042604611926884ss-section-description m_-49840426046119=26884ss-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_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-text" style=3D"margin:12px 0">
<=div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5=em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_823811303">
<div class=3D"m_-4984042604611926884ss-q-title" sty=le=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
I=ngrese el Rut del Paciente<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-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_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
8647701-7</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-text" style=3D"margin:12px 0">
<=div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5=em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1959365839">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=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_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
Marta Lopez</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-select" style=3D"margin:12px 0"=>
<div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1=.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_545002227">
<div class=3D"m_-4984042604611926884ss-q-title" sty=le=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
P=revisi=C3=B3n<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<select name=3D"entry.545002227" disabled=3D"" id=3D"m_-4984042604611926884e=ntry_545002227">
<option value=3D"">
</option>
<option value=3D"BANMEDICA" disabled=3D"">
BANMEDICA</option>
 <option value=3D="CAPREDENA" disabled=3D"">
CAPREDENA</option>
 <option value=3D"COLMENA" disab=led=3D"">
COLMENA</option>
 <option value=3D"CONSALUD" disabled=3D"">
CONSALUD<=/option>
 <option value=3D"CRUZ BLANCA" disabled=3D"">
CRUZ BLANCA</option>
 <o=ption value=3D"DIPRECA" disabled=3D"">
DIPRECA</option>
 <option value=3D"FONA=SA" disabled=3D"">
FONASA</option>
 <option value=3D"FUNDACION" disabled=3D"">
=FUNDACION</option>
 <option value=3D"ISAPRES DEL COBRE" disabled=3D"" selecte=d=3D"">
ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled=3D="">
NUEVA MASVIDA</option>
 <option value=3D"VIDATRES" disabled=3D"">
VIDATRES<=/option>
 <option value=3D"PARTICULAR" disabled=3D"">
PARTICULAR</option>
</sel=ect>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-text" style=3D"margin:12px 0">
<=div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5=em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1900161356">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Ciudad<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
chimbarongo</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-text" style=3D"margin:12px 0">
<=div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5=em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1298871758">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Comuna<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
chimbarongo</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<d=iv class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5e=m;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4984042604611926884ss-q-title" style=3D"display:block;font-w=eight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-4984042604611926884ss-image=" title=3D"" src=3D"https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrB=Ww-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" style=3D"width:78px;ou=tline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-page-break" style=3D"margin:12px 0">
<div class=3D"m_-49840426046119268=84ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-l=eft:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4984042604611926884ss-page-title" style=3D"padding:0.4em;bac=kground-color:#eee">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"m_-4984042604611926884ss-page-description m_-49840426046119268=84ss-no-ignore-whitespace" dir=3D"auto" style=3D"white-space:pre-wrap;word-w=rap: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_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-radio" style=3D"margin:12px 0">
=<div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.=5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_2073233714">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Tipo de Atenci=C3=B3n<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<ul class=3D"m_-4984042604611926884ss-choices" style=3D"list-style:none;padd=ing:0;margin:.5em 0 0">
<li class=3D"m_-4984042604611926884ss-choice-item" st=yle=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4984042604611926884ss-choice-item-control m_-498404=2604611926884goog-inline-block" style=3D"display:inline-block">
<input type=3D="radio" name=3D"entry.1222378237" disabled=3D"" checked=3D"" value=3D"Domici=lio" id=3D"m_-4984042604611926884group_1222378237_1" class=3D"m_-49840426046=11926884ss-q-radio">
</span>
<span class=3D"m_-4984042604611926884ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"m_-4984042604611926884ss-choice-item" style=3D"ma=rgin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4984042604611926884ss-choice-item-control m_-498404=2604611926884goog-inline-block" style=3D"display:inline-block">
<input type=3D="radio" name=3D"entry.1222378237" disabled=3D"" value=3D"Ambulatorio" id=3D"=m_-4984042604611926884group_1222378237_2" class=3D"m_-4984042604611926884ss-=q-radio">
</span>
<span class=3D"m_-4984042604611926884ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-date" style=3D"margin:12px 0">
<=div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5=em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1705849412">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Fecha de la Atenci=C3=B3n<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-date">
<div class=3D"m_-498404260461=1926884ss-datetime-box m_-4984042604611926884goog-inline-block" style=3D"bor=der:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vert=ical-align:middle;margin:4px 3px;display:inline-block">
 <select name=3D"entr=y.1705849412_day" disabled=3D"" class=3D"m_-4984042604611926884ss-day-dropdo=wn" id=3D"m_-4984042604611926884entry.1705849412_day">
<option value=3D"">
D=C3==ADa</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</op=tion>
 <option value=3D"11">
11</option>
 <option value=3D"12" selected=3D"">
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 val=ue=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 v=alue=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</opti=on>
 <option value=3D"29">
29</option>
 <option value=3D"30">
30</option>
 <optio=n value=3D"31">
31</option>
</select>
   <select name=3D"entry.1705849412_month=" disabled=3D"" class=3D"m_-4984042604611926884ss-month-dropdown" id=3D"m_-4=984042604611926884entry.1705849412_month">
<option value=3D"">
Mes</option>
<option value=3D"1">
enero</option>
 <option value=3D"2">
febrero</option>
 <opt=ion value=3D"3">
marzo</option>
 <option value=3D"4">
abril</option>
 <option va=lue=3D"5">
mayo</option>
 <option value=3D"6" selected=3D"">
junio</option>
 <op=tion value=3D"7">
julio</option>
 <option value=3D"8">
agosto</option>
 <option v=alue=3D"9">
septiembre</option>
 <option value=3D"10">
octubre</option>
 <option= value=3D"11">
noviembre</option>
 <option value=3D"12">
diciembre</option>
</se=lect>
=20<select name=3D"entry.1705849412_year" disabled=3D"" id=3D"m_-49840426046119=26884entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
 <option value=3D"1897">
1897</option>
 <o=ption value=3D"1898">
1898</option>
 <option value=3D"1899">
1899</option>
 <opt=ion value=3D"1900">
1900</option>
 <option value=3D"1901">
1901</option>
 <optio=n value=3D"1902">
1902</option>
 <option value=3D"1903">
1903</option>
 <option v=alue=3D"1904">
1904</option>
 <option value=3D"1905">
1905</option>
 <option val=ue=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"1=912">
1912</option>
 <option value=3D"1913">
1913</option>
 <option value=3D"191=4">
1914</option>
 <option value=3D"1915">
1915</option>
 <option value=3D"1916"=>
1916</option>
 <option value=3D"1917">
1917</option>
 <option value=3D"1918">
1=918</option>
 <option value=3D"1919">
1919</option>
 <option value=3D"1920">
192=0</option>
 <option value=3D"1921">
1921</option>
 <option value=3D"1922">
1922<=/option>
 <option value=3D"1923">
1923</option>
 <option value=3D"1924">
1924</o=ption>
 <option value=3D"1925">
1925</option>
 <option value=3D"1926">
1926</opt=ion>
 <option value=3D"1927">
1927</option>
 <option value=3D"1928">
1928</optio=n>
 <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>
 <op=tion value=3D"1935">
1935</option>
 <option value=3D"1936">
1936</option>
 <opti=on value=3D"1937">
1937</option>
 <option value=3D"1938">
1938</option>
 <option= value=3D"1939">
1939</option>
 <option value=3D"1940">
1940</option>
 <option v=alue=3D"1941">
1941</option>
 <option value=3D"1942">
1942</option>
 <option val=ue=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"1=949">
1949</option>
 <option value=3D"1950">
1950</option>
 <option value=3D"195=1">
1951</option>
 <option value=3D"1952">
1952</option>
 <option value=3D"1953"=>
1953</option>
 <option value=3D"1954">
1954</option>
 <option value=3D"1955">
1=955</option>
 <option value=3D"1956">
1956</option>
 <option value=3D"1957">
195=7</option>
 <option value=3D"1958">
1958</option>
 <option value=3D"1959">
1959<=/option>
 <option value=3D"1960">
1960</option>
 <option value=3D"1961">
1961</o=ption>
 <option value=3D"1962">
1962</option>
 <option value=3D"1963">
1963</opt=ion>
 <option value=3D"1964">
1964</option>
 <option value=3D"1965">
1965</optio=n>
 <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>
 <op=tion value=3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
 <opti=on value=3D"1974">
1974</option>
 <option value=3D"1975">
1975</option>
 <option= value=3D"1976">
1976</option>
 <option value=3D"1977">
1977</option>
 <option v=alue=3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option val=ue=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"1=986">
1986</option>
 <option value=3D"1987">
1987</option>
 <option value=3D"198=8">
1988</option>
 <option value=3D"1989">
1989</option>
 <option value=3D"1990"=>
1990</option>
 <option value=3D"1991">
1991</option>
 <option value=3D"1992">
1=992</option>
 <option value=3D"1993">
1993</option>
 <option value=3D"1994">
199=4</option>
 <option value=3D"1995">
1995</option>
 <option value=3D"1996">
1996<=/option>
 <option value=3D"1997">
1997</option>
 <option value=3D"1998">
1998</o=ption>
 <option value=3D"1999">
1999</option>
 <option value=3D"2000">
2000</opt=ion>
 <option value=3D"2001">
2001</option>
 <option value=3D"2002">
2002</optio=n>
 <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>
 <op=tion value=3D"2009">
2009</option>
 <option value=3D"2010">
2010</option>
 <opti=on value=3D"2011">
2011</option>
 <option value=3D"2012">
2012</option>
 <option= value=3D"2013">
2013</option>
 <option value=3D"2014">
2014</option>
 <option v=alue=3D"2015">
2015</option>
 <option value=3D"2016">
2016</option>
 <option val=ue=3D"2017">
2017</option>
 <option value=3D"2018">
2018</option>
 <option value==3D"2019" selected=3D"">
2019</option>
 <option value=3D"2020">
2020</option>
 <=option value=3D"2021">
2021</option>
 <option value=3D"2022">
2022</option>
 <op=tion value=3D"2023">
2023</option>
 <option value=3D"2024">
2024</option>
 <opti=on value=3D"2025">
2025</option>
 <option value=3D"2026">
2026</option>
 <option= value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
 <option v=alue=3D"2029">
2029</option>
 <option value=3D"2030">
2030</option>
 <option val=ue=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"2=037">
2037</option>
 <option value=3D"2038">
2038</option>
 <option value=3D"203=9">
2039</option>
 <option value=3D"2040">
2040</option>
 <option value=3D"2041"=>
2041</option>
 <option value=3D"2042">
2042</option>
 <option value=3D"2043">
2=043</option>
 <option value=3D"2044">
2044</option>
 <option value=3D"2045">
204=5</option>
 <option value=3D"2046">
2046</option>
 <option value=3D"2047">
2047<=/option>
 <option value=3D"2048">
2048</option>
 <option value=3D"2049">
2049</o=ption>
 <option value=3D"2050">
2050</option>
 <option value=3D"2051">
2051</opt=ion>
 <option value=3D"2052">
2052</option>
 <option value=3D"2053">
2053</optio=n>
 <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>
 <op=tion value=3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <opti=on value=3D"2062">
2062</option>
 <option value=3D"2063">
2063</option>
 <option= value=3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option v=alue=3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option val=ue=3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-time" style=3D"margin:12px 0;fo=nt:inherit">
<div class=3D"m_-4984042604611926884ss-form-entry" style=3D"marg=in-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:1=00%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_206244955">
<div class=3D"m_-4984042604611926884ss-q-title" sty=le=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
H=ora de la Atenci=C3=B3n<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-time">
<div class=3D"m_-498404260461=1926884ss-datetime-box m_-4984042604611926884goog-inline-block" dir=3D"ltr" s=tyle=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-le=ft:3px;vertical-align:middle;margin:4px 3px;display:inline-block">
<select na=me=3D"entry.206244955_hour" disabled=3D"" id=3D"m_-4984042604611926884entry.=206244955_hour">
<option value=3D"">
h</option>
<option value=3D"00">
00</option>
 <option value=3D"01">
01</option>
 <option va=lue=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</optio=n>
 <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</op=tion>
 <option value=3D"14">
14</option>
 <option value=3D"15">
15</option>
 <opt=ion value=3D"16">
16</option>
 <option value=3D"17">
17</option>
 <option value=3D="18" selected=3D"">
18</option>
 <option value=3D"19">
19</option>
 <option valu=e=3D"20">
20</option>
 <option value=3D"21">
21</option>
 <option value=3D"22">
2=2</option>
 <option value=3D"23">
23</option>
</select>
:<select name=3D"entry.206244955_minute" disabled=3D"" id=3D"m_-4984042604611=926884entry.206244955_minute">
<option value=3D"">
min</option>
<option value=3D"00">
00</option>
 <option value=3D"01">
01</option>
 <option va=lue=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</optio=n>
 <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</op=tion>
 <option value=3D"14">
14</option>
 <option value=3D"15">
15</option>
 <opt=ion 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</o=ption>
 <option value=3D"21">
21</option>
 <option value=3D"22">
22</option>
 <op=tion 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=3D"">
30</option>
 <option value=3D"31">
31</optio=n>
 <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</op=tion>
 <option value=3D"39">
39</option>
 <option value=3D"40">
40</option>
 <opt=ion 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</o=ption>
 <option value=3D"46">
46</option>
 <option value=3D"47">
47</option>
 <op=tion 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 val=ue=3D"57">
57</option>
 <option value=3D"58">
58</option>
 <option value=3D"59">
=59</option>
</select>
<div class=3D"m_-4984042604611926884ss-datetime-box-spacer m_-49840426046119=26884goog-inline-block" style=3D"height:32px;vertical-align:middle;display:i=nline-block">
</div>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-select" style=3D"margin:12px 0"=>
<div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1=.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1747608258">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Performance Status ECOG del Paciente<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<select name=3D"entry.1747608258" disabled=3D"" id=3D"m_-4984042604611926884=entry_1747608258">
<option value=3D"">
</option>
<option value=3D"0" disabled=3D"" selected=3D"">
0</option>
 <option value=3D"=1" disabled=3D"">
1</option>
 <option value=3D"2" disabled=3D"">
2</option>
 <op=tion value=3D"3" disabled=3D"">
3</option>
 <option value=3D"4" disabled=3D"">
=4</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-498404=2604611926884ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:midd=le;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1716090865">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Escala Dolor EVA Actual</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-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_-49840426046=11926884entry_1421689035">
<tbody>
<tr>
<td class=3D"m_-4984042604611926884ss-s=calenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:cent=er">
<label class=3D"m_-4984042604611926884ss-scalenumber" for=3D"m_-49840426=04611926884group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em">
=0</label>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"=text-align:center">
<label class=3D"m_-4984042604611926884ss-scalenumber" for==3D"m_-4984042604611926884group_1421689035_2" style=3D"display:block;padding=:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenum=bers" style=3D"text-align:center">
<label class=3D"m_-4984042604611926884ss-s=calenumber" for=3D"m_-4984042604611926884group_1421689035_3" style=3D"displa=y:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-498404260461192=6884ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-49840426=04611926884ss-scalenumber" for=3D"m_-4984042604611926884group_1421689035_4" s=tyle=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-4=984042604611926884ss-scalenumbers" style=3D"text-align:center">
<label class=3D="m_-4984042604611926884ss-scalenumber" for=3D"m_-4984042604611926884group_14=21689035_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td c=lass=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:center">
<=label class=3D"m_-4984042604611926884ss-scalenumber" for=3D"m_-4984042604611=926884group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em">
5</la=bel>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-=align:center">
<label class=3D"m_-4984042604611926884ss-scalenumber" for=3D"m=_-4984042604611926884group_1421689035_7" style=3D"display:block;padding:0.5e=m 0 .5em">
6</label>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenumbers"= style=3D"text-align:center">
<label class=3D"m_-4984042604611926884ss-scalen=umber" for=3D"m_-4984042604611926884group_1421689035_8" style=3D"display:blo=ck;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-4984042604611926884s=s-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4984042604611=926884ss-scalenumber" for=3D"m_-4984042604611926884group_1421689035_9" style==3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-49840=42604611926884ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m=_-4984042604611926884ss-scalenumber" for=3D"m_-4984042604611926884group_1421=689035_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td c=lass=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:center">
<=label class=3D"m_-4984042604611926884ss-scalenumber" for=3D"m_-4984042604611=926884group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em">
10</=label>
</td>
<td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:cent=er">
</td>
</tr>
<tr>
<td class=3D"m_-4984042604611926884ss-scalerow m_-4984042604611926884ss-=leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;bor=der-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class=3D"m=_-4984042604611926884aria-todo">
</div>
</td>
<td class=3D"m_-4984042604611926884ss-scalerow" style=3D"text-align:center;c=olor:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em= .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input ty=pe=3D"radio" name=3D"entry.1421689035" disabled=3D"" checked=3D"" value=3D"0=" id=3D"m_-4984042604611926884group_1421689035_1" class=3D"m_-49840426046119=26884ss-q-radio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-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_-4984042604611926884ss-=scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled==3D"" value=3D"1" id=3D"m_-4984042604611926884group_1421689035_2" class=3D"m=_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_-498404260461192=6884ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d=8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-498404=2604611926884ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421=689035" disabled=3D"" value=3D"2" id=3D"m_-4984042604611926884group_14216890=35_3" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_=-4984042604611926884ss-scalerow" style=3D"text-align:center;color:#666;borde=r:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div cl=ass=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input type=3D"radio" na=me=3D"entry.1421689035" disabled=3D"" value=3D"3" id=3D"m_-49840426046119268=84group_1421689035_4" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td>
= <td class=3D"m_-4984042604611926884ss-scalerow" style=3D"text-align:center;=color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5e=m .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input t=ype=3D"radio" name=3D"entry.1421689035" disabled=3D"" value=3D"4" id=3D"m_-4=984042604611926884group_1421689035_5" class=3D"m_-4984042604611926884ss-q-ra=dio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-scalerow" style=3D"te=xt-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-rig=ht:0;padding:.5em .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fie=ldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled=3D"" value=3D="5" id=3D"m_-4984042604611926884group_1421689035_6" class=3D"m_-498404260461=1926884ss-q-radio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-scalero=w" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-lef=t:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4984042604611926884s=s-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabl=ed=3D"" value=3D"6" id=3D"m_-4984042604611926884group_1421689035_7" class=3D="m_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_-4984042604611=926884ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d=3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4984=042604611926884ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.14=21689035" disabled=3D"" value=3D"7" id=3D"m_-4984042604611926884group_142168=9035_8" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"=m_-4984042604611926884ss-scalerow" style=3D"text-align:center;color:#666;bor=der:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div c=lass=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input type=3D"radio" n=ame=3D"entry.1421689035" disabled=3D"" value=3D"8" id=3D"m_-4984042604611926=884group_1421689035_9" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td=>
 <td class=3D"m_-4984042604611926884ss-scalerow" style=3D"text-align:center=;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5=em .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input t=ype=3D"radio" name=3D"entry.1421689035" disabled=3D"" value=3D"9" id=3D"m_-4=984042604611926884group_1421689035_10" class=3D"m_-4984042604611926884ss-q-r=adio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-scalerow" style=3D"t=ext-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-ri=ght:0;padding:.5em .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fi=eldcell">
<input type=3D"radio" name=3D"entry.1421689035" disabled=3D"" value==3D"10" id=3D"m_-4984042604611926884group_1421689035_11" class=3D"m_-4984042=604611926884ss-q-radio">
</div>
</td>
<td class=3D"m_-4984042604611926884ss-scalerow m_-4984042604611926884ss-righ=tlabel" 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_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-498404=2604611926884ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:midd=le;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_2064050596">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Escala Dolor EVA M=C3=A1ximo</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-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_-49840426046=11926884entry_1244707512">
<tbody>
<tr>
<td class=3D"m_-4984042604611926884ss-s=calenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:cent=er">
<label class=3D"m_-4984042604611926884ss-scalenumber" for=3D"m_-49840426=04611926884group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em">
=0</label>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"=text-align:center">
<label class=3D"m_-4984042604611926884ss-scalenumber" for==3D"m_-4984042604611926884group_1244707512_2" style=3D"display:block;padding=:0.5em 0 .5em">
1</label>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenum=bers" style=3D"text-align:center">
<label class=3D"m_-4984042604611926884ss-s=calenumber" for=3D"m_-4984042604611926884group_1244707512_3" style=3D"displa=y:block;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-498404260461192=6884ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-49840426=04611926884ss-scalenumber" for=3D"m_-4984042604611926884group_1244707512_4" s=tyle=3D"display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-4=984042604611926884ss-scalenumbers" style=3D"text-align:center">
<label class=3D="m_-4984042604611926884ss-scalenumber" for=3D"m_-4984042604611926884group_12=44707512_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td c=lass=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:center">
<=label class=3D"m_-4984042604611926884ss-scalenumber" for=3D"m_-4984042604611=926884group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em">
5</la=bel>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-=align:center">
<label class=3D"m_-4984042604611926884ss-scalenumber" for=3D"m=_-4984042604611926884group_1244707512_7" style=3D"display:block;padding:0.5e=m 0 .5em">
6</label>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenumbers"= style=3D"text-align:center">
<label class=3D"m_-4984042604611926884ss-scalen=umber" for=3D"m_-4984042604611926884group_1244707512_8" style=3D"display:blo=ck;padding:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-4984042604611926884s=s-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4984042604611=926884ss-scalenumber" for=3D"m_-4984042604611926884group_1244707512_9" style==3D"display:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-49840=42604611926884ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m=_-4984042604611926884ss-scalenumber" for=3D"m_-4984042604611926884group_1244=707512_10" style=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td c=lass=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:center">
<=label class=3D"m_-4984042604611926884ss-scalenumber" for=3D"m_-4984042604611=926884group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em">
10</=label>
</td>
<td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:cent=er">
</td>
</tr>
<tr>
<td class=3D"m_-4984042604611926884ss-scalerow m_-4984042604611926884ss-=leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;bor=der-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class=3D"m=_-4984042604611926884aria-todo">
</div>
</td>
<td class=3D"m_-4984042604611926884ss-scalerow" style=3D"text-align:center;c=olor:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em= .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input ty=pe=3D"radio" name=3D"entry.1244707512" disabled=3D"" checked=3D"" value=3D"0=" id=3D"m_-4984042604611926884group_1244707512_1" class=3D"m_-49840426046119=26884ss-q-radio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-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_-4984042604611926884ss-=scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled==3D"" value=3D"1" id=3D"m_-4984042604611926884group_1244707512_2" class=3D"m=_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_-498404260461192=6884ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d=8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-498404=2604611926884ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244=707512" disabled=3D"" value=3D"2" id=3D"m_-4984042604611926884group_12447075=12_3" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_=-4984042604611926884ss-scalerow" style=3D"text-align:center;color:#666;borde=r:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div cl=ass=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input type=3D"radio" na=me=3D"entry.1244707512" disabled=3D"" value=3D"3" id=3D"m_-49840426046119268=84group_1244707512_4" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td>
= <td class=3D"m_-4984042604611926884ss-scalerow" style=3D"text-align:center;=color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5e=m .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input t=ype=3D"radio" name=3D"entry.1244707512" disabled=3D"" value=3D"4" id=3D"m_-4=984042604611926884group_1244707512_5" class=3D"m_-4984042604611926884ss-q-ra=dio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-scalerow" style=3D"te=xt-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-rig=ht:0;padding:.5em .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fie=ldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled=3D"" value=3D="5" id=3D"m_-4984042604611926884group_1244707512_6" class=3D"m_-498404260461=1926884ss-q-radio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-scalero=w" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-lef=t:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4984042604611926884s=s-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabl=ed=3D"" value=3D"6" id=3D"m_-4984042604611926884group_1244707512_7" class=3D="m_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_-4984042604611=926884ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d=3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4984=042604611926884ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.12=44707512" disabled=3D"" value=3D"7" id=3D"m_-4984042604611926884group_124470=7512_8" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"=m_-4984042604611926884ss-scalerow" style=3D"text-align:center;color:#666;bor=der:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div c=lass=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input type=3D"radio" n=ame=3D"entry.1244707512" disabled=3D"" value=3D"8" id=3D"m_-4984042604611926=884group_1244707512_9" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td=>
 <td class=3D"m_-4984042604611926884ss-scalerow" style=3D"text-align:center=;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5=em .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input t=ype=3D"radio" name=3D"entry.1244707512" disabled=3D"" value=3D"9" id=3D"m_-4=984042604611926884group_1244707512_10" class=3D"m_-4984042604611926884ss-q-r=adio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-scalerow" style=3D"t=ext-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-ri=ght:0;padding:.5em .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fi=eldcell">
<input type=3D"radio" name=3D"entry.1244707512" disabled=3D"" value==3D"10" id=3D"m_-4984042604611926884group_1244707512_11" class=3D"m_-4984042=604611926884ss-q-radio">
</div>
</td>
<td class=3D"m_-4984042604611926884ss-scalerow m_-4984042604611926884ss-righ=tlabel" 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_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-scale" style=3D"margin:12px 0;overflow-x:auto">
<div class=3D"m_-498404=2604611926884ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:midd=le;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_2000523015">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Escala Dolor EVA M=C3=ADnimo</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-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_-49840426046=11926884entry_853118630">
<tbody>
<tr>
<td class=3D"m_-4984042604611926884ss-sc=alenumbers" style=3D"text-align:center">
</td>
<td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:cent=er">
<label class=3D"m_-4984042604611926884ss-scalenumber" for=3D"m_-49840426=04611926884group_853118630_1" style=3D"display:block;padding:0.5em 0 .5em">
0=</label>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"t=ext-align:center">
<label class=3D"m_-4984042604611926884ss-scalenumber" for=3D="m_-4984042604611926884group_853118630_2" style=3D"display:block;padding:0.5=em 0 .5em">
1</label>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenumbers=" style=3D"text-align:center">
<label class=3D"m_-4984042604611926884ss-scale=number" for=3D"m_-4984042604611926884group_853118630_3" style=3D"display:blo=ck;padding:0.5em 0 .5em">
2</label>
</td>
 <td class=3D"m_-4984042604611926884s=s-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4984042604611=926884ss-scalenumber" for=3D"m_-4984042604611926884group_853118630_4" style=3D="display:block;padding:0.5em 0 .5em">
3</label>
</td>
 <td class=3D"m_-49840426=04611926884ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-4=984042604611926884ss-scalenumber" for=3D"m_-4984042604611926884group_8531186=30_5" style=3D"display:block;padding:0.5em 0 .5em">
4</label>
</td>
 <td class=3D="m_-4984042604611926884ss-scalenumbers" style=3D"text-align:center">
<label c=lass=3D"m_-4984042604611926884ss-scalenumber" for=3D"m_-4984042604611926884g=roup_853118630_6" style=3D"display:block;padding:0.5em 0 .5em">
5</label>
</td=>
 <td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:ce=nter">
<label class=3D"m_-4984042604611926884ss-scalenumber" for=3D"m_-498404=2604611926884group_853118630_7" style=3D"display:block;padding:0.5em 0 .5em"=>
6</label>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D="text-align:center">
<label class=3D"m_-4984042604611926884ss-scalenumber" fo=r=3D"m_-4984042604611926884group_853118630_8" style=3D"display:block;padding=:0.5em 0 .5em">
7</label>
</td>
 <td class=3D"m_-4984042604611926884ss-scalenum=bers" style=3D"text-align:center">
<label class=3D"m_-4984042604611926884ss-s=calenumber" for=3D"m_-4984042604611926884group_853118630_9" style=3D"display=:block;padding:0.5em 0 .5em">
8</label>
</td>
 <td class=3D"m_-4984042604611926=884ss-scalenumbers" style=3D"text-align:center">
<label class=3D"m_-498404260=4611926884ss-scalenumber" for=3D"m_-4984042604611926884group_853118630_10" s=tyle=3D"display:block;padding:0.5em 0 .5em">
9</label>
</td>
 <td class=3D"m_-4=984042604611926884ss-scalenumbers" style=3D"text-align:center">
<label class=3D="m_-4984042604611926884ss-scalenumber" for=3D"m_-4984042604611926884group_85=3118630_11" style=3D"display:block;padding:0.5em 0 .5em">
10</label>
</td>
<td class=3D"m_-4984042604611926884ss-scalenumbers" style=3D"text-align:cent=er">
</td>
</tr>
<tr>
<td class=3D"m_-4984042604611926884ss-scalerow m_-4984042604611926884ss-=leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;bor=der-left:0;border-right:0;padding:.5em .25em;padding-left:0">
<div class=3D"m=_-4984042604611926884aria-todo">
</div>
</td>
<td class=3D"m_-4984042604611926884ss-scalerow" style=3D"text-align:center;c=olor:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em= .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input ty=pe=3D"radio" name=3D"entry.853118630" disabled=3D"" checked=3D"" value=3D"0"= id=3D"m_-4984042604611926884group_853118630_1" class=3D"m_-4984042604611926=884ss-q-radio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-scalerow" s=tyle=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;=border-right:0;padding:.5em .25em">
<div class=3D"m_-4984042604611926884ss-sc=alerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D="" value=3D"1" id=3D"m_-4984042604611926884group_853118630_2" class=3D"m_-49=84042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_-4984042604611926884=ss-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_-4984042604=611926884ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.85311863=0" disabled=3D"" value=3D"2" id=3D"m_-4984042604611926884group_853118630_3" c=lass=3D"m_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_-498404=2604611926884ss-scalerow" style=3D"text-align:center;color:#666;border:1px s=olid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"=m_-4984042604611926884ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"e=ntry.853118630" disabled=3D"" value=3D"3" id=3D"m_-4984042604611926884group_=853118630_4" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td>
 <td clas=s=3D"m_-4984042604611926884ss-scalerow" style=3D"text-align:center;color:#66=6;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
=<div class=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input type=3D"ra=dio" name=3D"entry.853118630" disabled=3D"" value=3D"4" id=3D"m_-49840426046=11926884group_853118630_5" class=3D"m_-4984042604611926884ss-q-radio">
</div>
=</td>
 <td class=3D"m_-4984042604611926884ss-scalerow" style=3D"text-align:ce=nter;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;paddin=g:.5em .25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<in=put type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"5" id=3D"=m_-4984042604611926884group_853118630_6" class=3D"m_-4984042604611926884ss-q=-radio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-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_-4984042604611926884ss-scalerow-=fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" valu=e=3D"6" id=3D"m_-4984042604611926884group_853118630_7" class=3D"m_-498404260=4611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_-4984042604611926884ss-scal=erow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-=left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-49840426046119268=84ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disa=bled=3D"" value=3D"7" id=3D"m_-4984042604611926884group_853118630_8" class=3D="m_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_-4984042604611=926884ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d=3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div class=3D"m_-4984=042604611926884ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.85=3118630" disabled=3D"" value=3D"8" id=3D"m_-4984042604611926884group_8531186=30_9" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td>
 <td class=3D"m_=-4984042604611926884ss-scalerow" style=3D"text-align:center;color:#666;borde=r:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em">
<div cl=ass=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input type=3D"radio" na=me=3D"entry.853118630" disabled=3D"" value=3D"9" id=3D"m_-498404260461192688=4group_853118630_10" class=3D"m_-4984042604611926884ss-q-radio">
</div>
</td>
 <=td class=3D"m_-4984042604611926884ss-scalerow" style=3D"text-align:center;co=lor:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .=25em">
<div class=3D"m_-4984042604611926884ss-scalerow-fieldcell">
<input type==3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"10" id=3D"m_-4984=042604611926884group_853118630_11" class=3D"m_-4984042604611926884ss-q-radio=">
</div>
</td>
<td class=3D"m_-4984042604611926884ss-scalerow m_-4984042604611926884ss-righ=tlabel" 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_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-paragraph-text" style=3D"margin=:12px 0">
<div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-=bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%=">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_2140974612">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Anamnesis/Evoluci=C3=B3n<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
paciente en BEG. Buen estado de animo, s=in dolor general. sin decaimiento</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-paragraph-text" style=3D"margin=:12px 0">
<div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-=bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%=">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_824006088">
<div class=3D"m_-4984042604611926884ss-q-title" sty=le=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
E=xamen F=C3=ADsico<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
no aplica</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-text" style=3D"margin:12px 0">
<=div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5=em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1690694733">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Diagn=C3=B3stico<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
Persona en situaci=C3=B3n de dependencia= funcional de car=C3=A1cter transitorio</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-item-required m_-4984042604611926884ss-paragraph-text" style=3D"margin=:12px 0">
<div class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-=bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%=">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1255665248">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Plan de Tratamiento e Indicaciones<label for=3D"m_-4984042604611926884itemView.getDomIdToLabel()">
</label>
<span class=3D"m_-4984042604611926884ss-required-asterisk" style=3D"color:#c=43b1d">
*</span>
</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
Prevenir p=C3=A9rdida de capacidad Respi=ratoria=EF=83=BC	 Prevenir atrofia muscular de Extremidades, principalmente d=e EEII=EF=83=BC	Evitar acortamientos musculares en extremidades=EF=83=BC	Mejorar patr=C3=B3n de activaci=C3=B3n muscular en EEII=EF=83=BC	Mejorar la capacidad  f=C3=ADsica y  autonom=C3=ADa del pac=iente</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-paragraph-text" style=3D"margin:12px 0">
<div class=3D"m_-4984042604611=926884ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;marg=in-left:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1648939075">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Medicamentos Indicados</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
no aplica</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-date" style=3D"margin:12px 0">
<div class=3D"m_-4984042604611926884ss-f=orm-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;=margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_2063615873">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=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_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-date">
<div class=3D"m_-498404260461=1926884ss-datetime-box m_-4984042604611926884goog-inline-block" style=3D"bor=der:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vert=ical-align:middle;margin:4px 3px;display:inline-block">
 <select name=3D"entr=y.2063615873_day" disabled=3D"" class=3D"m_-4984042604611926884ss-day-dropdo=wn" id=3D"m_-4984042604611926884entry.2063615873_day">
<option value=3D"">
D=C3==ADa</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</op=tion>
 <option value=3D"11">
11</option>
 <option value=3D"12">
12</option>
 <opt=ion value=3D"13">
13</option>
 <option value=3D"14" selected=3D"">
14</option>
 <=option value=3D"15">
15</option>
 <option value=3D"16">
16</option>
 <option val=ue=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 v=alue=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</opti=on>
 <option value=3D"29">
29</option>
 <option value=3D"30">
30</option>
 <optio=n value=3D"31">
31</option>
</select>
   <select name=3D"entry.2063615873_month=" disabled=3D"" class=3D"m_-4984042604611926884ss-month-dropdown" id=3D"m_-4=984042604611926884entry.2063615873_month">
<option value=3D"">
Mes</option>
<option value=3D"1">
enero</option>
 <option value=3D"2">
febrero</option>
 <opt=ion value=3D"3">
marzo</option>
 <option value=3D"4">
abril</option>
 <option va=lue=3D"5">
mayo</option>
 <option value=3D"6" selected=3D"">
junio</option>
 <op=tion value=3D"7">
julio</option>
 <option value=3D"8">
agosto</option>
 <option v=alue=3D"9">
septiembre</option>
 <option value=3D"10">
octubre</option>
 <option= value=3D"11">
noviembre</option>
 <option value=3D"12">
diciembre</option>
</se=lect>
=20<select name=3D"entry.2063615873_year" disabled=3D"" id=3D"m_-49840426046119=26884entry.2063615873_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
 <option value=3D"1897">
1897</option>
 <o=ption value=3D"1898">
1898</option>
 <option value=3D"1899">
1899</option>
 <opt=ion value=3D"1900">
1900</option>
 <option value=3D"1901">
1901</option>
 <optio=n value=3D"1902">
1902</option>
 <option value=3D"1903">
1903</option>
 <option v=alue=3D"1904">
1904</option>
 <option value=3D"1905">
1905</option>
 <option val=ue=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"1=912">
1912</option>
 <option value=3D"1913">
1913</option>
 <option value=3D"191=4">
1914</option>
 <option value=3D"1915">
1915</option>
 <option value=3D"1916"=>
1916</option>
 <option value=3D"1917">
1917</option>
 <option value=3D"1918">
1=918</option>
 <option value=3D"1919">
1919</option>
 <option value=3D"1920">
192=0</option>
 <option value=3D"1921">
1921</option>
 <option value=3D"1922">
1922<=/option>
 <option value=3D"1923">
1923</option>
 <option value=3D"1924">
1924</o=ption>
 <option value=3D"1925">
1925</option>
 <option value=3D"1926">
1926</opt=ion>
 <option value=3D"1927">
1927</option>
 <option value=3D"1928">
1928</optio=n>
 <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>
 <op=tion value=3D"1935">
1935</option>
 <option value=3D"1936">
1936</option>
 <opti=on value=3D"1937">
1937</option>
 <option value=3D"1938">
1938</option>
 <option= value=3D"1939">
1939</option>
 <option value=3D"1940">
1940</option>
 <option v=alue=3D"1941">
1941</option>
 <option value=3D"1942">
1942</option>
 <option val=ue=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"1=949">
1949</option>
 <option value=3D"1950">
1950</option>
 <option value=3D"195=1">
1951</option>
 <option value=3D"1952">
1952</option>
 <option value=3D"1953"=>
1953</option>
 <option value=3D"1954">
1954</option>
 <option value=3D"1955">
1=955</option>
 <option value=3D"1956">
1956</option>
 <option value=3D"1957">
195=7</option>
 <option value=3D"1958">
1958</option>
 <option value=3D"1959">
1959<=/option>
 <option value=3D"1960">
1960</option>
 <option value=3D"1961">
1961</o=ption>
 <option value=3D"1962">
1962</option>
 <option value=3D"1963">
1963</opt=ion>
 <option value=3D"1964">
1964</option>
 <option value=3D"1965">
1965</optio=n>
 <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>
 <op=tion value=3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
 <opti=on value=3D"1974">
1974</option>
 <option value=3D"1975">
1975</option>
 <option= value=3D"1976">
1976</option>
 <option value=3D"1977">
1977</option>
 <option v=alue=3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
 <option val=ue=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"1=986">
1986</option>
 <option value=3D"1987">
1987</option>
 <option value=3D"198=8">
1988</option>
 <option value=3D"1989">
1989</option>
 <option value=3D"1990"=>
1990</option>
 <option value=3D"1991">
1991</option>
 <option value=3D"1992">
1=992</option>
 <option value=3D"1993">
1993</option>
 <option value=3D"1994">
199=4</option>
 <option value=3D"1995">
1995</option>
 <option value=3D"1996">
1996<=/option>
 <option value=3D"1997">
1997</option>
 <option value=3D"1998">
1998</o=ption>
 <option value=3D"1999">
1999</option>
 <option value=3D"2000">
2000</opt=ion>
 <option value=3D"2001">
2001</option>
 <option value=3D"2002">
2002</optio=n>
 <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>
 <op=tion value=3D"2009">
2009</option>
 <option value=3D"2010">
2010</option>
 <opti=on value=3D"2011">
2011</option>
 <option value=3D"2012">
2012</option>
 <option= value=3D"2013">
2013</option>
 <option value=3D"2014">
2014</option>
 <option v=alue=3D"2015">
2015</option>
 <option value=3D"2016">
2016</option>
 <option val=ue=3D"2017">
2017</option>
 <option value=3D"2018">
2018</option>
 <option value==3D"2019" selected=3D"">
2019</option>
 <option value=3D"2020">
2020</option>
 <=option value=3D"2021">
2021</option>
 <option value=3D"2022">
2022</option>
 <op=tion value=3D"2023">
2023</option>
 <option value=3D"2024">
2024</option>
 <opti=on value=3D"2025">
2025</option>
 <option value=3D"2026">
2026</option>
 <option= value=3D"2027">
2027</option>
 <option value=3D"2028">
2028</option>
 <option v=alue=3D"2029">
2029</option>
 <option value=3D"2030">
2030</option>
 <option val=ue=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"2=037">
2037</option>
 <option value=3D"2038">
2038</option>
 <option value=3D"203=9">
2039</option>
 <option value=3D"2040">
2040</option>
 <option value=3D"2041"=>
2041</option>
 <option value=3D"2042">
2042</option>
 <option value=3D"2043">
2=043</option>
 <option value=3D"2044">
2044</option>
 <option value=3D"2045">
204=5</option>
 <option value=3D"2046">
2046</option>
 <option value=3D"2047">
2047<=/option>
 <option value=3D"2048">
2048</option>
 <option value=3D"2049">
2049</o=ption>
 <option value=3D"2050">
2050</option>
 <option value=3D"2051">
2051</opt=ion>
 <option value=3D"2052">
2052</option>
 <option value=3D"2053">
2053</optio=n>
 <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>
 <op=tion value=3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <opti=on value=3D"2062">
2062</option>
 <option value=3D"2063">
2063</option>
 <option= value=3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option v=alue=3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option val=ue=3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-text" style=3D"margin:12px 0">
<div class=3D"m_-4984042604611926884ss-f=orm-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;=margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_74766472">
<div class=3D"m_-4984042604611926884ss-q-title" styl=e=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
Tr=atamiento Realizado (si corresponde)</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-text" dir=3D"auto" style=3D"display:block;margin:.1em 0 .25em 0;color:#=666">
</div>
</label>
<div class=3D"m_-4984042604611926884ss-q-text" dir=3D"auto" style=3D"backgro=und-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-spac=e:pre-wrap;color:#545454;width:70%">
repetecion en tratamiento con variantes d=e ejercicios activos</div>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884ss-form-question m_-498404260461192=6884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-checkbox" style=3D"margin:12px 0">
<div class=3D"m_-4984042604611926884=ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-lef=t:0;margin-top:0;max-width:100%">
<label class=3D"m_-4984042604611926884ss-q-item-label" for=3D"m_-49840426046=11926884entry_1219705969">
<div class=3D"m_-4984042604611926884ss-q-title" st=yle=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em">
=Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"m_-4984042604611926884ss-q-help m_-4984042604611926884ss-secon=dary-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 visit=a de otro prestador del equipo</div>
</label>
<ul class=3D"m_-4984042604611926884ss-choices" style=3D"list-style:none;padd=ing:0;margin:.5em 0 0">
<li class=3D"m_-4984042604611926884ss-choice-item" st=yle=3D"margin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4984042604611926884ss-choice-item-control m_-498404=2604611926884goog-inline-block" style=3D"display:inline-block">
<input type=3D="checkbox" name=3D"entry.503039759" disabled=3D"" value=3D"ENFERMERA" id=3D"=m_-4984042604611926884group_503039759_1" class=3D"m_-4984042604611926884ss-q=-checkbox">
</span>
<span class=3D"m_-4984042604611926884ss-choice-label">
ENFERMERA</span>
</label>
</li>
 <li class=3D"m_-4984042604611926884ss-choice-item" style=3D"ma=rgin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4984042604611926884ss-choice-item-control m_-498404=2604611926884goog-inline-block" style=3D"display:inline-block">
<input type=3D="checkbox" name=3D"entry.503039759" disabled=3D"" value=3D"TENS" id=3D"m_-49=84042604611926884group_503039759_2" class=3D"m_-4984042604611926884ss-q-chec=kbox">
</span>
<span class=3D"m_-4984042604611926884ss-choice-label">
TENS</span>
</label>
</li>
 <li class=3D"m_-4984042604611926884ss-choice-item" style=3D"ma=rgin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4984042604611926884ss-choice-item-control m_-498404=2604611926884goog-inline-block" style=3D"display:inline-block">
<input type=3D="checkbox" name=3D"entry.503039759" disabled=3D"" value=3D"NUTRICIONISTA" id==3D"m_-4984042604611926884group_503039759_3" class=3D"m_-4984042604611926884=ss-q-checkbox">
</span>
<span class=3D"m_-4984042604611926884ss-choice-label">
NUTRICIONISTA</span>
</label>
</li>
 <li class=3D"m_-4984042604611926884ss-choice-item" style=3D"ma=rgin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4984042604611926884ss-choice-item-control m_-498404=2604611926884goog-inline-block" style=3D"display:inline-block">
<input type=3D="checkbox" name=3D"entry.503039759" disabled=3D"" value=3D"KINESIOLOGO" id=3D="m_-4984042604611926884group_503039759_4" class=3D"m_-4984042604611926884ss-=q-checkbox">
</span>
<span class=3D"m_-4984042604611926884ss-choice-label">
KINESIOLOGO</span>
</label>
</li>
 <li class=3D"m_-4984042604611926884ss-choice-item" style=3D"ma=rgin:0;line-height:1.3em;padding-bottom:.5em">
<label>
<span class=3D"m_-4984042604611926884ss-choice-item-control m_-498404=2604611926884goog-inline-block" style=3D"display:inline-block">
<input type=3D="checkbox" name=3D"entry.503039759" disabled=3D"" value=3D"PSICOLOGO" id=3D"=m_-4984042604611926884group_503039759_5" class=3D"m_-4984042604611926884ss-q=-checkbox">
</span>
<span class=3D"m_-4984042604611926884ss-choice-label">
PSICOLOGO</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"m_-4984042604611926884errorbox-good">
<div dir=3D"auto" class=3D"m_-4984042604611926884ss-item m_-4984042604611926=884ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%">
<d=iv class=3D"m_-4984042604611926884ss-form-entry" style=3D"margin-bottom:1.5e=m;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%">
<h2 class=3D"m_-4984042604611926884ss-q-title" style=3D"display:block;font-w=eight:bold;margin-top:.83em;margin-bottom:.83em">
</h2>
<div style=3D"text-align:right">
<img class=3D"m_-4984042604611926884ss-image=" title=3D"" src=3D"https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043h=rFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" style=3D"width:78px;ou=tline:none" alt=3D"Imagen sin leyenda">
</div>
</div>
</div>
</div>
<br>
</form>
</div>
</div>
</td>
</tr>
<tr height=3D"24px">
</tr>
</tbody>
</table>
</=div>
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"max=-width:672px;min-width:154px" width=3D"100%">
<tbody>
<tr height=3D"24px">
<td>
=</td>
</tr>
<tr>
<td>
<a href=3D"https://docs.google.com/forms?usp=3Dmail_form_l=ink" style=3D"color:#424242;font-size:13px" target=3D"_blank">
Crea tu propio= formulario de Google</a>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br cle=ar=3D"all">
<div>
<br>
</div>
-- <br>
<div dir=3D"ltr" class=3D"gmail_signature" d=ata-smartmail=3D"gmail_signature">
<div dir=3D"ltr">
<div>
<div dir=3D"ltr">
<di=v dir=3D"ltr">
<div dir=3D"ltr">
<div dir=3D"ltr">
<div dir=3D"ltr" style=3D"te=xt-align:center">
Camilo Villanueva Carrasco.</div>
<div style=3D"text-align:c=enter">
Kinesi=C3=B3logo Programa ERA</div>
<div style=3D"text-align:center">
<=span style=3D"font-size:12.8px">
Departamento de Salud Municipal</span>
</div>
=<div style=3D"text-align:center">
<span style=3D"font-size:12.8px">
Chimbarong=o.</span>
<br>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div id=3D="DAB4FAD8-2DD7-40BB-A1B8-4E2AA1F9FDF2">
<br>
 <table style=3D"border-top:1px s=olid #d3d4de">
	<tbody>
<tr>
      <td style=3D"width:55px;padding-top:18px">
<a href=3D"https://www.avast=.com/sig-email?utm_medium=3Demail&amp;utm_source=3Dlink&amp;utm_campaign=3Ds=ig-email&amp;utm_content=3Dwebmail" target=3D"_blank">
<img src=3D"https://ip=mcdn.avast.com/images/icons/icon-envelope-tick-round-orange-animated-no-repe=at-v1.gif" alt=3D"" width=3D"46" height=3D"29" style=3D"width: 46px; height:= 29px;">
</a>
</td>
		<td style=3D"width:470px;padding-top:17px;color:#41424e;fon=t-size:13px;font-family:Arial,Helvetica,sans-serif;line-height:18px">
Libre d=e virus. <a href=3D"https://www.avast.com/sig-email?utm_medium=3Demail&amp;u=tm_source=3Dlink&amp;utm_campaign=3Dsig-email&amp;utm_content=3Dwebmail" tar=get=3D"_blank" style=3D"color:#4453ea">
www.avast.com</a>
 		</t=d>
	</tr>
</tbody>
</table>
<a href=3D"#DAB4FAD8-2DD7-40BB-A1B8-4E2AA1F9FDF2" width=3D"1" height=3D"1">
<=/a>
</div>
</div>
</blockquote>
</div>
</body>
</html>
=--Apple-Mail-10320BC0-2244-4B90-ACD3-05504F1F23A9--