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<span style="font-size:11.0pt;font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;;color:#1F497D;mso-fareast-language:EN-US">
Estimadas(os) ,reenvío evolución medica realizada en domicilio a paciente de Linares ,Sra. Marcela Contreras.<o:p>
</o:p>
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<p class="MsoNormal">
<span style="font-size:11.0pt;font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;;color:#1F497D;mso-fareast-language:EN-US">
Muchas gracias.
<o:p>
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<p class="MsoNormal">
<b>
<span style="font-size:7.5pt;font-family:&quot;Verdana&quot;,&quot;sans-serif&quot;;color:#1F497D">
Mario Peña y Lillo Contreras</span>
</b>
<span style="font-size:7.5pt;font-family:&quot;Verdana&quot;,&quot;sans-serif&quot;;color:#1F497D">
<br>

Medico Director<br>

Gerencia de Salud<br>

Tel.: (73) 563825 <br>

Fax: (73) 563810<br>

e-mail: </span>
<u>
<span style="font-size:7.5pt;font-family:&quot;Verdana&quot;,&quot;sans-serif&quot;;color:blue">
mpenaylillo@mutual.cl</span>
</u>
<span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;;color:#1F497D">
<o:p>
</o:p>
</span>
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<span style="font-size:7.5pt;font-family:&quot;Verdana&quot;,&quot;sans-serif&quot;;color:#1F497D">
Freire n° 663- Linares Chile<br>

Mutual de Seguridad C. CH. C. Tel.: (2) 787 9000 - <a href="mailo:info@mutual.cl" title="mailo:info@mutual.cl">

info@mutual.cl</a>
 - <a href="http://www.mutual.cl/" title="http://www.mutual.cl/">

http://www.mutual.cl/</a>
</span>
<span style="font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;;color:#1F497D">
<o:p>
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&nbsp;</o:p>
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<p class="MsoNormal">
<span style="font-size:11.0pt;font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;;color:#1F497D;mso-fareast-language:EN-US">
<o:p>
&nbsp;</o:p>
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<div style="border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0cm 0cm 0cm">

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<b>
<span lang="ES" style="font-size:11.0pt;font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">
De:</span>
</b>
<span lang="ES" style="font-size:11.0pt;font-family:&quot;Calibri&quot;,&quot;sans-serif&quot;">
 Formularios de Google [mailto:forms-receipts-noreply@google.com]
<br>

<b>
Enviado el:</b>
 miércoles, 17 de julio de 2019 9:07<br>

<b>
Para:</b>
 Mario Peña Y Lillo C<br>

<b>
Asunto:</b>
 Registro de Atención Domiciliaria Oncovida<o:p>
</o:p>
</span>
</p>

</div>

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<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" width="100%" style="width:100.0%;background:#26049A">

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<img border="0" id="_x0000_i1025" src="https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png" alt="Formularios de Google">
<o:p>
</o:p>
</p>

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<span style="font-family:&quot;Helvetica&quot;,&quot;sans-serif&quot;;display:none">
<o:p>
&nbsp;</o:p>
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<b>
<span style="font-size:10.0pt;color:#424242">
Gracias por llenar
<a href="https://docs.google.com/forms/d/e/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=mail_form_link">

Registro de Atención Domiciliaria Oncovida</a>
<o:p>
</o:p>
</span>
</b>
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<span style="font-size:10.0pt;color:#424242">
Estas son tus respuestas:<o:p>
</o:p>
</span>
</p>

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</td>

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<tr>

<td style="padding:0cm 0cm 0cm 0cm">

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<h1 style="mso-margin-top-alt:8.05pt;margin-right:0cm;margin-bottom:8.05pt;margin-left:0cm">

Registro de Atención Domiciliaria Oncovida<o:p>
</o:p>
</h1>

<div style="margin-bottom:12.0pt;white-space:pre-wrap;word-wrap:break-word">

<p class="MsoNormal">
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 continuación indique su correo electrónico.<o:p>
</o:p>
</p>

</div>

</div>

<div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Dirección de correo electrónico
<span class="ss-required-asterisk">
<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

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<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
<a href="mailto:mpenaylillo@mutual.cl">
mpenaylillo@mutual.cl</a>
<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%">

<div style="margin-bottom:18.0pt;max-width:100%">

<p class="MsoNormal" align="right" style="text-align:right;vertical-align:middle">

<img border="0" id="_x0000_i1026" src="https://lh4.googleusercontent.com/7WxFGV5oEKKf6rzNb0Iw8YpwJxhebvN37sfEgvirGhVlOohE3P9pNEU3e4QpKhgH1mM-c1xwGQ" alt="Imagen sin título">
<o:p>
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<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
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<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<h2 style="mso-margin-top-alt:24.0pt;margin-right:-4.8pt;margin-bottom:0cm;margin-left:-4.8pt;margin-bottom:.0001pt;background:#EEEEEE;vertical-align:middle">

Identificación del Prestador<o:p>
</o:p>
</h2>

<div>

<p class="MsoNormal" style="vertical-align:middle">
Aquí debe ingresar sus datos personales<o:p>
</o:p>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Primer Nombre y Apellido Paterno
<span class="ss-required-asterisk">
<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
Mario Peña y Lillo<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
RUT <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="margin-top:1.2pt;margin-bottom:3.0pt">

<p class="MsoNormal" style="vertical-align:middle">
<span style="color:#666666">
RUT con Guión y Dígito Verificador, sin puntos ( Ej: 5632200-k)<o:p>
</o:p>
</span>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
7837871-9<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Tipo <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="margin-top:1.2pt;margin-bottom:3.0pt">

<p class="MsoNormal" style="vertical-align:middle">
<span style="color:#666666">
Si asisten más de 1 prestador simultáneamente, cada uno debe hacer un registro independiente<o:p>
</o:p>
</span>
</p>

</div>

<p class="MsoNormal" style="vertical-align:middle">
[MEDICO&nbsp;\/] <o:p>
</o:p>
</p>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%">

<div style="margin-bottom:18.0pt;max-width:100%">

<p class="MsoNormal" align="right" style="text-align:right;vertical-align:middle">

<img border="0" id="_x0000_i1027" src="https://lh4.googleusercontent.com/3_W3VwwMo1GiMEhNrv87B57PDW8BccI5mhSfE6p-lSCi4ennEWvZyCNRVNh9IS3zA_JNCIBLbA" alt="Imagen sin título">
<o:p>
</o:p>
</p>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<h2 style="mso-margin-top-alt:24.0pt;margin-right:-4.8pt;margin-bottom:0cm;margin-left:-4.8pt;margin-bottom:.0001pt;background:#EEEEEE;vertical-align:middle">

Identificación del Paciente<o:p>
</o:p>
</h2>

<div>

<p class="MsoNormal" style="vertical-align:middle">
En esta sección debe ingresar los datos del paciente visitado<o:p>
</o:p>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<h2 style="mso-margin-top-alt:24.0pt;margin-right:-4.8pt;margin-bottom:0cm;margin-left:-4.8pt;margin-bottom:.0001pt;background:#EEEEEE;vertical-align:middle">

Datos Personales del Paciente<o:p>
</o:p>
</h2>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Ingrese el Rut del Paciente
<span class="ss-required-asterisk">
<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="margin-top:1.2pt;margin-bottom:3.0pt">

<p class="MsoNormal" style="vertical-align:middle">
<span style="color:#666666">
RUT con Guión y Dígito Verificador, sin puntos ( Ej: 5632200-k)<o:p>
</o:p>
</span>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
10560826-8<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Ingrese el Primer Nombre y Apellido Paterno del Paciente
<span class="ss-required-asterisk">
<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
Marcela Contreras Aedo<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Previsión <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<p class="MsoNormal" style="vertical-align:middle">
[COLMENA&nbsp;\/] <o:p>
</o:p>
</p>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Ciudad <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
Pacifico 12,Linares.<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Comuna <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
Linares.<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%">

<div style="margin-bottom:18.0pt;max-width:100%">

<p class="MsoNormal" align="right" style="text-align:right;vertical-align:middle">

<img border="0" id="_x0000_i1028" src="https://lh3.googleusercontent.com/a--QM0tHOY2N-ywEy9inrBWw-4f6j9Ofzul9VQSNQn1ad8mPRl1_kCJQR9ynQdP2swvENM5UdQ" alt="Imagen sin título">
<o:p>
</o:p>
</p>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<h2 style="mso-margin-top-alt:24.0pt;margin-right:-4.8pt;margin-bottom:0cm;margin-left:-4.8pt;margin-bottom:.0001pt;background:#EEEEEE;vertical-align:middle">

Registro de la Atención Domiciliaria<o:p>
</o:p>
</h2>

<div>

<p class="MsoNormal" style="vertical-align:middle">
En esta sección debe ingresar los datos de la atención domiciliaria<o:p>
</o:p>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Tipo de Atención <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<p class="MsoNormal" style="margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:l1 level1 lfo1;vertical-align:middle">

<![if !supportLists]>
<span style="font-size:10.0pt;font-family:Symbol">
<span style="mso-list:Ignore">
·<span style="font:7.0pt &quot;Times New Roman&quot;">
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>
</span>
</span>
<![endif]>
<span class="ss-choice-item-control">
(X)</span>
 <span class="ss-choice-label">

Domicilio</span>
 <o:p>
</o:p>
</p>

<p class="MsoNormal" style="margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:l1 level1 lfo1;vertical-align:middle">

<![if !supportLists]>
<span style="font-size:10.0pt;font-family:Symbol">
<span style="mso-list:Ignore">
·<span style="font:7.0pt &quot;Times New Roman&quot;">
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>
</span>
</span>
<![endif]>
<span class="ss-choice-item-control">
(&nbsp;)</span>
 <span class="ss-choice-label">

Ambulatorio</span>
 <o:p>
</o:p>
</p>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Fecha de la Atención <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div>

<div style="border:solid gainsboro 1.0pt;padding:0cm 0cm 0cm 2.0pt;margin-left:2.25pt;margin-top:3.0pt;margin-right:2.25pt;margin-bottom:3.0pt;min-height:32px;display:inline-block">

<p class="MsoNormal" style="vertical-align:middle">
[julio&nbsp;\/] [13&nbsp;\/] [2019&nbsp;\/] <o:p>

</o:p>
</p>

</div>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Hora de la Atención <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div>

<div style="border:solid gainsboro 1.0pt;padding:0cm 0cm 0cm 2.0pt;margin-left:2.25pt;margin-top:3.0pt;margin-right:2.25pt;margin-bottom:3.0pt;min-height:32px;display:inline-block">

<p class="MsoNormal" style="vertical-align:middle">
[17&nbsp;\/] . [30&nbsp;\/] <o:p>
</o:p>
</p>

</div>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Performance Status ECOG del Paciente
<span class="ss-required-asterisk">
<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<p class="MsoNormal" style="vertical-align:middle">
[1&nbsp;\/] <o:p>
</o:p>
</p>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt;overflow-x:auto">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Escala Dolor EVA Actual <o:p>

</o:p>
</b>
</p>

</div>

<table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" id="entry_1421689035">

<tbody>

<tr>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">
</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
0<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
1<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
2<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
3<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
4<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
5<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
6<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
7<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
8<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
9<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
10<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">
</td>

</tr>

<tr>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 0cm">
</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(X)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 0cm 6.0pt 3.0pt">
</td>

</tr>

</tbody>

</table>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt;overflow-x:auto">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Escala Dolor EVA Máximo <o:p>

</o:p>
</b>
</p>

</div>

<table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" id="entry_1244707512">

<tbody>

<tr>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">
</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
0<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
1<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
2<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
3<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
4<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
5<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
6<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
7<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
8<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
9<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
10<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">
</td>

</tr>

<tr>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 0cm">
</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(X)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 0cm 6.0pt 3.0pt">
</td>

</tr>

</tbody>

</table>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt;overflow-x:auto">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Escala Dolor EVA Mínimo <o:p>

</o:p>
</b>
</p>

</div>

<table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" id="entry_853118630">

<tbody>

<tr>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">
</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
0<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
1<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
2<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
3<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
4<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
5<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
6<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
7<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
8<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
9<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">

<p class="MsoNormal" align="center" style="text-align:center">
10<o:p>
</o:p>
</p>

</td>

<td style="padding:3.75pt 3.75pt 3.75pt 3.75pt">
</td>

</tr>

<tr>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 0cm">
</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(X)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 3.0pt 6.0pt 3.0pt">

<div>

<p class="MsoNormal" align="center" style="text-align:center">
<span style="color:#666666">
(&nbsp;)<o:p>
</o:p>
</span>
</p>

</div>

</td>

<td style="border:solid #D3D8D3 1.0pt;padding:6.0pt 0cm 6.0pt 3.0pt">
</td>

</tr>

</tbody>

</table>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Anamnesis/Evolución <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
Paciente operada de cáncer Anexial izq. .hace &#43;- 3 meses que queda con dolor residual en zona de irradiación del Nervio ciático izq.,que por RNM solicitada se
 evidencia una inflamación asociada al uso terapéutico de radiación (Radioterapia previa a su cirugía ginecológica/oncológica).Se agregan además molestias urinarias consistentes en Disuria ,Poliaquiuria, con aumento de la frecuencia miccional ,por urgencia
 ,cada &#43;- 2-3 horas a lo mas . Desde ayer con fuertes dolores genitales ,ardor ,prurito y secreción vaginal lechosa sin causa aparente.<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Examen Físico <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
Síntomas y signos y lesiones compatibles con severa micosis genital(vulvar y vaginal) examen cardiopulmonar ,abdominal normales .Dolor lumbociatico izq. irradiado
 a pierna la cual genera Lasege positivo sin lesiones visibles.<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Diagnóstico <span class="ss-required-asterisk">

<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
Cancer Anexial Izq operado 2.- Neuralgia/Neuritis Ciatica iz post Irradiacion terapeutica 3.- Cistitis Actinica 4.- Vulvovaginitis Micotica en evolucion.<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Plan de Tratamiento e Indicaciones
<span class="ss-required-asterisk">
<span style="color:#C43B1D">
*</span>
</span>
<o:p>
</o:p>
</b>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
Aseo local con liquidas alcalinizan tés, Fluconazol 150 mg por la mañana semanalmente por 3 meses .Óvulos de Tinidazol/Miconazol ,uno cada noche por 10 días.<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Medicamentos Indicados <o:p>

</o:p>
</b>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
Fluconazol 150 mg una capsula al desayuno por semana por 3 meses. Óvulos de Tinidazol/Miconazol de uso vaginal ,cada noche por 10 días. Tramadol con paracetamol
 comp. :1/2-1/2 y uno por día permanente.<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Fecha aproximada del Próximo Control con usted
<o:p>
</o:p>
</b>
</p>

</div>

<div>

<div style="border:solid gainsboro 1.0pt;padding:0cm 0cm 0cm 2.0pt;margin-left:2.25pt;margin-top:3.0pt;margin-right:2.25pt;margin-bottom:3.0pt;min-height:32px;display:inline-block">

<p class="MsoNormal" style="vertical-align:middle">
[julio&nbsp;\/] [20&nbsp;\/] [2019&nbsp;\/] <o:p>

</o:p>
</p>

</div>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Tratamiento Realizado (si corresponde)
<o:p>
</o:p>
</b>
</p>

</div>

<div style="border:solid silver 1.0pt;padding:4.0pt 4.0pt 4.0pt 4.0pt;max-width:90%;white-space:pre-wrap">

<p class="MsoNormal" style="background:#EEEEEE;vertical-align:middle">
<span style="color:#545454">
No.<o:p>
</o:p>
</span>
</p>

</div>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt">

<div style="margin-bottom:18.0pt;max-width:100%">

<div style="margin-top:9.95pt;margin-bottom:9.95pt">

<p class="MsoNormal" style="vertical-align:middle">
<b>
Derivación a otro Prestador Domiciliario
<o:p>
</o:p>
</b>
</p>

</div>

<div style="margin-top:1.2pt;margin-bottom:3.0pt">

<p class="MsoNormal" style="vertical-align:middle">
<span style="color:#666666">
Sólo llene esta sección si es médico y solicita la visita de otro prestador del equipo<o:p>
</o:p>
</span>
</p>

</div>

<p class="MsoNormal" style="margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:l0 level1 lfo2;vertical-align:middle">

<![if !supportLists]>
<span style="font-size:10.0pt;font-family:Symbol">
<span style="mso-list:Ignore">
·<span style="font:7.0pt &quot;Times New Roman&quot;">
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>
</span>
</span>
<![endif]>
<span class="ss-choice-item-control">
[X]</span>
 <span class="ss-choice-label">

ENFERMERA</span>
 <o:p>
</o:p>
</p>

<p class="MsoNormal" style="margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:l0 level1 lfo2;vertical-align:middle">

<![if !supportLists]>
<span style="font-size:10.0pt;font-family:Symbol">
<span style="mso-list:Ignore">
·<span style="font:7.0pt &quot;Times New Roman&quot;">
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>
</span>
</span>
<![endif]>
<span class="ss-choice-item-control">
[&nbsp;]</span>
 <span class="ss-choice-label">

TENS</span>
 <o:p>
</o:p>
</p>

<p class="MsoNormal" style="margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:l0 level1 lfo2;vertical-align:middle">

<![if !supportLists]>
<span style="font-size:10.0pt;font-family:Symbol">
<span style="mso-list:Ignore">
·<span style="font:7.0pt &quot;Times New Roman&quot;">
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>
</span>
</span>
<![endif]>
<span class="ss-choice-item-control">
[&nbsp;]</span>
 <span class="ss-choice-label">

NUTRICIONISTA</span>
 <o:p>
</o:p>
</p>

<p class="MsoNormal" style="margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:l0 level1 lfo2;vertical-align:middle">

<![if !supportLists]>
<span style="font-size:10.0pt;font-family:Symbol">
<span style="mso-list:Ignore">
·<span style="font:7.0pt &quot;Times New Roman&quot;">
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span>
</span>
</span>
<![endif]>
<span class="ss-choice-item-control">
[&nbsp;]</span>
 <span class="ss-choice-label">

KINESIOLOGO</span>
 <o:p>
</o:p>
</p>

<p class="MsoNormal" style="margin-left:0cm;text-indent:-18.0pt;line-height:15.6pt;mso-list:l0 level1 lfo2;vertical-align:middle">

<![if !supportLists]>
<span style="font-size:10.0pt;font-family:Symbol">
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<span class="ss-choice-item-control">
[&nbsp;]</span>
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PSICOLOGO</span>
 <o:p>
</o:p>
</p>

</div>

</div>

</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
</p>

<div>

<div style="margin-top:9.0pt;margin-bottom:9.0pt;max-width:100%">

<div style="margin-bottom:18.0pt;max-width:100%">

<p class="MsoNormal" align="right" style="text-align:right;vertical-align:middle">

<img border="0" id="_x0000_i1029" src="https://lh6.googleusercontent.com/ho5-aEhqapElKPfY3C043hrFRDZHbYmYQL4MdTOUr9VmGAzMIk1T6XQ9jJN3CuGBWoqcxaMG3A" alt="Imagen sin título">
<o:p>
</o:p>
</p>

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<p class="MsoNormal">
<a href="https://docs.google.com/forms?usp=mail_form_link">
<span style="font-size:10.0pt;color:#424242">
Crear tu propio Formulario de Google</span>
</a>
<o:p>
</o:p>
</p>

</td>

</tr>

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</div>

<p class="MsoNormal">
<o:p>
&nbsp;</o:p>
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