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<div class=3D"ydp90a72fc5yahoo-style-wrap" style==3D"font-family:courier new, courier, monaco, monospace, sans-serif;font-size:13px;">
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       =20        </div>
<div id=3D"ydp3e08bb69yahoo_quoted_4392164851" class=3D"ydp3e08bb69yahoo_quoted">
            <div style=3D"font-family:'Helvetica Neue', Helvetica, Arial, sans-serif;font-size:13px;color:#26282a;">
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----- Mensaje reenviado -----</div>
                <div>
<b>
De:</b>
 Formularios de Google &lt;forms-receipts-noreply@google.com&gt;</div>
<div>
<b>
Para:</b>
 "alexaogaz@yahoo.com" &lt;alexaogaz@yahoo.com&gt;</div>
<div>
<b>
Enviado:</b>
 mi=C3=A9rcoles, 24 de julio de 2019 11:43:12 a.&nbsp;m. GMT-4</div>
<div>
<b>
Asunto:</b>
 Registro de Atenci=C3=B3n Domiciliaria Oncovida</div>
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<br>
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<div id=3D"ydp3e08bb69yiv4427437684">
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<table border=3D"0" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:rgb(38,4,154);" width=3D"100%">
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<img alt=3D"Formularios de Google" style=3D"display: inline-block; margin: 0px; vertical-align: middle; max-width: 286px;" src=3D"https://www.gstatic.com/docs/forms/google_forms_logo_lockup_white_2x.png" data-inlineimagemanipulating=3D"true">
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<div style=3D"padding:24px;background-color:rgb(229,218,254);">
<div align=3D"center" style=3D"background-color:#fff;border-bottom:1px solid #e0e0e0;margin:0 auto;max-width:624px;min-width:154px;padding:0 24px;">
<table align=3D"center" cellpadding=3D"0" cellspacing=3D"0" style=3D"background-color:#fff;" width=3D"100%">
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<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/1FAIpQLSdEtSr7xXzExpMb4RkiyPWKMwg1WaFIAImkCVv7UFdpPco75w/viewform?usp=3Dmail_form_link" rel=3D"nofollow" target=3D"_blank">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</a>
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<div style=3D"font-size:13px;line-height:18px;color:#424242;">
Esto es lo que nos has enviado:</div>
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<div class=3D"ydp3e08bb69yiv4427437684ss-form-container">
<div class==3D"ydp3e08bb69yiv4427437684ss-form-heading">
<h1 class=3D"ydp3e08bb69yiv4427437684ss-form-title" dir=3D"ltr" style=3D"margin:.67em 0;">
Registro de Atenci=C3=B3n Domiciliaria Oncovida</h1>
<div class=3D"ydp3e08bb69yiv4427437684ss-form-desc ydp3e08bb69yiv4427437684ss-no-ignore-whitespace" style=3D"font-style: inherit; font-weight: inherit; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: inherit; width: 99%; margin: 0px 0px 1em; white-space: pre-wrap;">
Este es el sistema de registro de atenciones domiciliarias de Oncovida.   Debe ser llenado por el prestador individual, y debe realizarse un registro por cada visita domiciliaria.   Si usted no es prestador de Oncovida por favor no llene este formulario.   A continuaci=C3=B3n indique su correo electr=C3=B3nico.</div>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-form">
<form method=3D"GET" id=3D"ydp3e08bb69yiv4427437684ss-form" rel=3D"nofollow" target=3D"_blank">
<br>
<div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-text" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"emailAddress">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Direcci=C3=B3n de correo electr=C3=B3nico<label for=3D"emailAddress">
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
</label>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-text ydp3e08bb69yiv4427437684ss-printable-text-line" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%;">
alexaogaz@yahoo.com</div>
</div>
</div>
</div>
<div class=3D"ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%;position:relative;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
</h2>
<div style=3D"text-align:right;">
<img class=3D"ydp3e08bb69yiv4427437684ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/00-FWRRIiJNpjLIXj1QrTLVceHhiPxWpIN-K4cI0enEtAvmFFnvOHRJTMz5Lq8yFpMHz7WvBnNdiNVchE6Snklpxxc7gIx3OoqTfn_sB2_iSp_6sx7Sr2pww-0pD" style=3D"width:78px;outline:none;" alt=3D"Imagen sin leyenda" data-inlineimagemanipulating=3D"true">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-page-break" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ydp3e08bb69yiv4427437684ss-page-title" style=3D"margin-top: 2em; margin-bottom: 0px; padding: 0.4em; background-color: rgb(238, 238, 238);">
Identificaci=C3=B3n del Prestador</h2>
<div class=3D"ydp3e08bb69yiv4427437684ss-page-description ydp3e08bb69yiv4427437684ss-no-ignore-whitespace" style=3D"white-space: pre-wrap;">
Aqu=C3=AD debe ingresar sus datos personales</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-text" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_579114469">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Primer Nombre y Apellido Paterno<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-text" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%;">
alexandra Ogaz </div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-text" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_1276273985">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
RUT<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" 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"ydp3e08bb69yiv4427437684ss-q-text" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%;">
9085723-1</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-select" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_133691676">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Tipo<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
Si asisten m=C3=A1s de 1 prestador simult=C3=A1neamente, cada uno debe hacer un registro independiente</div>
</label>
<select name=3D"entry.133691676" disabled=3D"" id=3D"ydp3e08bb69yiv4427437684entry_133691676">
<option value=3D"">
</option>
<option value=3D"MEDICO" disabled=3D"">
MEDICO</option>
 <option value=3D"ENFERMERA/O" disabled=3D"">
ENFERMERA/O</option>
 <option value=3D"TENS" disabled=3D"">
TENS</option>
 <option value=3D"KINESIOLOGA/O" disabled=3D"">
KINESIOLOGA/O</option>
 <option value=3D"PSICOLOGO" disabled=3D"" selected=3D"">
PSICOLOGO</option>
 <option value=3D"NUTRICIONISTA" disabled=3D"">
NUTRICIONISTA</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%;position:relative;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
</h2>
<div style=3D"text-align:right;">
<img class=3D"ydp3e08bb69yiv4427437684ss-image" title=3D"" src=3D"https://lh3.googleusercontent.com/mRJInQVKRU12r9blREv2jmlzETLT9JfIHWC0FaeXYfPraPFE9ebBRX8P_hmpfiBP6BNpOgjPBYU0zwBxYxgoLvjQ7EjfjoRTJ2_-8flTaiU_wC008XC8LpcEJ_Yp" style=3D"width:78px;outline:none;" alt=3D"Imagen sin leyenda" data-inlineimagemanipulating=3D"true">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-page-break" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ydp3e08bb69yiv4427437684ss-page-title" style=3D"margin-top: 2em; margin-bottom: 0px; padding: 0.4em; background-color: rgb(238, 238, 238);">
Identificaci=C3=B3n del Paciente</h2>
<div class=3D"ydp3e08bb69yiv4427437684ss-page-description ydp3e08bb69yiv4427437684ss-no-ignore-whitespace" style=3D"white-space: pre-wrap;">
En esta secci=C3=B3n debe ingresar los datos del paciente visitado</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-section-header" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ydp3e08bb69yiv4427437684ss-section-title" style=3D"background-color: rgb(238, 238, 238); padding: 0.4em; margin-top: 2em; margin-bottom: 0px;">
Datos Personales del Paciente</h2>
<div class=3D"ydp3e08bb69yiv4427437684ss-section-description ydp3e08bb69yiv4427437684ss-no-ignore-whitespace" style=3D"margin-top: 0.5em; white-space: pre-wrap;">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-text" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_823811303">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Ingrese el Rut del Paciente<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" 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"ydp3e08bb69yiv4427437684ss-q-text" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%;">
13980180-6</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-text" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_1959365839">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Ingrese el Primer Nombre y Apellido Paterno del Paciente<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-text" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%;">
Katherine Gonz=C3=A1lez</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-select" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_545002227">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Previsi=C3=B3n<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<select name=3D"entry.545002227" disabled=3D"" id=3D"ydp3e08bb69yiv4427437684entry_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" disabled=3D"">
COLMENA</option>
 <option value=3D"CONSALUD" disabled=3D"">
CONSALUD</option>
 <option value=3D"CRUZ BLANCA" disabled=3D"">
CRUZ BLANCA</option>
 <option value=3D"DIPRECA" disabled=3D"">
DIPRECA</option>
 <option value==3D"FONASA" disabled=3D"">
FONASA</option>
 <option value=3D"FUNDACION" disabled=3D"">
FUNDACION</option>
 <option value=3D"ISAPRES DEL COBRE" disabled=3D"">
ISAPRES DEL COBRE</option>
 <option value=3D"NUEVA MASVIDA" disabled=3D"" selected=3D"">
NUEVA MASVIDA</option>
 <option value=3D"VIDATRES" disabled==3D"">
VIDATRES</option>
 <option value=3D"PARTICULAR" disabled=3D"">
PARTICULAR</option>
</select>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-text" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_1900161356">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Ciudad<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-text" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%;">
Vi=C3=B1a del Mar</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-text" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_1298871758">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Comuna<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-text" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%;">
Vi=C3=B1a del Mar</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-embeddable-object-container" style=3D"margin:12px 0;max-width:100%;position:relative;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
</h2>
<div style=3D"text-align:right;">
<img class=3D"ydp3e08bb69yiv4427437684ss-image" title=3D"" src=3D"https://lh6.googleusercontent.com/URytM0QWRGW_JEL0xQxvOLvwPRJIHyqlnKOm6ky9DRBfzvYVPaAngXV35GNHnaVG-dm9Orno4lr8sy8E-KB9tMrmIhFbVQiOPWy3vUclqRKAJ51dvLdhjBKgXdLO" style=3D"width:78px;outline:none;" alt=3D"Imagen sin leyenda" data-inlineimagemanipulating=3D"true">
</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-page-break" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<h2 class=3D"ydp3e08bb69yiv4427437684ss-page-title" style=3D"margin-top: 2em; margin-bottom: 0px; padding: 0.4em; background-color: rgb(238, 238, 238);">
Registro de la Atenci=C3=B3n Domiciliaria</h2>
<div class=3D"ydp3e08bb69yiv4427437684ss-page-description ydp3e08bb69yiv4427437684ss-no-ignore-whitespace" style=3D"white-space: pre-wrap;">
En esta secci=C3=B3n debe ingresar los datos de la atenci=C3=B3n domiciliaria</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-radio" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_2073233714">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Tipo de Atenci=C3=B3n<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<ul class=3D"ydp3e08bb69yiv4427437684ss-choices" style=3D"list-style:none;padding:0;margin:.5em 0 0;">
<li class=3D"ydp3e08bb69yiv4427437684ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em;">
<label>
<span class=3D"ydp3e08bb69yiv4427437684ss-choice-item-control ydp3e08bb69yiv4427437684goog-inline-block" style=3D"position:relative;display:inline-block;">
<input type=3D"radio" name=3D"entry.1222378237" disabled=3D"" checked=3D"" value=3D"Domicilio" id=3D"ydp3e08bb69yiv4427437684group_1222378237_1" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</span>
<span class=3D"ydp3e08bb69yiv4427437684ss-choice-label">
Domicilio</span>
</label>
</li>
 <li class=3D"ydp3e08bb69yiv4427437684ss-choice-item" style=3D"margin:0;line-height:1.3em;padding-bottom:.5em;">
<label>
<span class=3D"ydp3e08bb69yiv4427437684ss-choice-item-control ydp3e08bb69yiv4427437684goog-inline-block" style=3D"position:relative;display:inline-block;">
<input type=3D"radio" name=3D"entry.1222378237" disabled=3D"" value=3D"Ambulatorio" id=3D"ydp3e08bb69yiv4427437684group_1222378237_2" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</span>
<span class=3D"ydp3e08bb69yiv4427437684ss-choice-label">
Ambulatorio</span>
</label>
</li>
</ul>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-date" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_1705849412">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Fecha de la Atenci=C3=B3n<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-date">
<div class=3D"ydp3e08bb69yiv4427437684ss-datetime-box ydp3e08bb69yiv4427437684goog-inline-block" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;position:relative;display:inline-block;">
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<option value=3D"">
D=C3=ADa</option>
<option value=3D"1">
1</option>
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2</option>
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3</option>
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4</option>
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5</option>
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6</option>
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7</option>
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8</option>
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9</option>
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10</option>
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11</option>
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12</option>
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13</option>
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14</option>
 <option value=3D"15">
15</option>
 <option value=3D"16">
16</option>
 <option value==3D"17">
17</option>
 <option value=3D"18">
18</option>
 <option value=3D"19">
19</option>
 <option value=3D"20">
20</option>
 <option value=3D"21">
21</option>
 <option value=3D"22">
22</option>
 <option value=3D"23" selected=3D"">
23</option>
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24</option>
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25</option>
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26</option>
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27</option>
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28</option>
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29</option>
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30</option>
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31</option>
</select>
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<option value=3D"">
Mes</option>
<option value=3D"1">
enero</option>
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febrero</option>
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marzo</option>
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abril</option>
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mayo</option>
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junio</option>
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julio</option>
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agosto</option>
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septiembre</option>
 <option value=3D"10">
octubre</option>
 <option value=3D"11">
noviembre</option>
 <option value=3D"12">
diciembre</option>
</select>
=20<select name=3D"entry.1705849412_year" disabled=3D"" id=3D"ydp3e08bb69yiv4427437684entry.1705849412_year">
<option value=3D"">
A=C3=B1o</option>
<option value=3D"1896">
1896</option>
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1897</option>
 <option value=3D"1898">
1898</option>
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1899</option>
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1900</option>
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1901</option>
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1902</option>
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1903</option>
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1904</option>
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1905</option>
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1906</option>
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1907</option>
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1908</option>
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1909</option>
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1910</option>
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1911</option>
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1912</option>
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1913</option>
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1914</option>
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1915</option>
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1916</option>
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1917</option>
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1918</option>
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1919</option>
 <option value=3D"1920">
1920</option>
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1921</option>
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1922</option>
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1923</option>
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1924</option>
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1925</option>
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1926</option>
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1927</option>
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1928</option>
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1929</option>
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1930</option>
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1931</option>
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1932</option>
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1933</option>
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1934</option>
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1935</option>
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1936</option>
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1937</option>
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1938</option>
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1939</option>
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1940</option>
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1941</option>
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1942</option>
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1943</option>
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1944</option>
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1945</option>
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1946</option>
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1947</option>
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1948</option>
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1949</option>
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1950</option>
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1951</option>
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1952</option>
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1953</option>
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1954</option>
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1955</option>
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1956</option>
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1957</option>
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1958</option>
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1959</option>
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1960</option>
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1961</option>
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1962</option>
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1963</option>
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1964</option>
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1965</option>
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1966</option>
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1967</option>
 <option value==3D"1968">
1968</option>
 <option value=3D"1969">
1969</option>
 <option value==3D"1970">
1970</option>
 <option value=3D"1971">
1971</option>
 <option value==3D"1972">
1972</option>
 <option value=3D"1973">
1973</option>
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1974</option>
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1975</option>
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1976</option>
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1977</option>
 <option value==3D"1978">
1978</option>
 <option value=3D"1979">
1979</option>
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1980</option>
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1981</option>
 <option value==3D"1982">
1982</option>
 <option value=3D"1983">
1983</option>
 <option value==3D"1984">
1984</option>
 <option value=3D"1985">
1985</option>
 <option value==3D"1986">
1986</option>
 <option value=3D"1987">
1987</option>
 <option value==3D"1988">
1988</option>
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1989</option>
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1990</option>
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1991</option>
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1992</option>
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1993</option>
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1994</option>
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1995</option>
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1996</option>
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1997</option>
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1998</option>
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1999</option>
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2000</option>
 <option value=3D"2001">
2001</option>
 <option value==3D"2002">
2002</option>
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2003</option>
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2004</option>
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2005</option>
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2006</option>
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2007</option>
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2008</option>
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2009</option>
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2010</option>
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2011</option>
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2012</option>
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2013</option>
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2014</option>
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2015</option>
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2016</option>
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2017</option>
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2018</option>
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2019</option>
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2020</option>
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2021</option>
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2022</option>
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2023</option>
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2024</option>
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2025</option>
 <option value=3D"2026">
2026</option>
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2027</option>
 <option value=3D"2028">
2028</option>
 <option value=3D"2029">
2029</option>
 <option value=3D"2030">
2030</option>
 <option value=3D"2031">
2031</option>
 <option value=3D"2032">
2032</option>
 <option value=3D"2033">
2033</option>
 <option value=3D"2034">
2034</option>
 <option value=3D"2035">
2035</option>
 <option value=3D"2036">
2036</option>
 <option value=3D"2037">
2037</option>
 <option value=3D"2038">
2038</option>
 <option value=3D"2039">
2039</option>
 <option value=3D"2040">
2040</option>
 <option value=3D"2041">
2041</option>
 <option value=3D"2042">
2042</option>
 <option value=3D"2043">
2043</option>
 <option value=3D"2044">
2044</option>
 <option value=3D"2045">
2045</option>
 <option value=3D"2046">
2046</option>
 <option value=3D"2047">
2047</option>
 <option value==3D"2048">
2048</option>
 <option value=3D"2049">
2049</option>
 <option value==3D"2050">
2050</option>
 <option value=3D"2051">
2051</option>
 <option value==3D"2052">
2052</option>
 <option value=3D"2053">
2053</option>
 <option value==3D"2054">
2054</option>
 <option value=3D"2055">
2055</option>
 <option value==3D"2056">
2056</option>
 <option value=3D"2057">
2057</option>
 <option value==3D"2058">
2058</option>
 <option value=3D"2059">
2059</option>
 <option value==3D"2060">
2060</option>
 <option value=3D"2061">
2061</option>
 <option value==3D"2062">
2062</option>
 <option value=3D"2063">
2063</option>
 <option value==3D"2064">
2064</option>
 <option value=3D"2065">
2065</option>
 <option value==3D"2066">
2066</option>
 <option value=3D"2067">
2067</option>
 <option value==3D"2068">
2068</option>
 <option value=3D"2069">
2069</option>
</select>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-time" style=3D"margin: 12px 0px; font-style: inherit; font-weight: inherit; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: inherit;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_206244955">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Hora de la Atenci=C3=B3n<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-time">
<div class=3D"ydp3e08bb69yiv4427437684ss-datetime-box ydp3e08bb69yiv4427437684goog-inline-block" dir==3D"ltr" style=3D"border:1px solid #dcdcdc;margin-right:2em;min-height:32px;padding-left:3px;vertical-align:middle;margin:4px 3px;position:relative;display:inline-block;">
<select name=3D"entry.206244955_hour" disabled=3D"" id=3D"ydp3e08bb69yiv4427437684entry.206244955_hour">
<option value=3D"">
h</option>
<option value=3D"00">
00</option>
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01</option>
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02</option>
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03</option>
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04</option>
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05</option>
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06</option>
 <option value=3D"07">
07</option>
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23</option>
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min</option>
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00</option>
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01</option>
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02</option>
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14</option>
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17</option>
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20</option>
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59</option>
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</div>
</div>
</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-item-required ydp3e08bb69yiv4427437684ss-select" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_1747608258">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Performance Status ECOG del Paciente<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
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</label>
<select name=3D"entry.1747608258" disabled=3D"" id=3D"ydp3e08bb69yiv4427437684entry_1747608258">
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0</option>
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1</option>
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2</option>
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3</option>
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4</option>
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</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-scale" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_1716090865">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Escala Dolor EVA Actual</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" 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"ydp3e08bb69yiv4427437684entry_1421689035">
<tbody>
<tr>
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</td>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1421689035_1" style=3D"display:block;padding:0.5em 0 .5em;">
0</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1421689035_2" style=3D"display:block;padding:0.5em 0 .5em;">
1</label>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1421689035_3" style=3D"display:block;padding:0.5em 0 .5em;">
2</label>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for==3D"group_1421689035_4" style=3D"display:block;padding:0.5em 0 .5em;">
3</label>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1421689035_5" style=3D"display:block;padding:0.5em 0 .5em;">
4</label>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1421689035_6" style=3D"display:block;padding:0.5em 0 .5em;">
5</label>
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6</label>
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7</label>
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8</label>
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9</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1421689035_11" style=3D"display:block;padding:0.5em 0 .5em;">
10</label>
</td>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
</td>
</tr>
<tr>
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<div class=3D"ydp3e08bb69yiv4427437684aria-todo">
</div>
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</div>
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</div>
</td>
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</div>
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</div>
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</div>
</td>
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</div>
</td>
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</div>
</td>
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</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-scale" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_2064050596">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Escala Dolor EVA M=C3=A1ximo</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" 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"ydp3e08bb69yiv4427437684entry_1244707512">
<tbody>
<tr>
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</td>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1244707512_1" style=3D"display:block;padding:0.5em 0 .5em;">
0</label>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1244707512_2" style=3D"display:block;padding:0.5em 0 .5em;">
1</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1244707512_3" style=3D"display:block;padding:0.5em 0 .5em;">
2</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for==3D"group_1244707512_4" style=3D"display:block;padding:0.5em 0 .5em;">
3</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1244707512_5" style=3D"display:block;padding:0.5em 0 .5em;">
4</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1244707512_6" style=3D"display:block;padding:0.5em 0 .5em;">
5</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1244707512_7" style=3D"display:block;padding:0.5em 0 .5em;">
6</label>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1244707512_8" style=3D"display:block;padding:0.5em 0 .5em;">
7</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1244707512_9" style=3D"display:block;padding:0.5em 0 .5em;">
8</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1244707512_10" style=3D"display:block;padding:0.5em 0 .5em;">
9</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_1244707512_11" style=3D"display:block;padding:0.5em 0 .5em;">
10</label>
</td>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
</td>
</tr>
<tr>
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<div class=3D"ydp3e08bb69yiv4427437684aria-todo">
</div>
</td>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
</td>
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<input type=3D"radio" name=3D"entry.1244707512" disabled=3D"" value=3D"10" id=3D"ydp3e08bb69yiv4427437684group_1244707512_11" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</div>
</td>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalerow ydp3e08bb69yiv4427437684ss-rightlabel" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0;">
</td>
</tr>
</tbody>
</table>
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</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-scale" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_2000523015">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Escala Dolor EVA M=C3=ADnimo</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" 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"ydp3e08bb69yiv4427437684entry_853118630">
<tbody>
<tr>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
</td>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_853118630_1" style=3D"display:block;padding:0.5em 0 .5em;">
0</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_853118630_2" style=3D"display:block;padding:0.5em 0 .5em;">
1</label>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_853118630_3" style=3D"display:block;padding:0.5em 0 .5em;">
2</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_853118630_4" style=3D"display:block;padding:0.5em 0 .5em;">
3</label>
</td>
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<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_853118630_5" style=3D"display:block;padding:0.5em 0 .5em;">
4</label>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_853118630_6" style=3D"display:block;padding:0.5em 0 .5em;">
5</label>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for==3D"group_853118630_7" style=3D"display:block;padding:0.5em 0 .5em;">
6</label>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_853118630_8" style=3D"display:block;padding:0.5em 0 .5em;">
7</label>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_853118630_9" style=3D"display:block;padding:0.5em 0 .5em;">
8</label>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_853118630_10" style=3D"display:block;padding:0.5em 0 .5em;">
9</label>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
<label class=3D"ydp3e08bb69yiv4427437684ss-scalenumber" for=3D"group_853118630_11" style=3D"display:block;padding:0.5em 0 .5em;">
10</label>
</td>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalenumbers" style=3D"text-align:center;">
</td>
</tr>
<tr>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalerow ydp3e08bb69yiv4427437684ss-leftlabel" style=3D"text-align:right;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-left:0;">
<div class=3D"ydp3e08bb69yiv4427437684aria-todo">
</div>
</td>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ydp3e08bb69yiv4427437684ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"0" id==3D"ydp3e08bb69yiv4427437684group_853118630_1" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</div>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ydp3e08bb69yiv4427437684ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" checked=3D"" value=3D"1" id=3D"ydp3e08bb69yiv4427437684group_853118630_2" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</div>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ydp3e08bb69yiv4427437684ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"2" id=3D"ydp3e08bb69yiv4427437684group_853118630_3" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</div>
</td>
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</div>
</td>
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<div class=3D"ydp3e08bb69yiv4427437684ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"4" id=3D"ydp3e08bb69yiv4427437684group_853118630_5" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</div>
</td>
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<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"5" id=3D"ydp3e08bb69yiv4427437684group_853118630_6" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</div>
</td>
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<div class=3D"ydp3e08bb69yiv4427437684ss-scalerow-fieldcell">
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</div>
</td>
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<div class=3D"ydp3e08bb69yiv4427437684ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"7" id=3D"ydp3e08bb69yiv4427437684group_853118630_8" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</div>
</td>
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<div class=3D"ydp3e08bb69yiv4427437684ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"8" id=3D"ydp3e08bb69yiv4427437684group_853118630_9" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</div>
</td>
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<div class=3D"ydp3e08bb69yiv4427437684ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"9" id=3D"ydp3e08bb69yiv4427437684group_853118630_10" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</div>
</td>
 <td class=3D"ydp3e08bb69yiv4427437684ss-scalerow" style=3D"text-align:center;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;">
<div class=3D"ydp3e08bb69yiv4427437684ss-scalerow-fieldcell">
<input type=3D"radio" name=3D"entry.853118630" disabled=3D"" value=3D"10" id=3D"ydp3e08bb69yiv4427437684group_853118630_11" class=3D"ydp3e08bb69yiv4427437684ss-q-radio">
</div>
</td>
<td class=3D"ydp3e08bb69yiv4427437684ss-scalerow ydp3e08bb69yiv4427437684ss-rightlabel" style=3D"text-align:left;color:#666;border:1px solid #d3d8d3;border-left:0;border-right:0;padding:.5em .25em;padding-right:0;">
</td>
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</tbody>
</table>
</div>
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<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_2140974612">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Anamnesis/Evoluci=C3=B3n<label>
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<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
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</label>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-text" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%;">
Paciente que ha estado estable est=C3=A1 semana a nivel emocional. Ha logrado estar tranquila con su hijos . La cicatrizaci=C3=B3n ha ido evolucionando adecuadamente. </div>
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<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
<label class=3D"ydp3e08bb69yiv4427437684ss-q-item-label" for=3D"entry_824006088">
<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Examen F=C3=ADsico<label>
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*</span>
</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
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<div class=3D"ydp3e08bb69yiv4427437684ss-q-text" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%;">
Paciente autovalente, es capaz de realizar actividades cotidianas.</div>
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<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
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Diagn=C3=B3stico<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
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</div>
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C=C3=A1ncer Ovarico</div>
</div>
</div>
</div>
<br>
 <div class=3D"ydp3e08bb69yiv4427437684ss-form-question ydp3e08bb69yiv4427437684errorbox-good">
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<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Plan de Tratamiento e Indicaciones<label>
</label>
<span class=3D"ydp3e08bb69yiv4427437684ss-required-asterisk" style=3D"color:#c43b1d;">
*</span>
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</div>
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Trabajar con la paciente a generar metas a corto plazo y que las logre realizar.manejo emocional en relaci=C3=B3n a sus hijos, con habilidades parentales adecuadas.</div>
</div>
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<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-paragraph-text" style=3D"margin:12px 0;">
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Medicamentos Indicados</div>
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Fecha aproximada del Pr=C3=B3ximo Control con usted</div>
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</div>
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D=C3=ADa</option>
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3</option>
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17</option>
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19</option>
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20</option>
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21</option>
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22</option>
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25</option>
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27</option>
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A=C3=B1o</option>
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1900</option>
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1911</option>
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1918</option>
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1920</option>
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1940</option>
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1951</option>
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1984</option>
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1985</option>
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1986</option>
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1987</option>
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1988</option>
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1992</option>
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1993</option>
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1998</option>
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1999</option>
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2000</option>
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2010</option>
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2011</option>
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2012</option>
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2013</option>
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2014</option>
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2015</option>
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2017</option>
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2018</option>
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2021</option>
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2026</option>
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2027</option>
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2028</option>
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2030</option>
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2031</option>
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2033</option>
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2034</option>
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2035</option>
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2036</option>
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2037</option>
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2039</option>
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2040</option>
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2041</option>
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2042</option>
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2043</option>
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2044</option>
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2045</option>
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2046</option>
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2047</option>
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2048</option>
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2049</option>
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2050</option>
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2051</option>
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2052</option>
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2054</option>
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2055</option>
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2056</option>
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2057</option>
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2058</option>
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2059</option>
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2060</option>
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2061</option>
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2062</option>
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2063</option>
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2064</option>
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2065</option>
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2066</option>
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2067</option>
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2068</option>
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2069</option>
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<div class=3D"ydp3e08bb69yiv4427437684ss-item ydp3e08bb69yiv4427437684ss-text" style=3D"margin:12px 0;">
<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
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<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Tratamiento Realizado (si corresponde)</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
</div>
</label>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-text" style=3D"background-color:#eee;max-width:90%;border:1px solid #c0c0c0;padding:5px;white-space:pre-wrap;color:#545454;width:70%;">
</div>
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<br>
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<div class=3D"ydp3e08bb69yiv4427437684ss-form-entry" style=3D"margin-bottom:1.5em;vertical-align:middle;margin-left:0;margin-top:0;max-width:100%;">
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<div class=3D"ydp3e08bb69yiv4427437684ss-q-title" style=3D"display:block;font-weight:bold;margin-top:.83em;margin-bottom:.83em;">
Derivaci=C3=B3n a otro Prestador Domiciliario</div>
<div class=3D"ydp3e08bb69yiv4427437684ss-q-help ydp3e08bb69yiv4427437684ss-secondary-text" style=3D"display:block;margin:.1em 0 .25em 0;color:#666;">
S=C3=B3lo llene esta secci=C3=B3n si es m=C3=A9dico y solicita la visita de otro prestador del equipo</div>
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TENS</span>
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<label>
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NUTRICIONISTA</span>
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<label>
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<img class=3D"ydp3e08bb69yiv4427437684ss-image" title=3D"" src=3D"https://lh5.googleusercontent.com/Bpur5zPteyG-bXtM-WNRuiLwTi8myvetX7lBkdjzbnQyqUlGcuv84zmWyU3x0Ua2-_WXX9PiJ2cMBOO0zhG2nHX7tXXPHH6_X8UTG8MZzIBwxETkF0a8JyZtuxSL" style=3D"width:78px;outline:none;" alt=3D"Imagen sin leyenda" data-inlineimagemanipulating=3D"true">
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