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["A. DATOS DEL ESTABLECIMIENTO"]
["INSTITUCIÓN DEL SISTEMA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"UNICÓDIGO",null,null,null,null,null,"ESTABLECIMIENTO DE SALUD",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NÚMERO DE HISTORIA CLÍNICA ÚNICA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NÚMERO DE ARCHIVO"]
[]
[]
["B. REGISTRO DE ADMISIÓN"]
["FECHA DE ADMISIÓN\n(aaaa-mm-dd)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NOMBRE Y APELLIDO DEL ADMISIONISTA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HISTORIA CLÍNICA EN ESTABLECIMIENTO"]
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["PRIMER APELLIDO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SEGUNDO APELLIDO",null,null,null,null,null,null,null,null,null,null,null,null,null,"PRIMER NOMBRE",null,null,null,null,null,null,null,null,null,null,null,"SEGUNDO NOMBRE",null,null,null,null,null,null,null,null,null,null,null,"TIPO DE DOCUMENTO DE IDENTIFICACIÓN"]
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[]
["ESTADO CIVIL",null,null,null,null,null,null,null,null,null,null,null,null,null,"SEXO",null,null,null,null,"Nº  TELÉFONO FIJO",null,null,null,null,null,null,null,null,null,null,null,"Nº  TELÉFONO CELULAR",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FECHA DE NACIMIENTO\n(aaaa-mm-dd)"]
["SOL",null,"CAS",null,"DIV",null,"VIU",null,"UN",null,"U-H",null,"NA"]
[]
["LUGAR DE NACIMIENTO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NACIONALIDAD",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"EDAD",null,null,null,null,"CONDICIÓN EDAD     (MARCAR)",null,null,null,null,null,null,null,"GRUPO PRIORITARIO",null,null,null,null,null,null,null,null,null,null,"SI",null,null,null,"NO"]
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[]
["AUTOIDENTIFICACIÓN ÉTNICA",null,null,null,null,null,null,null,null,null,null,null,null,null,"NACIONALIDAD ÉTNICA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"*PUEBLOS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NIVEL DE EDUCACIÓN"]
[]
["ESTADO DEL NIVEL DE EDUCACIÓN",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TIPO DE EMPRESA DE TRABAJO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"OCUPACIÓN / PROFESIÓN",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SEGURO SALUD PRINCIPAL"]
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[]
["RESIDENCIA",null,null,null,null,null,"PROVINCIA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CANTÓN",null,null,null,null,null,null,null,null,null,null,null,"PARROQUIA",null,null,null,null,null,null,null,null,null,null,"BARRIO O SECTOR"]
[]
[null,null,null,null,null,null,"CALLE PRINCIPAL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CALLE SECUNDARIA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"REFERENCIA"]
[]
["EN CASO NECESARIO LLAMAR A:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PARENTESCO",null,null,null,null,null,null,null,null,"DIRECCIÓN ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nº  TELÉFONO"]
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["FORMA DE LLEGADA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FUENTE DE INFORMACIÓN",null,null,null,null,null,null,null,null,null,null,null,null,"INSTITUCIÓN O PERSONA QUE ENTREGA AL PACIENTE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Nº  TELÉFONO"]
["AMBULATORIO",null,null,null,null,null,null,null,"AMBULANCIA",null,null,null,null,null,null,null,"OTRO TRANSPORTE"]
[]
["C. INICIO DE ATENCIÓN"]
["FECHA\n(aaaa-mm-dd)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HORA\n(hh:mm)",null,null,null,null,null,null,null,null,null,null,null,null,"CONDICIÓN DE LLEGADA",null,null,null,null,null,null,null,"ESTABLE",null,null,null,null,null,null,"INESTABLE",null,null,null,null,null,null,null,null,"FALLECIDO"]
["MOTIVO DE ATENCIÓN"]
[]
["D. ACCIDENTE, VIOLENCIA, INTOXICACIÓN"]
["FECHA\n(aaaa-mm-dd)",null,null,null,null,null,null,"HORA\n(hh:mm)",null,null,null,null,null,null,"LUGAR DEL EVENTO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DIRECCIÓN DEL EVENTO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CUSTODIA POLICIAL"]
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["ACCIDENTE DE TRANSITO",null,null,null,null,null,null,null,"CAÍDA",null,null,null,null,null,null,null,"QUEMADURA",null,null,null,null,null,null,null,"MORDEDURA",null,null,null,null,null,null,null,"AHOGAMIENTO",null,null,null,null,null,null,null,"CUERPO \nEXTRAÑO",null,null,null,null,null,null,null,"APLASTAMIENTO",null,null,null,null,null,null,null,null,"OTRO ACCIDENTE"]
["VIOLENCIA POR ARMA DE FUEGO",null,null,null,null,null,null,null,"VIOLENCIA POR ARMA C. PUNZANTE",null,null,null,null,null,null,null,"VIOLENCIA POR RIÑA",null,null,null,null,null,null,null,"VIOLENCIA FAMILIAR",null,null,null,null,null,null,null,"PRESUNTA VIOLENCIA FÍSICA",null,null,null,null,null,null,null,"PRESUNTA VIOLENCIA PSICOLÓGICA",null,null,null,null,null,null,null,"PRESUNTA VIOLENCIA SEXUAL",null,null,null,null,null,null,null,null,"NOTIFICACIÓN"]
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["INTOXICACIÓN\nALCOHÓLICA",null,null,null,null,null,null,null,"INTOXICACIÓN\nALIMENTARIA",null,null,null,null,null,null,null,"INTOXICACIÓN\nPOR DROGAS",null,null,null,null,null,null,null,"INHALACIÓN DE GASES",null,null,null,null,null,null,null,"OTRA INTOXICACIÓN",null,null,null,null,null,null,null,"PICADURA",null,null,null,null,null,null,null,"ENVENENAMIENTO",null,null,null,null,null,null,null,null,"ANAFILAXIA"]
["OBSERVACIONES"]
[]
[]
[]
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[]
["E. ANTECEDENTES PATOLÓGICOS PERSONALES Y FAMILIARES",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MARCAR CON X EL NÚMERO CORRESPONDEINTE Y DESCRIBIR SEÑALANDO EL NÚMERO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NO APLICA"]
["1. ALÉRGICOS",null,null,null,null,null,null,null,null,null,null,"3. GINECOLÓGICOS",null,null,null,null,null,null,null,null,null,null,null,"5. PEDIÁTRICOS",null,null,null,null,null,null,null,null,null,null,null,null,null,"7. FARMACOLÓGICOS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"9. FAMILIARES"]
["2. CLÍNICOS",null,null,null,null,null,null,null,null,null,null,"4. TRAUMATOLÓGICOS",null,null,null,null,null,null,null,null,null,null,null,"6. QUIRÚRGICOS",null,null,null,null,null,null,null,null,null,null,null,null,null,"8. HÁBITOS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"10. OTROS"]
[]
[]
[]
[]
[]
["F. ENFERMEDAD O PROBLEMA ACTUAL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CRONOLOGÍA - LOCALIZACIÓN - CARACTERÍSTICAS - INTENSIDAD - FRECUENCIA - FACTORES AGRAVANTES"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["SNS-MSP/HCU-form.008/2021",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"EMERGENCIA  (1)"]

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["G. CONSTANTES VITALES Y ANTROPOMETRÍA"]
["SIN CONSTANTES VITALES",null,null,null,null,null,null,null,null,null,null,null,null,null,"PRESIÓN ARTERIAL(mmHg)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PULSO / min",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FRECUENCIA RESPIRATORIA / min"]
["PULSIOXIMETRIA (%)",null,null,null,null,null,null,null,null,null,null,null,null,null,"PERÍMETRO CEFÁLICO (cm)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PESO\n(kg)",null,null,null,null,null,null,null,null,"TALLA\n(cm)",null,null,null,null,null,null,null,null,null,null,"GLICEMIA CAPILAR (mg/dl)"]
["GLASGOW INICIAL",null,null,null,null,null,null,"OCULAR (4)",null,null,null,null,null,null,null,null,null,"VERBAL (5)",null,null,null,null,null,null,null,null,null,"MOTORA (6)",null,null,null,null,null,null,null,null,null,"REACCIÓN PUPILA DER.",null,null,null,null,null,null,null,"REACCIÓN PUPILA IZQ.",null,null,null,null,null,null,null,"T. LLENADO CAPILAR"]
[]
["H. EXAMEN FÍSICO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MARCAR \"X\"  CUANDO PRESENTE PATOLOGÍA Y DESCRIBA"]
["1.",null,"PIEL - FANERAS",null,null,null,null,null,null,null,null,null,"4.",null,"OÍDOS",null,null,null,null,null,null,null,null,null,"7.",null,"ORO FARINGE",null,null,null,null,null,null,null,null,null,null,"10.",null,"TÓRAX",null,null,null,null,null,null,null,null,null,null,"13.",null,"INGLE-PERINÉ"]
["2.",null,"CABEZA ",null,null,null,null,null,null,null,null,null,"5.",null,"NARIZ",null,null,null,null,null,null,null,null,null,"8.",null,"CUELLO",null,null,null,null,null,null,null,null,null,null,"11.",null,"ABDOMEN ",null,null,null,null,null,null,null,null,null,null,"14.",null,"MIEMBROS SUPERIORES"]
["3.",null,"OJOS",null,null,null,null,null,null,null,null,null,"6.",null,"BOCA",null,null,null,null,null,null,null,null,null,"9.",null,"AXILAS - MAMAS",null,null,null,null,null,null,null,null,null,null,"12.",null,"COLUMNA VERTEBRAL",null,null,null,null,null,null,null,null,null,null,"15.",null,"MIEMBROS INFERIORES"]
[]
[]
[]
[]
[]
[]
["I. EXAMEN FÍSICO DE TRAUMA / CRÍTICO"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["J. EMBARAZO - PARTO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NO APLICA"]
["NÚMERO GESTAS",null,null,null,null,null,null,null,null,"NÚMERO PARTOS",null,null,null,null,null,null,null,null,"NÚMERO ABORTOS",null,null,null,null,null,null,null,"NÚMERO CESÁREAS",null,null,null,null,null,null,null,null,"FUM",null,null,null,null,null,null,null,null,"SEMANAS GESTACIÓN",null,null,null,null,null,null,null,null,null,"MOVIMIENTO FETAL"]
["FECUENCIA CARDÌACA FETAL",null,null,null,null,null,null,null,null,null,null,null,null,null,"RUPTURA DE MEMBRANAS",null,null,null,null,null,null,null,null,null,null,null,"TIEMPO",null,null,null,null,null,null,null,null,"AFU",null,null,null,null,null,null,null,null,"PRESENTACIÓN"]
["DILATACIÓN",null,null,null,null,null,null,null,null,null,null,null,null,null,"BORRAMIENTO",null,null,null,null,null,null,null,null,null,null,null,"PLANO",null,null,null,null,null,null,null,null,"PELVIS VIABLE",null,null,null,null,null,null,null,null,"SANGRADO VAGINAL",null,null,null,null,null,null,null,null,"CONTRACCIONES"]
["SCORE MAMÁ"]
[]
[]
[]
[]
["K. EXÁMENES COMPLEMENTARIOS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NO APLICA"]
["1. BIOMETRÍA",null,null,null,null,null,null,null,"3. QUÍMICA SANGUÍNEA",null,null,null,null,null,null,null,"5. GASOMETRÍA",null,null,null,null,null,null,null,"7. ENDOSCOPIA",null,null,null,null,null,null,null,"9. RX ABDOMEN",null,null,null,null,null,null,"11. ECOGRAFÌA ABDOMEN",null,null,null,null,null,null,null,"13. TOMOGRAFÌA",null,null,null,null,null,null,null,null,"15. INTERCONSULTA"]
["2. UROANALISIS",null,null,null,null,null,null,null,"4. ELECTROLITOS",null,null,null,null,null,null,null,"6. ELECTRO CARDIOGRAMA ",null,null,null,null,null,null,null,"8. RX TÓRAX",null,null,null,null,null,null,null,"10. RX OSEA",null,null,null,null,null,null,"12. ECOGRAFÌA PÈLVICA",null,null,null,null,null,null,null,"14. RESONANCIA",null,null,null,null,null,null,null,null,"16. OTROS"]
["OBSERVACIONES: "]
[]
[]
[]
["L. DIAGNÓSTICOS PRESUNTIVOS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CIE",null,null,null,null,"M. DIAGNÓSTICOS DEFINITIVOS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CIE"]
["1.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"1."]
["2.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2."]
["3.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"3."]
[]
["N. PLAN DE TRATAMIENTO"]
["MEDICAMENTOS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"VIA",null,null,null,null,null,null,"DOSIS",null,null,null,null,null,null,"POSOLOGIA",null,null,null,null,null,null,null,null,null,null,"DIAS"]
["1."]
["2."]
["3."]
["4."]
["5."]
["6."]
["7."]
[]
[]
[]
[]
[]
[]
["O. CONDICIÓN AL EGRESO DE EMERGENCIA"]
["VIVO",null,null,null,null,null,null,null,null,null,null,"ESTABLE",null,null,null,null,null,null,null,null,"INESTABLE",null,null,null,null,null,null,null,null,"FALLECIDO",null,null,null,null,null,null,null,null,"ALTA DEFINITIVA",null,null,null,null,null,null,null,"CONSULTA EXTERNA",null,null,null,null,null,null,null,"OBSERVACIÓN DE EMERGENCIA"]
["HOSPITALIZACIÓN",null,null,null,null,null,null,null,null,null,null,"REFERENCIA",null,null,null,null,null,null,null,null,"REFERENCIA INVERSA",null,null,null,null,null,null,null,null,"DERIVACIÓN",null,null,null,null,null,null,null,null,"ESTABLECIMIENTO"]
["OBSERVACIONES:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DÍAS DE REPOSO"]
[]
[]
["P. DATOS DEL PROFESIONAL RESPONSABLE"]
["FECHA\n(aaaa-mm-dd)",null,null,null,null,null,null,null,"HORA\n(hh:mm)",null,null,null,null,null,"PRIMER NOMBRE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PRIMER APELLIDO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SEGUNDO APELLIDO"]
[]
["NÚMERO DE DOCUMENTO DE IDENTIFICACIÓN",null,null,null,null,null,null,null,null,null,null,null,null,null,"FIRMA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SELLO"]
[]
[]
["SNS-MSP/HCU-form.008/2021",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"EMERGENCIA  (2)"]