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["A. DATOS DEL ESTABLECIMIENTO Y USUARIO / PACIENTE"]
["INSTITUCIÓN DEL SISTEMA",null,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"]
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["PRIMER APELLIDO",null,null,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,null,"PRIMER NOMBRE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SEGUNDO NOMBRE",null,null,null,null,null,null,null,null,null,null,null,null,"SEXO",null,null,null,"EDAD (AÑOS)"]
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["B. ATENCIÓN MÉDICA"]
["NOMBRE DEL INFORMANTE"]
["MOTIVO DE CONSULTA"]
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["TIPO DE CONSULTA:",null,null,null,null,null,null,null,null,null,null,null,null,null,"PRIMERA",null,null,null,null,null,null,"SUBSECUENTE",null,null,null,null,null,null,null,null,null,null,"FECHA DE ÚLTIMA CONSULTA POR PLANIFICACIÓN FAMILIAR"]
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["CARACTERES FÍSICO-SEXUALES"]
["DESARROLLO PUBERAL MUJER",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,"DESARROLLO PUBERAL HOMBRE"]
["TELARQUIA",null,null,null,null,null,null,null,null,"PUBARQUIA",null,null,null,null,null,null,null,null,null,"MENARQUIA",null,null,null,null,null,null,null,null,"VELLO AXILAR",null,null,null,null,null,null,null,null,null,"PUBARQUIA",null,null,null,null,null,null,null,null,null,"VELLO AXILAR",null,null,null,null,null,null,null,null,null,"ESPERMARQUIA"]
["EDAD",null,null,null,null,null,"NO",null,null,"EDAD",null,null,null,null,null,null,"NO",null,null,"EDAD",null,null,null,null,null,"NO",null,null,"EDAD",null,null,null,null,null,null,"NO",null,null,"EDAD",null,null,null,null,null,null,"NO",null,null,"EDAD",null,null,null,null,null,null,"NO",null,null,"EDAD",null,null,null,null,null,null,"NO"]
["RITMO MENSTRUAL"]
["CICLOS",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,"CANTIDAD",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,"COÁGULOS"]
["REGULAR",null,null,null,null,null,null,"IRREGULAR",null,null,null,null,null,null,null,"DURACIÓN",null,null,null,null,null,null,null,null,"/",null,null,"ESCASO",null,null,null,null,null,null,null,"REGULAR",null,null,null,null,null,null,null,"ABUNDANTE",null,null,null,null,null,null,null,"N/C",null,null,null,null,null,null,null,"SI",null,null,"NO",null,null,"N/C"]
["DOLOR MENSTRUAL",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,"DOLOR MAMARIO",null,null,null,null,null,null,null,null,"MASTODINIA",null,null,null,null,null,null,null,null,"OTRAS MOLESTIAS"]
["SI",null,null,"NO",null,null,"N/C",null,null,"PREMENSTRUAL",null,null,null,null,null,null,null,null,null,null,"MENSTRUAL",null,null,null,null,null,null,null,null,null,"POSTMENSTRUAL",null,null,null,null,null,null,null,null,null,null,"SI",null,null,"NO",null,null,"N/C",null,null,"SI",null,null,"NO",null,null,"N/C",null,null,"SI",null,null,"NO",null,null,"N/C"]
["DETECCIÓN OPORTUNA DE CÁNCER"]
["CERVICO UTERINO",null,null,null,null,null,null,null,null,"SI",null,null,"NO",null,null,"N/C",null,null,"FECHA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MAMARIO",null,null,null,null,null,null,"SI",null,null,"NO",null,null,"N/C",null,null,"FECHA"]
["OBSERVACIONES:"]
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["SEXUALIDAD"]
["CALIDAD DE LA INFORMACIÓN",null,null,null,null,null,null,"SUFICIENTE",null,null,null,null,null,"INSUFICIENTE",null,null,null,null,null,"PAREJA ACTUAL",null,null,null,"SI",null,null,"NO",null,null,"N/C",null,null,"TIEMPO DE RELACIÓN",null,null,null,null,"AÑOS",null,null,null,null,"N/C",null,null,"EDAD PAREJA",null,null,null,null,null,null,null,null,"N/C",null,null,"No. PAREJAS SEXUALES",null,null,null,null,null,null,null,"N/C"]
["TIPO DE EXPERIENCIA SEXUAL",null,null,null,null,null,null,null,null,null,"NO",null,null,null,null,"VAGINAL",null,null,null,null,"ORAL",null,null,null,null,"ANAL",null,null,null,"N/C",null,null,"VIOLENCIA SEXUAL",null,null,null,null,"SI",null,null,"NO",null,null,"N/C",null,null,"EDAD AGRESOR",null,null,null,null,null,null,"N/C",null,null,"EDAD OCURRIÓ VIOLENCIA",null,null,null,null,null,null,null,null,"N/C"]
["TIEMPO DE\nVIOLENCIA",null,null,null,null,null,null,null,null,null,null,null,null,"A",null,null,"M",null,null,"D",null,null,"N/C",null,null,"TRATAMIENTO\nPROFILÁCTICO",null,null,null,null,null,null,null,null,null,null,null,null,"SI",null,null,"NO",null,null,"N/C",null,null,"TRATAMIENTO\nPSICOLÓGICO",null,null,null,null,null,null,null,null,null,null,null,"SI",null,null,"NO",null,null,"N/C"]
["OBSERVACIONES:"]
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["C. MÉTODOS ANTICONCEPTIVOS"]
["EMBARAZO CON USO DE \nMÉTODOS ANTICONCEPTIVOS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HISTORIA ANTICONCEPTIVA"]
["SI",null,null,"NO",null,null,"CUAL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"GESTÁGENO ORAL",null,null,null,null,null,"GESTÁGENO DEPÓSITO",null,null,null,null,null,"DIU",null,null,"OTROS",null,null,null,"TIEMPO DE USO",null,null,null,null,null,null,"CAUSA ABANDONO"]
["USO ACTUÁL DE\nALGÚN MÉTODO"]
["SI",null,null,"NO",null,null,"CUAL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TIEMPO DE USO",null,null,null,null,null,null,null,null,null,null,null,"OBSERVACIÓN."]
["BENEFICIARIO DEL MÉTODO",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,"ADOPCIÓN MÉTODO ACTUAL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CRITERIO DE ELEGIBILIDAD"]
["MUJER EN EDAD FÉRTIL",null,null,null,null,null,null,null,null,null,null,"MADRE LACTANTE",null,null,null,null,null,null,null,null,"HOMBRE",null,null,null,null,null,"GESTÁGENO ORAL",null,null,null,null,null,null,"GESTÁGENO DEPÓSITO",null,null,null,null,"DIU",null,null,null,"OTROS",null,null,null,null,"FECHA DE INICIO"]
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["SNS-MSP/HCU-form.052/2021",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,"PLANIFICACIÓN FAMILIAR (1)"]

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57,63,57,64],[57,65,57,66],[56,35,56,58],[54,30,54,31],[41,60,41,64],[50,24,50,25],[54,32,54,33],[54,0,54,16],[54,17,54,25],[55,35,55,58],[50,54,50,55],[43,26,43,27],[43,28,43,31],[33,45,33,54],[34,45,34,48],[41,21,41,25],[41,26,41,27],[33,0,33,12],[41,15,41,18],[34,10,34,12],[40,28,40,40],[51,0,51,66],[41,65,41,66],[43,0,43,3],[42,0,42,14],[33,34,33,44],[45,8,45,66],[44,0,45,7],[41,58,41,59],[40,0,40,14],[50,8,50,13],[49,16,49,23],[50,16,50,23],[49,56,49,64],[50,56,50,64],[50,14,50,15],[50,46,50,53],[77,40,77,66],[75,0,75,8],[75,9,75,15],[75,16,75,35],[75,36,75,52],[75,53,75,66],[78,16,78,39],[78,40,78,66],[74,0,74,66],[76,0,76,8],[76,9,76,15],[76,16,76,35],[76,36,76,52],[76,53,76,66],[77,0,77,15],[77,16,77,39],[78,0,78,15]]}
["D. CONTROLES"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"PRIMERA",null,null,null,null,"SUBSECUENTE",null,null,null,null,null,null,"SUBSECUENTE",null,null,null,null,null,null,"SUBSECUENTE",null,null,null,null,null,null,"SUBSECUENTE",null,null,null,null,null,null,"SUBSECUENTE",null,null,null,null,null,null,"SUBSECUENTE",null,null,null,null,null,null,"SUBSECUENTE"]
["FECHA"]
["PRESION ARTERIAL"]
["PESO / Kg"]
["SANGRE INTERMENSTRUAL"]
["FLUJO GENITAL"]
["MAMAS (PALPACIÓN)"]
["ÚLTIMA MENSTRUACIÓN",null,null,null,null,null,null,null,"FECHA"]
[null,null,null,null,null,null,null,null,"DURACIÓN"]
[null,null,null,null,null,null,null,null,"CANTIDAD"]
["EVOLUCIÓN DIU",null,null,null,null,null,null,null,"HILO"]
[null,null,null,null,null,null,null,null,"EXPULSIÓN"]
[null,null,null,null,null,null,null,null,"RETIRO"]
[null,null,null,null,null,null,null,null,"REINSERCIÓN"]
["CAUSA ABANDONO MÉTODO",null,null,null,null,null,null,null,"SALUD"]
[null,null,null,null,null,null,null,null,"PERSONALES"]
[null,null,null,null,null,null,null,null,"DESEA HIJO"]
[null,null,null,null,null,null,null,null,"EMBARAZO"]
["MOLESTIAS SECUNDARIAS"]
["CAMBIO DE MÉTODO"]
["NOMBRE EXAMINADOR"]
[]
["E. INFECCIONES DE TRANSMISIÓN SEXUAL - ITS"]
["TIENE O HA TENIDO\n ALGUNA",null,null,null,null,null,null,null,null,null,null,null,null,"SI",null,null,null,"NO",null,null,null,"CUAL",null,null,null,null,null,null,null,null,null,null,null,null,"TRATAMIENTO",null,null,null,null,null,null,null,null,null,null,null,"SI",null,null,null,"NO",null,null,null,"CUAL"]
["OBSERVACIONES:"]
[]
[]
["F. FECUNDIDAD"]
["NÚMERO EMBARAZOS",null,null,null,null,null,null,null,null,"NÚMERO PARTOS",null,null,null,null,null,null,null,null,"NÚMERO CESÁREAS",null,null,null,null,null,null,null,null,"NÚMERO ABORTOS",null,null,null,null,null,null,null,null,"EMBARAZOS ECTÓPICOS",null,null,null,null,null,null,null,null,"NÚMERO NACIDOS VIVOS",null,null,null,null,null,null,null,null,null,null,"NÚMERO NACIDOS MUERTOS"]
["FECHA ULTIMA GESTACIÓN",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"LACTANCIA ANTERIOR",null,null,null,null,null,null,null,null,"SI",null,null,null,"NO",null,null,null,"LACTANCIA ACTUAL",null,null,null,null,null,null,null,null,"SI",null,null,null,"NO",null,null,null,"LACTANCIA MÁXIMA EN MESES"]
[]
["G. EXÁMEN FÍSICO GENITALES FEMENINOS"]
["TANNER",null,null,null,null,null,null,null,null,null,null,null,null,"EXAMEN MAMARIO",null,null,null,null,null,null,null,null,null,null,"VULVA",null,null,null,null,null,null,null,null,null,"CLITORIS",null,null,null,null,null,null,null,null,null,null,"VAGINA",null,null,null,null,null,null,null,null,null,"CUELLO UTERINO"]
["MAMAS",null,null,null,null,null,null,"VELLO",null,null,null,null,null,"NORMAL",null,null,null,null,"ANORMAL",null,null,null,null,null,"NORMAL",null,null,null,null,"ANORMAL",null,null,null,null,"NORMAL",null,null,null,null,"ANORMAL",null,null,null,null,null,"NORMAL",null,null,null,null,"ANORMAL",null,null,null,null,"NORMAL",null,null,null,null,null,"ANORMAL"]
["OBSERVACIONES:"]
[]
[]
[]
["H. EXÁMEN FÍSICO GENITALES MASCULINOS"]
["TANNER",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"EXAMEN MAMARIO",null,null,null,null,null,null,null,null,null,null,null,null,"CUERPO PENE",null,null,null,null,null,null,null,null,null,null,null,null,"GLANDE",null,null,null,null,null,null,null,null,null,null,null,null,"PREPUCIO"]
["GENITALES",null,null,null,null,null,null,null,"VELLO",null,null,null,null,null,null,"NORMAL",null,null,null,null,null,"ANORMAL",null,null,null,null,null,null,"NORMAL",null,null,null,null,null,"ANORMAL",null,null,null,null,null,null,"NORMAL",null,null,null,null,null,"ANORMAL",null,null,null,null,null,null,"NORMAL",null,null,null,null,null,"ANORMAL"]
["ESCROTO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TESTÍCULO DERECHO",null,null,null,null,null,null,null,null,null,null,null,null,"TESTÍCULO IZQUIERDO"]
["NORMAL",null,null,null,null,null,null,null,"ANORMAL",null,null,null,null,null,null,"NORMAL",null,null,null,null,null,"ANORMAL",null,null,null,null,null,null,"NORMAL",null,null,null,null,null,"ANORMAL"]
["OBSERVACIONES:"]
[]
[]
[]
["I. EXÁMENES COMPLEMENTARIOS"]
["HEMOGRAMA",null,null,null,null,null,null,null,"GLICEMIA",null,null,null,null,null,null,null,"PERFIL HORMONAL",null,null,null,null,null,null,null,null,null,"EMO",null,null,null,null,null,null,null,null,null,null,"TORCH",null,null,null,null,null,null,null,null,"VRDL",null,null,null,null,null,null,null,null,null,"HIV"]
["HEPATITIS",null,null,null,null,null,null,null,"HPV",null,null,null,null,null,null,null,"CITOLOGÍA VAGINAL",null,null,null,null,null,null,null,null,null,"COLPOSCOPIA",null,null,null,null,null,null,null,null,null,null,"ECO",null,null,null,null,null,null,null,null,"MAMOGRAFÍA",null,null,null,null,null,null,null,null,null,"OTROS"]
[]
[]
[]
["J. DIAGNÓSTICO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PRE= PRESUNTIVO                     DEF= DEFINITIVO",null,null,null,null,null,null,null,null,"CIE",null,null,null,"PRE",null,"DEF",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,"PRE",null,"DEF"]
["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,null,"4."]
["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,null,"5."]
["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,null,"6."]
[]
["K. PLANES DE TRATAMIENTO",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,"REGISTRAR LOS PLANES:  DIAGNOSTICO, TERAPÉUTICO Y EDUCACIONAL"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["CARNET CEMA",null,null,null,null,null,null,"SI",null,null,null,null,"NO"]
["OBSERVACIONES"]
[]
[]
["L. DATOS DEL PROFESIONAL RESPONSABLE"]
["FECHA\n(aaaa-mm-dd)",null,null,null,null,null,null,null,null,"HORA\n(hh:mm)",null,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,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,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,null,"SELLO"]
[]
[]
["SNS-MSP/HCU-form.052/2021",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,"PLANIFICACIÓN FAMILIAR (2)"]