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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,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"]
[]
["PRIMER APELLIDO",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,null,"PRIMER NOMBRE",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,null,"SEXO",null,null,null,"EDAD (AÑOS)"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["ACOMPAÑANTE",null,null,null,null,null,null,null,null,null,null,"NO",null,null,null,null,"PAREJA",null,null,null,null,null,"MADRE",null,null,null,null,null,"PADRE",null,null,null,null,null,"AMIGO/A",null,null,null,null,null,"PARIENTE",null,null,null,null,null,"OTROS"]
[]
["B. ATENCIÓN MÉDICA"]
["MOTIVO DE CONSULTA (según adolescente)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MOTIVO DE CONSULTA (según acompañante)"]
[]
[]
[]
[]
["C. ENFERMEDAD ACTUAL"]
[]
[]
[]
[]
[]
["D. ANTECEDENTES PATOLÓGICOS Y PERSONALES",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"N/C: NO CONOCE"]
["PERINATALES NORMALES",null,null,null,null,null,null,null,null,"CRECIMIENTO NORMAL",null,null,null,null,null,null,null,null,null,"DESARROLLO NORMAL",null,null,null,null,null,null,null,null,null,"VACUNAS COMPLETAS",null,null,null,null,null,null,null,null,null,"ENFERMEDADES CRÓNICAS",null,null,null,null,null,null,null,null,null,"ENFERMEDADES INFECTO CONTAGIOSAS",null,null,null,null,null,null,null,null,null,"TRASTORNO PSICOLÓGICO"]
["SI",null,null,"NO",null,null,"N/C",null,null,"SI",null,null,null,"NO",null,null,"N/C",null,null,"SI",null,null,null,"NO",null,null,"N/C",null,null,"SI",null,null,null,"NO",null,null,"N/C",null,null,"SI",null,null,null,"NO",null,null,"N/C",null,null,"SI",null,null,null,"NO",null,null,"N/C",null,null,"SI",null,null,"NO",null,null,"N/C"]
["USO DE MEDICINAS O SUSTANCIAS",null,null,null,null,null,null,null,null,"ACCIDENTES INTOXICACIÓN",null,null,null,null,null,null,null,null,null,"ALERGIAS",null,null,null,null,null,null,null,null,null,"INFECCIONES RECURRENTES",null,null,null,null,null,null,null,null,null,"CIRUGÍA / HOSPITALIZACIÓN",null,null,null,null,null,null,null,null,null,"PRESUNTA VIOLENCIA",null,null,null,null,null,null,null,null,null,"JUDICIALES"]
["SI",null,null,"NO",null,null,"N/C",null,null,"SI",null,null,null,"NO",null,null,"N/C",null,null,"SI",null,null,null,"NO",null,null,"N/C",null,null,"SI",null,null,null,"NO",null,null,"N/C",null,null,"SI",null,null,null,"NO",null,null,"N/C",null,null,"SI",null,null,null,"NO",null,null,"N/C",null,null,"SI",null,null,"NO",null,null,"N/C"]
["DESCRIBA"]
[]
[]
[]
[]
["E. ANTECEDENTES PATOLÓGICOS FAMILIARES"]
["DIABETES",null,null,null,null,null,null,null,null,null,null,null,null,null,"OBESIDAD",null,null,null,null,null,null,null,null,null,null,null,null,"ALERGIAS",null,null,null,null,null,null,null,null,null,null,null,null,null,"CARDIO\nVASCULARES",null,null,null,null,null,null,null,null,null,null,null,null,"CANCER"]
["SI",null,null,null,null,"NO",null,null,null,null,"N/C",null,null,null,"SI",null,null,null,null,"NO",null,null,null,null,"N/C",null,null,"SI",null,null,null,null,"NO",null,null,null,null,"N/C",null,null,null,"SI",null,null,null,null,"NO",null,null,null,null,"N/C",null,null,"SI",null,null,null,null,"NO",null,null,null,null,"N/C"]
["INFECCIONES",null,null,null,null,null,null,null,null,null,null,null,null,null,"ALCOHOL / DROGAS",null,null,null,null,null,null,null,null,null,null,null,null,"VIOLENCIA FAMILIAR",null,null,null,null,null,null,null,null,null,null,null,null,null,"MADRE / PADRE ADOLESCENTE",null,null,null,null,null,null,null,null,null,null,null,null,"JUDICIALES"]
["SI",null,null,null,null,"NO",null,null,null,null,"N/C",null,null,null,"SI",null,null,null,null,"NO",null,null,null,null,"N/C",null,null,"SI",null,null,null,null,"NO",null,null,null,null,"N/C",null,null,null,"SI",null,null,null,null,"NO",null,null,null,null,"N/C",null,null,"SI",null,null,null,null,"NO",null,null,null,null,"N/C"]
["DESCRIBA"]
[]
[]
[]
["F. DATOS ENTORNO FAMILIAR"]
["FAMILIA",null,null,null,null,null,null,null,null,null,"NIVEL DE INSTRUCCIÓN",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FAMILIOGRAMA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"VIVIENDA"]
["CONVIVE\nCON",null,null,null,null,null,"SI",null,"NO",null,"PADRE O\nSUSTITUTO",null,null,null,null,null,null,null,null,"MADRE O\nSUSTITUTA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ENERGÍA ELÉCTRICA",null,null,null,null,null,"SI",null,null,"NO"]
["MADRE",null,null,null,null,null,null,null,null,null,null,null,null,"ANALFABETO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"EN HOGAR",null,null,null,"FUERA HOGAR"]
["PADRE",null,null,null,null,null,null,null,null,null,null,null,null,"INICIAL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"AGUA"]
["MADRASTRA",null,null,null,null,null,null,null,null,null,null,null,null,"BÁSICA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"EXCRETAS"]
["PADRASTRO",null,null,null,null,null,null,null,null,null,null,null,null,"BACHILLERATO"]
["HERMANOS",null,null,null,null,null,null,null,null,null,null,null,null,"TÉCNICO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NÚMERO DE CUARTOS PARA DORMIR"]
["PAREJA",null,null,null,null,null,null,null,null,null,null,null,null,"TÉRCER NIVEL"]
["HIJO/A",null,null,null,null,null,null,null,null,null,null,null,null,"CUARTO NIVEL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NÚMERO DE PERSONAS QUE HABITAN"]
["SOLO",null,null,null,null,null,null,null,null,null,"TRABAJO"]
["OTROS",null,null,null,null,null,null,null,null,null,"PADRE O\nSUSTITUTO",null,null,null,null,null,null,null,null,"MADRE O\nSUSTITUTA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"COMPARTE CAMA"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"NINGUNO"]
["VIVE",null,null,null,null,null,"SI",null,"NO",null,null,null,null,"ESTABLE"]
["EN INSTITUCIÓN",null,null,null,null,null,null,null,null,null,null,null,null,"NO ESTABLE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"OBSERVACIONES:"]
["EN LA CALLE",null,null,null,null,null,null,null,null,null,"ESPECIFIQUE:"]
["CASA",null,null,null,null,null,null,null,null,null,"PERCEPCIÓN FAMILIAR DEL ADOLESCENTE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"OBSERVACIONES:"]
[null,null,null,null,null,null,null,null,null,null,"BUENA",null,null,null,"REGULAR",null,null,null,null,"MALA",null,null,null,"NO HAY"]
[]
["SNS-MSP/HCU-form.056/2021",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,"ATENCIÓN ADOLESCENTES (1)"]

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["G. DATOS SOBRE LA EDUCACIÓN"]
["ESTUDIA",null,null,null,null,null,"NOMBRE INSTITUCIÓN EDUCATIVA",null,null,null,null,null,null,null,null,null,null,null,"NIVEL EN CURSO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"GRADO / CURSO",null,null,null,"PRESUNTA VIOLENCIA / ABUSO ESCOLAR",null,null,null,null,null,null,null,null,"AÑOS REPETIDOS",null,null,null,null,null,null,null,null,"DESERCIÓN / EXCLUSIÓN",null,null,null,null,null,"SI",null,null,"NO"]
["SI",null,null,"NO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"NINGUNO",null,null,null,null,null,null,null,null,"BACHILLERATO",null,null,null,null,null,null,null,null,null,null,"SI",null,null,null,"NO",null,null,null,null,"CAUSAS",null,null,null,null,null,null,null,null,"CAUSAS"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BÁSICO",null,null,null,null,null,null,null,null,"TERCER NIVEL"]
["OBSERVACIONES:"]
[]
["H. DATOS SOBRE EL TRABAJO"]
["ACTIVIDAD",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"EDAD INICIO TRABAJO",null,null,null,null,null,"TRABAJO",null,null,null,null,null,"HORAS DE TRABAJO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"RAZÓN DEL TRABAJO",null,null,null,null,null,null,null,null,null,"TRABAJO\nLEGALIZADO",null,null,null,null,null,null,"TRABAJO\nINSALUBRE"]
["TRABAJA",null,null,null,null,null,null,null,null,"BUSCA POR PRIMERA VEZ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MAÑANA",null,null,null,null,"FIN DE SEMANA",null,null,null,null,"NOCHE",null,null,null,null,"ECONÓMICA",null,null,null,null,null,"ME GUSTA",null,null,null,"SI",null,null,"N/C",null,null,null,"SI",null,null,"N/C"]
["NO Y NO BUSCA",null,null,null,null,null,null,null,null,"DESOCUPADO",null,null,null,null,null,null,null,"AÑOS",null,null,null,null,null,"HORAS POR SEMANA",null,null,null,null,null,"TARDE",null,null,null,null,"TODO EL DIA",null,null,null,null,"N/C",null,null,null,null,"AUTONOMÍA",null,null,null,null,null,"N/C",null,null,null,"NO",null,null,null,null,null,null,"NO"]
["OBSERVACIONES:"]
[]
["I. DATOS SOBRE VIDA SOCIAL"]
["ACEPTACIÓN",null,null,null,null,null,null,null,null,null,null,null,"PAREJA",null,null,null,"AMIGOS",null,null,null,"ACTIVIDAD GRUPAL",null,null,null,null,"DEPORTE",null,null,null,null,"TELEVISIÓN",null,null,null,null,null," COMPUTADOR",null,null,null,null,null,null,"REDES SOCIALES",null,null,null,null,"CELULAR",null,null,null,null,"VIDEOJUEGO",null,null,null,null,null,"OTRAS ACTIVIDADES"]
["ACEPTADO",null,null,null,null,null,"RECHAZADO",null,null,null,null,null,"SI",null,null,null,"SI",null,null,null,"SI",null,null,null,null,"SI",null,null,null,null,"SI",null,null,null,null,null,"SI",null,null,null,null,null,null,"SI",null,null,null,null,"SI",null,null,null,null,"SI",null,null,null,null,null,"SI",null,null,"CUALES"]
["IGNORADO",null,null,null,null,null,"NO CONOCE",null,null,null,null,null,"NO",null,null,null,"NO",null,null,null,"NO",null,null,null,null,"NO",null,null,null,null,"NO",null,null,null,null,null,"NO",null,null,null,null,null,null,"NO",null,null,null,null,"NO",null,null,null,null,"NO",null,null,null,null,null,"NO"]
["HORAS POR DIA"]
["OBSERVACIONES:"]
[]
["J. HÁBITOS"]
["HORAS DE SUEÑO",null,null,null,null,null,null,null,"ALIMENTACIÓN SALUDABLE",null,null,null,null,null,null,"COMIDAS POR DIA CON LA FAMILIA",null,null,null,null,null,null,"TABACO",null,null,null,null,null,null,null,null,"EDAD INICIO TABACO",null,null,null,null,"ALCOHOL",null,null,null,null,"EDAD INICIO ALCOHOL",null,null,null,null,null,"OTRAS SUSTANCIAS",null,null,null,null,null,null,null,null,null,null,null,null,"CONDUCE VEHÍCULO"]
["MENOS 8 HORAS",null,null,null,null,null,null,null,"SI",null,null,null,null,null,null,"SI",null,null,"CUANTAS",null,null,null,"SI",null,null,"CUANTOS",null,null,null,null,null,"AÑOS",null,null,null,null,"SI",null,null,null,null,"AÑOS",null,null,null,null,null,"SI",null,null,"CUAL",null,null,null,null,null,null,null,null,null,"SI",null,null,null,null,"CUAL"]
["MAS 8 HORAS",null,null,null,null,null,null,null,"NO",null,null,null,null,null,null,"NO",null,null,null,null,null,null,"NO",null,null,"FRECUENCIA",null,null,null,null,null,null,null,null,null,null,"NO",null,null,null,null,"FRECUENCIA",null,null,null,null,null,"NO",null,null,"FRECUENCIA",null,null,null,null,null,null,null,null,null,"NO"]
["OBSERVACIONES:"]
[]
["K. ANTECEDENTES GINECO-UROLÓGICO"]
["MENARQUIA / ESPERMARQUIA",null,null,null,null,null,null,"FECHA ÚLTIMA MENSTRUACIÓN",null,null,null,null,null,null,null,null,null,null,null,"CICLOS REGULARES",null,null,null,null,null,"DISMENORREA",null,null,null,null,null,null,"SECRECIÓN GENITAL",null,null,null,null,null,null,null,null,null,"INFECCIONES DE TRANSMISIÓN SEXUAL",null,null,null,null,null,null,null,null,null,null,"OTROS"]
["EDAD",null,null,null,null,null,null,"NO CONOCE","SI",null,null,null,"NO CORRESPONDE",null,null,null,null,null,null,"SI",null,null,"N/C",null,null,"SI",null,null,null,"N/C",null,null,"SI",null,null,null,null,null,null,null,null,null,"SI",null,null,"ESPECIFIQUE",null,null,null,null,null,null,null,"EMBARAZOS",null,null,null,null,null,"PARTOS",null,null,null,"CESÁREAS"]
["NO CONOCE",null,null,null,null,null,null,"AÑO",null,null,null,"MES",null,null,null,"DIA",null,null,null,"NO",null,null,null,null,null,"NO",null,null,null,null,null,null,"NO",null,null,null,null,null,null,null,null,null,"NO",null,null,null,null,null,null,null,null,null,null,"ABORTOS",null,null,null,null,null,"HIJOS VIVOS",null,null,null,"HIJOS MUERTOS"]
["OBSERVACIONES:"]
[]
["L. SEXUALIDAD"]
["NECESITA ASESORÍA",null,null,null,null,"TIPO RELACIONES SEXUALES",null,null,null,null,null,null,null,null,null,null,null,null,null,"PAREJA ACTUAL",null,null,null,null,null,null,"EDAD INICIO RELACIONES SEXUALES",null,null,null,null,null,null,null,null,null,null,"DISFUNCIÓN SEXUAL",null,null,null,null,null,"MÉTODO ANTICONCEPTIVO",null,null,null,null,null,null,null,null,null,"APOYO DE PAREJA",null,null,null,null,null,null,null,null,"PRESUNTA VIOLENCIA SEXUAL"]
["SI",null,null,null,null,"NO",null,null,null,null,null,"HOMOSEXUAL",null,null,null,null,null,null,null,"ÚNICA",null,null,null,"N/C",null,null,"AÑOS",null,null,"VOLUNTARIAS",null,null,null,null,null,null,null,"SI",null,null,null,"N/C",null,"SI",null,null,null,"NO",null,null,null,null,null,"SIEMPRE",null,null,null,null,null,"NUNCA",null,null,"SI",null,null,null,"N/C"]
["NO",null,null,null,null,"BISEXUAL",null,null,null,null,null,"HETEROSEXUAL",null,null,null,null,null,null,null,"VARIAS",null,null,null,null,null,null,null,null,null,"SI",null,"NO",null,null,"N/C",null,null,"NO",null,null,null,null,null,"CUAL",null,null,null,null,null,null,null,null,null,"A VECES",null,null,null,null,null,null,null,null,"NO"]
["OBSERVACIONES:"]
[]
["M. SITUACIÓN PSICOEMOCIONAL"]
["IMAGEN CORPORAL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ESTADO DE ÁNIMO (SALUD MENTAL)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"REFERENTE PERSONAL",null,null,null,null,null,null,null,null,null,null,null,null,null,"PROYECTO DE VIDA"]
["CONFORME",null,null,null,null,null,null,null,"IMPIDE RELACIÓN CON DEMÁS",null,null,null,null,null,null,"BUENO",null,null,null,null,"TRISTE",null,null,null,null,"NERVIOSO",null,null,null,null,null,"MADRE",null,null,null,"OTRO FAMILIAR",null,null,null,null,null,"NINGUNO",null,null,null,"CLARO",null,null,null,null,null,"NINGUNO"]
["CREA PREOCUPACIÓN",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ALEGRE",null,null,null,null,"MUY TÍMIDO",null,null,null,null,"OTRO",null,null,null,null,null,"PADRE",null,null,null,"FUERA DEL HOGAR",null,null,null,null,null,null,null,null,null,"CONFUSO"]
["OBSERVACIONES:"]
[]
["N. CONSTANTES VITALES Y ANTROPOMETRÍA"]
["TEMPERATURA (ºC)",null,null,null,null,null,null,null,"PRESIÓN ARTERIAL (mmHg)",null,null,null,null,null,null,null,"PULSO /  min",null,null,null,null,null,null,"FRECUENCIA RESPIRATORIA / min",null,null,null,null,null,null,null,null,"PESO (Kg)",null,null,null,null,null,null,"TALLA (cm)",null,null,null,null,null,null,"IMC (Kg/m2)",null,null,null,null,null,"PERÍMETRO CEFÁLICO (cm)",null,null,null,null,null,null,"PULSIOXIMETRIA (%)"]
[]
[]
["O. 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,"MARCAR \"X\"  CUANDO PRESENTE PATOLOGÍA Y DESCRIBA"]
["1. ASPECTO NORMAL",null,null,null,null,null,null,null,null,null,null,"4. AGUDEZA AUDITIVA",null,null,null,null,null,null,null,null,"7. TÓRAX Y MAMAS",null,null,null,null,null,null,null,null,null,null,null,"10. ABDOMEN",null,null,null,null,null,null,null,null,null,null,"13. MIEMBROS SUPERIORES",null,null,null,null,null,null,null,null,null,null,null,"16. TANNER"]
["2. PIEL Y FANERAS",null,null,null,null,null,null,null,null,null,null,"5. BOCA Y DIENTES",null,null,null,null,null,null,null,null,"8. CARDIO PULMONAR",null,null,null,null,null,null,null,null,null,null,null,"11. GENITO URINARIO",null,null,null,null,null,null,null,null,null,null,"14. MIEMBROS INFERIORES",null,null,null,null,null,null,null,null,null,null,null,"MAMAS",null,null,null,"GENITALES",null,null,null,null,"VELLO PÚBICO"]
["3. AGUDEZA VISUAL",null,null,null,null,null,null,null,null,null,null,"6. CUELLO Y TIROIDES",null,null,null,null,null,null,null,null,"9. COLUMNA VERTEBRAL",null,null,null,null,null,null,null,null,null,null,null,"12. ANO - RECTAL",null,null,null,null,null,null,null,null,null,null,"15. NEUROLÓGICO"]
["OBSERVACIONES:"]
[]
[]
["P. 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,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,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,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,null,"6."]
[]
["Q. PLAN 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,"DE DIAGNÓSTICO, TERAPÉUTICOS, EDUCACIONALES Y REHABILITACIÓN"]
[]
[]
[]
[]
[]
[]
[]
["R. 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,"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,null,"SEGUNDO APELLIDO"]
[]
["NÙMERO DE DOCUMENTO DE IDENTIFICACIÒN",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.056/2021",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,"ATENCIÓN ADOLESCENTES (2)"]