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["A. DATOS DEL ESTABLECIMIENTO Y USUARIO"]
["INSTITUCIÓN DEL SISTEMA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ESTABLECIMIENTO DE SALUD",null,null,null,null,null,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,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,null,null,null,"SEGUNDO NOMBRE",null,null,null,null,null,null,null,null,null,null,null,null,null,"SEXO",null,null,"EDAD (AÑOS)"]
[]
[]
[]
["B. ENTORNO SOCIAL"]
["VIVE SOLO",null,null,null,null,null,null,"VIVE ACOMPAÑADO",null,null,null,null,null,null,null,null,null,null,"CON QUIÈN",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"VIVE EN LA CALLE",null,null,null,null,null,null,null,null,null,null,"No. HIJOS VIVOS"]
["ESTADO CIVIL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"INSTITUCIONALIZADO",null,null,null,null,null,null,null,null,null,"NOMBRE"]
["TRABAJA",null,null,null,null,null,null,null,"JUBILADO",null,null,null,null,null,null,null,"RECIBE BONO",null,null,null,null,null,null,"OTROS INGRESOS"]
[]
["C. MOTIVO DE CONSULTA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PACIENTE",null,null,null,null,null,"CUIDADOR",null,null,null,null,null,"OTROS"]
[]
[]
[]
["D. ENFERMEDAD ACTUAL"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["E. ANTECEDENTES 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,"DESCRIBIR ANOTANDO EL NÚMERO"]
["ALERTAS DE RIESGO",null,null,null,null,null,"1. No. CAÍDAS EN UN AÑO",null,null,null,null,null,null,null,null,null,"2. No. CAÍDAS EN EL ÚLTIMO MES",null,null,null,null,null,null,null,null,null,"3. DISMOVILIDAD",null,null,null,null,null,null,null,null,"4. PÉRDIDA DE PESO",null,null,null,null,null,null,null,null,"5. ASTENIA",null,null,null,null,null,null,null,null,null,null,"6. PÈRDIDA DE APETITO"]
[null,null,null,null,null,null,"7. PROBLEMAS DE DEGLUCIÓN",null,null,null,null,null,null,null,null,null,"8. DESORIENTACIÓN",null,null,null,null,null,null,null,null,null,"9. PÉRDIDA DE MEMORIA",null,null,null,null,null,null,null,null,"10. ALTERACIONES DEL ÁNIMO",null,null,null,null,null,null,null,null,"11. ALTERACIONES DEL SUEÑO"]
["DESCRIBA:"]
[]
[]
[]
["GENERALES",null,null,null,null,null,"1. INMUNIZACIONES",null,null,null,null,null,null,null,null,null,null,null,null,"2. HIGIENE GENERAL",null,null,null,null,null,null,null,null,null,null,null,null,"3. HIGIENE ORAL",null,null,null,null,null,null,null,null,null,null,null,null,"4. EJERCICIO",null,null,null,null,null,null,null,null,null,"5. ALIMENTACIÓN"]
[null,null,null,null,null,null,"6. ACTIVIDAD RECREATIVA",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"7. CONTROLES DE SALUD",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"8. ALERGIAS",null,null,null,null,null,null,null,null,null,null,null,null,"9. OTROS"]
["DESCRIBA:"]
[]
["HÁBITOS NOCIVOS",null,null,null,null,null,"1. TABAQUISMO",null,null,null,null,null,null,null,null,null,"2. ALCOHOLISMO",null,null,null,null,null,null,null,null,null,"3. ADICCIONES",null,null,null,null,null,null,null,null,"4. OTRO HÁBITO"]
["DESCRIBA:"]
[]
["CLÍNICO QUIRÚRGICO",null,null,null,null,null,"1. DERMATOLÓGICOS",null,null,null,null,null,null,null,null,null,"2. VISUALES",null,null,null,null,null,null,null,null,null,"3. OTORRINO",null,null,null,null,null,null,null,null,"4. ODONTOLÓGICOS",null,null,null,null,null,null,null,null,"5. ENDÓCRINOS",null,null,null,null,null,null,null,null,null,null,"6. CARDIO VASCULARES"]
[null,null,null,null,null,null,"7. RESPIRATORIOS",null,null,null,null,null,null,null,null,null,"8. DIGESTIVOS",null,null,null,null,null,null,null,null,null,"9. NEUROLÓGICOS",null,null,null,null,null,null,null,null,"10. UROLÓGICOS",null,null,null,null,null,null,null,null,"11. HEMOLINFÁTICOS",null,null,null,null,null,null,null,null,null,null,"12. INFECCIOSOS"]
[null,null,null,null,null,null,"13. ONCOLÓGICOS",null,null,null,null,null,null,null,null,null,"14. MUSCULO ESQUELÉTICOS",null,null,null,null,null,null,null,null,null,"15. PSIQUIÁTRICOS",null,null,null,null,null,null,null,null,"16. GINECOLÓGICOS",null,null,null,null,null,null,null,null,"17. NEFROLÓGICOS",null,null,null,null,null,null,null,null,null,null,"18. HOSPITALIZACIÒN EN EL ÙLTIMO AÑO"]
["DESCRIBA:"]
[]
[]
[]
["GINECO OBSTÉTRICOS",null,null,null,null,null,null,"1. EDAD DE MENOPAUSIA",null,null,null,null,null,null,null,"2. EDAD DE ÚLTIMA MAMOGRAFÍA",null,null,null,null,null,null,null,null,null,"3. EDAD DE ÚLTIMA CITOLOGÍA",null,null,null,null,null,null,null,null,null,"4. EMBARAZOS",null,null,null,null,null,null,null,"5. PARTOS",null,null,null,null,null,null,"6. CESÁREAS",null,null,null,null,null,null,"7. TERAPIA HORMONAL"]
["DESCRIBA:"]
["ANDROLÓGICOS",null,null,null,null,null,null,null,null,"1. EDAD ULTIMO ANTÍGENO PROSTÁTICO",null,null,null,null,null,null,null,null,null,null,null,"2. TERAPIA HORMONAL"]
["DESCRIBA:"]
[]
["F. ANTECEDENTES FARMACOLÒGICOS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DESCRIBIR ANOTANDO EL NÚMERO"]
["1. AINES",null,null,null,null,null,null,null,"2. ANALGÉSICOS",null,null,null,null,null,null,null,null,"3. ANTI DIABÉTICOS",null,null,null,null,null,null,null,null,null,"4. ANTI HIPERTENSIVOS",null,null,null,null,null,null,null,null,null,null,"5. ANTICOAGULANTES",null,null,null,null,null,null,null,null,null,null,"6. PSICO FÁRMACOS",null,null,null,null,null,null,null,null,null,"7. ANTIBIÓTICOS"]
["8. OTROS",null,null,null,null,null,null,null,"9. AUTOMEDICACIÓN"]
["DESCRIBA:"]
[]
[]
[]
[]
[]
["G. ANTECEDENTES FAMILIARES"]
["1. CARDIOPATÍA",null,null,null,null,null,null,null,"2. DIABETES",null,null,null,"3. HIPERTENSIÓN ARTERIAL",null,null,null,null,null,"4. \nNEOPLASIA",null,null,null,null,null,"5. ALZHEIMER",null,null,null,null,null,"6, PARKINSON",null,null,null,null,"7. TUBERCULOSIS",null,null,null,null,null,null,null,"8,VIOLENCIA INTRAFAMILIAR",null,null,null,null,null,null,null,"9, SINDROME DEL CUIDADOR CANSADO",null,null,null,null,null,null,null,null,null,null,"10, OTROS"]
[]
[]
[]
[]
["H. SITUACIÓN FUNCIONAL"]
["ACTIVIDADES BÁSICAS DE LA VIDA DIARIA",null,null,null,null,null,null,null,null,null,null,"SI",null,"NO",null,"ACTIVIDADES BÁSICAS DE LA VIDA DIARIA",null,null,null,null,null,null,null,null,null,null,null,null,null,"SI",null,"NO",null,"ACTIVIDAD INSTRUMENTAL",null,null,null,null,null,null,null,null,null,null,null,null,"SI",null,"NO",null,"ACTIVIDAD INSTRUMENTAL",null,null,null,null,null,null,null,null,null,null,null,null,"SI",null,"NO"]
["SE BAÑA SOLO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CONTROLA ESFÌNTERES",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"USA EL TELÈFONO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PREPARA LA COMIDA"]
["SE VISTE Y DESVISTE SOLO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SE TRASLADA, SE ACUESTA, SE LEVANTA SOLO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"USA MEDIOS DE TRANSPORTE",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CONTROLA SUS MEDICAMENTOS"]
["CUIDA SU APARIENCIA PERSONAL SOLO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"CAMINA SOLO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"VA DE COMPRAS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"MANEJA DINERO"]
["UTILIZA EL INODORO SOLO",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"SE ALIMENTA SOLO"]
[]
["SNS-MSP/HCU-form.057/2021",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 AL ADULTO MAYOR (1)"]

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["I. CONSTANTES VITALES Y ANTROPOMETRÍA"]
["PRESIÓN ARTERIAL ACOSTADO",null,null,null,null,"PRESIÓN ARTERIAL SENTADO",null,null,null,null,"PULSI OXIMETRIA",null,null,null,null,null,"TEMPERATURA",null,null,null,null,null,null,"PULSO / min",null,null,null,"FRECUENCIA RESPIRATORIA",null,null,null,null,null,"PESO\nkg",null,null,null,"TALLA\ncm",null,null,null,"IMC",null,null,null,null,"PERÍMETRO ABDOMINAL",null,null,null,null,null,null,"PERÍMETRO BRAQUIAL",null,null,null,null,null,"PERÍMETRO PANTORRILLA"]
[]
[]
["J. REVISIÓN ACTUAL DE ÓRGANOS Y SISTEMAS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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. VISIÓN",null,null,null,null,null,null,null,null,null,"3. OLFATO Y GUSTO",null,null,null,null,null,null,null,null,null,null,"5. CARDIOVASCULAR",null,null,null,null,null,null,null,null,null,null,"7. GENITOURINARIO",null,null,null,null,null,null,null,null,null,null,"9. ENDOCRINO",null,null,null,null,null,null,null,null,null,null,null,"11. NERVIOSO"]
["2. AUDICIÓN",null,null,null,null,null,null,null,null,null,"4. RESPIRATORIO",null,null,null,null,null,null,null,null,null,null,"6. DIGESTIVO",null,null,null,null,null,null,null,null,null,null,"8. MÚSCULO ESQUELÉTICO",null,null,null,null,null,null,null,null,null,null,"10. HEMO LINFÁTICO",null,null,null,null,null,null,null,null,null,null,null,"12. PIEL"]
[]
[]
[]
[]
["K. 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,null,null,null,null,null,"MARCAR \"X\"  CUANDO PRESENTE PATOLOGÍA Y DESCRIBA"]
["1. PIEL - ANEXOS",null,null,null,null,null,null,null,null,null,null,null,"4. OIDOS",null,null,null,null,null,null,null,null,null,null,null,null,"7. CUELLO",null,null,null,null,null,null,null,null,null,null,null,null,null,"10. ABDOMEN",null,null,null,null,null,null,null,null,null,null,null,null,null,"13. MIEMBROS SUPERIORES"]
["2. CABEZA",null,null,null,null,null,null,null,null,null,null,null,"5. BOCA",null,null,null,null,null,null,null,null,null,null,null,null,"8. AXILAS - MAMAS",null,null,null,null,null,null,null,null,null,null,null,null,null,"11. COLUMNA",null,null,null,null,null,null,null,null,null,null,null,null,null,"14. MIEMBROS INFERIORES"]
["3. OJOS",null,null,null,null,null,null,null,null,null,null,null,"6. NARIZ",null,null,null,null,null,null,null,null,null,null,null,null,"9. TÓRAX",null,null,null,null,null,null,null,null,null,null,null,null,null,"12. PELVIS",null,null,null,null,null,null,null,null,null,null,null,null,null,"15. NEUROLÓGICO"]
[]
[]
[]
[]
[]
[]
[]
[]
["L. DIAGNÓSTICOS",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PRE= PRESUNTIVO\nDEF= DEFINITIVO",null,null,null,null,null,null,null,null,null,"CIE",null,null,null,"PRE",null,"DEF",null,"SINDROMES GERIÁTRICOS"]
[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,null,null,null,null,null,null,null,null,null,null,"FRAGILIDAD",null,null,null,null,null,null,null,null,null,null,"DISMOVILIDAD"]
[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,null,null,null,null,null,null,null,null,null,null,"DEPRESIÓN",null,null,null,null,null,null,null,null,null,null,"CAÍDA"]
[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,null,null,null,null,null,null,null,null,null,null,"DELIRIUM",null,null,null,null,null,null,null,null,null,null,"MAL NUTRICIÓN"]
[4,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ÚLCERAS POR PRESIÓN",null,null,null,null,null,null,null,null,null,null,"DEMENCIA"]
[5,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"INCONTINENCIA",null,null,null,null,null,null,null,null,null,null,"SINDROME DEL CUIDADOR CANSADO"]
[6,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ESTREÑIMIENTO"]
[]
["M. PRUEBAS DIAGNÓSTICAS"]
[]
[]
[]
["N. TRATAMIENTO"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["O. DATOS DEL PROFESIONAL RESPONSABLE"]
["FECHA",null,null,null,null,null,null,null,null,null,"HORA",null,null,null,null,null,null,null,"NOMBRE Y APELLIDO DEL PROFESIONAL",null,null,null,null,null,null,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,"SELLO Y CÓDIGO"]
[]
["SNS-MSP / HCU-form.057/2021",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 AL ADULTO MAYOR (2)"]