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["ANEXO 1"]
[]
[]
[]
["    FORMATO ÚNICO DE ATENCIÓN - FUA"]
[{"$nulls":17},"        NÚMERO DE FORMATO",{"$nulls":25},"INSTITUCIÓN EDUCATIVA",{"$nulls":16},"CÓDIGO"]
[{"$nulls":17},230,{"$nulls":5},19,null,null,null,932488]
["AMBOS SEXOS",{"$nulls":42},"   INIC.",null,null," PRIM. ",null,null,null,"SEC.",{"$nulls":4},"SECCIÓN",{"$nulls":4},"TURNO"]
[]
["DE LA INSTITUCIÓN PRESTADORA DE SERVICIOS DE SALUD"]
["CÓDIGO RENAES DE LA IPRESS",{"$nulls":18},"NOMBRE  DE LA IPRESS QUE REALIZA LA ATENCIÓN"]
[]
["00006107",{"$nulls":18},"CS OLLANTAY"]
[]
["PERSONAL QUE ATIENDE",{"$nulls":18},"LUGAR DE \nATENCIÓN",{"$nulls":8},"ATENCIÓN",{"$nulls":9},"REFERENCIA REALIZADA POR"]
["DE LA IPRESS",{"$nulls":4},"x",null,null,"CÓDIGO DE LA OFERTA FLEXIBLE",{"$nulls":10},"INTRAMURAL",{"$nulls":8},"AMBULATORIA",{"$nulls":6},"x",null,null,"CÓD. RENAES ",{"$nulls":7},"NOMBRE DE LA IPRESS U OFERTA FLEXIBLE ",{"$nulls":14},"N° HOJA DE REFERENCIA"]
[]
["ITINERANTE ",{"$nulls":18},"EXTRAMURAL",{"$nulls":6},"X",null,"REFERENCIA"]
["OFERTA FLEXIBLE",{"$nulls":27},"EMERGENCIA"]
[]
["DEL ASEGURADO / USUARIO"]
["IDENTIFICACIÓN",{"$nulls":15},"CÓDIGO DEL ASEGURADO  SIS",{"$nulls":19},"ASEGURADO DE OTRA IAFAS"]
["TDI",null,"N° DOCUMENTO DE\n IDENTIDAD",{"$nulls":13},"DIRESA / OTROS",{"$nulls":5},"NÚMERO",{"$nulls":13},"INSTITUCIÓN"]
[]
[1,null,"75465855",{"$nulls":13},230,{"$nulls":5},2,null,null,"75465855",{"$nulls":10},"COD. SEGURO"]
[]
["APELLIDO PATERNO",{"$nulls":35},"APELLIDO MATERNO"]
["PEREZ",{"$nulls":35},"ROBLES"]
[]
["PRIMER NOMBRE",{"$nulls":35},"OTROS NOMBRES"]
["BRISET"]
[]
["SEXO",{"$nulls":7},"FECHA",{"$nulls":8},"DIA",{"$nulls":6},"MES",{"$nulls":5},"AÑO",{"$nulls":12},"N° DE HISTORIA CLÍNICA",{"$nulls":13},"ETNIA"]
[]
["MASCULINO",{"$nulls":7},"FECHA PROBABLE DE PARTO / FECHA DE PARTO ",{"$nulls":34},7645,{"$nulls":13},80]
["FEMENINO",null,null,null,"X"]
[]
["SALUD MATERNA",{"$nulls":7},"  FECHA DE NACIMIENTO ",{"$nulls":8},0,null,null,null,7,null,null,1,null,0,null,null,null,2,null,null,0,null,null,1,null,null,null,8,null,null," DNI / CNV / AFILIACIÓN DEL  RN  1"]
[]
[]
[]
["GESTANTE",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  2"]
[]
[]
[{"$nulls":8},"FECHA DE FALLECIMIENTO"]
[]
["PUERPERA",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  3"]
[]
["                                                                                                                                     DE LA ATENCIÓN"]
[]
["FECHA DE ATENCIÓN",{"$nulls":18},"HORA",{"$nulls":6},"UPS",{"$nulls":5},"CÓD. PRESTA.",null,null,null,"CÓD. PRESTACION(ES) ADICIONAL (ES)",{"$nulls":11},"HOSPITALIZACIÓN",null,null,"FECHA ",{"$nulls":5},"DIA",null,"MES",null,"AÑO"]
["DIA",null,"MES",null,null,null,"AÑO",{"$nulls":44},"DE INGRESO"]
[{"$nulls":19},9,null,null,null,":",30,{"$nulls":7},"060"]
[0,7,0,4,null,null,2,{"$nulls":4},0,null,1,null,9]
[]
[{"$nulls":51}," DE ALTA"]
[]
[]
[]
[]
["REPORTE VINCULADO",{"$nulls":10},"CÓD. AUTORIZACIÓN",{"$nulls":14},"N° FUA A VINCULAR",{"$nulls":24},"DE CORTE ADMINISTRATIVO"]
[]
[]
["CONCEPTO PRESTACIONAL"]
["ATENCIÓN DIRECTA",null,null,"X",null,null,"COB EXTRAORDINARIA ",{"$nulls":17},"CARTA DE GARANTIA",{"$nulls":12},"TRASLADO",{"$nulls":7},"SEPELIO"]
[{"$nulls":6},"Nº Autorización",{"$nulls":17},"Nº Autorización",{"$nulls":20},"NATIMUERTO",{"$nulls":10},"OBITO",{"$nulls":4},"OTRO"]
[{"$nulls":6},"Monto S/.",{"$nulls":17},"Monto S/."]
[]
["DEL DESTINO DEL ASEGURADO/USUARIO"]
["ALTA",null,"CITA",null,null,null,"X",{"$nulls":4},"HOSPITALIZACIÓN",{"$nulls":7},"REFERIDO",{"$nulls":29},"CONTRA\nRREFERIDO",{"$nulls":6},"FALLECIDO",{"$nulls":4},"CORTE ADMINIS."]
[{"$nulls":19},"EMERGENCIA",{"$nulls":7},"CONSULTA EXTERNA",{"$nulls":10},"APOYO AL\nDIAGNÓSTICO"]
[]
["SE REFIERE / CONTRARREFIERE A:"]
["CÓDIGO RENAES DE LA IPRESS",{"$nulls":12},"NOMBRE DE LA IPRESS A LA QUE SE REFIERE / CONTRARREFIERE",{"$nulls":41},"N° HOJA DE REFER / CONTRARR."]
[]
[]
["ACTIVIDADES PREVENTIVAS Y OTROS",{"$nulls":44},"VACUNAS N° DE DOSIS"]
["PESO (Kg)",{"$nulls":8},8.4,{"$nulls":4},"TALLA (cm)",{"$nulls":9},66.6,null,null,null,"P.A. (mmHg)",{"$nulls":16},"BCG",{"$nulls":8},"INFLUENZA",{"$nulls":5},"ANTIAMARILICA"]
["DE LA\n GESTANTE",{"$nulls":4},"DEL RECIEN NACIDO",{"$nulls":12},"GESTANTE / RN /  NIÑO / ADOLESCENTE / JOVEN Y ADULTO / ADULTO MAYOR",{"$nulls":19},"JOVEN Y ADULTO",{"$nulls":6},"DPT",{"$nulls":8},"PAROTID",{"$nulls":5},"ANTINEUMOC"]
["CPN (N°)",{"$nulls":4},"EDAD GEST RN (SEM)",{"$nulls":12},"CRED N°",{"$nulls":9},"PAB (cm)",{"$nulls":4},25,{"$nulls":4},"EVALUACIÓN INTEGRAL"]
[{"$nulls":45},"APO",{"$nulls":5},1,null,null,"RUBEOLA",{"$nulls":5},"ANTITETANICA"]
[]
["EDAD GEST ",{"$nulls":4},"APGAR",{"$nulls":5},"1°",null,"5°",{"$nulls":4},"R.N. PREMATURO",{"$nulls":7},"NO",null,"TAP/ EEDP o  \nTEPSI",{"$nulls":9},"ADULTO MAYOR",{"$nulls":6},"ASA",{"$nulls":8},"ROTAVIRUS",{"$nulls":5}," COMPLETAS PARA LA EDAD",null,null,"SI","NO"]
[{"$nulls":38},"VACAM"]
["ALTURA UTERINA ",{"$nulls":17},"BAJO PESO AL NACER",{"$nulls":7},"NO",null,"CONSEJERIA NUTRICIONAL",{"$nulls":5},"X",{"$nulls":10},"SPR",{"$nulls":8},"DT ADULTO (N° DOSIS)",{"$nulls":5},"VPH"]
[{"$nulls":45},"SR",{"$nulls":8},"IPV",{"$nulls":5},"OTRA VACUNA"]
["PARTO VERTICAL",{"$nulls":4},"Corte Tardío de Cordón (2 a 3 min)",{"$nulls":12},"ENFER. CONGENITA / SECUELA AL NACER",{"$nulls":9},"CONSEJERIA \n INTEGRAL",{"$nulls":9},"TAMIZAJE DE SALUD MENTAL",null,null,null,"PAT."]
[{"$nulls":42},"NOR.",null,null,"HVB",{"$nulls":8},"PENTAVAL",{"$nulls":5},"____________"]
[]
["CONTROL PUERP (N°)",{"$nulls":17},"N° FAMILIARES DE GEST / PUERP. CASA MAT.",{"$nulls":9},"IMC (Kg/M2)",{"$nulls":5},"22",{"$nulls":10},"GRUPO DE RIESGO HVB",{"$nulls":9},"GRUPO DE RIESGO HVB: 1. TRABAJADOR DE SALUD   2. TRABAJAD. SEXUALES   3. HSH   4. PRIVADO LIBERTAD   5. FF. AA.  6. POLICIA NACIONAL   7. ESTUDIANTES DE SALUD   8. POLITRANFUNDIDOS  9. DROGO DEPENDIENTES "]
[]
[]
["DIAGNÓSTICOS"]
["N°","DESCRIPCIÓN",{"$nulls":38},"INGRESO",{"$nulls":15},"EGRESO"]
[{"$nulls":40},"TIPO DE DX",{"$nulls":8},"CIE - 10",{"$nulls":6},"TIPO DE DX",{"$nulls":4},"CIE - 10"]
[1,"Problemas relacionados con la necesidad de asistencia domiciliaria y que ningun otro miembro del hogar puede proporcionar",{"$nulls":38},"P",null,"D",null,null,"R",null,null,null,"Z74.2",{"$nulls":6},"D",null,null,"R"]
[2,"OTRAS MEDIDAS PROFILACTICAS ESPECIFICADAS",{"$nulls":38},"P",null,"D",null,null,"R",null,null,null,"Z29.8",{"$nulls":6},"D",null,null,"R"]
[3,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[4,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[5,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[]
["N° DE DNI",{"$nulls":13},"NOMBRE DEL RESPONSABLE DE LA ATENCIÓN",{"$nulls":42},"N° DE COLEGIATURA"]
[94582702,{"$nulls":13},"MARIA FERNANDEZ PEREZ",{"$nulls":42},2258]
[]
["RESPONSABLE DE LA ATENCIÓN",{"$nulls":16},"ESPECIALIDAD",{"$nulls":28},"N° RNE",{"$nulls":10},"EGRESADO"]
["1. MÉDICO   2. FARMACEUTICO   3. CIRUJANO DENTISTA   4. BIÓLOGO  5. OBSTETRIZ   6. ENFERMERA  7. TRABAJADORA SOCIAL   8. PSICOLOGA  9.TECNOLOGO MEDICO    10.NUTRICION    11. TECNICO ENFERMERIA   12. AUXILIAR DE ENFERMERIA    13. OTRO"]
[]
[{"$nulls":33},"FIRMA"]
[]
[{"$nulls":33},"ASEGURADO"]
[]
[{"$nulls":33},"APODERADO"]
[]
[]
[]
[]
[{"$nulls":33}," APODERADO:"]
[{"$nulls":32},"    NOMBRES Y APELLIDOS "]
[]
[]
[null,null,"  FIRMA Y SELLO DEL RESPONSABLE DE LA ATENCIÓN ",{"$nulls":29},"   DNI  o CE DEL APODERADO:"]
[{"$nulls":60},"        HUELLA DIGITAL Asegurado\n              / Usuario /  Apoderado"]

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["ANEXO 1"]
[]
[]
[]
["    FORMATO ÚNICO DE ATENCIÓN - FUA"]
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[]
["DE LA INSTITUCIÓN PRESTADORA DE SERVICIOS DE SALUD"]
["CÓDIGO RENAES DE LA IPRESS",{"$nulls":18},"NOMBRE  DE LA IPRESS QUE REALIZA LA ATENCIÓN"]
[]
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["ITINERANTE ",{"$nulls":18},"EXTRAMURAL",{"$nulls":6},"X",null,"REFERENCIA"]
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[]
["DEL ASEGURADO / USUARIO"]
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["PRIMER NOMBRE",{"$nulls":35},"OTROS NOMBRES"]
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[]
[]
[]
["GESTANTE",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  2"]
[]
[]
[{"$nulls":8},"FECHA DE FALLECIMIENTO"]
[]
["PUERPERA",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  3"]
[]
["                                                                                                                                     DE LA ATENCIÓN"]
[]
["FECHA DE ATENCIÓN",{"$nulls":18},"HORA",{"$nulls":6},"UPS",{"$nulls":5},"CÓD. PRESTA.",null,null,null,"CÓD. PRESTACION(ES) ADICIONAL (ES)",{"$nulls":11},"HOSPITALIZACIÓN",null,null,"FECHA ",{"$nulls":5},"DIA",null,"MES",null,"AÑO"]
["DIA",null,"MES",null,null,null,"AÑO",{"$nulls":44},"DE INGRESO"]
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[]
[{"$nulls":51}," DE ALTA"]
[]
[]
[]
[]
["REPORTE VINCULADO",{"$nulls":10},"CÓD. AUTORIZACIÓN",{"$nulls":14},"N° FUA A VINCULAR",{"$nulls":24},"DE CORTE ADMINISTRATIVO"]
[]
[]
["CONCEPTO PRESTACIONAL"]
["ATENCIÓN DIRECTA",null,null,"X",null,null,"COB EXTRAORDINARIA ",{"$nulls":17},"CARTA DE GARANTIA",{"$nulls":12},"TRASLADO",{"$nulls":7},"SEPELIO"]
[{"$nulls":6},"Nº Autorización",{"$nulls":17},"Nº Autorización",{"$nulls":20},"NATIMUERTO",{"$nulls":10},"OBITO",{"$nulls":4},"OTRO"]
[{"$nulls":6},"Monto S/.",{"$nulls":17},"Monto S/."]
[]
["DEL DESTINO DEL ASEGURADO/USUARIO"]
["ALTA",null,"CITA",null,null,null,"X",{"$nulls":4},"HOSPITALIZACIÓN",{"$nulls":7},"REFERIDO",{"$nulls":29},"CONTRA\nRREFERIDO",{"$nulls":6},"FALLECIDO",{"$nulls":4},"CORTE ADMINIS."]
[{"$nulls":19},"EMERGENCIA",{"$nulls":7},"CONSULTA EXTERNA",{"$nulls":10},"APOYO AL\nDIAGNÓSTICO"]
[]
["SE REFIERE / CONTRARREFIERE A:"]
["CÓDIGO RENAES DE LA IPRESS",{"$nulls":12},"NOMBRE DE LA IPRESS A LA QUE SE REFIERE / CONTRARREFIERE",{"$nulls":41},"N° HOJA DE REFER / CONTRARR."]
[]
[]
["ACTIVIDADES PREVENTIVAS Y OTROS",{"$nulls":44},"VACUNAS N° DE DOSIS"]
["PESO (Kg)",{"$nulls":8},8.4,{"$nulls":4},"TALLA (cm)",{"$nulls":9},66.6,null,null,null,"P.A. (mmHg)",{"$nulls":16},"BCG",{"$nulls":8},"INFLUENZA",{"$nulls":5},"ANTIAMARILICA"]
["DE LA\n GESTANTE",{"$nulls":4},"DEL RECIEN NACIDO",{"$nulls":12},"GESTANTE / RN /  NIÑO / ADOLESCENTE / JOVEN Y ADULTO / ADULTO MAYOR",{"$nulls":19},"JOVEN Y ADULTO",{"$nulls":6},"DPT",{"$nulls":8},"PAROTID",{"$nulls":5},"ANTINEUMOC"]
["CPN (N°)",{"$nulls":4},"EDAD GEST RN (SEM)",{"$nulls":12},"CRED N°",{"$nulls":9},"PAB (cm)",{"$nulls":9},"EVALUACIÓN INTEGRAL"]
[{"$nulls":45},"APO",{"$nulls":8},"RUBEOLA",{"$nulls":5},"ANTITETANICA"]
[]
["EDAD GEST ",{"$nulls":4},"APGAR",{"$nulls":5},"1°",null,"5°",{"$nulls":4},"R.N. PREMATURO",{"$nulls":7},"NO",null,"TAP/ EEDP o  \nTEPSI",{"$nulls":9},"ADULTO MAYOR",{"$nulls":6},"ASA",{"$nulls":8},"ROTAVIRUS",{"$nulls":5}," COMPLETAS PARA LA EDAD",null,null,"SI","NO"]
[{"$nulls":38},"VACAM"]
["ALTURA UTERINA ",{"$nulls":17},"BAJO PESO AL NACER",{"$nulls":7},"NO",null,"CONSEJERIA NUTRICIONAL",{"$nulls":5},"X",{"$nulls":10},"SPR",{"$nulls":8},"DT ADULTO (N° DOSIS)",{"$nulls":5},"VPH"]
[{"$nulls":45},"SR",{"$nulls":8},"IPV",{"$nulls":5},"OTRA VACUNA"]
["PARTO VERTICAL",{"$nulls":4},"Corte Tardío de Cordón (2 a 3 min)",{"$nulls":12},"ENFER. CONGENITA / SECUELA AL NACER",{"$nulls":9},"CONSEJERIA \n INTEGRAL",{"$nulls":9},"TAMIZAJE DE SALUD MENTAL",null,null,null,"PAT."]
[{"$nulls":42},"NOR.",null,null,"HVB",{"$nulls":8},"PENTAVAL",{"$nulls":5},"____________"]
[]
["CONTROL PUERP (N°)",{"$nulls":17},"N° FAMILIARES DE GEST / PUERP. CASA MAT.",{"$nulls":9},"IMC (Kg/M2)",{"$nulls":16},"GRUPO DE RIESGO HVB",{"$nulls":9},"GRUPO DE RIESGO HVB: 1. TRABAJADOR DE SALUD   2. TRABAJAD. SEXUALES   3. HSH   4. PRIVADO LIBERTAD   5. FF. AA.  6. POLICIA NACIONAL   7. ESTUDIANTES DE SALUD   8. POLITRANFUNDIDOS  9. DROGO DEPENDIENTES "]
[]
[]
["DIAGNÓSTICOS"]
["N°","DESCRIPCIÓN",{"$nulls":38},"INGRESO",{"$nulls":15},"EGRESO"]
[{"$nulls":40},"TIPO DE DX",{"$nulls":8},"CIE - 10",{"$nulls":6},"TIPO DE DX",{"$nulls":4},"CIE - 10"]
[1,"Problemas relacionados con la necesidad de asistencia domiciliaria y que ningun otro miembro del hogar puede proporcionar",{"$nulls":38},"P",null,"D",null,null,"R",null,null,null,"Z74.2",{"$nulls":6},"D",null,null,"R"]
[2,"ANEMIA",{"$nulls":38},"P",null,"D",null,null,"R",null,null,null,"D50.9",{"$nulls":6},"D",null,null,"R"]
[3,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[4,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[5,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[]
["N° DE DNI",{"$nulls":13},"NOMBRE DEL RESPONSABLE DE LA ATENCIÓN",{"$nulls":42},"N° DE COLEGIATURA"]
[9458270,{"$nulls":13},"MARIA FERNANDEZ PEREZ",{"$nulls":42},2258]
[]
["RESPONSABLE DE LA ATENCIÓN",{"$nulls":16},"ESPECIALIDAD",{"$nulls":28},"N° RNE",{"$nulls":10},"EGRESADO"]
["1. MÉDICO   2. FARMACEUTICO   3. CIRUJANO DENTISTA   4. BIÓLOGO  5. OBSTETRIZ   6. ENFERMERA  7. TRABAJADORA SOCIAL   8. PSICOLOGA  9.TECNOLOGO MEDICO    10.NUTRICION    11. TECNICO ENFERMERIA   12. AUXILIAR DE ENFERMERIA    13. OTRO"]
[]
[{"$nulls":33},"FIRMA"]
[]
[{"$nulls":33},"ASEGURADO"]
[]
[{"$nulls":33},"APODERADO"]
[]
[]
[]
[]
[{"$nulls":33}," APODERADO:"]
[{"$nulls":32},"    NOMBRES Y APELLIDOS "]
[]
[]
[null,null,"  FIRMA Y SELLO DEL RESPONSABLE DE LA ATENCIÓN ",{"$nulls":29},"   DNI  o CE DEL APODERADO:"]
[{"$nulls":60},"        HUELLA DIGITAL Asegurado\n              / Usuario /  Apoderado"]

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["PRODUCTOS FARMACEUTICOS / MEDICAMENTOS "]
["CÓDIGO SISMED",null,"NOMBRE",{"$nulls":7},"FF","CONCENTR","PRES","ENTR","DX","CÓD. \nSISMED",null,"NOMBRE",{"$nulls":6},"FF","CONCENTR","PRES","ENTR","DX"]
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["05986",null,"SULFAMETOXAZOL + TRIMETOPRIMA",{"$nulls":7},"SUS.","200mg+40 mg/5mL x 60 mL"]
["04582",null,"MEBENDAZOL",{"$nulls":7},"SUS.","100mg/5mLx\n30 mL"]
["05253",null,"OXITOCINA",{"$nulls":7},"INY","10 UI"]
["05309",null,"PARACETAMOL",{"$nulls":7},"JBE","120 mg/5 mL x 60 mL"]
["03513",null,"ACIDO FOLICO",{"$nulls":7},"TAB","500 ug"]
["S0001",null,"MULTIMICRONUTRIENTES",{"$nulls":7},"SB1","12.5 mg Fe"]
["03519",null,"SULFATO FERROSO",{"$nulls":7},"JBE","15mg Fe/5mL x 180 mL",1,1,1]
["03536",null,"SULFATO FERROSO",{"$nulls":7},"SOL","25mgFe/mL x 30 mL",1,1,1]
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["PROCEDIMIENTOS/ DIAGNÓSTICO POR IMÁGENES/ LABORATORIO"]
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[99403,null,"CONSEJERÍA NUTRICIONAL     ",{"$nulls":8},1,1,1,null,86701,null,"ELISA O PRUEBA RAPIDA HIV-1 Y HIV-2"]
["87177c",null,"TEST DE GRAHAM       ",{"$nulls":12},81005,null,"EXAMEN DE ORINA"]
[87177,null,"EXAMEN DE PARÁSITOS Y HUEVOS POR FROTIS DIRECTO (3 MUESTRAS) ",{"$nulls":12},99209,null,"ATENCION EN NUTRICION"]
[82947,null,"GLUCOSA BASAL"]
[82465,null,"COLESTEROL SERICO TOTAL"]
[84478,null,"TRIGLICERIDOS"]
[84152,null,"ANTIGENO PROSTATICO ESPECIFICO"]
[81005,null,"EXAMEN DE ORINA"]
[80061,null,"PERFIL LIPIDO(Colesterol total, HDL, LDL, VLDL, triglicéridos y lípidos totales)"]
[99402,null,"CONSEJERIA PLANIFICACION FAMILIAR"]
[90471,null,"ADMINISTRACION DE INMUNIZACION"]
["SUB COMPONENTE PRESTACIONAL (PROCEDIMIENTOS)"]
["CÓDIGO",null,"NOMBRE",{"$nulls":10},"CARACT",null,null,null,"IND/ PRES",null,null,"EJE/ ENTR",null,null,"DX",null,"RES","N°\nTICKET","PO"]
[]
[]
[]
[]
[]
[]
["OBSERVACIONES"]
{"$rows_empty":11}
[{"$nulls":12}," FIRMA  "]
[{"$nulls":12}," ASEGURADO "]
[{"$nulls":12}," APODERADO",null,"X"]
[]
[]
[]
[{"$nulls":12},"   APODERADO"]
[null,"Firma y Sello del Responsable de Procedimiento y/o Farmacia y/o Laboratorio",{"$nulls":10},"   NOMBRES Y APELLIDOS  ",{"$nulls":5},"XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX"]
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[{"$nulls":12},"   DNI o CE DEL APODERADO",{"$nulls":5},"XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX",{"$nulls":7},"Huella Digital del \nAsegurado o Apoderado\n"]

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["ANEXO 1"]
[]
[]
[]
["    FORMATO ÚNICO DE ATENCIÓN - FUA"]
[{"$nulls":17},"        NÚMERO DE FORMATO",{"$nulls":25},"INSTITUCIÓN EDUCATIVA",{"$nulls":16},"CÓDIGO"]
[{"$nulls":17},230,{"$nulls":5},19,null,null,null,932488]
["AMBOS SEXOS",{"$nulls":42},"   INIC.",null,null," PRIM. ",null,null,null,"SEC.",{"$nulls":4},"SECCIÓN",{"$nulls":4},"TURNO"]
[]
["DE LA INSTITUCIÓN PRESTADORA DE SERVICIOS DE SALUD"]
["CÓDIGO RENAES DE LA IPRESS",{"$nulls":18},"NOMBRE  DE LA IPRESS QUE REALIZA LA ATENCIÓN"]
[]
["00006107",{"$nulls":18},"CS OLLANTAY"]
[]
["PERSONAL QUE ATIENDE",{"$nulls":18},"LUGAR DE \nATENCIÓN",{"$nulls":8},"ATENCIÓN",{"$nulls":9},"REFERENCIA REALIZADA POR"]
["DE LA IPRESS",{"$nulls":4},"x",null,null,"CÓDIGO DE LA OFERTA FLEXIBLE",{"$nulls":10},"INTRAMURAL",{"$nulls":6},"x",null,"AMBULATORIA",{"$nulls":6},"x",null,null,"CÓD. RENAES ",{"$nulls":7},"NOMBRE DE LA IPRESS U OFERTA FLEXIBLE ",{"$nulls":14},"N° HOJA DE REFERENCIA"]
[]
["ITINERANTE ",{"$nulls":18},"EXTRAMURAL",{"$nulls":8},"REFERENCIA"]
["OFERTA FLEXIBLE",{"$nulls":27},"EMERGENCIA"]
[]
["DEL ASEGURADO / USUARIO"]
["IDENTIFICACIÓN",{"$nulls":15},"CÓDIGO DEL ASEGURADO  SIS",{"$nulls":19},"ASEGURADO DE OTRA IAFAS"]
["TDI",null,"N° DOCUMENTO DE\n IDENTIDAD",{"$nulls":13},"DIRESA / OTROS",{"$nulls":5},"NÚMERO",{"$nulls":13},"INSTITUCIÓN"]
[]
[1,null,"75465855",{"$nulls":13},230,{"$nulls":5},2,null,null,"75465855",{"$nulls":10},"COD. SEGURO"]
[]
["APELLIDO PATERNO",{"$nulls":35},"APELLIDO MATERNO"]
["PEREZ",{"$nulls":35},"ROBLES"]
[]
["PRIMER NOMBRE",{"$nulls":35},"OTROS NOMBRES"]
["BRISET"]
[]
["SEXO",{"$nulls":7},"FECHA",{"$nulls":8},"DIA",{"$nulls":6},"MES",{"$nulls":5},"AÑO",{"$nulls":12},"N° DE HISTORIA CLÍNICA",{"$nulls":13},"ETNIA"]
[]
["MASCULINO",{"$nulls":7},"FECHA PROBABLE DE PARTO / FECHA DE PARTO ",{"$nulls":34},7645,{"$nulls":13},80]
["FEMENINO",null,null,null,"X"]
[]
["SALUD MATERNA",{"$nulls":7},"  FECHA DE NACIMIENTO ",{"$nulls":8},0,null,null,null,7,null,null,1,null,0,null,null,null,2,null,null,0,null,null,1,null,null,null,8,null,null," DNI / CNV / AFILIACIÓN DEL  RN  1"]
[]
[]
[]
["GESTANTE",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  2"]
[]
[]
[{"$nulls":8},"FECHA DE FALLECIMIENTO"]
[]
["PUERPERA",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  3"]
[]
["                                                                                                                                     DE LA ATENCIÓN"]
[]
["FECHA DE ATENCIÓN",{"$nulls":18},"HORA",{"$nulls":6},"UPS",{"$nulls":5},"CÓD. PRESTA.",null,null,null,"CÓD. PRESTACION(ES) ADICIONAL (ES)",{"$nulls":11},"HOSPITALIZACIÓN",null,null,"FECHA ",{"$nulls":5},"DIA",null,"MES",null,"AÑO"]
["DIA",null,"MES",null,null,null,"AÑO",{"$nulls":44},"DE INGRESO"]
[{"$nulls":19},9,null,null,null,":",30,{"$nulls":7},"056"]
[0,7,0,4,null,null,2,{"$nulls":4},0,null,1,null,9]
[]
[{"$nulls":51}," DE ALTA"]
[]
[]
[]
[]
["REPORTE VINCULADO",{"$nulls":10},"CÓD. AUTORIZACIÓN",{"$nulls":14},"N° FUA A VINCULAR",{"$nulls":24},"DE CORTE ADMINISTRATIVO"]
[]
[]
["CONCEPTO PRESTACIONAL"]
["ATENCIÓN DIRECTA",null,null,"X",null,null,"COB EXTRAORDINARIA ",{"$nulls":17},"CARTA DE GARANTIA",{"$nulls":12},"TRASLADO",{"$nulls":7},"SEPELIO"]
[{"$nulls":6},"Nº Autorización",{"$nulls":17},"Nº Autorización",{"$nulls":20},"NATIMUERTO",{"$nulls":10},"OBITO",{"$nulls":4},"OTRO"]
[{"$nulls":6},"Monto S/.",{"$nulls":17},"Monto S/."]
[]
["DEL DESTINO DEL ASEGURADO/USUARIO"]
["ALTA",null,"CITA",null,null,null,"X",{"$nulls":4},"HOSPITALIZACIÓN",{"$nulls":7},"REFERIDO",{"$nulls":29},"CONTRA\nRREFERIDO",{"$nulls":6},"FALLECIDO",{"$nulls":4},"CORTE ADMINIS."]
[{"$nulls":19},"EMERGENCIA",{"$nulls":7},"CONSULTA EXTERNA",{"$nulls":10},"APOYO AL\nDIAGNÓSTICO"]
[]
["SE REFIERE / CONTRARREFIERE A:"]
["CÓDIGO RENAES DE LA IPRESS",{"$nulls":12},"NOMBRE DE LA IPRESS A LA QUE SE REFIERE / CONTRARREFIERE",{"$nulls":41},"N° HOJA DE REFER / CONTRARR."]
[]
[]
["ACTIVIDADES PREVENTIVAS Y OTROS",{"$nulls":44},"VACUNAS N° DE DOSIS"]
["PESO (Kg)",{"$nulls":8},8.4,{"$nulls":4},"TALLA (cm)",{"$nulls":9},66.6,null,null,null,"P.A. (mmHg)",{"$nulls":16},"BCG",{"$nulls":8},"INFLUENZA",{"$nulls":5},"ANTIAMARILICA"]
["DE LA\n GESTANTE",{"$nulls":4},"DEL RECIEN NACIDO",{"$nulls":12},"GESTANTE / RN /  NIÑO / ADOLESCENTE / JOVEN Y ADULTO / ADULTO MAYOR",{"$nulls":19},"JOVEN Y ADULTO",{"$nulls":6},"DPT",{"$nulls":8},"PAROTID",{"$nulls":5},"ANTINEUMOC"]
["CPN (N°)",{"$nulls":4},"EDAD GEST RN (SEM)",{"$nulls":12},"CRED N°",{"$nulls":9},"PAB (cm)",{"$nulls":9},"EVALUACIÓN INTEGRAL"]
[{"$nulls":45},"APO",{"$nulls":8},"RUBEOLA",{"$nulls":5},"ANTITETANICA"]
[]
["EDAD GEST ",{"$nulls":4},"APGAR",{"$nulls":5},"1°",null,"5°",{"$nulls":4},"R.N. PREMATURO",{"$nulls":7},"NO",null,"TAP/ EEDP o  \nTEPSI",{"$nulls":9},"ADULTO MAYOR",{"$nulls":6},"ASA",{"$nulls":8},"ROTAVIRUS",{"$nulls":5}," COMPLETAS PARA LA EDAD",null,null,"SI","NO"]
[{"$nulls":38},"VACAM"]
["ALTURA UTERINA ",{"$nulls":17},"BAJO PESO AL NACER",{"$nulls":7},"NO",null,"CONSEJERIA NUTRICIONAL",{"$nulls":5},"X",{"$nulls":10},"SPR",{"$nulls":8},"DT ADULTO (N° DOSIS)",{"$nulls":5},"VPH"]
[{"$nulls":45},"SR",{"$nulls":8},"IPV",{"$nulls":5},"OTRA VACUNA"]
["PARTO VERTICAL",{"$nulls":4},"Corte Tardío de Cordón (2 a 3 min)",{"$nulls":12},"ENFER. CONGENITA / SECUELA AL NACER",{"$nulls":9},"CONSEJERIA \n INTEGRAL",{"$nulls":9},"TAMIZAJE DE SALUD MENTAL",null,null,null,"PAT."]
[{"$nulls":42},"NOR.",null,null,"HVB",{"$nulls":8},"PENTAVAL",{"$nulls":5},"____________"]
[]
["CONTROL PUERP (N°)",{"$nulls":17},"N° FAMILIARES DE GEST / PUERP. CASA MAT.",{"$nulls":9},"IMC (Kg/M2)",{"$nulls":16},"GRUPO DE RIESGO HVB",{"$nulls":9},"GRUPO DE RIESGO HVB: 1. TRABAJADOR DE SALUD   2. TRABAJAD. SEXUALES   3. HSH   4. PRIVADO LIBERTAD   5. FF. AA.  6. POLICIA NACIONAL   7. ESTUDIANTES DE SALUD   8. POLITRANFUNDIDOS  9. DROGO DEPENDIENTES "]
[]
[]
["DIAGNÓSTICOS"]
["N°","DESCRIPCIÓN",{"$nulls":38},"INGRESO",{"$nulls":15},"EGRESO"]
[{"$nulls":40},"TIPO DE DX",{"$nulls":8},"CIE - 10",{"$nulls":6},"TIPO DE DX",{"$nulls":4},"CIE - 10"]
[1,"ANEMIA",{"$nulls":38},"P",null,"D",null,null,"R",null,null,null,"D50.9",{"$nulls":6},"D",null,null,"R"]
[2,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[3,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[4,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[5,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[]
["N° DE DNI",{"$nulls":13},"NOMBRE DEL RESPONSABLE DE LA ATENCIÓN",{"$nulls":42},"N° DE COLEGIATURA"]
[9458270,{"$nulls":13},"MARIA FERNANDEZ PEREZ",{"$nulls":42},2258]
[]
["RESPONSABLE DE LA ATENCIÓN",{"$nulls":13},1,null,null,"ESPECIALIDAD",{"$nulls":28},"N° RNE",{"$nulls":10},"EGRESADO"]
["1. MÉDICO   2. FARMACEUTICO   3. CIRUJANO DENTISTA   4. BIÓLOGO  5. OBSTETRIZ   6. ENFERMERA  7. TRABAJADORA SOCIAL   8. PSICOLOGA  9.TECNOLOGO MEDICO    10.NUTRICION    11. TECNICO ENFERMERIA   12. AUXILIAR DE ENFERMERIA    13. OTRO"]
[]
[{"$nulls":33},"FIRMA"]
[]
[{"$nulls":33},"ASEGURADO"]
[]
[{"$nulls":33},"APODERADO"]
[]
[]
[]
[]
[{"$nulls":33}," APODERADO:"]
[{"$nulls":32},"    NOMBRES Y APELLIDOS "]
[]
[]
[null,null,"  FIRMA Y SELLO DEL RESPONSABLE DE LA ATENCIÓN ",{"$nulls":29},"   DNI  o CE DEL APODERADO:"]
[{"$nulls":60},"        HUELLA DIGITAL Asegurado\n              / Usuario /  Apoderado"]

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["ANEXO 1"]
[]
[]
[]
["    FORMATO ÚNICO DE ATENCIÓN - FUA"]
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["DE LA INSTITUCIÓN PRESTADORA DE SERVICIOS DE SALUD"]
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[]
[]
[]
["GESTANTE",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  2"]
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[]
[{"$nulls":8},"FECHA DE FALLECIMIENTO"]
[]
["PUERPERA",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  3"]
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["                                                                                                                                     DE LA ATENCIÓN"]
[]
["FECHA DE ATENCIÓN",{"$nulls":18},"HORA",{"$nulls":6},"UPS",{"$nulls":5},"CÓD. PRESTA.",null,null,null,"CÓD. PRESTACION(ES) ADICIONAL (ES)",{"$nulls":11},"HOSPITALIZACIÓN",null,null,"FECHA ",{"$nulls":5},"DIA",null,"MES",null,"AÑO"]
["DIA",null,"MES",null,null,null,"AÑO",{"$nulls":44},"DE INGRESO"]
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[]
[{"$nulls":51}," DE ALTA"]
[]
[]
[]
[]
["REPORTE VINCULADO",{"$nulls":10},"CÓD. AUTORIZACIÓN",{"$nulls":14},"N° FUA A VINCULAR",{"$nulls":24},"DE CORTE ADMINISTRATIVO"]
[]
[]
["CONCEPTO PRESTACIONAL"]
["ATENCIÓN DIRECTA",null,null,"X",null,null,"COB EXTRAORDINARIA ",{"$nulls":17},"CARTA DE GARANTIA",{"$nulls":12},"TRASLADO",{"$nulls":7},"SEPELIO"]
[{"$nulls":6},"Nº Autorización",{"$nulls":17},"Nº Autorización",{"$nulls":20},"NATIMUERTO",{"$nulls":10},"OBITO",{"$nulls":4},"OTRO"]
[{"$nulls":6},"Monto S/.",{"$nulls":17},"Monto S/."]
[]
["DEL DESTINO DEL ASEGURADO/USUARIO"]
["ALTA",null,"CITA",null,null,null,"X",{"$nulls":4},"HOSPITALIZACIÓN",{"$nulls":7},"REFERIDO",{"$nulls":29},"CONTRA\nRREFERIDO",{"$nulls":6},"FALLECIDO",{"$nulls":4},"CORTE ADMINIS."]
[{"$nulls":19},"EMERGENCIA",{"$nulls":7},"CONSULTA EXTERNA",{"$nulls":10},"APOYO AL\nDIAGNÓSTICO"]
[]
["SE REFIERE / CONTRARREFIERE A:"]
["CÓDIGO RENAES DE LA IPRESS",{"$nulls":12},"NOMBRE DE LA IPRESS A LA QUE SE REFIERE / CONTRARREFIERE",{"$nulls":41},"N° HOJA DE REFER / CONTRARR."]
[]
[]
["ACTIVIDADES PREVENTIVAS Y OTROS",{"$nulls":44},"VACUNAS N° DE DOSIS"]
["PESO (Kg)",{"$nulls":8},8.4,{"$nulls":4},"TALLA (cm)",{"$nulls":9},66.6,null,null,null,"P.A. (mmHg)",{"$nulls":16},"BCG",{"$nulls":8},"INFLUENZA",{"$nulls":5},"ANTIAMARILICA"]
["DE LA\n GESTANTE",{"$nulls":4},"DEL RECIEN NACIDO",{"$nulls":12},"GESTANTE / RN /  NIÑO / ADOLESCENTE / JOVEN Y ADULTO / ADULTO MAYOR",{"$nulls":19},"JOVEN Y ADULTO",{"$nulls":6},"DPT",{"$nulls":8},"PAROTID",{"$nulls":5},"ANTINEUMOC"]
["CPN (N°)",{"$nulls":4},"EDAD GEST RN (SEM)",{"$nulls":12},"CRED N°",{"$nulls":9},"PAB (cm)",{"$nulls":9},"EVALUACIÓN INTEGRAL"]
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[]
["EDAD GEST ",{"$nulls":4},"APGAR",{"$nulls":5},"1°",null,"5°",{"$nulls":4},"R.N. PREMATURO",{"$nulls":7},"SI/NO",null,"TAP/ EEDP o  \nTEPSI",{"$nulls":9},"ADULTO MAYOR",{"$nulls":6},"ASA",{"$nulls":8},"ROTAVIRUS",{"$nulls":5}," COMPLETAS PARA LA EDAD",null,null,"SI","NO"]
[{"$nulls":38},"VACAM"]
["ALTURA UTERINA ",{"$nulls":17},"BAJO PESO AL NACER",{"$nulls":7},"SI/NO",null,"CONSEJERIA NUTRICIONAL",{"$nulls":16},"SPR",{"$nulls":8},"DT ADULTO (N° DOSIS)",{"$nulls":5},"VPH"]
[{"$nulls":45},"SR",{"$nulls":8},"IPV",{"$nulls":5},"OTRA VACUNA"]
["PARTO VERTICAL",{"$nulls":4},"Corte Tardío de Cordón (2 a 3 min)",{"$nulls":12},"ENFER. CONGENITA / SECUELA AL NACER",{"$nulls":7},"SI/NO",null,"CONSEJERIA \n INTEGRAL",{"$nulls":9},"TAMIZAJE DE SALUD MENTAL",null,null,null,"PAT."]
[{"$nulls":42},"NOR.",null,null,"HVB",{"$nulls":8},"PENTAVAL",{"$nulls":5},"____________"]
[]
["CONTROL PUERP (N°)",{"$nulls":17},"N° FAMILIARES DE GEST / PUERP. CASA MAT.",{"$nulls":9},"IMC (Kg/M2)",{"$nulls":16},"GRUPO DE RIESGO HVB",{"$nulls":9},"GRUPO DE RIESGO HVB: 1. TRABAJADOR DE SALUD   2. TRABAJAD. SEXUALES   3. HSH   4. PRIVADO LIBERTAD   5. FF. AA.  6. POLICIA NACIONAL   7. ESTUDIANTES DE SALUD   8. POLITRANFUNDIDOS  9. DROGO DEPENDIENTES "]
[]
[]
["DIAGNÓSTICOS"]
["N°","DESCRIPCIÓN",{"$nulls":38},"INGRESO",{"$nulls":15},"EGRESO"]
[{"$nulls":40},"TIPO DE DX",{"$nulls":8},"CIE - 10",{"$nulls":6},"TIPO DE DX",{"$nulls":4},"CIE - 10"]
[1,"OTRAS MEDIDAS PROFILACTICAS ESPECIFICADAS",{"$nulls":38},"P",null,"D",null,null,"R",null,null,null,"Z29.8",{"$nulls":6},"D",null,null,"R"]
[2,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[3,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[4,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[5,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[]
["N° DE DNI",{"$nulls":13},"NOMBRE DEL RESPONSABLE DE LA ATENCIÓN",{"$nulls":42},"N° DE COLEGIATURA"]
[94582702,{"$nulls":13},"MARIA FERNANDEZ PEREZ",{"$nulls":42},2258]
[]
["RESPONSABLE DE LA ATENCIÓN",{"$nulls":13},10,null,null,"ESPECIALIDAD",{"$nulls":28},"N° RNE",{"$nulls":10},"EGRESADO"]
["1. MÉDICO   2. FARMACEUTICO   3. CIRUJANO DENTISTA   4. BIÓLOGO  5. OBSTETRIZ   6. ENFERMERA  7. TRABAJADORA SOCIAL   8. PSICOLOGA  9.TECNOLOGO MEDICO    10.NUTRICION    11. TECNICO ENFERMERIA   12. AUXILIAR DE ENFERMERIA    13. OTRO"]
[]
[{"$nulls":33},"FIRMA"]
[]
[{"$nulls":33},"ASEGURADO"]
[]
[{"$nulls":33},"APODERADO"]
[]
[]
[]
[]
[{"$nulls":33}," APODERADO:"]
[{"$nulls":32},"    NOMBRES Y APELLIDOS "]
[]
[]
[null,null,"  FIRMA Y SELLO DEL RESPONSABLE DE LA ATENCIÓN ",{"$nulls":29},"   DNI  o CE DEL APODERADO:"]
[{"$nulls":60},"        HUELLA DIGITAL Asegurado\n              / Usuario /  Apoderado"]

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["PRODUCTOS FARMACEUTICOS / MEDICAMENTOS "]
["CÓDIGO SISMED",null,"NOMBRE",{"$nulls":7},"FF","CONCENTR","PRES","ENTR","DX","CÓD. \nSISMED",null,"NOMBRE",{"$nulls":6},"FF","CONCENTR","PRES","ENTR","DX"]
["00794",null,"AMOXICILINA ",{"$nulls":7},"SUS.","250mg/5mlLX 60 mL"]
["05986",null,"SULFAMETOXAZOL + TRIMETOPRIMA",{"$nulls":7},"SUS.","200mg+40 mg/5mL x 60 mL"]
["04582",null,"MEBENDAZOL",{"$nulls":7},"SUS.","100mg/5mLx\n30 mL"]
["05253",null,"OXITOCINA",{"$nulls":7},"INY","10 UI"]
["05309",null,"PARACETAMOL",{"$nulls":7},"JBE","120 mg/5 mL x 60 mL"]
["03513",null,"ACIDO FOLICO",{"$nulls":7},"TAB","500 ug"]
["S0001",null,"MULTIMICRONUTRIENTES",{"$nulls":7},"SB1","12.5 mg Fe",30,30,1]
["03519",null,"SULFATO FERROSO",{"$nulls":7},"JBE","15mg Fe/5mL x 180 mL",1,1,1]
["03536",null,"SULFATO FERROSO",{"$nulls":7},"SOL","25mgFe/mL x 30 mL",1,1,1]
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["PROCEDIMIENTOS/ DIAGNÓSTICO POR IMÁGENES/ LABORATORIO"]
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["99173",null,"TAMIZAJE DE AGUDEZA VISUAL",{"$nulls":12},86592,null,"SEROLOGIA RPR O VDRL"]
[99403,null,"CONSEJERÍA NUTRICIONAL     ",{"$nulls":12},86701,null,"ELISA O PRUEBA RAPIDA HIV-1 Y HIV-2"]
["87177c",null,"TEST DE GRAHAM       ",{"$nulls":12},81005,null,"EXAMEN DE ORINA"]
[87177,null,"EXAMEN DE PARÁSITOS Y HUEVOS POR FROTIS DIRECTO (3 MUESTRAS) ",{"$nulls":12},99209,null,"ATENCION EN NUTRICION"]
[82947,null,"GLUCOSA BASAL"]
[82465,null,"COLESTEROL SERICO TOTAL"]
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[84152,null,"ANTIGENO PROSTATICO ESPECIFICO"]
[81005,null,"EXAMEN DE ORINA"]
[80061,null,"PERFIL LIPIDO(Colesterol total, HDL, LDL, VLDL, triglicéridos y lípidos totales)"]
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[]
[]
[]
[]
[]
[]
["OBSERVACIONES"]
{"$rows_empty":11}
[{"$nulls":12}," FIRMA  "]
[{"$nulls":12}," ASEGURADO "]
[{"$nulls":12}," APODERADO",null,"X"]
[]
[]
[]
[{"$nulls":12},"   APODERADO"]
[null,"Firma y Sello del Responsable de Procedimiento y/o Farmacia y/o Laboratorio",{"$nulls":10},"   NOMBRES Y APELLIDOS  ",{"$nulls":5},"XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX"]
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[{"$nulls":12},"   DNI o CE DEL APODERADO",{"$nulls":5},"XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX",{"$nulls":7},"Huella Digital del \nAsegurado o Apoderado\n"]

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["ANEXO 1"]
[]
[]
[]
["    FORMATO ÚNICO DE ATENCIÓN - FUA"]
[{"$nulls":17},"        NÚMERO DE FORMATO",{"$nulls":25},"INSTITUCIÓN EDUCATIVA",{"$nulls":16},"CÓDIGO"]
[{"$nulls":17},230,{"$nulls":5},19,null,null,null,932488]
["AMBOS SEXOS",{"$nulls":42},"   INIC.",null,null," PRIM. ",null,null,null,"SEC.",{"$nulls":4},"SECCIÓN",{"$nulls":4},"TURNO"]
[]
["DE LA INSTITUCIÓN PRESTADORA DE SERVICIOS DE SALUD"]
["CÓDIGO RENAES DE LA IPRESS",{"$nulls":18},"NOMBRE  DE LA IPRESS QUE REALIZA LA ATENCIÓN"]
[]
["00006107",{"$nulls":18},"CS OLLANTAY"]
[]
["PERSONAL QUE ATIENDE",{"$nulls":18},"LUGAR DE \nATENCIÓN",{"$nulls":8},"ATENCIÓN",{"$nulls":9},"REFERENCIA REALIZADA POR"]
["DE LA IPRESS",{"$nulls":4},"x",null,null,"CÓDIGO DE LA OFERTA FLEXIBLE",{"$nulls":10},"INTRAMURAL",{"$nulls":6},"x",null,"AMBULATORIA",{"$nulls":6},"x",null,null,"CÓD. RENAES ",{"$nulls":7},"NOMBRE DE LA IPRESS U OFERTA FLEXIBLE ",{"$nulls":14},"N° HOJA DE REFERENCIA"]
[]
["ITINERANTE ",{"$nulls":18},"EXTRAMURAL",{"$nulls":8},"REFERENCIA"]
["OFERTA FLEXIBLE",{"$nulls":27},"EMERGENCIA"]
[]
["DEL ASEGURADO / USUARIO"]
["IDENTIFICACIÓN",{"$nulls":15},"CÓDIGO DEL ASEGURADO  SIS",{"$nulls":19},"ASEGURADO DE OTRA IAFAS"]
["TDI",null,"N° DOCUMENTO DE\n IDENTIDAD",{"$nulls":13},"DIRESA / OTROS",{"$nulls":5},"NÚMERO",{"$nulls":13},"INSTITUCIÓN"]
[]
[1,null,"75465855",{"$nulls":13},230,{"$nulls":5},2,null,null,"75465855",{"$nulls":10},"COD. SEGURO"]
[]
["APELLIDO PATERNO",{"$nulls":35},"APELLIDO MATERNO"]
["PEREZ",{"$nulls":35},"ROBLES"]
[]
["PRIMER NOMBRE",{"$nulls":35},"OTROS NOMBRES"]
["BRISET"]
[]
["SEXO",{"$nulls":7},"FECHA",{"$nulls":8},"DIA",{"$nulls":6},"MES",{"$nulls":5},"AÑO",{"$nulls":12},"N° DE HISTORIA CLÍNICA",{"$nulls":13},"ETNIA"]
[]
["MASCULINO",{"$nulls":7},"FECHA PROBABLE DE PARTO / FECHA DE PARTO ",{"$nulls":34},7645,{"$nulls":13},80]
["FEMENINO",null,null,null,"X"]
[]
["SALUD MATERNA",{"$nulls":7},"  FECHA DE NACIMIENTO ",{"$nulls":8},0,null,null,null,7,null,null,1,null,0,null,null,null,2,null,null,0,null,null,1,null,null,null,8,null,null," DNI / CNV / AFILIACIÓN DEL  RN  1"]
[]
[]
[]
["GESTANTE",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  2"]
[]
[]
[{"$nulls":8},"FECHA DE FALLECIMIENTO"]
[]
["PUERPERA",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  3"]
[]
["                                                                                                                                     DE LA ATENCIÓN"]
[]
["FECHA DE ATENCIÓN",{"$nulls":18},"HORA",{"$nulls":6},"UPS",{"$nulls":5},"CÓD. PRESTA.",null,null,null,"CÓD. PRESTACION(ES) ADICIONAL (ES)",{"$nulls":11},"HOSPITALIZACIÓN",null,null,"FECHA ",{"$nulls":5},"DIA",null,"MES",null,"AÑO"]
["DIA",null,"MES",null,null,null,"AÑO",{"$nulls":44},"DE INGRESO"]
[{"$nulls":19},9,null,null,null,":",30,{"$nulls":7},"005"]
[0,7,0,4,null,null,2,{"$nulls":4},0,null,1,null,9]
[]
[{"$nulls":51}," DE ALTA"]
[]
[]
[]
[]
["REPORTE VINCULADO",{"$nulls":10},"CÓD. AUTORIZACIÓN",{"$nulls":14},"N° FUA A VINCULAR",{"$nulls":24},"DE CORTE ADMINISTRATIVO"]
[]
[]
["CONCEPTO PRESTACIONAL"]
["ATENCIÓN DIRECTA",null,null,"X",null,null,"COB EXTRAORDINARIA ",{"$nulls":17},"CARTA DE GARANTIA",{"$nulls":12},"TRASLADO",{"$nulls":7},"SEPELIO"]
[{"$nulls":6},"Nº Autorización",{"$nulls":17},"Nº Autorización",{"$nulls":20},"NATIMUERTO",{"$nulls":10},"OBITO",{"$nulls":4},"OTRO"]
[{"$nulls":6},"Monto S/.",{"$nulls":17},"Monto S/."]
[]
["DEL DESTINO DEL ASEGURADO/USUARIO"]
["ALTA",null,"CITA",null,null,null,"X",{"$nulls":4},"HOSPITALIZACIÓN",{"$nulls":7},"REFERIDO",{"$nulls":29},"CONTRA\nRREFERIDO",{"$nulls":6},"FALLECIDO",{"$nulls":4},"CORTE ADMINIS."]
[{"$nulls":19},"EMERGENCIA",{"$nulls":7},"CONSULTA EXTERNA",{"$nulls":10},"APOYO AL\nDIAGNÓSTICO"]
[]
["SE REFIERE / CONTRARREFIERE A:"]
["CÓDIGO RENAES DE LA IPRESS",{"$nulls":12},"NOMBRE DE LA IPRESS A LA QUE SE REFIERE / CONTRARREFIERE",{"$nulls":41},"N° HOJA DE REFER / CONTRARR."]
[]
[]
["ACTIVIDADES PREVENTIVAS Y OTROS",{"$nulls":44},"VACUNAS N° DE DOSIS"]
["PESO (Kg)",{"$nulls":8},8.4,{"$nulls":4},"TALLA (cm)",{"$nulls":9},66.6,null,null,null,"P.A. (mmHg)",{"$nulls":16},"BCG",{"$nulls":8},"INFLUENZA",{"$nulls":5},"ANTIAMARILICA"]
["DE LA\n GESTANTE",{"$nulls":4},"DEL RECIEN NACIDO",{"$nulls":12},"GESTANTE / RN /  NIÑO / ADOLESCENTE / JOVEN Y ADULTO / ADULTO MAYOR",{"$nulls":19},"JOVEN Y ADULTO",{"$nulls":6},"DPT",{"$nulls":8},"PAROTID",{"$nulls":5},"ANTINEUMOC"]
["CPN (N°)",{"$nulls":4},"EDAD GEST RN (SEM)",{"$nulls":12},"CRED N°",{"$nulls":9},"PAB (cm)",{"$nulls":4},30,{"$nulls":4},"EVALUACIÓN INTEGRAL"]
[{"$nulls":45},"APO",{"$nulls":8},"RUBEOLA",{"$nulls":5},"ANTITETANICA"]
[]
["EDAD GEST ",{"$nulls":4},"APGAR",{"$nulls":5},"1°",null,"5°",{"$nulls":4},"R.N. PREMATURO",{"$nulls":7},"NO",null,"TAP/ EEDP o  \nTEPSI",{"$nulls":9},"ADULTO MAYOR",{"$nulls":6},"ASA",{"$nulls":8},"ROTAVIRUS",{"$nulls":5}," COMPLETAS PARA LA EDAD",null,null,"SI","NO"]
[{"$nulls":38},"VACAM"]
["ALTURA UTERINA ",{"$nulls":17},"BAJO PESO AL NACER",{"$nulls":7},"NO",null,"CONSEJERIA NUTRICIONAL",{"$nulls":5},"X",{"$nulls":10},"SPR",{"$nulls":8},"DT ADULTO (N° DOSIS)",{"$nulls":5},"VPH"]
[{"$nulls":45},"SR",{"$nulls":8},"IPV",{"$nulls":5},"OTRA VACUNA"]
["PARTO VERTICAL",{"$nulls":4},"Corte Tardío de Cordón (2 a 3 min)",{"$nulls":12},"ENFER. CONGENITA / SECUELA AL NACER",{"$nulls":9},"CONSEJERIA \n INTEGRAL",{"$nulls":9},"TAMIZAJE DE SALUD MENTAL",null,null,null,"PAT."]
[{"$nulls":42},"NOR.",null,null,"HVB",{"$nulls":8},"PENTAVAL",{"$nulls":5},"____________"]
[]
["CONTROL PUERP (N°)",{"$nulls":17},"N° FAMILIARES DE GEST / PUERP. CASA MAT.",{"$nulls":9},"IMC (Kg/M2)",{"$nulls":5},"22",{"$nulls":10},"GRUPO DE RIESGO HVB",{"$nulls":9},"GRUPO DE RIESGO HVB: 1. TRABAJADOR DE SALUD   2. TRABAJAD. SEXUALES   3. HSH   4. PRIVADO LIBERTAD   5. FF. AA.  6. POLICIA NACIONAL   7. ESTUDIANTES DE SALUD   8. POLITRANFUNDIDOS  9. DROGO DEPENDIENTES "]
[]
[]
["DIAGNÓSTICOS"]
["N°","DESCRIPCIÓN",{"$nulls":38},"INGRESO",{"$nulls":15},"EGRESO"]
[{"$nulls":40},"TIPO DE DX",{"$nulls":8},"CIE - 10",{"$nulls":6},"TIPO DE DX",{"$nulls":4},"CIE - 10"]
[1,"HISTORIA PERSONAL DE FACTORES DE RIESGO NO CLASIFICADOS",{"$nulls":38},"P",null,"D",null,null,"R",null,null,null,"Z91.8",{"$nulls":6},"D",null,null,"R"]
[2,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[3,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[4,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[5,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[]
["N° DE DNI",{"$nulls":13},"NOMBRE DEL RESPONSABLE DE LA ATENCIÓN",{"$nulls":42},"N° DE COLEGIATURA"]
[9458270,{"$nulls":13},"MARIA FERNANDEZ PEREZ",{"$nulls":42},2258]
[]
["RESPONSABLE DE LA ATENCIÓN",{"$nulls":13},10,null,null,"ESPECIALIDAD",{"$nulls":28},"N° RNE",{"$nulls":10},"EGRESADO"]
["1. MÉDICO   2. FARMACEUTICO   3. CIRUJANO DENTISTA   4. BIÓLOGO  5. OBSTETRIZ   6. ENFERMERA  7. TRABAJADORA SOCIAL   8. PSICOLOGA  9.TECNOLOGO MEDICO    10.NUTRICION    11. TECNICO ENFERMERIA   12. AUXILIAR DE ENFERMERIA    13. OTRO"]
[]
[{"$nulls":33},"FIRMA"]
[]
[{"$nulls":33},"ASEGURADO"]
[]
[{"$nulls":33},"APODERADO"]
[]
[]
[]
[]
[{"$nulls":33}," APODERADO:"]
[{"$nulls":32},"    NOMBRES Y APELLIDOS "]
[]
[]
[null,null,"  FIRMA Y SELLO DEL RESPONSABLE DE LA ATENCIÓN ",{"$nulls":29},"   DNI  o CE DEL APODERADO:"]
[{"$nulls":60},"        HUELLA DIGITAL Asegurado\n              / Usuario /  Apoderado"]

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["ANEXO 1"]
[]
[]
[]
["    FORMATO ÚNICO DE ATENCIÓN - FUA"]
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[]
["DE LA INSTITUCIÓN PRESTADORA DE SERVICIOS DE SALUD"]
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["PRIMER NOMBRE",{"$nulls":35},"OTROS NOMBRES"]
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[]
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[]
[]
[]
["GESTANTE",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  2"]
[]
[]
[{"$nulls":8},"FECHA DE FALLECIMIENTO"]
[]
["PUERPERA",{"$nulls":42}," DNI / CNV / AFILIACIÓN DEL  RN  3"]
[]
["REGISTRAR FPP/ FP SI ES: GESTANTE O PUERPERA                                     DE LA ATENCIÓN"]
[]
["FECHA DE ATENCIÓN",{"$nulls":18},"HORA",{"$nulls":6},"UPS",{"$nulls":5},"CÓD. PRESTA.",null,null,null,"CÓD. PRESTACION(ES) ADICIONAL (ES)",{"$nulls":11},"HOSPITALIZACIÓN",null,null,"FECHA ",{"$nulls":5},"DIA",null,"MES",null,"AÑO"]
["DIA",null,"MES",null,null,null,"AÑO",{"$nulls":44},"DE INGRESO"]
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[]
[{"$nulls":51}," DE ALTA"]
[]
[]
[]
[]
["REPORTE VINCULADO",{"$nulls":10},"CÓD. AUTORIZACIÓN",{"$nulls":14},"N° FUA A VINCULAR",{"$nulls":24},"DE CORTE ADMINISTRATIVO"]
[]
[]
["CONCEPTO PRESTACIONAL"]
["ATENCIÓN DIRECTA",null,null,"X",null,null,"COB EXTRAORDINARIA ",{"$nulls":17},"CARTA DE GARANTIA",{"$nulls":12},"TRASLADO",{"$nulls":7},"SEPELIO"]
[{"$nulls":6},"Nº Autorización",{"$nulls":17},"Nº Autorización",{"$nulls":20},"NATIMUERTO",{"$nulls":10},"OBITO",{"$nulls":4},"OTRO"]
[{"$nulls":6},"Monto S/.",{"$nulls":17},"Monto S/."]
[]
["DEL DESTINO DEL ASEGURADO/USUARIO"]
["ALTA",null,"CITA",null,null,null,"X",{"$nulls":4},"HOSPITALIZACIÓN",{"$nulls":7},"REFERIDO",{"$nulls":29},"CONTRA\nRREFERIDO",{"$nulls":6},"FALLECIDO",{"$nulls":4},"CORTE ADMINIS."]
[{"$nulls":19},"EMERGENCIA",{"$nulls":7},"CONSULTA EXTERNA",{"$nulls":10},"APOYO AL\nDIAGNÓSTICO"]
[]
["SE REFIERE / CONTRARREFIERE A:"]
["CÓDIGO RENAES DE LA IPRESS",{"$nulls":12},"NOMBRE DE LA IPRESS A LA QUE SE REFIERE / CONTRARREFIERE",{"$nulls":41},"N° HOJA DE REFER / CONTRARR."]
[]
[]
["ACTIVIDADES PREVENTIVAS Y OTROS",{"$nulls":44},"VACUNAS N° DE DOSIS"]
["PESO (Kg)",{"$nulls":8},8.4,{"$nulls":4},"TALLA (cm)",{"$nulls":9},66.6,null,null,null,"P.A. (mmHg)",{"$nulls":16},"BCG",{"$nulls":8},"INFLUENZA",{"$nulls":5},"ANTIAMARILICA"]
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["CPN (N°)",{"$nulls":4},"EDAD GEST RN (SEM)",{"$nulls":12},"CRED N°",{"$nulls":7},6,null,"PAB (cm)",{"$nulls":9},"EVALUACIÓN INTEGRAL"]
[{"$nulls":45},"APO",{"$nulls":5},1,null,null,"RUBEOLA",{"$nulls":5},"ANTITETANICA"]
[]
["EDAD GEST ",{"$nulls":4},"APGAR",{"$nulls":5},"1°",null,"5°",{"$nulls":4},"R.N. PREMATURO",{"$nulls":7},"NO",null,"TAP/ EEDP o  \nTEPSI",{"$nulls":5},"X",null,null,null,"ADULTO MAYOR",{"$nulls":6},"ASA",{"$nulls":8},"ROTAVIRUS",{"$nulls":5}," COMPLETAS PARA LA EDAD",null,null,"SI","NO"]
[{"$nulls":38},"VACAM"]
["ALTURA UTERINA ",{"$nulls":17},"BAJO PESO AL NACER",{"$nulls":7},"NO",null,"CONSEJERIA NUTRICIONAL",{"$nulls":5},"X",{"$nulls":10},"SPR",{"$nulls":8},"DT ADULTO (N° DOSIS)",{"$nulls":5},"VPH"]
[{"$nulls":45},"SR",{"$nulls":8},"IPV",{"$nulls":5},"OTRA VACUNA"]
["PARTO VERTICAL",{"$nulls":4},"Corte Tardío de Cordón (2 a 3 min)",{"$nulls":12},"ENFER. CONGENITA / SECUELA AL NACER",{"$nulls":9},"CONSEJERIA \n INTEGRAL",{"$nulls":9},"TAMIZAJE DE SALUD MENTAL",null,null,null,"PAT."]
[{"$nulls":42},"NOR.",null,null,"HVB",{"$nulls":8},"PENTAVAL",null,null,null,3,null,"____________"]
[]
["CONTROL PUERP (N°)",{"$nulls":17},"N° FAMILIARES DE GEST / PUERP. CASA MAT.",{"$nulls":9},"IMC (Kg/M2)",{"$nulls":16},"GRUPO DE RIESGO HVB",{"$nulls":9},"GRUPO DE RIESGO HVB: 1. TRABAJADOR DE SALUD   2. TRABAJAD. SEXUALES   3. HSH   4. PRIVADO LIBERTAD   5. FF. AA.  6. POLICIA NACIONAL   7. ESTUDIANTES DE SALUD   8. POLITRANFUNDIDOS  9. DROGO DEPENDIENTES "]
[]
[]
["DIAGNÓSTICOS"]
["N°","DESCRIPCIÓN",{"$nulls":38},"INGRESO",{"$nulls":15},"EGRESO"]
[{"$nulls":40},"TIPO DE DX",{"$nulls":8},"CIE - 10",{"$nulls":6},"TIPO DE DX",{"$nulls":4},"CIE - 10"]
[1,"CONTROL DE SALUD DE RUTINA DEL NIÑO (NIÑO SANO)",{"$nulls":38},"P",null,"D",null,null,"R",null,null,null,"Z00.1",{"$nulls":6},"D",null,null,"R"]
[2,"OTRAS MEDIDAS PROFILACTICAS ESPECIFICADAS",{"$nulls":38},"P",null,"D",null,null,"R",null,null,null,"Z29.8",{"$nulls":6},"D",null,null,"R"]
[3,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[4,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[5,{"$nulls":39},"P",null,"D",null,null,"R",{"$nulls":10},"D",null,null,"R"]
[]
["N° DE DNI",{"$nulls":13},"NOMBRE DEL RESPONSABLE DE LA ATENCIÓN",{"$nulls":42},"N° DE COLEGIATURA"]
[9458270,{"$nulls":13},"MARIA FERNANDEZ PEREZ",{"$nulls":42},2258]
[]
["RESPONSABLE DE LA ATENCIÓN",{"$nulls":13},6,null,null,"ESPECIALIDAD",{"$nulls":28},"N° RNE",{"$nulls":10},"EGRESADO"]
["1. MÉDICO   2. FARMACEUTICO   3. CIRUJANO DENTISTA   4. BIÓLOGO  5. OBSTETRIZ   6. ENFERMERA  7. TRABAJADORA SOCIAL   8. PSICOLOGA  9.TECNOLOGO MEDICO    10.NUTRICION    11. TECNICO ENFERMERIA   12. AUXILIAR DE ENFERMERIA    13. OTRO"]
[]
[{"$nulls":33},"FIRMA"]
[]
[{"$nulls":33},"ASEGURADO"]
[]
[{"$nulls":33},"APODERADO"]
[]
[]
[]
[]
[{"$nulls":33}," APODERADO:"]
[{"$nulls":32},"    NOMBRES Y APELLIDOS "]
[]
[]
[null,null,"  FIRMA Y SELLO DEL RESPONSABLE DE LA ATENCIÓN ",{"$nulls":29},"   DNI  o CE DEL APODERADO:"]
[{"$nulls":60},"        HUELLA DIGITAL Asegurado\n              / Usuario /  Apoderado"]

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[{"$nulls":19},"FORMATO DE ATENCIÓN  Nº"]
[]
[]
["PRODUCTOS FARMACEUTICOS / MEDICAMENTOS "]
["CÓDIGO SISMED",null,"NOMBRE",{"$nulls":7},"FF","CONCENTR","PRES","ENTR","DX","CÓD. \nSISMED",null,"NOMBRE",{"$nulls":6},"FF","CONCENTR","PRES","ENTR","DX"]
["00794",null,"AMOXICILINA ",{"$nulls":7},"SUS.","250mg/5mlLX 60 mL"]
["05986",null,"SULFAMETOXAZOL + TRIMETOPRIMA",{"$nulls":7},"SUS.","200mg+40 mg/5mL x 60 mL"]
["04582",null,"MEBENDAZOL",{"$nulls":7},"SUS.","100mg/5mLx\n30 mL"]
["05253",null,"OXITOCINA",{"$nulls":7},"INY","10 UI"]
["05309",null,"PARACETAMOL",{"$nulls":7},"JBE","120 mg/5 mL x 60 mL"]
["03513",null,"ACIDO FOLICO",{"$nulls":7},"TAB","500 ug"]
["S0001",null,"MULTIMICRONUTRIENTES",{"$nulls":7},"SB1","12.5 mg Fe",30,30,2]
["03519",null,"SULFATO FERROSO",{"$nulls":7},"JBE","15mg Fe/5mL x 180 mL",1,1,2]
["03536",null,"SULFATO FERROSO",{"$nulls":7},"SOL","25mgFe/mL x 30 mL",1,1,2]
[28551,null,"FIERRO POLIMALTOSADO",{"$nulls":7},"SOL","50mg/ml",1,1,2]
{"$rows_empty":13}
["DISPOSITIVOS MÉDICOS / PRODUCTOS SANITARIOS"]
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[26943,null,"PASTAS DENTRIFICAS PARA LIMPIEZA DE DIENTES PARA NIÑOS",{"$nulls":7},"Tbo","90g"]
{"$rows_empty":8}
["PROCEDIMIENTOS/ DIAGNÓSTICO POR IMÁGENES/ LABORATORIO"]
["CÓDIGO",null,"NOMBRE",{"$nulls":8},"IND","EJE","DX","RES","CÓDIGO",null,"NOMBRE",{"$nulls":7},"IND","EJE","DX","RES"]
[85018,null,"DOSAJE DE HEMOGLOBINA",{"$nulls":8},1,1,1,12,59400,null,"ATENCION OBSTETRICA DE RUTINA"]
["99173",null,"TAMIZAJE DE AGUDEZA VISUAL",{"$nulls":12},86592,null,"SEROLOGIA RPR O VDRL"]
[99403,null,"CONSEJERÍA NUTRICIONAL     ",{"$nulls":8},1,1,1,null,86701,null,"ELISA O PRUEBA RAPIDA HIV-1 Y HIV-2"]
["87177c",null,"TEST DE GRAHAM       ",{"$nulls":12},81005,null,"EXAMEN DE ORINA"]
[87177,null,"EXAMEN DE PARÁSITOS Y HUEVOS POR FROTIS DIRECTO (3 MUESTRAS) ",{"$nulls":12},99401,null,"EVALUACION ANTROPOMETRICA"]
[82947,null,"GLUCOSA BASAL"]
[82465,null,"COLESTEROL SERICO TOTAL"]
[84478,null,"TRIGLICERIDOS"]
[84152,null,"ANTIGENO PROSTATICO ESPECIFICO"]
[81005,null,"EXAMEN DE ORINA"]
[80061,null,"PERFIL LIPIDO(Colesterol total, HDL, LDL, VLDL, triglicéridos y lípidos totales)"]
[99402,null,"CONSEJERIA PLANIFICACION FAMILIAR"]
[90471,null,"ADMINISTRACION DE INMUNIZACION",{"$nulls":8},1,1,1]
["SUB COMPONENTE PRESTACIONAL (PROCEDIMIENTOS)"]
["CÓDIGO",null,"NOMBRE",{"$nulls":10},"CARACT",null,null,null,"IND/ PRES",null,null,"EJE/ ENTR",null,null,"DX",null,"RES","N°\nTICKET","PO"]
[]
[]
[]
[]
[]
[]
["OBSERVACIONES"]
{"$rows_empty":11}
[{"$nulls":12}," FIRMA  "]
[{"$nulls":12}," ASEGURADO "]
[{"$nulls":12}," APODERADO"]
[]
[]
[]
[{"$nulls":12},"   APODERADO"]
[null,"Firma y Sello del Responsable de Procedimiento y/o Farmacia y/o Laboratorio",{"$nulls":10},"   NOMBRES Y APELLIDOS  "]
[]
[{"$nulls":12},"   DNI o CE DEL APODERADO",{"$nulls":13},"Huella Digital del \nAsegurado o Apoderado\n"]