NOMBRE 8 a 3 3 g g & rEMPERATURA FIEBRE (+38)C MALESTAR GENERAL wwcIO MUSCULAR 1A RESPIRAR| PPERDIOADET | DE FATIGA gusto.o oe |_verance ‘OUFATO |_ovrato_I p] vooRot Je|_carcanta 7 DyFICULTAD lean SJ SENSATION =| cans IP g ta < 7 q IE § re sd et zIC|* a NONE fan Nem ONY MONA o Aci TE XA \ WAL. O 30% A AD Petts et OFS Wo Mons, DeSVONS cosy Te (Ss FRCHIESTA PRFOPERACIONAL DE SALUD DIARIA TE: DZS MAAR Dean ecg cn SOS “Bee ee Sfous revsctens ce, febes Han orn. orwrensi 36.4 MA. LON Cam Z4 Cid RNAS eee GO PL DAA = To 0o fuse. 25 VR Rew. Asleness LTR? pipe PAPE IE Je fpza 22/_[aeC|si eh 17 (ace > |F77 917 £0 [35.5 |INUh sforn Co NCP on he YSEN 7) Vem e478 YP PCT IS raeoceay Vy. CIN | IN DES ZI BSA WL cong [5x7 TT logis 37 [aye | o/] we ftogs sigtup 2at| ti roas s213ss]-%, 2 [13 [s-ENCUESTA PREOPERACIONAL DE SALUD DIARIA Tas labar se Geno sign formate ene cale a Tar SRO wat CREED TOR UT BHD AS 6 preseraiss se debe contnuat con astro ya preven propagation de enfermedad y rote pels de los tabajndoresywstantes de emer 3 ZHI PRESENTADO ALGUNO DE ESTOSSINTOMASEN LAS | wavsncown| et | Ee HA HORA Jz pans Ors aha ecm orice a ee NOMBRE ceoua | 8) 8] 3] 28] 22/532 3| 2 iE Bp | maenores |morsse| tra ~ €) 2] 3] 8) 9 2]3 5] 8) SSB g S| cites aac 2) 8) &| 88] 28|g3|s2| 5 SE 3°] sow JAUBA ROCIO NAVARO ea] SOT BOTS OS STL ST ALEXANDER GOMEZ 7095832063 “| i SO eee aims 23550031 Bie Wo [PET PO P10 [CANDIA CECILIA ALARCON 63368232| POPNOW yo [Ho | NO [CARLOS ARTURO RAMIREZ 91258340] ne [vole {wo | Ae \ ote 2-9 [CLAUDIA XIMENA LEON 3751373: 7S POIROTES [RST DANIEL SIERRA 7199583491 ie see] eres DIANA MARCELA RODRIGUEZ | 1095823025 AI ERICK YESIO ROMERO. 7098683400] Wo HUMBERTO FLOREZ 91287803 oo eM FDIISACC LUQUE prose? RAAT] [ FF HSZ futtam antontez Frooss2627 [to [NqRo| Ma | Wo | NC ~[-_——atancica nex 4098773432 1 5 DIEGO CAMARON 1096018078 =} AVIER ENRRIQUE OSSES 91268520] ; : JESUS LEON 5570246 ssa oy t [DIEGO MANTILIA a1697664 TAM Oh Ss = “S au | as IEDINSON RANGEL 91536784 [60.1 Rolpol >ENCUESTA PREOPERACIONAL DF SALUD DIARIA "] HA PRESENTADO ALGUNO DE ESTOS SINTOMAS EN LAS varias 24nones . aioe oneent coun | 3/8] 5] =] 2 4/28/83] 2 2B Se reasaiacon | EVALUADOR g/g] 3] 88) 28135138) 22623 2[ 8| °] 83) 8/2 8|3 =| 3 2S [105€ ALFREDO CALDERON [aiaraga3| [DUAN CALDERON | suvessesTin [ST PS TS eS JS 1 GIIUAN JOSE GARCIA | for0237a97[ 75 wel Re 1 Bo ie [ae NV] [karina UiCETH MENDOTA [110237425] [FFT tuka STEFANIA LOZANO. [rossssraseps rl TATA | NTA DW A TPE [uZETH PAOLA ARISMENDI | a0B97aaS65FS [oof e [sof s | [> 1» | We a ae t SSS SEE | J7ZZ [naria CONSUELO GARCIA | __28154638/4L,\ 1p] Ni Ry 1: [2a IG3F [MIGUEL ANGEL BERMUDEZ I soo Tf [__|onice uiiana quinteno | 63562581 Ze [mavevasa sais [37303877 a S| ee J [wATaua quinreRo [63478329]. EZ 5 [AVDA ALEJANDRA GONZALEZ | Tosaesoosafzazf— ff j— | — | = ~ TNIDIA ELEWA FORERO [__63498117 TIN JOHANA RIO | s7a4a7saf fo I [SANDRA LANDAZABAL | 30210463]. tect [BE Jamby maa ak [rosssossers UR ea] gs SRA fe TY le PENX [aoors6s76e[75-7] eT wo] Kol wivoT no Tue | Tec Hesse z “ZA |vesica GABRIeLA ALMEIDA4 Gr TeO 1 yaaue ne dado case oe ¢ HA PRESENTADO ALGUNO DE ESTOS LULTIMAS 24 HORAS Ee Noi ar sha FIRMA DEL MBRE ceputa Slal <| ss| <2/2s|95| 22h 20 soos TRABAIADOR EVALUADOR 3) 2| §] 22] &2|s 2/23] 23k o2 us ele] | 88] 22/3=/33| 22B85 nsracacon iG 2] 2| ©) 88) 2&lg3|52| 58h s ora s fh 7 JANGEL DARIO ACOSTA 10588225596)35.BIOINS [ISS et [RS ST ye 271, ~JBERNANDINIO QUINTERO 91177579] =v 4.5 TAL I60< [CARLOS GUILLERMO ROJAS. 91178685B6D [i] n> | 1 ORS RY E7Cr onson nanines TEE | Po RSP TD DUBAN ALEXIS TORRES 1005198762| 1 Ae poms As ime say [NTBTC Tiara anTuRO CAMACHO 11006775815] TU AO TAO TPO Hi fi [JESUS ANDRES HERNANDEZ 1001548247 /4A J.J a IA a fa Te 7 [ VAPOSE MARIA URBINA 18972796] 3.5 7H 1 SiS The f 925°, [JUAN GOMEZ BARAIAS 91175892] i SPSS TY [672 [WAN CALDERON DUARTE 9117685454, STS STS PETA DS Bi [pico [MARCO ANTONIO BALLESTEROS 73227800727 WOH> [RO LS [RS] RISD [RO J 1c [MARINELA SEPULVEDA, 3772732655 MND Ito [> [ko [AS [> TSS bs —Amicaer varcas (parree | rosaessseal34./ | mylag | ce [a0 alee {0 [SERIO Davio suanez 137 PS PS SSO IS RTS TE ~~ [WILSON GRANADOS 91108809| YA IST ROPES] AS TAY ‘395 [EMERSON RAMOS 706524479049 SIX Pao hdd Pe TN Te TS.‘tether segs abnor OSTRALGISTOS A nds copings al noo nr ons ee OND ST e Bresentaron ve debe contin con clan yt preven I propagcan deta enemy eter estes ls tatnndres wont Bela emrece ‘THA PRESENTADO ALGUNO DE ESTOS SINTOMAS EN LAS eTIMAS 24 HORAS eos etna : 2 z/e @ SEE & _ | ontserte tos | anrtsoe FIRMA DEL HAMA DEL Scta [hora Nomene 2] 3] fg 226 3 ol "irene | conse) teaswnpor EVALUADOR |= a BBB 8 S| comers |v Ae 35 2 SBE S| ctumac™|nacnaon =| 2 38 Bee 3 o| sions 7 5 |B Swe Ne [wa —[ No x eat ste |= = 7» | ee poe s[X ee < C oa via: = S ASTIN lo R437: [098608 5 ey 212 Sr TE ir z 1G: