3] s| 8] Eg 25Bs =| §| 88) 22 2ebe | 5| 28) 28 eee 3 See eh aS ORO aS > S Ries TO} IRS poms) r SIE Rone 1k ROS chat et [rae TL 1 wT aA WO) Ve Wao. BDL BS [SS [SS 1S TRO TE oS PST ss | is) Isod> 89 OQ. s Soh SS IS S| Nw le [sw We wl ao | i |e te eo Boyett Be a L RS PS) [iss TS cS rp iY |e w R= | BOT! STS E> | Bs a ecalieeiae a BLY Te oO¢ e ata ENCUESTA PREOPERACIONAL DESALUD DIARIA eee ene “Gntomas asociados con COVID 19 ¥9' Soe OTRASTOEAT a WSR a sosyranones Set ores [sane oR STONE TUS si imiMas 24 HORAS 2 anna DEL = ca FIRMA DEL ae cou | 3] 5] 3s] ee[ea]2 3] 2 2B 22 * EsrEvatuano® £/z] S| $8) 22/3 £/28] 22825 insratncon z/é| ©] 88] £8|g 8/8 =| 3 36 3° 6350362113711 NS OC] | IT SUT ESD Tessasz0s3f2hf sf so] so] sUlwo be] VS] oe r 63559437 OF M4wO [GO| WO | Wo] WO] WO | N Ni wit V7 63368232| 32.7] mad we | NA Vol We] vo | We WSO st 31258340 - wsis7PSE PS IS |S | SIS—[e pS fe DK i Tosenasi8 [ZS foana wancetanoonrovee —f ossssnes] 9 | =} ET = 7 X CK YESID ROMERO) 71098683449] eps 7 (tune roe SEE eet jesccivaue [sioosaer | Si i ZB |ltian ANTONE 0952627 o +t | [scan RS roe pe |S Pee af ae |e onary Li EGO CAMAON [rossorea7e ST DS} Ip NER ENRRIQUE O53E5 I ee I spepe tet #€ & ENCUESTA PREOPERACIONAL DE SALUD DIARIA cre tatoo oe 7 19 ya ave letivo de ‘*sevimiento alos Wabajadores de DISTRIAUGUSTO SAS que ha ngresado 8 Gp sus bores se desarolla el sgulete formato, en el cual = tendra en cuenta os Sintoras soclndos con COVIO 19, emaraymemnetneses ce resets gebe coin con etalon Ya event eevee tree easy tenet {HA PRESENTADO ALGUNO DEESTOSSINTOMASENLAS [watsicomn | nnizo ULTIMAS 24 HORAS _ eoroacro BY ae f ao. DO. we gle R | SS TA, ISD. : 6 SIE 2 9: A loAs wie [2.1 [n 1 BatEY “ ee Cc 4 \ ENCUESTA PREOPERACIONAL DE SALUD DIARIA romas nocd con COD 19 ya que ne 0 : THAR “a ad IRMA DEL Hora NOMBRE cous | 4/8 3] 38 23|6 8 33 ae Bo een | evatuadoR 4 hp Lae Bs swap ee PO POT TO He = " Table (face Keke ees ae RS OS Z = Lex tS TS SN TATA Ti a PSOTRS INS POTAI TASTES E: ION PIV ISS BON SES ZS ROMS RNR Are Bn - L Drs iho ISD {NO [elo TRO TE — = l ONY loach 7734 1861 he [NSE Aisa [SO ee More Heady Fase |Shd] © [Hs [Po |RO[Wefe 9 [ef Gctits O- ie Eee 2 fae 1 wal Sele. rere = = me 3 Cel Oro9 Speti Bel he MSS SS Tao No | le. EQ]. AIS aoe LL Tat TAL A NIDA TN 24 WV} 14. [ea rrbovy fas | [> [eS Ofer fo Ta [oa z Sy ase Bid. “Cty [opaetste BSB fh eo TS Ce A 7 oe: 3 ws ~~ £20] v9) + 66> Seen, & Ste Ses | aX IR me pore im se e ti f 1 [Lysf\oa a Mbp bag [568 IIs NS N45 WA em f15310- 70] 4-1 KN AES WS PSTN TSF _ Io eZ FS) Lucha eIG3b.1 col al aw | Lalag | au To Vi cle (ag G STAT Mat & pene adeyess bad [Silas = 1S & T= Te S: cama OTA ae DAs Yzz\h722 57p Si > |< |X [Ss _|s = =c na Set Z LEZ, AGF Ro Fs [RO [AD Oe CoyallD ich A DE VSS STRSTR TSS 7 Wii lew loHOHAL OF SALUD CHARI arr ean m0 dO cra eneorer a’ rman De suena OL Fro fron soil cain | EE ahh ee ee z esp 92 / ae seb we eg ar =f rassrsoots fe sets Bafana et sy wise 3 As Si a poppet ue Ty can os ARTURG nanan Srzs8302 0 [so Ne ee ets i 375137336505 J) ss = sossenoe| ac a a 4 = Z| ERICK VESTO ROMERO 3098683449[ 354] be] e (2 [HUMBERTO FLOREZ 91287803 x — a [sac wave Br002ee7 [= — [LANA ANTONILEZ 77100962821 Ly) TTI MARIANGEICA RIGERO permepe ew) ww Se ps Te at 2 DIEGO CamaRON 1065918678 [/AVIER ENRRIQUE OSES 91268520). J 1® : =| ENCUESTA PREOPERACIONAL DE SALUD DIARIA re ado eas rn cuata los unto oraladon can COND TB 7m 08 itr secorvento alos trabajadors de ISTRIALGUSTO SAS que ha ngresado& Gopi savor se desl ol agulente Toray ss cam ro vase res ce Se prevents ve debe continua con ease yas preven a propagcion de a enfermedad y protege laa ERPRESENTADO ACGUNO DE ESTOSSNTOMASENLAS Twassnovy | en | ULTINAS 24 HORAS teem |aracas a= A BE g | rusemeios |" acesce | Finan ven fata Del Drs NOMBRE CEDULA 3] 8] s| sé #2|8 3 33 eobse marenons | crea) TRaBasaDOR EVALUAI 2] i] 2] 83] S218 5/3] 326 3 §| creme | "te 2] 8] 88] 25/55/28) Se6 oS er lasmcraon £| B] &] 88] 2818 5] 5 3] 2 sp 8 S]usutanss an 2/2 z - [OSE ALFREDO CALDERON sare — [I S\DUAN CALOERON s176854460 SS OWES TS TS SS TSS [SS = x Udi 2K 7 Duan ose cance 7010237497] spe [ARIA LICETH MENDOZA 710237826]. [Fy > [LAURA ESTEFAMIA LOZANO “osess7a5s psa IAT | WL 7 St ee tS FHS [27 |UZETH PAOLA ARISMENDI tose7aasesf3ry [rio] wf no [wy [wo [wo [wo Dw] a = oA: Cy [LUZ MAYERLY PRADA 63563109 QILY |MaRix CONSUELO GARCIA 28154633] Me fre The The [te | be i = “ JIMIGUEL ANGEL BERMUDEZ '91154902| Is] EAs BOTOINS BS PLEO a ~*~ (5 IWONICA LUANA QUINTERO. 63562583) seg Ze ES |mvrian saines 37943877| 6 >| =] = == T= = a TO ‘ED INATALIA QUINTERO 62478329145 { [8S BS BO [758 IS Tao po HS Tr = Z Fei INAYOR ALLANDRA GONZALEZ | Tossssoosift-\ | =] = = T= = 7 = I Ip |wibia ELENA FORERO sso JATRE RS Ss hs Be rR NW JOHANA WIRiO 37843759] at Z TER ISANDRA CANDAZABAT 30210463f9 Ws WS Re ZEZLA| SINDv PAOLA CALA 7095806687]. i [YESICA GABRIELA ALMEIDA coressr6shas Aw [we] 6S] Wwe as a pas PTE fessita Cy Hee Le