<form method="post" action="IncapacidadesAfiliado.

aspx" id="ctl00">
<div>
<input type="hidden" name="__VIEWSTATE" id="
__VIEWSTATE" value="" />
</div>
<div>
<table cellspacing="0" cellpadding="3" align="Center" rules="all" border="1"
id="ctl00_Content__Resultado1_gvCotizon" style="color:#333333;background-
color:White;border-color:#CCCCCC;border-width:1px;border-style:None;font-
family:Tahoma;font-size:XX-Small;width:85%;border-collapse:collapse;">
<tr class="Header_Grid" align="center" valign="top"
style="color:Black;background-color:Azure;font-family:Tahoma;font-size:XX-
Small;font-weight:bold;">
<th scope="col">Imprimir Certificado</th><th
scope="col">Documento Cotizante</th><th scope="col">Nombre Cotizante</th><th
scope="col">N&#250;mero Autorizador</th><th scope="col">Valor Liquidado</th><th
scope="col">Fecha Inicio</th><th scope="col">Fecha Fin</th><th
scope="col">D&#237;as Autorizados</th><th scope="col">D&#237;as Acumulados</th><th
scope="col">D&#237;as Liquidados</th><th scope="col">Tipo Incapacidad</th><th
scope="col">C&#243;digo Diagnostico</th><th scope="col">Origen Inc/Lm</th><th
scope="col">Estado Liquidaci&#243;n</th><th scope="col">IBC</th><th scope="col">IPS
Expide</th>
</tr><tr align="center" valign="middle"
style="color:#4A3C8C;background-color:#E7E7FF;font-family:Tahoma;font-size:XX-
Small;height:15px;">
<td valign="middle">
<input type="image" name="gvCotizon$ctl10$imgImprimir"
id="gvCotizon_ctl10_imgImprimir" title="Imprimir"
src="../App_Themes/Theme_Transaccional/images/botones/boton_Icono/ico_imprimir_1.pn
g" style="height:24px;width:26px;border-width:0px;" />
</td><td>CC 1023955692</td><td>Yuly Zuleyma Llanos
Sacristan</td><td>57527502</td><td>$0</td><td>Feb 15 de 2018</td><td>Feb 17 de
2018</td><td>3</td><td>0</td><td>0</td><td>Nueva</td><td>K590</td><td>Enfermedad
General</td><td>Sin reconocimiento por parte de la
EPS</td><td>781,242</td><td>Medimas EPS CENTRO DE ATENCION DE URGENCIAS AV 68
ESIMED</td>
</tr><tr align="center" valign="middle"
style="color:#333333;background-color:#F7F7F7;font-family:Verdana;font-size:XX-
Small;height:15px;">
<td valign="middle">
<input type="image" name="gvCotizon$ctl11$imgImprimir"
id="gvCotizon_ctl11_imgImprimir" title="Imprimir"
src="../App_Themes/Theme_Transaccional/images/botones/boton_Icono/ico_imprimir_1.pn
g" style="height:24px;width:26px;border-width:0px;" />
</td><td>CC 1023955692</td><td>Yuly Zuleyma Llanos
Sacristan</td><td>77182404</td><td>$0</td><td>Abr 5 de 2018</td><td>Abr 6 de
2018</td><td>2</td><td>0</td><td>0</td><td>Nueva</td><td>J00X</td><td>Enfermedad
General</td><td>Sin reconocimiento por parte de la
EPS</td><td>781,242</td><td>Nuestra IPS Olaya</td>
</tr><tr align="center" valign="middle"
style="color:#4A3C8C;background-color:#E7E7FF;font-family:Tahoma;font-size:XX-
Small;height:15px;">
<td valign="middle">
<input type="image" name="gvCotizon$ctl12$imgImprimir"
id="gvCotizon_ctl12_imgImprimir" title="Imprimir"
src="../App_Themes/Theme_Transaccional/images/botones/boton_Icono/ico_imprimir_1.pn
g" style="height:24px;width:26px;border-width:0px;" />
</td><td>CC 1023955692</td><td>Yuly Zuleyma Llanos
Sacristan</td><td>87943105</td><td>$0</td><td>May 9 de 2018</td><td>May 10 de
2018</td><td>2</td><td>0</td><td>0</td><td>Nueva</td><td>N938</td><td>Enfermedad
General</td><td>Sin reconocimiento por parte de la
EPS</td><td>781,242</td><td>Nuestra IPS Olaya</td>
</tr><tr align="center" valign="middle"
style="color:#333333;background-color:#F7F7F7;font-family:Verdana;font-size:XX-
Small;height:15px;">
<td valign="middle">
<input type="image" name="gvCotizon$ctl13$imgImprimir"
id="gvCotizon_ctl13_imgImprimir" title="Imprimir"
src="../App_Themes/Theme_Transaccional/images/botones/boton_Icono/ico_imprimir_1.pn
g" style="height:24px;width:26px;border-width:0px;" />
</td><td>CC 1023955692</td><td>Yuly Zuleyma Llanos
Sacristan</td><td>115306207</td><td>$0</td><td>Jul 30 de 2018</td><td>Jul 31 de
2018</td><td>2</td><td>0</td><td>0</td><td>Nueva</td><td>N946</td><td>Enfermedad
General</td><td>Sin reconocimiento por parte de la
EPS</td><td>781,242</td><td>Nuestra IPS Olaya</td>
</tr><tr align="center" valign="middle"
style="color:#4A3C8C;background-color:#E7E7FF;font-family:Tahoma;font-size:XX-
Small;height:15px;">
<td valign="middle">

</td><td>Totales</td><td> </td><td>&nbsp;</td><td>
</td><td> </td><td> </td><td>9</td><td>0</td><td>0</td><td> </td><td> </td><td>
</td><td> </td><td> </td><td> </td>
</tr>
</table>
</div></form>