Include P12 V2 - HSPAHRDY

HSPAHRDY.CH

 #DEFINE STR0001 FWI18NLang("HSPAHRDY","STR0001",1)
#DEFINE STR0002 FWI18NLang("HSPAHRDY","STR0002",2)
#DEFINE STR0003 FWI18NLang("HSPAHRDY","STR0003",3)
#DEFINE STR0004 FWI18NLang("HSPAHRDY","STR0004",4)
#DEFINE STR0005 FWI18NLang("HSPAHRDY","STR0005",5)
#DEFINE STR0006 FWI18NLang("HSPAHRDY","STR0006",6)
#DEFINE STR0007 FWI18NLang("HSPAHRDY","STR0007",7)
#DEFINE STR0008 FWI18NLang("HSPAHRDY","STR0008",8)
#DEFINE STR0009 FWI18NLang("HSPAHRDY","STR0009",9)
#DEFINE STR0010 FWI18NLang("HSPAHRDY","STR0010",10)
#DEFINE STR0011 FWI18NLang("HSPAHRDY","STR0011",11)
#DEFINE STR0012 FWI18NLang("HSPAHRDY","STR0012",12)
#DEFINE STR0013 FWI18NLang("HSPAHRDY","STR0013",13)
#DEFINE STR0014 FWI18NLang("HSPAHRDY","STR0014",14)
#DEFINE STR0015 FWI18NLang("HSPAHRDY","STR0015",15)
#DEFINE STR0016 FWI18NLang("HSPAHRDY","STR0016",16)
#DEFINE STR0017 FWI18NLang("HSPAHRDY","STR0017",17)
#DEFINE STR0018 FWI18NLang("HSPAHRDY","STR0018",18)
#DEFINE STR0019 FWI18NLang("HSPAHRDY","STR0019",19)
#DEFINE STR0020 FWI18NLang("HSPAHRDY","STR0020",20)
#DEFINE STR0021 FWI18NLang("HSPAHRDY","STR0021",21)
#DEFINE STR0022 FWI18NLang("HSPAHRDY","STR0022",22)
#DEFINE STR0023 FWI18NLang("HSPAHRDY","STR0023",23)
#DEFINE STR0024 FWI18NLang("HSPAHRDY","STR0024",24)
#DEFINE STR0025 FWI18NLang("HSPAHRDY","STR0025",25)
#DEFINE STR0026 FWI18NLang("HSPAHRDY","STR0026",26)
#DEFINE STR0027 FWI18NLang("HSPAHRDY","STR0027",27)
#DEFINE STR0028 FWI18NLang("HSPAHRDY","STR0028",28)
#DEFINE STR0029 FWI18NLang("HSPAHRDY","STR0029",29)
#DEFINE STR0030 FWI18NLang("HSPAHRDY","STR0030",30)
#DEFINE STR0031 FWI18NLang("HSPAHRDY","STR0031",31)
#DEFINE STR0032 FWI18NLang("HSPAHRDY","STR0032",32)
#DEFINE STR0033 FWI18NLang("HSPAHRDY","STR0033",33)
#DEFINE STR0034 FWI18NLang("HSPAHRDY","STR0034",34)
#DEFINE STR0035 FWI18NLang("HSPAHRDY","STR0035",35)
#DEFINE STR0036 FWI18NLang("HSPAHRDY","STR0036",36)
#DEFINE STR0037 FWI18NLang("HSPAHRDY","STR0037",37)
#DEFINE STR0038 FWI18NLang("HSPAHRDY","STR0038",38)
#DEFINE STR0039 FWI18NLang("HSPAHRDY","STR0039",39)
#DEFINE STR0040 FWI18NLang("HSPAHRDY","STR0040",40)
#DEFINE STR0041 FWI18NLang("HSPAHRDY","STR0041",41)
#DEFINE STR0042 FWI18NLang("HSPAHRDY","STR0042",42)
#DEFINE STR0043 FWI18NLang("HSPAHRDY","STR0043",43)
#DEFINE STR0044 FWI18NLang("HSPAHRDY","STR0044",44)
#DEFINE STR0045 FWI18NLang("HSPAHRDY","STR0045",45)
#DEFINE STR0046 FWI18NLang("HSPAHRDY","STR0046",46)
#DEFINE STR0047 FWI18NLang("HSPAHRDY","STR0047",47)
#DEFINE STR0048 FWI18NLang("HSPAHRDY","STR0048",48)
#DEFINE STR0049 FWI18NLang("HSPAHRDY","STR0049",49)
#DEFINE STR0050 FWI18NLang("HSPAHRDY","STR0050",50)
#DEFINE STR0051 FWI18NLang("HSPAHRDY","STR0051",51)
#DEFINE STR0052 FWI18NLang("HSPAHRDY","STR0052",52)
#DEFINE STR0053 FWI18NLang("HSPAHRDY","STR0053",53)
#DEFINE STR0054 FWI18NLang("HSPAHRDY","STR0054",54)
#DEFINE STR0055 FWI18NLang("HSPAHRDY","STR0055",55)
#DEFINE STR0056 FWI18NLang("HSPAHRDY","STR0056",56)
#DEFINE STR0057 FWI18NLang("HSPAHRDY","STR0057",57)
#DEFINE STR0058 FWI18NLang("HSPAHRDY","STR0058",58)
#DEFINE STR0059 FWI18NLang("HSPAHRDY","STR0059",59)
#DEFINE STR0060 FWI18NLang("HSPAHRDY","STR0060",60)
#DEFINE STR0061 FWI18NLang("HSPAHRDY","STR0061",61)
#DEFINE STR0062 FWI18NLang("HSPAHRDY","STR0062",62)
#DEFINE STR0063 FWI18NLang("HSPAHRDY","STR0063",63)
#DEFINE STR0064 FWI18NLang("HSPAHRDY","STR0064",64)
#DEFINE STR0065 FWI18NLang("HSPAHRDY","STR0065",65)
#DEFINE STR0066 FWI18NLang("HSPAHRDY","STR0066",66)
#DEFINE STR0067 FWI18NLang("HSPAHRDY","STR0067",67)
#DEFINE STR0068 FWI18NLang("HSPAHRDY","STR0068",68)
#DEFINE STR0069 FWI18NLang("HSPAHRDY","STR0069",69)
#DEFINE STR0070 FWI18NLang("HSPAHRDY","STR0070",70)
#DEFINE STR0071 FWI18NLang("HSPAHRDY","STR0071",71)
 

HSPAHRDY_EN.TRES

 0001#STR0001#ALL#OUTPATIENT PROCEDURE REQUEST/AUTHORIZATION REPORT
0002#STR0002#ALL#REPORT FOR REQUEST/AUTHORIZATION OF
0003#STR0003#ALL#OUTPATIENT PROCEDURE
0004#STR0004#ALL#HEALTH INSTITUTE IDENTIFICATION (REQUESTER)
0005#STR0005#ALL#1 - NAME OF REQUESTING HEALTH INSTITUTE
0006#STR0006#ALL#2 - CNES
0007#STR0007#ALL#PATIENT IDENTIFICATION
0008#STR0008#ALL#3 - PATIENT NAME
0009#STR0009#ALL#4 - SEX
0010#STR0010#ALL#Male
0011#STR0011#ALL#Female
0012#STR0012#ALL#5 - MEDICAL RECORD Nr.
0013#STR0013#ALL#6 - NATIONAL HEALTH CARD (CNS)
0014#STR0014#ALL#7 - DATE OF BIRTH
0015#STR0015#ALL#8 - RACE/COLOR
0016#STR0016#ALL#8.1 - ETHNICITY
0017#STR0017#ALL#9 MOTHER'S NAME
0018#STR0018#ALL#10 - CONTACT NUMBER
0019#STR0019#ALL#11 - NAME OF RESPONSIBLE
0020#STR0020#ALL#12 - CONTACT NUMBER
0021#STR0021#ALL#13 - ADDRESS (STREET, Nr, DISTRICT
0022#STR0022#ALL#14 - MUNICIPALITY OF RESIDENCE
0023#STR0023#ALL#15 - MUNICIPALITY IBGE CODE
0024#STR0024#ALL#16 - STATE
0025#STR0025#ALL#17 - POSTAL CODE
0026#STR0026#ALL#PROCEDURE REQUESTED
0027#STR0027#ALL#18 - MAIN PROCEDURE CODE
0028#STR0028#ALL#19 - MAIN PROCEDURE NAME
0029#STR0029#ALL#20 - QTY
0030#STR0030#ALL#SECONDARY PROCEDURE(S)
0031#STR0031#ALL#21 - SECONDARY PROCEDURE CODE
0032#STR0032#ALL#22 - SECONDARY PROCEDURE NAME
0033#STR0033#ALL#QTY
0034#STR0034#ALL#24 - SECONDARY PROCEDURE CODE
0035#STR0035#ALL#25 - SECONDARY PROCEDURE NAME
0036#STR0036#ALL#27 - SECONDARY PROCEDURE CODE
0037#STR0037#ALL#28 - SECONDARY PROCEDURE NAME
0038#STR0038#ALL#30 - SECONDARY PROCEDURE CODE
0039#STR0039#ALL#31 - SECONDARY PROCEDURE NAME
0040#STR0040#ALL#33 - SECONDARY PROCEDURE CODE
0041#STR0041#ALL#34 - SECONDARY PROCEDURE NAME
0042#STR0042#ALL#JUSTIFICATION FOR REQUESTED PROCEDURE(S)
0043#STR0043#ALL#36 - DESCRIPTION OF DIAGNOSTIC
0044#STR0044#ALL#37- CID10 MAIN
0045#STR0045#ALL#38- CID10 SECONDARY
0046#STR0046#ALL#39-CID10 ASSOCIATED CAUSES
0047#STR0047#ALL#40 - NOTES
0048#STR0048#ALL#REQUEST
0049#STR0049#ALL#41 - NAME OF REQUESTING PRACTITIONER
0050#STR0050#ALL#42 - DATE OF REQUEST
0051#STR0051#ALL#45 - SIGNATURE AND STAMP (COUNCIL RECORD Nr.)
0052#STR0052#ALL#43 - DOCUMENT
0053#STR0053#ALL#(    )CNS             (     )CPF
0054#STR0054#ALL#44 - DOCUMENT Nr. (CNS/CPF) OF REQUESTING PRACTITIONER
0055#STR0055#ALL#AUTHORIZATION
0056#STR0056#ALL#46 - NAME OF AUTHORIZING PRACTITIONER
0057#STR0057#ALL#47 - ISSUING BODY CODE
0058#STR0058#ALL#52 - AUTHORIZATION Nr. (APAC)
0059#STR0059#ALL#48 - DOCUMENT
0060#STR0060#ALL#49 - DOCUMENT Nr. (CNS/CPF) OF REQUESTING PRACTITIONER
0061#STR0061#ALL#50 - DATE OF AUTHORIZATION
0062#STR0062#ALL#51 - SIGNATURE AND STAMP (COUNCIL RECORD Nr.)
0063#STR0063#ALL#53 - APAC VALIDITY PERIOD
0064#STR0064#ALL#HEALTH INSTITUTE IDENTIFICATION (EXECUTOR)
0065#STR0065#ALL#54 - TRADE NAME OF EXECUTING HEALTH INSTITUTE
0066#STR0066#ALL#55 - CNES
0067#STR0067#ALL#WHITE
0068#STR0068#ALL#BLACK
0069#STR0069#ALL#MULATTO
0070#STR0070#ALL#YELLOW
0071#STR0071#ALL#INDIGENOUS NATIVE
 

HSPAHRDY_ES.TRES

 0001#STR0001#ALL#LAUDO PARA SOLICITUD/AUTORIZACION DE PROCEDIMIENTO AMBULATORIAL
0002#STR0002#ALL#LAUDO PARA SOLICITUD DE AUTORIZACION DE
0003#STR0003#ALL#PROCEDIMIENTO AMBULATORIAL
0004#STR0004#ALL#IDENTIFICACION DE ESTABLECIMIENTO DE SALUD (SOLICITANTE)
0005#STR0005#ALL#1 - NOMBRE DE ESTABLECIMIENTO DE SALUD SOLICITANTE
0006#STR0006#ALL#2 - CNES
0007#STR0007#ALL#IDENTIFICACION DEL PACIENTE
0008#STR0008#ALL#3 - NOMBRE DEL PACIENTE
0009#STR0009#ALL#4 - SEXO
0010#STR0010#ALL#Mas.
0011#STR0011#ALL#Fem.
0012#STR0012#ALL#5 - N� DE LA FICHA MEDICA
0013#STR0013#ALL#6 - TARJETA NACIONAL DE SALUD (CNS)
0014#STR0014#ALL#7 - FECHA DE NACIMIENTO
0015#STR0015#ALL#8 - RAZA/COLOR
0016#STR0016#ALL#8.1 - ETNIA
0017#STR0017#ALL#9 - NOMBRE DE LA MADRE
0018#STR0018#ALL#10 - TELEFONO DE CONTACTO
0019#STR0019#ALL#11 - NOMBRE DE LA RESPONSABLE
0020#STR0020#ALL#12 - TELEFONO DE CONTACTO
0021#STR0021#ALL#13 - DIRECCION (CALLE, N�, BARRIO
0022#STR0022#ALL#14 - MUNICIPIO DE RESIDENCIA
0023#STR0023#ALL#15 - COD. IBGE MUNICIPIO
0024#STR0024#ALL#16 - UF
0025#STR0025#ALL#17 - CEP
0026#STR0026#ALL#PROCEDIMIENTO SOLICITADO
0027#STR0027#ALL#18 - CODIGO DEL PROCEDIMIENTO PRINCIPAL
0028#STR0028#ALL#19 - NOMBRE DEL PROCEDIMIENTO PRINCIPAL
0029#STR0029#ALL#20 - CTD
0030#STR0030#ALL#PROCEDIMIENTO(S) SECUNDARIO(S)
0031#STR0031#ALL#21 - CODIGO DEL PROCEDIMIENTO SECUNDARIO
0032#STR0032#ALL#22 - NOMBRE DEL PROCEDIMIENTO SECUNDARIO
0033#STR0033#ALL#CNTD.
0034#STR0034#ALL#24 - CODIGO DEL PROCEDIMIENTO SECUNDARIO
0035#STR0035#ALL#25 - NOMBRE DEL PROCEDIMIENTO SECUNDARIO
0036#STR0036#ALL#27 - CODIGO DEL PROCEDIMIENTO SECUNDARIO
0037#STR0037#ALL#28 - NOMBRE DEL PROCEDIMIENTO SECUNDARIO
0038#STR0038#ALL#30 - CODIGO DEL PROCEDIMIENTO SECUNDARIO
0039#STR0039#ALL#31 - NOMBRE DEL PROCEDIMIENTO SECUNDARIO
0040#STR0040#ALL#33 - CODIGO DEL PROCEDIMIENTO SECUNDARIO
0041#STR0041#ALL#34 - NOMBRE DEL PROCEDIMIENTO SECUNDARIO
0042#STR0042#ALL#JUSTIFICATIVA DE(LOS) PROCEDIMIENTO(S) SOLICITADO(S)
0043#STR0043#ALL#36 - DESCRIPCION DEL DIAGNOSTICO
0044#STR0044#ALL#37-CID10 PRINCIPAL
0045#STR0045#ALL#38-CID10 SECUNDARIO
0046#STR0046#ALL#39-CID10 CAUSAS ASOCIADAS
0047#STR0047#ALL#40 - OBSERVACIONES
0048#STR0048#ALL#SOLICITUD
0049#STR0049#ALL#41 - NOMBRE DEL PROFESIONAL SOLICITANTE
0050#STR0050#ALL#42-FECHA DE LA SOLICITUD
0051#STR0051#ALL#45-FIRMA Y SELLO (N� REGISTRO DEL CONSEJO)
0052#STR0052#ALL#43 - DOCUMENTO
0053#STR0053#ALL#(    )CNS             (     )RFC
0054#STR0054#ALL#44 - N� DOCUMENTO (CNS/CPF) DEL PROFESIONAL SOLICITANTE
0055#STR0055#ALL#Autorizacion
0056#STR0056#ALL#46 - NOMBRE DEL PROFESIONAL AUTORIZADOR
0057#STR0057#ALL#47 - COD. ORGANO EMISOR
0058#STR0058#ALL#52-N� DE LA AUTORIZACION (APAC)
0059#STR0059#ALL#48 - DOCUMENTO
0060#STR0060#ALL#49 - N� DOCUMENTO (CNS/RFC) DEL PROFESIONAL SOLICITANTE
0061#STR0061#ALL#50-FECHA DE LA AUTORIZACION
0062#STR0062#ALL#51-FIRMA Y SELLO (N� DEL REGISTRO DEL CONSEJO)
0063#STR0063#ALL#53-PERIODO DE VALIDEZ DE LA APAC
0064#STR0064#ALL#IDENTIFICACION DE ESTABLECIMIENTO DE SALUD (EJECUTANTE)
0065#STR0065#ALL#54 - NOMBRE FANTASIA DEL ESTABLECIMIENTO DE SALUD EJECUTANTE
0066#STR0066#ALL#55 - CNES
0067#STR0067#ALL#BLANCA
0068#STR0068#ALL#NEGRA
0069#STR0069#ALL#PARDA
0070#STR0070#ALL#AMARILLA
0071#STR0071#ALL#INDIGENA
 

HSPAHRDY_PT-BR.TRES

 0001#STR0001#ALL#LAUDO PARA SOLICITA��O/AUTORIZA��O DE PROCEDIMENTO AMBULATORIAL
0002#STR0002#ALL#LAUDO PARA SOLICITA��O/AUTORIZA��O DE
0003#STR0003#ALL#PROCEDIMENTO AMBULATORIAL
0004#STR0004#ALL#IDENTIFICA��O DO ESTABELECIMENTO DE SA�DE (SOLICITANTE)
0005#STR0005#ALL#1 - NOME DO ESTABELECIMENTO DE SA�DE SOLICITANTE
0006#STR0006#ALL#2 - CNES
0007#STR0007#ALL#IDENTIFICA��O DO PACIENTE
0008#STR0008#ALL#3 - NOME DO PACIENTE
0009#STR0009#ALL#4 - SEXO
0010#STR0010#ALL#Mas.
0011#STR0011#ALL#Fem.
0012#STR0012#ALL#5 - N� DO PRONTU�RIO
0013#STR0013#ALL#6 - CART�O NACIONAL DE SA�DE (CNS)
0014#STR0014#ALL#7 - DATA DE NASCIMENTO
0015#STR0015#ALL#8 - RA�A/COR
0016#STR0016#ALL#8.1 - ETNIA
0017#STR0017#ALL#9 - NOME DA M�E
0018#STR0018#ALL#10 - TELEFONE DE CONTATO
0019#STR0019#ALL#11 - NOME DA RESPONS�VEL
0020#STR0020#ALL#12 - TELEFONE DE CONTATO
0021#STR0021#ALL#13 - ENDERE�O (RUA, N�, BAIRRO
0022#STR0022#ALL#14 - MUNIC�PIO DE RESID�NCIA
0023#STR0023#ALL#15 - C�D. IBGE MUN�CIPIO
0024#STR0024#ALL#16 - UF
0025#STR0025#ALL#17 - CEP
0026#STR0026#ALL#PROCEDIMENTO SOLICITADO
0027#STR0027#ALL#18 - C�DIGO DO PROCEDIMENTO PRINCIPAL
0028#STR0028#ALL#19 - NOME DO PROCEDIMENTO PRINCIPAL
0029#STR0029#ALL#20 - QTDE
0030#STR0030#ALL#PROCEDIMENTO(S) SECUND�RIO(S)
0031#STR0031#ALL#21 - C�DIGO DO PROCEDIMENTO SECUND�RIO
0032#STR0032#ALL#22 - NOME DO PROCEDIMENTO SECUND�RIO
0033#STR0033#ALL#QTDE
0034#STR0034#ALL#24 - C�DIGO DO PROCEDIMENTO SECUND�RIO
0035#STR0035#ALL#25 - NOME DO PROCEDIMENTO SECUND�RIO
0036#STR0036#ALL#27 - C�DIGO DO PROCEDIMENTO SECUND�RIO
0037#STR0037#ALL#28 - NOME DO PROCEDIMENTO SECUND�RIO
0038#STR0038#ALL#30 - C�DIGO DO PROCEDIMENTO SECUND�RIO
0039#STR0039#ALL#31 - NOME DO PROCEDIMENTO SECUND�RIO
0040#STR0040#ALL#33 - C�DIGO DO PROCEDIMENTO SECUND�RIO
0041#STR0041#ALL#34 - NOME DO PROCEDIMENTO SECUND�RIO
0042#STR0042#ALL#JUSTIFICATIVA DO(S) PROCEDIMENTOS(S) SOLICITADO(S)
0043#STR0043#ALL#36 - DESCRI��O DO DIAGN�STICO
0044#STR0044#ALL#37-CID10 PRINCIPAL
0045#STR0045#ALL#38-CID10 SECUND�RIO
0046#STR0046#ALL#39-CID10 CAUSAS ASSOCIADAS
0047#STR0047#ALL#40 - OBSERVA��ES
0048#STR0048#ALL#SOLICITA��O
0049#STR0049#ALL#41 - NOME DO PROFISSIONAL SOLICITANTE
0050#STR0050#ALL#42-DATA DA SOLICITA��O
0051#STR0051#ALL#45-ASSINATURA E CARIMBO (N� REGISTRO DO CONSELHO)
0052#STR0052#ALL#43 - DOCUMENTO
0053#STR0053#ALL#(    )CNS             (     )CPF
0054#STR0054#ALL#44 - N� DOCUMENTO (CNS/CPF) DO PROFISSIONAL SOLICITANTE
0055#STR0055#ALL#AUTORIZA��O
0056#STR0056#ALL#46 - NOME DO PROFISSIONAL AUTORIZADOR
0057#STR0057#ALL#47 - C�D. �RG�O EMISSOR
0058#STR0058#ALL#52-N� DA AUTORIZA��O (APAC)
0059#STR0059#ALL#48 - DOCUMENTO
0060#STR0060#ALL#49 - N� DOCUMENTO (CNS/CPF) DO PROFISSIONAL SOLICITANTE
0061#STR0061#ALL#50-DATA DA AUTORIZA��O
0062#STR0062#ALL#51-ASSINATURA E CARIMBO (N� DO REGISTRO DO CONSELHO)
0063#STR0063#ALL#53-PER�ODO DE VALIDADE DA APAC
0064#STR0064#ALL#IDENTIFICA��O DO ESTABELECIMENTO DE SA�DE (EXECUTANTE)
0065#STR0065#ALL#54 - NOME FANTASIA DO ESTABELECIMENTO DE SA�DE EXECUTANTE
0066#STR0066#ALL#55 - CNES
0067#STR0067#ALL#BRANCA
0068#STR0068#ALL#PRETA
0069#STR0069#ALL#PARDA
0070#STR0070#ALL#AMARELA
0071#STR0071#ALL#IND�GENA
 

HSPAHRDY_PT-PT.TRES

 0018#STR0018#ALL#10 - TELEFONE DE CONTACTO
0020#STR0020#ALL#12 - TELEFONE DE CONTACTO
0021#STR0021#ALL#13 - MORADA (RUA, N�, FREG.
0024#STR0024#ALL#16 - DISTRITO
0025#STR0025#ALL#17 - CP
0029#STR0029#ALL#20 - QTD
0033#STR0033#ALL#QTD
0051#STR0051#ALL#45-ASSINATURA E CARIMBO (N� REGISTO DO CONSELHO)
0053#STR0053#ALL#(    )CNS             (     )NC
0054#STR0054#ALL#44 - N� DOCUMENTO (CNS/NC) DO PROFISSIONAL SOLICITANTE
0060#STR0060#ALL#49 - N� DOCUMENTO (CNS/NC) DO PROFISSIONAL SOLICITANTE
0062#STR0062#ALL#51-ASSINATURA E CARIMBO (N� DO REGISTO DO CONSELHO)
 

HSPAHRDY_RU.TRES

 0001#STR0001#ALL#OUTPATIENT PROCEDURE REQUEST/AUTHORIZATION REPORT
0002#STR0002#ALL#REPORT FOR REQUEST/AUTHORIZATION OF
0003#STR0003#ALL#OUTPATIENT PROCEDURE
0004#STR0004#ALL#HEALTH INSTITUTE IDENTIFICATION (REQUESTER)
0005#STR0005#ALL#1 - NAME OF REQUESTING HEALTH INSTITUTE
0006#STR0006#ALL#2 - CNES
0007#STR0007#ALL#PATIENT IDENTIFICATION
0008#STR0008#ALL#3 - PATIENT NAME
0009#STR0009#ALL#4 - SEX
0010#STR0010#ALL#���.
0011#STR0011#ALL#���.  
0012#STR0012#ALL#5 - MEDICAL RECORD Nr.
0013#STR0013#ALL#6 - NATIONAL HEALTH CARD (CNS)
0014#STR0014#ALL#7 - DATE OF BIRTH
0015#STR0015#ALL#8 - RACE/COLOR
0016#STR0016#ALL#8.1 - ETHNICITY
0017#STR0017#ALL#9 MOTHER'S NAME
0018#STR0018#ALL#10 - CONTACT NUMBER
0019#STR0019#ALL#11 - NAME OF RESPONSIBLE
0020#STR0020#ALL#12 - CONTACT NUMBER
0021#STR0021#ALL#13 - ADDRESS (STREET, Nr, DISTRICT
0022#STR0022#ALL#14 - MUNICIPALITY OF RESIDENCE
0023#STR0023#ALL#15 - MUNICIPALITY IBGE CODE
0024#STR0024#ALL#16 - STATE

0025#STR0025#ALL#17 - POSTAL CODE
0026#STR0026#ALL#PROCEDURE REQUESTED
0027#STR0027#ALL#18 - MAIN PROCEDURE CODE
0028#STR0028#ALL#19 - MAIN PROCEDURE NAME
0029#STR0029#ALL#20 - QTY
0030#STR0030#ALL#SECONDARY PROCEDURE(S)
0031#STR0031#ALL#21 - SECONDARY PROCEDURE CODE
0032#STR0032#ALL#22 - SECONDARY PROCEDURE NAME
0033#STR0033#ALL#���-��
0034#STR0034#ALL#24 - SECONDARY PROCEDURE CODE
0035#STR0035#ALL#25 - SECONDARY PROCEDURE NAME
0036#STR0036#ALL#27 - SECONDARY PROCEDURE CODE
0037#STR0037#ALL#28 - SECONDARY PROCEDURE NAME
0038#STR0038#ALL#30 - SECONDARY PROCEDURE CODE
0039#STR0039#ALL#31 - SECONDARY PROCEDURE NAME
0040#STR0040#ALL#33 - SECONDARY PROCEDURE CODE
0041#STR0041#ALL#34 - SECONDARY PROCEDURE NAME
0042#STR0042#ALL#JUSTIFICATION FOR REQUESTED PROCEDURE(S)
0043#STR0043#ALL#36 - DESCRIPTION OF DIAGNOSTIC
0044#STR0044#ALL#37- CID10 MAIN
0045#STR0045#ALL#38- CID10 SECONDARY
0046#STR0046#ALL#39-CID10 ASSOCIATED CAUSES
0047#STR0047#ALL#40 - NOTES
0048#STR0048#ALL#REQUEST
0049#STR0049#ALL#41 - NAME OF REQUESTING PRACTITIONER
0050#STR0050#ALL#42 - DATE OF REQUEST
0051#STR0051#ALL#45 - SIGNATURE AND STAMP (COUNCIL RECORD Nr.)
0052#STR0052#ALL#43 - DOCUMENT
0053#STR0053#ALL#(    )CNS             (     )CPF
0054#STR0054#ALL#44 - DOCUMENT Nr. (CNS/CPF) OF REQUESTING PRACTITIONER
0055#STR0055#ALL#AUTHORIZATION
0056#STR0056#ALL#46 - NAME OF AUTHORIZING PRACTITIONER
0057#STR0057#ALL#47 - ISSUING BODY CODE
0058#STR0058#ALL#52 - AUTHORIZATION Nr. (APAC)
0059#STR0059#ALL#48 - DOCUMENT
0060#STR0060#ALL#49 - DOCUMENT Nr. (CNS/CPF) OF REQUESTING PRACTITIONER
0061#STR0061#ALL#50 - DATE OF AUTHORIZATION
0062#STR0062#ALL#51 - SIGNATURE AND STAMP (COUNCIL RECORD Nr.)
0063#STR0063#ALL#53 - APAC VALIDITY PERIOD
0064#STR0064#ALL#HEALTH INSTITUTE IDENTIFICATION (EXECUTOR)
0065#STR0065#ALL#54 - TRADE NAME OF EXECUTING HEALTH INSTITUTE
0066#STR0066#ALL#55 - CNES
0067#STR0067#ALL#WHITE
0068#STR0068#ALL#BLACK
0069#STR0069#ALL#MULATTO
0070#STR0070#ALL#YELLOW
0071#STR0071#ALL#INDIGENOUS NATIVE