<?php 

	include("Funciones.php");
	include("funcion/funciones.php");
  	include("clases/BDConexion.php");
  	include("clases/clsclinico.php");
  	$objclinico = new clsclinico;
if(isset($doc_id)){
			$existe=$objclinico->DioFichaMedica($doc_id);
			if ($existe==1){
			   $aler=2;
			   }
			else{
				if($existe==0){$aler=1;}
				}
			
			}
			

?><!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<title>FICHA MEDICA - PERENCO</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<link href="stilos/Estilos.css" rel="stylesheet" type="text/css">
<style type="text/css">
<!--
.Estilo1 {font-size: 14px}
.Estilo3 {font-size: 16px}
.Estilo4 {font-size: 10px}
.Estilo9 {color: #000000}
.Estilo10 {
	font-size: 12px;
	color: #FFFFFF;
}
.Estilo12 {font-size: 12px}
.Estilo13 {
	font-size: 11px;
	color: #000000;
}
.Estilo14 {font-size: 11px}
.Estilo15 {font-size: 9px}
.Estilo17 {color: #FF0000}
.Estilo21 {color: #FFFFFF}
.Estilo22 {color: #0000FF; font-size: 10px; }
.Estilo23 {font-size: 10px; color: #FFFFFF; }
-->
</style>
<SCRIPT language=JavaScript src="js/calendario.js"></SCRIPT><SCRIPT LANGUAGE=javascript>
function fn(form,field)
{
var next=0, found=false
var f=form
if(event.keyCode!=13) return;
for(var i=0;i<f.length;i++) {
if(field.name==f.item(i).name){
next=i+1;
found=true
break;
}
}
while(found){
if( f.item(next).disabled==false && f.item(next).type!='hidden'){
f.item(next).focus();
break;
}
else{
if(next<f.length-1)
next=next+1;
else
break;
}
}
}
</SCRIPT>
<script>
function enviar_url(form,url){

		if (form1.fecha.value==""){
				alert("Debe Ingresar la Fecha.\n y es Obligatorio");
				return;	
								}
		if (form1.nombres.value==""){
				alert("Debe Ingresar el Nombre del Trabajador.\n y es Obligatorio. \n presiona Buscar o Nuevo");
				return;	
	  						}
		if(form1.grabar.value)
		{
			form1.submit();
		}
}
function volver(form){
  location.reload('fondo.php');
  
  }
  
function Limpiar(form)
{
		var next=0;
		var f=form;
		for(var i=0;i<f.length;i++) {
			if(f.item(i).type=='text'){
				f.item(i).value="";
						}
			}
}
</script>
<script language="JavaScript"> 
<!--
//sURL,x,y
function Abrir_Ventanapopup1(sURL,x,y) { 
/*var especificaciones="top=0, left=0, toolbar=no,location=no, status=yes,menubar=no,scrollbars=no, resizable=no, width=1,height=1" 
var titulo="Titulo"
window.open(el_url,titulo,especificaciones);*/ 

if (!window.focus) return;
			var par;
			par = "width=" +x + ",height="+y+","
			par = par + "dependent=no,scrollbars=yes,resizable=no"
			par = par + "menubar=no,toolbar=no,status=yes"
			var ventana = window.open(sURL,"Ver",par)
			ventana.focus();
}
//--> 
</script>
<script language="JavaScript"> 
<!--
//sURL,x,y
function Abrir_Ventanapopup2(sURL,x,y) { 
/*var especificaciones="top=0, left=0, toolbar=no,location=no, status=yes,menubar=no,scrollbars=no, resizable=no, width=1,height=1" 
var titulo="Titulo"
window.open(el_url,titulo,especificaciones);*/ 

if (!window.focus) return;
			var par;
			par = "width=" +x + ",height="+y+","
			par = par + "dependent=no,scrollbars=yes,resizable=no"
			par = par + "menubar=no,toolbar=no,status=yes"
			var ventana = window.open(sURL,"Ver",par)
			ventana.focus();
}
//--> 
</script>
<?php $url="ficha_medica.php?a=1"?>
<script language="JavaScript" type="text/JavaScript">
function MensajeEditar(m){
if (m==1){window.alert("Se Guardará la Ficha Médica satisfactoriamente")
          form1.submit();
		 }
if (m==2){
		    if(confirm("Ya! Existe Una Ficha Médica Registrado para el Trabajador-Verifique en el Menu Consulta : \n ¿Si desea crear Un Registro Nuevo Presiones Aceptar? O \n Presione Cancelar Para Ver la Ficha Existente"))
			 	{
				form1.submit();
				}
			 else{
				 alert("Se Mostrará La Ficha médica existente del Trabajador");
				 var docid = '<?php echo $doc_id;?>';
				 window.location="editar_fichamedica.php?docid="+docid;
				  }
			 }
if(m==3){alert('Se Guardó una Ficha Nueva del Trabajador');}
	
}
</script>
</head>

<?php
if($aler==1){
     echo "<body onLoad='MensajeEditar(1)'> ";
	 $envio = "procesos/grabar_fichamedica.php?param=0";
	 $mes = date("m");
	} 
else {
     if (empty($aler)){
	 echo "<body background='imagenes/fondo.jpg'>";
	 $envio = "ficha_medica.php";
	 $mes = date("m");
	 }
	 if($aler==2){
	 $envio = "procesos/grabar_fichamedica.php?param=1";
	 echo "<body onLoad='MensajeEditar(2)'  background='imagenes/fondo.jpg'>";
	 $mes = $mes;
	 }
    }
 if($aler==3){
     echo "<body onLoad='MensajeEditar(3)' background='imagenes/fondo.jpg'> ";
	 $envio = "ficha_medica.php";
	 $mes = date("m");
	} 
if($a==1){$envio = "ficha_medica.php";}
?>
<table width="460" border="0" align="center" cellpadding="0" cellspacing="0" >
  <tr class="lblCampo" >
    <td colspan="4"><div align="center">
        <table width="319" border="0" align="center" cellpadding="0" cellspacing="0">
          <tr>
            <td>&nbsp;</td>
            <td valign="bottom">&nbsp;</td>
            <td>&nbsp;</td>
          </tr>
          <tr>
            <td width="25"><img src="estilo_tabla/parte_sup_izq.gif" width="25" height="25"></td>
            <td width="409" background="estilo_tabla/parte_sup_cen.gif" valign="bottom">
              <div align="left" class="lblTitulo Estilo21" ><span class="lblSubTitulo">Ficha M&eacute;dica</span>M&eacute;dico PreLaboral </div></td>
            <td width="25"><img src="estilo_tabla/parte_sup_der.gif" width="25" height="25" border="0" usemap="#Map"></td>
          </tr>
          <tr>
            <td width="25" background="estilo_tabla/parte_med_izq.gif">&nbsp;</td>
            <td width="409" height="86" background="estilo_tabla/parte_med_cen.gif"><div align="center">
              <form action="<?=$envio?>" method="post" name="form1">
                <table width="720" border="0" align="left" cellpadding="0" cellspacing="0">
                  <tr>
                    <td width="75" rowspan="3">&nbsp;</td>
                    <td width="483">&nbsp;</td>
                    <td colspan="3">&nbsp;</td>
                  </tr>
                  <tr>
                    <td><div align="center" class="lblParrafo Estilo1"><em>DEPARTAMENTO DE QHSE- CR</em></div></td>
                    <td colspan="3">&nbsp;</td>
                  </tr>
                  <tr>
                    <td><div align="center" class="lblParrafo"><em>Perenco Per&uacute; Limited Sucursal del Per&uacute;</em></div></td>
                    <td width="38"><div align="right"><span class="rdoBanners Estilo4">FECHA</span></div></td>
                    <td width="68"><div align="center">
                        <input name="fecha" type="text" class="lblForm" id="fecha" onkeyup=fn(this.form,this) value="<? echo $fecha?>" size="12" readonly >
                    </div></td>
                    <td width="56"><a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                  </tr>
                  <tr>
                    <td colspan="5"><table width="720" border="1" align="left" cellpadding="0" cellspacing="0"><tr><td width="720" height="20" bgcolor="#009900"><div align="center" class="lblSubTitulo Estilo3"><div align="center" class="Estilo9"></div>
                          </div></td>
                        </tr>
                    </table></td>
                  </tr>
                  <tr>
                    <td colspan="5"><table width="711" border="0" align="left" cellpadding="0" cellspacing="0">
                        <tr>
                          <td height="26"><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr>
                                <td width="87" height="24" class="lblParrafo">PROYECTO</td>
                                <td width="114"><div align="left">
                                  <input name="proy" type="text" class="lblForm" id="proy" onkeyup=fn(this.form,this) value="<? echo $proy?>" size="20">
                                </div></td>
                                <td width="118" class="lblParrafo">TIPO DE EXAMEN</td>
                                <td width="89"><input name="tipo_exafisi" type="radio" class="lblForm" value="INGRESO" <?php if($tipo_exafisi=='INGRESO'){echo "checked";}?>>
                                  <span class="rdoBanners">INGRESO</span></td>
                                <td width="86"><input name="tipo_exafisi" type="radio" class="lblForm" value="PERIODO" <?php if($tipo_exafisi=='PERIODO'){echo "checked";}?>>
                                  <span class="rdoBanners">PERIODO</span></td>
                                <td width="90"><input name="tipo_exafisi" type="radio" class="lblForm" value="RETIRO" <?php if($tipo_exafisi=='RETIRO'){echo "checked";}?>>
                                  <span class="rdoBanners">RETIRO</span></td>
                                <td width="120"><input name="tipo_exafisi" type="radio" class="lblForm" value="OTRO" <?php if($tipo_exafisi=='OTRO'){echo "checked";}?>>
                                  <span class="rdoBanners">OTRO</span></td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td><div align="center" class="lblParrafo">DATOS DE IDENTIFICACI&Oacute;N DEL TRABAJADOR</div></td>
                        </tr>
                        <tr>
                          <td><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr>
                                <td width="189" class="rdoBanners Estilo4">APELLIDOS Y NOMBRES </td>
                                <td colspan="2"><div align="left">
                                  <input name="nombres" type="text" class="lblForm" id="nombres" onkeyup=fn(this.form,this) value="<? echo $nombres?>" size="50" readonly>
                                </div></td>
                                <td width="107"><input name="btn_ver1" type="button" class="botira" id="btn_ver1" style="<?=$stylo['st2']?>" value="Buscar" onClick="javascript:Abrir_Ventanapopup1('reg_clinico_ver3.php',465,300)" ></td>
                                <td width="125"><input name="btn_ver12" type="button" class="botira" id="btn_ver122" style="<?=$stylo['st2']?>" value="Nuevo" onClick="javascript:Abrir_Ventanapopup2('cvp_personal3.php',800,300)" ></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">FECHA DE NACIMIENTO</td>
                                <td width="105" bgcolor="#D4D3CA"><div align="left">
                                  <input name="fechanac" type="text" class="lblForm" id="fechanac" onkeyup=fn(this.form,this) value="<? echo $fechanac?>" size="12" readonly >
                                  </div></td>
                                <td width="182" class="rdoBanners Estilo4"><div align="left">EMPRESA</div></td>
                                <td colspan="2" bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="left">
                                  <input name="lug_nac" type="text" class="lblForm" id="lug_nac" onkeyup=fn(this.form,this) value="<? echo $lug_nac?>" size="30">
                                </div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">EDAD</td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="edad" type="text" class="lblForm" id="edad" onkeyup=fn(this.form,this) value="<? echo $edad?>" size="12">
                                </div></td>
                                <td class="rdoBanners Estilo4"><div align="left">GENERO</div></td>
                                <td class="rdoBanners Estilo4"><div align="left">
                                  <input name="genero_sex" type="radio" class="lblForm" value="MASCULINO" <?php if($genero_sex=='MASCULINO'){echo "checked";}?>>
                                  <span class="rdoBanners">MASCULINO</span></div></td>
                                <td class="rdoBanners Estilo4"><div align="left">
                                  <input name="genero_sex" type="radio" class="lblForm" value="FEMENINO" <?php if($genero_sex=='FEMENINO'){echo "checked";}?>>
                                  <span class="rdoBanners">FEMENINO</span></div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners">DOCUMENTO DE IDENTIFICACI&Oacute;N</td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="doc_id" type="text" class="lblForm" id="doc_id" onkeyup=fn(this.form,this) value="<? echo $doc_id?>" size="20" readonly>
                                </div></td>
                                <td class="rdoBanners Estilo4"><div align="left">N&ordm; DE PASAPORTE </div></td>
                                <td colspan="2" bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="left">
                                  <input name="exp_en" type="text" class="lblForm" id="exp_en" onkeyup=fn(this.form,this) value="<? echo $exp_en?>" size="30">
                                  </div></td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr bgcolor="#009900" class="rdoBanners">
                                <td colspan="3"><span class="Estilo4">DATOS DE PROCEDENCIA DEL TRABAJADOR</span></td>
                                <td width="109"><span class="Estilo4">ESTADO CIVIL</span></td>
                                <td width="25">&nbsp;</td>
                                <td width="283"><span class="Estilo4">GRADO INSTRUCCI&Oacute;N</span></td>
                              </tr>
                              <tr>
                                <td width="109" class="rdoBanners"><div align="right">DISTRITO</div></td>
                                <td width="155" bgcolor="#009900"><div align="left">
                                  <input name="pro_dist" type="text" class="lblForm" id="pro_dist" onkeyup=fn(this.form,this) value="<? echo $pro_dist?>" size="30">
                                </div></td>
                                <td width="25">&nbsp;</td>
                                <td><div align="left">
                                  <input name="estado_civil" type="radio" class="lblForm" value="SOLTERO(A)" <?php if($estado_civil=='SOLTERO(A)'){echo "checked";}?>>
                                    <span class="rdoBanners">SOLTERO(A)</span></div></td>
                                <td><div align="left"></div></td>
                                <td width="283"><div align="left">
                                  <input name="grado_instruc" type="radio" class="lblForm" value="ANALFABETA" <?php if($grado_instruc=='ANALFABETA'){echo "checked";}?> >
                                  <span class="rdoBanners">ANALFABETA</span></div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners"><div align="right">DEPARTAMENTO</div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="pro_depa" type="text" class="lblForm" id="pro_depa" onkeyup=fn(this.form,this) value="<? echo $pro_depa?>" size="30">
                                </div></td>
                                <td>&nbsp;</td>
                                <td><div align="left">
                                  <input name="estado_civil" type="radio" class="lblForm" value="CASADO(A)" <?php if($estado_civil=='CASADO(A)'){echo "checked";}?>>
                                    <span class="rdoBanners">CASADO(A)</span></div></td>
                                <td><div align="left"></div></td>
                                <td><div align="left">
                                  <input name="grado_instruc" type="radio" class="lblForm" value="PRIMARIA" <?php if($grado_instruc=='PRIMARIA'){echo "checked";}?>>
                                    <span class="rdoBanners">PRIMARIA</span></div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners"><div align="right">DIRECCI&Oacute;N</div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="pro_dire" type="text" class="lblForm" id="pro_dire" onkeyup=fn(this.form,this) value="<? echo $pro_dire?>" size="30">
                                </div></td>
                                <td>&nbsp;</td>
                                <td><div align="left">
                                  <input name="estado_civil" type="radio" class="lblForm" value="VIUDO(A)" <?php if($estado_civil=='VIUDO(A)'){echo "checked";}?>>
                                    <span class="rdoBanners">VIUDO(A)</span></div></td>
                                <td width="25"><div align="left"></div></td>
                                <td><div align="left">
                                  <input name="grado_instruc" type="radio" class="lblForm" value="SECUNDARIA" <?php if($grado_instruc=='SECUNDARIA'){echo "checked";}?>>
                                    <span class="rdoBanners">SECUNDARIA</span></div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners"><div align="right">TEL&Eacute;FONO</div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="pro_telef" type="text" class="lblForm" id="pro_telef" onkeyup=fn(this.form,this) value="<? echo $pro_telef?>" size="30">
                                </div></td>
                                <td>&nbsp;</td>
                                <td><div align="left">
                                  <input name="estado_civil" type="radio" class="lblForm" value="U. LIBRE(A)" <?php if($estado_civil=='U. LIBRE(A)'){echo "checked";}?> >
                                    <span class="rdoBanners">U. LIBRE(A)</span></div></td>
                                <td><div align="left"></div></td>
                                <td><div align="left">
                                  <input name="grado_instruc" type="radio" class="lblForm" value="TECNICO" <?php if($grado_instruc=='TECNICO'){echo "checked";}?>>
                                    <span class="rdoBanners">T&Eacute;CNICO</span></div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners"><div align="right">OTRO</div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="pro_otro" type="text" class="lblForm" id="pro_otro" onkeyup=fn(this.form,this) value="<? echo $pro_otro?>" size="30">
                                </div></td>
                                <td>&nbsp;</td>
                                <td><div align="left">
                                  <input name="estado_civil" type="radio" class="lblForm" value="SEPARADO(A)" <?php if($estado_civil=='SEPARADO(A)'){echo "checked";}?> >
                                    <span class="rdoBanners">SEPARADO(A)</span></div></td>
                                <td><div align="left"></div></td>
                                <td><div align="left">
                                  <input name="grado_instruc" type="radio" class="lblForm" value="UNIVERSITARIO"  <?php if($grado_instruc=='UNIVERSITARIO'){echo "checked";}?>>
                                    <span class="rdoBanners">UNIVERSITARIO</span></div></td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr class="rdoBanners">
                                <td colspan="3"><span class="Estilo4">ESPECIFICACIONES DEL CARGO ACTUAL</span></td>
                                <td colspan="4"><div align="center" class="Estilo4">ANTECEDENTES FAMILIARES</div></td>
                              </tr>
                              <tr>
                                <td width="127" class="rdoBanners"><div align="right">PROFESI&Oacute;N</div></td>
                                <td width="172" bgcolor="#D4D3CA"><div align="left">
                                  <input name="esp_profe" type="text" class="lblForm" id="esp_profe" onkeyup=fn(this.form,this) value="<? echo $esp_profe?>" size="30">
                                </div></td>
                                <td width="11">&nbsp;</td>
                                <td width="106"><span class="rdoBanners Estilo4">PATOLOG&Iacute;A</span></td>
                                <td><span class="rdoBanners Estilo4">PARENTESCO</span></td>
                                <td width="118"><span class="rdoBanners Estilo4">PATOLOG&Iacute;A</span></td>
                                <td width="91"><span class="rdoBanners Estilo4">PARENTESCO</span></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners"><div align="right">CARGO</div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="esp_carg" type="text" class="lblForm" id="esp_carg" onkeyup=fn(this.form,this) value="<? echo $esp_carg?>" size="30">
                                </div></td>
                                <td>&nbsp;</td>
                                <td> <div align="left"><span class="rdoBanners">
                                    <input name="check1" type="checkbox" id="check1" value="SI" <?php if($check1=='SI'){echo "checked";}?>>
                      H.T.A</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="paret_hta" type="text" class="lblForm" id="paret_hta" onkeyup=fn(this.form,this) value="<? echo $paret_hta?>" size="15">
                                </div></td>
                                <td> <div align="left"><span class="rdoBanners">
                                    <input name="check7" type="checkbox" id="check7" value="SI" <?php if($check7=='SI'){echo "checked";}?>>
                      T.B.C</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="paret_tbc" type="text" class="lblForm" id="paret_tbc" onkeyup=fn(this.form,this) value="<? echo $paret_tbc?>" size="15">
                                </div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners"><div align="right">DEPARTAMENTO</div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="esp_dep" type="text" class="lblForm" id="esp_dep" onkeyup=fn(this.form,this) value="<? echo $esp_dep?>" size="30">
                                </div></td>
                                <td>&nbsp;</td>
                                <td> <div align="left"><span class="rdoBanners">
                                    <input name="check2" type="checkbox" id="check2" value="SI" <?php if($check2=='SI'){echo "checked";}?>>
                      A.C.V.</span></div></td>
                                <td width="79" bgcolor="#D4D3CA"><div align="left">
                                  <input name="paret_acv" type="text" class="lblForm" id="paret_acv" onKeyUp=fn(this.form,this) value="<? echo $paret_acv?>" size="15">
</div></td>
                                <td> <div align="left"><span class="rdoBanners">
                                    <input name="check8" type="checkbox" id="check8" value="SI" <?php if($check8=='SI'){echo "checked";}?>>
                      VARICES</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="paret_var" type="text" class="lblForm" id="paret_var" onkeyup=fn(this.form,this) value="<? echo $paret_var?>" size="15">
                                </div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners"><div align="right">FECHA DE INGRESO </div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="fechatrabajoin" type="text" class="lblForm" id="fechatrabajoin" value="<? echo $fechatrabajoin?>" size="12" readonly>
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fechatrabajoin');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a> </div></td>
                                <td>&nbsp;</td>
                                <td> <div align="left"><span class="rdoBanners">
                                    <input name="check3" type="checkbox" id="check3" value="SI" <?php if($check3=='SI'){echo "checked";}?>>
                      E. CORONARIA</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="paret_ecoro" type="text" class="lblForm" id="paret_ecoro" onkeyup=fn(this.form,this) value="<? echo $paret_ecoro?>" size="15">
                                </div></td>
                                <td> <div align="left"><span class="rdoBanners">
                                    <input name="check9" type="checkbox" id="check9" value="SI" <?php if($check9=='SI'){echo "checked";}?>>
                                  C&Aacute;NCER</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="paret_canc" type="text" class="lblForm" id="paret_canc" onkeyup=fn(this.form,this) value="<? echo $paret_canc?>" size="15">
                                </div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners"><div align="right">TIEMPO SER. EMPRESA</div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="esp_tiemserv" type="text" class="lblForm" id="esp_tiemserv" onkeyup=fn(this.form,this) value="<? echo $esp_tiemserv?>" size="30">
                                </div></td>
                                <td>&nbsp;</td>
                                <td> <div align="left"><span class="rdoBanners">
                                    <input name="check4" type="checkbox" id="check4" value="SI" <?php if($check4=='SI'){echo "checked";}?>>
MELLITUS</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="paret_diab" type="text" class="lblForm" id="paret_diab" onkeyup=fn(this.form,this) value="<? echo $paret_diab?>" size="15">
                                </div></td>
                                <td> <div align="left"><span class="rdoBanners">
                                    <input name="check10" type="checkbox" id="check10" value="SI" <?php if($check10=='SI'){echo "checked";}?>>
                      MALFORMAC.</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="paret_malf" type="text" class="lblForm" id="paret_malf" onkeyup=fn(this.form,this) value="<? echo $paret_malf?>" size="15">
                                </div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners"><div align="right">TIEMPO EN EL CARGO</div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="esp_tiemcarg" type="text" class="lblForm" id="esp_tiemcarg" onkeyup=fn(this.form,this) value="<? echo $esp_tiemcarg?>" size="30">
                                </div></td>
                                <td>&nbsp;</td>
                                <td> <div align="left"><span class="rdoBanners">
                                    <input name="check5" type="checkbox" id="check5" value="SI" <?php if($check5=='SI'){echo "checked";}?>>
                      EPILEPSIA</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="paret_epilep" type="text" class="lblForm" id="paret_epilep" onkeyup=fn(this.form,this) value="<? echo $paret_epilep?>" size="15">
                                </div></td>
                                <td>
                                  <div align="left"><span class="rdoBanners">
                                    <input name="check12" type="checkbox" id="check12" value="SI" <?php if($check12=='SI'){echo "checked";}?>>
                                    ENF. MENTALES </span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                    <input name="paret_enfmen" type="text" class="lblForm" id="paret_enfmen" onkeyup=fn(this.form,this) value="<? echo $paret_enfmen?>" size="15">
                                </div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners"><div align="right">TIEMPO EN DEPTO</div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="esp_endp" type="text" class="lblForm" id="esp_endp" onkeyup=fn(this.form,this) value="<? echo $esp_endp?>" size="30">
                                </div></td>
                                <td>&nbsp;</td>
                                <td> <div align="left"><span class="rdoBanners">
                                    <input name="check6" type="checkbox" id="check6" value="SI" <?php if($check6=='SI'){echo "checked";}?>>
                      ASMA</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="paret_asma" type="text" class="lblForm" id="paret_asma" onkeyup=fn(this.form,this) value="<? echo $paret_asma?>" size="15">
                                </div></td>
                                <td>
                                  <div align="left"><span class="rdoBanners">
                                    <input name="check13" type="checkbox" id="check13" value="SI" <?php if($check13=='SI'){echo "checked";}?>>
    CONVULCIONES</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                    <input name="paret_convul" type="text" class="lblForm" id="paret_convul" onkeyup=fn(this.form,this) value="<? echo $paret_convul?>" size="15">
                                </div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners">&nbsp;</td>
                                <td>&nbsp;</td>
                                <td>&nbsp;</td>
                                <td>&nbsp;</td>
                                <td>&nbsp;</td>
                                <td>
                                  <div align="left"><span class="rdoBanners">
                                    <input name="check11" type="checkbox" id="check11" value="SI" <?php if($check11=='SI'){echo "checked";}?>>
    OTROS</span></div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                    <input name="paret_otr" type="text" class="lblForm" id="paret_otr" onkeyup=fn(this.form,this) value="<? echo $paret_otr?>" size="15">
                                </div></td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td><div align="center"><span class="rdoBanners Estilo10"><span class="rdoBanners  Estilo12">ANTECEDENTES PERSONALES </span></span></div></td>
                        </tr>
                        <tr>
                          <td><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr bgcolor="#009900">
                                <td width="448" bgcolor="#009900" class="rdoBanners Estilo13">Ha padecido usted de enfermedades como:</td>
                                <td width="33" bgcolor="#009900" class="rdoBanners Estilo14"><div align="center">SI</div></td>
                                <td width="33" bgcolor="#009900" class="rdoBanners Estilo14"><div align="center">NO</div></td>
                                <td width="80" bgcolor="#009900" class="rdoBanners Estilo14"><div align="center">A&Ntilde;O</div></td>
                                <td width="131" bgcolor="#D4D3CA" class="rdoBanners Estilo14"><div align="left"></div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">a- Infecciones Intestinales (Tifoidea, salmonelosis, Malta, Hepatitis)</td>
                                <td><div align="center">
                                    <input name="antepers_infeIntes" type="radio" class="lblForm" value="SI" <?php if($antepers_infeIntes=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_infeIntes" type="radio" class="lblForm" value="NO" <?php if($antepers_infeIntes=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_a" type="text" class="lblForm" id="aperanio_a" onkeyup=fn(this.form,this) value="<? echo $aperanio_a?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">b- Bronco Pulmonares o Pleurales (Tuberculosis, Asma, Bronquitis, Otros)</td>
                                <td><div align="center">
                                    <input name="antepers_broncopul" type="radio" class="lblForm" value="SI" <?php if($antepers_broncopul=='SI'){echo "checked";}?> >
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_broncopul" type="radio" class="lblForm" value="NO" <?php if($antepers_broncopul=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left"><span class="Estilo12">
                                    <input name="aperanio_b" type="text" class="lblForm" id="aperanio_b" onkeyup=fn(this.form,this) value="<? echo $aperanio_b?>" size="15" maxlength="4">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">c- Cardiovasculares (Hipertensi&oacute;n Arterial, dislipidemia, otras)</td>
                                <td><div align="center">
                                    <input name="antepers_cardiova" type="radio" class="lblForm" value="SI" <?php if($antepers_cardiova=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_cardiova" type="radio" class="lblForm" value="NO" <?php if($antepers_cardiova=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left"><span class="Estilo12">
                                    <input name="aperanio_c" type="text" class="lblForm" id="aperanio_c" onkeyup=fn(this.form,this) value="<? echo $aperanio_c?>" size="15" maxlength="4">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">d- Gastrointestinales (Hemorroides, Ulceras, Colon Irritable</td>
                                <td><div align="center">
                                    <input name="antepers_gastroint" type="radio" class="lblForm" value="SI" <?php if($antepers_gastroint=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_gastroint" type="radio" class="lblForm" value="NO" <?php if($antepers_gastroint=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left"><span class="Estilo12">
                                    <input name="aperanio_d" type="text" class="lblForm" id="aperanio_d" onkeyup=fn(this.form,this) value="<? echo $aperanio_d?>" size="15" maxlength="4">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">e- Enfermedades del H&iacute;gado y V&iacute;as Biliares</td>
                                <td><div align="center">
                                    <input name="antepers_higayvias" type="radio" class="lblForm" value="SI" <?php if($antepers_higayvias=='NO'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_higayvias" type="radio" class="lblForm" value="NO" <?php if($antepers_higayvias=='SI'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left"><span class="Estilo12">
                                    <input name="aperanio_e" type="text" class="lblForm" id="aperanio_e" onkeyup=fn(this.form,this) value="<? echo $aperanio_e?>" size="15" maxlength="4">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">f- Renales, Vejiga, Uretra (Infecciones Urinarias frecuentes)</td>
                                <td><div align="center">
                                    <input name="antepers_renales" type="radio" class="lblForm" value="SI" <?php if($antepers_renales=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_renales" type="radio" class="lblForm" value="NO" <?php if($antepers_renales=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left"><span class="Estilo12">
                                    <input name="aperanio_f" type="text" class="lblForm" id="aperanio_f" onkeyup=fn(this.form,this) value="<? echo $aperanio_f?>" size="15" maxlength="4">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">g- Del cerebro, sistema Nervioso, Psiqui&aacute;tricas (Epilepsia)</td>
                                <td><div align="center">
                                    <input name="antepers_cerebro" type="radio" class="lblForm" value="SI" <?php if($antepers_cerebro=='SI'){echo "checked";}?> >
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_cerebro" type="radio" class="lblForm" value="NO" <?php if($antepers_cerebro=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_g" type="text" class="lblForm" id="aperanio_g" onkeyup=fn(this.form,this) value="<? echo $aperanio_g?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">h- De la Piel (Leishmaniasis)</td>
                                <td><div align="center">
                                    <input name="antepers_piel" type="radio" class="lblForm" value="SI" <?php if($antepers_piel=='SI'){echo "checked";}?> >
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_piel" type="radio" class="lblForm" value="NO" <?php if($antepers_piel=='NO'){echo "checked";}?> >
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_h" type="text" class="lblForm" id="aperanio_h" onkeyup=fn(this.form,this) value="<? echo $aperanio_h?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">i- S&iacute;filis, u otras de transmisi&oacute;n Sexual (Gonorrea, Herpes genital, Otras)</td>
                                <td><div align="center">
                                    <input name="antepers_sexual" type="radio" class="lblForm" value="SI" <?php if($antepers_sexual=='SI'){echo "checked";}?> >
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_sexual" type="radio" class="lblForm" value="NO" <?php if($antepers_sexual=='NO'){echo "checked";}?> >
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_i" type="text" class="lblForm" id="aperanio_i" onkeyup=fn(this.form,this) value="<? echo $aperanio_i?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">j-Diabetes, Gota o enfermedades Endocrinas</td>
                                <td><div align="center">
                                    <input name="antepers_diabetes" type="radio" class="lblForm" value="SI" <?php if($antepers_diabetes=='SI'){echo "checked";}?> >
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_diabetes" type="radio" class="lblForm" value="NO" <?php if($antepers_diabetes=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_j" type="text" class="lblForm" id="aperanio_j" onkeyup=fn(this.form,this) value="<? echo $aperanio_j?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">k- De la sangre (Anemia, P&uacute;rpura, Leucemia) o Ganglios Linf&aacute;ticos</td>
                                <td><div align="center">
                                    <input name="antepers_desangre" type="radio" class="lblForm" value="SI" <?php if($antepers_desangre=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_desangre" type="radio" class="lblForm" value="NO" <?php if($antepers_desangre=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_k" type="text" class="lblForm" id="aperanio_k" onkeyup=fn(this.form,this) value="<? echo $aperanio_k?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">l-Tumoraciones, C&aacute;ncer (Quistes, liponas)</td>
                                <td><div align="center">
                                    <input name="antepers_tumor" type="radio" class="lblForm" value="SI" <?php if($antepers_tumor=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_tumor" type="radio" class="lblForm" value="NO" <?php if($antepers_tumor=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_l" type="text" class="lblForm" id="aperanio_l" onkeyup=fn(this.form,this) value="<? echo $aperanio_l?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">m- Reumatol&oacute;gicas (Artritis reumatoide, Gota)</td>
                                <td><div align="center">
                                    <input name="antepers_reuma" type="radio" class="lblForm" value="SI" <?php if($antepers_reuma=='SI'){echo "checked";}?> >
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_reuma" type="radio" class="lblForm" value="NO" <?php if($antepers_reuma=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_m" type="text" class="lblForm" id="aperanio_m" onkeyup=fn(this.form,this) value="<? echo $aperanio_m?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">n- &Oacute;rganos Sentidos ( Visi&oacute;n, Olfato, Gusto, Audici&oacute;n y Tacto)</td>
                                <td><div align="center">
                                    <input name="antepers_sentidos" type="radio" class="lblForm" value="SI"  <?php if($antepers_sentidos=='SI'){echo "checked";}?> >
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_sentidos" type="radio" class="lblForm" value="NO"  <?php if($antepers_sentidos=='NO'){echo "checked";}?> >
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_n" type="text" class="lblForm" id="aperanio_n" onKeyUp=fn(this.form,this) value="<? echo $aperanio_n?>" size="15" maxlength="4">
</div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">o-Malaria</td>
                                <td><div align="center">
                                    <input name="antepers_malaria" type="radio" class="lblForm" value="SI" <?php if($antepers_malaria=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_malaria" type="radio" class="lblForm" value="NO" <?php if($antepers_malaria=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_o" type="text" class="lblForm" id="aperanio_o" onkeyup=fn(this.form,this) value="<? echo $aperanio_o?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">P- Otras no Mencionados</td>
                                <td><div align="center">
                                    <input name="antepers_otros" type="radio" class="lblForm" value="SI" <?php if($antepers_otros=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepers_otros" type="radio" class="lblForm" value="NO" <?php if($antepers_otros=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aperanio_p" type="text" class="lblForm" id="aperanio_p" onkeyup=fn(this.form,this) value="<? echo $aperanio_o?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr bgcolor="#D4D3CA">
                                <td colspan="5"><table width="696" border="0" cellpadding="0" cellspacing="0" bgcolor="#D4D3C9">
                                    <tr>
                                      <td width="239"><span class="rdoBanners Estilo8 Estilo4">Detalle lo marcado como SI:</span></td>
                                      <td width="457" bgcolor="#D4D3CA"><textarea name="anteper_detsi" cols="70" rows="2" class="lblForm" id="anteper_detsi"><? echo $anteper_detsi?></textarea></td>
                                    </tr>
                                </table></td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td><div align="center"><span class="rdoBanners Estilo10"><span class="rdoBanners  Estilo12">ANTECEDENTES PATOL&Oacute;GICOS</span></span></div></td>
                        </tr>
                        <tr>
                          <td><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr bgcolor="#009900">
                                <td width="498" bgcolor="#009900" class="rdoBanners Estilo13">Ha padecido usted de:</td>
                                <td width="29" bgcolor="#009900" class="rdoBanners Estilo14"><div align="center">SI</div></td>
                                <td width="29" bgcolor="#009900" class="rdoBanners Estilo14"><div align="center">NO</div></td>
                                <td width="81" bgcolor="#009900" class="rdoBanners Estilo14"><div align="center">A&Ntilde;O</div></td>
                                <td width="113" bgcolor="#009900" class="rdoBanners Estilo14"><div align="left"></div></td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">a- Present&oacute; alg&uacute;n problema en su desarrollo psicomotor ( Conducta, Rendimiento escolar, etc.)</td>
                                <td><div align="center">
                                    <input name="antepato_psico" type="radio" class="lblForm" value="SI" <?php if($antepato_psico=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepato_psico" type="radio" class="lblForm" value="NO" <?php if($antepato_psico=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aptoanio_a" type="text" class="lblForm" id="aptoanio_a" onkeyup=fn(this.form,this) value="<? echo $aptoanio_a?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">b- Ha sufrido de alg&uacute;n accidente o herida</td>
                                <td><div align="center">
                                    <input name="antepato_accident" type="radio" class="lblForm" value="SI" <?php if($antepato_accident=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepato_accident" type="radio" class="lblForm" value="NO" <?php if($antepato_accident=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left"><span class="Estilo12">
                                    <input name="aptoanio_b" type="text" class="lblForm" id="aptoanio_b" onkeyup=fn(this.form,this) value="<? echo $aptoanio_b?>" size="15" maxlength="4">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">c- Antecedentes quir&uacute;rgicos, hospitalarios</td>
                                <td><div align="center">
                                    <input name="antepato_quirurgi" type="radio" class="lblForm" value="SI" <?php if($antepato_quirurgi=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepato_quirurgi" type="radio" class="lblForm" value="NO" <?php if($antepato_quirurgi=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left"><span class="Estilo12">
                                    <input name="aptoanio_c" type="text" class="lblForm" id="aptoanio_c" value="<? echo $aptoanio_c?>" size="15" maxlength="4">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">d- Se le han tomado ex&aacute;menes especiales tales como (Rx, EKG, TAC, EEG, otros)</td>
                                <td><div align="center">
                                    <input name="antepato_exaespe" type="radio" class="lblForm" value="SI" <?php if($antepato_exaespe=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepato_exaespe" type="radio" class="lblForm" value="NO" <?php if($antepato_exaespe=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left"><span class="Estilo12">
                                    <input name="aptoanio_d" type="text" class="lblForm" id="aptoanio_d" value="<? echo $aptoanio_d?>" size="15" maxlength="4">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">e- Esta en tratamiento medico actualmente</td>
                                <td><div align="center">
                                    <input name="antepato_tratami" type="radio" class="lblForm" value="SI" <?php if($antepato_tratami=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepato_tratami" type="radio" class="lblForm" value="NO" <?php if($antepato_tratami=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left"><span class="Estilo12">
                                    <input name="aptoanio_e" type="text" class="lblForm" id="aptoanio_e" value="<? echo $aptoanio_e?>" size="15" maxlength="4">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">f- Usa Regularmente alg&uacute;n medicamento (Diabetes, Hipertensi&oacute;n, Otros)</td>
                                <td><div align="center">
                                    <input name="antepato_usamedi" type="radio" class="lblForm" value="SI" <?php if($antepato_usamedi=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepato_usamedi" type="radio" class="lblForm" value="NO" <?php if($antepato_usamedi=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left"><span class="Estilo12">
                                    <input name="aptoanio_f" type="text" class="lblForm" id="aptoanio_f" value="<? echo $aptoanio_f?>" size="15" maxlength="4">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">g-Alergias a medicamentos, Alimentos u otros</td>
                                <td><div align="center">
                                    <input name="antepato_alergi" type="radio" class="lblForm" value="SI" <?php if($antepato_alergi=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepato_alergi" type="radio" class="lblForm" value="NO" <?php if($antepato_alergi=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aptoanio_g" type="text" class="lblForm" id="aptoanio_g" value="<? echo $aptoanio_g?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">h- Esta o estuvo sometido a alg&uacute;n r&eacute;gimen alimenticio</td>
                                <td><div align="center">
                                    <input name="antepato_regimenalimen" type="radio" class="lblForm" value="SI" <?php if($antepato_regimenalimen=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepato_regimenalimen" type="radio" class="lblForm" value="NO" <?php if($antepato_regimenalimen=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aptoanio_h" type="text" class="lblForm" id="aptoanio_h" value="<? echo $aptoanio_h?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">i- Ha aumentado o reducido de peso recientemente</td>
                                <td><div align="center">
                                    <input name="antepato_sbpeso" type="radio" class="lblForm" value="SI" <?php if($antepato_sbpeso=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepato_sbpeso" type="radio" class="lblForm" value="NO" <?php if($antepato_sbpeso=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aptoanio_i" type="text" class="lblForm" id="aptoanio_i" value="<? echo $aptoanio_i?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">j-Practica usted alg&uacute;n deporte</td>
                                <td><div align="center">
                                    <input name="antepato_deporte" type="radio" class="lblForm" value="SI" <?php if($antepato_deporte=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="antepato_deporte" type="radio" class="lblForm" value="NO" <?php if($antepato_deporte=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#009900"><div align="left">
                                  <input name="aptoanio_j" type="text" class="lblForm" id="aptoanio_j" value="<? echo $aptoanio_j?>" size="15" maxlength="4">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr bgcolor="#D4D3CA">
                                <td colspan="5"><table width="706" border="0" cellspacing="0" cellpadding="0">
                                    <tr>
                                      <td width="240" bgcolor="#D4D3CA"><span class="rdoBanners Estilo8 Estilo4">Detalle lo marcado como SI:</span></td>
                                      <td width="466" bgcolor="#D4D3CA"><textarea name="antpato_detsi" cols="70" rows="2" class="lblForm" id="antpato_detsi"><? echo $antpato_detsi?></textarea></td>
                                    </tr>
                                </table></td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td><div align="center"><span class="rdoBanners Estilo10"><span class="rdoBanners  Estilo12">H&Aacute;BITOS NOCIVOS</span></span></div></td>
                        </tr>
                        <tr>
                          <td><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr bgcolor="#009900">
                                <td width="298" bgcolor="#009900" class="rdoBanners Estilo13">&nbsp;</td>
                                <td width="30" bgcolor="#009900" class="rdoBanners Estilo14"><div align="center">SI</div></td>
                                <td width="33" bgcolor="#009900" class="rdoBanners Estilo14"><div align="center">NO</div></td>
                                <td bgcolor="#009900" class="rdoBanners Estilo14"><div align="center">Que clase y cantidad diaria</div>
                                    <div align="left"></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo14">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">a- Toma habitualmente bebidas alcoh&oacute;licas</td>
                                <td><div align="center">
                                    <input name="habito_bhalcohol" type="radio" class="lblForm" value="SI" <?php if($habito_bhalcohol=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="habito_bhalcohol" type="radio" class="lblForm" value="NO" <?php if($habito_bhalcohol=='NO'){echo "checked";}?>>
                                </div></td>
                                <td width="230" bgcolor="#D4D3CA"><div align="left">
                                  <input name="habcual_a" type="text" class="lblForm" id="habcual_a" value="<? echo $habcual_a?>" size="30">
                                </div></td>
                                <td width="164" bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4">b-Consume o ha consumido usted</td>
                                <td bgcolor="#D4D3CA"><div align="center"> </div></td>
                                <td bgcolor="#D4D3CA"><div align="center"> </div></td>
                                <td bgcolor="#D4D3CA"><div align="left"><span class="Estilo12"> </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4"><div align="right">Drogras </div></td>
                                <td><div align="center">
                                    <input name="habito_droga" type="radio" class="lblForm" value="SI" <?php if($habito_droga=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="habito_droga" type="radio" class="lblForm" value="NO" <?php if($habito_droga=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#D4D3CA"><div align="left"><span class="Estilo12">
                                    <input name="habcual_ba" type="text" class="lblForm" id="habcual_ba" value="<? echo $habcual_ba?>" size="30">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4"><div align="right">Hoja de coca</div></td>
                                <td><div align="center">
                                    <input name="habito_hcoca" type="radio" class="lblForm" value="SI" <?php if($habito_hcoca=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="habito_hcoca" type="radio" class="lblForm" value="NO" <?php if($habito_hcoca=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#D4D3CA"><div align="left"><span class="Estilo12">
                                    <input name="habcual_bb" type="text" class="lblForm" id="habcual_bb" value="<? echo $habcual_bb?>" size="30">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4"><div align="right">Alucin&oacute;genos</div></td>
                                <td><div align="center">
                                    <input name="habito_alucino" type="radio" class="lblForm" value="SI" <?php if($habito_alucino=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="habito_alucino" type="radio" class="lblForm" value="NO" <?php if($habito_alucino=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#D4D3CA"><div align="left"><span class="Estilo12">
                                    <input name="habcual_bc" type="text" class="lblForm" id="habcual_bc" value="<? echo $habcual_bc?>" size="30">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4"><div align="right">Sustancias Psicoactivas</div></td>
                                <td><div align="center">
                                    <input name="habito_sustpsico" type="radio" class="lblForm" value="SI" <?php if($habito_sustpsico=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="habito_sustpsico" type="radio" class="lblForm" value="NO" <?php if($habito_sustpsico=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#D4D3CA"><div align="left"><span class="Estilo12">
                                    <input name="habcual_bd" type="text" class="lblForm" id="habcual_bd" value="<? echo $habcual_bd?>" size="30">
                                </span></div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4"><div align="right">Fuma</div></td>
                                <td><div align="center">
                                    <input name="habito_fuma" type="radio" class="lblForm" value="SI" <?php if($habito_fuma=='SI'){echo "checked";}?>>
                                </div></td>
                                <td><div align="center">
                                    <input name="habito_fuma" type="radio" class="lblForm" value="NO" <?php if($habito_fuma=='NO'){echo "checked";}?>>
                                </div></td>
                                <td bgcolor="#D4D3CA"><div align="left">
                                  <input name="habcual_be" type="text" class="lblForm" id="habcual_be" value="<? echo $habcual_be?>" size="30">
                                </div></td>
                                <td bgcolor="#D4D3CA">&nbsp;</td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr>
                          <td>&nbsp;</td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td><div align="center"><span class="rdoBanners Estilo10"><span class="rdoBanners  Estilo12">ANTECEDENTES UROL&Oacute;GICOS / GINECOL&Oacute;GICOS</span></span></div></td>
                        </tr>
                        <tr>
                          <td><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr bgcolor="#D4D3CA">
                                <td width="273" class="rdoBanners Estilo4"><div align="left">a- Sufre o a sufrido de enfermedades genitales</div></td>
                                <td width="42">
                                    <div align="left">
                                      <input name="anteuro_enfergeni" type="radio" class="lblForm" value="SI" <?php if($anteuro_enfergeni=='SI'){echo "checked";}?>>
                                  <span class="rdoBanners">SI </span></div></td>
                                <td width="56">
                                    <div align="left">
                                      <input name="anteuro_enfergeni" type="radio" class="lblForm" value="NO" <?php if($anteuro_enfergeni=='NO'){echo "checked";}?>>
                                  <span class="rdoBanners">NO</span> </div></td>
                                <td colspan="2" valign="middle" class="rdoBanners"><div align="left">CUALES</div></td>
                                <td width="235"><div align="left">
                                  <input name="anturo_cuala" type="text" class="lblForm" id="anturo_cuala" value="<? echo $anturo_cuala?>" size="30">
                                </div></td>
                              </tr>
                              <tr bgcolor="#D4D3CA">
                                <td class="rdoBanners Estilo4"><div align="left">b- A tenido cirug&iacute;as Gineco Obst&eacute;tricas</div></td>
                                <td>
                                    <div align="left">
                                      <input name="anteuro_cirugine" type="radio" class="lblForm" value="SI" <?php if($anteuro_cirugine=='SI'){echo "checked";}?>>
                                  <span class="rdoBanners">SI </span></div></td>
                                <td>
                                    <div align="left">
                                      <input name="anteuro_cirugine" type="radio" class="lblForm" value="NO" <?php if($anteuro_cirugine=='NO'){echo "checked";}?>>
                                  <span class="rdoBanners">NO</span> </div></td>
                                <td colspan="2"><div align="left"><span class="rdoBanners">CUALES </span></div></td>
                                <td><div align="left"><span class="Estilo12">
                                    <input name="anturo_cualb" type="text" class="lblForm" id="anturo_cualb" value="<? echo $anturo_cualb?>" size="30">
                                </span></div></td>
                              </tr>
                              <tr bgcolor="#D4D3CA">
                                <td colspan="6" class="rdoBanners Estilo4"><div align="left">
                                  <table width="708" border="0" cellspacing="0" cellpadding="0">
                                        <tr>
                                          <td width="79">c- Menarquia</td>
                                          <td width="156" bgcolor="#D4D3CA"><input name="anturo_c" type="text" class="lblForm" id="anturo_c" value="<? echo $anturo_c?>" size="30"></td>
                                          <td width="17" bgcolor="#D4D3CA">RC</td>
                                          <td width="156" bgcolor="#D4D3CA"><input name="anturo_rc" type="text" class="lblForm" id="anturo_rc" value="<? echo $anturo_rc?>" size="30"></td>
                                          <td width="177">M&eacute;todos Anticonceptivos</td>
                                          <td width="123" bgcolor="#D4D3CA"><input name="anturo_metanti" type="text" class="lblForm" id="anturo_metanti" value="<? echo $anturo_metanti?>" size="20"></td>
                                        </tr>
                                      </table>
                                </div></td>
                              </tr>
                              <tr bgcolor="#D4D3CA">
                                <td class="rdoBanners Estilo4"><div align="left">d- Esta usted embarazada</div></td>
                                <td>
                                    <div align="left">
                                      <input name="anteuro_emba" type="radio" class="lblForm" value="SI" <?php if($anteuro_emba=='SI'){echo "checked";}?>>
                                  <span class="rdoBanners">SI </span></div></td>
                                <td>
                                    <div align="left">
                                      <input name="anteuro_emba" type="radio" class="lblForm" value="NO" <?php if($anteuro_emba=='NO'){echo "checked";}?>>
                                  <span class="rdoBanners">NO</span> </div></td>
                                <td width="70"><div align="left"><span class="rdoBanners">Cuantos Meses </span></div></td>
                                <td width="30"><div align="left">
                                  <input name="anturo_nmes" type="text" class="lblForm" id="anturo_nmes" value="<? echo $anturo_nmes?>" size="5">
                                </div></td>
                                <td class="rdoBanners Estilo4"><div align="left"><span class="Estilo15">Problemas en su Embrazo</span>
                                      <input name="anturo_premba" type="text" class="lblForm" id="anturo_premba" value="<? echo $anturo_premba?>" size="15">
                                </div></td>
                              </tr>
                              <tr bgcolor="#D4D3CA">
                                <td colspan="6" class="rdoBanners Estilo4"><div align="left">e- Numero de Hijos
                                        <input name="anteuro_nh" type="text" class="lblForm" id="anteuro_nh" value="<? echo $anteuro_nh?>" size="8">
                      Parto Normal
                      <input name="anturo_parnor" type="text" class="lblForm" id="anturo_parnor" value="<? echo $anturo_parnor?>" size="8">
                      Parto Prematuro
                      <input name="anturo_pprema" type="text" class="lblForm" id="anturo_pprema" value="<? echo $anturo_pprema?>" size="8">
                      C&eacute;sareas
                      <input name="anturo_cesa" type="text" class="lblForm" id="anturo_cesa" value="<? echo $anturo_cesa?>" size="8">
                      Abortos
                      <input name="anturo_abort" type="text" class="lblForm" id="anturo_abort" value="<? echo $anturo_abort?>" size="10">
                      <span class="Estilo12"> </span></div></td>
                              </tr>
                              <tr bgcolor="#D4D3CA">
                                <td colspan="6" class="rdoBanners Estilo4"><div align="left">f- Fecha ultima regla
                                        <input name="fechauregla" type="text" class="lblForm" id="fechauregla" value="<? echo $fechauregla?>" size="12" readonly>
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fechauregla');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a> </div></td>
                              </tr>
                              <tr bgcolor="#D4D3CA">
                                <td colspan="6" class="rdoBanners Estilo4"><div align="left">g- Problemas o enfermedades durante su embrazo y/o partos
                                        <input name="anturo_produemba" type="text" class="lblForm" id="anturo_produemba" value="<? echo $anturo_produemba?>" size="60">
                                  </div></td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td><div align="center"><span class="rdoBanners Estilo10"><span class="rdoBanners  Estilo12">ESQUEMA DE VACUNACI&Oacute;N</span></span></div></td>
                        </tr>
                        <tr>
                          <td bgcolor="#D4D3CA"><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr bgcolor="#009900">
                                <td width="23" rowspan="6" bgcolor="#D4D3CA" class="rdoBanners Estilo13">&nbsp;</td>
                                <td width="81" bgcolor="#009900" class="rdoBanners Estilo13"><div align="center">DOSIS</div></td>
                                <td width="98" bgcolor="#009900" class="rdoBanners Estilo13"><div align="center">HEPATITIS A</div></td>
                                <td width="98" bgcolor="#009900" class="rdoBanners Estilo13"><div align="center">HEPATITIS B</div></td>
                                <td class="rdoBanners Estilo13"><div align="center">T&Eacute;TANO</div></td>
                                <td class="rdoBanners Estilo13"><div align="center">RABIA</div></td>
                                <td width="98" class="rdoBanners Estilo14"><div align="center">F. AMARILLA</div></td>
                                <td width="53" rowspan="6" bgcolor="#D4D3CA" class="rdoBanners Estilo13">&nbsp;</td>
                              </tr>
                              <tr>
                                <td bgcolor="#FFFFFF" class="rdoBanners Estilo4"><div align="center">Primera</div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha3" type="text" class="lblForm" id="fecha3" onkeyup=fn(this.form,this) value="<? echo $fecha3?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha3');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha8" type="text" class="lblForm" id="fecha8" onkeyup=fn(this.form,this) value="<? echo $fecha8?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha8');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha18" type="text" class="lblForm" id="fecha18" onkeyup=fn(this.form,this) value="<? echo $fecha18?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha18');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><input name="fecha43" type="text" class="lblForm" id="fecha43" onkeyup=fn(this.form,this) value="<? echo $fecha43?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha43');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha28" type="text" class="lblForm" id="fecha28" onkeyup=fn(this.form,this) value="<? echo $fecha28?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha28');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                              </tr>
                              <tr>
                                <td bgcolor="#FFFFFF" class="rdoBanners Estilo4"><div align="center">Segunda</div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha4" type="text" class="lblForm" id="fecha4" onkeyup=fn(this.form,this) value="<? echo $fecha4?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha4');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha9" type="text" class="lblForm" id="fecha9" onkeyup=fn(this.form,this) value="<? echo $fecha9?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha9');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha19" type="text" class="lblForm" id="fecha19" onkeyup=fn(this.form,this) value="<? echo $fecha19?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha19');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><input name="fecha44" type="text" class="lblForm" id="fecha44" onkeyup=fn(this.form,this) value="<? echo $fecha44?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha44');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha29" type="text" class="lblForm" id="fecha29" onkeyup=fn(this.form,this) value="<? echo $fecha29?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha29');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                              </tr>
                              <tr>
                                <td bgcolor="#FFFFFF" class="rdoBanners Estilo4"><div align="center">Tercera</div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha5" type="text" class="lblForm" id="fecha5" onkeyup=fn(this.form,this) value="<? echo $fecha5?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha5');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha10" type="text" class="lblForm" id="fecha10" onKeyUp=fn(this.form,this) value="<? echo $fecha10?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha10');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha20" type="text" class="lblForm" id="fecha20" onkeyup=fn(this.form,this) value="<? echo $fecha20?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha20');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><input name="fecha45" type="text" class="lblForm" id="fecha45" onkeyup=fn(this.form,this) value="<? echo $fecha45?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha45');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha30" type="text" class="lblForm" id="fecha30" onkeyup=fn(this.form,this) value="<? echo $fecha30?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha30');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                              </tr>
                              <tr>
                                <td bgcolor="#FFFFFF" class="rdoBanners Estilo4"><div align="center">Refuerzo</div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha6" type="text" class="lblForm" id="fecha6" onkeyup=fn(this.form,this) value="<? echo $fecha6?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha6');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha11" type="text" class="lblForm" id="fecha11" onkeyup=fn(this.form,this) value="<? echo $fecha11?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha11');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha21" type="text" class="lblForm" id="fecha21" onkeyup=fn(this.form,this) value="<? echo $fecha21?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha21');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><input name="fecha46" type="text" class="lblForm" id="fecha46" onkeyup=fn(this.form,this) value="<? echo $fecha46?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha46');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha31" type="text" class="lblForm" id="fecha31" onkeyup=fn(this.form,this) value="<? echo $fecha31?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha31');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                              </tr>
                              <tr>
                                <td bgcolor="#FFFFFF" class="rdoBanners Estilo4"><div align="center">Inmunizado</div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha7" type="text" class="lblForm" id="fecha7" onkeyup=fn(this.form,this) value="<? echo $fecha7?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha7');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha12" type="text" class="lblForm" id="fecha12" onkeyup=fn(this.form,this) value="<? echo $fecha12?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha12');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha22" type="text" class="lblForm" id="fecha22" onkeyup=fn(this.form,this) value="<? echo $fecha22?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha22');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><input name="fecha47" type="text" class="lblForm" id="fecha47" onkeyup=fn(this.form,this) value="<? echo $fecha47?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha47');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                  <input name="fecha32" type="text" class="lblForm" id="fecha32" onkeyup=fn(this.form,this) value="<? echo $fecha32?>" size="12" readonly >
                                  <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha32');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr bgcolor="#009900">
                                <td width="20" rowspan="6" bgcolor="#D4D3CA" class="rdoBanners Estilo13">&nbsp;</td>
                                <td width="81" bgcolor="#009900" class="rdoBanners Estilo13"><div align="center">DOSIS</div></td>
                                <td class="rdoBanners Estilo14"><div align="center">F. TIFOIDEA</div></td>
                                <td class="rdoBanners Estilo14"><div align="center">OTRAS</div></td>
                                <td class="rdoBanners Estilo14"><div align="center">INFLUENZA</div></td>
                                <td width="98" bgcolor="#009900" class="rdoBanners Estilo14">&nbsp;</td>
                                <td width="98" bgcolor="#009900" class="rdoBanners Estilo14">&nbsp;</td>
                                <td width="49" rowspan="6" bgcolor="#D4D3CA" class="rdoBanners Estilo14">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4"><div align="center">Primera</div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha33" type="text" class="lblForm" id="fecha33" onkeyup=fn(this.form,this) value="<? echo $fecha33?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha33');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha38" type="text" class="lblForm" id="fecha38" onkeyup=fn(this.form,this) value="<? echo $fecha38?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha38');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><input name="fecha48" type="text" class="lblForm" id="fecha48" onkeyup=fn(this.form,this) value="<? echo $fecha48?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha48');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4">&nbsp;</td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4"><div align="center">Segunda</div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha34" type="text" class="lblForm" id="fecha34" onkeyup=fn(this.form,this) value="<? echo $fecha34?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha34');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha39" type="text" class="lblForm" id="fecha39" onkeyup=fn(this.form,this) value="<? echo $fecha39?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha39');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><input name="fecha49" type="text" class="lblForm" id="fecha49" onkeyup=fn(this.form,this) value="<? echo $fecha49?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha49');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4">&nbsp;</td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4"><div align="center">Tercera</div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha35" type="text" class="lblForm" id="fecha35" onkeyup=fn(this.form,this) value="<? echo $fecha35?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha35');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha40" type="text" class="lblForm" id="fecha40" onkeyup=fn(this.form,this) value="<? echo $fecha40?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha40');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><input name="fecha50" type="text" class="lblForm" id="fecha50" onkeyup=fn(this.form,this) value="<? echo $fecha50?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha50');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4">&nbsp;</td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4"><div align="center">Refuerzo</div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha36" type="text" class="lblForm" id="fecha36" onkeyup=fn(this.form,this) value="<? echo $fecha36?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha36');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha41" type="text" class="lblForm" id="fecha41" onkeyup=fn(this.form,this) value="<? echo $fecha41?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha41');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><input name="fecha51" type="text" class="lblForm" id="fecha51" onkeyup=fn(this.form,this) value="<? echo $fecha51?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha51');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4">&nbsp;</td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4">&nbsp;</td>
                              </tr>
                              <tr>
                                <td class="rdoBanners Estilo4"><div align="center">Inmunizado</div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha37" type="text" class="lblForm" id="fecha37" onkeyup=fn(this.form,this) value="<? echo $fecha37?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha37');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><div align="center">
                                    <input name="fecha42" type="text" class="lblForm" id="fecha42" onkeyup=fn(this.form,this) value="<? echo $fecha42?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha42');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></div></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4"><input name="fecha52" type="text" class="lblForm" id="fecha52" onkeyup=fn(this.form,this) value="<? echo $fecha52?>" size="12" readonly >
                                    <a onMouseOver="window.status='Calendario';return true;" onMouseOut="window.status='';return true;"  href="javascript:show_calendar('form1.fecha52');"><img src="imagenes/calendar.jpg" alt="Calendario" width="16" height="15" border="0"></a></td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4">&nbsp;</td>
                                <td bgcolor="#D4D3CA" class="rdoBanners Estilo4">&nbsp;</td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td><div align="center"><span class="rdoBanners Estilo10"><span class="rdoBanners  Estilo12">ANTECEDENTES OCUPACIONALES</span></span></div></td>
                        </tr>
                        <tr>
                          <td><table width="720" border="1" cellspacing="0" cellpadding="0">
                              <tr class="rdoBanners">
                                <td width="160" rowspan="6" bgcolor="#D4D3CA">&nbsp;</td>
                                <td width="77" bgcolor="#009900"><div align="center">EMPRESA</div></td>
                                <td width="66" bgcolor="#009900"><div align="center">CARGO</div></td>
                                <td width="69" bgcolor="#009900"><div align="center">TIEMPO</div></td>
                                <td width="69" bgcolor="#009900"><div align="center">TURNO</div></td>
                                <td width="206" rowspan="6" bgcolor="#D4D3CA"><div align="center"></div></td>
                                </tr>
                              <tr bgcolor="#009900" class="rdoBanners">
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="emp_1" type="text" class="lblForm" id="emp_1" value="<? echo $emp_1?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="carg_1" type="text" class="lblForm" id="carg_1" value="<? echo $carg_1?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="tiemp_1" type="text" class="lblForm" id="tiemp_1" value="<? echo $tiemp_1?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                    <div align="center">
                                      <input name="turno_1" type="text" class="lblForm" id="turno_1" value="<? echo $turno_1?>" size="10">
                                  </div></td>
                                </tr>
                              <tr bgcolor="#009900" class="rdoBanners">
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="emp_2" type="text" class="lblForm" id="emp_2" value="<? echo $emp_2?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="carg_2" type="text" class="lblForm" id="carg_2" value="<? echo $carg_1?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="tiemp_2" type="text" class="lblForm" id="tiemp_2" value="<? echo $tiemp_2?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                    <div align="center">
                                      <input name="turno_2" type="text" class="lblForm" id="turno_2" value="<? echo $turno_2?>" size="10">
                                  </div></td>
                                </tr>
                              <tr bgcolor="#009900" class="rdoBanners">
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="emp_3" type="text" class="lblForm" id="emp_3" value="<? echo $emp_3?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="carg_3" type="text" class="lblForm" id="carg_3" value="<? echo $carg_1?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="tiemp_3" type="text" class="lblForm" id="tiemp_3" value="<? echo $tiemp_3?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                    <div align="center">
                                      <input name="turno_3" type="text" class="lblForm" id="turno_3" value="<? echo $turno_3?>" size="10">
                                  </div></td>
                                </tr>
                              <tr bgcolor="#009900" class="rdoBanners">
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="emp_4" type="text" class="lblForm" id="emp_4" value="<? echo $emp_4?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="carg_4" type="text" class="lblForm" id="carg_4" value="<? echo $carg_4?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="tiemp_4" type="text" class="lblForm" id="tiemp_4" value="<? echo $tiemp_4?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                    <div align="center">
                                      <input name="turno_4" type="text" class="lblForm" id="turno_4" value="<? echo $turno_4?>" size="10">
                                  </div></td>
                                </tr>
                              <tr bgcolor="#009900" class="rdoBanners">
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="emp_5" type="text" class="lblForm" id="emp_5" value="<? echo $emp_5?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="carg_5" type="text" class="lblForm" id="carg_5" value="<? echo $carg_5?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                  <div align="center">
                                    <input name="tiemp_5" type="text" class="lblForm" id="tiemp_5" value="<? echo $tiemp_5?>" size="12">
                                  </div></td>
                                <td bgcolor="#D4D3CA">
                                    <div align="center">
                                      <input name="turno_5" type="text" class="lblForm" id="turno_5" value="<? echo $turno_5?>" size="10">
                                  </div></td>
                                </tr>
                              <tr bgcolor="#D4D3CA" class="rdoBanners">
                                <td colspan="6"><div align="center"></div></td>
                                </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td><div align="center" class="rdoBanners Estilo12">
                              <div align="center">FACTORES DE RIESGO</div>
                          </div></td>
                        </tr>
                        <tr>
                          <td><table width="722" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr bgcolor="#009900" class="rdoBanners">
                                <td colspan="2"><span class="Estilo4 Estilo21">F&Iacute;SICO</span></td>
                                <td colspan="2"><span class="Estilo23">QU&Iacute;MICO</span></td>
                                <td colspan="2"><span class="Estilo23">BIOL&Oacute;GICO</span></td>
                                </tr>
                              <tr class="rdoBanners">
                                <td width="198">RUIDO</td>
                                <td width="23"><label>
                                  <input name="frfisico_1" type="checkbox" id="frfisico_1" value="RUIDO" <?php if($frfisico_1=='RUIDO'){echo "checked";}?>>
                                </label></td>
                                <td width="240">GASES, GASE</td>
                                <td width="20"><input name="frquim_1" type="checkbox" id="frquim_1" value="GASES.GASE" <?php if($frquim_1=='GASES.GASE'){echo "checked";}?>></td>
                                <td width="207">HONGOS, VIRUS</td>
                                <td width="20"><input name="frbiolg_1" type="checkbox" id="frbiolg_1" value="HONGOS, VIRUS" <?php if($frbiolg_1=='HONGOS, VIRUS'){echo "checked";}?>></td>
                              </tr>
                              <tr class="rdoBanners">
                                <td>VIBRACIONES</td>
                                <td><input name="frfisico_2" type="checkbox" id="frfisico_2" value="VIBRACIONES" <?php if($frfisico_2=='VIBRACIONES'){echo "checked";}?>></td>
                                <td>GASES, VAPORES</td>
                                <td><input name="frquim_2" type="checkbox" id="frquim_2" value="GASES.VAPORES" <?php if($frquim_2=='GASES.VAPORES'){echo "checked";}?>></td>
                                <td>BACTERIAS</td>
                                <td><input name="frbiolg_2" type="checkbox" id="frbiolg_2" value="BACTERIAS" <?php if($frbiolg_2=='BACTERIAS'){echo "checked";}?>></td>
                              </tr>
                              <tr class="rdoBanners">
                                <td>RAD. IONIZANTES</td>
                                <td><input name="frfisico_3" type="checkbox" id="frfisico_3" value="RAD.IONIZANTE" <?php if($frfisico_3=='RAD.IONIZANTE'){echo "checked";}?>></td>
                                <td>AEROS. LIQUIDO</td>
                                <td><input name="frquim_3" type="checkbox" id="frquim_3" value="AEROS.LIQUITO" <?php if($frquim_3=='AEROS.LIQUITO'){echo "checked";}?>></td>
                                <td>VEGETALES</td>
                                <td><input name="frbiolg_3" type="checkbox" id="frbiolg_3" value="VEGETALES" <?php if($frbiolg_3=='VEGETALES'){echo "checked";}?>></td>
                              </tr>
                              <tr class="rdoBanners">
                                <td>RAD. NO IONIZANTES</td>
                                <td><input name="frfisico_4" type="checkbox" id="frfisico_4" value="RAD.NO IONIZANTE" <?php if($frfisico_4=='RAD.NO IONIZANTE'){echo "checked";}?>></td>
                                <td>AEROS.SOL. POLVOS</td>
                                <td><input name="frquim_4" type="checkbox" id="frquim_4" value="AEROS.SOL.POLVOS" <?php if($frquim_4=='AEROS.SOL.POLVOS'){echo "checked";}?>></td>
                                <td>ANI. VERTEBRADOS</td>
                                <td><input name="frbiolg_4" type="checkbox" id="frbiolg_4" value="ANI. INVERTEBRADOS" <?php if($frbiolg_4=='ANI. INVERTEBRADOS'){echo "checked";}?>></td>
                              </tr>
                              <tr class="rdoBanners">
                                <td>COND. CLIM&Aacute;TICAS</td>
                                <td><input name="frfisico_5" type="checkbox" id="frfisico_5" value="COND.CLIMATICAS" <?php if($frfisico_5=='COND.CLIMATICAS'){echo "checked";}?>></td>
                                <td>AEROS.SOL.HUMOS</td>
                                <td><input name="frquim_5" type="checkbox" id="frquim_5" value="AEROS.SOL.HUMOS" <?php if($frquim_5=='AEROS.SOL.HUMOS'){echo "checked";}?>></td>
                                <td>INSECTOS</td>
                                <td><input name="frbiolg_5" type="checkbox" id="frbiolg_5" value="INSECTOS" <?php if($frbiolg_5=='INSECTOS'){echo "checked";}?>></td>
                              </tr>
                              <tr bgcolor="#009900" class="rdoBanners">
                                <td colspan="2"><span class="Estilo23">DE INSEGURIDAD</span></td>
                                <td colspan="2"><span class="Estilo23">ERGON&Oacute;MICO</span></td>
                                <td colspan="2"><span class="Estilo23">PSICOSOCIAL</span></td>
                              </tr>
                              <tr class="rdoBanners">
                                <td>EL&Eacute;CTRICOS</td>
                                <td><input name="frdeinsg_1" type="checkbox" id="frdeinsg_1" value="ELECTRICOS" <?php if($frdeinsg_1=='ELECTRICOS'){echo "checked";}?>></td>
                                <td>CARGA DIN&Aacute;MICA</td>
                                <td><input name="frergo_1" type="checkbox" id="frergo_1" value="carga" <?php if($frergo_1=='carga'){echo "checked";}?>></td>
                                <td>M.AMB. LABORAL</td>
                                <td><input name="frpsico_1" type="checkbox" id="frpsico_1" value="M.AMB.LABORAL" <?php if($frpsico_1=='M.AMB.LABORAL'){echo "checked";}?>></td>
                              </tr>
                              <tr class="rdoBanners">
                                <td>MAN. HERTAS MANUA</td>
                                <td><input name="frdeinsg_2" type="checkbox" id="frdeinsg_2" value="manHertasmanua" <?php if($frdeinsg_2=='manHertasmanua'){echo "checked";}?>></td>
                                <td>CARGA EST&Aacute;TICA</td>
                                <td><input name="frergo_2" type="checkbox" id="frergo_2" value="cargaestatica" <?php if($frergo_2=='cargaestatica'){echo "checked";}?>></td>
                                <td>M.AMB. SOCIAL</td>
                                <td><input name="frpsico_2" type="checkbox" id="frpsico_2" value="M.AMB.SOCIAL" <?php if($frpsico_2=='M.AMB.SOCIAL'){echo "checked";}?>></td>
                              </tr>
                              <tr class="rdoBanners">
                                <td>MAN. EQUIPOS EN MOV</td>
                                <td><input name="frdeinsg_3" type="checkbox" id="frdeinsg_3" value="manequiposdemov" <?php if($frdeinsg_3=='manequiposdemov'){echo "checked";}?>></td>
                                <td colspan="2">&nbsp;</td>
                                <td>M.AMB.INDIVIDUA</td>
                                <td><input name="frpsico_3" type="checkbox" id="frpsico_3" value="M.AMB.INDIVIDUA" <?php if($frpsico_3=='M.AMB.INDIVIDUA'){echo "checked";}?>></td>
                              </tr>
                              <tr class="rdoBanners">
                                <td>PROYECCI&Oacute;N DE PART.</td>
                                <td><input name="frdeinsg_4" type="checkbox" id="frdeinsg_4" value="proyecdepar" <?php if($frdeinsg_4=='proyecdepar'){echo "checked";}?>></td>
                                <td colspan="2">&nbsp;</td>
                                <td colspan="2">&nbsp;</td>
                              </tr>
                              <tr class="rdoBanners">
                                <td>EXPLOSI&Oacute;N</td>
                                <td><input name="frdeinsg_5" type="checkbox" id="frdeinsg_5" value="explosion" <?php if($frdeinsg_5=='explosion'){echo "checked";}?>></td>
                                <td colspan="2">&nbsp;</td>
                                <td colspan="2">&nbsp;</td>
                              </tr>
                              <tr class="rdoBanners">
                                <td><span class="Estilo22">TRABAJOS HELITRANSPORTADOS</span></td>
                                <td><input name="trabaHelitrans" type="checkbox" id="trabaHelitrans" value="trabajhelitransportados" <?php if($trabaHelitrans=='trabajhelitransportados'){echo "checked";}?>></td>
                                <td><div align="center"><span class="Estilo17">OTROS</span></div></td>
                                <td><input name="frotros" type="checkbox" id="frotros" value="OTROS" <?php if($frotros=='OTROS'){echo "checked";}?>></td>
                                <td><span class="Estilo22">MANEJO INTEGRAL DE EXPLOSIVOS</span></td>
                                <td><input name="manejoideexplociones" type="checkbox" id="manejoideexplociones" value="MANEJO_I_EXPLOSIVO" <?php if($manejoideexplociones=='MANEJO_I_EXPLOSIVO'){echo "checked";}?>></td>
                              </tr>
                              <tr class="rdoBanners">
                                <td><span class="Estilo22">TRABAJO EN ALTURA</span></td>
                                <td><input name="traenaltura" type="checkbox" id="traenaltura" value="TRABAJOENALTURA" <?php if($traenaltura=='TRABAJOENALTURA'){echo "checked";}?>></td>
                                <td colspan="2">&nbsp;</td>
                                <td>&nbsp;</td>
                                <td>&nbsp;</td>
                              </tr>
                              <tr class="rdoBanners">
                                <td colspan="2">ESPECIFIQUE OTROS: </td>
                                <td colspan="4"><input name="especi_ot" type="text" class="lblForm" id="especi_ot" value="<? echo $especi_ot?>" size="62"></td>
                                </tr>
                              <tr class="rdoBanners">
                                <td colspan="2">OBSERVACIONES</td>
                                <td colspan="4"><textarea name="observ" cols="60" rows="2" class="lblForm" id="observ"><? echo $observ?></textarea></td>
                                </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td class="rdoBanners">Declaro que la respuestas anteriores han sido ofrecidas por mi sin coacci&oacute;n, que son verdaderas y que el medico examinador me ha explicado los t&eacute;rminos fuera de mi comprensi&oacute;n, en fe de lo cual firmo este documento en presencia del Medico examinador.</td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td>&nbsp;</td>
                        </tr>
                        <tr>
                          <td><table width="720" border="1" align="left" cellpadding="0" cellspacing="0">
                              <tr class="rdoBanners">
                                <td width="183"><div align="right"><span class="Estilo12">Se firma en el mes de</span></div></td>
                                <td width="105" bgcolor="#009900"><span class="Estilo12"><span class="Estilo4">
                                  <select name="meses" class="lblForm" id="mes" >
                                    <?= getCboMeses($mes);?>
                                  </select>
                                </span></span></td>
                                <td width="35"><div align="center"><span class="Estilo12">a los </span></div></td>
                                <td width="105" bgcolor="#009900"><span class="Estilo12"><span class="Estilo4">
                                  <input name="alos_firma" type="text" class="lblForm" id="alos_firma" value="<? echo $alos_firma?>" size="20">
                                </span></span></td>
                                <td width="53"><div align="center"><span class="Estilo12">d&iacute;as de</span></div></td>
                                <td width="105" bgcolor="#009900"><span class="Estilo12"><span class="Estilo4">
                                  <input name="diasde_firma" type="text" class="lblForm" id="diasde_firma" value="<? echo $diasde_firma?>" size="20">
                                </span></span></td>
                                <td width="163" bgcolor="#009900"><span class="Estilo12"></span></td>
                              </tr>
                          </table></td>
                        </tr>
                        <tr bgcolor="#009900">
                          <td height="16">&nbsp;</td>
                        </tr>
                        <tr>
                          <td><div align="center">                          </div>                            
                            <div align="center">
                              <table width="720" border="1" align="left" cellpadding="1" cellspacing="1">
                                <tr>
                                  <td><div align="center">
                                      <input name="grabar" type="button" class="lblForm" id="grabar3" value=".:   Grabar:." onClick="enviar_url(form1,'procesos/grabar_fichamedica.php')">
                                  </div></td>
                                  <td>
                                      <div align="center">
                                        <input name="salir" type="button" class="lblForm" id="salir" value=".:   Salir  :." onClick="volver(this.form);">
                                      </div></td></tr>
                              </table>
                            </div>                            <div align="center">                          </div></td>
                          </tr>
                    </table></td>
                  </tr>
                </table>
                <div align="center"></div>
              </form>
                </div></td>
            <td background="estilo_tabla/parte_med_der.gif">&nbsp;</td>
          </tr>
          <tr>
            <td><img src="estilo_tabla/parte_inf_izq.gif" width="25" height="25"></td>
            <td background="estilo_tabla/parte_inf_cen.gif">&nbsp;</td>
            <td><img src="estilo_tabla/parte_inf_der.gif" width="25" height="25"></td>
          </tr>
        </table>
    </div></td>
  </tr>
  <tr valign="top" class="lblCampo" >
    <td colspan="4">
      <div align="center"> </div></td>
  </tr>
</table>
<map name="Map">
  <area shape="circle" coords="12,11,10" href="fondo.php">
</map>
</body>
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