CITA PARA SARS-COV-2 Con este formulario puedes solicitar para una cita de la prueba PCR SARS-COV-2 según los requerimientos establecidos por el ministerio de salud publica. Field is required!Field is required!Edad-+Tu edad no concuerda.Correo electronico erroneo.Field is required![{"field":"{phonenumber}","logic":"not_equal","value":"0","and_method":"and","field_and":"{whatsapp}","logic_and":"not_equal","value_and":"0"}]Field is required!Field is required!SíntomasGripeFiebreTemperatura AltaTosDolor de gargantaDificultad para respirarDolor corporalDolor de cabezaDolor OcularSecreción nasalPerdida del olfatoMalestar estomacalNauseasDiarrea permanenteDolor de espaldaDolor de pechoConvulsionesDesorientaciónSomnolenciaPerdida del gustoOtroNingunasField is required!ReferenciasField is required!Field is required!Field is required!FemeninoMasculinoField is required![{"field":"{edad}","logic":"less_than","value":"18","and_method":"or","field_and":"{edad}","logic_and":"greater_than","value_and":"100"}]Cédula Invalida.[{"field":"","logic":"","value":"","and_method":"","field_and":"","logic_and":"","value_and":"","new_value":""}]Cédula Invalida.[{"field":"","logic":"","value":"","and_method":"","field_and":"","logic_and":"","value_and":"","new_value":""}]Field is required!San Pedro de MacorísSan Pedro de MacorísLa RomanaSanto DomingoElija una provincia.Quieres agregar otro contacto?SINOField is required!No. de Contacto:[{"field":"{otrocontacto}","logic":"equal","value":"SI","and_method":"and","field_and":"{otrocontacto}","logic_and":"not_equal","value_and":"NO"}]Field is required!¿Estás hospitalizado?SINOField is required!Especifique tipo de tratamiento.[{"field":"hospitalizado","logic":"equal","value":"SI","and_method":"and","field_and":"hospitalizado","logic_and":"not_equal","value_and":"NO"}]Field is required!¿Te encuentras en tratamiento actualmente?SINOField is required!Especifique tipo de tratamiento.[{"field":"tratamiento","logic":"equal","value":"SI","and_method":"and","field_and":"tratamiento","logic_and":"not_equal","value_and":"NO"}]Field is required!Información Adicional¿Posee alguna condición especial?SINOField is required!Hipertensión ArterialDiabetesEnfermedad PulmonarVIHEnfermedad CardíacaAutoinmunesTuberculosisAsma[{"field":"field_yeoVD","logic":"equal","value":"SI","and_method":"and","field_and":"field_yeoVD","logic_and":"equal","value_and":"NO"}]Field is required!¿Has tenido contacto con persona confirmada o sospechosa con sars –cov-2?SINOField is required!¿Has tenido contacto con personas con síntoma respiratorio?SINOField is required!¿Has viajado fuera del país en los últimos 15 dias?SINOField is required!¿Has tenido contacto con alguna persona procedente o que haya estado fuera del país?SINOField is required!- Seleccione un país -AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCyprusCzechiaCôte d\'IvoireDemocratic People\'s Republic of KoreaDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFaroe Islands FijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People\'s Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia (Federated States of)MonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNiueNorth MacedoniaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of KoreaRepublic of MoldovaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyrian Arab RepublicTajikistanThailandTimor-LesteTogoTokelau TongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited Republic of TanzaniaUnited States of AmericaUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamYemenZambiaZimbabwe[{"field":"hasviajado","logic":"equal","value":"SI","and_method":"or","field_and":"personaviajo","logic_and":"equal","value_and":"SI"}]Field is required!¿Se ha realizado la prueba anteriormente?SINOField is required!¿Que resultado obtuvo?POSITIVO IGG NEGATIVO IGMPOSITIVO IGM POSITIVO IGGPOSITIVO IGM NEGATIVO IGGPOSITIVO IGM NEGATIVO IGM[{"field":"pruebaanterior","logic":"equal","value":"SI","and_method":"or","field_and":"pruebaanterior","logic_and":"not_equal","value_and":"NO"}]Field is required!¿Que tipo de prueba?RápidaPCR[{"field":"{pruebaanterior}","logic":"equal","value":"SI","and_method":"or","field_and":"{pruebaanterior}","logic_and":"not_equal","value_and":"NO"}]Field is required![{"field":"pruebaanterior","logic":"equal","value":"SI","and_method":"or","field_and":"pruebaanterior","logic_and":"not_equal","value_and":"NO"}]Field is required!Fecha de la última pruebaDiga un estimado si no recuerda la exacta.[{"field":"pruebaanterior","logic":"equal","value":"SI","and_method":"or","field_and":"pruebaanterior","logic_and":"not_equal","value_and":"NO"}]Field is required!Enviar Documentos obligatorios. Los documentos obligatorios son:Cedula/ pasaporteIndicación vigente firmada y sellada por el medicoSeguro médico ( si tiene)