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["千葉県共用　脳卒中地域医療連携パス\n診療経過表【患者基本情報】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"発行病院"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"送り先"]
["氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生年月日"]
[]
["診断",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"発症日"]
[]
["機能障害",null,null,"　　","右麻痺",null,null,"左麻痺",null,null,"失調",null,"高次脳機能障害",null,null,null,null,"認知症",null,"　視野障害",null,null,"　構音・嚥下障害"]
[null,null,null,null,"その他（",null,null,null,null,null,null,null,")",null,"なし"]
["かかりつけ医で管理する\n疾患・生活習慣など",null,null,null,null,null,null,"　　高血圧",null,null,null,null,"脂質異常症",null,null,null,"糖尿病",null,null,null,"心房細動",null,null,null,"その他の不整脈"]
[null,null,null,null,null,null,null,"　　心不全",null,null,null,"肝硬変",null,null,"その他の肝機能障害",null,null,null,null,null,null,"腎不全",null,null,"その他の腎障害"]
[null,null,null,null,null,null,null,"　　喫煙",null,null,null,"飲酒",null,null,"肥満",null,"　　その他（",null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
["入院の記録","病院","入院日",null,null,null,null,"退院日",null,null,null,null,"病院・診療科(連絡先)",null,null,null,null,null,null,null,null,null,null,null,null,"担当医"]
[]
[null,"①"]
[]
[null,"②"]
[]
[null,"③"]
[]
[null,"④"]
[]
[null,"⑤"]
[]
["専門医の経過観察が\n必要な特殊疾患",null,null,null,null,null,null,"　　手術後の経過",null,null,null,null,null,"血管の狭窄・閉塞",null,null,null,null,null,null,"未破裂脳動脈瘤(",null,null,null,null,null,null,null,null,null,")"]
[null,null,null,null,null,null,null,null,"その他（",null,null,null,null,null,null,null,null,null,"）",null,"特になし"]
["定期的に必要な\n特殊検査",null,null,null,null,null,null,null,"CT",null,null,"MRI",null,null,"血管撮影",null,null,null,"SPECT",null,null,null,"頸部エコー",null,null,null,null,"心エコー"]
[null,null,null,null,null,null,null,null,"その他（",null,null,null,null,null,null,null,null,null,"）",null,"特になし"]
["外来診察・検査の予定",null,null,null,null,null,null,"病院（",null,null,"）：（",null,")月に1回：",null,null,"次回",null,null,null,"病院（",null,null,"）：（",null,")月に1回：",null,null,"次回"]
[]
["伝達事項","感染症",null,null,null,null,null,null,"疥癬",null,null,"梅毒",null,null,"HBｓ抗原",null,null,null,"HCV",null,null,"その他（",null,null,null,null,null,null,null,null,"）"]
[]
[null,"アレルギー",null,null,null,null,null,null,"薬剤（",null,null,null,null,null,"）",null,"食物（",null,null,null,null,"）",null,"その他（",null,null,null,null,null,null,"）"]
[]
[null,"その他伝達事項"]
[]
[]
[]
[]
["身障手帳",null,null,null,null,null,null,null,null,null,null,"級",null,"肢体不自由",null,null,null,"平衡",null,null,"音声言語",null,null,null,"そしゃく",null,null,"聴覚"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"視覚",null,null,"内部",null,null,"精神"]
["介護保険情報",null,null,null,null,null,null,null,null,null,null,"介護度",null,null,null,null,"→",null,null,null,null,"→",null,null,null,null,"→"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"　年　　月　　日",null,null,null,null,"　年　　月　　日",null,null,null,null,"　年　　月　　日",null,null,null,null,"　年　　月　　日"]
["かかりつけ医・歯科医",null,null,null,null,null,null,null,null,null,"医院名",null,null,null,null,null,null,null,null,null,"連絡先"]
[]
[]
[]
[]
[]
[]
["ケアマネージャー",null,null,null,null,null,null,null,null,null,"事業所名",null,null,null,null,null,null,null,null,null,"連絡先"]
[]
[]
[]
[]
[]
[]
["リハビリテーション評価担当事業所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"サービス種別",null,null,null,null,"連絡先"]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成27年4月版"]

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["脳卒中連携パス　　　　　　　　かかりつけ医→専門医　       再発予防シート",null,"ID:",null,null,null,null,"患者名："]
[null,null,"かかりつけ医：",null,null,null,null,"電話："]
[null,null,"　　　　　　　",null,null,null,null,"FAX：　　　　　　　"]
[null,null,"経過 ",null,"発症（　　）　　",null,"１ヵ月　　　　／　　／　","３ヵ月\n　／　　／　","６ヵ月　　　　／　　／　","９ヵ月\n　／　　／　","１２ヵ月\n　／　　／　"]
["専　門　医","病院：電話　/FAX　","再発予防のための検査　",null,null,null,null,null,"検査予約　　　　　□済□未　外来予約　　□済□未　",null,"脳MRI・MRA\n ( 　 /　  )\n頸動脈ｴｺｰ\n（　　/　　）\n外来\n（  　/   　）"]
[null,"担当医：","担当医署名"]
["回復期 ","病院：電話　/FAX　","回復期における　　リハビリチェック         回復期退院日　　　（    /    ）　　　　　　　□再診有　　　　　　□再診無",null,null,null,null,null,"外来予約　　□済□未　",null,"外来         （　/ 　）"]
[null,"担当医：","担当医署名"]
["かかりつけ医　（　　　　　　　　　　　　　　　　　　）","☆退院時所見\n●麻痺（日常生活低下）\n□無し　　　　□右片麻痺\n□左片麻痺 □　　　　　　　\n●嚥下障害　\n□無し　□よだれ\n□痰・咳　　□　　　　　\n●構音障害　\n□無し　□呂律障害　\n□　　　　　　　\n●その他\n□視野障害　　□高次機能障害　　　□","診　　察","体重 （kg）"]
[null,null,null,"BMI"]
[null,null,null,"血圧（mmHg）"]
[null,null,null,"麻痺の増悪","□無　□有",null,"□無　□有","□無　□有","□無　□有","□無　□有","□無　□有"]
[null,null,null,"嚥下障害増悪","□無　□有",null,"□無　□有","□無　□有","□無　□有","□無　□有","□無　□有"]
[]
[null,null,"検査（＊印は適宜実施）","血糖（空腹時）"]
[null,null,null,"血糖（食後）"]
[null,null,null,"HbA1c（％）"]
[null,"☆ｺﾝﾄﾛｰﾙ必要な生活習慣病\n□　糖尿病\n□　高血圧\n□　脂質異常症\n（目標値：　　　　　　　　　　　　\n□　喫煙\n□　心房細動\n□　慢性腎疾患　　",null,"LDL-C（mg/dl）"]
[null,null,null,"HDL-C（mg/dl）"]
[null,null,null,"TG（mg/dl）"]
[]
[null,null,null,"尿蛋白"]
[null,null,null,"尿中アルブミン＊"]
[null,null,null,"血清ｸﾚｱﾁﾆﾝ\n"]
[null,null,null,"PT-INR"]
[null,"☆抗血小板薬など\n□ｱｽﾋﾟﾘﾝ　　　□ﾌﾟﾗﾋﾞｯｸｽ\n□ﾌﾟﾚﾀｰﾙ　　　□ｴﾊﾟﾃﾞｰﾙ　　　"]
[null,null,null,"胸部ＸＰ＊"]
[null,"☆抗凝固薬　　□ﾜｰﾌｧﾘﾝ\n（目標PT-INR　　　～　　　）\n□プラザキサ　□イグザレルト　□エリキュース　□リクシアナ",null,"ＥＣＧ＊"]
[null,null,"薬　　　　剤","抗血小板薬",null,null,"□変更無","□変更無","□変更無","□変更無","□変更無",null,null,null,"　　　"]
[null,null,null,"抗凝固薬",null,null,"□変更有","□変更有","□変更有","□変更有","□変更有"]
[null,null,null,"降圧剤"]
[null,"抗血小板薬・抗凝固薬に関して\n歯科治療・白内障手術\n□中止可　　□中止不可\n内視鏡検査は観察のみであれば可。生検・処置時は連絡ください。"]
[]
[]
[]
[]
[null,null,"特記事項\n（経過記録）"]
[null,null,"かかりつけ医署名"]
[]
[null,null,null,null,null,null,null,null,null,null,"平成27年4月版"]

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["千葉県共用　脳卒中地域医療連携パス"]
["診療経過表【歯科シート】　"]
["患者名",null,null,null,null,null,null,null,"ID",null,"　　"]
["医療機関名"]
["記入日",null,null,null,"　　　       年  　　　月   　　　日",null,"　　　　　　年　　　月　　　日",null,"　　　　　  年　　　月　　　日",null,"　　　  　　年　　　月　　　日"]
["内容",null,"主な観察",null,"状態",null,"状態",null,"状態",null,"状態"]
[1,"口腔衛生機能","歯磨き",null,"□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助"]
[null,null,"うがい",null,"□　□","コップの水を自分で口に含むことができる　　　　　　　　　　　　　できない","□　□","コップの水を自分で口に含むことができる　　　　　　　　　　　　　できない","□　□","コップの水を自分で口に含むことができる　　　　　　　　　　　　　できない","□　□","コップの水を自分で口に含むことができる　　　　　　　　　　　　　できない"]
[null,null,null,null,"□□□□","強いうがいができる　　　　　　　口に含む程度　　　　　　　　　　　飲み込んでしまう　　　　　　　　　むせる","□□□□","強いうがいができる　　　　　　　口に含む程度　　　　　　　　　　　飲み込んでしまう　　　　　　　　　むせる","□□□□","強いうがいができる　　　　　　　口に含む程度　　　　　　　　　　　飲み込んでしまう　　　　　　　　　むせる","□□□□","強いうがいができる　　　　　　　口に含む程度　　　　　　　　　　　飲み込んでしまう　　　　　　　　　むせる"]
[null,null,"義歯着脱",null,"□□□","自立　　　　　　　　　　　　　　　　　一部介助　（□着　□脱）　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　（□着　□脱）　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　（□着　□脱）　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　（□着　□脱）　　　　　　　　　　　　　　全介助"]
[null,null,"義歯清掃",null,"□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助"]
[null,null,"義歯管理",null,"□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助","□□□","自立　　　　　　　　　　　　　　　　　一部介助　　　　　　　　　　　　　　全介助"]
[null,null,"専門職による口腔ケア",null,"□□","導入している　　　　　　　　　　　　未導入","□□","導入している　　　　　　　　　　　　未導入","□□","導入している　　　　　　　　　　　　未導入","□□","導入している　　　　　　　　　　　　未導入"]
[2,"清掃用具等",null,null,"□歯ブラシ　□電動ブラシ　            □スポンジブラシ　□義歯ブラシ　    □保湿剤　　　　　□義歯洗浄剤　　　　　　□その他（　　　　　　　　）　",null,"□歯ブラシ　□電動ブラシ　            □スポンジブラシ　□義歯ブラシ　    □保湿剤　　　　　□義歯洗浄剤　　　　　　□その他（　　　　　　　　）　",null,"□歯ブラシ　□電動ブラシ　            □スポンジブラシ　□義歯ブラシ　    □保湿剤　　　　　□義歯洗浄剤　　　　　　□その他（　　　　　　　　）　",null,"□歯ブラシ　□電動ブラシ　            □スポンジブラシ　□義歯ブラシ　    □保湿剤　　　　　□義歯洗浄剤　　　　　　□その他（　　　　　　　　）　"]
[3,"歯牙","残存歯数",null,"□□□","20歯以上　　　　　　                                  　10～19歯　　　　　　              　                      0～9歯","□□□","20歯以上　　　　　　                                  　10～19歯　　　　　　              　                      0～9歯","□□□","20歯以上　　　　　　                                  　10～19歯　　　　　　              　                      0～9歯","□□□","20歯以上　　　　　　                                  　10～19歯　　　　　　              　                      0～9歯"]
[null,null,"う蝕",null,"□□","なし　　　　　　　　　                                 　　あり","□□","なし　　　　　　　　　                                 　　あり","□□","なし　　　　　　　　　                                 　　あり","□□","なし　　　　　　　　　                                 　　あり"]
[4,"歯肉","歯肉炎・歯周炎",null,"□□□","なし・軽度　　　　　　　　　　                          中等度　　　　　　　　　　                              重度","□□□","なし・軽度　　　　　　　　　　                          中等度　　　　　　　　　　                              重度","□□□","なし・軽度　　　　　　　　　　                          中等度　　　　　　　　　　                              重度","□□□","なし・軽度　　　　　　　　　　                          中等度　　　　　　　　　　                              重度"]
[5,"その他疾患","口腔乾燥",null,"□□□","なし　　　　　　　　　　                                 　軽度　　　　　　　　　　                                  重度","□□□","なし　　　　　　　　　　                                 　軽度　　　　　　　　　　                                  重度","□□□","なし　　　　　　　　　　                                 　軽度　　　　　　　　　　                                  重度","□□□","なし　　　　　　　　　　                                 　軽度　　　　　　　　　　                                  重度"]
[null,null,"粘膜疾患",null,"□□","なし　　　　　　　　　                                 　　あり（　　　　　　　　　　　　　　　）","□□","なし　　　　　　　　　                                 　　あり（　　　　　　　　　　　　　　　）","□□","なし　　　　　　　　　                                 　　あり（　　　　　　　　　　　　　　　）","□□","なし　　　　　　　　　                                 　　あり（　　　　　　　　　　　　　　　）"]
[6,"義歯状況","有無/必要性",null,"□□","なし（□必要 上・下 □不要）    あり　（□上顎　□下顎）","□□","なし（□必要 上・下 □不要）    あり　（□上顎　□下顎）","□□","なし（□必要 上・下 □不要）    あり　（□上顎　□下顎）","□□","なし（□必要 上・下 □不要）    あり　（□上顎　□下顎）"]
[null,null,"適合状況","上顎","□□","良好　　　　　　　　　　　　　　　　　 不適合・破損","□□","良好　　　　　　　　　　　　　　　　　 不適合・破損","□□","良好　　　　　　　　　　　　　　　　　 不適合・破損","□□","良好　　　　　　　　　　　　　　　　　 不適合・破損"]
[null,null,null,"下顎","□□","良好　　　　　　　　　　　　　　　　　 不適合・破損","□□","良好　　　　　　　　　　　　　　　　　 不適合・破損","□□","良好　　　　　　　　　　　　　　　　　 不適合・破損","□□","良好　　　　　　　　　　　　　　　　　 不適合・破損"]
[null,null,"義歯の使用状況",null,"□□□□","就寝時以外常時使用　　　　　　食事時のみ　　　　　　　　　　　　不使用　　　　　　　　　　　　　　　　その他（　　　　　　　　　　　　）","□□□□","就寝時以外常時使用　　　　　　食事時のみ　　　　　　　　　　　　不使用　　　　　　　　　　　　　　　　その他（　　　　　　　　　　　　）","□□□□","就寝時以外常時使用　　　　　　食事時のみ　　　　　　　　　　　　不使用　　　　　　　　　　　　　　　　その他（　　　　　　　　　　　　）","□□□□","就寝時以外常時使用　　　　　　食事時のみ　　　　　　　　　　　　不使用　　　　　　　　　　　　　　　　その他（　　　　　　　　　　　　）"]
[null,null,"義歯の清掃状況",null,"□□","良好　　　　　　　　　　　　　　　　　要改善","□□","良好　　　　　　　　　　　　　　　　　要改善","□□","良好　　　　　　　　　　　　　　　　　要改善","□□","良好　　　　　　　　　　　　　　　　　要改善"]
[7,"咀嚼機能（機能歯数）",null,null,"□□□","正常（20歯以上）                                       やや困難（20歯以下）                               困難（なし）","□□□","正常（20歯以上）                                       やや困難（20歯以下）                               困難（なし）","□□□","正常（20歯以上）                                       やや困難（20歯以下）                               困難（なし）","□□□","正常（20歯以上）                                       やや困難（20歯以下）                               困難（なし）"]
[8,"嚥下機能","検査",null,"□□□□","未　　　　　　　　　　　　　　　　　　　VF                                           VE                                           その他（　　　　　　　　　　　　）","□□□□","未　　　　　　　　　　　　　　　　　　　VF                                           VE                                           その他（　　　　　　　　　　　　）","□□□□","未　　　　　　　　　　　　　　　　　　　VF                                           VE                                           その他（　　　　　　　　　　　　）","□□□□","未　　　　　　　　　　　　　　　　　　　VF                                           VE                                           その他（　　　　　　　　　　　　）"]
[null,null,"検査所見　"]
[null,null,"嚥下訓練の内容"]
[9,"歯科介入状況",null,null,"□□□","歯科治療中　　　　　　　　　　　　メインテナンス中　　　　　　　　　経過観察中","□□□","歯科治療中　　　　　　　　　　　　メインテナンス中　　　　　　　　　経過観察中","□□□","歯科治療中　　　　　　　　　　　　メインテナンス中　　　　　　　　　経過観察中","□□□","歯科治療中　　　　　　　　　　　　メインテナンス中　　　　　　　　　経過観察中"]
[10,"特記事項等"]
["記入者名"]
[null,null,null,null,null,null,null,null,null,null,null,"平成27年4月版"]

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[null,"千葉県共用脳卒中地域医療連携パス　栄養シート",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"送り先"]
["施設名：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"作成日：",null,null,null,null,"平成",null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
["連絡先：",null,null,null,null,null,null,"直通",null,null,null,null,"代表",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"作成者"]
[]
["患者氏名：",null,null,null,null,null,{"$f":"IF([1]計画管理病院用診療計画書!$C$4=\"\",\"\",[1]計画管理病院用診療計画書!$C$4)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"様",null,null,null,"年齢：",null,null,null,null,null,null,"歳",null,null,null,"性別：",null,null,null,null,null,"男",null,null,null,"女"]
["生年月日：",null,null,null,null,null,null,null,"M",null,null,null,"T",null,null,null,"年",null,null,null,"月",null,null,null,"日",null,null,null,"身長：",null,null,null,null,null,null,null,"cm",null,null,"体重：",null,null,null,null,null,null,null,"kg"]
[null,null,null,null,null,null,null,null,"S",null,null,null,"H",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"BMI：",null,null,null,{"$f":"IF(AR6=\"\",\"\",AR6/(AG6/100)/(AG6/100))","v":""},null,null,null,null,null,null,"標準体重：",null,null,null,null,null,{"$f":"IF(AG6=\"\",\"\",AG6/100*AG6/100*22)","v":""},null,null,null,"kg"]
[]
["＜食事情報＞",null,null,null,null,null,null,null,null,null,null,null,null,"経口",null,null,null,null,null,"経管",null,null,null,null,null,null,"※",null,"入院時（測定あれば記入）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"体重：",null,null,null,null,null,null,"kg"]
[null,"食種",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"エネルギー",null,null,null,null,null,null,null,null,null,null,"kcaｌ",null,null,null,"蛋白質",null,null,null,null,null,null,null,"g"]
[]
[null,"摂取量：",null,null,null,null,"主",null,null,null,null,"％",null,"副",null,null,null,null,"％",null,null,null,null,null,null,"kcaｌ",null,null,null,"経管水分量",null,null,null,null,null,null,null,null,null,"追加",null,null,null,null,"総量",null,null,null,null,null,null,null,"ml"]
[]
[]
["その他特記事項"]
[]
[]
[]
[]
[]
["＜分類シート＞"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"飲水とろみの状態"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"段階０　とろみなし"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"段階１　薄いとろみ"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"段階２　中間のとろみ"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"段階３　濃いとろみ"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["１mm角\n極きざみ",null,null,null,null,null,null,"５mm角\nきざみ",null,null,null,null,null,null,null,"１cm角\nさいの目",null,null,null,null,null,null,null,"２cm角\n一口大",null,null,null,null,null,null,null,"それ以上\n原形",null,null,null,null,null,null,"大きさ"]
[]
[]
[]
["説明"]
["０ｊ：",null,"均質で、付着性・凝集性・硬さに配慮したゼリー。"]
[null,null,"離水が少なく、スライス状にすくうことが可能。"]
["０ｔ：",null,"均質で、付着性・凝集性・硬さに配慮したとろみ水。"]
[null,null,"（原則的には、中間のとろみあるいは濃いとろみのどちらかが適している。）"]
["１ｊ：",null,"均質で、付着性・凝集性・硬さ・離水に配慮したゼリー・プリン・ムース状のもの。"]
["２－１：",null,null,null,"ピューレ・ペースト・ミキサー食など、均質でなめらかでべたつかず、まとまりやすいもの。"]
[null,null,null,null,"スプーンですくって食べることが可能なもの。"]
["２－２：",null,null,null,"ピューレ・ペースト・ミキサー食などで、べたつかず、まとまりやすいもので不均質なものも含む。"]
[null,null,null,null,"スプーンですくって食べることが可能なもの。"]
[3,null,"：","形はあるが、押しつぶしが容易、"]
[null,null,null,"食塊形成や移送が容易、咽頭でばらけず嚥下しやすいように配慮されたもの。"]
[null,null,null,"多量の離水がない。"]
[4,null,"：","硬さ・ばらけやすさ・貼りつきのないもの。箸やスプーンで切れるやわらかさ。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成27年4月版"]

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["千葉県共用 地域医療連携パス 連携シート\nリハシート 【地域生活期作成用】",null,null,null,null,null,null,null,null,null,null,null,null,null,"発行施設"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"評価日"]
["リハビリテーション基本情報",null,null,null,null,null,null,null,null,null,null,"　　　　評価者",null,"　　　　PT",null,"OT","　ST","（",null,null,null,null,null,")"]
["患者名（イニシャル可）　　",null,null,null,null,null,null,null,null,null,null,null,"生年月日",null,null,null,null,null,"ID"]
["リハ開始日",null,null,null,null,null,null,null,null,null,"リハ頻度（時間）",null,null,null,null,"／週",null,"/月","性別","　　男性",null,"　　女性"]
["診断名・既往歴",null,null,null,"1)",null,null,null,"発症日",null,null,null,"2)",null,null,null,"3)",null,null,null,"4)"]
["要介護度",null,null,null,"　　要支援1",null,"　　要支援2",null,"　　要介護1",null,"　　要介護2",null,"　　要介護3",null,"　　要介護4",null,"　　要介護5"]
["禁忌・配慮事項",null,null,null,"　　転倒",null,"　　誤嚥性肺炎",null,null,"褥瘡","　　その他 (　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,")"]
["　"," 　1．身体機能",null,null,null,"運動障害",null,null,null,null,"(",null,null,null,")"]
[null,null,null,null,null,"筋力低下",null,null,null,null,"上肢（",null,null,null,null,null,"）","下肢（",null,null,null,null,null,")"]
[null,null,null,null,null,null,null,null,null,null,"上肢（",null,null,null,null,null,"）","下肢（",null,null,null,null,null,"）"]
[null,null,null,null,null,"感覚障害",null,null,"　  なし",null,"あり（",null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,"痛み",null,null,"　  なし",null,"あり（",null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,"関節可動域制限",null,null,"　  なし",null,"あり（",null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,"呼吸循環機能障害",null,null,"　  なし",null,"あり（",null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,"嚥下障害",null,null,"　　なし",null,"あり（",null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,"　 2．コミュニケーション",null,null,null,"ｺﾐｭﾆｹｰｼｮﾝ障害",null,null,"　　なし",null,"あり     （",null,"　　失語症",null,"　　構音障害",null,"　　難聴",null,"　　その他（",null,null,null,null,"）)"]
[null,"　 3．高次脳機能・\n　　　　　　　精神機能",null,null,null,"認知症",null,null,"　　なし",null,"あり（",null,null,null,null,null,null,null,null,null,"）","　　不明"]
[null,null,null,null,null,"その他",null,null,"　　見当識障害",null,null,"　　問題行動",null,null,"　　失行",null,"失認（","　　　半側空間無視",null,null,"　　その他（"]
[null,null,null,null,null,null,null,null,"　　記憶障害",null,"　  注意障害",null,"　　  遂行機能障害",null,null,"　　うつ症状",null,"　　　その他（",null,null,null,null,null,"）"]
[null," 　4．寝返り　　　　　不可",null,null,null,"道具",null,null,"　　なし",null,"　　あり     （",null,"  　　柵　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,"　　その他（",null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,"介助量",null,null,"　　自立",null,"　　見守り ・ 声かけ",null,null,null,"　　軽介助",null,"　　中等度介助",null,null,"重度介助",null,"　　全介助"]
[null,"　 5．起き上がり　　 不可",null,null,null,"道具",null,null,"　　なし",null,"　　あり     （",null,"  　　柵　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,"　　その他（",null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,"介助量",null,null,"　　自立",null,"　　見守り ・ 声かけ",null,null,null,"　　軽介助",null,"　　中等度介助",null,null,"重度介助",null,"　　全介助"]
[null,"　 6．座位　　　　　　 不可",null,null,null,"道具",null,null,"　　なし",null,"　　あり     （",null," 　　 柵　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,"　　背もたれ",null,"　　クッション等",null,null,"その他（",null,null,null,"）"]
[null,null,null,null,null,"介助量",null,null,"　　自立",null,"　　見守り ・ 声かけ",null,null,null,"　　軽介助",null,"　　中等度介助",null,null,"重度介助",null,"　　全介助"]
[null,null,null,null,null,"連続保持時間",null,null,"　　１分～",null,"　　５分～",null,"　　  １０分～",null,"　　３０分～",null,"　　１時間～",null,null,"保持困難"]
[null," 　7．立ち上がり　　 不可",null,null,null,"道具",null,null,"　　なし",null,"　　あり     （",null," 　　 手すり　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,"　　杖",null,"　　座面・肘掛を押す",null,null,null,null,null,null,"）"]
[null,null,null,null,null,"介助量",null,null,"　　自立",null,"　　見守り ・ 声かけ",null,null,null,"　　軽介助",null,"　　中等度介助",null,null,"重度介助",null,"　　全介助"]
[null,null,null,null,null,"回数/30秒",null,null,"（　　　　　　　）回"]
[null,"　 8．立位　　　　　　 不可",null,null,null,"道具",null,null,"　　なし",null,"　　あり     （       ",null," 　 　手すり",null,"　　杖",null,"　　その他",null,null,null,null,null,null,"）"]
[null,null,null,null,null,"介助量",null,null,"　　自立",null,"　　見守り ・ 声かけ",null,null,null,"　　軽介助",null,"　　中等度介助",null,null,"重度介助",null,"　　全介助"]
[null,null,null,null,null,"連続保持時間",null,null,"　　～60秒(",null,null,null,")","　　それ以上"]
[null,"　9．移動　　　　　　",null,null,null,"歩行補助具",null,null,"　　なし",null,"　　あり     （",null," 　　 手すり　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",null,"　　杖","　　歩行器",null,"　　ｼﾙﾊﾞｰｶｰ",null,"　　屋内装具",null,"　  屋外装具",null,"）"]
[null,null,null,null,null,"介助者",null,null,"　　なし",null,"あり（",null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,"介助量",null,null,"　　自立",null,"　　見守り ・ 声かけ",null,null,null,"　　軽介助",null,"　　中等度介助",null,null,"重度介助",null,"　　全介助"]
[null,null,null,null,null,"連続移動距離",null,null," 　 移動不可",null,"　　～1m",null,"　　　～3m",null,"　　～5m",null,"　　～10m",null,null," それ以上(",null,null,null,"m ）"]
[null,"[　　　　　　　　　　　　　]",null,null,null,"上記に要する時間",null,null,"　　　分　　　秒",null,"(",null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null," 10．TUG",null,null,null,null,null,null,null,null,"右回り",null,null,null,"秒","：左回り",null,null,null,"秒"]
[null," 11．生活範囲",null,null,null,"移動範囲",null,null,"　　ベッド",null,"　　居室",null,"　　　屋内",null,"　　屋外"]
[null," 12．寝たきり度ランク",null,null,null,null,null,null,"　　J１",null,"J２","　　A１",null,"A２","　　B１",null,"B２","　　C１",null,"C２"]
["ＦＩＭ",null,null,"点数","福祉用具・介助方法等",null,null,null,null,null,null,null,"ＦＩＭ",null,null,"点数","福祉用具・介助方法等"]
["セルフケア","　食事・スプーン",null,null,null,null,null,null,null,null,null,null,"移動","歩行"]
[null,"　整容",null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(N43=\"\",\"\",IF(N43=\"歩行\",\"車イス\",\"歩行\"))","v":"車イス"}]
[null,"　入浴（洗い動作）",null,null,null,null,null,null,null,null,null,null,null,"階段"]
[null,"　更衣（上半身）",null,null,null,null,null,null,null,null,null,null,null,"小計",null,{"$f":"IF(P45=\"\",\"\",P43+P45)","v":""}]
[null,"　更衣（下半身）",null,null,null,null,null,null,null,null,null,null,"ｺﾐｭﾆ\nｹｰｼｮﾝ","　理解(聴覚･視覚)"]
[null,"　ﾄｲﾚ動作",null,null,null,null,null,null,null,null,null,null,null,"　表出(音声･非音声)"]
[null,"小計",null,{"$f":"IF(D48=\"\",\"\",SUM(D43:D48))","v":""},null,null,null,null,null,null,null,null,null,"小計",null,{"$f":"IF(P48=\"\",\"\",SUM(P47:P48))","v":""}]
["排泄","　排尿",null,null,null,null,null,null,null,null,null,null,"社会認識","　社会的交流"]
[null,"　排便",null,null,null,null,null,null,null,null,null,null,null,"　問題解決"]
[null,"小計",null,{"$f":"IF(D51=\"\",\"\",SUM(D50:D51))","v":""},null,null,null,null,null,null,null,null,null,"　記憶"]
["移乗","　ﾍﾞｯﾄﾞ・ｲｽ・車ｲｽ",null,null,null,null,null,null,null,null,null,null,null,"小計",null,{"$f":"IF(P52=\"\",\"\",SUM(P50:P52))","v":""}]
[null,"　ﾄｲﾚ",null,null,null,null,null,null,null,null,null,null,"　ＦＩＭ合計",null,null,{"$f":"IF(P52=\"\",\"\",D49+D52+D56+P46+P49+P53)","v":""}]
[null,"　浴漕・ｼｬﾜｰ",null,null,null,null,null,null,null,null,null,null,"ＦＩＭ採点\n目安",null,"[７点：自立][６点：修正自立][５点：見守り][４点：軽介助（25％介助）]"]
[null,"小計",null,{"$f":"IF(D55=\"\",\"\",SUM(D53:D55))","v":""},null,null,null,null,null,null,null,null,null,null,"[３点：中介助（50％介助）][２点：重介助（75％介助）][１点：全介助]"]
["特記事項（意欲・栄養状態・家屋状況・福祉用具・介護力・コミュニケーション方法、IADLなど・・・）"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成27年4月版"]

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["千葉県共用 脳卒中地域医療連携パス 連携シート"]
["薬剤シート",null,null,null,null,null,null,null,null,null,null,"発行機関",null,{"$f":"IF(基本情報!$W$1=\"\",\"\",基本情報!$W$1)","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,"送り先"]
["患者基本情報　　",null,null,"　(",null,null,"記入）",null,"　　　　　　　　　　　　薬剤師名"]
["患者氏名",null,{"$f":"IF(基本情報!$D$3=\"\",\"\",基本情報!$D$3)","v":""},null,null,null,"生年月日",null,{"$f":"IF(基本情報!$T$3=\"\",\"\",基本情報!$T$3)","v":""},null,null,null,"年齢",{"$f":"IF(E4=\"\",\"\",DATEDIF(I5,E4,\"Y\"))","v":""},"性別",{"$f":"IF(基本情報!$N$3=\"\",\"\",基本情報!$N$3)","v":""}]
["薬剤の管理者",null,"　　本人","　　家族（","　　夫・妻","　　　その他）",null,"施設（施設名",null,null,null,"）　　その他（",null,null,null,null,"）"]
["指導上の注意"]
["服用方法",null,"　　経口",null,"胃管",null,"胃ろう",null,"その他（",null,null,null,null,"）"]
["副作用・アレルギー　※可能ならば原因薬剤と年月日を記載"]
[null,"あり",null,"なし",null,"不明"]
[]
["服用薬剤"]
["※ 現在服用中の全薬剤 (内服薬・外用薬・注射薬等、定時薬・臨時薬) を記録する。\n※ 「粉砕」・「簡易懸濁」は、現在の状況についてチェック (✓) を入れる。\n※ 数種類の散剤、軟膏剤を混合している場合には、内容も記録する。\n※ 「医療機関等」には、「処方した医療機関、調剤した薬局」の欄より対応する番号を記載する。"]
["No.","調剤医薬品",null,null,null,"先発医薬品",null,null,null,"用法・用量",null,null,null,"粉砕","簡易懸濁","医療機関等"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["調剤に関する特記事項"]
[]
["その他"]
[]
["一般用医薬品、健康食品等",null,null,null,null,null,null,null,"嗜好品"]
[null,"不明",null,"あり",null,"なし",null,null,null,"喫煙歴",null,"飲酒",null,"その他"]
[]
["医療機器・医療材料"]
[null,"血糖自己測定器",null,null,"その他"]
[]
["処方した医療機関、調剤した薬局"]
[null,"医療機関等の名称",null,null,null,"TEL",null,null,null,"医療機関等の名称",null,null,null,"TEL"]
["①",null,null,null,null,null,null,null,"⑤"]
["②",null,null,null,null,null,null,null,"⑥"]
["③",null,null,null,null,null,null,null,"⑦"]
["④",null,null,null,null,null,null,null,"⑧"]
["※かかりつけ薬局には○を付けること。"]
["※","院外処方せんを発行する際には、「薬剤シート (本シート)」および「診療情報シート」の写しを添付してください。患者さんへは処方せんと写しを合わせて薬局に提示するように説明してください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"平成27年4月版"]

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[null,"千葉県共用 脳卒中地域医療連携パス\n連絡票 【様式Ａ】介護・福祉発",null,null,null,null,null,null,null,null,null,null,null,null,"発行者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"送り先"]
[null,null,null,null,"（","月　　日",null,null,"記入）",null,"記入者名"]
["患者氏名",null,null,{"$f":"IF(基本情報!$D$3=\"\",\"\",基本情報!$D$3)","v":""},null,null,null,null,null,null,null,"性別",null,{"$f":"IF(基本情報!$N$3=\"\",\"\",基本情報!$N$3)","v":""},null,"ID"]
[null,null,null,null,null,null,null,null,null,null,null,"年齢",null,"歳"]
["現在の生活の場",null,null,"□自宅　□グループホーム　□老人保健施設　□その他の施設"]
["現在のサービス",null,null,"□通所リハ　□訪問リハ　□デイサービス　　□デイケア　□ショートステイ　□訪問看護"]
["□かかりつけ医から計画管理病院・回復期病院へ報告（日常生活機能評価は必ず記載）　□報告　□お聞きしたいこと・お願いしたいこと"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["現在の情報（　　　　月　　　　日",null,null,null,null,null,null,null,"）　記入必要思われる部分のみ記載　記入者"]
["ﾊﾞｲﾀﾙｻｲﾝ",null,null,"体温","　　～　　　　度",null,null,"脈拍","～",null,null,"不整脈",null,"□なし □あり",null,null,"血圧","収縮期",null,"～"]
["褥そう　",null,null,"□なし　　　□あり　処置方法：",null,null,null,null,null,null,null,null,null,null,null,null,null,"拡張期",null,"～"]
[null,"（内容）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"体  重",null,null,"Kg"]
["食事栄養","経路","□経口、　□経管摂取　（銘柄                       ) (投与量         　　　　　　　）ｋcal、　投与時間　（　　　　時間/回）　"]
[null,"形態","主食","□ご飯、　□軟飯、　□全粥、　□ミキサー粥",null,null,null,null,null,null,null,"□鼻腔　□胃瘻　□経口訓練併用　□TPN (                  )Cal"]
[null,null,"副食","□ゼリー、 □ゼリー食、 □ミキサー・ペースト食、 □やわらか食、 □軟菜・刻み食、 □常食 （下記の副菜コメント参照）"]
[null,"水分","□とろみあり、　　（トロミの強さ　□弱め、　□強め）、　　（とろみ剤の銘柄・分量など　　　　　　　　　　　　　　　　　　）、　　水分量　（　　　　　　　ml）"]
[null,"動作","□自立(□補助具使用）、　□見守り必要、　□一部介助（　　　　　　　　　　　　　　　　　　　　　　） 、　□全介助"]
[null,"摂取量","□全量　　　　□3/4～1/2  　　  □1/2～1/4　　　　□1/4以下　　　□その他（　　　　　　　　　　　　　　）"]
[null,"治療食","□なし　□あり（ＤＭ食　　　　　　ｋｃａｌ　　□塩分　　　　ｇ　　□ﾜｰﾌｧﾘﾝ食　　□タンパク制限（　　　　　　）ｇ　"]
[null,"特記","□禁止食（　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）　　　　□その他（　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）"]
["排泄","方法",null,"日中；",null,null,null,"夜間；",null,null,null,"伝達事項",null,null,null,null,"最終交換日",null,"サイズ",null,"種類"]
[null,"尿意",null,"□あり　　□不明確　　□なし",null,null,null,null,null,null,null,null,"□留置ｶﾃｰﾃﾙ　　　",null,null,null,"　　　／",null,"Ｆｒ"]
[null,"失禁",null,"□なし　　　　　□あり",null,null,null,null,null,null,null,null,"□鼻腔・胃ろう　　　",null,null,null,"　　　／",null,"Ｆｒ"]
[null,"便意",null,"□あり　　□不明確　　□なし",null,null,null,null,null,null,null,null,"□気管切開　　　　　　　",null,null,null,"　　　／",null,"ｍｍ"]
[null,"排便ｺﾝﾄﾛｰﾙ",null,null,null,null,null,null,null,null,null,null,"□その他（　　　　　　　　）",null,null,null,"　　　／"]
[null,"動作",null,"□自立　□一部介助　□全介助",null,null,null,null,null,null,null,null,"□その他（　　　　　　　　）",null,null,null,"　　　／"]
["入浴","一般浴（□自立□介助）　　ｼｬﾜｰ浴（□自立□介助　　□リフト浴　　□機械浴　　□ﾍﾞｯﾄﾞ上清拭",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ﾊﾞｲﾀﾙ上限下限"]
["日常生活機能評価","患者の状況",null,null,null,null,null,"得点",null,null,null,null,null,null,null,null,null,null,null,"特記事項"]
[null,null,null,null,null,null,null,"0点",null,null,"1点",null,null,null,null,null,"2点"]
[null,"床上安静の指示",null,null,null,null,null,"□なし",null,null,"□あり"]
[null,"どちらかの手を胸元まで持ち上げられる",null,null,null,null,null,"□できる",null,null,"□できない"]
[null,"寝返り",null,null,null,null,null,"□できる",null,null,"□何かにつかまればできる",null,null,null,null,null,"□できない"]
[null,"起き上がり",null,null,null,null,null,"□できる",null,null,"□できない"]
[null,"座位保持",null,null,null,null,null,"□できる",null,null,"□支えがあればできる",null,null,null,null,null,"□できない"]
[null,"移乗",null,null,null,null,null,"□できる",null,null,"□見守り一部介助が必要",null,null,null,null,null,"□できない"]
[null,"移乗方法",null,null,null,null,null,"□介助を要しない",null,null,"□介助を要する移動（搬送含む）"]
[null,"口腔清潔",null,null,null,null,null,"□できる",null,null,"□できない"]
[null,"食事摂取",null,null,null,null,null,"□介助無し",null,null,"□できない",null,null,null,null,null,"□全介助"]
[null,"衣服の着脱",null,null,null,null,null,"□介助無し",null,null,"□一部介助",null,null,null,null,null,"□全介助"]
[null,"他者への意思の伝達",null,null,null,null,null,"□できる",null,null,"□できる時とできない時がある",null,null,null,null,null,"□できない"]
[null,"診療・療養上の指示が通じる",null,null,null,null,null,"□はい",null,null,"□いいえ"]
[null,"危険行動",null,null,null,null,null,"□なし",null,null,"□あり"]
[null,"合計得点",null,null,null,null,null,"点"]
["＊かかりつけ医から計画管理病院への報告・照会・連絡，福祉・介護事業所等から医療機関への照会・連絡等にご使用ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成27年4月版"]

{"sheet":"連絡票様式B","index":7,"n_rows":45,"n_cols":18,"rows_kept":45,"cut":false,"hidden":false,"merged":[[4,0,4,2],[4,3,4,23],[2,17,2,23],[3,15,3,16],[3,17,3,23],[3,0,3,2],[3,3,3,10],[3,11,3,12],[3,13,3,14],[44,0,44,23],[34,0,35,4],[34,5,35,23],[36,0,37,4],[36,5,37,23],[38,5,39,23],[40,0,42,4],[40,5,42,23],[43,0,43,4],[43,5,43,23],[38,0,39,4],[29,0,31,4],[29,5,31,23],[32,0,33,4],[32,5,33,23],[6,0,6,23],[26,0,26,4],[26,5,26,23],[27,0,27,4],[27,5,27,23],[11,0,19,23],[21,0,25,23],[0,18,0,23],[1,18,1,23],[20,0,20,19],[28,5,28,19],[28,0,28,4],[0,0,1,9],[0,10,1,10],[0,17,1,17],[2,0,2,2],[2,3,2,10],[2,11,2,12],[2,15,2,16],[2,13,2,14],[0,11,0,16],[1,11,1,16],[5,0,5,23]]}
["千葉県共用脳卒中地域医療連携パス連絡票\n【様式B】□お返事　□診療情報提供書\n□初回　　□　　ヵ月後　□　　年後\n",null,null,null,null,null,null,null,null,null,"発信","\n",null,null,null,null,null,"宛先"]
[]
["ﾌﾘｶﾞﾅ",null,null,null,null,null,null,null,null,null,null,"性別",null,{"$f":"IF(基本情報!$N$3=\"\",\"\",基本情報!$N$3)","v":""},null,"ID"]
["患者氏名",null,null,{"$f":"IF(基本情報!$D$3=\"\",\"\",基本情報!$D$3)","v":""},null,null,null,null,null,null,null,"年齢",null,"歳",null,"生年月日",null,{"$f":"IF(基本情報!$T$3=\"\",\"\",基本情報!$T$3)","v":""}]
["診断",null,null,{"$f":"IF(基本情報!$D$5=\"\",\"\",基本情報!$D$5)","v":""}]
["発信：　□専門医　□回復期病院から　（　　　　月　　　　日）記入者名　　"]
["宛先：　□かかりつけ医　□ｹｱﾏﾈｰｼﾞｬ-　□リハビリ　□訪問看護　□　　　　　　　　　　　"]
["検査・受診結果："]
[null,"□　前回より良くなっています。",null,null,null,null,null,null,null,null,null,"□　ADLは良くなっています。"]
[null,"□　前回と同様です。　",null,null,null,null,null,null,null,null,null,"□　ADLは変わりありません。"]
[null,"□　前回より悪化しています。",null,null,null,null,null,null,null,null,null,"□　ADLは低下しています。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["処方薬の変更：　□　無・このまま継続をお願いします　　□　有（以下に記載）"]
[]
[]
[]
[]
[]
["次回検査予定（　　か月後）",null,null,null,null,"□頭部MRI・MRA　（予約　□済（　　/　　）　□未）　□頸動脈ｴｺｰ　（予約　□済（　　/　　）　□未）"]
["次回外来予定　（　　　か月後）",null,null,null,null,"□無　　□有　（　□予約済（　　/　　）　□予約未　）"]
[null,null,null,null,null,"□　検査・外来予約を（　　　か月後）に取ってください。"]
["御本人・御家族への説明内容"]
[]
[]
["□血液検査（　　月　　日）",null,null,null,null,"□別紙参照"]
[]
["□頭部MRI　（　　　月　　日）",null,null,null,null,"□別紙参照"]
[]
["□頭部MRA（　　月　　　日）",null,null,null,null,"□別紙参照"]
[]
["□頸動脈エコー（　月　　日）",null,null,null,null,"□別紙参照"]
[]
["□その他の検査\n　　　　　　　（　　月　　日）"]
[]
[]
["添付資料",null,null,null,null,"□ＣＴ 　□ＭＲＩ　 □ＸーＰ　 □ＥCＧ 　□血液検査　 □尿　 □感染症"]
["平成27年4月版"]

{"sheet":"連絡票様式C","index":8,"n_rows":50,"n_cols":20,"rows_kept":50,"cut":false,"hidden":false,"merged":[[0,11,0,16],[1,11,1,16],[0,18,0,23],[1,18,1,23],[16,0,25,23],[27,0,32,23],[0,0,1,9],[0,10,1,10],[10,4,10,6],[10,8,10,10],[0,17,1,17],[2,0,2,23],[3,15,3,16],[3,17,3,23],[3,0,3,2],[3,3,3,10],[3,11,3,12],[3,13,3,14],[7,0,8,2],[7,3,8,23],[4,0,4,2],[4,3,4,10],[4,11,4,12],[4,13,4,14],[6,0,6,2],[6,3,6,23],[4,15,4,16],[4,17,4,23],[5,0,5,2],[5,3,5,23],[11,19,11,20],[11,21,11,23],[11,11,11,12],[11,13,11,14],[11,15,11,16],[11,17,11,18],[11,9,11,10],[9,0,10,2],[9,4,9,6],[9,8,9,10],[11,0,12,2],[11,3,11,4],[11,5,11,6],[11,7,11,8],[12,19,12,20],[12,21,12,23],[9,19,9,23],[10,12,10,18],[10,19,10,23],[9,11,9,12],[9,13,9,15],[9,16,9,18],[13,0,13,4],[13,5,13,23],[12,3,12,4],[12,5,12,6],[12,7,12,8],[12,9,12,10],[12,11,12,12],[12,13,12,14],[12,15,12,16],[12,17,12,18],[35,16,35,18],[35,19,35,23],[36,1,36,6],[36,7,36,9],[36,10,36,15],[36,16,36,18],[36,19,36,23],[33,0,48,0],[33,1,34,6],[33,7,33,18],[33,19,34,23],[34,7,34,9],[34,10,34,15],[34,16,34,18],[35,1,35,6],[35,7,35,9],[35,10,35,15],[37,1,37,6],[37,7,37,9],[37,10,37,15],[37,16,37,18],[37,19,37,23],[38,1,38,6],[38,7,38,9],[38,10,38,15],[38,16,38,18],[38,19,38,23],[39,1,39,6],[39,7,39,9],[39,10,39,15],[39,16,39,18],[39,19,39,23],[40,1,40,6],[40,7,40,9],[40,10,40,15],[40,16,40,18],[40,19,40,23],[41,1,41,6],[41,7,41,9],[41,10,41,15],[41,16,41,18],[41,19,41,23],[42,1,42,6],[42,7,42,9],[42,10,42,15],[42,16,42,18],[42,19,42,23],[43,1,43,6],[43,7,43,9],[43,10,43,15],[43,16,43,18],[43,19,43,23],[44,1,44,6],[44,7,44,9],[44,10,44,15],[44,16,44,18],[44,19,44,23],[45,1,45,6],[45,7,45,9],[45,10,45,15],[45,16,45,18],[45,19,45,23],[46,1,46,6],[46,7,46,9],[46,10,46,15],[46,16,46,18],[46,19,46,23],[49,0,49,23],[47,1,47,6],[47,7,47,9],[47,10,47,15],[47,16,47,18],[47,19,47,23],[48,1,48,6],[48,7,48,9],[48,10,48,15],[48,16,48,18],[48,19,48,23]]}
["千葉県共用脳卒中地域医療連携パス連絡票\n【様式C】　診療情報提供書\n□初回　　□　　ヵ月後　□　　年後",null,null,null,null,null,null,null,null,null,"発信","\n",null,null,null,null,null,"宛先"]
[]
["　発信：□かかりつけ医　 □介護老人福保健施設　から　□専門医　　□回復期病院へ（　　　　月　　　　日）記入者名　　　　　　　　　　　　　　　　"]
["ﾌﾘｶﾞﾅ",null,null,null,null,null,null,null,null,null,null,"性別",null,{"$f":"IF(基本情報!$N$3=\"\",\"\",基本情報!$N$3)","v":""},null,"ID"]
["患者氏名",null,null,{"$f":"IF(基本情報!$D$3=\"\",\"\",基本情報!$D$3)","v":""},null,null,null,null,null,null,null,"年齢",null,"歳",null,"生年月日",null,{"$f":"IF(基本情報!$T$3=\"\",\"\",基本情報!$T$3)","v":""}]
["診断",null,null,{"$f":"IF(基本情報!$D$5=\"\",\"\",基本情報!$D$5)","v":""}]
["現在の生活の場",null,null,"□自宅　□グループホーム　□老人保健施設　□その他の施設（"]
["現在のサービス",null,null,"□通院　□訪問診療　□通所リハ　□訪問リハ　□デイサービス　　□デイケア　　□ショートステイ　□訪問看護　□受診科（□内科　□外科　□眼科　□皮膚科　□泌尿器科　□歯科　□　　　　　　　　　　　　　　　　　"]
[]
["ﾊﾞｲﾀﾙｻｲﾝ等",null,null,"体温","　         　　　度",null,null,"脈拍",null,null,null,"不整脈",null,"□無　 □有",null,null,"血圧"]
[null,null,null,"身長","ｃｍ",null,null,"体重","Kg",null,null,"喫煙","　□無　　□有"]
["血液検査　　　　　　（　　/　　）",null,null,"血糖（空腹時）",null,null,null,"血糖（食後）",null,null,null,"HbA1c（％）",null,null,null,"血清ｸﾚｱﾁﾆﾝ\n"]
[null,null,null,"LDL-C（mg/dl）",null,null,null,"HDL-C（mg/dl）",null,null,null,"TG（mg/dl）",null,null,null,"PT-INR"]
["添付資料",null,null,null,null,"□ＣＴ 　□ＭＲＩ　 □ＸーＰ　 □ＥCＧ 　□血液検査　 □尿　 □感染症"]
[null,null,null,null,null," □　お世話になっております。　状態変化ありません。"]
[null,null,null,null,null," □　以下ご報告したい事項があります。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["処方薬："]
[]
[]
[]
[]
[]
[]
["日常生活機能評価（必須項目）","患者の状況",null,null,null,null,null,"得点",null,null,null,null,null,null,null,null,null,null,null,"特記事項"]
[null,null,null,null,null,null,null,"0点",null,null,"1点",null,null,null,null,null,"2点"]
[null,"床上安静",null,null,null,null,null,"□できる",null,null,"□あり"]
[null,"どちらかの手を胸元まで持ち上げられる",null,null,null,null,null,"□できる",null,null,"□できない"]
[null,"寝返り",null,null,null,null,null,"□できる",null,null,"□何かにつかまればできる",null,null,null,null,null,"□できない"]
[null,"起き上がり",null,null,null,null,null,"□できる",null,null,"□できない"]
[null,"座位保持",null,null,null,null,null,"□できる",null,null,"□支えがあればできる",null,null,null,null,null,"□できない"]
[null,"移乗",null,null,null,null,null,"□できる",null,null,"□見守り一部介助が必要",null,null,null,null,null,"□できない"]
[null,"移乗方法",null,null,null,null,null,"□介助を要しない",null,null,"□介助を要する移動（搬送含む）"]
[null,"口腔清潔",null,null,null,null,null,"□できる",null,null,"□できない"]
[null,"食事摂取",null,null,null,null,null,"□介助無し",null,null,"□できない",null,null,null,null,null,"□全介助"]
[null,"衣服の着脱",null,null,null,null,null,"□介助無し",null,null,"□一部介助",null,null,null,null,null,"□全介助"]
[null,"他者への意思の伝達",null,null,null,null,null,"□できる",null,null,"□できる時とできない時がある",null,null,null,null,null,"□できない"]
[null,"診療・療養上の指示が通じる",null,null,null,null,null,"□はい",null,null,"□いいえ"]
[null,"危険行動",null,null,null,null,null,"□なし",null,null,"□あり"]
[null,"合計得点",null,null,null,null,null,null,null,null,"点",null,null,null,null,null,"点",null,null,"総合計　　　　　　　点"]
["かかりつけ医側　初回：地域連携診療計画退院時指導料（Ⅱ）　算定　　2回目以降：診療情報提供料算定　　　　平成27年4月案　　"]

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[]
[null,"千葉県地域生活連携シート（参考様式）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 【 介護支援専門員 ⇄ 医療機関 】 ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成23年4月版"]
[]
[]
[null,"(1)入院先の医療機関等名称",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"下記利用者(家族)の同意に基づき、\n利用者の身体・生活機能等の情報を\n送付しますので、ご活用ください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(2)送付日\n　 (面談日)",null,null,null,null,null,null,null,null,"平成",null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"様"]
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[]
[]
[null,"(4)利用者氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(基本情報!$D$3=\"\",\"\",基本情報!$D$3)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(5)生年・\n性別等",null,null,null,null,null,null,null,null,null,"明治",null,null,null,null,null,null,"大正",null,null,null,null,null,null,"昭和",null,null,null,null,null,"(6)生活\n  保護",null,null,null,null,null,null,null,null,"無し",null,null,null,null,"(7)障害等\n  認定",null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,"身障(",null,null,null,null,null,null,null,null,null,null,null,")"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"療育",null,null,null,null,null,null,"精神(",null,null,null,null,null,null,null,null,null,"級)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有り"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"男",null,null,null,null,"女",null,null,"(満",null,null,null,null,null,null,null,"歳)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定疾患(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,"(8)要介護度",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認定有効期間",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日",null,null,"(9)障害高齢者日常生活\n自立度（寝たきり度）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(10)認知症高齢者\n日常生活自立度"]
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[null,"(11)介護ｻｰﾋﾞｽ\n　 利用状況",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"訪問介護(",null,null,null,null,null,null,null,null,null,null,null,"回/週)",null,null,null,null,null,null,null,null,null,null,null,"訪問リハ(",null,null,null,null,null,null,null,null,null,null,null,"回/週)",null,null,null,null,null,null,null,null,null,null,null,"通所介護(",null,null,null,null,null,null,null,null,null,null,null,"回/週)",null,null,null,null,null,null,null,null,null,null,null,"訪問入浴(",null,null,null,null,null,null,null,null,null,null,null,"回/週)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"訪問看護(",null,null,null,null,null,null,null,null,null,null,null,"回/週)",null,null,null,null,null,null,null,null,null,null,null,"通所リハ(",null,null,null,null,null,null,null,null,null,null,null,"回/週)",null,null,null,null,null,null,null,null,null,null,null,"ショート(",null,null,null,null,null,null,null,null,null,null,null,"日/月)",null,null,null,null,null,null,null,null,null,null,null,"その他(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"居宅療養管理指導(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")",null,null,null,null,null,null,null,"福祉用具(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,"(12)同居家族",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,"配偶者",null,null,null,null,null,null,null,null,"兄弟姉妹",null,null,null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,"(13)住居",null,null,null,null,null,null,null,null,"戸建",null,null,null,null,null,null,null,"アパート",null,null,null,null,null,null,null,null,null,null,"マンション(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"階)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"子",null,null,null,null,null,"子の配偶者",null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,")",null,null,null,null,null,null,null,null,null,null,"施設(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")",null,"(エレベータ:",null,null,null,null,null,null,null,null,null,null,null,null,"有り",null,null,null,null,null,null,"無し)"]
[null,"(14)主介護者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"続柄",null,null,null,null,null,null,null,null,null,null,null,null,"同居",null,null,null,null,"電話",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"就労\n状況",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"健康\n状態"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"別居"]
[null,"(15)ｷｰﾊﾟｰｿﾝ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"続柄",null,null,null,null,null,null,null,null,null,null,null,null,"同居",null,null,null,null,"電話",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(16)緊急\n連絡先"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"別居"]
[null,"(17)かかりつけ情報等 (医師・歯科医師・訪問看護ステーション・薬局等)"]
[]
[null,"主病名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"情報源",null,null,null,null,null,null,null,null,"医療機関等名称",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"診療科名等",null,null,null,null,null,null,null,null,null,null,null,"受診状況等",null,null,null,null,null,null,null,null,null,null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特記事項(既往歴等)"]
[null,1,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"意見書"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"家族等"]
[null,2,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"意見書"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"家族等"]
[null,3,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"意見書"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"家族等"]
[]
[null,"記入時の身体・生活機能等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(18)記入日",null,null,null,null,null,null,null,null,"平成",null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,"月",null,null,null,null,null,null,"日",null,null,null,null,"入院時",null,null,null,null,null,null,null,null,"入院中",null,null,null,null,null,null,null,null,"退院時"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域生活期",null,null,null,null,null,null,null,null,null,null,null,null,"その他(",null,null,null,null,null,null,null,null,null,null,null,")"]
[null,"(19)麻痺の状況",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,null,"軽度",null,null,null,null,null,null,null,"中度",null,null,null,null,null,null,null,"重度",null,null,null,null,"麻痺の部位",null,null,null,null,null,null,null,null,null,null,null,null,null,"左上肢",null,null,null,null,null,null,null,null,"右上肢",null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,"(50)具体的内容"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"左下肢",null,null,null,null,null,null,null,null,"右下肢",null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,")"]
[null,"(20)褥瘡の有無",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,null,"有り(部位：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")",null,"(21)皮膚疾患",null,null,null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,"有り(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[null,"(22)視力",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"新聞等の字が見える",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"目の前の物が見える",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(23)眼鏡",null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,"有り"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ほとんど見えない",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"判断不能"]
[null,"(24)聴力",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日常生活に支障なし",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"大声なら何とか聞こえる",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(25)補聴器",null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,"有り"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ほとんど聞こえない",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"判断不能"]
[null,"(26)意思の伝達",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"可",null,null,null,null,null,"時々可",null,null,null,null,null,null,null,null,null,"ほとんど不可",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"不可",null,null,null,null,null,"(27)失語症",null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,"有り",null,null,null,null,null,null,"不明"]
[]
[null,"(28)認知症症状",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,null,"記憶障害",null,null,null,null,null,null,null,null,null,null,null,"幻覚･妄想",null,null,null,null,null,null,null,null,null,null,null,"昼夜逆転",null,null,null,null,null,null,null,null,null,null,"介護への抵抗",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"抑うつ･不安"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"暴言･暴力",null,null,null,null,null,null,null,null,null,null,null,"不潔行為",null,null,null,null,null,null,null,null,null,null,"徘徊",null,null,null,null,null,null,null,"その他(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,"(29)睡眠の状態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"良眠",null,null,null,null,null,null,"睡眠障害(",null,null,null,null,null,null,null,null,"眠りが浅い",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")",null,"(30)眠剤",null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,null,"時々",null,null,null,null,null,null,null,"毎晩"]
[]
[null,"(31)起居動作",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"起き上がれる",null,null,null,null,null,null,null,null,null,null,null,null,null,"立ち上がれる",null,null,null,null,null,null,null,null,null,null,null,null,null,"寝たきり",null,null,null,null,null,null,null,null,"(32)移動",null,null,null,null,null,null,null,null,"自立",null,null,null,null,null,null,null,"杖無し",null,null,null,null,null,null,null,null,"歩行器"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"介助が必要",null,null,null,null,null,null,null,null,null,null,null,null,null,"介助が必要",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"介助",null,null,null,null,null,null,null,"杖",null,null,null,null,null,null,null,null,"車椅子"]
[null,"食事摂取",null,"(33)摂取方法",null,null,null,null,null,null,null,null,null,null,null,null,null,"経口",null,null,null,null,null,null,null,null,"経管(方法:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"内容:",null,null,null,null,null,null,null,null,null,null,null,null,null,"量:",null,null,null,null,null,null,null,null,null,null,"所要時間:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[null,null,null,"(34)食形態",null,null,null,null,null,null,null,null,null,null,null,null,null,"普通",null,null,null,null,null,null,"刻み",null,null,null,null,null,null,null,"嚥下障害食",null,null,null,null,null,null,null,null,null,null,null,null,"ミキサー",null,null,null,null,null,null,null,null,"(35)水分トロミ",null,null,null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,null,"有り"]
[]
[null,null,null,"(36)食動作",null,null,null,null,null,null,null,null,null,null,null,null,null,"自立",null,null,null,null,null,null,"見守り",null,null,null,null,null,null,null,null,"一部介助",null,null,null,null,null,null,null,null,null,null,"全介助",null,null,null,null,null,null,null,null,null,"(37)食事制限",null,null,null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,null,"有り"]
[]
[null,"口腔",null,"(38)口腔環境",null,null,null,null,null,null,null,null,null,null,null,null,null,"良",null,null,null,null,null,null,"やや不良",null,null,null,null,null,null,null,null,null,null,"不良",null,null,null,null,null,null,null,"著しく不良",null,null,null,null,null,null,null,null,null,null,"(39)義歯使用",null,null,null,null,null,null,null,null,null,null,null,null,null,"良",null,null,null,null,null,null,null,null,null,"不使用"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"不良",null,null,null,null,null,null,null,null,null,"義歯不要"]
[null,null,null,"(40)口腔ケア",null,null,null,null,null,null,null,null,null,null,null,null,null,"自立",null,null,null,null,null,null,"見守り",null,null,null,null,null,null,null,null,"一部介助",null,null,null,null,null,null,null,null,null,null,"全介助",null,null,null,null,null,null,null,null,null,"(41)方法",null,null,null,null,null,null,null,null,null,null,null,null,null,"歯ブラシ",null,null,null,null,null,null,null,null,null,null,null,"うがい"]
[]
[null,"排泄",null,"(42)排尿介助",null,null,null,null,null,null,null,null,null,null,null,null,null,"自立",null,null,null,null,null,null,"見守り",null,null,null,null,null,null,null,null,"一部介助",null,null,null,null,null,null,null,null,null,null,"全介助",null,null,null,null,null,null,null,null,null,"(43)排尿能力",null,null,null,null,null,null,null,null,null,null,null,null,null,"自排尿",null,null,null,null,null,null,null,null,null,"間欠導尿"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"留置カテーテル"]
[null,null,null,"(44)排便介助",null,null,null,null,null,null,null,null,null,null,null,null,null,"自立",null,null,null,null,null,null,"見守り",null,null,null,null,null,null,null,null,"一部介助",null,null,null,null,null,null,null,null,null,null,"全介助",null,null,null,null,null,null,null,null,null,"(45)Pﾄｲﾚ使用",null,null,null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,"夜間",null,null,null,null,null,null,"常時"]
[]
[null,"(47)衣服の着脱",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"自立",null,null,null,null,null,null,"見守り",null,null,null,null,null,null,null,null,"一部介助",null,null,null,null,null,null,null,null,null,null,"全介助",null,null,null,null,null,null,null,null,null,"(46)ｵﾑﾂ使用",null,null,null,null,null,null,null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,"夜間",null,null,null,null,null,null,"常時"]
[]
[null,"(48)服薬管理",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"自立",null,null,null,null,null,null,"見守り",null,null,null,null,null,null,null,null,"一部介助",null,null,null,null,null,null,null,null,null,null,"全介助",null,null,null,null,null,null,null,null,null,"(49)薬の形状",null,null,null,null,null,null,null,null,null,null,null,null,null,"錠剤",null,null,null,null,null,null,"散剤",null,null,null,null,null,null,"液剤"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[null,"(51)介護上、特に注意すべき点等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(52)介護・看取りに関する本人・家族の意向等"]
[]
[]
[]
[]
[null,"(53)本シートの記入者"]
[]
[null,"所属",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
[]
[null,"電話",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FAX",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Eﾒｰﾙ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(54)ケアプラン",null,null,null,null,null,null,null,null,null,null,null,null,null,"作成済",null,null,null,null,null,null,null,null,null,"未済"]
[]
[]
[null,null,"千葉県地域生活連携シート使用上の留意点"]
[]
[]
[]
[null,null,null,1,null,null,"千葉県地域生活連携シートの使用方法（入院時）"]
[]
[null,null,null,null,null,null,"　本シートは、居宅介護支援事業所等の担当介護支援専門員が、記入対象者である介護サービス利用者本人または家族の同意を得たうえで、利用者の身体機能等の情報について記入し、入院先の医療機関に送付するものです。\n　なお、居宅介護支援事業所が、利用者が入院してから7日以内に、入院先の医療機関に対し、本シートの送付等により利用者情報を提供した場合には、介護保険の医療連携加算の算定対象となります。"]
[]
[]
[]
[]
[]
[]
[null,null,null,2,null,null,"千葉県地域生活連携シートの使用方法（退院・退所時）"]
[]
[null,null,null,null,null,null,"　本シートは、居宅介護支援事業所等の担当介護支援専門員が、利用者の退院・退所の際、入院先の医療機関または入所先の施設の職員と面談し提供された利用者情報を記入しておき、居宅サービス計画の作成等に活用するためのものです。\n　なお、利用者の退院・退所に当たり、当該病院、診療所、地域密着型介護老人福祉施設または介護保険施設の職員と面談を行い、必要な情報提供を受けたうえで、居宅サービス計画を作成し、居宅サービスの利用に関する調整を行った場合には、介護保険の退院・退所加算の算定対象となります。"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,3,null,null,"個人情報の取り扱いについて"]
[]
[null,null,null,null,null,null,"　本シートには、利用者等の身体機能等、数多くの個人情報が含まれておりますので、取り扱いには最大限の注意を払ってください。\n　本シートの記入及び送付に当たっては、必ず本人または家族の同意を得てください。\n　特に、本シートをFAXまたはEメール等で医療機関に送付する際は、一旦、利用者及び主介護者等の氏名の欄を空欄にして医療機関に送付した後、医療機関に電話連絡し、医療機関のほうで氏名を記入してもらう等の配慮が必要です。\n　また、本シートは、利用者本人及び家族等が見ることを前提に作成してください。そのため、記入する内容（特に認知症症状や既往歴等）については充分に注意してください。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,4,null,null,"千葉県地域生活連携シートの記入頻度等について"]
[]
[null,null,null,null,null,null,"　概ね半年に一度、利用者の在宅安定時の状況を本シートに記入し、保管しておくことが、利用者の入院時に迅速に対応できるという点から、望ましいと考えます。\n　また、月一回のモニタリングの際、本シートをモニタリングシートとして使用することもできます。\n　ただし、利用者の身体機能等に変化があった場合には、その都度、本シートに直近の情報を記入してください。\n　なお、認定調査結果や主治医意見書等を参考に本シートを記入する場合においては、認定調査結果や主治医意見書等に記載されている利用者の身体機能等の情報と、直近の情報が異なる場合には、直近の情報を優先して記入してください。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,5,null,null,"家族等との連絡体制"]
[]
[null,null,null,null,null,null,"　利用者が入院した際、居宅介護支援事業所の介護支援専門員に対し、家族等から即時その旨の連絡がなされるよう、利用者及び家族等には日頃から本シートの趣旨を説明し、理解を得ておくことが必要です。"]
[]
[]
[]
[]
[null,null,null,6,null,null,"入院先の医療機関への送付について"]
[]
[null,null,null,null,null,null,"　利用者が入院した際、直ちに本シートを医療機関に持参または郵送、FAX、Eメール等により送付してください。\n　また、シートを送付した際は、居宅介護支援経過に、入院日、送付日及び送付先の医療機関等名称を必ず記録してください。\n（記入例）\n　「平成22年4月1日△△病院に入院。平成22年4月2日△△病院に地域生活連携シートを送付し情報提供した」\n　なお、シートを送付する際の手段（郵送、FAXまたはEメール等）や、医療機関がシートを受領したか否かを確認する際の手段（電話、FAXまたはEメール等）については、地域の医療機関と事前に協議のうえ取り決めておくことが望ましいと考えます。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,7,null,null,"千葉県共用脳卒中地域医療連携パスとの関係"]
[]
[null,null,null,null,null,null,"　本シートは、千葉県共用脳卒中地域医療連携パスの中の「介護シート」として、脳卒中の患者が退院する際に、回復期医療機関等から提供されることもあります。介護シートは、脳卒中の再発に備え、上記と同様に概ね半年に一度記入しておくことが望ましいと考えます。\n　なお、介護シートは、本シートと記入項目が完全に一致しており、本シートから転記することが可能です。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
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[null,"歩行器",false,{"$f":"IF(C55=FALSE,\"\",IF(C59=FALSE,\"\",\"歩行器を使用すれば、介助無しで歩行できる\"))","v":""},{"$f":"IF(C56=FALSE,\"\",IF(C59=FALSE,\"\",\"介助があれば、歩行器を使用して歩行できる\"))","v":""},null,null,null,null,null,5,{"$f":"IF(地域生活連携シート!CJ55=\"\",\"\",地域生活連携シート!CJ55)","v":""}]
[null,"車椅子",false,{"$f":"IF(C55=FALSE,\"\",IF(C60=FALSE,\"\",\"車椅子に乗れば、介助無しで移動できる\"))","v":""},{"$f":"IF(C56=FALSE,\"\",IF(C60=FALSE,\"\",\"移動には車椅子を押す等の介助が必要\"))","v":""},null,null,null,null,null,6,{"$f":"IF(地域生活連携シート!CJ59=\"\",\"\",地域生活連携シート!CJ59)","v":""}]
["摂取方法","経口",false,null,null,null,"摂取方法",{"$f":"IF(C61=TRUE,B61,IF(C62=FALSE,\"\",B62&\"（\"&C63&C64&C65&C66&\"）\"))","v":""},null,null,7,{"$f":"IF(地域生活連携シート!CJ63=\"\",\"\",地域生活連携シート!CJ63)","v":""}]
[null,"経管",false,null,null,null,null,null,null,null,8,{"$f":"IF(地域生活連携シート!CJ67=\"\",\"\",地域生活連携シート!CJ67)","v":""}]
[null,"方法",{"$f":"IF(地域生活連携シート!AJ53=\"\",\"\",地域生活連携シート!AJ53&\"、\")","v":""},null,null,null,null,null,null,"介護上、特に注意すべき点等",null,{"$f":"IF(地域生活連携シート!P71=\"\",\"\",地域生活連携シート!P71)","v":""}]
[null,"内容",{"$f":"IF(地域生活連携シート!AX53=\"\",\"\",地域生活連携シート!AX53)","v":""},null,null,null,null,null,null,"介護・看取りに関する本人・家族の意向等",null,{"$f":"IF(地域生活連携シート!CC71=\"\",\"\",地域生活連携シート!CC71)","v":""}]
[null,"量",{"$f":"IF(地域生活連携シート!BK53=\"\",\"\",地域生活連携シート!BK53&\"を\")","v":""},null,null,null,null,null,null,"記入者","所属",{"$f":"IF(地域生活連携シート!H78=\"\",\"\",地域生活連携シート!H78)","v":""}]
[null,"所要時間",{"$f":"IF(地域生活連携シート!CA53=\"\",\"\",地域生活連携シート!CA53&\"で摂取\")","v":""},null,null,null,null,null,null,null,"氏名",{"$f":"IF(地域生活連携シート!BF78=\"\",\"\",地域生活連携シート!BF78)","v":""}]
["食形態","普通",false,null,null,null,"食形態",{"$f":"IF(C70=TRUE,B70,IF(C69=TRUE,B69,IF(C68=TRUE,B68,IF(C67=TRUE,B67,\"\"))))","v":""},null,null,"電話",{"$f":"IF(地域生活連携シート!H80=\"\",\"\",地域生活連携シート!H80)","v":""}]
[null,"刻み食",false,null,null,null,null,null,null,null,"FAX",{"$f":"IF(地域生活連携シート!AG80=\"\",\"\",地域生活連携シート!AG80)","v":""}]
[null,"嚥下障害食",false,null,null,null,null,null,null,null,"E-maiｌ",{"$f":"IF(地域生活連携シート!BF80=\"\",\"\",地域生活連携シート!BF80)","v":""}]
[null,"ミキサー食",false]
["水分トロミ","無し",false,null,null,null,"水分トロミ",{"$f":"IF(C72=TRUE,B72,IF(C71=TRUE,B71,\"\"))","v":""}]
[null,"有り",false]
["食動作","自立",false,null,null,null,"食動作",{"$f":"IF(C76=TRUE,B76,IF(C75=TRUE,B75,IF(C74=TRUE,B74,IF(C73=TRUE,B73,\"\"))))","v":""}]
[null,"見守り",false]
[null,"一部介助",false]
[null,"全介助",false]
["食事制限","無し",false,null,null,null,"食事制限",{"$f":"IF(C78=TRUE,B78,IF(C77=TRUE,B77,\"\"))","v":""}]
[null,"有り",false]
["口腔環境","良",false,null,null,null,"口腔環境",{"$f":"IF(C82=TRUE,B82,IF(C81=TRUE,B81,IF(C80=TRUE,B80,IF(C79=TRUE,B79,\"\"))))","v":""}]
[null,"やや不良",false]
[null,"不良",false]
[null,"著しく不良",false]
["義歯使用","良",false,null,null,null,"義歯使用",{"$f":"IF(C86=TRUE,B86,IF(C85=TRUE,B85,IF(C84=TRUE,B84,IF(C83=TRUE,B83,\"\"))))","v":""}]
[null,"不良",false]
[null,"不使用",false]
[null,"義歯不要",false]
["口腔ケア","自立",false,null,null,null,"口腔ケア",{"$f":"IF(C90=TRUE,B90,IF(C89=TRUE,B89,IF(C88=TRUE,B88,IF(C87=TRUE,B87,\"\"))))","v":""}]
[null,"見守り",false]
[null,"一部介助",false]
[null,"全介助",false]
["方法","（歯ブラシ）",false,null,null,null,"方法",{"$f":"IF(C92=TRUE,B92,IF(C91=TRUE,B91,\"\"))","v":""}]
[null,"（うがい）",false]
["排尿介助","自立",false,null,null,null,"排尿介助",{"$f":"IF(C96=TRUE,B96,IF(C95=TRUE,B95,IF(C94=TRUE,B94,IF(C93=TRUE,B93,\"\"))))","v":""}]
[null,"見守り",false]
[null,"一部介助",false]
[null,"全介助",false]
["排尿能力","（自排尿）",false,null,null,null,"排尿能力",{"$f":"IF(C99=TRUE,B99,IF(C98=TRUE,B98,IF(C97=TRUE,B97,\"\")))","v":""}]
[null,"（間欠導尿）",false]
[null,"（留置カテーテル）",false]
["排便介助","自立",false,null,null,null,"排便介助",{"$f":"IF(C103=TRUE,B103,IF(C102=TRUE,B102,IF(C101=TRUE,B101,IF(C100=TRUE,B100,\"\"))))","v":""}]
[null,"見守り",false]
[null,"一部介助",false]
[null,"全介助",false]
["Pトイレ","（無し）",false,null,null,null,"Pトイレ",{"$f":"IF(C106=TRUE,B106,IF(C105=TRUE,B105,IF(C104=TRUE,B104,\"\")))","v":""}]
[null,"（夜間のみ使用）",false]
[null,"（常時使用）",false]
["オムツ","（無し）",false,null,null,null,"オムツ",{"$f":"IF(C109=TRUE,B109,IF(C108=TRUE,B108,IF(C107=TRUE,B107,\"\")))","v":""}]
[null,"（夜間のみ使用）",false]
[null,"（常時使用）",false]
["衣服の着脱","自立",false,null,null,null,"衣服の着脱",{"$f":"IF(C113=TRUE,B113,IF(C112=TRUE,B112,IF(C111=TRUE,B111,IF(C110=TRUE,B110,\"\"))))","v":""}]
[null,"見守り",false]
[null,"一部介助",false]
[null,"全介助",false]
["服薬管理","自立",false,null,null,null,"服薬管理",{"$f":"IF(C117=TRUE,B117,IF(C116=TRUE,B116,IF(C115=TRUE,B115,IF(C114=TRUE,B114,\"\"))))","v":""}]
[null,"見守り",false]
[null,"一部介助",false]
[null,"全介助",false]
["薬の形状","錠剤、",false,{"$f":"IF(C118=TRUE,B118,\"\")","v":""},null,null,"薬の形状",{"$f":"D118&D119&D120&D121","v":""}]
[null,"散剤、",false,{"$f":"IF(C119=TRUE,B119,\"\")","v":""}]
[null,"液剤、",false,{"$f":"IF(C120=TRUE,#REF!,\"\")","v":""}]
[null,"その他",false,{"$f":"IF(地域生活連携シート!BX70=\"\",\"\",地域生活連携シート!BX70)","v":""}]
[]
[]
["介護サービス","訪問介護",false,"（",{"$f":"IF(地域生活連携シート!AA16=\"\",\"\",地域生活連携シート!AA16)","v":""},"回/週）",{"$f":"IF(C124=FALSE,\"\",B124&D124&E124&F124)","v":""}]
[null,"訪問看護",false,"（",{"$f":"IF(地域生活連携シート!AA17=\"\",\"\",地域生活連携シート!AA17)","v":""},"回/週）",{"$f":"IF(C125=FALSE,\"\",B125&D125&E125&F125)","v":""}]
[null,"訪問リハビリ",false,"（",{"$f":"IF(地域生活連携シート!AY16=\"\",\"\",地域生活連携シート!AY16)","v":""},"回/週）",""]
[null,"訪問入浴",false,"（",{"$f":"IF(地域生活連携シート!CU16=\"\",\"\",地域生活連携シート!CU16)","v":""},"回/週）",""]
[null,"通所介護",false,"（",{"$f":"IF(地域生活連携シート!BW16=\"\",\"\",地域生活連携シート!BW16)","v":""},"回/週）",""]
[null,"通所リハビリ",false,"（",{"$f":"IF(地域生活連携シート!AY17=\"\",\"\",地域生活連携シート!AY17)","v":""},"回/週）",""]
[null,"ショートステイ",false,"（",{"$f":"IF(地域生活連携シート!BW17=\"\",\"\",地域生活連携シート!BW17)","v":""},"日/月）",""]
[null,"居宅療養管理指導",false,"（",{"$f":"IF(地域生活連携シート!AI18=\"\",\"\",地域生活連携シート!AI18)","v":""},"）",""]
[null,"福祉用具",false,"（",{"$f":"IF(地域生活連携シート!BW18=\"\",\"\",地域生活連携シート!BW18)","v":""},"）",""]
[null,"その他",false,"（",{"$f":"IF(地域生活連携シート!CT17=\"\",\"\",地域生活連携シート!CT17)","v":""},"）",{"$f":"IF(C133=FALSE,\"\",E133)","v":""}]
[]
[]
["記入時の状況","入院時",false,null,null,null,"記入時の状況",{"$f":"IF(C136=TRUE,B136,IF(C137=TRUE,B137,IF(C138=TRUE,B138,IF(C139=TRUE,B139,IF(C140=TRUE,D140,\"\")))))","v":""}]
[null,"入院中",false]
[null,"退院時",false]
[null,"地域生活期",false]
[null,"その他",false,{"$f":"IF(地域生活連携シート!CZ36=\"\",\"\",地域生活連携シート!CZ36)","v":""}]

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