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{"sheet":"訪問調査票作成手引き","index":0,"n_rows":184,"n_cols":1,"rows_kept":184,"cut":false,"hidden":false,"merged":[]}
["訪問調査票、特記事項作成手引き"]
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["以下の手順に従い、訪問調査票を作成、印刷を行ってください。"]
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["①シート「入力フォーム」に訪問調査結果内容を記入してください。"]
["　説明欄に記述している文字数制限に従い、入力してください。"]
["　入力可能な場所は黄色（入力欄）、ピンク（選択欄）、青（チェック欄）のみです。"]
["　その他の項目は入力・修正不可に設定しています。"]
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["②調査した内容を元に概況エリア、調査項目を入力してください。"]
["　　注意事項として他のセルから内容をコピーするような操作は行わないでください。"]
["　　調査票へのチェックの反映がうまくいかなくなります。"]
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["③調査票を印刷するときは「訪問調査票」を選択して印刷してください。"]
["　　調査票は3枚で1セットとなります。"]
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["④特記事項は「特記（1）入力」で内容を入力し、「特記(１)印刷」シートを印刷して下さい。"]
["　　誤って「特記（1）入力」シートを印刷した場合、エラーメッセージが表示されます。"]
["　　特記（２）入力、特記（３）入力も同様です。"]
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["　　「特記（1）入力」"]
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["特記（１）入力シートを印刷した時のエラーメッセージ"]
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["特記（１）印刷シート"]

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["No.","タイトル",null,"項目名","入力欄","説明","参照用（編集不可）"]
[{"$f":"ROW()-1","v":1},"ヘッダ",null,"保険者番号","352013","半角6桁",{"$f":"ASC(E2)","v":"352013"}]
[{"$f":"ROW()-1","v":2},null,null,"被保険者番号",null,"半角10桁",{"$f":"ASC(E3)","v":""}]
[3,"調査対象者",null,"カナ氏名",null,"半角18文字まで",{"$f":"IF(E4<>\"\",E4,\"\")","v":""}]
[4,null,null,"氏名",null,"全角２０文字まで",{"$f":"IF(E5<>\"\",E5,\"\")","v":""}]
[5,null,null,"性別","男","リストから選択",{"$f":"IF($E$6=\"男\",\"レ\",\"\")","v":"レ"},{"$f":"IF($E$6=\"女\",\"レ\",\"\")","v":""}]
[6,null,null,"生年月日",null,"和暦（元号はM,T,Sまたは1,2,3）例：昭和24年3月3日→3240303",{"$f":"IF(OR(LEFT($E$7,1)=\"M\",LEFT($E$7,1)=\"1\"),\"レ\",\"\")","v":""},{"$f":"IF(OR(LEFT($E$7,1)=\"T\",LEFT($E$7,1)=\"2\"),\"レ\",\"\")","v":""},{"$f":"IF(OR(LEFT($E$7,1)=\"S\",LEFT($E$7,1)=\"3\"),\"レ\",\"\")","v":""},{"$f":"MID($E$7,2,2)","v":""},{"$f":"MID($E$7,4,2)","v":""},{"$f":"MID($E$7,6,2)","v":""}]
[7,null,null,"年齢",null,null,{"$f":"ASC(E8)","v":""}]
[8,null,null,"(連絡先)家族等氏名",null,"全角２０文字まで",{"$f":"IF(E9<>\"\",E9,\"\")","v":""}]
[9,null,null,"(連絡先)関係",null,null,{"$f":"IF(E10<>\"\",E10,\"\")","v":""}]
[10,null,null,"(連絡先)本人現住所郵便番号",null,null,{"$f":"ASC(E11)","v":""}]
[11,null,null,"(連絡先)本人現住所１行目",null,"全角２０文字まで",{"$f":"IF(E12<>\"\",E12,\"\")","v":""}]
[12,null,null,"(連絡先)本人現住所２行目",null,"全角２０文字まで",{"$f":"IF(E13<>\"\",E13,\"\")","v":""}]
[13,null,null,"(連絡先)本人現住所TEL",null,null,{"$f":"ASC(E14)","v":""}]
[14,null,null,"(連絡先)家族等連絡先郵便番号",null,null,{"$f":"ASC(E15)","v":""}]
[15,null,null,"(連絡先)家族等連絡先住所１行目",null,"全角２０文字まで",{"$f":"IF(E16<>\"\",E16,\"\")","v":""}]
[16,null,null,"(連絡先)家族等連絡先住所２行目",null,"全角２０文字まで",{"$f":"IF(E17<>\"\",E17,\"\")","v":""}]
[17,null,null,"(連絡先)家族等連絡先TEL",null,null,{"$f":"ASC(E18)","v":""}]
[18,null,null,"家族状況","　","リストから選択　施設等に入所中の場合は空白",{"$f":"IF($E$19=\"独居\",\"0\",IF($E$19=\"同居（夫婦のみ）\",\"1\",IF($E$19=\"同居（その他）\",\"2\",\"\")))","v":""}]
[19,"調査実施者",null,"実施日",null,"和暦（平成は4,令和は5）例：平成29年7月3日→4290703",{"$f":"IF(OR(LEFT($E$20,1)=\"H\",LEFT($E$20,1)=\"4\",LEFT($E$20,1)=\"5\"),\"レ\",\"\")","v":""},{"$f":"MID($E$20,1,1)","v":""},{"$f":"MID($E$20,2,2)","v":""},{"$f":"MID($E$20,4,2)","v":""},{"$f":"MID($E$20,6,2)","v":""}]
[20,null,null,"調査員番号",null,"半角8桁",{"$f":"ASC(E21)","v":""}]
[21,null,null,"調査員氏名",null,"全角２０文字まで",{"$f":"IF(E22<>\"\",E22,\"\")","v":""}]
[22,null,null,"調査員所属機関",null,"全角３２文字まで",{"$f":"IF(E23<>\"\",E23,\"\")","v":""}]
[23,null,null,"調査員所属機関電話番号",null,null,{"$f":"ASC(E24)","v":""}]
[24,"施設情報",null,"施設名",null,"全角２３文字まで",{"$f":"ASC(E25)","v":""}]
[25,null,null,"施設所在地",null,"全角３７文字まで",{"$f":"IF(E26<>\"\",E26,\"\")","v":""}]
[26,null,null,"施設電話番号",null,null,{"$f":"ASC(E27)","v":""}]
[27,"現在受けているサービス","サービス利用状況",null,"なし","リストから選択",{"$f":"IF($E$28=\"介護給付\",\"レ\",\"\")","v":""},{"$f":"IF($E$28=\"予防給付総合事業\",\"レ\",\"\")","v":""},{"$f":"IF($E$28=\"なし\",\"レ\",\"\")","v":"レ"}]
[28,null,"施設利用",null,"　","リストから選択",{"$f":"IF($E29=\"老人福祉施設\",\"02\",IF($E29=\"老人保健施設\",\"03\",IF($E29=\"介護療養型医療施設\",\"04\",IF($E29=\"グループホーム\",\"05\",IF($E29=\"特定施設\",\"06\",IF($E29=\"医療機関（療養）\",\"07\",IF($E29=\"　\",\"01\",\"\")))))))","v":"01"},{"$f":"IF($E29=\"医療機関（療養以外）\",\"08\",IF($E29=\"介護医療院\",\"10\",IF($E29=\"その他施設\",\"09\",IF($E29=\"養護老人ホーム\",\"11\",IF($E29=\"軽費老人ホーム\",\"12\",IF($E29=\"有料老人ホーム\",\"13\",IF($E29=\"サービス付高齢者住宅\",\"14\",\" \")))))))","v":" "}]
[29,null,"在宅利用","訪問介護",0,"回",{"$f":"INT(ASC(E30))","v":0},{"$f":"SUM(G30:G45,G47:G50)","v":0}]
[30,null,null,"療養指導",0,"回",{"$f":"INT(ASC(E31))","v":0}]
[31,null,null,"短期療養",0,"日",0]
[32,null,null,"夜間訪問　※介護給付",0,"日　※介護給付のみの項目",0]
[33,null,null,"地域福祉　※介護給付",0,"日　※介護給付のみの項目",0]
[34,null,null,"定期巡回　※介護給付",0,"回　※介護給付のみの項目",0]
[35,null,null,"訪問入浴",0,"回",0]
[36,null,null,"通所介護",0,"回",0]
[37,null,null,"特定施設",0,"日",0]
[38,null,null,"認知通所",0,"日",0]
[39,null,null,"地域特定　※介護給付",0,"日　※介護給付のみの項目",0]
[40,null,null,"看護小規模　※介護給付",0,"日　※介護給付のみの項目",0]
[41,null,null,"訪問看護",0,"回",0]
[42,null,null,"通所リハ",0,"回",0]
[43,null,null,"用具貸与",0,"品",0]
[44,null,null,"小規模居宅",0,"日",0]
[45,null,null,"住宅改修","無","リストから選択",{"$f":"IF($E$46=\"有\",\"レ\",\"\")","v":""},{"$f":"IF($E$46=\"無\",\"レ\",\"\")","v":"レ"}]
[46,null,null,"訪問リハ",0,"回",0]
[47,null,null,"短期生活",0,"日",0]
[48,null,null,"用具販売",0,"品",0]
[49,null,null,"認知共同",0,"日",0]
[50,null,null,"市町村特別給付有無","無","リストから選択",{"$f":"IF($E$51=\"有\",\"レ\",\"\")","v":""}]
[51,null,null,"市町村特別給付",null,"全角32文字まで",{"$f":"IF(E52<>\"\",E52,\"\")","v":""}]
[52,null,null,"他在宅サービス有無","無","リストから選択",{"$f":"IF($E$53=\"有\",\"レ\",\"\")","v":""}]
[53,null,null,"他在宅サービス",null,"全角24文字まで",{"$f":"IF(E54<>\"\",E54,\"\")","v":""}]
[54,null,"特記事項",null,null,"全角255文字まで",{"$f":"IF(E55<>\"\",E55,\"\")","v":""},null,{"$f":"LEN(E55)","v":0}]
[55,"第１群\n身体機能・起居動作","1-1 麻痺",null,null,"該当にチェック（複数可）",false,{"$f":"IF($G56=TRUE,\"レ\",\"\")","v":""},{"$f":"COUNTIF(G56:G60,\"TRUE\")","v":0}]
[56,null,null,null,null,null,false,{"$f":"IF($G57=TRUE,\"レ\",\"\")","v":""}]
[57,null,null,null,null,null,false,""]
[58,null,null,null,null,null,false,""]
[59,null,null,null,null,null,false,""]
[60,null,"1-2 拘縮",null,null,"該当にチェック（複数可）",false,{"$f":"IF($G61=TRUE,\"レ\",\"\")","v":""},{"$f":"COUNTIF(G61:G64,\"TRUE\")","v":0}]
[61,null,null,null,null,null,false,""]
[62,null,null,null,null,null,false,""]
[63,null,null,null,null,null,false,""]
[64,null,"1-3 寝返り",null,"　","※必ずリストから選択してください。\n他のセルからコピーすると正しく調査項目が反映されません。",{"$f":"IF($E$65=\"できる\",\"レ\",\"\")","v":""},{"$f":"IF($E$65=\"つかまれば可\",\"レ\",\"\")","v":""},{"$f":"IF($E$65=\"できない\",\"レ\",\"\")","v":""}]
[65,null,"1-4 起き上がり",null,"　",null,{"$f":"IF($E$66=\"できる\",\"レ\",\"\")","v":""},{"$f":"IF($E$66=\"つかまれば可\",\"レ\",\"\")","v":""},{"$f":"IF($E$66=\"できない\",\"レ\",\"\")","v":""}]
[66,null,"1-5 座位保持",null,"　",null,{"$f":"IF($E$67=\"できる\",\"レ\",\"\")","v":""},{"$f":"IF($E$67=\"自分で支えれば可\",\"レ\",\"\")","v":""},{"$f":"IF($E$67=\"支えが必要\",\"レ\",\"\")","v":""},{"$f":"IF($E$67=\"できない\",\"レ\",\"\")","v":""}]
[{"$f":"ROW()-1","v":67},null,"1-6 両足立位",null,"　",null,{"$f":"IF($E$68=\"できる\",\"レ\",\"\")","v":""},{"$f":"IF($E$68=\"支えが必要\",\"レ\",\"\")","v":""},{"$f":"IF($E$68=\"できない\",\"レ\",\"\")","v":""}]
[68,null,"1-7 歩行",null,"　",null,{"$f":"IF($E69=\"できる\",\"レ\",\"\")","v":""},{"$f":"IF($E69=\"つかまれば可\",\"レ\",\"\")","v":""},{"$f":"IF($E69=\"できない\",\"レ\",\"\")","v":""}]
[69,null,"1-8 立ち上がり",null,"　",null,{"$f":"IF($E70=\"できる\",\"レ\",\"\")","v":""},{"$f":"IF($E70=\"つかまれば可\",\"レ\",\"\")","v":""},{"$f":"IF($E70=\"できない\",\"レ\",\"\")","v":""}]
[70,null,"1-9 片足立位",null,"　",null,{"$f":"IF($E71=\"できる\",\"レ\",\"\")","v":""},{"$f":"IF($E71=\"支えが必要\",\"レ\",\"\")","v":""},{"$f":"IF($E71=\"できない\",\"レ\",\"\")","v":""}]
[71,null,"1-10 洗身",null,"　",null,{"$f":"IF($E72=\"介助なし\",\"レ\",\"\")","v":""},{"$f":"IF($E72=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E72=\"全介助\",\"レ\",\"\")","v":""},{"$f":"IF($E$72=\"行っていない\",\"レ\",\"\")","v":""}]
[72,null,"1-11 つめ切り",null,"　",null,{"$f":"IF($E73=\"介助なし\",\"レ\",\"\")","v":""},{"$f":"IF($E73=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E73=\"全介助\",\"レ\",\"\")","v":""}]
[73,null,"1-12 視力",null,"　",null,{"$f":"IF($E74=\"普通\",\"レ\",\"\")","v":""},{"$f":"IF($E74=\"１ｍ先が見える\",\"レ\",\"\")","v":""},{"$f":"IF($E74=\"目の前が見える\",\"レ\",\"\")","v":""},{"$f":"IF($E74=\"ほとんど見えず\",\"レ\",\"\")","v":""},{"$f":"IF($E74=\"判断不能\",\"レ\",\"\")","v":""}]
[74,null,"1-13 聴力",null,"　",null,{"$f":"IF($E75=\"普通\",\"レ\",\"\")","v":""},{"$f":"IF($E75=\"やっと聞こえる\",\"レ\",\"\")","v":""},{"$f":"IF($E75=\"大声が聞こえる\",\"レ\",\"\")","v":""},{"$f":"IF($E75=\"ほとんど聞こえず\",\"レ\",\"\")","v":""},{"$f":"IF($E75=\"判断不能\",\"レ\",\"\")","v":""}]
[75,"第２群\n生活機能","2-1 移乗",null,"　","※必ずリストから選択してください。\n他のセルからコピーすると正しく調査項目が反映されません。",{"$f":"IF($E76=\"介助なし\",\"レ\",\"\")","v":""},{"$f":"IF($E76=\"見守り等\",\"レ\",\"\")","v":""},{"$f":"IF($E76=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E76=\"全介助\",\"レ\",\"\")","v":""}]
[76,null,"2-2 移動",null,"　",null,{"$f":"IF($E77=\"介助なし\",\"レ\",\"\")","v":""},"",{"$f":"IF($E77=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E77=\"全介助\",\"レ\",\"\")","v":""}]
[77,null,"2-3 えん下",null,"　",null,{"$f":"IF($E78=\"できる\",\"レ\",\"\")","v":""},"",{"$f":"IF($E78=\"できない\",\"レ\",\"\")","v":""}]
[78,null,"2-4 食事摂取",null,"　",null,{"$f":"IF($E79=\"介助なし\",\"レ\",\"\")","v":""},"",{"$f":"IF($E79=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E79=\"全介助\",\"レ\",\"\")","v":""}]
[79,null,"2-5 排尿",null,"　",null,"","",{"$f":"IF($E80=\"一部介助\",\"レ\",\"\")","v":""},""]
[80,null,"2-6 排便",null,"　",null,"","",{"$f":"IF($E81=\"一部介助\",\"レ\",\"\")","v":""},""]
[81,null,"2-7 口腔清潔",null,"　",null,"",{"$f":"IF($E82=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E82=\"全介助\",\"レ\",\"\")","v":""},""]
[82,null,"2-8 洗顔",null,"　",null,"",{"$f":"IF($E83=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E83=\"全介助\",\"レ\",\"\")","v":""},""]
[83,null,"2-9 整髪",null,"　",null,"",{"$f":"IF($E84=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E84=\"全介助\",\"レ\",\"\")","v":""},""]
[84,null,"2-10 上衣の着脱",null,"　",null,"",{"$f":"IF($E85=\"見守り等\",\"レ\",\"\")","v":""},{"$f":"IF($E85=\"一部介助\",\"レ\",\"\")","v":""},""]
[85,null,"2-11 ズボン等の着脱",null,"　",null,"",{"$f":"IF($E86=\"見守り等\",\"レ\",\"\")","v":""},{"$f":"IF($E86=\"一部介助\",\"レ\",\"\")","v":""},""]
[86,null,"2-12 外出頻度",null,"　",null,{"$f":"IF($E87=\"週１回以上\",\"レ\",\"\")","v":""},{"$f":"IF($E87=\"月１回以上\",\"レ\",\"\")","v":""},{"$f":"IF($E87=\"月１回未満\",\"レ\",\"\")","v":""},""]
[87,"第３群\n認知機能","3-1 意思の伝達",null,"　","※必ずリストから選択してください。\n他のセルからコピーすると正しく調査項目が反映されません。",{"$f":"IF($E88=\"できる\",\"レ\",\"\")","v":""},{"$f":"IF($E88=\"時々可\",\"レ\",\"\")","v":""},{"$f":"IF($E88=\"ほとんど不可\",\"レ\",\"\")","v":""},{"$f":"IF($E88=\"できない\",\"レ\",\"\")","v":""}]
[88,null,"3-2 毎日の日課を理解",null,"　",null,"",{"$f":"IF($E89=\"できない\",\"レ\",\"\")","v":""},null,{"$f":"IF($E89=\"できない\",\"レ\",\"\")","v":""}]
[89,null,"3-3 生年月日・年齢を言う",null,"　",null,"",""]
[90,null,"3-4 短期記憶",null,"　",null,"",""]
[91,null,"3-5 自分の名前を言う",null,"　",null,"",""]
[92,null,"3-6 今の季節を理解",null,"　",null,"",""]
[93,null,"3-7 場所の理解",null,"　",null,"",""]
[94,null,"3-8 徘徊",null,"　",null,{"$f":"IF($E95=\"ない\",\"レ\",\"\")","v":""},{"$f":"IF($E95=\"時々ある\",\"レ\",\"\")","v":""},{"$f":"IF($E95=\"ある\",\"レ\",\"\")","v":""}]
[95,null,"3-9 外出して戻れない",null,"　",null,{"$f":"IF($E96=\"ない\",\"レ\",\"\")","v":""},{"$f":"IF($E96=\"時々ある\",\"レ\",\"\")","v":""},{"$f":"IF($E96=\"ある\",\"レ\",\"\")","v":""}]
[96,"第４群\n精神・行動障害","4-1 被害的",null,"　","※必ずリストから選択してください。\n他のセルからコピーすると正しく調査項目が反映されません。",{"$f":"IF($E97=\"ない\",\"レ\",\"\")","v":""},{"$f":"IF($E97=\"時々ある\",\"レ\",\"\")","v":""},{"$f":"IF($E97=\"ある\",\"レ\",\"\")","v":""}]
[97,null,"4-2 作話",null,"　",null,"","",""]
[98,null,"4-3 感情が不安定",null,"　",null,"","",""]
[99,null,"4-4 昼夜逆転",null,"　",null,"","",""]
[100,null,"4-5 同じ話をする",null,"　",null,"","",""]
[101,null,"4-6 大声を出す",null,"　",null,"","",""]
[102,null,"4-7 介護に抵抗",null,"　",null,"","",""]
[103,null,"4-8 落ち着きなし",null,"　",null,"","",""]
[104,null,"4-9 一人で出たがる",null,"　",null,"","",""]
[105,null,"4-10 収集癖",null,"　",null,"","",""]
[106,null,"4-11 物や衣類を壊す",null,"　",null,"","",""]
[107,null,"4-12 ひどい物忘れ",null,null,null,"","",""]
[108,null,"4-13 独り言・独り笑い",null,null,null,"","",""]
[109,null,"4-14 自分勝手に行動する",null,null,null,"","",""]
[110,null,"4-15 話がまとまらない",null,null,null,"","",""]
[111,"第５群\n社会生活への適応","5-1 薬の内服",null,"　","※必ずリストから選択してください。\n他のセルからコピーすると正しく調査項目が反映されません。",{"$f":"IF($E112=\"介助なし\",\"レ\",\"\")","v":""},{"$f":"IF($E112=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E112=\"全介助\",\"レ\",\"\")","v":""}]
[112,null,"5-2 金銭の管理",null,"　",null,{"$f":"IF($E113=\"介助なし\",\"レ\",\"\")","v":""},{"$f":"IF($E113=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E113=\"全介助\",\"レ\",\"\")","v":""}]
[113,null,"5-3 日常の意思決定",null,"　",null,{"$f":"IF($E114=\"できる\",\"レ\",\"\")","v":""},{"$f":"IF($E114=\"特別除\",\"レ\",\"\")","v":""},{"$f":"IF($E114=\"困難\",\"レ\",\"\")","v":""},{"$f":"IF($E114=\"できない\",\"レ\",\"\")","v":""}]
[114,null,"5-4 集団への不適応",null,"　",null,{"$f":"IF($E115=\"ない\",\"レ\",\"\")","v":""},{"$f":"IF($E115=\"時々ある\",\"レ\",\"\")","v":""},{"$f":"IF($E115=\"ある\",\"レ\",\"\")","v":""}]
[115,null,"5-5 買い物",null,"　",null,{"$f":"IF($E116=\"介助なし\",\"レ\",\"\")","v":""},{"$f":"IF($E116=\"見守り等\",\"レ\",\"\")","v":""},{"$f":"IF($E116=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E116=\"全介助\",\"レ\",\"\")","v":""}]
[116,null,"5-6 簡単な調理",null,"　",null,{"$f":"IF($E117=\"介助なし\",\"レ\",\"\")","v":""},{"$f":"IF($E117=\"見守り等\",\"レ\",\"\")","v":""},{"$f":"IF($E117=\"一部介助\",\"レ\",\"\")","v":""},{"$f":"IF($E117=\"全介助\",\"レ\",\"\")","v":""}]
[117,"過去14日間にうけた特別な医療について","1. 点滴の管理",null,null,"該当にチェック（複数可）",false,{"$f":"IF($G118=TRUE,\"レ\",\"\")","v":""},{"$f":"COUNTIF(G118:G129,\"TRUE\")","v":0}]
[118,null,"2. 中心静脈栄養",null,null,null,false,{"$f":"IF($G119=TRUE,\"レ\",\"\")","v":""}]
[119,null,"3. 透析",null,null,null,false,""]
[120,null,"4. ストーマ（人工肛門）の処置",null,null,null,false,""]
[121,null,"5. 酸素療法",null,null,null,false,""]
[122,null,"6. レスピレーター（人工呼吸器）",null,null,null,false,""]
[123,null,"7. 気管切開の処置",null,null,null,false,""]
[124,null,"8. 疼痛の看護",null,null,null,false,""]
[125,null,"9. 経管栄養",null,null,null,false,""]
[126,null,"10. モニター測定（血圧、心拍、酸素飽和度）",null,null,null,false,""]
[127,null,"11. じょくそうの処置",null,null,null,false,""]
[128,null,"12. カテーテル",null,null,null,false,""]
[129,"日常生活介助なし度","1.障害高齢者の日常生活自立度",null,null,"※必ずリストから選択してください。\n他のセルからコピーすると正しく調査項目が反映されません。",{"$f":"IF($E130=\"自立\",\"レ\",\"\")","v":""},{"$f":"IF($E130=\"J1\",\"レ\",\"\")","v":""},{"$f":"IF($E130=\"J2\",\"レ\",\"\")","v":""},{"$f":"IF($E130=\"A1\",\"レ\",\"\")","v":""},{"$f":"IF($E130=\"A2\",\"レ\",\"\")","v":""},{"$f":"IF($E130=\"B1\",\"レ\",\"\")","v":""},{"$f":"IF($E130=\"B2\",\"レ\",\"\")","v":""},null,{"$f":"IF($E130=\"C1\",\"レ\",\"\")","v":""},{"$f":"IF($E130=\"C2\",\"レ\",\"\")","v":""}]
[130,null,"2.認知証高齢者の日常生活自立度",null,null,null,{"$f":"IF($E131=\"自立\",\"レ\",\"\")","v":""},{"$f":"IF($E131=\"I\",\"レ\",\"\")","v":""},{"$f":"IF($E131=\"IIa\",\"レ\",\"\")","v":""},{"$f":"IF($E131=\"IIb\",\"レ\",\"\")","v":""},{"$f":"IF($E131=\"IIIa\",\"レ\",\"\")","v":""},{"$f":"IF($E131=\"IIIb\",\"レ\",\"\")","v":""},{"$f":"IF($E131=\"IV\",\"レ\",\"\")","v":""},null,{"$f":"IF($E131=\"M\",\"レ\",\"\")","v":""}]
[128,"主治医意見書の使用","主治医意見書の使用",null,null,"リストから選択",{"$f":"IF($E132=\"あり\",\"レ\",\"\")","v":""},{"$f":"IF($E132=\"なし\",\"レ\",\"\")","v":""}]
[129,null,"意見書短期記憶",null,null,"リストから選択",{"$f":"IF($E133=\"問題なし\",\"レ\",\"\")","v":""},{"$f":"IF($E133=\"問題あり\",\"レ\",\"\")","v":""}]
[130,null,"意見書認知能力",null,null,"リストから選択",{"$f":"IF($E134=\"介助なし\",\"レ\",\"\")","v":""},{"$f":"IF($E134=\"いくらか困難\",\"レ\",\"\")","v":""},{"$f":"IF($E134=\"見守りが必要\",\"レ\",\"\")","v":""},{"$f":"IF($E134=\"判断できない\",\"レ\",\"\")","v":""}]
[131,null,"意見書伝達能力",null,null,"リストから選択",{"$f":"IF($E135=\"伝えられる\",\"レ\",\"\")","v":""},{"$f":"IF($E135=\"いくらか困難\",\"レ\",\"\")","v":""},{"$f":"IF($E135=\"具体的要求に限られる\",\"レ\",\"\")","v":""},{"$f":"IF($E135=\"伝えられない\",\"レ\",\"\")","v":""}]
[132,null,"意見書食事行為",null,null,"リストから選択",{"$f":"IF($E136=\"自立ないし何とか自分で食べられる\",\"レ\",\"\")","v":""},{"$f":"IF($E136=\"全面介助\",\"レ\",\"\")","v":""}]
[133,null,"障害高齢者自立度",null,null,"リストから選択",{"$f":"IF($E137=\"介助なし\",\"レ\",\"\")","v":""},{"$f":"IF($E137=\"J1\",\"レ\",\"\")","v":""},{"$f":"IF($E137=\"J2\",\"レ\",\"\")","v":""},{"$f":"IF($E137=\"A1\",\"レ\",\"\")","v":""},{"$f":"IF($E137=\"A2\",\"レ\",\"\")","v":""},{"$f":"IF($E137=\"B1\",\"レ\",\"\")","v":""},{"$f":"IF($E137=\"B2\",\"レ\",\"\")","v":""},null,{"$f":"IF($E137=\"C1\",\"レ\",\"\")","v":""},{"$f":"IF($E137=\"C2\",\"レ\",\"\")","v":""}]
[134,null,"認知証高齢者介助なし度",null,null,"リストから選択",{"$f":"IF($E138=\"介助なし\",\"レ\",\"\")","v":""},{"$f":"IF($E138=\"I\",\"レ\",\"\")","v":""},{"$f":"IF($E138=\"IIa\",\"レ\",\"\")","v":""},{"$f":"IF($E138=\"IIb\",\"レ\",\"\")","v":""},{"$f":"IF($E138=\"IIIa\",\"レ\",\"\")","v":""},{"$f":"IF($E138=\"IIIb\",\"レ\",\"\")","v":""},{"$f":"IF($E138=\"IV\",\"レ\",\"\")","v":""},null,{"$f":"IF($E138=\"M\",\"レ\",\"\")","v":""}]

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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査票表に被保険者番号を入れると反映されるようにしています"]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"概況調査",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ⅳ．調査対象者の家族状況、居住環境、傷病、既往歴、立会いの有無、調査場所等"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"字の大きさを９ポイントにしているため"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"白塗り部分は印刷すると切れてしまいます。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"文章が白塗り部分にかかったら改行してください。"]
[null,null,"1.",null,null,null,null,null,"身体機能・起居動作",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１麻痺等の有無,２拘縮の有無,３寝返り,４起き上がり,５座位保持,６両足での立位,７歩行,８立ち上がり,９片足での立位,１０洗身,１１つめ切り,１２視力,１３聴力)"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,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.",null,null,null,null,null,"生活機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１移乗,２移動,３えん下,４食事摂取,５排尿,６排便,７口腔清潔,８洗顔,９整髪,１０上衣の着脱,１１ズボン等の着脱,１２外出頻度)"]
[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,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"3.",null,null,null,null,null,"認知機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１意思の伝達,２毎日の日課を理解,３生年月日を言う,４短期記憶,５自分の名前を言う,６今の季節を理解,７場所の理解,８徘徊,９外出して戻れない)"]
[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,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"4.",null,null,null,null,null,"精神・行動障害",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１被害的,２作話,３感情が不安定,４昼夜逆転,５同じ話をする,６大声を出す,７介護に抵抗,８落ち着きなし,９一人で出たがる,１０収集癖,１１物や衣類を壊す,１２ひどい物忘れ,１３独り言・独り笑い,１４自分勝手に行動する,１５話がまとまらない)"]
[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,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"5.",null,null,null,null,null,"社会生活への適応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１薬の内服,２金銭の管理,３日常の意思決定,４集団への不適応,５買い物,６簡単な調理)"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"6.",null,null,null,null,null,"特別な医療",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(過去14日間に受けた医療)"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"7.",null,null,null,null,null,"日常生活自立度",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,"(１障害高齢者の日常生活自立度(寝たきり度),２認知症高齢者の日常生活自立度)"]
[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,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]

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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査票表に被保険者番号を入れると反映されるようにしています"]
[]
[]
[]
[]
[]
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[null,null,null,null,null,null,"概況調査",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ⅳ．調査対象者の家族状況、居住環境、傷病、既往歴、立会いの有無、調査場所等"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"字の大きさを９ポイントにしているため"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"白塗り部分は印刷すると切れてしまいます。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"文章が白塗り部分にかかったら改行してください。"]
[null,null,"1.",null,null,null,null,null,"身体機能・起居動作",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１麻痺等の有無,２拘縮の有無,３寝返り,４起き上がり,５座位保持,６両足での立位,７歩行,８立ち上がり,９片足での立位,１０洗身,１１つめ切り,１２視力,１３聴力)"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,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.",null,null,null,null,null,"生活機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１移乗,２移動,３えん下,４食事摂取,５排尿,６排便,７口腔清潔,８洗顔,９整髪,１０上衣の着脱,１１ズボン等の着脱,１２外出頻度)"]
[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,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"3.",null,null,null,null,null,"認知機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１意思の伝達,２毎日の日課を理解,３生年月日を言う,４短期記憶,５自分の名前を言う,６今の季節を理解,７場所の理解,８徘徊,９外出して戻れない)"]
[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,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"4.",null,null,null,null,null,"精神・行動障害",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１被害的,２作話,３感情が不安定,４昼夜逆転,５同じ話をする,６大声を出す,７介護に抵抗,８落ち着きなし,９一人で出たがる,１０収集癖,１１物や衣類を壊す,１２ひどい物忘れ,１３独り言・独り笑い,１４自分勝手に行動する,１５話がまとまらない)"]
[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,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"5.",null,null,null,null,null,"社会生活への適応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１薬の内服,２金銭の管理,３日常の意思決定,４集団への不適応,５買い物,６簡単な調理)"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"6.",null,null,null,null,null,"特別な医療",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(過去14日間に受けた医療)"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"7.",null,null,null,null,null,"日常生活自立度",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,"(１障害高齢者の日常生活自立度(寝たきり度),２認知症高齢者の日常生活自立度)"]
[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,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]

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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査票表に被保険者番号を入れると反映されるようにしています"]
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[null,null,null,null,null,null,"概況調査",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ⅳ．調査対象者の家族状況、居住環境、傷病、既往歴、立会いの有無、調査場所等"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"白塗り部分は印刷すると切れてしまいます。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"文章が白塗り部分にかかったら改行してください。"]
[null,null,"1.",null,null,null,null,null,"身体機能・起居動作",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１麻痺等の有無,２拘縮の有無,３寝返り,４起き上がり,５座位保持,６両足での立位,７歩行,８立ち上がり,９片足での立位,１０洗身,１１つめ切り,１２視力,１３聴力)"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
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[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,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.",null,null,null,null,null,"生活機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１移乗,２移動,３えん下,４食事摂取,５排尿,６排便,７口腔清潔,８洗顔,９整髪,１０上衣の着脱,１１ズボン等の着脱,１２外出頻度)"]
[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,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"3.",null,null,null,null,null,"認知機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１意思の伝達,２毎日の日課を理解,３生年月日を言う,４短期記憶,５自分の名前を言う,６今の季節を理解,７場所の理解,８徘徊,９外出して戻れない)"]
[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,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"4.",null,null,null,null,null,"精神・行動障害",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１被害的,２作話,３感情が不安定,４昼夜逆転,５同じ話をする,６大声を出す,７介護に抵抗,８落ち着きなし,９一人で出たがる,１０収集癖,１１物や衣類を壊す,１２ひどい物忘れ,１３独り言・独り笑い,１４自分勝手に行動する,１５話がまとまらない)"]
[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,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"5.",null,null,null,null,null,"社会生活への適応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１薬の内服,２金銭の管理,３日常の意思決定,４集団への不適応,５買い物,６簡単な調理)"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"6.",null,null,null,null,null,"特別な医療",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(過去14日間に受けた医療)"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,"7.",null,null,null,null,null,"日常生活自立度",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,"(１障害高齢者の日常生活自立度(寝たきり度),２認知症高齢者の日常生活自立度)"]
[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,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査票表に被保険者番号を入れると反映されるようにしています"]
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[null,null,null,null,null,null,"概況調査",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ⅳ．調査対象者の家族状況、居住環境、傷病、既往歴、立会いの有無、調査場所等"]
[null,null,null,null,null,{"$f":"IF('特記 (1)入力'!F10:FK12=\"\",\"\",'特記 (1)入力'!F10:FK12)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"字の大きさを９ポイントにしているため"]
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[null,null,"1.",null,null,null,null,null,"身体機能・起居動作",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１麻痺等の有無,２拘縮の有無,３寝返り,４起き上がり,５座位保持,６両足での立位,７歩行,８立ち上がり,９片足での立位,１０洗身,１１つめ切り,１２視力,１３聴力)"]
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[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L17:T17=\"\",\"\",'特記 (1)入力'!L17:T17)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA17:FK17=\"\",\"\",'特記 (1)入力'!AA17:FK17)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L18:T18=\"\",\"\",'特記 (1)入力'!L18:T18)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA18:FK18=\"\",\"\",'特記 (1)入力'!AA18:FK18)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L19:T19=\"\",\"\",'特記 (1)入力'!L19:T19)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA19:FK19=\"\",\"\",'特記 (1)入力'!AA19:FK19)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L20:T20=\"\",\"\",'特記 (1)入力'!L20:T20)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA20:FK20=\"\",\"\",'特記 (1)入力'!AA20:FK20)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L21:T21=\"\",\"\",'特記 (1)入力'!L21:T21)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA21:FK21=\"\",\"\",'特記 (1)入力'!AA21:FK21)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L22:T22=\"\",\"\",'特記 (1)入力'!L22:T22)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA22:FK22=\"\",\"\",'特記 (1)入力'!AA22:FK22)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L23:T23=\"\",\"\",'特記 (1)入力'!L23:T23)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA23:FK23=\"\",\"\",'特記 (1)入力'!AA23:FK23)","v":""}]
[null,null,"2.",null,null,null,null,null,"生活機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１移乗,２移動,３えん下,４食事摂取,５排尿,６排便,７口腔清潔,８洗顔,９整髪,１０上衣の着脱,１１ズボン等の着脱,１２外出頻度)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L25:T25=\"\",\"\",'特記 (1)入力'!L25:T25)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA25:FK25=\"\",\"\",'特記 (1)入力'!AA25:FK25)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L26:T26=\"\",\"\",'特記 (1)入力'!L26:T26)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA26:FK26=\"\",\"\",'特記 (1)入力'!AA26:FK26)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L27:T27=\"\",\"\",'特記 (1)入力'!L27:T27)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA27:FK27=\"\",\"\",'特記 (1)入力'!AA27:FK27)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L28:T28=\"\",\"\",'特記 (1)入力'!L28:T28)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA28:FK28=\"\",\"\",'特記 (1)入力'!AA28:FK28)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L29:T29=\"\",\"\",'特記 (1)入力'!L29:T29)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA29:FK29=\"\",\"\",'特記 (1)入力'!AA29:FK29)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L30:T30=\"\",\"\",'特記 (1)入力'!L30:T30)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA30:FK30=\"\",\"\",'特記 (1)入力'!AA30:FK30)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L31:T31=\"\",\"\",'特記 (1)入力'!L31:T31)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA31:FK31=\"\",\"\",'特記 (1)入力'!AA31:FK31)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L32:T32=\"\",\"\",'特記 (1)入力'!L32:T32)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA32:FK32=\"\",\"\",'特記 (1)入力'!AA32:FK32)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L33:T33=\"\",\"\",'特記 (1)入力'!L33:T33)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA33:FK33=\"\",\"\",'特記 (1)入力'!AA33:FK33)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L34:T34=\"\",\"\",'特記 (1)入力'!L34:T34)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA34:FK34=\"\",\"\",'特記 (1)入力'!AA34:FK34)","v":""}]
[null,null,"3.",null,null,null,null,null,"認知機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１意思の伝達,２毎日の日課を理解,３生年月日を言う,４短期記憶,５自分の名前を言う,６今の季節を理解,７場所の理解,８徘徊,９外出して戻れない)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L36:T36=\"\",\"\",'特記 (1)入力'!L36:T36)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA36:FK36=\"\",\"\",'特記 (1)入力'!AA36:FK36)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L37:T37=\"\",\"\",'特記 (1)入力'!L37:T37)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA37:FK37=\"\",\"\",'特記 (1)入力'!AA37:FK37)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L38:T38=\"\",\"\",'特記 (1)入力'!L38:T38)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA38:FK38=\"\",\"\",'特記 (1)入力'!AA38:FK38)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L39:T39=\"\",\"\",'特記 (1)入力'!L39:T39)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA39:FK39=\"\",\"\",'特記 (1)入力'!AA39:FK39)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L40:T40=\"\",\"\",'特記 (1)入力'!L40:T40)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA40:FK40=\"\",\"\",'特記 (1)入力'!AA40:FK40)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L41:T41=\"\",\"\",'特記 (1)入力'!L41:T41)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA41:FK41=\"\",\"\",'特記 (1)入力'!AA41:FK41)","v":""}]
[null,null,"4.",null,null,null,null,null,"精神・行動障害",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１被害的,２作話,３感情が不安定,４昼夜逆転,５同じ話をする,６大声を出す,７介護に抵抗,８落ち着きなし,９一人で出たがる,１０収集癖,１１物や衣類を壊す,１２ひどい物忘れ,１３独り言・独り笑い,１４自分勝手に行動する,１５話がまとまらない)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L43:T43=\"\",\"\",'特記 (1)入力'!L43:T43)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA43:FK43=\"\",\"\",'特記 (1)入力'!AA43:FK43)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L44:T44=\"\",\"\",'特記 (1)入力'!L44:T44)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA44:FK44=\"\",\"\",'特記 (1)入力'!AA44:FK44)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L45:T45=\"\",\"\",'特記 (1)入力'!L45:T45)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA45:FK45=\"\",\"\",'特記 (1)入力'!AA45:FK45)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L46:T46=\"\",\"\",'特記 (1)入力'!L46:T46)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA46:FK46=\"\",\"\",'特記 (1)入力'!AA46:FK46)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L47:T47=\"\",\"\",'特記 (1)入力'!L47:T47)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA47:FK47=\"\",\"\",'特記 (1)入力'!AA47:FK47)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L48:T48=\"\",\"\",'特記 (1)入力'!L48:T48)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA48:FK48=\"\",\"\",'特記 (1)入力'!AA48:FK48)","v":""}]
[null,null,"5.",null,null,null,null,null,"社会生活への適応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１薬の内服,２金銭の管理,３日常の意思決定,４集団への不適応,５買い物,６簡単な調理)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L50:T50=\"\",\"\",'特記 (1)入力'!L50:T50)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA50:FK50=\"\",\"\",'特記 (1)入力'!AA50:FK50)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L51:T51=\"\",\"\",'特記 (1)入力'!L51:T51)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA51:FK51=\"\",\"\",'特記 (1)入力'!AA51:FK51)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L52:T52=\"\",\"\",'特記 (1)入力'!L52:T52)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA52:FK52=\"\",\"\",'特記 (1)入力'!AA52:FK52)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L53:T53=\"\",\"\",'特記 (1)入力'!L53:T53)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA53:FK53=\"\",\"\",'特記 (1)入力'!AA53:FK53)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L54:T54=\"\",\"\",'特記 (1)入力'!L54:T54)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA54:FK54=\"\",\"\",'特記 (1)入力'!AA54:FK54)","v":""}]
[null,null,"6.",null,null,null,null,null,"特別な医療",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(過去14日間に受けた医療)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L56:T56=\"\",\"\",'特記 (1)入力'!L56:T56)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA56:FK56=\"\",\"\",'特記 (1)入力'!AA56:FK56)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L57:T57=\"\",\"\",'特記 (1)入力'!L57:T57)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA57:FK57=\"\",\"\",'特記 (1)入力'!AA57:FK57)","v":""}]
[null,null,"7.",null,null,null,null,null,"日常生活自立度",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１障害高齢者の日常生活自立度(寝たきり度),２認知症高齢者の日常生活自立度)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L59:T59=\"\",\"\",'特記 (1)入力'!L59:T59)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA59:FK59=\"\",\"\",'特記 (1)入力'!AA59:FK59)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (1)入力'!L60:T60=\"\",\"\",'特記 (1)入力'!L60:T60)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (1)入力'!AA60:FK60=\"\",\"\",'特記 (1)入力'!AA60:FK60)","v":""}]

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[null,null,null,null,null,null,"概況調査",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ⅳ．調査対象者の家族状況、居住環境、傷病、既往歴、立会いの有無、調査場所等"]
[null,null,null,null,null,{"$f":"IF('特記 (2)入力'!F10:FK12=\"\",\"\",'特記 (2)入力'!F10:FK12)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"字の大きさを９ポイントにしているため"]
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[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L17:T17=\"\",\"\",'特記 (2)入力'!L17:T17)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA17:FK17=\"\",\"\",'特記 (2)入力'!AA17:FK17)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L18:T18=\"\",\"\",'特記 (2)入力'!L18:T18)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA18:FK18=\"\",\"\",'特記 (2)入力'!AA18:FK18)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L19:T19=\"\",\"\",'特記 (2)入力'!L19:T19)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA19:FK19=\"\",\"\",'特記 (2)入力'!AA19:FK19)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L20:T20=\"\",\"\",'特記 (2)入力'!L20:T20)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA20:FK20=\"\",\"\",'特記 (2)入力'!AA20:FK20)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L21:T21=\"\",\"\",'特記 (2)入力'!L21:T21)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA21:FK21=\"\",\"\",'特記 (2)入力'!AA21:FK21)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L22:T22=\"\",\"\",'特記 (2)入力'!L22:T22)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA22:FK22=\"\",\"\",'特記 (2)入力'!AA22:FK22)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L23:T23=\"\",\"\",'特記 (2)入力'!L23:T23)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA23:FK23=\"\",\"\",'特記 (2)入力'!AA23:FK23)","v":""}]
[null,null,"2.",null,null,null,null,null,"生活機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１移乗,２移動,３えん下,４食事摂取,５排尿,６排便,７口腔清潔,８洗顔,９整髪,１０上衣の着脱,１１ズボン等の着脱,１２外出頻度)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L25:T25=\"\",\"\",'特記 (2)入力'!L25:T25)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA25:FK25=\"\",\"\",'特記 (2)入力'!AA25:FK25)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L26:T26=\"\",\"\",'特記 (2)入力'!L26:T26)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA26:FK26=\"\",\"\",'特記 (2)入力'!AA26:FK26)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L27:T27=\"\",\"\",'特記 (2)入力'!L27:T27)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA27:FK27=\"\",\"\",'特記 (2)入力'!AA27:FK27)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L28:T28=\"\",\"\",'特記 (2)入力'!L28:T28)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA28:FK28=\"\",\"\",'特記 (2)入力'!AA28:FK28)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L29:T29=\"\",\"\",'特記 (2)入力'!L29:T29)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA29:FK29=\"\",\"\",'特記 (2)入力'!AA29:FK29)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L30:T30=\"\",\"\",'特記 (2)入力'!L30:T30)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA30:FK30=\"\",\"\",'特記 (2)入力'!AA30:FK30)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L31:T31=\"\",\"\",'特記 (2)入力'!L31:T31)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA31:FK31=\"\",\"\",'特記 (2)入力'!AA31:FK31)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L32:T32=\"\",\"\",'特記 (2)入力'!L32:T32)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA32:FK32=\"\",\"\",'特記 (2)入力'!AA32:FK32)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L33:T33=\"\",\"\",'特記 (2)入力'!L33:T33)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA33:FK33=\"\",\"\",'特記 (2)入力'!AA33:FK33)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L34:T34=\"\",\"\",'特記 (2)入力'!L34:T34)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA34:FK34=\"\",\"\",'特記 (2)入力'!AA34:FK34)","v":""}]
[null,null,"3.",null,null,null,null,null,"認知機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１意思の伝達,２毎日の日課を理解,３生年月日を言う,４短期記憶,５自分の名前を言う,６今の季節を理解,７場所の理解,８徘徊,９外出して戻れない)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L36:T36=\"\",\"\",'特記 (2)入力'!L36:T36)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA36:FK36=\"\",\"\",'特記 (2)入力'!AA36:FK36)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L37:T37=\"\",\"\",'特記 (2)入力'!L37:T37)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA37:FK37=\"\",\"\",'特記 (2)入力'!AA37:FK37)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L38:T38=\"\",\"\",'特記 (2)入力'!L38:T38)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA38:FK38=\"\",\"\",'特記 (2)入力'!AA38:FK38)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L39:T39=\"\",\"\",'特記 (2)入力'!L39:T39)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA39:FK39=\"\",\"\",'特記 (2)入力'!AA39:FK39)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L40:T40=\"\",\"\",'特記 (2)入力'!L40:T40)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA40:FK40=\"\",\"\",'特記 (2)入力'!AA40:FK40)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L41:T41=\"\",\"\",'特記 (2)入力'!L41:T41)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA41:FK41=\"\",\"\",'特記 (2)入力'!AA41:FK41)","v":""}]
[null,null,"4.",null,null,null,null,null,"精神・行動障害",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１被害的,２作話,３感情が不安定,４昼夜逆転,５同じ話をする,６大声を出す,７介護に抵抗,８落ち着きなし,９一人で出たがる,１０収集癖,１１物や衣類を壊す,１２ひどい物忘れ,１３独り言・独り笑い,１４自分勝手に行動する,１５話がまとまらない)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L43:T43=\"\",\"\",'特記 (2)入力'!L43:T43)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA43:FK43=\"\",\"\",'特記 (2)入力'!AA43:FK43)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L44:T44=\"\",\"\",'特記 (2)入力'!L44:T44)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA44:FK44=\"\",\"\",'特記 (2)入力'!AA44:FK44)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L45:T45=\"\",\"\",'特記 (2)入力'!L45:T45)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA45:FK45=\"\",\"\",'特記 (2)入力'!AA45:FK45)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L46:T46=\"\",\"\",'特記 (2)入力'!L46:T46)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA46:FK46=\"\",\"\",'特記 (2)入力'!AA46:FK46)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L47:T47=\"\",\"\",'特記 (2)入力'!L47:T47)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA47:FK47=\"\",\"\",'特記 (2)入力'!AA47:FK47)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L48:T48=\"\",\"\",'特記 (2)入力'!L48:T48)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA48:FK48=\"\",\"\",'特記 (2)入力'!AA48:FK48)","v":""}]
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[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L50:T50=\"\",\"\",'特記 (2)入力'!L50:T50)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA50:FK50=\"\",\"\",'特記 (2)入力'!AA50:FK50)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L51:T51=\"\",\"\",'特記 (2)入力'!L51:T51)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA51:FK51=\"\",\"\",'特記 (2)入力'!AA51:FK51)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L52:T52=\"\",\"\",'特記 (2)入力'!L52:T52)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA52:FK52=\"\",\"\",'特記 (2)入力'!AA52:FK52)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L53:T53=\"\",\"\",'特記 (2)入力'!L53:T53)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA53:FK53=\"\",\"\",'特記 (2)入力'!AA53:FK53)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L54:T54=\"\",\"\",'特記 (2)入力'!L54:T54)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA54:FK54=\"\",\"\",'特記 (2)入力'!AA54:FK54)","v":""}]
[null,null,"6.",null,null,null,null,null,"特別な医療",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(過去14日間に受けた医療)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L56:T56=\"\",\"\",'特記 (2)入力'!L56:T56)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA56:FK56=\"\",\"\",'特記 (2)入力'!AA56:FK56)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L57:T57=\"\",\"\",'特記 (2)入力'!L57:T57)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA57:FK57=\"\",\"\",'特記 (2)入力'!AA57:FK57)","v":""}]
[null,null,"7.",null,null,null,null,null,"日常生活自立度",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１障害高齢者の日常生活自立度(寝たきり度),２認知症高齢者の日常生活自立度)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L59:T59=\"\",\"\",'特記 (2)入力'!L59:T59)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA59:FK59=\"\",\"\",'特記 (2)入力'!AA59:FK59)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (2)入力'!L60:T60=\"\",\"\",'特記 (2)入力'!L60:T60)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (2)入力'!AA60:FK60=\"\",\"\",'特記 (2)入力'!AA60:FK60)","v":""}]

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[null,null,null,null,null,null,"概況調査",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ⅳ．調査対象者の家族状況、居住環境、傷病、既往歴、立会いの有無、調査場所等"]
[null,null,null,null,null,{"$f":"IF('特記 (3)入力'!F10:FK12=\"\",\"\",'特記 (3)入力'!F10:FK12)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"字の大きさを９ポイントにしているため"]
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[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L14:T14=\"\",\"\",'特記 (3)入力'!L14:T14)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA14:FK14=\"\",\"\",'特記 (3)入力'!AA14:FK14)","v":""}]
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[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L16:T16=\"\",\"\",'特記 (3)入力'!L16:T16)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA16:FK16=\"\",\"\",'特記 (3)入力'!AA16:FK16)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L17:T17=\"\",\"\",'特記 (3)入力'!L17:T17)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA17:FK17=\"\",\"\",'特記 (3)入力'!AA17:FK17)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L18:T18=\"\",\"\",'特記 (3)入力'!L18:T18)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA18:FK18=\"\",\"\",'特記 (3)入力'!AA18:FK18)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L19:T19=\"\",\"\",'特記 (3)入力'!L19:T19)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA19:FK19=\"\",\"\",'特記 (3)入力'!AA19:FK19)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L20:T20=\"\",\"\",'特記 (3)入力'!L20:T20)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA20:FK20=\"\",\"\",'特記 (3)入力'!AA20:FK20)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L21:T21=\"\",\"\",'特記 (3)入力'!L21:T21)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA21:FK21=\"\",\"\",'特記 (3)入力'!AA21:FK21)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L22:T22=\"\",\"\",'特記 (3)入力'!L22:T22)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA22:FK22=\"\",\"\",'特記 (3)入力'!AA22:FK22)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L23:T23=\"\",\"\",'特記 (3)入力'!L23:T23)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA23:FK23=\"\",\"\",'特記 (3)入力'!AA23:FK23)","v":""}]
[null,null,"2.",null,null,null,null,null,"生活機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１移乗,２移動,３えん下,４食事摂取,５排尿,６排便,７口腔清潔,８洗顔,９整髪,１０上衣の着脱,１１ズボン等の着脱,１２外出頻度)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L25:T25=\"\",\"\",'特記 (3)入力'!L25:T25)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA25:FK25=\"\",\"\",'特記 (3)入力'!AA25:FK25)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L26:T26=\"\",\"\",'特記 (3)入力'!L26:T26)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA26:FK26=\"\",\"\",'特記 (3)入力'!AA26:FK26)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L27:T27=\"\",\"\",'特記 (3)入力'!L27:T27)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA27:FK27=\"\",\"\",'特記 (3)入力'!AA27:FK27)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L28:T28=\"\",\"\",'特記 (3)入力'!L28:T28)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA28:FK28=\"\",\"\",'特記 (3)入力'!AA28:FK28)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L29:T29=\"\",\"\",'特記 (3)入力'!L29:T29)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA29:FK29=\"\",\"\",'特記 (3)入力'!AA29:FK29)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L30:T30=\"\",\"\",'特記 (3)入力'!L30:T30)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA30:FK30=\"\",\"\",'特記 (3)入力'!AA30:FK30)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L31:T31=\"\",\"\",'特記 (3)入力'!L31:T31)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA31:FK31=\"\",\"\",'特記 (3)入力'!AA31:FK31)","v":""}]
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[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L33:T33=\"\",\"\",'特記 (3)入力'!L33:T33)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA33:FK33=\"\",\"\",'特記 (3)入力'!AA33:FK33)","v":""}]
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[null,null,"3.",null,null,null,null,null,"認知機能",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１意思の伝達,２毎日の日課を理解,３生年月日を言う,４短期記憶,５自分の名前を言う,６今の季節を理解,７場所の理解,８徘徊,９外出して戻れない)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L36:T36=\"\",\"\",'特記 (3)入力'!L36:T36)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA36:FK36=\"\",\"\",'特記 (3)入力'!AA36:FK36)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L37:T37=\"\",\"\",'特記 (3)入力'!L37:T37)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA37:FK37=\"\",\"\",'特記 (3)入力'!AA37:FK37)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L38:T38=\"\",\"\",'特記 (3)入力'!L38:T38)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA38:FK38=\"\",\"\",'特記 (3)入力'!AA38:FK38)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L39:T39=\"\",\"\",'特記 (3)入力'!L39:T39)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA39:FK39=\"\",\"\",'特記 (3)入力'!AA39:FK39)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L40:T40=\"\",\"\",'特記 (3)入力'!L40:T40)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA40:FK40=\"\",\"\",'特記 (3)入力'!AA40:FK40)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L41:T41=\"\",\"\",'特記 (3)入力'!L41:T41)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA41:FK41=\"\",\"\",'特記 (3)入力'!AA41:FK41)","v":""}]
[null,null,"4.",null,null,null,null,null,"精神・行動障害",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１被害的,２作話,３感情が不安定,４昼夜逆転,５同じ話をする,６大声を出す,７介護に抵抗,８落ち着きなし,９一人で出たがる,１０収集癖,１１物や衣類を壊す,１２ひどい物忘れ,１３独り言・独り笑い,１４自分勝手に行動する,１５話がまとまらない)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L43:T43=\"\",\"\",'特記 (3)入力'!L43:T43)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA43:FK43=\"\",\"\",'特記 (3)入力'!AA43:FK43)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L44:T44=\"\",\"\",'特記 (3)入力'!L44:T44)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA44:FK44=\"\",\"\",'特記 (3)入力'!AA44:FK44)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L45:T45=\"\",\"\",'特記 (3)入力'!L45:T45)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA45:FK45=\"\",\"\",'特記 (3)入力'!AA45:FK45)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L46:T46=\"\",\"\",'特記 (3)入力'!L46:T46)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA46:FK46=\"\",\"\",'特記 (3)入力'!AA46:FK46)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L47:T47=\"\",\"\",'特記 (3)入力'!L47:T47)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA47:FK47=\"\",\"\",'特記 (3)入力'!AA47:FK47)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L48:T48=\"\",\"\",'特記 (3)入力'!L48:T48)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA48:FK48=\"\",\"\",'特記 (3)入力'!AA48:FK48)","v":""}]
[null,null,"5.",null,null,null,null,null,"社会生活への適応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１薬の内服,２金銭の管理,３日常の意思決定,４集団への不適応,５買い物,６簡単な調理)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L50:T50=\"\",\"\",'特記 (3)入力'!L50:T50)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA50:FK50=\"\",\"\",'特記 (3)入力'!AA50:FK50)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L51:T51=\"\",\"\",'特記 (3)入力'!L51:T51)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA51:FK51=\"\",\"\",'特記 (3)入力'!AA51:FK51)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L52:T52=\"\",\"\",'特記 (3)入力'!L52:T52)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA52:FK52=\"\",\"\",'特記 (3)入力'!AA52:FK52)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L53:T53=\"\",\"\",'特記 (3)入力'!L53:T53)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA53:FK53=\"\",\"\",'特記 (3)入力'!AA53:FK53)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L54:T54=\"\",\"\",'特記 (3)入力'!L54:T54)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA54:FK54=\"\",\"\",'特記 (3)入力'!AA54:FK54)","v":""}]
[null,null,"6.",null,null,null,null,null,"特別な医療",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(過去14日間に受けた医療)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L56:T56=\"\",\"\",'特記 (3)入力'!L56:T56)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA56:FK56=\"\",\"\",'特記 (3)入力'!AA56:FK56)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L57:T57=\"\",\"\",'特記 (3)入力'!L57:T57)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA57:FK57=\"\",\"\",'特記 (3)入力'!AA57:FK57)","v":""}]
[null,null,"7.",null,null,null,null,null,"日常生活自立度",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(１障害高齢者の日常生活自立度(寝たきり度),２認知症高齢者の日常生活自立度)"]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L59:T59=\"\",\"\",'特記 (3)入力'!L59:T59)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA59:FK59=\"\",\"\",'特記 (3)入力'!AA59:FK59)","v":""}]
[null,null,null,null,null,null,"（",null,null,null,null,{"$f":"IF('特記 (3)入力'!L60:T60=\"\",\"\",'特記 (3)入力'!L60:T60)","v":""},null,null,null,null,null,null,null,null,null,"）",null,null,null,null,{"$f":"IF('特記 (3)入力'!AA60:FK60=\"\",\"\",'特記 (3)入力'!AA60:FK60)","v":""}]