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[]
[null,null,null,null,"退院時共同指導票",null,null,null,null,null,null,null,null,null,null,null,null,"介護支援連携指導票"]
[]
["ID：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"病院"]
["実施日",null,null,null,null,"年",null,null,"月",null,null,"日",null,null,"時",null,null,"分 〜",null,null,null,null,"時",null,null,"分","第",null,null,null,null,"回"]
["患者氏名",null,null,null,null,null,null,null,null,null,"様","場所",null,null,null,null,null,null,null,null,null,null,null,null,"記載者"]
["住所"]
["指導を受けた人",null,null,"本人",null,null,null,"家族（",null,null,null,null,null,null,null,null,null,"）",null,null,"その他（",null,null,null,null,null,null,null,null,null,null,"）"]
[]
[]
["参加者","病院担当者",null,null,null,null,null,null,null,null,null,null,null,"在宅担当者"]
[null,"職種",null,null,null,null,null,"氏名",null,null,null,null,null,"職種",null,null,null,null,null,"事業所",null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,"病院担当者（下記でﾌﾟﾙﾀﾞｳﾝ）"]
[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,null,null,"　主治医,看護師,社会福祉士,退院支援看護師,PT,OT,ST,栄養士,薬剤師"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在宅担当者（下記でﾌﾟﾙﾀﾞｳﾝ）"]
[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,null,null,"　在宅医,訪問看護師,介護支援専門員"]
[]
[]
[]
[]
["要介護度",null,null,"なし",null,null,null,"申請中",null,null,null,null,"更新中",null,null,null,null,"区分変更中",null,null,null,null,null,"あり",null,null,null,null,null,null,null,null,null,null,"要支援１,要支援2,要介護１,要介護２,要介護３,要介護４,要介護５"]
[]
[]
["障害区分",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"なし,あり,不明"]
["入院日",null,null,null,null,null,null,"月",null,null,null,"日",null,"退院の目途",null,null,null,null,null,null,null,null,null,"月",null,null,null,"日",null,null,null,null,null,null,"頃,以降,までに,時"]
["疾患名",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,"フリーで記載"]
[]
["現在の状態(ADL,処置等)",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,"現在の病状等を簡潔に記載"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療行為、回数等を記載"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ADLも伝えるべきことは記載"]
[null,null,null,"喀痰吸引",null,null,null,null,null,"気管切開",null,null,null,null,null,"人工肛門",null,null,null,null,null,"Ｂaカテーテル"]
[]
[]
[null,null,null,"点滴",null,null,null,null,null,"経管栄養(",null,null,null,null,null,null,null,null,null,")",null,"インスリン"]
[]
[]
[null,null,null,"酸素",null,null,null,null,null,"褥瘡",null,null,null,null,null,"その他(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
["退院後の注意事項(医療行為等)",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,"上記に関し、注意事項を記載"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"「上記について実施」でも可能"]
[]
["退院後必要なサービス",null,null,"訪問介護",null,null,null,null,null,"訪問看護",null,null,null,null,null,"訪問入浴",null,null,null,null,null,"訪問リハビリ",null,null,null,null,null,null,null,null,null,null,null,null,"介護支援連携は必要と思われるサービス"]
[]
[]
[null,null,null,"通所介護",null,null,null,null,null,"通所リハビリ",null,null,null,null,null,"短期入所",null,null,null,null,null,"福祉用具",null,null,null,null,null,"住宅改修",null,null,null,null,null,null,"退院時共同は実際に利用するサービスを記入"]
[]
[]
[null,null,null,"訪問診療",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,null,null,null,null,null,null,null,null,"フリースペースは上記に関しての補足事項を記入"]
[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,null,null,null,null,null,"回数等も記載必要であればこの欄へ"]
[]
["その他留意事項"]
[]
[]
[]
["上記の通り指導を受けました。"]
["なお、当院が介護支援専門員に対し指導の内容を踏まえて作成されたケアプラン等の情報を求めることに同意します。"]
[null,null,"患者本人",null,null,null,null,null,null,"家族  (続柄：",null,null,null,null,null,null,null,")",null,"署名："]

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["なし","あり","不明"]
[null,"区分１"]
[null,"区分２"]
[null,"区分３"]
[null,"区分４"]
[null,"区分５"]
[null,"区分６"]
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[null,null,null,null,null,"なし",null,null,"[あり]の場合"]
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[null,null,null,null,null,"あり",null,null,"区分１"]
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[null,null,null,null,null,"不明",null,null,"区分２"]
[null,null,null,null,null,null,null,null,"区分３"]
[null,null,null,null,null,null,null,null,"区分４"]
[null,null,null,null,null,null,null,null,"区分５"]
[null,null,null,null,null,null,null,null,"区分６"]