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["伊勢地区における主治医と介護支援専門員連携シート"]
["送付日 ",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,"2019-09-18"]
["医療機関名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"介護支援事業所"]
["TEL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL"]
["FAX",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FAX"]
["医師名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"様",null,null,"担当者名"]
["　平素はお世話になっております。"]
["　下記の利用者様、ケアマネージャーとしてケアプランを作成しております。"]
["サービスを提供する上で、先生にご指示を承りたくご連絡いたします。お忙しいところ申し訳ございませんが、"]
["ご都合の良い連絡方法で、",null,null,null,null,null,null,null,null,null,null,"月",null,null,"日  までにご回答をお願いいたします。"]
["本人・家族の同意",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"契約時の同意"]
["利用者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
["生年月日",null,null,null,null,null,null,"年",null,null,"月",null,null,"日","（",{"$f":"DATEDIF(AM2,AF2,\"Y\")","v":{"$error":"#NUM!"}},null,"歳）",null,"TEL",null,null,null,null,null,null,null,"-",null,null,null,"-"]
["要介護度",null,null,null,null,null,null,null,null,null,"有効期限",null,null,null,null,null,null,"年",null,null,"月",null,null,"日","〜",null,null,null,null,null,"年",null,null,"月",null,null,"日"]
["介護支援専門員記載欄"]
[null,null,"担当者挨拶",null,null,null,null,null,null,"ケアプラン作成時の意見について （",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"新規",null,null,"変更",null,null,"区分変更",null,null,null,null,"更新）"]
[]
[]
[null,null,"医療系サービス利用について",null,null,null,null,null,null,null,null,null,null,null,null,"心身状態について",null,null,null,null,null,null,null,null,"福祉用具購入貸与について"]
[]
[]
[null,null,"その他"]
[]
[]
[null,null,"サービス担当者会議開催あり",null,null,null,null,null,null,null,null,null,null,"開催日時：",null,null,null,null,null,"月",null,null,"日",null,null,"時",null,null,"分／場所："]
[]
[]
["上記記載欄項目の具体的相談内容"]
[]
[]
[]
[]
[]
[]
[]
[]
[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,"返信",null,null,null,"要",null,null,"不要"]
[]
[]
["主治医記入欄"]
["回答"]
[null,null,"ケアプランはこのままでよい",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ケアプランに変更の要望がある"]
[]
[]
[null,null,"ケアプランに意見があり、説明が必要である",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話をします（",null,null,null,null,null,null,null,"月",null,null,"日",null,null,"時頃）"]
[]
[]
["サービス担当者会議に",null,null,null,null,null,null,null,null,"出席します（",null,null,null,null,null,"診療所",null,null,null,"利用者宅",null,null,null,null,"その他[",null,null,null,null,null,null,null,"]）",null,"出席不可"]
[]
[]
["コメント"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"R",null,null,"年",null,null,"月",null,null,"日","主治医"]