{"text_format":"1","workbook":"xlsx","n_sheets":1,"sheets":["核医学 "],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":1,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"核医学 ","index":0,"n_rows":119,"n_cols":72,"rows_kept":119,"cut":false,"hidden":false,"merged":[[63,50,65,56],[63,57,65,57],[63,58,65,70],[63,71,65,71],[54,0,65,7],[54,8,56,32],[54,33,56,49],[54,50,56,71],[57,8,59,32],[57,33,59,49],[57,50,59,71],[63,8,65,32],[63,33,65,49],[48,0,53,5],[48,6,53,31],[48,32,50,71],[51,32,53,33],[51,34,53,39],[51,40,53,41],[51,42,53,47],[51,48,53,71],[60,33,62,49],[60,50,62,71],[60,8,62,32],[41,0,42,5],[41,6,42,8],[41,9,42,19],[41,20,42,71],[43,0,45,71],[46,0,47,5],[46,6,47,6],[46,7,47,12],[46,13,47,13],[46,14,47,19],[46,20,47,21],[46,22,47,27],[46,28,47,35],[46,36,47,41],[46,42,47,42],[46,43,47,48],[46,49,47,49],[46,50,47,55],[46,56,47,57],[46,58,47,63],[46,64,47,71],[38,30,40,32],[38,33,40,37],[38,38,40,40],[38,42,39,43],[38,44,39,49],[38,50,39,51],[38,52,39,58],[38,59,39,60],[38,61,39,71],[34,0,35,5],[34,6,35,18],[34,19,35,40],[34,42,35,43],[34,44,35,49],[34,50,35,69],[34,70,35,71],[36,0,40,5],[36,6,37,7],[36,8,37,12],[36,13,37,14],[36,15,37,19],[36,20,37,21],[36,22,37,26],[36,27,37,28],[36,29,37,33],[36,34,37,35],[36,36,37,40],[36,42,37,71],[38,6,40,11],[38,12,40,14],[38,15,40,20],[38,21,40,23],[38,24,40,29],[26,0,27,5],[26,6,27,30],[26,31,27,35],[26,36,27,40],[26,42,27,71],[28,0,33,5],[28,6,33,30],[28,31,30,32],[28,33,30,35],[28,36,30,37],[28,38,30,40],[28,42,29,43],[28,44,29,71],[30,42,31,43],[30,44,31,71],[31,31,33,32],[31,33,33,35],[31,36,33,37],[31,38,33,40],[32,42,33,43],[32,44,33,71],[25,0,25,71],[4,35,4,71],[0,0,3,14],[0,15,3,44],[5,0,8,34],[5,36,6,55],[5,56,6,71],[0,46,3,52],[0,53,3,55],[0,56,3,58],[0,59,3,61],[0,62,3,64],[0,65,3,67],[0,68,3,70],[7,36,12,71],[16,64,18,71],[9,0,14,34],[13,36,15,45],[13,46,15,53],[13,54,15,55],[13,56,15,68],[13,69,15,71],[16,36,18,45],[16,46,18,47],[66,35,68,37],[69,32,71,34],[69,0,71,7],[69,8,71,10],[69,11,71,12],[69,13,71,14],[69,15,71,17],[69,25,71,31],[69,35,71,37],[75,15,77,17],[75,25,77,31],[75,32,77,34],[75,35,77,37],[75,0,77,7],[75,8,77,10],[75,11,77,12],[75,13,77,14],[72,32,74,34],[72,35,74,37],[66,18,77,24],[66,25,68,31],[72,0,74,7],[72,8,74,10],[72,11,74,12],[72,13,74,14],[72,15,74,17],[72,25,74,31],[66,0,68,7],[66,8,68,10],[66,11,68,12],[66,13,68,14],[66,15,68,17],[66,32,68,34],[66,47,68,51],[66,52,74,71],[66,38,68,40],[66,41,68,43],[66,44,68,46],[72,38,74,40],[69,44,71,46],[75,47,77,51],[75,52,77,53],[72,47,74,51],[72,41,74,43],[72,44,74,46],[69,47,71,51],[75,44,77,46],[75,54,77,69],[75,70,77,71],[75,38,77,40],[75,41,77,43],[69,38,71,40],[69,41,71,43],[78,38,80,40],[78,41,80,41],[78,42,80,45],[78,46,80,71],[81,0,83,7],[81,8,83,32],[81,33,83,40],[81,41,83,71],[78,20,80,20],[78,21,80,25],[78,26,80,28],[78,29,80,31],[78,32,80,34],[78,35,80,37],[78,0,80,7],[78,8,80,9],[78,10,80,13],[78,14,80,15],[78,16,80,19],[114,0,116,71],[118,0,119,71],[111,0,111,71],[84,0,85,50],[84,51,85,70],[87,1,103,70],[108,0,110,22],[108,26,110,32],[108,36,110,51],[108,54,110,71],[112,0,113,71],[105,2,106,9],[105,10,106,14],[105,15,106,22],[105,23,106,29],[105,30,106,40],[105,41,106,49],[105,50,106,59],[105,60,106,69],[16,48,18,53],[16,54,18,55],[16,56,18,61],[16,62,18,63],[22,36,24,45],[22,46,24,71],[19,0,24,8],[19,9,24,12],[19,13,24,15],[19,16,24,17],[19,18,24,20],[19,21,24,22],[19,23,24,25],[19,26,24,27],[19,28,24,29],[19,30,24,32],[19,33,24,34],[19,36,21,45],[19,46,21,47],[19,48,21,53],[19,54,21,55],[19,56,21,61],[19,62,21,63],[19,64,21,71]]}
["紹介状",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（診療情報提供書・核医学検査依頼書）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日"]
[]
[]
[]
[]
["北播磨総合医療センター",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"紹介元医療機関名及び所在地：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※改行は　「Altキー ＋ Enterキー」"]
[]
[]
[]
["担当医　先生"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当医師名：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"科",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号：",null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,")",null,null,null,null,null,null,null,"-"]
[]
[]
["受診希望日",null,null,null,null,null,null,null,null,"令和",null,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日",null,"(",null,null,null,null,")",null,null,"ＦＡＸ番号：",null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,")",null,null,null,null,null,null,null,"-"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申込担当者："]
[]
[]
[]
["フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受診歴",null,null,null,null,"性別",null,null,null,null,null,"患者さん予約待ち状況"]
[]
["氏　　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,"有",null,null,null,null,"男",null,null,null,null,null,"貴医療機関にて外来待機中"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"貴医療機関に入院中"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"無",null,null,null,null,"女"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"帰宅され、貴医療機関より連絡待ち"]
[]
["旧　　姓",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※お分かりでしたらご記入お願いします。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"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,"）"]
[]
["生年月日",null,null,null,null,null,null,null,"明治",null,null,null,null,null,null,"大正",null,null,null,null,null,null,"昭和",null,null,null,null,null,null,"平成",null,null,null,null,null,null,"令和",null,null,null,null,null,"患者さん来院方法"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,null,"日",null,null,null,null,null,null,null,"歳",null,null,null,null,null,"独歩",null,null,null,null,null,null,null,"車イス",null,null,null,null,null,null,null,null,"ストレッチャー"]
[]
[]
["住　　所",null,null,null,null,null,"〒",null,null,"-"]
[]
[]
[]
[]
["自　宅",null,null,null,null,null,"(",null,null,null,null,null,null,")",null,null,null,null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"連絡先",null,null,null,null,null,"(",null,null,null,null,null,null,")",null,null,null,null,null,null,"-"]
[]
["紹介目的",null,null,null,null,null,"検査（核医学）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"患者さんの都合により当医療センターと直接予約日を変更することについて\n（直接予約日変更時も下記予約受付時間での対応となります）"]
[]
[]
[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,"承諾する",null,null,null,null,null,null,null,"不承諾",null,null,null,null,null,"不承諾並びにどちらにもチェックがない場合は、紹介元を通しての変更をお願いします。"]
[]
[]
["検査名"]
[]
[]
[]
[]
[]
[]
[]
[]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[]
[]
["肝障害",null,null,null,null,null,null,null,null,null,null,"無",null,null,null,"有",null,null,"感染症",null,null,null,null,null,null,"HBs",null,null,null,null,null,null,null,null,null,"＋",null,null,null,null,null,"－",null,null,null,null,null,"未検査"]
[]
[]
["腎障害",null,null,null,null,null,null,null,null,null,null,"無",null,null,null,"有",null,null,null,null,null,null,null,null,null,"HCV",null,null,null,null,null,null,null,null,null,"＋",null,null,null,null,null,"－",null,null,null,null,null,"未検査"]
[]
[]
["アレルギー歴",null,null,null,null,null,null,null,null,null,null,"無",null,null,null,"有",null,null,null,null,null,null,null,null,null,"Wa氏",null,null,null,null,null,null,null,null,null,"＋",null,null,null,null,null,"－",null,null,null,null,null,"未検査"]
[]
[]
["喘息",null,null,null,null,null,null,null,null,null,null,"無",null,null,null,"有",null,null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,"＋",null,null,null,null,null,"－",null,null,null,null,null,"未検査",null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
["前回検査",null,null,null,null,null,null,null,null,null,"初診",null,null,null,null,null,"再診",null,null,null,"(",null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,")","所見:"]
[]
[]
["診断名",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,"主訴"]
[]
[]
["①現病歴　②現症　③検査所見　④治療経過　⑤現在の処方　⑥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,null,null,null,null,null,null,null,"※改行は　「Altキー ＋ Enterキー」"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"添付資料"]
[]
[]
["結果（所見）返送方法",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"すべて返送",null,null,null,null,null,null,null,null,null,"所見のみFAX、その他郵送",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他（　　　　　　　　　　　　　　）"]
[]
[]
[]
["※ FAX予約受付時間（月～金　9:00～18:30　土　9:00～11:30　（祝祭日・年末年始は除く））　（FAX受信は24時間可能です）"]
[]
["北播磨総合医療センター地域医療連携室　  FAX：0794-62-9911　TEL：0794-88-8800㈹"]
[]
[]
[]
["2024-04-01"]