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["氏　名"]
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["ジェノグラム",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会資源"]
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[null,null,null,null,null,null,null,null,null,"気管切開",null,null,null,null,null,null,null,null,null,null,null,null,null,"BSチェック"]
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[null,null,null,null,null,null,null,null,null,"アレルギー",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,"聴覚障害",null,null,null,null,null,null,"(",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"言語障害",null,null,null,null,null,null,"(",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"嚥下障害",null,null,null,null,null,null,"(",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"麻痺",null,null,null,null,null,null,null,"部位：",null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"意思疎通"]
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[null,null,null,null,null,null,null,null,null,"食事"]
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[null,null,null,null,null,null,null,null,null,null,null,"摂取量",null,null,"(",null,null,null,null,"割","）"]
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[null,null,null,null,null,null,null,null,null,"清潔",null,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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[]
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["本人の病識や今後の意向",null,null,null,null,null,null,null,null,null,"例：家に帰りたい、長期入院を希望、病状変化があったときには転院を希望　等"]
[]
[]
[]
["家族の病識や今後の意向"]
[]
[]
[]
["本人・家族の当院への要望等"]
[]
[]
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["氏　名"]
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["ジェノグラム",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会資源"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"介護保険",null,null,null,null,null,null,null,null,"(",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"居宅事業所",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,"障害支援区分",null,null,null,null,null,null,null,null,null,"(",null,null,null,"）"]
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["連絡先"]
["身体状況",null,null,null,null,null,null,null,null,"酸素",null,null,null,null,null,null,"(",null,null,null,null,"lm","）","インスリン"]
[null,null,null,null,null,null,null,null,null,"気管切開",null,null,null,null,null,null,null,null,null,null,null,null,null,"BSチェック"]
[null,null,null,null,null,null,null,null,null,"吸引",null,null,null,null,null,null,null,"(頻度：",null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"褥瘡",null,null,null,null,null,null,"(","部位：",null,null,null,null,"）","(サイズ：",null,null,null,null,"）","現状の処置",null,null,"（",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"感染症",null,null,null,null,null,null,null,"検査検体",null,null,"(",null,null,null,null,null,"）"]
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[null,null,null,null,null,null,null,null,null,"アレルギー",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,"身長体重",null,"身長",null,null,null,"cm",null,null,"体重",null,null,null,"kg"]
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[null,null,null,null,null,null,null,null,null,"聴覚障害",null,null,null,null,null,null,"(",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"言語障害",null,null,null,null,null,null,"(",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"嚥下障害",null,null,null,null,null,null,"(",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"麻痺",null,null,null,null,null,null,null,"部位：",null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"意思疎通"]
[null,null,null,null,null,null,null,null,null,"認知症"]
[null,null,null,null,null,null,null,null,null,"問題行動",null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"具体的エピソード",null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"抑制",null,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",null,null,null,null,null,null,null,null,"移動",null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"食事"]
[null,null,null,null,null,null,null,null,null,null,null,"種類",null,"(",null,null,null,null,null,null,"）","形態",null,"(","主食：",null,null,null,null,null,"副食：",null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,"特記事項",null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,"摂取量",null,null,"(",null,null,null,null,"割","）"]
[null,null,null,null,null,null,null,null,null,null,null,"経管栄養",null,null,"(",null,null,null,null,"）",null,"注入メニュー",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,"バルーンカテーテル",null,null,null,null,null,"(",null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,"）","尿意",null,"(",null,null,null,"）","便意(",null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"清潔",null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
["リハビリ",null,null,null,null,null,null,null,null,null,null,null,null,null,"(","疾患名：",null,null,null,null,null,null,null,null,null,null,null,null,"）","起算日："]
["DNAR",null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
["特記事項"]
[]
[]
[]
["本人の病識や今後の意向",null,null,null,null,null,null,null,null,null,"例：家に帰りたい、長期入院を希望、病状変化があったときには転院を希望　等"]
[]
[]
[]
["家族の病識や今後の意向"]
[]
[]
[]
["本人・家族の当院への要望等"]
[]
[]
[]
["当院記入欄",null,null,null,null,"患者ID",null,"：",null,null,null,null,"連携室担当者",null,null,null,null,null,null,null,null,null,"期日",null,null,null,null,null,null,"個室希望"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"玖珂中央病院"]