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["【日常生活動作状況書】"]
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[null,null,null,null,"幻視","幻覚","幻聴","奇声","介護抵抗"]
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[null,"MRSA","陽性","陰性","未検","検査日","--","--","--",null,"より検出"]
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[null,"その他"]
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[]
[null,"介護保険","有","無","申請中","実調済み","--","--","要支援","--"]
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[]
[null,"障害者\n手帳","有","無","申請中","--","--","相談支援事業所"]
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[]
[null,"家族構成\n※同居の方はマルで囲んで下さい。",null,null,null,null,null,"キーパーソン①"]
[]
[null,null,null,null,null,null,null,"連絡先"]
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[null,null,null,null,null,null,null,"キーパーソン②"]
[]
[null,null,null,null,null,null,null,"連絡先"]
[]
[null,null,null,null,null,null,null,"備考欄"]
[]
[]
[]
[]
[]
["特記\n事項"]
[]
[]
[]
[]
[null,null,null,null,null,"医療法人岩切病院　　地域医療連携室（2022.10.1改正）"]

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