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{"sheet":"紹介患者診療申し込み ","index":0,"n_rows":54,"n_cols":47,"rows_kept":54,"cut":false,"hidden":false,"merged":[[7,15,7,22],[6,0,7,11],[27,23,28,23],[10,12,10,14],[11,12,11,14],[12,12,12,14],[23,0,23,22],[8,15,9,22],[10,15,10,22],[11,15,11,22],[8,12,9,14],[7,12,7,14],[3,0,3,22],[4,12,4,17],[4,18,4,22],[5,12,5,14],[6,12,6,14],[6,15,6,22],[30,0,32,1],[30,2,30,5],[36,7,36,10],[37,0,37,2],[12,15,12,22],[27,20,28,20],[27,14,28,19],[27,21,28,21],[33,14,33,17],[27,22,28,22],[28,0,29,1],[28,2,29,9],[28,10,29,11],[29,12,29,13],[29,14,29,22],[37,48,37,49],[38,0,38,2],[38,3,38,6],[37,34,37,36],[36,24,36,26],[36,27,36,30],[52,5,52,6],[52,10,52,11],[52,15,52,16],[51,0,51,1],[52,0,52,1],[42,0,42,22],[27,2,27,9],[27,10,27,11],[27,12,28,13],[33,0,33,1],[34,0,34,1],[36,0,36,2],[36,3,36,6],[31,2,32,22],[40,0,40,2],[40,3,40,6],[38,9,40,11],[38,12,40,22],[27,0,27,1],[39,0,39,2],[39,3,39,6],[13,26,13,31],[26,0,26,22],[13,12,13,14],[13,15,13,22],[24,0,24,22]]}
[]
[]
[]
["紹介患者診療予約申込書"]
[null,null,null,null,null,null,null,null,null,null,null,null,"申込日（FAX送信日）：",null,null,null,null,null,{"$f":"TODAY()","v":"2024-11-11"}]
[null,null,null,null,null,null,null,null,null,null,null,null,"紹介元"]
["医療法人渓和会 江別病院",null,null,null,null,null,null,null,null,null,null,null,"医療機関名"]
[null,null,null,null,null,null,null,null,null,null,null,null,"郵便番号"]
[null,null,null,null,null,null,null,null,"医療連携室　行",null,null,null,"所在地"]
["FAX番号：011-382-2050（連携室直通）"]
["FAXは24時間受信可能です。平日は16：30以降、第1，3，5土曜日",null,null,null,null,null,null,null,null,null,null,null,"診療科"]
["11：30以降にFAXをいただいた場合は、翌診療日に返信いたします。",null,null,null,null,null,null,null,null,null,null,null,"医師名"]
[null,null,null,null,null,null,null,null,null,null,null,null,"電話番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,"FAX番号"]
[]
["※当日受付時間外の御依頼・緊急依頼の場合にはDr.to Dr.での御連絡をお願いします。"]
["　電話番号（代表）011-382-1111 へ発信し、電話交換自動音声ガイダンス「８」を押してください。"]
[]
["【予約の流れと注意事項】"]
["①本紙に必要事項を記入願います。"]
["②予約を希望する診療科・担当医を選択願います。特に希望のない場合は【ご担当医】を選択してください。"]
["③本紙及び診療情報提供書（別紙）を上記FAX番号へ送信してください。"]
["④患者様が貴院外来で待っている場合には30分以内を目処に当院より受診予約票を返送いたしますが、時間を要する場合は"]
["　その旨を電話でご連絡させていただきます。"]
["⑤診療情報提供書の原本・検査結果・CD-Rは当院の該当診療科に事前にご郵送いただくか、患者様にお渡しください。"]
[]
["患者情報"]
["フリガナ",null,null,null,null,null,null,null,null,null,"性別",null,"生年月日",null,null,null,null,null,null,null,"年齢",{"$f":"IF(X28<110,X28,\"\")","v":""},"歳",{"$f":"DATEDIF(O28,S5,\"Y\")","v":124}]
["患者氏名"]
[null,null,null,null,null,null,null,null,null,null,null,null,"電話番号"]
["住所",null,"〒"]
[]
[]
["患者\n状況",null,null,null,null,null,null,null,null,null,null,"（退院予定：",null,null,null,null,null,null,"）"]
["資料",null,null,null,null,"（",null,null,null,null,null,null,null,"）"]
[]
["希望診療科",null,null,"消化器内科",null,null,null,"ご担当医",null,null,null,"医師",null,null,null,null,null,null,null,null,null,null,null,{"$f":"D37","v":"消化器内科"}]
["受診希望日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"H37","v":"ご担当医"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　　　　　　　　"]
["第1希望日時",null,null,null,null,null,null,null,null,"別途希望があればご記入ください。"]
["第2希望日時"]
["第3希望日時"]
[]
["主訴または傷病名・紹介目的"]
["※診療情報提供書を同時にお送りいただけない場合のみ、必ずご記入ください"]
[]
[]
[]
[]
[]
[]
["【渓和会江別病院記入欄】以下は本院使用欄です。記入は不要です。"]
["患者ID"]
["医師名",null,null,null,null,"予約日時",null,null,null,null,"来院時間",null,null,null,null,"受付日"]
["〒069-0817　北海道江別市野幌代々木町81－6　渓和会江別病院　医療連携室"]

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[]
["診療情報提供書"]
[null,null,null,null,null,null,null,null,null,null,null,null,"申込日（FAX送信日）：",null,null,null,null,null,{"$f":"TODAY()","v":"2024-11-11"}]
[null,null,null,null,null,null,null,null,null,null,null,null,"紹介元"]
[null,null,null,null,null,null,null,null,null,null,null,null,"医療機関名",null,null,{"$f":"IF('紹介患者診療申し込み '!$P7>1,'紹介患者診療申し込み '!$P7,\"\")","v":""}]
["医療法人渓和会 江別病院",null,null,null,null,null,null,null,null,null,null,null,"所在地",null,null,{"$f":"IF('紹介患者診療申し込み '!$P8>1,'紹介患者診療申し込み '!$P8,\"\")","v":""}]
["〒069-0817　北海道江別市野幌代々木町81－6　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF('紹介患者診療申し込み '!$P9>1,'紹介患者診療申し込み '!$P9,\"\")","v":""}]
[null,"診療科名",null,{"$f":"'紹介患者診療申し込み '!D37","v":"消化器内科"}]
[null,"医師氏名",null,{"$f":"'紹介患者診療申し込み '!H37","v":"ご担当医"},null,null,null,"先生御机下",null,null,null,null,"診療科",null,null,{"$f":"IF('紹介患者診療申し込み '!$P11>1,'紹介患者診療申し込み '!$P11,\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,"医師名",null,null,{"$f":"IF('紹介患者診療申し込み '!$P12>1,'紹介患者診療申し込み '!$P12,\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,"電話番号",null,null,{"$f":"IF('紹介患者診療申し込み '!$P13>1,'紹介患者診療申し込み '!$P13,\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,"FAX番号",null,null,{"$f":"IF('紹介患者診療申し込み '!$P14>1,'紹介患者診療申し込み '!$P14,\"\")","v":""}]
["患者情報"]
["フリガナ",null,{"$f":"IF('紹介患者診療申し込み '!$C28>1,'紹介患者診療申し込み '!$C28,\"\")","v":""},null,null,null,null,null,null,null,"性別",null,"生年月日",null,{"$f":"IF('紹介患者診療申し込み '!$O28>1,'紹介患者診療申し込み '!$O28,\"\")","v":""},null,null,null,null,null,"年齢",{"$f":"'紹介患者診療申し込み '!V28","v":""},"歳",{"$f":"DATEDIF(O14,S3,\"Y\")","v":{"$error":"#VALUE!"}}]
["患者氏名",null,{"$f":"IF('紹介患者診療申し込み '!$C29>1,'紹介患者診療申し込み '!$C29,\"\")","v":""},null,null,null,null,null,null,null,{"$f":"IF('紹介患者診療申し込み '!$K29>1,'紹介患者診療申し込み '!$K29,\"\")","v":""}]
[null,null,null,null,null,null,null,null,null,null,null,null,"電話番号",null,{"$f":"IF('紹介患者診療申し込み '!$O30>1,'紹介患者診療申し込み '!$O30,\"\")","v":""}]
["住所",null,{"$f":"IF('紹介患者診療申し込み '!$C31>1,'紹介患者診療申し込み '!$C31,\"\")","v":"〒"}]
[null,null,{"$f":"IF('紹介患者診療申し込み '!$C32>1,'紹介患者診療申し込み '!$C32,\"\")","v":""}]
[]
[]
["傷病名"]
[]
[]
["紹介目的"]
[]
["既往歴及び家族歴"]
[]
["症状、治療経過および検査結果"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["現在の処方",null,null,"お薬手帳のコピー",null,null,null,{"$f":"IF(X43=TRUE,\"有\",\"無\")","v":"無"},null,null,null,"お薬手帳のコピーがある際は、記載は不要です。",null,null,null,null,null,null,null,null,null,null,null,false]

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[null,"消化器内科","循環器内科","呼吸器内科","外科","脳神経外科","整形外科","糖尿病内科"]
[null,"品田　恵佐","鍛冶　徹","秋山　也寸史","野村　克","野村　三起夫","永井　正弘","ご担当医"]
[null,"大森　沙織","佐々木　基","中野　浩輔","梅本　浩平","石井　伸明","ご担当医"]
[null,"寺下　勝巳","松本　純一","ご担当医","佐々木　彩実","舘澤　諒大"]
[null,"ご担当医","ご担当医",null,"永井　一真","池田　寛"]
[null,null,null,null,"ご担当医","ご担当医"]