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{"sheet":"(はじめにお読み下さい)実績報告書の使い方","index":0,"n_rows":18,"n_cols":3,"rows_kept":18,"cut":false,"hidden":false,"merged":[[2,1,2,2],[5,1,5,2],[6,1,6,2],[4,1,4,2],[0,1,0,2]]}
[null,"　　　　　　　　　　　　　　　　　　実績報告書について"]
[]
[null,"【提出先】三重県医療保健部長寿介護課へ郵送（メール・FAX不可）\n　　　　　　宛先：〒514-8570　津市広明町１３番地　三重県 医療保健部 長寿介護課\n\n　　※交付申請書の提出先が国保連合会・県のいずれの場合も、実績報告書は三重県医療保健部\n　　　長寿介護課へ郵送してください。（国保連合会には提出しないでください。）"]
[]
[null,"【作成単位】\n１件の交付決定に対して１件の実績報告書を作成していただくことになります。複数の交付決定を受けている法人は、それぞれの交付決定ごとに、実績報告書を作成してください。\n\n【実績報告額】\n事業所ごとに、実績報告額が交付決定額を下回る場合は、差額分を返金していただきます。なお、事業所ごとの実績額が交付決定額を上回る場合でも、交付決定額以上の金額を交付することはできません。\n"]
[null,"【実績報告の作成手順】"]
[null,"・黄色のセルのみに入力してください！\n　（白色セルには計算式が入っているので、入力しないでください！）\n・シートの作成手順：様式３（職員票）→様式２（個票）→様式１（実績額一覧）→実績報告書（様式第10号）　　　"]
[]
["手順","都道府県の作業","事業所（法人本部）の作業"]
[1,"本Excelを管内の介護サービス事業者に配布"]
[2,null,"【様式３（職員表）】\n・支払実績を入力（交付申請書提出後に変更が生じた場合は修正）\n・慰労金の支払年月日、支払金額、支払わなかった場合の理由を記入\n※変更がなければ、交付申請書ファイルの様式３（職員表）のデータをコピーしていただいても結構です。\n※Excelファイルを開封した際は、｢コンテンツの有効化｣をクリック\n"]
[{"$f":"A11+1","v":3},null,"各事業所の様式３（職員表）を法人単位で一覧表として取りまとめ\n兼務する複数の介護サービス事業所等から重複して申請している者がいないかを確認\n※記入欄が不足する場合は、6行目～85行目を行ごとコピーし、86行目に右クリック→「コピーしたセルの挿入」で挿入。\n"]
[4,null,"【様式２（個票）】\n黄色のセルに入力\n各事業所の個票のシートを１つのExcelファイルに集約し、個票シート名を「個票●」（●は１からの半角の通し番号）に修正\n※個票シート名は、交付申請時のそれぞれの事業所の番号と同じにしてください。（各事業所の順番を交付申請時と同じにする。）\n"]
[5,null,"様式２（個票）の内容が、様式１（実績額一覧）に正しく反映されていることを確認\n※記入欄が不足する場合は、6行目～20行目を行ごとコピーし、21行目に右クリック→「コピーしたセルの挿入」で挿入。\n\n"]
[6,null,"実績報告書に、提出年月日、法人名、代表者名、交付決定日、文書番号、連絡先を入力\n"]
[{"$f":"A15+1","v":7},null,"完成したExcelファイルを紙に出力し、印刷が正しく表示されているか確認のうえ、封筒に「実績報告書（介護分）在中」と明記し、郵送\n※他の書類（介護給付費等に関する費用等の請求等）を同封しないこと。\n"]
[8,"事業者から実績報告書を受領し、内容を審査し、額の確定通知を発出\n返還金がある場合は、納入通知書を発行\n"]
[9,null,"実績報告額が交付決定額を下回る事業所がある場合、県から送付される納入通知書により、実績報告額と交付決定額の差額を返還\n"]

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["（様式第10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,{"$f":"IF($K$16=SUM(実績額一覧!$L$5:$L$29),\"○\",\"!実績額一覧の合計額と一致しません\")","v":"○"}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,null,"月",null,null,"日"]
[]
["三重県知事",null,null,null,null,null,"様"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（法人名）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※","送付済の交付決定通知の様式"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（役職・代表者名）"]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（介護分）に係る実績報告書"]
[]
[null,"令","和　",null,"年",null,null,"月",null,null,"日付け",null,null,"医保第１３－",null,null,null,null,null,null,null,"号","で交付決定を受けた令和２年度新型コロナ"]
["ウイルス感染症緊急包括支援交付金（介護分）について、事業が完了したので、交付要領第10条の"]
["規定により、関係書類を添え、下記のとおり報告します。"]
["記"]
[null,"実績報告額：　",null,null,null,null,null,null,null,null,{"$f":"R28","v":0},null,null,null,null,null,null,null,"千円"]
[]
[null,"（内訳）"]
[null,null,"事業名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"実績報告額",null,null,null,null,null,null,"交付決定額\n(交付済額）",null,null,null,null,null,null,"返還額"]
[null,null,"1.","介護慰労金事業",null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(実績額一覧!G5:G29)","v":0},null,null,null,"千円",null,null,{"$f":"SUM(実績額一覧!M5:M29)","v":0},null,null,null,"千円",null,null,{"$f":"IF(SUM(実績額一覧!R5:R29)=0,\"0\",SUM(実績額一覧!R5:R29))","v":"0"},null,null,null,"千円"]
[]
[null,null,"2．","感染症対策を徹底した上での",null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(実績額一覧!I5:I29)","v":0},null,null,null,"千円",null,null,{"$f":"SUM(実績額一覧!N5:N29)","v":0},null,null,null,"千円",null,null,{"$f":"IF(SUM(実績額一覧!S5:S29)=0,\"0\",SUM(実績額一覧!S5:S29))","v":"0"},null,null,null,"千円"]
[null,null,null,"介護サービス提供支援事業"]
[null,null,"3．","在宅サービス事業所による",null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(実績額一覧!J5:J29)","v":0},null,null,null,"千円",null,null,{"$f":"SUM(実績額一覧!O5:O29)","v":0},null,null,null,"千円",null,null,{"$f":"IF(SUM(実績額一覧!T5:T29)=0,\"0\",SUM(実績額一覧!T5:T29))","v":"0"},null,null,null,"千円"]
[null,null,null,"利用者への再開支援への助成事業"]
[null,null,"4．","在宅サービス事業所における",null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(実績額一覧!K5:K29)","v":0},null,null,null,"千円",null,null,{"$f":"SUM(実績額一覧!P5:P29)","v":0},null,null,null,"千円",null,null,{"$f":"IF(SUM(実績額一覧!U5:U29)=0,\"0\",SUM(実績額一覧!U5:U29))","v":"0"},null,null,null,"千円"]
[null,null,null,"環境整備への助成事業"]
[null,null,"計",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(実績額一覧!L5:L29)","v":0},null,null,null,"千円",null,null,{"$f":"SUM(実績額一覧!Q5:Q29)","v":0},null,null,null,"千円",null,null,{"$f":"IF(SUM(実績額一覧!V5:V29)=0,\"0\",SUM(実績額一覧!V5:V29))","v":"0"},null,null,null,"千円"]
[]
[]
[]
[null,"（関係書類）"]
[null,"１　事業所・施設別実績額一覧（様式１）"]
[null,"２　新型コロナウイルス感染症緊急包括支援交付金（介護分）に関する事業実績報告書"]
[null,null,null,"（事業所単位）（様式２）"]
[null,"３　介護慰労金受給職員表（法人単位）（様式３）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"【実績内容に関する連絡先】"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 法人住所",null,null,null,null,null,null,null,"〒"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 部署名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 担当者氏名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 連絡先",null,null,null,"電話番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," e-mail"]

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["（様式１）事業所・施設別実績額一覧"]
[]
["No.","介護保険\n事業所番号","事業所・施設名","サービス種別","郵便番号","住所","実績報告額（千円）",null,null,null,null,null,"交付済額（交付決定額）（千円）",null,null,null,null,"返還額（千円）"]
[null,null,null,null,null,null,"介護\n慰労金","20万円\n対象者の\n有無","感染対策\n費用助成\n事業","個別再開\n支援助成\n事業","再開環境\n整備助成\n事業","合計","介護\n慰労金","感染対策\n費用助成\n事業","個別再開\n支援助成\n事業","再開環境\n整備助成\n事業","合計","介護\n慰労金","感染対策\n費用助成\n事業","個別再開\n支援助成\n事業","再開環境\n整備助成\n事業","合計"]
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["（注）行が不足する場合には、「実績報告書の使い方」に従って、行を追加すること。列の挿入は絶対に行わないこと。"]
[null,null,"　"]

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["（様式２）"]
[]
["新型コロナウイルス感染症緊急包括支援交付金（介護分）に関する事業実績報告書（事業所単位）",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（１）①　",null,null,"（２）②"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"共通",null,"単価","共通"]
["施設概要",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通所介護事業所（通常規模型）",892,"/事業所",null,200,"/事業所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通所介護事業所（大規模型（Ⅰ））",1137,"/事業所",null,200,"/事業所"]
["介護保険事業所番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所名称",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通所介護事業所（大規模型（Ⅱ））",1480,"/事業所",null,200,"/事業所"]
["所在地",null,null,"郵便番号",null,null,null,"都道府県名",null,null,null,"住所",null,null,null,null,null,null,null,null,null,null,null,null,null,"連絡先",null,null,"電話番号",null,null,null,null,"担当部署名",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,"地域密着型通所介護事業所(療養通所介護事業所を含む)",384,"/事業所",null,200,"/事業所"]
[null,null,null,null,null,null,null,"三重県",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認知症対応型通所介護事業所",375,"/事業所",null,200,"/事業所"]
["提供サービス",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"サービス種類コード",null,null,null,null,null,null,null,"定員",null,null,null,null,"人",null,"職員数\n(派遣含む)",null,null,null,null,"人",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通所リハビリテーション事業所（通常規模型）",939,"/事業所",null,200,"/事業所"]
["事業区分",null,null,null,null,null,null,null,null," 介護慰労金事業　→　1を記載",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"  感染対策費用助成事業　→ 2を記載",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通所リハビリテーション事業所（大規模型（Ⅰ））",1181,"/事業所",null,200,"/事業所"]
[null,null,null,null,null,null,null,null,null," 個別再開支援助成事業　→ 3を記載",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　再開環境整備助成事業　→ 4を記載",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通所リハビリテーション事業所（大規模型（Ⅱ））",1885,"/事業所",null,200,"/事業所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"短期入所生活介護事業所",{"$f":"CD13*個票1!$AC$10","v":0},"/定員",44,200,"/事業所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"短期入所療養介護事業所",{"$f":"CD14*個票1!$AC$10","v":0},"/定員",44,200,"/事業所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"訪問介護事業所",534,"/事業所",null,200,"/事業所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"訪問入浴介護事業所",564,"/事業所",null,200,"/事業所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"訪問看護事業所",518,"/事業所",null,200,"/事業所"]
["支出済額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"訪問リハビリテーション事業所",227,"/事業所",null,200,"/事業所"]
["１．介護慰労金事業",null,null,null,null,null,null,null," ※対象職員の氏名等について、様式３を作成すること。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"定期巡回・随時対応型訪問介護看護事業所",508,"/事業所",null,200,"/事業所"]
[null,null,null,null,null,null,null,null,null,null,null,"実績報告額①",null,null,null,null,{"$f":"IF(Z20=\"\",\"0\",MIN(AE22,Z20))","v":"0"},null,null,"千円",null,"交付済額",null,null,null,null,null,null,"千円",null,"返還額",null,null,null,{"$f":"IF(Z20-Q20=0,\"0\",Z20-Q20)","v":"0"},null,null,"千円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"夜間対応型訪問介護事業所",204,"/事業所",null,200,"/事業所"]
["慰労金の区分・人数",null,null,null,null,null,null,"20万円対象",null,null,null,null,null,null,null,"人","5万円対象",null,null,null,null,null,null,null,"人","振込手数料",null,null,null,null,null,null,null,"千円（千円未満切り捨て）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"居宅介護支援事業所",148,"/事業所",null,200,"/事業所"]
["実績額（基準額に慰労金給付対象者の人数を乗じた額及び振込手数料の実費の合計）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF((20*M21+5*V21)*10+AE21=0,0,(20*M21+5*V21)*10+AE21)","v":0},null,null,"千円（千円未満切り捨て）",null,null,null,null,null,null,{"$f":"IF(M21=0,,\"有\")","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"福祉用具貸与事業所",148,"/事業所",null,200,"/事業所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"居宅療養管理指導事業所",33,"/事業所",null,200,"/事業所"]
["2．感染症対策を徹底した上での介護サービス提供支援事業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"補助上限額",null,null,null,null,"実績額","実績報告額②",null,null,null,null,{"$f":"IF(OR(X25=\"\",AI25=\"\"),\"0\",MIN(X25,ROUNDDOWN(H37/1000,0),AI25))","v":"0"},null,null,"千円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"小規模多機能型居宅介護事業所",475,"/事業所",null,200,"/事業所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(VLOOKUP(H10,個票1!CA5:CB39,2,FALSE),\"\")","v":""},null,null,"千円",null,null,"交付済額",null,null,null,null,null,null,null,"千円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"看護小規模多機能型居宅介護事業所",638,"/事業所",null,200,"/事業所"]
["【感染拡大防止対策や介護サービスの提供体制の確保のための経費】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返還額",null,null,null,null,{"$f":"IF(AI25-AI24=0,\"0\",AI25-AI24)","v":"0"},null,null,"千円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"介護老人福祉施設",{"$f":"CD26*個票1!$AC$10","v":0},"/定員",38,"-"]
["科目",null,null,null,null,null,null,"実績額（円）",null,null,null,null,"品目（必須）・数量（必須）・用途（品目のみでは、用途が判らない場合）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地域密着型介護老人福祉施設",{"$f":"CD27*個票1!$AC$10","v":0},"/定員",40,"-"]
["賃金・報酬",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"介護老人保健施設",{"$f":"CD28*個票1!$AC$10","v":0},"/定員",38,"-"]
["謝金",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"介護医療院",{"$f":"CD29*個票1!$AC$10","v":0},"/定員",48,"-"]
["会議費",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"介護療養型医療施設",{"$f":"CD30*個票1!$AC$10","v":0},"/定員",43,"-"]
["旅費",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認知症対応型共同生活介護事業所",{"$f":"CD31*個票1!$AC$10","v":0},"/定員",36,"-"]
["需用費",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"養護老人ホーム（定員30人以上）",{"$f":"CD32*個票1!$AC$10","v":0},"/定員",37,"-"]
["役務費",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"養護老人ホーム（定員29人以下）",{"$f":"CD33*個票1!$AC$10","v":0},"/定員",35,"-"]
["委託料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"軽費老人ホーム（定員30人以上）",{"$f":"CD34*個票1!$AC$10","v":0},"/定員",37,"-"]
["使用料及び賃借料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"軽費老人ホーム（定員29人以下）",{"$f":"CD35*個票1!$AC$10","v":0},"/定員",35,"-"]
["備品購入費",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有料老人ホーム（定員30人以上）",{"$f":"CD36*個票1!$AC$10","v":0},"/定員",37,"-"]
["合計",null,null,null,null,null,null,{"$f":"SUM(H28:L36)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有料老人ホーム（定員29人以下）",{"$f":"CD37*個票1!$AC$10","v":0},"/定員",35,"-"]
["3．在宅サービス事業所による利用者への再開支援への助成事業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"サービス付き高齢者向け住宅（定員30人以上）",{"$f":"CD38*個票1!$AC$10","v":0},"/定員",37,"-"]
[null,null,null,null,null,null,null,null,null,null,null,"実績報告額③",null,null,null,null,{"$f":"IF(Z39=\"\",\"0\",MIN(AI46,Z39))","v":"0"},null,null,"千円",null,"交付済額",null,null,null,null,null,null,"千円",null,"返還額",null,null,null,{"$f":"IF(Z39-Q39=0,\"0\",Z39-Q39)","v":"0"},null,null,"千円",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"サービス付き高齢者向け住宅（定員29人以下）",{"$f":"CD39*個票1!$AC$10","v":0},"/定員",35,"-"]
["利用者１人あたり単価\n　（居宅介護支援以外共通）",null,null,null,null,null,null,null,null,null,"電話による確認",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF($H$10=\"介護予防・生活支援サービス事業の事業者\",\"\",1500)","v":1500},null,null,"円",null,"対象利用者数",null,null,null,null,null,null,null,null,"人",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"介護予防・生活支援サービス事業の事業者"]
[null,null,null,null,null,null,null,null,null,null,"訪問による確認",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF($H$10=\"介護予防・生活支援サービス事業の事業者\",\"\",3000)","v":3000},null,null,"円",null,"対象利用者数",null,null,null,null,null,null,null,null,"人"]
[null,"居宅介護支援のみ\n右欄に記載",null,null,null,null,null,null,null,null,"電話による確認",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF($H$10=\"介護予防・生活支援サービス事業の事業者\",\"\",1500)","v":1500},null,null,"円",null,"対象利用者数",null,null,null,null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,null,"電話による確認（看護師等が協力した場合）",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF($H$10=\"介護予防・生活支援サービス事業の事業者\",\"\",4500)","v":4500},null,null,"円",null,"対象利用者数",null,null,null,null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,null,"訪問による確認",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF($H$10=\"介護予防・生活支援サービス事業の事業者\",\"\",3000)","v":3000},null,null,"円",null,"対象利用者数",null,null,null,null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,null,"訪問による確認（看護師等が協力した場合）",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF($H$10=\"介護予防・生活支援サービス事業の事業者\",\"\",6000)","v":6000},null,null,"円",null,"対象利用者数",null,null,null,null,null,null,null,null,"人"]
["実績額（基準額に対象利用者数を乗じた額の合計）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(H10=\"居宅介護支援事業所\",(X42*AI42+X43*AI43+X44*AI44+X45*AI45)/1000,(X40*AI40+X41*AI41)/1000)","v":0},null,null,"千円"]
[]
["4．在宅サービス事業所における環境整備への助成事業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"補助上限額",null,null,null,null,"申請額","実績報告額④",null,null,null,null,{"$f":"IF(OR(X49=\"-\",AI49=\"\"),\"0\",MIN(X49,ROUNDDOWN(H61/1000,0),AI49))","v":"0"},null,null,"千円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IFERROR(VLOOKUP(H10,個票1!CA5:CE39,5,FALSE),\"\")","v":""},null,null,"千円",null,null,"交付済額",null,null,null,null,null,null,null,"千円"]
["【在宅サービス事業所における環境整備のための経費】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"返還額",null,null,null,null,{"$f":"IF(AI49-AI48=0,\"0\",AI49-AI48)","v":"0"},null,null,"千円"]
["科目",null,null,null,null,null,null,"実績額（円）",null,null,null,null,"品目（必須）・数量（必須）・用途（品目のみでは、用途が判らない場合）"]
["賃金・報酬"]
["謝金"]
["会議費"]
["旅費"]
["需用費"]
["役務費"]
["委託料"]
["使用料及び賃借料"]
["備品購入費"]
["合計",null,null,null,null,null,null,{"$f":"SUM(H52:L60)","v":0}]
["※記入スペースがない場合は、行の幅を広げて、入力内容をすべて印字させてください。（行の挿入、削除は不可）"]

{"sheet":"職員表","index":4,"n_rows":86,"n_cols":22,"rows_kept":86,"cut":false,"hidden":false,"merged":[[3,19,3,21],[3,15,3,18],[3,0,4,0],[3,6,4,6],[3,7,3,9],[3,14,4,14],[3,1,4,1],[3,2,4,2],[3,3,4,3],[3,10,3,13]]}
["（様式３）介護慰労金受給職員表（法人単位）"]
[]
["※　本表は法人単位でまとめて記載すること。"]
[null,"氏名\n（漢字）","氏名\n（全角カナ）","生年月日\n（西暦）",null,null,"本人の住所","主たる勤務先",null,null,"分類",null,null,null,"慰労金\n(万円)","確認事項",null,null,null,"支払実績"]
[null,null,null,null,"（確認用）","（確認用）",null,"事業所番号","サービス種類コード","事業所・施設の名称","施設区分","対応区分","(計算用)","他の施設等との期間通算がある場合その施設名",null,"委任状の有無","他法人での慰労金の申請の有無","業務委託による\n従事者","重複\n申請者確認用","支払年月日\n(西暦)","支払金額\n（円）","支払わなかった場合の理由"]
[{"$f":"ROW()-5","v":1},null,null,null,{"$f":"B6&C6&D6","v":""},{"$f":"IF(E6=\"\",\"\",COUNTIF($E$6:$E$85,E6))","v":""},null,null,null,null,null,null,{"$f":"K6&L6","v":""},null,{"$f":"IFERROR(VLOOKUP(M6,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,{"$f":"IF(F6>=2,\"\",\"可\")","v":""}]
[{"$f":"ROW()-5","v":2},null,null,null,{"$f":"B7&C7&D7","v":""},{"$f":"IF(E7=\"\",\"\",COUNTIF($E$6:$E$85,E7))","v":""},null,null,null,null,null,null,{"$f":"K7&L7","v":""},null,{"$f":"IFERROR(VLOOKUP(M7,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,{"$f":"IF(F7>=2,\"\",\"可\")","v":""}]
[3,null,null,null,{"$f":"B8&C8&D8","v":""},{"$f":"IF(E8=\"\",\"\",COUNTIF($E$6:$E$85,E8))","v":""},null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M8,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[4,null,null,null,"",{"$f":"IF(E9=\"\",\"\",COUNTIF($E$6:$E$85,E9))","v":""},null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M9,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[5,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M10,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[6,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M11,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[7,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M12,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[8,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M13,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[9,null,null,null,"","",null,null,null,null,null,null,{"$f":"K14&L14","v":""},null,{"$f":"IFERROR(VLOOKUP(M14,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[10,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M15,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[11,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M16,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[12,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M17,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[13,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M18,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[14,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M19,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[15,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M20,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[16,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M21,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[17,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M22,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[18,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M23,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[19,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M24,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[20,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M25,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[21,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M26,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[22,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M27,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[23,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M28,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[24,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M29,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[25,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M30,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[26,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M31,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[27,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M32,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[28,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M33,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[29,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M34,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[30,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M35,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[31,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M36,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[32,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M37,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[33,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M38,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,{"$f":"IF(F38>=2,\"\",\"可\")","v":""}]
[34,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M39,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[35,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M40,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[36,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M41,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[37,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M42,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[38,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M43,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[39,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M44,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[40,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M45,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[41,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M46,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[42,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M47,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
[43,null,null,null,"","",null,null,null,null,null,null,"",null,{"$f":"IFERROR(VLOOKUP(M48,計算用!$A$8:$B$15,2,FALSE),\"\")","v":""},null,null,null,""]
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[null,"（注）行が不足する場合には、「実績報告書の使い方」に従って、行を追加すること。列の挿入は絶対に行わないこと。"]

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["別紙"]
["役　員　等　調　書"]
[]
["法人名"]
["交付決定年月日","令和",null,"年",null,"月",null,"日"]
["交付決定番号","三重県指令医保第１３－　　　　号",null,null,null,null,null,"号"]
["交付決定額（計）",null,null,null,null,null,null,"円"]
["役員等の状況"]
["ｼﾒｲ","氏名",null,"生年月日",null,null,null,"性別","備考","法人名"]
[null,null,null,"元号","年","月","日",null,"（氏名の異体字など）"]
["(例) ﾊﾂﾄﾘ ｼﾕｳｿﾞｳ","服部　修造",null,"S",40,1,1,"M"]
[null,null,null,null,null,null,null,null,null,{"$f":"IF($A12=\"\",\"\",$B$4)","v":""}]
[null,null,null,null,null,null,null,null,null,""]
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[null,null,null,null,null,null,null,"※本シートは絶対に編集しないこと。"]
["施設区分"]
["陽性者(濃厚接触者)発生施設","通所系･施設系で1日以上勤務又は訪問系で陽性者等に1日以上対応","訪問系で陽性者等への対応はないが対象期間に10日以上勤務","対象期間の勤務が９日以下"]
["その他の施設","対象期間に10日以上勤務","対象期間の勤務が9日以下"]
[]
[]
["慰労金単価"]
[{"$f":"A3&B3","v":"陽性者(濃厚接触者)発生施設通所系･施設系で1日以上勤務又は訪問系で陽性者等に1日以上対応"},20]
[{"$f":"A3&C3","v":"陽性者(濃厚接触者)発生施設訪問系で陽性者等への対応はないが対象期間に10日以上勤務"},5]
[{"$f":"A3&D3","v":"陽性者(濃厚接触者)発生施設対象期間の勤務が９日以下"},0]
[{"$f":"A4&B4","v":"その他の施設対象期間に10日以上勤務"},5]
[{"$f":"A4&C4","v":"その他の施設対象期間の勤務が9日以下"},0]
[]
[]
[]
[]
["なし"]
["あり"]
[]
[]
["北海道"]
["青森県"]
["岩手県"]
["宮城県"]
["秋田県"]
["山形県"]
["福島県"]
["茨城県"]
["栃木県"]
["群馬県"]
["埼玉県"]
["千葉県"]
["東京都"]
["神奈川県"]
["新潟県"]
["富山県"]
["石川県"]
["福井県"]
["山梨県"]
["長野県"]
["岐阜県"]
["静岡県"]
["愛知県"]
["三重県"]
["滋賀県"]
["京都府"]
["大阪府"]
["兵庫県"]
["奈良県"]
["和歌山県"]
["鳥取県"]
["島根県"]
["岡山県"]
["広島県"]
["山口県"]
["徳島県"]
["香川県"]
["愛媛県"]
["高知県"]
["福岡県"]
["佐賀県"]
["長崎県"]
["熊本県"]
["大分県"]
["宮崎県"]
["鹿児島県"]
["沖縄県"]