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[null,null,null,"「医療措置協定」の締結に係る事前回答票\n （訪問看護事業所用）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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\n事業所用"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"…必須回答欄です"]
[]
[]
[]
[null,"第１　基本情報を入力してください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"第３　「個人防護具の備蓄」について入力してください。"]
[null,null,"１　医療機関（訪問看護事業所）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,"１　個人防護具の備蓄について"]
[null,null,"２　管理者氏名",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,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AW7=\"否\",\"【以下は入力不要・第５へ進んでください】\",\"↓\")","v":"↓"}]
[null,null,"３　担当者氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"２　各物資の備蓄数量・期間を入力してください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（備蓄を行わない物資については「0」をご記入ください）"]
[null,null,"４　郵便番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・サージカルマスク",null,null,null,null,null,null,null,null,null,null,null,"枚","×",null,null,null,"か月分",null,"=",{"$f":"AR10*AW10","v":0},null,null,"枚"]
[null,null,"５　所在地",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・Ｎ95マスク",null,null,null,null,null,null,null,null,null,null,null,"枚","×",null,null,null,"か月分",null,"=",{"$f":"AR11*AW11","v":0},null,null,"枚"]
[null,null,"６　電話番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・アイソレーションガウン",null,null,null,null,null,null,null,null,null,null,null,"枚","×",null,null,null,"か月分",null,"=",0,null,null,"枚"]
[null,null,"７　メールアドレス",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・フェイスシールド",null,null,null,null,null,null,null,null,null,null,null,"枚","×",null,null,null,"か月分",null,"=",0,null,null,"枚"]
[null,null,"８　ファックス番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・非滅菌手袋",null,null,null,null,null,null,null,null,null,null,null,"枚","×",null,null,null,"か月分",null,"=",0,null,null,"枚"]
[null,null,"９　保険医療機関コード",null,null,null,null,null,null,null,null,null,null,null,null,null,"（10ケタ・未定時は「未定」と入力）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（",{"$f":"AR14/2","v":0},null,"双","×",{"$f":"AW14","v":0},null,null,"か月分",null,"=",{"$f":"AS15*AW15","v":0},null,"双）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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月当たりの枚数　",null,null,null,null,null,"協定書には太字部分の値を記載します。"]
[]
[null,"第２　「自宅療養者等への医療の提供」について入力してください。"]
[null,null,"１　自宅療養者等への医療の提供について",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,"第４　その他事項・第二種協定指定医療機関への指定について"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(S19=\"否\",IF(#REF!=\"否\",\"\",\"【以下は入力不要・第３へ進んでください】\"),\"↓\")","v":"↓"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,"１　その他事項があればご入力ください。"]
[null,null,"２　以下の事項について、対応の可否を入力してください。"]
[null,null,null," 一　自宅療養者への対応"]
[null,null,null,null,"・普段から訪問看護を実施している患者への対応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"２　第二種協定指定医療機関への指定について"]
[null,null,null,null,"・普段連携している医療機関から対応の依頼があった新規患者への対応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療措置協定にあわせて、感染症法の規定に基づき「第二種協定指定医療機関」への指定も行います。（指定に当たっては以下の指定要件を満たす必要があります。）"]
[null,null,null,null,"・普段連携を行っていない医療機関から対応の依頼があった新規患者への対応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"開設者氏名"]
[null,null,null,"二　高齢者施設内療養者への対応"]
[null,null,null,null,"・普段から訪問看護を実施している患者への対応"]
[null,null,null,null,"・普段連携している医療機関から対応の依頼があった新規患者への対応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"第二種協定指定医療機関の指定要件"]
[null,null,null,null,"・普段連携を行っていない医療機関から対応の依頼があった新規患者への対応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"＜外出自粛対象者への医療提供（自宅療養者等への医療提供）＞"]
[null,null,null," 三　障害者施設内療養者への対応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"当該指定訪問看護事業者に所属する者に対して、最新の知見に基づき適切な感染防止等の措置を実施することが\n"]
[null,null,null,null,"・普段から訪問看護を実施している患者への対応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　可能であること。"]
[null,null,null,null,"・普段連携している医療機関から対応の依頼があった新規患者への対応",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 新型インフルエンザ等感染症等発生等公表期間において、都道府県からの要請を受けて、外出自粛対象者に対して\n　訪問看護を行う体制が整っていると認められること。"]
[null,null,null,null,"・普段連携を行っていない医療機関から対応の依頼があった新規患者への対応"]
[null,null,"３　特記事項があればご入力ください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※ご入力いただいた事前回答票は三重県ホームページの回答フォームからご提出下さい。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　（お問い合わせ先：三重県医療保健部　感染症対策課　☎：059-224-2352（平日8:30～17:15））"]