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["情報連携シート"]
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["氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"J2","Ⅱa"]
["利用者住所\n連絡先",null,"〒",null,null,null,null,null,null,"家族構成（同一世帯は○で囲む・キーパーソンは☆をつける）",null,null,null,null,null,null,null,null,null,null,null,"A1","Ⅱb"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"A2","Ⅲa"]
[null,null,"TEL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"B1","Ⅲb"]
["緊急連絡先➀",null,null,null,null,"様","続柄",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"B2","Ⅳ"]
[null,null,"TEL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C1","Ｍ"]
["緊急連絡先②",null,null,null,null,"様","続柄",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C2","自立"]
[null,null,"TEL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"自立"]
["介護度",null,null,null,null,null,"期間",null,null,null,null,"負担割合"]
["かかりつけ医\n等",null,"医師名　　　　　　　　",null,null,null,"医療機関名",null,null,null,null,null,"TEL"]
[null,null,"医師名　　　　　　　　　医療機関名：　　　　　　　　　　　　　TEL：",null,null,null,"医療機関名",null,null,null,null,null,"TEL"]
[null,null,"病名/障害名",null,null,null,"（発症年月日）",null,null,"病名/障害名",null,null,null,"（発症年月日）"]
["意見書傷病名\nほか病名/障害名"]
[]
["認知症高齢者\n自立度",null,null,"障害/日常生活\n自立度",null,null,"認知症の症状"]
["視力","普通　弱視　全盲",null,null,null,null,null,null,"食事摂取","自立　一部介助　全介助"]
["聴力","普通　難聴",null,null,null,null,null,null,"移動\n（屋内）","自立　一部介助　全介助"]
["意思\n疎通","普通　やや困難　困難",null,null,null,null,null,null,"移動\n（屋外）","自立　一部介助　全介助"]
["麻痺","無し　有",null,null,null,null,null,null,"排泄","自立　一部介助　全介助"]
["座位保持","自立　支えが必要　出来ない",null,null,null,null,null,null,"更衣","自立　一部介助　全介助"]
["立位保持","自立　つまかれば可　出来ない",null,null,null,null,null,null,"入浴","自立　一部介助　全介助"]
["普段の生活",null,null,null,null,null,null,null,null,null,null,null,"サービス種別"]
[]
[]
[]
[]
["退院後又は療養先　もしくは　利用者の生活に対する希望・思い等"]
[null,"自宅",null,"施設",null,null,null,null,"未定",null,"医療機関"]
["フリースペース"]
[]
["介護支援専門員",null,null,null,null,"事業所名",null,null,null,null,null,"TEL"]
[null,"退院時に書類を希望します。"]
["泉佐野泉南医師会・６市町ケアマネジャー合同連絡会・南泉州地域医療介護連携協議会　　　作成年月日　2017．6．21"]

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["医療・介護　情報連携シート"]
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["フリガナ",null,null,null,null,null,"性別",null,null,"生年月日",null,null,null,null,"歳"]
["氏名"]
["利用者住所\n連絡先",null,"〒",null,null,null,null,null,null,"家族構成（同一世帯は○で囲む・キーパーソンは☆をつける）"]
[null,null,"TEL"]
["緊急連絡先",null,null,null,null,"様","続柄"]
[null,null,"TEL"]
["介護度",null,null,null,null,null,"期間","～　平成　　 年　　月　　　日",null,null,null,"負担割合"]
["かかりつけ医\n等",null,"医師名：　　　　　　　　　医療機関名：　　　　　　　　　　　　　TEL："]
[null,null,"医師名：　　　　　　　　　医療機関名：　　　　　　　　　　　　　TEL："]
[null,null,"病名/障害名",null,null,null,"（発症年月日）",null,null,"病名/障害名",null,null,null,"（発症年月日）"]
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[]
["認知症高齢者\n自立度",null,null,"障害/日常生活\n自立度",null,null,"認知症の症状"]
["視力","普通　弱視　全盲",null,null,"[　　　　　　　　　　]",null,null,null,"食事摂取","自立　一部介助　全介助",null,null,"[　　　　　　　　　　]"]
["聴力","普通　難聴",null,null,"[　　　　　　　　　　]",null,null,null,"移動\n（屋内）","自立　一部介助　全介助",null,null,"[　　　　　　　　　　]"]
["意思\n疎通","普通　やや困難　困難",null,null,"[　　　　　　　　　　]",null,null,null,"移動\n（屋外）","自立　一部介助　全介助",null,null,"[　　　　　　　　　　]"]
["麻痺","無し　有",null,null,"[　　　　　　　　　　]",null,null,null,"排泄","自立　一部介助　全介助",null,null,"[　　　　　　　　　　]"]
["座位保持","自立　支えが必要　出来ない",null,null,"[　　　　　　　　　　]",null,null,null,"更衣","自立　一部介助　全介助",null,null,"[　　　　　　　　　　]"]
["立位保持","自立　つまかれば可　出来ない",null,null,"[　　　　　　　　　　]",null,null,null,"入浴","自立　一部介助　全介助",null,null,"[　　　　　　　　　　]"]
["普段の生活",null,null,null,null,null,null,null,null,null,null,null,"サービス種別"]
[]
[]
[]
[]
["退院後又は療養先　もしくは　利用者の生活に対する希望・思い等"]
["□","自宅","□","施設","（　　　　　　　）",null,null,"□","未定","□","医療機関",null,"（　　　　　　　　）"]
["フリースペース"]
[]
["介護支援専門員",null,null,null,null,"事業所名",null,null,null,null,null,"TEL"]
["□　退院時に書類を希望します。"]
["泉佐野泉南医師会・６市町ケアマネジャー合同連絡会・南泉州地域医療介護連携協議会　　　作成年月日　２０１７．６．２１"]

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["医療・介護　情報連携シート",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"作成日","Ｈ29.4"]
[null,null,null,null,null,null,null,null,null,null,null,null,"作成日","2017-06-21",null,null,null,null,"フリガナ"]
["フリガナ",null,null,null,null,null,"性別","男・女",null,"生年月日","大正\n昭和","1７年４月１日",null,null,"75歳",null,null,null,"利用者　氏名","inoue "]
["氏名",null,"Ａさん",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別","otoko "]
["利用者住所\n連絡先",null,"〒599-0301","大阪府泉南郡岬町",null,null,null,null,null,"家族構成（同一世帯は○で囲む・キーパーソンは☆をつける）",null,null,null,null,null,null,null,null,"生年月日"]
[null,null,"TEL","494-0000",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"利用者住所"]
["緊急連絡先",null,null,"Ｂさん",null,"様","続柄","夫",null,null,null,null,null,null,null,null,null,null,"連絡先"]
[null,null,"TEL","090-1111-1111",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"緊急連絡先"]
["介護度",null,"要介護②",null,null,null,"期間","～　平成　30　年　3　月　1日",null,null,null,"負担割合",null,"2割",null,null,null,null,"介護度"]
["かかりつけ医\n等",null,"医師名：　Ｃ医師　　　　　　　　医療機関名：　　Ｃクリニック　　　　　　　　　　　TEL：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"かかりつけ医"]
[null,null,"医師名：　　　　　　　　　医療機関名：　　　　　　　　　　　　　TEL："]
[null,null,"病名/障害名",null,null,null,"（発症年月日）",null,null,"病名/障害名",null,null,null,"（発症年月日）"]
["意見書傷病名\nほか病名/障害名",null,"糖尿病",null,null,null,"不詳"]
[null,null,"脳梗塞",null,null,null,"2015-01-01"]
["認知症高齢者\n自立度",null,"Ⅱａ","障害/日常生活\n自立度",null,"Ａ2","認知症の症状",null,"物忘れと理解力の低下で服薬管理ができない。"]
["視力","普通　弱視　全盲",null,null,"[　　　　　　　　　　]",null,null,null,"食事摂取","自立　一部介助　全介助",null,null,"[　キザミ食　　　　　]"]
["聴力","普通　難聴",null,null,"[　　　　　　　　　　]",null,null,null,"移動\n（屋内）","自立　一部介助　全介助",null,null,"[　四点杖使用　　　　]"]
["意思\n疎通","普通　やや困難　困難",null,null,"[言語障害のため聞き取りにくい]",null,null,null,"移動\n（屋外）","自立　一部介助　全介助",null,null,"[　歩行器使用　]"]
["麻痺","無し　有",null,null,"[　　右半身マヒ　　　　]",null,null,null,"排泄","自立　一部介助　全介助",null,null,"[　　リハビリパンツ使用、　]"]
["座位保持","自立　支えが必要　出来ない",null,null,"[　　　背もたれ必要　　]",null,null,null,"更衣","自立　一部介助　全介助",null,null,"[上着の着替え時に介助が必要]"]
["立位保持","自立　つまかれば可　出来ない",null,null,"[　片足での立位は困難　]",null,null,null,"入浴","自立　一部介助　全介助",null,null,"[　週２回デイケアにて　]"]
["普段の生活",null,null,null,null,null,null,null,null,null,null,null,"サービス種別"]
["夫と二人暮らし。糖尿病でインシュリン注射を夫の介助でて行っていたが、2015年1月に",null,null,null,null,null,null,null,null,null,null,null,"通所リハビリ（火、木）"]
["脳梗塞を発症し、右半身マヒ、言語障害と認知能力の低下があり、着替え、排泄等",null,null,null,null,null,null,null,null,null,null,null,"福祉用具貸与"]
["身の回りのことは夫が介助している。また、関節の拘縮予防と下肢筋力の維持や"]
["認知症の抑制のためデイケアを利用している。"]
["退院後又は療養先　もしくは　利用者の生活に対する希望・思い等"]
["■","自宅","□","施設","（　　　　　　　）",null,null,"□","未定","□","医療機関",null,"（　　　　　　　　）"]
["フリースペース",null,"脳梗塞の再発で入院することになりましたが、本人も夫も退院後は自宅での生活を希望されています。言語障害、物忘れはありますが、問題行動はほとんどありません。右半身まひのため、立ち上がりや歩行が不安定で転倒のリスクは大きく、注意が必要です。娘二人は、遠方に住んでいるため本人の介助は期待できません。夫婦ともに厚生年金があり、持ち家に住んでいます。夫は、車の運転ができますので病院までの通院や付添も可能ですが、退院後に状態が悪化していると夫の介護負担も大きくなると思われます。"]
[]
["介護支援専門員",null,"T．Ｏ",null,null,"事業所名",null,"Ｏケアプランセンター",null,null,null,"TEL","072-494-0000"]
["■　退院時に書類を希望します。"]
["泉佐野泉南医師会・６市町ケアマネジャー合同連絡会・南泉州地域医療介護連携協議会　　　作成年月日　２０１７．６．２１"]

{"sheet":"記入例（認知症）","index":3,"n_rows":33,"n_cols":20,"rows_kept":33,"cut":false,"hidden":false,"merged":[[31,0,31,15],[32,0,32,15],[33,11,33,15],[28,0,29,1],[28,2,29,15],[30,0,30,1],[30,2,30,4],[30,5,30,6],[30,7,30,10],[30,12,30,15],[27,4,27,6],[27,10,27,11],[27,12,27,15],[21,0,21,11],[21,12,21,15],[22,0,22,11],[22,12,22,15],[23,0,23,11],[23,12,23,15],[24,0,24,11],[24,12,24,15],[25,0,25,11],[25,12,25,15],[26,0,26,10],[19,1,19,3],[19,4,19,7],[19,9,19,11],[19,12,19,15],[20,1,20,3],[20,4,20,7],[20,9,20,11],[20,12,20,15],[17,1,17,3],[17,4,17,7],[17,9,17,11],[17,12,17,15],[18,1,18,3],[18,4,18,7],[18,9,18,11],[18,12,18,15],[15,1,15,3],[15,4,15,7],[15,9,15,11],[15,12,15,15],[16,1,16,3],[16,4,16,7],[16,9,16,11],[16,12,16,15],[13,2,13,5],[13,6,13,8],[13,9,13,12],[13,13,13,15],[14,0,14,1],[14,3,14,4],[14,6,14,7],[14,8,14,15],[12,0,13,1],[12,2,12,5],[12,6,12,8],[12,9,12,12],[12,13,12,15],[11,0,11,1],[11,2,11,5],[11,6,11,8],[11,9,11,12],[11,13,11,15],[9,0,10,1],[9,2,9,15],[10,2,10,15],[2,14,3,15],[3,0,3,1],[3,2,3,5],[4,0,5,1],[4,9,7,15],[6,0,7,1],[8,0,8,1],[8,2,8,5],[8,7,8,10],[8,11,8,12],[8,13,8,15],[0,0,0,15],[1,9,1,10],[1,13,1,15],[2,0,2,1],[2,2,2,5],[2,6,3,6],[2,7,3,8],[2,9,3,9],[2,10,3,10],[2,11,3,13]]}
["医療・介護　情報連携シート",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"作成日","Ｈ29.4"]
[null,null,null,null,null,null,null,null,null,null,null,null,"作成日","2017-06-21",null,null,null,null,"フリガナ"]
["フリガナ",null,"ハンナン　タロウ",null,null,null,"性別","男・女",null,"生年月日","大正\n昭和","1942-04-01",null,null,"75歳",null,null,null,"利用者　氏名","inoue "]
["氏名",null,"阪南　太郎",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別","otoko "]
["利用者住所\n連絡先",null,"〒599-0202",null,"大阪府阪南市下出○○○",null,null,null,null,"家族構成（同一世帯は○で囲む・キーパーソンは☆をつける）",null,null,null,null,null,null,null,null,"生年月日"]
[null,null,"TEL","072-493-○○○○",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"利用者住所"]
["緊急連絡先",null,"阪南　次郎",null,null,"様","続柄","長男",null,null,null,null,null,null,null,null,null,null,"連絡先"]
[null,null,"TEL","072-493-○○○○",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"緊急連絡先"]
["介護度",null,"要介護③",null,null,null,"期間","平成29年4月1日～平成30年3月31日",null,null,null,"負担割合",null,"1割負担",null,null,null,null,"介護度"]
["かかりつけ医\n等",null,"医師名：泉南　卓也先生　　医療機関名：○○病院　　　　　　　　　TEL：072-493-○○○○",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"かかりつけ医"]
[null,null,"医師名：　　　　　　　　　医療機関名：　　　　　　　　　　　　　TEL："]
[null,null,"病名/障害名",null,null,null,"（発症年月日）",null,null,"病名/障害名",null,null,null,"（発症年月日）"]
["意見書傷病名\nほか病名/障害名",null,"アルツハイマー型認知症",null,null,null,"平成20年4月ごろ"]
[]
["認知症高齢者\n自立度",null,"Ⅲa","障害/日常生活\n自立度",null,"A2","認知症の症状",null,"徘徊・物忘れ"]
["視力","普通　弱視　全盲",null,null,"[　　　　　　　　　　]",null,null,null,"食事摂取","自立　一部介助　全介助",null,null,"[認知症状から声かけが無ければ接種されない]"]
["聴力","普通　難聴",null,null,"[　　　　　　　　　　]",null,null,null,"移動\n（屋内）","自立　一部介助　全介助",null,null,"[自宅や慣れた環境内では自立移動できる]"]
["意思\n疎通","普通　やや困難　困難",null,null,"[　　　　　　　　　　]",null,null,null,"移動\n（屋外）","自立　一部介助　全介助",null,null,"[見守りが無ければ迷ってしまう]"]
["麻痺","無し　有",null,null,"[　　　　　　　　　　]",null,null,null,"排泄","自立　一部介助　全介助",null,null,"[声かけやきっかけが無ければお手洗いへ行かれない。排泄動作は出来る。]"]
["座位保持","自立　支えが必要　出来ない",null,null,"[　　　　　　　　　　]",null,null,null,"更衣","自立　一部介助　全介助",null,null,"[声かけや衣類を渡すと着用できる]"]
["立位保持","自立　つまかれば可　出来ない",null,null,"[　　　　　　　　　　]",null,null,null,"入浴","自立　一部介助　全介助",null,null,"[一人でいると出来ない。\n声かけを行うことがきっかけで出来る。]"]
["普段の生活",null,null,null,null,null,null,null,null,null,null,null,"サービス種別"]
["約10年前、退職を機にアルツハイマー型認知症を発症。妻と一緒に住んでいる長男世帯が熱心に",null,null,null,null,null,null,null,null,null,null,null,"通所介護週3回(月水金)"]
["介護をされており進行は緩やか。日中はデイサービスや週末は都合がつけば家族達と外出をして",null,null,null,null,null,null,null,null,null,null,null,"ショートステイ(不定期)"]
["刺激ある生活を過ごされている。"]
[]
["退院後又は療養先　もしくは　利用者の生活に対する希望・思い等"]
["■","自宅","□","施設","（　　　　　　　）",null,null,"□","未定","□","医療機関",null,"（　　　　　　　　）"]
["フリースペース",null,"家族の介護力が強く、外出(公園、本人の好きな山を見に行く。)や声かけ見守りを行い本人認知症の進行を緩やかにさせています。退院後は在宅での生活を考えており担当ケアマネとしても「好きな山や公園、外出した生活を過ごす」を目標設定しており家族、デイサービスの支援を位置付けています。ｼｮｰﾄｽﾃｲの利用は不定行きで家族が介護を続けていけるように位置付けています。退院されてからも引き続き利用予定です。入院中も可能であれば病院周辺を散歩や院内の散歩の付き添いをお願いできれば助かります。自宅は長男の持家で、１階に自室があり、妻が見守り等介護をしています。玄関上り框部に段差解消および手すりを設置しています。"]
[]
["介護支援専門員",null,"はなてぃ　大輔",null,null,"事業所名",null,"はなてぃケアプランセンター",null,null,null,"TEL","072-493-○○○○"]
["■　退院時に書類を希望します。"]
["泉佐野泉南医師会・６市町ケアマネジャー合同連絡会・南泉州地域医療介護連携協議会　　　作成年月日　２０１７．６．２１"]