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{"sheet":"検査依頼書","index":0,"n_rows":56,"n_cols":58,"rows_kept":56,"cut":false,"hidden":false,"merged":[[0,1,1,24],[3,1,4,24],[5,1,5,3],[6,1,7,3],[8,12,9,13],[8,14,9,15],[8,16,9,24],[5,14,7,15],[5,16,7,24],[5,4,5,13],[6,4,7,13],[8,8,9,9],[8,10,9,11],[8,1,9,3],[8,4,9,5],[8,6,9,7],[30,15,30,16],[28,17,28,24],[30,9,30,10],[30,17,30,24],[51,14,52,23],[49,13,49,14],[33,2,35,24],[37,2,40,24],[49,7,49,8],[49,9,49,10],[49,4,49,6],[49,23,49,24],[49,21,49,22],[49,15,49,16],[49,17,49,20],[49,11,49,12],[21,1,21,4],[11,5,12,7],[13,5,14,7],[15,5,16,7],[11,4,12,4],[13,4,14,4],[15,4,16,4],[22,2,23,24],[28,11,29,12],[25,2,26,24],[28,2,29,10],[28,15,28,16],[24,1,24,4],[18,1,19,4],[18,5,19,24],[11,13,12,13],[11,9,12,12],[13,9,14,12],[13,13,14,13],[11,1,16,2],[13,8,14,8],[11,8,12,8],[41,20,41,21],[42,2,48,24],[49,1,49,3],[51,1,52,1],[51,2,52,10],[51,13,52,13]]}
[null,"検査依頼書 （兼 診療情報提供書）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"T","S","H","R"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]
[null,"依　　頼　　患　　者",null,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","無"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"単純","造影"]
[null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
[null,"氏　名"]
[]
[null,"生年月日",null,null,"TSHR",null,"年",null,"月",null,"日",null,"歳",null,"電話"]
[]
[]
[null,"検査項目",null,null,"□","ＣＴ",null,null,"（","単純・造影",null,null,null,"）"]
[]
[null,null,null,null,"□","ＭＲＩ",null,null,"（","単純・造影",null,null,null,"）"]
[]
[null,null,null,null,"□","ＲＩ"]
[]
[]
[null,"検査部位"]
[]
[]
[null,"医療機関名"]
[]
[]
[null,"住　所"]
[]
[]
[null,"医師名"]
[null,null,null,null,null,null,null,null,null,null,null,"先生",null,null,null,"TEL"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FAX"]
[]
[null,"疾患名／ 既往歴"]
[]
[]
[]
[null,"検査目的／ ご紹介の主旨"]
[]
[]
[]
[]
[null,"症状の経過および検査結果／ 治療経過／ 薬物アレルギー",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（","有・無",null,"）"]
[]
[]
[]
[]
[]
[]
[]
[null,"検体採取日",null,null,"年",null,null,"月",null,"日",null,"BUN（",null,null,null,"mg/dl）",null,"クレアチニン（",null,null,null,null,null,"mg/dl）"]
[]
[null,"□","患者さんへDVDの手渡し希望",null,null,null,null,null,null,null,null,null,null,"□","検査当日に結果報告書のFAX希望"]
[]
[]
[null,"熊本労災病院　地域医療連携室",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL　0965-33-4151"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FAX　0965-34-5799"]

{"sheet":"説明書","index":1,"n_rows":46,"n_cols":7,"rows_kept":46,"cut":false,"hidden":false,"merged":[[0,0,1,9],[42,6,42,9],[43,6,43,9]]}
["検査を受けられる方へ"]
[]
[]
[]
["１．検査当日は総合受付へ検査依頼票（兼 診療情報提供書）をご提出ください。"]
["２．予約時間に遅れますと検査が遅れたり、当日できなくなることもあります。"]
["　　都合で検査に遅れたり、来院できない場合には、必ずご連絡をお願い致します。"]
["　　なお、受付時刻のおよそ 30 分後が検査予定の時間です。"]
["３．妊娠中、妊娠の可能性のある方は、必ず、お申し出ください。"]
[]
[]
["あなたの検査は"]
[]
["□","ＣＴ"]
[]
[null,"原則として、食事・水分制限はありません。"]
[null,"胃、胆嚢の検査の場合、検査３時間前から食事は摂らないでください。"]
[null,"下記に該当される方は、検査前に必ずかかりつけの先生へご相談ください。"]
[null,"　・アレルギー、喘息、腎疾患のある方"]
[null,"　・過去に造影剤を用いた検査で気分不良などの問題のあった方"]
[null,"膀胱の検査の場合には、検査１時間前からトイレ（尿）は控えてください。"]
[]
["□","ＭＲＩ"]
[]
[null,"原則として、食事・水分制限はありません。"]
[null,"胃、胆嚢の検査の場合、検査３時間前から食事は摂らないでください。"]
[null,"下記に該当される方は、検査前に必ずかかりつけの先生へご相談ください。"]
[null,"　・心臓ペースメーカー装着者",null,null,null,null,"・脳動脈瘤手術後の方"]
[null,"　・体内に金属のある方",null,null,null,null,"・心臓手術後の方"]
[null,"　・ステントを挿入されている方",null,null,null,null,"・喘息の既住のある方"]
[null,"　・アレルギー、喘息、腎疾患のある方"]
[null,"　・過去に造影剤を用いた検査で気分不良などの問題のあった方"]
[null,"膀胱の検査の場合には、検査１時間前からトイレ（尿）は控えてください。"]
[]
["□","ＲＩ"]
[]
[null,"検査開始時間、所要時間は、検査の種類によって異なります。"]
[null,"検査に用いる薬品は、当日しか使用できない高価な特殊薬品です。"]
[null,"検査日時はお間違えにならないようにお願い致します。"]
[]
[]
[]
["お問合せ先",null,null,null,null,null,"TEL　0965-33-4151"]
["熊本労災病院　地域医療連携室",null,null,null,null,null,"FAX　0965-34-5799"]
[]
[null,"お問い合せ時間　　平日午前８時１５分から午後５時００分まで"]