{"text_format":"1","workbook":"xlsx","n_sheets":1,"sheets":["MRI"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":1,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"MRI","index":0,"n_rows":122,"n_cols":72,"rows_kept":122,"cut":false,"hidden":false,"merged":[[80,41,82,43],[80,44,82,46],[80,47,82,51],[74,35,76,37],[74,38,76,40],[74,41,76,43],[74,44,76,46],[74,47,76,51],[77,44,79,46],[77,47,79,51],[80,38,82,40],[77,58,79,60],[77,65,79,67],[77,63,79,64],[69,45,73,50],[63,35,68,35],[63,36,68,71],[69,51,73,71],[69,36,73,41],[69,42,73,44],[74,52,76,71],[77,56,79,57],[60,39,62,39],[60,40,62,41],[60,42,62,46],[57,37,59,39],[57,40,59,41],[60,47,62,47],[60,70,62,70],[60,48,62,69],[60,27,62,28],[60,29,62,31],[60,32,62,33],[0,0,3,14],[0,15,3,44],[4,0,5,14],[74,0,76,7],[54,0,56,7],[54,8,56,71],[19,46,21,47],[19,48,21,53],[19,54,21,55],[19,56,21,61],[19,62,21,63],[19,64,21,71],[19,35,21,45],[57,0,62,7],[51,18,53,22],[51,23,53,25],[51,26,53,33],[36,19,37,71],[38,0,40,71],[51,0,53,7],[51,34,53,43],[51,44,53,44],[51,45,53,70],[41,0,42,5],[89,0,91,7],[89,8,91,32],[89,33,91,40],[77,8,79,10],[77,11,79,12],[77,13,79,14],[77,15,79,17],[77,25,79,31],[77,32,79,34],[77,35,79,37],[77,38,79,40],[83,8,85,10],[83,11,85,12],[83,13,85,14],[83,15,85,17],[83,25,85,31],[83,32,85,34],[86,26,88,28],[86,29,88,31],[86,32,88,34],[86,35,88,37],[80,0,82,7],[86,38,88,40],[86,8,88,9],[89,41,91,71],[92,0,93,50],[77,0,79,7],[83,0,85,7],[84,52,85,53],[84,70,85,71],[92,51,93,70],[80,8,82,10],[80,11,82,12],[80,13,82,14],[80,15,82,17],[80,25,82,31],[80,32,82,34],[77,41,79,43],[83,35,85,37],[83,38,85,40],[83,41,85,43],[80,52,83,71],[84,54,85,69],[83,44,85,46],[83,47,85,51],[86,0,88,7],[86,20,88,20],[86,21,88,25],[115,71,117,71],[115,8,117,65],[115,67,117,70],[111,23,113,24],[111,25,113,31],[111,32,113,33],[111,34,113,48],[111,49,113,50],[111,51,113,54],[119,0,120,71],[121,0,123,71],[13,56,15,68],[13,69,15,71],[20,0,24,5],[20,7,24,11],[20,12,24,14],[20,15,24,17],[20,18,24,20],[20,21,24,23],[20,24,24,26],[20,27,24,29],[20,30,24,30],[20,31,24,32],[20,33,24,33],[118,0,118,71],[95,1,109,70],[111,0,113,22],[111,55,113,56],[111,57,113,69],[111,70,113,71],[114,0,114,71],[115,0,117,7],[115,66,117,66],[0,49,3,53],[0,54,3,56],[0,57,3,59],[0,60,3,62],[0,63,3,65],[0,66,3,68],[0,69,3,71],[4,35,4,71],[5,35,6,54],[5,55,6,71],[7,0,11,33],[12,0,15,33],[7,35,12,71],[22,35,24,45],[22,46,24,71],[13,35,15,45],[16,35,18,45],[16,46,18,47],[16,48,18,53],[16,54,18,55],[16,56,18,61],[16,62,18,63],[16,64,18,71],[13,46,15,53],[13,54,15,55],[36,0,37,4],[36,5,37,7],[36,8,37,11],[36,12,37,13],[36,14,37,18],[41,41,42,41],[41,42,42,47],[41,48,42,48],[41,6,42,6],[41,7,42,12],[41,13,42,13],[41,14,42,19],[41,20,42,21],[41,22,42,27],[47,3,50,4],[47,5,50,20],[47,21,50,22],[47,23,50,37],[47,41,50,50],[47,51,50,71],[43,0,50,2],[43,3,46,12],[43,13,46,30],[43,31,44,37],[43,38,50,40],[43,41,46,50],[43,51,46,71],[45,31,46,37],[57,15,59,16],[57,17,59,22],[63,13,65,15],[63,16,65,18],[57,35,59,36],[57,23,59,24],[57,30,59,31],[57,32,59,34],[51,8,53,10],[51,11,53,14],[51,15,53,17],[57,25,59,28],[57,29,59,29],[60,34,62,38],[74,11,76,12],[74,13,76,14],[74,15,76,17],[74,18,85,24],[74,25,76,31],[74,32,76,34],[63,8,68,12],[69,0,71,32],[72,0,73,32],[68,19,68,34],[63,19,67,27],[63,28,67,34],[69,33,73,35],[66,13,68,15],[66,16,68,18],[63,0,68,7],[80,35,82,37],[41,55,42,56],[41,57,42,62],[41,63,42,71],[57,42,59,44],[57,45,59,45],[57,46,59,47],[57,48,59,51],[57,52,59,52],[57,53,59,62],[57,63,59,63],[57,64,59,65],[57,66,59,70],[26,0,27,7],[26,8,27,25],[26,26,27,29],[26,30,27,35],[26,36,27,41],[26,42,27,71],[28,0,31,7],[28,8,31,25],[28,26,31,29],[28,30,29,32],[28,33,29,35],[28,36,29,38],[28,39,29,41],[28,42,29,43],[28,44,29,71],[30,30,31,32],[30,33,31,35],[30,36,31,38],[30,39,31,41],[34,31,35,33],[34,34,35,38],[34,39,35,41],[34,42,35,43],[86,41,88,41],[86,42,88,45],[86,46,88,71],[60,8,62,10],[74,8,76,10],[86,10,88,13],[86,14,88,15],[86,16,88,19],[60,11,62,15],[60,16,62,16],[60,17,62,18],[60,19,62,21],[60,22,62,23],[60,24,62,26],[57,8,59,10],[57,11,59,14],[41,28,42,34],[41,35,42,40],[51,71,53,71],[41,49,42,54],[34,44,35,48],[34,49,35,50],[34,51,35,69],[34,70,35,71],[30,42,31,43],[30,44,31,71],[32,0,35,7],[32,8,33,9],[32,10,33,14],[32,15,33,16],[32,17,33,21],[32,22,33,23],[32,24,33,28],[32,29,33,30],[32,31,33,35],[32,36,33,37],[32,38,33,41],[32,42,33,43],[32,44,33,71],[34,8,35,14],[34,15,35,17],[34,18,35,22],[34,23,35,25],[34,27,35,30]]}
["紹介状",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（ＭＲＩ検査依頼書）",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,null,null,null,null,null,null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日"]
[]
[]
[]
["(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,null,null,null,null,null,null,null,null,null,null,"紹介元医療機関名及び所在地：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※改行は　「Altキー ＋ Enterキー」"]
[]
["北播磨総合医療センター"]
[]
[]
[]
[]
["担当医　先生"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当医師名：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"科",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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,null,null,null,null,null,")",null,null,null,null,null,null,null,"-"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,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,"-"]
["予　約\n希望日",null,null,null,null,null,null,"令和",null,null,null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,"(",null,null,")"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申込担当者："]
[]
[]
[]
["フ リ ガ ナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"旧姓",null,null,null,null,null,null,null,null,null,"性別",null,null,null,null,null,"患者さん予約待ち状況"]
[]
["患者氏名",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,"受診歴",null,null,null,null,null,null,"有",null,null,null,null,null,"男",null,null,null,null,"当院外来にて待機中"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"無",null,null,null,null,null,"女",null,null,null,null,"当院入院中"]
[]
["生年月日",null,null,null,null,null,null,null,null,null,"明治",null,null,null,null,null,null,"大正",null,null,null,null,null,null,"昭和",null,null,null,null,null,null,"平成",null,null,null,null,null,null,"令和",null,null,null,null,null,"帰宅の後、貴医療機関より連絡待ち"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,null,null,"月",null,null,null,null,null,null,null,"日",null,null,null,null,null,null,null,"歳",null,null,null,null,"その他",null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
["住所",null,null,null,null,"〒",null,null,null,null,null,null,"-"]
[]
[]
[]
[]
["自　宅",null,null,null,null,null,"(",null,null,null,null,null,null,")",null,null,null,null,null,null,"-",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"連絡先",null,null,null,null,null,"(",null,null,null,null,null,null,")",null,null,null,null,null,null,"-"]
[]
["主保険",null,null,"保険者番号",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,null,null,null,"併用保険",null,null,"負担者番号"]
[]
[]
[]
[null,null,null,"記号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受給者番号"]
[]
[]
[]
["来院方法",null,null,null,null,null,null,null,null,null,null,"独歩",null,null,null,null,null,null,"車いす",null,null,null,null,null,null,null,"ストレッチャー",null,null,null,null,null,null,null,"その他特記事項",null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
["紹介目的",null,null,null,null,null,null,null,"　検査（ＭＲＩ）"]
[]
[]
["目的臓器",null,null,null,null,null,null,null,null,null,null,"頭部",null,null,null,null,null,"頭＋MRA",null,null,null,null,null,null,null,"脊髄",null,null,null,"(",null,null,"頚",null,null,null,null,"胸",null,null,null,null,"腰",null,null,"）",null,null,"胸部",null,null,null,"(",null,null,null,null,null,null,null,null,null,null,"）",null,null,"前立腺"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,"上腹部",null,null,null,null,"(",null,null,"肝",null,null,null,null,"胆",null,null,null,null,"膵",null,null,null,null,"MRCP",null,null,null,null,"）",null,null,"その他",null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
["(目的部位）",null,null,null,null,null,null,null,"造影",null,null,null,null,null,null,null,"要",null,null,"[クレアチニン]",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※造影検査を希望される場合、3か月以内の血清クレアチニン値を記入してください。\n※腎機能が悪い場合は、性・年齢・検査内容等を担当検査室にご連絡ください。"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"不要"]
[]
[]
["患者さんの都合により当医療センターと直接予約日を変更することについて　　",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,null,null,null,null,null,null,null,"承諾する",null,null,null,null,null,null,null,null,"不承諾",null,null,null,null,null,"不承諾並びにどちらにもチェックがない場合は従来どおり紹介元を通しての変更をお願いします。"]
[]
[]
["（直接予約日変更時も下記予約受付時間での対応となります）"]
[]
["肝障害",null,null,null,null,null,null,null,null,null,null,"無",null,null,null,"有",null,null,"感染症",null,null,null,null,null,null,"HBs",null,null,null,null,null,null,null,null,null,"＋",null,null,null,null,null,"－",null,null,null,null,null,"未検査",null,null,null,null,"ペースメーカー等の有無"]
[]
[]
["腎障害",null,null,null,null,null,null,null,null,null,null,"無",null,null,null,"有",null,null,null,null,null,null,null,null,null,"HCV",null,null,null,null,null,null,null,null,null,"＋",null,null,null,null,null,"－",null,null,null,null,null,"未検査",null,null,null,null,null,null,null,null,null,null,"無",null,null,null,null,null,null,"有"]
[]
[]
["アレルギー歴",null,null,null,null,null,null,null,null,null,null,"無",null,null,null,"有",null,null,null,null,null,null,null,null,null,"Wa氏",null,null,null,null,null,null,null,null,null,"＋",null,null,null,null,null,"－",null,null,null,null,null,"未検査",null,null,null,null,"※MRI対応可能な機種のみ検査実施。\n※ペースメーカー外来（金曜日）の受診後にMRI検査日を決定。"]
[]
[]
["喘息",null,null,null,null,null,null,null,null,null,null,"無",null,null,null,"有",null,null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,"＋",null,null,null,null,null,"－",null,null,null,null,null,"未検査"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[]
["前回検査",null,null,null,null,null,null,null,null,null,"初診",null,null,null,null,null,"再診",null,null,null,"(",null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日",null,null,")","所見:"]
[]
[]
["診断名",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,"主訴"]
[]
[]
["①現病歴　②現症　③検査所見　④治療経過　⑤現在の処方　⑥その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※改行は　「Altキー ＋ Enterキー」"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["結果（所見）返送方法",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"すべて郵送",null,null,null,null,null,null,null,null,"所見のみFAX、その他郵送",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他",null,null,null,"(",null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
[]
[]
[]
["添付資料",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,")"]
[]
[]
[]
["※ FAX予約受付時間（月～金　9:00～18:30　土　9:00～11:30　（祝祭日・年末年始は除く））　（FAX受信は24時間可能です）"]
[]
["北播磨総合医療センター地域医療連携室　  FAX：0794-62-9911　TEL：0794-88-8800㈹"]