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["在宅医療資源及び在宅医療の提供等に関する調査（薬局用）"]
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["【調査にあたってのお願い】"]

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["１　【基本情報について】"]
[]
[null,null,null,"項目",null,null,null,null,null,"登録情報"]
[null,null,null,"名称",null,null,null,null,null,"（ふりがな）"]
[null,null,null,null,null,null,null,null,null,"法人名"]
[null,null,null,null,null,null,null,null,null,"（ふりがな）"]
[null,null,null,null,null,null,null,null,null,"施設名"]
[null,null,null,"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,"区"]
[null,null,null,"電話番号",null,null,"通常"]
[null,null,null,null,null,null,"夜間・休日"]
[null,null,null,"ホームページURL"]
[null,null,null,"外国語対応\n（対応可能な言語に〇を記入）",null,null,null,null,null,null,null,null,null,null,"英",null,null,"中国",null,null,"韓国",null,null,"その他",null,null,"（その他の言語を記載）"]
[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,"管理者名"]
[]
[]
[null,null,null,"営業日\n営業時間",null,null,null,null,null,"曜日",null,null,"午前",null,null,null,null,null,null,null,null,null,null,"午後"]
[null,null,null,null,null,null,null,null,null,"月",null,null,null,null,"：",null,null,"～",null,null,"：",null,null,null,null,"：",null,null,"～",null,null,"："]
[null,null,null,null,null,null,null,null,null,"火",null,null,null,null,"：",null,null,"～",null,null,"：",null,null,null,null,"：",null,null,"～",null,null,"："]
[null,null,null,null,null,null,null,null,null,"水",null,null,null,null,"：",null,null,"～",null,null,"：",null,null,null,null,"：",null,null,"～",null,null,"："]
[null,null,null,null,null,null,null,null,null,"木",null,null,null,null,"：",null,null,"～",null,null,"：",null,null,null,null,"：",null,null,"～",null,null,"："]
[null,null,null,null,null,null,null,null,null,"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,"土",null,null,null,null,"：",null,null,"～",null,null,"：",null,null,null,null,"：",null,null,"～",null,null,"："]
[null,null,null,null,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,"祝日・盆・年末年始等の営業"]
[]
[]
["２　【在宅医療情報について】"]
["2－①",null,null,"訪問可能地域・条件について\n※訪問可能地域については「〇〇区内」、「〇〇区△△町」とご記入ください。\n　また、訪問の条件などがありましたら、その内容をご記入ください。"]
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[]
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["2－②",null,null,"業務内容について\n※下記の業務項目について、現在実施していれば実施状況欄に「〇」をご記入ください。"]
[]
[null,null,null,"業務項目",null,null,null,null,null,null,"実施状況",null,null,null,"業務項目",null,null,null,null,null,null,null,null,null,"実施状況"]
[null,null,null,"麻薬調剤",null,null,null,null,null,null,null,null,null,null,"特定医療材料の取り扱い"]
[]
[null,null,null,"一包化調剤",null,null,null,null,null,null,null,null,null,null,"近隣の薬局と連携して24時間調剤\n及び在宅業務を行っている"]
[]
[null,null,null,"高度医療機器の販売",null,null,null,null,null,null,null,null,null,null,"自局単独で24時間調剤及び\n在宅業務を行っている"]
[]
[]
[]
[]
["3　【報酬算定の実績について】"]
["3－①",null,null,"各種算定について過去１年間（R5.4.1～R6.3.31）の間に算定したことがある場合は「○」をご記入ください。"]
[null,null,null,"報酬別",null,null,null,null,null,null,"項目",null,null,null,null,null,null,null,null,null,null,null,null,"過去1年間に\n算定したことがある"]
[null,null,null,"診療報酬",null,null,null,null,null,null,"在宅患者訪問薬剤管理指導"]
[null,null,null,"介護報酬",null,null,null,null,null,null,"居宅療養管理指導"]
[]
[]
[null,null,null,"全ての情報を非公表にする。"]
[]
[]
[null,null,null,"☆ご協力ありがとうございました。"]