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{"sheet":"調査にあたってのお願い","index":0,"n_rows":5,"n_cols":1,"rows_kept":5,"cut":false,"hidden":false,"merged":[[0,0,2,36],[4,0,6,36],[57,3,58,35]]}
["在宅医療資源及び在宅医療の提供等に関する調査（診療所用）"]
[]
[]
[]
["【調査にあたってのお願い】"]

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["１","【基本情報等について】"]
[]
["1－①",null,"診療所名称等についてご記入ください。"]
[]
[null,null,"回答者名"]
[]
[]
[null,null,"診療所の名称",null,null,null,null,"（ふりがな）"]
[null,null,null,null,null,null,null,"法人名"]
[]
[null,null,null,null,null,null,null,"（ふりがな）"]
[null,null,null,null,null,null,null,"名称"]
[]
[null,null,"所在地",null,null,null,null,"（〒",null,null,null,"－",null,null,"）",null,null,null,null,"区"]
[]
[null,null,"診療科目"]
[]
[null,null,"駐車場",null,null,null,null,null,null,null,"（",null,null,"台","）"]
[]
[null,null,"連絡先",null,null,null,null,"代表",null,null,null,"電話",null,null,null,null,null,null,null,null,null,"－"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"ＦＡＸ",null,null,null,null,null,null,null,null,null,"－"]
[]
[null,null,null,null,null,null,null,"在宅医療・地域連携等相談窓口",null,null,null,"部署名"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"電話",null,null,null,null,null,null,null,null,null,"－"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"ＦＡＸ",null,null,null,null,null,null,null,null,null,"－"]
[]
[null,null,null,null,null,null,null,"緊急往診を行っている場合の連絡窓口",null,null,null,"診療\n時間内",null,null,null,"窓口\n（部署名等）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話",null,null,null,null,null,null,null,"－"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"診療\n時間外",null,null,null,"窓口\n（部署名等）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話",null,null,null,null,null,null,null,"－"]
[]
[null,null,"ホームページURL"]
[]
[null,null,"外国語対応\n（対応可能な言語に○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,"　）"]
[]
[]
["２","【施設情報について】"]
["2－①",null,"外来診療時間等についてご記入ください。"]
[]
[null,null,"外来診療時間",null,null,null,null,null,"曜日",null,"月",null,null,"火",null,null,"水",null,null,"木",null,null,"金",null,null,"土",null,null,"日"]
[]
[null,null,null,null,null,null,null,null,"午前",null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"："]
[null,null,null,null,null,null,null,null,null,null,"～",null,null,"～",null,null,"～",null,null,"～",null,null,"～",null,null,"～",null,null,"～"]
[null,null,null,null,null,null,null,null,null,null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"："]
[null,null,null,null,null,null,null,null,"午後",null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"："]
[null,null,null,null,null,null,null,null,null,null,"～",null,null,"～",null,null,"～",null,null,"～",null,null,"～",null,null,"～",null,null,"～"]
[null,null,null,null,null,null,null,null,null,null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"：",null,null,"："]
[null,null,"祝日・盆・年末年始等の診療"]
[]
[]
["2－②",null,"各種届出状況についてご記入ください"]
[]
[null,null,"届出項目",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"届出状況に○を記入"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有り",null,null,null,"今後予定"]
[null,null,"在宅療養支援診療所"]
[]
[null,null,"機能強化型在宅療養支援診療所（連携型）"]
[]
[null,null,"機能強化型在宅療養支援診療所（単独型）"]
[]
[null,null,"オンライン診療料"]
[]
[]
[]
["2－③",null,"有床診療所の場合は、病床数をご記入ください。\n無床診療所の場合は、「設問２-⑥の下にある注意書き」を参照の上、「３【在宅医療情報について】」以下に進んでください。"]
[]
[]
[]
[null,null,"病床数"]
[]
[null,null,"一般病床"]
[]
[null,null,"療養病床"]
[]
[null,null,"計",null,null,null,{"$f":"IF(AND(G78=\"\",G80=\"\"),\"\",SUM(G78:K81))","v":""}]
[]
[]
[]
["2－④",null,"病床の利用目的について該当する項目すべてに○を記入してください。"]
[]
[null,null,"病床の利用目的",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"該当するもの\nに○を記入",null,null,null,null,"その他の内容を記載"]
[]
[null,null,"病院からの在宅・介護施設への受け渡し"]
[]
[null,null,"専門医療を担い病院の役割を補完"]
[]
[null,null,"緊急時の一時入院"]
[]
[null,null,"レスパイト入院"]
[]
[null,null,"終末期医療の提供"]
[]
[null,null,"長期入院"]
[]
[null,null,"その他"]
[]
[]
[]
["2－⑤",null,"在宅療養患者が緊急時に入院できるように確保している病床があれば、その病床数をご記入ください。"]
[]
[]
[null,null,"病床区分",null,null,null,"確保している病床数"]
[]
[null,null,"一般病床"]
[]
[null,null,"療養病床"]
[]
[null,null,"計",null,null,null,{"$f":"IF(AND(G111=\"\",G113=\"\"),\"\",SUM(G111:M114))","v":""}]
[]
[]
[]
[]
[]
["2－⑥",null,"在宅療養患者がレスパイト入院できるように確保している病床があれば、その病床数をご記入ください。"]
[]
[]
[null,null,"病床区分",null,null,null,"確保している病床数"]
[]
[null,null,"一般病床"]
[]
[null,null,"療養病床"]
[]
[null,null,"計",null,null,null,{"$f":"IF(AND(G126=\"\",G128=\"\"),\"\",SUM(G126:M129))","v":""}]
[]
[]
[]
[]
[null,"●在宅医療を実施していない医療機関は、以下の設問で「★」がついた設問に回答をお願いします。\n\n　なお、一部でも実施している場合は、「３【在宅医療情報について】」以下の該当する設問についてご回答をお願いします。"]
[]
[]
[]
[]
[]
[]
["３","【在宅医療情報について】"]
[]
["3－①",null,"在宅医療を担当する医師の数をご記入ください。"]
[]
[null,null,"医師数",null,null,null,"計"]
[]
[null,null,"男"]
[]
[null,null,"女"]
[]
[]
[]
["3－②",null,"訪問診療の実施についてあてはまるものに○をご記入ください。"]
[]
[null,null,"訪問診療の実施",null,null,null,null,null,null,null,null,null,null,null,null,"○を記入"]
[]
[null,null,"している"]
[]
[null,null,"していない",null,null,null,null,"今後実施の意向あり"]
[]
[null,null,null,null,null,null,null,"今後実施の意向なし"]
[]
[]
[]
["3－③",null,"訪問診療先についてあてはまるものに○をご記入ください。"]
[]
[null,null,"訪問診療先の限定",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"○を記入"]
[]
[null,null,"特に限定していない"]
[]
[null,null,"特定の訪問先に\n限定している\n（複数回答可）",null,null,null,null,null,null,null,"自宅"]
[]
[null,null,null,null,null,null,null,null,null,null,"居住系施設（有料老人ホーム、グループホーム、\n                  サービス付き高齢者向け住宅等）"]
[]
[null,null,null,null,null,null,null,null,null,null,"その他："]
[]
[]
[]
["3－④",null,"訪問診療を実施するにあたり、要件があればご記入ください。\n　【例】：かかりつけ患者のみ、○○区のみなど"]
[]
[]
[]
[]
[]
[]
[]
[]
["3－⑤",null,"訪問診療の患者対象年齢についてご記入ください。"]
[]
[null,null,"年齢区分",null,null,null,null,null,null,null,null,null,"○を記入"]
[]
[null,null,"全年齢対象"]
[]
[null,null,"小児以外を対象",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"おおむね",null,null,null,null,"才以上"]
[]
[null,null,"小児のみを対象",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"おおむね",null,null,null,null,"才以下"]
[]
[null,null,"その他：　"]
[]
[]
[]
["3－⑥",null,"自宅患者の１ヶ月あたりの訪問診療のおおよその対応可能患者数（のべ人数）をご記入ください。"]
[]
[]
[null,null,"対応可能患者数\n（のべ人数）"]
[]
[]
[]
["3－⑦",null,"訪問診療で対応可能な処置についてご記入ください。"]
[]
[null,null,"対応可能な処置",null,null,null,null,null,null,null,null,null,null,null,null,"○を記入",null,null,null,null,null,null,null,null,"その他の内容を記載"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"可",null,null,"要相談",null,null,"不可"]
[null,null,"経管栄養（経鼻・胃瘻）の管理"]
[]
[null,null,"中心静脈栄養の管理"]
[]
[null,null,"膀胱留置カテーテル"]
[]
[null,null,"在宅酸素療法"]
[]
[null,null,"人工呼吸器の管理"]
[]
[null,null,"気管カニューレの管理"]
[]
[null,null,"腹膜透析"]
[]
[null,null,"麻薬管理"]
[]
[null,null,"ストーマ管理"]
[]
[null,null,"点滴・静脈注射"]
[]
[null,null,"皮下植込み型ポートからの薬剤注入"]
[]
[null,null,"喀痰吸引"]
[]
[null,null,"麻薬を用いた疼痛管理"]
[]
[null,null,"褥瘡処置"]
[]
[null,null,"人工膀胱の管理"]
[]
[null,null,"その他"]
[]
[]
[]
["3－⑧",null,"貴院の訪問看護の実施状況についてご記入ください。"]
[]
[null,null,"項目",null,null,null,null,null,null,null,null,null,null,null,null,"○を記入",null,null,null,"その他の内容を記載"]
[null,null,"連携する訪問看護ステーションが実施"]
[null,null,"自院の訪問看護部門で実施",null,null,null,null,null,"24時間365日対応"]
[null,null,null,null,null,null,null,null,"診療日は対応"]
[null,null,null,null,null,null,null,null,"その他"]
[null,null,"実施していない",null,null,null,null,null,"今後実施の意向あり"]
[null,null,null,null,null,null,null,null,"今後実施の意向なし"]
[null,null,null,null,null,null,null,null,"その他"]
[]
[]
["3－⑨",null,"緊急時の連絡を受ける体制についてご記入ください。"]
[]
[null,null,"緊急時の連絡を受ける体制",null,null,null,null,null,null,null,null,null,null,null,"○を記入",null,null,null,"その他の内容を記載"]
[]
[null,null,"有り",null,null,"24時間365日対応可能"]
[]
[null,null,null,null,null,"診療日は対応可能"]
[]
[null,null,null,null,null,"その他"]
[]
[null,null,"無し",null,null,"今後実施の意向あり",null,null,null,"24時間365日対応"]
[]
[null,null,null,null,null,null,null,null,null,"診療日は対応"]
[]
[null,null,null,null,null,null,null,null,null,"その他"]
[]
[null,null,null,null,null,"今後実施の意向なし"]
[]
[]
[]
["3－⑩",null,"緊急往診の実施についてご記入ください。"]
[]
[null,null,"緊急往診の実施",null,null,null,null,null,null,null,null,null,null,null,"○を記入",null,null,null,"その他の内容を記載"]
[]
[null,null,"している",null,null,"24時間365日対応可能"]
[]
[null,null,null,null,null,"診療日は対応可能"]
[]
[null,null,null,null,null,"その他"]
[]
[null,null,"していない",null,null,"今後実施の意向あり",null,null,null,"24時間365日対応"]
[]
[null,null,null,null,null,null,null,null,null,"診療日は対応"]
[]
[null,null,null,null,null,null,null,null,null,"その他"]
[]
[null,null,null,null,null,"今後実施の意向なし"]
[]
[]
["3－⑪",null,"上記の設問3－⑩で「実施している」と回答した場合、過去１年間（R5.4.1～R6.3.31）に緊急往診を実施した実績をご記入ください。"]
[]
[]
[null,null,"緊急往診の実施場所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"〇を記入",null,null,null,"その他の内容を記載"]
[]
[null,null,"自宅"]
[]
[null,null,"居住系施設（有料老人ホーム、グループホーム、\n                   サービス付き高齢者向け住宅等）"]
[]
[null,null,"その他"]
[]
[null,null,"計",null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[]
[]
["3－⑫",null,"在宅での看取りの実施についてご記入ください。"]
[]
[null,null,"在宅での看取りの実施",null,null,null,null,null,null,null,null,null,null,null,"○を記入",null,null,null,"その他の内容を記載"]
[]
[null,null,"している",null,null,"24時間365日対応可能"]
[]
[null,null,null,null,null,"診療日は対応可能"]
[]
[null,null,null,null,null,"その他"]
[]
[null,null,"していない",null,null,"今後実施の意向あり",null,null,null,"24時間365日対応"]
[]
[null,null,null,null,null,null,null,null,null,"診療日は対応"]
[]
[null,null,null,null,null,null,null,null,null,"その他"]
[]
[null,null,null,null,null,"今後実施の意向なし"]
[]
[]
[]
["3－⑬",null,"上記の設問3－⑫で「実施している」と回答した場合、過去１年間（R5.4.1～R6.3.31）の在宅での看取り実績がございましたら〇をご記入ください。"]
[]
[]
[null,null,"看取りの実施場所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"〇を記入",null,null,null,"その他の内容を記載"]
[]
[null,null,"自宅"]
[]
[null,null,"居住系施設（有料老人ホーム、グループホーム、\n                   サービス付き高齢者向け住宅等）"]
[]
[null,null,"その他"]
[]
[null,null,"計",null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[]
[]
[]
["3－⑭",null,"認知症（中等度以上）を有する患者の認知症以外の疾患への対応可否について、対応可能な場合は〇を記入してください。"]
[]
[]
[null,null,"認知症を有する患者対応",null,null,null,null,null,null,null,null,null,"○を記入"]
[]
[null,null,"外来"]
[]
[null,null,"入院"]
[]
[null,null,"往診・訪問診療"]
[]
[]
[]
[4,"【その他】"]
["4－①",null,"貴院での人工透析について、該当する番号に○を記入してください。"]
[]
[null,null,"項目",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"○を記入"]
[null,null,"人工透析の取組",null,null,null,null,null,"実施している"]
[null,null,null,null,null,null,null,null,"実施している透析の種類",null,null,null,null,null,null,null,null,"腹膜透析"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"血液透析"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"血液透析濾過"]
[null,null,null,null,null,null,null,null,"対応状況",null,null,null,null,null,null,null,null,"腹膜透析",null,null,null,"入院のみ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通院のみ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"どちらも可"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"血液透析",null,null,null,"入院のみ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通院のみ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"どちらも可"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"血液透析\n濾過",null,null,null,"入院のみ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通院のみ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"どちらも可"]
[null,null,null,null,null,null,null,null,"その他の取組",null,null,null,null,null,null,null,null,"通院送迎"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"夜間透析"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"在宅血液透析"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"栄養指導"]
[]
["4－②",null,"その他、人工透析についてご意見等があればご記入ください。"]
[]
[]
[]
[]
[]
["4－③",null,"今後の在宅医療への取り組みについてあてはまるものに○をご記入ください。"]
[]
[null,null,"今後の取り組み",null,null,null,null,null,null,null,null,null,null,"○を記入"]
[]
[null,null,"拡充"]
[]
[null,null,"現状維持"]
[]
[null,null,"縮小"]
[]
[null,null,"開始について検討中"]
[]
[null,null,"取り組む予定なし"]
[]
[]
["4－④",null,"貴院の特徴や、特に力を入れている取り組みなどございましたらご記入ください。"]
[]
[]
[]
[]
[]
[]
[null,null,"全ての情報を非公表にする。  "]
[]
[null,null,"☆ご協力ありがとうございました。"]