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["◎基本情報に関する項目",null,null,null,"受講申込み者氏名："]
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["受付年月",null,"　　　　　　年　　　月",null,"受付担当者"]
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["受付経路"]
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["氏　名",null,"　（イニシャル表記で）"]
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["年齢・性別",null,"　　　　　　　　　　　　　歳　　　・　　　　　男　・　女"]
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["住　所",null,"　　　　　　　　　　　　　　　　　　　市　・　　町　　・　村"]
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["家族状況"]
{"$rows_empty":11}
["保険・他法利用"]
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["以前から利用しているサービス"]
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[]
[]
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["障害老人の日常生活自立度"]
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["認知症である老人の日常生活自立度"]
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["主訴・経過"]
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["認定情報"]
[]
["この事例で検討したいこと"]
[]
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["◎アセスメントに関する項目"]
["健康状態"]
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[]
[]
[]
[]
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["ADL"]
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[]
[]
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[]
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["IADL"]
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[]
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["認知"]
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["コミュニケーション能力"]
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["社会との関わり"]
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[]
["排尿・排便"]
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[]
["スキントラブル"]
[]
[]
["口腔衛生"]
[]
[]
["食事摂取"]
[]
[]
["問題行動"]
[]
["介護力"]
[]
[]
["居住環境"]
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[]
[]
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["特別な状況"]