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["資料1：入退院支援情報共有シート"]
["入退院支援情報共有シート"]
[]
["記  入  日 ： ",null,null,null,null,null,null,null,"令和　3 年　7 月　1 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,"情報提供日：",null,null,null,null,null,null,null,"令和　3 年　7 月　4 日"]
["施設名",null,null,null,null,null,null,null,"黒松病院",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設名",null,null,null,null,null,null,null,"つつじケアプランセンター"]
["部署・担当者名",null,null,null,null,null,null,null,"地域連携室・屋島　夕子",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"部署・担当者名",null,null,null,null,null,null,null,"栗林　雪男"]
["電話番号",null,null,null,null,null,null,null,"087-839-〇〇〇〇",null,null,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,"087-839-△△△△"]
["ＦＡＸ番号",null,null,null,null,null,null,null,"087‐839‐××××",null,null,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,"087-839-□□□□"]
[]
["◆ 利用者・患者、家族の同意に基づき、以下の情報を提供します。"]
[" 利用者・患者の基本情報"]
["フリガナ",null,null,null,null,null,null,null,"タカマツ　タロウ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年齢",null,null,88,null,null,null,"歳",null,"性別"]
["氏名",null,null,null,null,null,null,null,"高松　太郎"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8,null,null,"年",null,7,null,null,"月",null,29,null,null,"日生"]
[]
["住所",null,null,null,null,null,null,null,null,"〒",760,null,"-",8571,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,"０８７－８３９－２３４６"]
[null,null,null,null,null,null,null,null,"高松市番町一丁目８－１５"]
[]
["住  環  境\n＊可能なら写真\nなど添付",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"階建て",null,null,null,null,null,"／居室　　階",null,null,null,null,null,null,null," エレベーター"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," トイレ"]
[null,null,null,null,null,null,null,null,"名称："]
[null,null,null,null,null,null,null,null,"特記事項",null,null,null,null,null,null," ペット",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"玄関や室内には段差が多い"]
[]
["要介護度"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2,null,null,null,null,null,"  ) 申請日： ",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,"令和　年　月　日"]
[null,null,null,null,null,null,null,null,"有効期限",null,null,null,null,null,null,"令和",null,null,null,2,null,null,"年",null,10,null,null,"月",null,1,null,null,"日 ～ 令和",null,null,null,null,null,3,null,null,"年",null,9,null,null,"月",null,30,null,null,"日"]
["介護保険の",null,null,null,null,null,null,null,"１割",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ケアマネ",null,null,null,null,null,"つつじケアプランセンター",null,null,null,null,null,null,null,null,null,null,null,null,null,"ケアマネ",null,null,null,null,null,"栗林　雪男"]
["自己負担割合",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名"]
["障害高齢者の日常生活自立度※₁",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"A2",null,null,null,null,null,null,null,null,"認知症高齢者の日常生活自立度※₂",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"自立"]
["障がい等認定"]
["手帳等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"診断名："]
["医療保険"]
["経済状況"]
[null,null,null,null,null,null,null,null,"特記事項"]
[]
[]
["  家族構成／連絡先"]
["世帯構成",null,null,null,null,null,null,null," (家族構成数：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人）"]
[null,null,null,null,null,null,null,null,"氏　　名",null,null,null,null,null,null,null,null,null,"住　　　　所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年齢",null,null,null,"続柄",null,null,null,null,"TEL"]
["主介護者",null,null,null,null,null,null,null,"高松　花子",null,null,null,null,null,null,null,null,null,"高松市番町一丁目８－１５",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,80,null,null,null,"妻",null,null,null,null,"087－839-2346"]
["キーパーソン",null,null,null,null,null,null,null,"①",null,"高松　次郎",null,null,null,null,null,null,null,"高松市桜町一丁目〇‐〇",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,50,null,null,null,"長男",null,null,null,null,"087‐839‐〇〇〇〇"]
[null,null,null,null,null,null,null,null,"②"]
[null,null,null,null,null,null,null,null,"③"]
["特 記 事 項",null,null,null,null,null,null,null,"通院や買い物等、長男夫婦の支援あり。"]
[]
[]
[" 本人・家族の意向"]
["本人の性格／趣味・関心等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社交的で友人も多い。趣味はスポーツ観戦。特にプロ野球や相撲が好き。"]
["本人の生活歴・職歴等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"仕事は営業職で、若い頃は転勤で全国を転々としていた。定年まで勤めた後、高松へ帰郷した。"]
["本人の意向・望む生活",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"妻や息子の支援を受けながら家で暮らしたい。"]
["家族の意向・望む生活",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"本人の希望に沿って、サービスを利用しながら、自宅で生活を続けたい。"]
["その時に備えて(ACP/人生会議)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⇒別紙「その時に備えて」参照      "]
[" 入院前の受診・受療状況"]
["治療中の疾患名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療機関名称",null,null,null,null,null,null,null,null,"診療科／医師名",null,null,null,null,null,null,null,null,null,null,null,null,null,"受診状況",null,null,null,null,null,null,"治療・医療処置管理等"]
["高血圧",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"香川クリニック",null,null,null,null,null,null,null,null,"内科/瀬戸　海子",null,null,null,null,null,null,null,null,null,null,null,null,null,"通院(月1回)",null,null,null,null,null,null,"投薬治療"]
["慢性心不全",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"香川クリニック",null,null,null,null,null,null,null,null,"内科/瀬戸　海子",null,null,null,null,null,null,null,null,null,null,null,null,null,"通院(月1回)",null,null,null,null,null,null,"投薬治療"]
[]
[]
[]
["既往歴"]
[null,null,null,null,null,null,null,null,"55歳：拡張型心筋症、心房細動の診断にて心不全の治療を実施"]
[]
["手術歴",null,null,null,null,null,null,null,"65歳：僧帽弁閉鎖不全にて、僧帽弁置換術、三尖弁形成術施行"]
[]
["入院歴",null,null,null,null,null,null,null,"最近半年間",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"病名："]
[null,null,null,null,null,null,null,null,"での入院",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"期間：",null,null,null,"年　　月　　日",null,null,null,null,null,null,null,null,null,null,"～",null,"年　　月　　日"]
[null,null,null,null,null,null,null,null,"入院頻度"]
["医療処置"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,"特記事項：",null,null,null,null,null,null,"【酸素指示】安静時：酸素流量1.5ℓ/分、労作時：酸素流量3ℓ/分"]
[]
[]
[" 入院前の服薬状況"]
["使用中の薬剤",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"居宅療養管理指導"]
["薬剤管理",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"妻"]
["服薬状況"]
["かかりつけ薬局・薬剤師",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⇒ 薬局名：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"峰山薬局",null,null,null,null,null,null,null,null,null,null,null,null,null,"薬剤師名：",null,null,null,null,null,"石清尾　緑"]
["特記事項",null,null,null,null,null,null,null," 副作用"]
[]
[]
[]
[" 入院前の介護サービスの利用状況"]
["入院前の\n介護サービス\n利用状況"]
[]
[" 今後の在宅生活の展望について（ケアマネジャーとしての意見）"]
["退院後の希望"]
[null,null,null,null,null,null,null,null,"  詳細："]
["退院後の世帯状況と配慮の 有無"]
[null,null,null,null,null,null,null,null,"  世帯に対する配慮　"]
["退院後の\n介護力",null,null,null,null,null,null,null,"主介護者"]
[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,"氏名：",null,null,null,null,null,null,null,null,null,null,null,null,null,"続柄：",null,null,null,null,null,null,null,"連絡先："]
[]
["特記事項",null,null,null,null,null,null,null," 家族や同居者等による虐待・DVの疑い"]
[]
[]
[]
["  身体・生活機能の状況"]
[]
["利用者・患者氏名：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記入日：",null,null,null,null,"令和　3 年  〇 月  〇 日",null,null,null,null,null,null,null,null,null,null,null,null,null,"情報提供日：",null,null,null,null,null,null,null,"令和　3 年  〇 月  〇 日"]
[]
["身長：",null,null,null,160,null,null,"cm",null,"体重：",null,null,null,48,null,null,"Kg",null,"アレルギー",null,null,null,null,null,null,"内容："]
["感染症",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"部位：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
["褥瘡",null,null,null,null,null,null,null,"部位：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"皮膚障害",null,null,null,null,null,null,"部位："]
["麻痺"]
["拘縮",null,null,null,null,null,null,null,"部位：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"四肢欠損",null,null,null,null,null,null,"部位："]
[null,null,null,null,null,null,null,null,"自立",null,null,null,"見守り",null,null,null,"一部介助",null,null,null,"全介助",null,null,null,"移動（屋内）"]
["移動",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"移動（屋外）"]
["移乗",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"装具の有無"]
["起居動作",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(身体清潔の状況等、特記事項)"]
["更衣"]
["整 容",null,null,null,"洗 顔"]
[null,null,null,null,"整 髪"]
[null,null,null,null,"爪 切"]
["入浴",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"入浴制限"]
["食事",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"食事回数・時間",null,null,null,null,null,null,null,3,null,null,null,null,null,null,"回／日",null,null,null,null,6,null,null,"時、",null,null,12,null,null,"時、",null,null,18,null,null,"時"]
["口腔ケア",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"嚥下",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"咀嚼"]
["食事形態",null,null,null,null,null,null,null,"）                      "]
["摂取方法",null,null,null,null,null,null,null,")　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"言語"]
["栄養",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"kg/週・月",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Kcal",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ｇ"]
[null,null,null,null,null,null,null,null,"　　　　  （",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
["（摂食・嚥下に関する特記事項）"]
[]
[]
["排尿"]
["排便"]
["（排泄に関する特記事項）"]
[]
["睡眠の状態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"眠剤の使用"]
["喫煙",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"本くらい／日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,40,null,null,null,null,null,"年間",null,null,10,null,null,null,null,null,null,"本くらい／日"]
["飲酒",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"合くらい／日",null,null,null,null,null,null,null,"特記事項："]
[" コミュニケーション能力",null,null,null,null,null,null,null,"視力",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"眼鏡"]
[null,null,null,null,null,null,null,null,"聴力",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"補聴器"]
[null,null,null,null,null,null,null,null,"言語",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"意思疎通"]
[null,null,null,null,null,null,null,null," 特記事項："]
[]
[]
["精神面に\nおける療養上\nの問題"]
[]
[]
[null,null,null,null,null,null,null,null," 特記事項："]
[]
[]
["身体・生活機能の状況についての情報："]
[]
[]
[" 今回の入院概要"]
["入院日",null,null,null,null,null,null,null,"令３ 年  〇月  〇 日",null,null,null,null,null,null,null,null,"入院経路"]
["診療科･主治医",null,null,null,null,null,null,null,"循環器内科",null,null,null,null,null,null,null,null,"担当医：",null,null,null,null,null,null,"四国　三郎",null,null,null,null,null,null,null,null,null,"科",null,null,null,null,null,null,null,null,"担当医："]
["退(転)院のめやす･予定日など",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2週間程度"]
[]
[]
["入院原因疾患名･入院目的",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"慢性心不全急性増悪"]
[]
[]
["入院中の治療概要･看護･ 療養\n経過",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"心臓の機能を強くするため、２４時間持続的に薬剤を投与し、心機能増強と浮腫の改善に努める。しばらくは、ベッド上で安静状態となる。"]
[]
[]
["症状･病状説明、予後･予測、\n注意事項等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"心臓の働きの低下により、全身の血液流量が低下、全身に浮腫が出現し、心不全が急激に悪化した状態。"]
[]
[]
["退院後の外来受診",null,null,null,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週間に1回"]
["本人",null,null,null,null,null,null,null,"病気･障害･後遺症等の受け止め方",null,null,null,null,null,null,null,null,"病気の経過は長いので、ある程度疾患や気を付ける点など理解しているつもり。"]
[]
[]
[null,null,null,null,null,null,null,null,"退院･転院後についての意向",null,null,null,null,null,null,null,null,"家族やケアスタッフの支援を受けながら、自宅で療養したい。"]
[]
[]
["家族",null,null,null,null,null,null,null,"病気･障害･後遺症等の受け止め方",null,null,null,null,null,null,null,null,"これ以上悪化せずに病気と付き合っていけたらと思う。"]
[]
[]
[null,null,null,null,null,null,null,null,"退院･転院後についての意向",null,null,null,null,null,null,null,null,"本人の意向に沿って、ケアスタッフの支援を受けながら、自宅で療養をさせてあげたい。"]
[]
[]
["退院先(医療機関・施設等)"]
[" 転院・退院後に必要な事柄"]
["医療処置管理",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"留意事項・継続依頼したい事柄等"]
[]
[]
[]
[]
[]
["薬剤管理"]
[null,null,null,null,null,null,null,null,"退院後の注意点"]
[]
[]
[null,null,null,null,null,null,null,null,"服用管理の注意点"]
[]
["看護の視点"]
[]
[]
[]
[]
["リハビリ\nの視点"]
[]
[]
[]
[]
[]
[]
[]
["社会福祉\nサービスの\n利用"]
[]
[]
["禁忌事項"]
["備考"]

{"sheet":"入退院情報共有シート","index":1,"n_rows":210,"n_cols":61,"rows_kept":210,"cut":false,"hidden":false,"merged":[[3,0,3,7],[3,8,3,26],[3,35,3,42],[3,43,3,61],[4,0,4,7],[4,8,4,26],[4,35,4,42],[4,43,4,61],[7,0,7,7],[7,8,7,26],[7,35,7,42],[7,43,7,61],[9,0,9,61],[10,0,10,61],[5,0,5,7],[5,8,5,26],[5,35,5,42],[5,43,5,61],[6,0,6,7],[6,8,6,26],[6,35,6,42],[6,43,6,61],[15,0,17,7],[15,10,15,11],[15,13,15,15],[15,16,15,36],[15,37,17,42],[15,43,17,61],[16,8,17,36],[11,50,14,51],[11,52,14,54],[11,55,14,61],[12,0,14,7],[12,8,14,23],[13,27,14,29],[13,30,14,31],[13,32,14,34],[13,35,14,36],[13,37,14,39],[11,0,11,7],[11,8,11,23],[11,24,14,26],[11,27,12,42],[11,43,14,45],[11,46,14,49],[13,40,14,42],[25,19,25,21],[25,22,25,23],[25,24,25,26],[25,27,25,28],[21,31,21,61],[22,15,22,61],[23,0,25,7],[23,8,23,14],[23,15,23,20],[23,21,23,61],[24,8,24,14],[24,15,24,20],[24,21,24,50],[24,51,24,61],[18,0,22,7],[18,8,19,27],[18,28,19,33],[18,34,19,41],[18,42,18,61],[19,42,19,61],[20,8,20,18],[20,19,20,61],[21,8,22,14],[21,15,21,30],[27,24,27,29],[27,44,27,49],[28,0,28,14],[28,15,28,23],[28,24,28,39],[28,40,28,49],[25,48,25,50],[25,51,25,61],[26,0,26,7],[26,8,27,14],[26,15,27,23],[26,24,26,29],[26,30,27,43],[26,44,26,49],[26,50,27,61],[27,0,27,7],[25,29,25,31],[25,32,25,37],[25,38,25,40],[25,41,25,42],[25,43,25,45],[25,46,25,47],[25,8,25,14],[25,15,25,18],[28,50,28,61],[29,0,29,7],[29,8,30,14],[29,15,29,20],[29,21,29,23],[29,24,29,29],[29,30,29,39],[29,40,29,61],[30,0,30,7],[30,15,30,20],[32,0,35,7],[32,8,32,50],[32,51,32,61],[33,8,35,14],[33,15,35,61],[36,0,36,61],[30,21,30,23],[30,24,30,36],[30,37,30,61],[31,0,31,7],[31,8,31,50],[31,51,31,61],[39,0,39,7],[39,8,39,17],[39,18,39,41],[39,42,39,45],[39,46,39,50],[39,51,39,61],[37,0,37,7],[37,8,37,35],[37,36,37,37],[37,38,37,51],[37,52,37,61],[38,8,38,17],[38,18,38,41],[38,42,38,45],[38,46,38,50],[38,51,38,61],[42,46,42,50],[42,51,42,61],[43,0,45,7],[43,8,45,61],[46,0,46,61],[47,0,47,14],[47,15,47,61],[40,51,40,61],[41,8,41,9],[41,10,41,17],[41,18,41,41],[41,42,41,45],[41,46,41,50],[41,51,41,61],[40,0,42,7],[40,8,40,9],[40,10,40,17],[40,18,40,41],[40,42,40,45],[40,46,40,50],[42,8,42,9],[42,10,42,17],[42,18,42,41],[42,42,42,45],[51,0,51,14],[51,15,51,61],[52,0,52,61],[53,0,53,16],[53,17,53,25],[53,26,53,39],[53,40,53,46],[53,47,53,61],[48,0,48,14],[48,15,48,61],[49,0,49,14],[49,15,49,61],[50,0,50,14],[50,15,50,61],[54,0,54,16],[54,17,54,25],[54,26,54,39],[54,40,54,46],[54,47,54,61],[55,0,55,16],[55,17,55,25],[55,26,55,39],[55,40,55,46],[55,47,55,61],[56,0,56,16],[56,17,56,25],[56,26,56,39],[56,40,56,46],[56,47,56,61],[57,0,57,16],[57,17,57,25],[57,26,57,39],[57,40,57,46],[57,47,57,61],[58,0,58,16],[58,17,58,25],[58,26,58,39],[58,40,58,46],[58,47,58,61],[59,0,61,7],[59,8,59,52],[59,53,59,61],[60,8,61,61],[62,0,63,7],[62,8,63,61],[64,0,66,7],[64,8,64,14],[64,15,65,25],[64,26,64,29],[64,30,64,55],[64,56,65,61],[65,8,65,14],[65,26,65,29],[65,30,65,40],[65,41,65,42],[65,43,65,53],[66,8,66,14],[66,15,66,61],[67,0,75,7],[67,8,69,61],[70,8,70,52],[70,53,70,61],[71,8,71,52],[74,8,75,61],[76,0,76,61],[77,0,77,7],[77,8,77,40],[77,41,77,50],[77,51,77,61],[71,53,71,61],[72,8,72,15],[72,16,72,36],[72,37,72,42],[72,43,72,61],[73,8,73,14],[73,15,73,61],[78,0,78,7],[78,8,78,43],[78,44,78,61],[79,0,79,7],[79,8,79,61],[80,0,80,14],[80,15,80,31],[80,32,80,45],[80,46,80,51],[80,52,80,61],[88,0,88,61],[89,0,90,7],[89,8,89,45],[89,46,89,61],[90,8,90,12],[90,13,90,61],[81,0,84,7],[81,8,81,22],[81,23,81,61],[82,8,84,61],[85,0,85,61],[86,0,87,7],[86,8,86,61],[87,8,87,14],[87,15,87,61],[94,25,94,28],[94,29,94,38],[94,39,94,42],[94,43,94,46],[94,47,94,51],[94,52,94,61],[91,0,92,7],[91,8,91,36],[91,37,91,61],[92,8,92,28],[92,29,92,61],[93,0,95,7],[93,8,94,14],[93,15,93,24],[93,25,93,61],[94,15,94,24],[100,0,100,61],[102,0,102,10],[102,11,102,20],[102,21,102,25],[102,26,102,39],[102,40,102,47],[102,48,102,61],[95,8,95,61],[96,0,99,7],[96,8,96,28],[96,29,96,38],[96,39,96,61],[97,8,99,61],[106,60,106,61],[107,0,107,7],[107,8,107,21],[107,22,107,31],[107,32,107,38],[107,39,107,51],[107,52,107,61],[104,18,104,24],[104,25,104,47],[104,48,104,61],[105,0,106,7],[105,8,105,43],[105,44,105,47],[105,48,105,59],[105,60,105,61],[106,8,106,42],[106,43,106,59],[104,0,104,3],[104,4,104,6],[104,7,104,8],[104,9,104,12],[104,13,104,15],[104,16,104,17],[108,0,108,7],[108,8,108,40],[108,41,108,61],[109,0,109,7],[109,8,109,21],[109,22,109,31],[109,32,109,38],[109,39,109,51],[109,52,109,61],[110,32,110,56],[110,57,110,61],[111,0,111,7],[111,8,111,11],[111,12,111,15],[111,16,111,19],[111,20,111,23],[111,24,111,31],[111,32,111,56],[111,57,111,61],[110,0,110,7],[110,8,110,11],[110,12,110,15],[110,16,110,19],[110,20,110,23],[110,24,110,31],[114,24,117,61],[115,0,117,3],[115,4,115,7],[115,8,115,11],[115,12,115,15],[112,32,112,41],[112,42,112,61],[113,0,113,7],[113,8,113,11],[113,12,113,15],[113,16,113,19],[113,20,113,23],[113,24,113,40],[113,41,113,61],[112,0,112,7],[112,8,112,11],[112,12,112,15],[112,16,112,19],[112,20,112,23],[112,24,112,31],[115,16,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["資料1：入退院支援情報共有シート"]
["入退院支援情報共有シート"]
[]
["記  入  日 ： ",null,null,null,null,null,null,null,"令和　　　年　　　月　　　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,"情報提供日：",null,null,null,null,null,null,null,"令和　　　年　　　月　　　日"]
["施設名",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,null,null,"施設名"]
["部署・担当者名",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,null,null,"部署・担当者名"]
["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,"電話番号"]
["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,null,null,null,null,null,null,null,null,null,null,"ＦＡＸ番号"]
[]
["◆ 利用者・患者、家族の同意に基づき、以下の情報を提供します。"]
[" 利用者・患者の基本情報"]
["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,"生年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年齢",null,null,null,null,null,null,"歳",null,"性別"]
["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,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日生"]
[]
["住所",null,null,null,null,null,null,null,null,"〒",null,null,"-",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"]
[]
[]
["住  環  境\n＊可能なら写真\nなど添付",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"階建て",null,null,null,null,null,"／居室　　階",null,null,null,null,null,null,null," エレベーター"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," トイレ"]
[null,null,null,null,null,null,null,null,"名称："]
[null,null,null,null,null,null,null,null,"特記事項",null,null,null,null,null,null," ペット"]
[]
["要介護度"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"  ) 申請日： ",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,"令和　年　月　日"]
[null,null,null,null,null,null,null,null,"有効期限",null,null,null,null,null,null,"令和",null,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日 ～ 令和",null,null,null,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日"]
["介護保険の",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ケアマネ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ケアマネ"]
["自己負担割合",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名"]
["障害高齢者の日常生活自立度※₁",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認知症高齢者の日常生活自立度※₂"]
["障がい等認定"]
["手帳等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"診断名："]
["医療保険"]
["経済状況"]
[null,null,null,null,null,null,null,null,"特記事項"]
[]
[]
["  家族構成／連絡先"]
["世帯構成",null,null,null,null,null,null,null," (家族構成数：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人）"]
[null,null,null,null,null,null,null,null,"氏　　名",null,null,null,null,null,null,null,null,null,"住　　　　所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年齢",null,null,null,"続柄",null,null,null,null,"TEL"]
["主介護者"]
["キーパーソン",null,null,null,null,null,null,null,"①"]
[null,null,null,null,null,null,null,null,"②"]
[null,null,null,null,null,null,null,null,"③"]
["特 記 事 項"]
[]
[]
[" 本人・家族の意向"]
["本人の性格／趣味・関心等"]
["本人の生活歴・職歴等"]
["本人の意向・望む生活"]
["家族の意向・望む生活"]
["その時に備えて(ACP/人生会議)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⇒別紙「その時に備えて」参照      "]
[" 入院前の受診・受療状況"]
["治療中の疾患名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療機関名称",null,null,null,null,null,null,null,null,"診療科／医師名",null,null,null,null,null,null,null,null,null,null,null,null,null,"受診状況",null,null,null,null,null,null,"治療・医療処置管理等"]
[]
[]
[]
[]
[]
["既往歴"]
[]
[]
["手術歴"]
[]
["入院歴",null,null,null,null,null,null,null,"最近半年間",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"病名："]
[null,null,null,null,null,null,null,null,"での入院",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"期間：",null,null,null,"年　　月　　日",null,null,null,null,null,null,null,null,null,null,"～",null,"年　　月　　日"]
[null,null,null,null,null,null,null,null,"入院頻度"]
["医療処置"]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,"特記事項："]
[]
[]
[" 入院前の服薬状況"]
["使用中の薬剤",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"居宅療養管理指導"]
["薬剤管理"]
["服薬状況"]
["かかりつけ薬局・薬剤師",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⇒ 薬局名：",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,"薬剤師名："]
["特記事項",null,null,null,null,null,null,null," 副作用"]
[]
[]
[]
[" 入院前の介護サービスの利用状況"]
["入院前の\n介護サービス\n利用状況"]
[]
[" 今後の在宅生活の展望について（ケアマネジャーとしての意見）"]
["退院後の希望"]
[null,null,null,null,null,null,null,null,"  詳細："]
["退院後の世帯状況と配慮の 有無"]
[null,null,null,null,null,null,null,null,"  世帯に対する配慮　"]
["退院後の\n介護力",null,null,null,null,null,null,null,"主介護者"]
[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,"氏名：",null,null,null,null,null,null,null,null,null,null,null,null,null,"続柄：",null,null,null,null,null,null,null,"連絡先："]
[]
["特記事項",null,null,null,null,null,null,null," 家族や同居者等による虐待・DVの疑い"]
[]
[]
[]
["  身体・生活機能の状況"]
[]
["利用者・患者氏名：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記入日：",null,null,null,null,"令和　　年　　月　　日",null,null,null,null,null,null,null,null,null,null,null,null,null,"情報提供日：",null,null,null,null,null,null,null,"令和　　年　　月　　日"]
[]
["身長：",null,null,null,null,null,null,"cm",null,"体重：",null,null,null,null,null,null,"Kg",null,"アレルギー",null,null,null,null,null,null,"内容："]
["感染症",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"部位：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
["褥瘡",null,null,null,null,null,null,null,"部位：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"皮膚障害",null,null,null,null,null,null,"部位："]
["麻痺"]
["拘縮",null,null,null,null,null,null,null,"部位：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"四肢欠損",null,null,null,null,null,null,"部位："]
[null,null,null,null,null,null,null,null,"自立",null,null,null,"見守り",null,null,null,"一部介助",null,null,null,"全介助",null,null,null,"移動（屋内）"]
["移動",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"移動（屋外）"]
["移乗",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"装具の有無"]
["起居動作",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(身体清潔の状況等、特記事項)"]
["更衣"]
["整 容",null,null,null,"洗 顔"]
[null,null,null,null,"整 髪"]
[null,null,null,null,"爪 切"]
["入浴",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"入浴制限"]
["食事",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"食事回数・時間",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"回／日",null,null,null,null,null,null,null,"時、",null,null,null,null,null,"時、",null,null,null,null,null,"時"]
["口腔ケア",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"嚥下",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"咀嚼"]
["食事形態",null,null,null,null,null,null,null,"）                      "]
["摂取方法",null,null,null,null,null,null,null,")　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"言語"]
["栄養",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"kg/週・月",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Kcal",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ｇ"]
[null,null,null,null,null,null,null,null,"　　　　  （",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,")"]
["（摂食・嚥下に関する特記事項）"]
[]
[]
["排尿"]
["排便"]
["（排泄に関する特記事項）"]
[]
["睡眠の状態",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"眠剤の使用"]
["喫煙",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"本くらい／日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年間",null,null,null,null,null,null,null,null,null,"本くらい／日"]
["飲酒",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"合くらい／日",null,null,null,null,null,null,null,"特記事項："]
[" コミュニケーション能力",null,null,null,null,null,null,null,"視力",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"眼鏡"]
[null,null,null,null,null,null,null,null,"聴力",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"補聴器"]
[null,null,null,null,null,null,null,null,"言語",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"意思疎通"]
[null,null,null,null,null,null,null,null," 特記事項："]
[]
[]
["精神面に\nおける療養上\nの問題"]
[]
[]
[null,null,null,null,null,null,null,null," 特記事項："]
[]
[]
["身体・生活機能の状況についての情報："]
[]
[]
[" 今回の入院概要"]
["入院日",null,null,null,null,null,null,null,"令　 年　月　日",null,null,null,null,null,null,null,null,"入院経路"]
["診療科･主治医",null,null,null,null,null,null,null,"科",null,null,null,null,null,null,null,null,"担当医：",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,"担当医："]
["退(転)院のめやす･予定日など"]
[]
[]
["入院原因疾患名･入院目的"]
[]
[]
["入院中の治療概要･看護･ 療養\n経過"]
[]
[]
["症状･病状説明、予後･予測、\n注意事項等"]
[]
[]
["退院後の外来受診"]
["本人",null,null,null,null,null,null,null,"病気･障害･後遺症等の受け止め方"]
[]
[]
[null,null,null,null,null,null,null,null,"退院･転院後についての意向"]
[]
[]
["家族",null,null,null,null,null,null,null,"病気･障害･後遺症等の受け止め方"]
[]
[]
[null,null,null,null,null,null,null,null,"退院･転院後についての意向"]
[]
[]
["退院先(医療機関・施設等)"]
[" 転院・退院後に必要な事柄"]
["医療処置管理",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"留意事項・継続依頼したい事柄等"]
[]
[]
[]
[]
[]
["薬剤管理"]
[null,null,null,null,null,null,null,null,"退院後の注意点"]
[]
[]
[null,null,null,null,null,null,null,null,"服用管理の注意点"]
[]
["看護の視点"]
[]
[]
[]
[]
["リハビリ\nの視点"]
[]
[]
[]
[]
[]
[]
[]
["社会福祉\nサービスの\n利用"]
[]
[]
["禁忌事項"]
["備考"]

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["資料１：入退院支援情報共有シート　別紙"]
["カンファレンス等の実施状況"]
[]
[null,null,null,null,"利用者・患者氏名"]
[" 話し合いの日時・場所",null,"日時"," 令　年　月　日","：","～","場所"]
[]
["参加者",null,null,null,null,null,null,"※下欄に氏名、本人との関係を記入"]
[]
[]
[]
[]
[]
[]
[null,"医療・介護・福祉等関係者"]
[null,"所属施設・事業所名","職種","氏名","所属施設・事業所名",null,null,"職種",null,"氏名"]
[]
[]
[]
[]
[]
[" ＜話し合いの概要、備考＞"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[" 話し合いの内容について、了承しました。　",null,null," 令　年　月　日","利用者・患者／家族："]

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["資料１：入退院支援情報共有シート　別紙"]
["そ の 時 に 備 え て"]
[]
["＊ご本人の希望や想いに沿った選択ができるよう、ご家族や大切な人、医療・介護関係者で話し合っておきましょう。"]
["＊法定伝染病や事件、事故、災害等の場合は適応外となる場合もあります。"]
[null,null,null,null,"利用者・患者氏名"]
[" 「その時に備えて」医療に対する利用者・患者の希望"]
["基本的な希望","大切にしていること"]
[]
[]
[]
[]
[]
[null,"痛みや苦痛について"]
[null,"終末期を迎える場所"]
[null,"その他基本的な希望"]
[]
[]
[null,"自由記載："]
[]
[]
["終末期になったときの希望"," ① 心臓マッサージなどの心肺蘇生"]
[null," ② 延命のための人工呼吸器"]
[null," ③ 胃ろうによる栄養補給"]
[null," ④ 経鼻チューブによる栄養補給"]
[null," ⑤ 高カロリー輸液の投与"]
[null," ⑥ その他（輸血・人工透析など）の希望"]
[null,"自由記載："]
[]
[]
[" 代理決定者（利用者・患者が自分で判断ができなくなったとき、主治医が相談すべき人）"]
[" 氏名：",null,"関係：",null,"特記事項："]
[" 氏名：",null,"関係："]
[" 氏名：",null,"関係："]
["「その時に備えて」の話し合い　＊上記に記載している内容について、話し合った時の状況"]
[" 話し合いの日時・場所",null,"日時"," 令　年　月　日","：","～","場所"]
["参加者",null,null,null,null,null,null,"※下欄に氏名、本人との関係を記入"]
[]
[]
[]
[null,"医療・介護・福祉等関係者"]
[null,"所属施設・事業所名","職種","氏名","所属施設・事業所名",null,null,"職種",null,"氏名"]
[]
[]
[]
[" ＜話し合いの概要、備考＞"]

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["※１　障害高齢者の日常生活自立度（寝たきり度）判定基準"]
["生活自立",null,"何らかの障害等を有するが、日常生活はほぼ自立しており独力で外出する"]
[null,"ランクJ","１．交通機関などを利用して外出する"]
[null,null,"２．隣近所へなら外出する"]
["準寝たきり",null,"屋内での生活は概ね自立しているが、介助なしには外出しない"]
[null,"ランクA","１．介助により外出し、日中はほとんどベッドから離れて生活する"]
[null,null,"２．外出の頻度が少なく、日中も寝たり起きたりの生活をしている"]
["寝たきり",null,"屋内での生活は何らかの介助を要し、日中もベッド上での生活が主体であるが、座位を保つ"]
[null,"ランクB","１．車いすに移乗し、食事、排泄はベッドから離れて行う"]
[null,null,"２．介助により車いすに移乗する"]
[null,null,"１日中ベッド上で過ごし、排泄、食事、着替えにおいて介助を要する"]
[null,"ランクC","１．自分で寝返りをうつ"]
[null,null,"２．自力では寝返りもうたない"]
[]
["※２　認知症高齢者の日常生活自立度判定基準"]
["ランク","判断基準",null,null,"見られる症状・行動の例",null,null,"判断にあたっての留意事項　　　　\n及び提供されるサービスの例"]
["Ⅰ","何らかの認知症を有するが、日常生活は家庭内及び社会的にほぼ自立している。",null,null,null,null,null,"在宅生活が基本であり、一人暮らしも可能である。相談、指導等を実施することにより、症状の改善や進行の阻止を図る。"]
["Ⅱ","日常生活に支障を来たすような症状・行動や意思疎通の困難さが多少見られても、誰かが注意していれば自立できる。",null,null,null,null,null,"在宅生活が基本であるが、一人暮らしは困難な場合もあるので、日中の居宅サービスを利用することにより、在宅生活の支援と症状の改善及び進行の阻止を図る。"]
["Ⅱa","家庭外で上記Ⅱの状態がみられる。",null,null,"たびたび道に迷うとか、買物や事務、金銭管理等それまでできたことにミスが目立つ等"]
["Ⅱb","家庭内でも上記Ⅱの状態がみられる。",null,null,"服薬管理ができない、電話の応対や訪問者との対応等一人で留守番ができない等"]
["Ⅲ","日常生活に支障を来たすような症状・行動や意思疎通の困難さが見られ、介護を必要とする。",null,null,null,null,null,"日常生活に支障を来すような行動や意思疎通の困難さがランクⅡより重度となり、介護が必要となる状態である。「ときどき」とはどのくらいの頻度を指すかについては、症状・行動の種類等により異なるので一概には決められないが、一時も目を離せない状態ではない。在宅生活が基本であるが、一人暮らしは困難であるので、夜間の利用も含めた居宅サービスを利用しこれらのサービスを組み合わせることによる在宅での対応を図る。"]
["Ⅲa","夜間を中心として上記Ⅲの状態が見られる。",null,null,"着替え、食事、排便、排尿が上手にできない、時間がかかる。\nやたらに物を口に入れる、物を拾い集める、徘徊、失禁、大声、奇声をあげる、火の不始末、不潔行為、性的異常行為等"]
["Ⅲb","夜間を中心として上記Ⅲの状態が見られる。",null,null,"ランクⅢaに同じ"]
["Ⅳ","日常生活に支障を来たすような症状・行動や意思疎通の困難さが頻繁に見られ、常に介護を必要とする。",null,null,"ランクⅢに同じ",null,null,"常に目を離すことができない状態である。症状・行動はランクⅢと同じであるが、頻度の違いにより区分される。家族の介護力等の住宅基盤の強弱により居宅サービスを利用しながら住宅生活を続けるか、または特別養護老人ホーム・老人保健施設等の施設サービスを利用するかを選択する。施設サービスを選択する場合には、施設の特徴を踏まえた選択を行う。"]
["M","著しい精神症状や周辺症状あるいは重篤な身体疾患が見られ、専門医療を必要とする。",null,null,"せん妄、妄想、興奮、自傷・他害等の精神症状や精神症状に起因する周辺症状が継続する状態等",null,null,"ランクⅠ～Ⅳと判定されていた高齢者が、精神病院や認知症専門棟を有する老人保健施設等での治療が必要となったり、重篤な身体疾患が見られ老人病院等での治療が必要となった状態である。専門医療機関を受診するよう勧める必要がある。"]