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["看護・介護状況申告書"]
[null,null,null,null,null,null,null,"日付："]
["文京区長殿　文京区教育委員会 殿"]
["　私の看護・介護状況は、下記のとおりです。\n（看護・介護要件で申し込む場合には、同居の親族（長期間入院等をしている親族を含む）を常時\n　看護または介護していることが必要です。）"]
["看護・介護をする方の住所"]
["看護・介護をする方の氏名"]
["申込児氏名\n（生年月日）",null,"氏名",null,null,null,null,"生年月日"]
[]
[]
["看護・介護を受ける方の氏名"]
["看護・介護を受ける方の住所"]
["看護・介護をする方からみた\n続柄",null,null,"1.配偶者",null,null,"2.子",null,"3.その他（",null,null,null,null,")",false,false,false,{"$f":"IF(COUNTIF(O12:Q12,TRUE)>0,2,1)","v":1},{"$f":"IF(AND(Q12=TRUE,K12=\"\"),1,2)","v":2}]
["看護・介護を\n必要とする理由",null," 身体障害者手帳",null,null,null,"（",null,"）種","（",null,"）級"]
[null,null," 愛の手帳",null,null,null,"（",null,"）度"]
[null,null," 精神保健福祉手帳",null,null,null,"（",null,"）級"]
[null,null," 要介護認定",null,null,"要介護（",null,null,"）","要支援（",null,null,"）"]
[null,null," その他　",null,null,null,"病名","（",null,null,null,null,"）"]
["看護・介護日数",null," 平均週",null,"（",null,"）","日"]
["看護・介護の状況",null," 食事",null,"1.介助なし",null,null,"2.一部介助",null,null,"3.すべて介助",null,null,null,false,false,false,{"$f":"IF(COUNTIF(O19:Q19,TRUE)=1,2,1)","v":1}]
[null,null," 入浴",null,"1.介助なし",null,null,"2.一部介助",null,null,"3.すべて介助",null,null,null,false,false,false,{"$f":"IF(COUNTIF(O20:Q20,TRUE)=1,2,1)","v":1}]
[null,null," 排泄",null,"1.介助なし",null,null,"2.一部介助",null,null,"3.すべて介助",null,null,null,false,false,false,1]
["その他具体的な\n看護・介護内容"]
[]
[]
[null,"※裏面も記入してください"]
[null,"添付書類　（あてはまるものの写しを添付してください）"]
[null,"○　身体障害者手帳　　○　愛の手帳　　○　精神保健福祉手帳"]
[null,"○　介護保険被保険者証（要介護認定を受けた方）　　○　診断書"]
[null,null,null,null,null,null,null,null,null,null,null,null,"文京区 幼児保育課 入園相談係　電話 03-5803-1190"]
["● 一週間の看護・介護状況"]
["曜日によって状況が変わらない場合は、月曜のみ記入し、他は「同左」記入。"]
[null,"例","月曜日",null,"火曜日",null,"水曜日",null,"木曜日",null,"金曜日",null,"土曜日"]
["07:00:00",null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(COUNTA(C33:N58)>0,2,1)","v":1}]
[]
["08:00:00","食事介助"]
[]
["09:00:00","↑"]
[]
["10:00:00"]
[null,"通院付き添い"]
["11:00:00"]
[]
["12:00:00","↓"]
[]
["13:00:00","食事介助"]
[]
["14:00:00","↑"]
[null,"掃除・選択\n買い物\n他雑事"]
["15:00:00"]
[]
["16:00:00"]
[null,"↓"]
["17:00:00","入浴介助"]
[]
["18:00:00","食事介助"]
[]
["19:00:00"]
[]
[]
["● 通院 ・ 通所先"]
["名称",null,null,null,null,"日数",null,"週","月（",null,"）回","不定期",null,null,false,false,false,{"$f":"IF(COUNTIF(O61:Q61,TRUE)=1,2,1)","v":1},{"$f":"IF(AND(OR(O61=TRUE,P61=TRUE),J61=\"\"),1,2)","v":2}]
["名称",null,null,null,null,"日数",null,"週","月（",null,"）回","不定期",null,null,false,false,false,{"$f":"IF(COUNTIF(O62:Q62,TRUE)=1,2,1)","v":1},{"$f":"IF(AND(OR(O62=TRUE,P62=TRUE),J62=\"\"),1,2)","v":2}]
["名称",null,null,null,null,"日数",null,"週","月（",null,"）回","不定期",null,null,false,false,false,1,2]