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["介護福祉士等から介護支援専門員への連携シート"]
["送付日"]
["居宅介護支援事業所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"訪問介護\n事業所"]
["TEL",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL"]
["FAX",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FAX"]
["担当ケア",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"サービス提供"]
["マネジャー",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"責任者"]
["平素はお世話になっております。\n下記の利用者様の訪問介護時の状況を、ご報告させていただきます。"]
["利用者",null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
["報告項目",null,null,null,null,null,"服薬状況",null,null,null,null,null,"口腔機能",null,null,null,null,null,"心身状況",null,null,null,null,null,"その他"]
[]
[]
["上記記載欄項目の具体的報告"]
["服薬状況",null," ①薬が多量に残っているか"]
[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複数回数分の薬を一度に服用しているか"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"➔"]
[]
[null,null," ③薬の服用を拒絶しているか"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"➔"]
[]
[null,null," ④使い切らないうちに新たに薬が処方されているか"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"➔"]
[]
["口腔機能",null," ①口臭や口腔内出血があるか"]
[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食事量・食事回数に変化があるか"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"➔"]
[]
["その他の心身状況",null," ①体重増減が推測される見た目の変化があるか"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"➔"]
[]
[null,null," ②下痢や便秘が続いているか"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"➔"]
[]
[null,null," ③皮膚が乾燥しているか"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"➔"]
[]
[null,null," ④湿疹があるか"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"➔",null,"湿疹ありの\n場合の部位"]
[]
[]
[]
[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,"薬が多量に残っている","多量に残っている","新しい薬"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"多量に残っていない","古い薬","自分で飲む能力がない"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"多量に残っている","新しい薬","飲みたくない"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"身体機能低下で飲む行為ができない"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"複数回数分の薬を一度に服用している","服用している","薬の服用を拒絶している","拒絶している"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"服用していない","わかっていない","拒絶していない","わかっていない"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"服用している","自分の意思","拒絶している","自分の意思"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"忘れている",null,"忘れている"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"使い切らないうちに新たに薬が処方されている","残っているのに処方されている"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"飲み切って処方されている","わかっていない"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"残っているのに処方されている","自分の意思"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"忘れている"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口臭や口腔内出血があるか","口臭や出血が有","出血"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口臭や出血が無","口臭","歯"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"口臭や出血が有","出血","口腔"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"両方"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"食事量・食事回数に変化がある","変化有"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"変化無","増えた"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"変化有","減った"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"体重増減が推測される見た目の変化がある","見た目の変化有"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"見た目の変化無","体重が減った"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"見た目の変化有","体重が増えた"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"下痢や便秘が続いている","下痢や便秘有"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"下痢や便秘無","下痢"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"下痢や便秘有","便秘"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"皮膚が乾燥しているか","乾燥有"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"乾燥無","水分取れている"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"乾燥有","水分取れていない"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"室内が暑い"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"湿疹があるか"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"湿疹無"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"湿疹有"]