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["伏見CKD連携パス　かかりつけ医用診療情報提供書 (連携開始時)"]
[{"$nulls":14},"診療所名"]
[{"$nulls":14},"医師名"]
["患者氏名",{"$nulls":11},"性別",null,"男","・","女"]
["生年月日",{"$nulls":3},"大正",null,"・","昭和",null,"・","平成",{"$nulls":3},"年",null,null,"月",null,null,"日",null,null,"歳"]
["紹介目的"]
[null,"1. 尿所見異常",{"$nulls":5},"2. 腎機能障害"]
[null,"3. その他",{"$nulls":3},"(　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",{"$nulls":26},")"]
["合併症"]
[null,"1. 高血圧症",{"$nulls":4}," 2. 糖尿病",{"$nulls":4},"3. 脂質異常症",{"$nulls":5},"4. 心臓病",{"$nulls":4},"5. 脳血管障害"]
[null,"6. その他",{"$nulls":3},"(　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",{"$nulls":26},")"]
["既往歴・家族歴"]
[]
[]
["診察時の希望"]
[null,"1. 栄養指導を受けさせて下さい。"]
[null,"2. 右記の検査を受けさせて下さい。",{"$nulls":12},"（",{"$nulls":17},")"]
[null,"3. 必要であれば入院加療をお願いします。"]
[null,"4. 連携パスを適応して下さい。",{"$nulls":10},"/","適応するかどうか貴院にお任せします。"]
[null,"/","しばらく貴院で診療して下さい。"]
["コメント"]
{"$rows_empty":13}
[{"$nulls":13},"※最近の検査データ・処方内容の添付をお願いします。"]