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["医療的ケア児保育所等利用事前相談票",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療的ケア児保育所等利用事前相談票"]
[null,null,null,null,null,null,null,null,"（相談日）",null,"年　   　   月　     　日",null,null,null,null,null,null,null,null,null,null,null,null,null,"（相談日）",null,"2024-05-01"]
["相談回数","初回　・　継続（　　）",null,null,null,null,"相談担当者",null,null,null,null,null,null,null,null,null,"相談回数","初回　・　継続（　　）",null,null,null,null,"相談担当者"]
[]
["（ふりがな）",null,null,null,null,null,"性別",null,"生年月日",null,null,null,"現年齢",null,"学年齢",null,"（ふりがな）","やつしろ　はな",null,null,null,null,"性別",null,"生年月日",null,null,null,"現年齢",null,"学年齢"]
["児童名",null,null,null,null,null,"男　　女",null,"　年　　月　　日",null,null,null,null,null,null,null,"児童名","八代　はな",null,null,null,null,"男　　女",null,"2022-12-01",null,null,null,1,null,1]
["（ふりがな）",null,null,null,null,null,"続柄",null,"電話番号",null,null,null,null,null,null,null,"（ふりがな）","やつしろ　たろう",null,null,null,null,"続柄",null,"電話番号"]
["保護者名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保護者名","八代　太郎",null,null,null,null,"父",null,"090-〇〇〇〇-××××（父）",null,null,null,"090-〇〇〇〇-××××（母）"]
["現住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"現住所","八代市〇●町12-3"]
["入所希望施設","第1希望",null,null,null,null,null,null,null,null,"入所希望年月",null,null,"年　　月",null,null,"入所希望施設","第1希望",null,null,"○○〇保育園",null,null,null,null,null,"入所希望年月",null,null,"令和6年８月"]
[null,"第2希望",null,null,null,null,null,null,null,null,"利用希望曜日",null,null,null,null,null,null,"第2希望",null,null,"×××保育園",null,null,null,null,null,"利用希望曜日"]
[null,"第3希望",null,null,null,null,null,null,null,null,"月　　火　　水　　木　　金",null,null,null,null,null,null,"第3希望",null,null,"△△△保育園",null,null,null,null,null,"月　　火　　水　　木　　金"]
["見学希望日\n（時間）","年　　月　　日",null,null,null,null,null,null,null,null,"利用希望時間",null,null,null,null,null,"見学希望日\n（時間）","令和６年５月２０日～２５日",null,null,null,null,null,null,null,null,"利用希望時間"]
[null,"　時頃",null,null,null,null,null,null,null,null,"　時　　分　 ～　 　時　　分",null,null,null,null,null,null,"　午前１０時～午後３時頃",null,null,null,null,null,null,null,null,"９時００分　 ～　 １７時００分"]
["その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他"]
["同居家族","氏名",null,null,null,null,"続柄",null,"生年月日",null,null,null,"勤務先・学校名等",null,null,null,"同居家族","氏名",null,null,null,null,"続柄",null,"生年月日",null,null,null,"勤務先・学校名等"]
[null,null,null,null,null,null,null,null,"年　　月　　日",null,null,null,null,null,null,null,null,"八代　太郎",null,null,null,null,"父",null,"1990-07-02",null,null,null,"㈱○○会社"]
[null,null,null,null,null,null,null,null,"年　　月　　日",null,null,null,null,null,null,null,null,"八代　桃子",null,null,null,null,"母",null,"1993-05-12",null,null,null,"〇×病院"]
[null,null,null,null,null,null,null,null,"年　　月　　日",null,null,null,null,null,null,null,null,"八代　たくみ",null,null,null,null,"兄",null,"2016-09-09",null,null,null,"○○小学校"]
[null,null,null,null,null,null,null,null,"年　　月　　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月　　日"]
[null,null,null,null,null,null,null,null,"年　　月　　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月　　日"]
[null,null,null,null,null,null,null,null,"年　　月　　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月　　日"]
[null,null,null,null,null,null,null,null,"年　　月　　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年　　月　　日"]
[]
["該当する医療的ケア等に☑をつけてください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"該当する医療的ケア等に☑をつけてください。"]
["経管栄養\n（経鼻・胃瘻・腸瘻）",null,null,"口から食べている",null,null,null,null,null,null,"鼻からチューブで入れている",null,null,null,null,null,"経管栄養\n（経鼻・胃瘻・腸瘻）",null,null,"口から食べている",null,null,null,null,null,null,"鼻からチューブで入れている"]
[null,null,null,"おなかからチューブで入れている",null,null,null,null,null,null,"首の近くから点滴をしている",null,null,null,null,null,null,null,null,"おなかからチューブで入れている",null,null,null,null,null,null,"首の近くから点滴をしている"]
[null,null,null,"その他（　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他（　　　　　　　　　　）"]
["吸引\n（口腔・鼻腔内・気管切開・気管カニューレ内）",null,null,"喉にチューブがついている",null,null,null,null,null,null,"人工呼吸器を使っている",null,null,null,null,null,"吸引\n（口腔・鼻腔内・気管切開・気管カニューレ内）",null,null,"喉にチューブがついている",null,null,null,null,null,null,"人工呼吸器を使っている"]
[null,null,null,"管やマスクで酸素を吸っている",null,null,null,null,null,null,"痰を器械でとっている",null,null,null,null,null,null,null,null,"管やマスクで酸素を吸っている",null,null,null,null,null,null,"痰を器械でとっている"]
[null,null,null,"その他（　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他（　　　　　　　　　　）"]
["導尿",null,null,"管を入れて尿を出している",null,null,null,null,null,null,"オムツを使用している",null,null,null,null,null,"導尿",null,null,"管を入れて尿を出している",null,null,null,null,null,null,"オムツを使用している"]
[null,null,null,"その他（　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他（　　　　　　　　　　）"]
["血糖管理",null,null,"器械を使って血糖値を測っている",null,null,null,null,null,null,"毎日注射をしている",null,null,null,null,null,"血糖管理",null,null,"器械を使って血糖値を測っている",null,null,null,null,null,null,"毎日注射をしている"]
[null,null,null,"毎日薬を飲ませている",null,null,null,null,null,null,"その他（　　　　　　　　　　）",null,null,null,null,null,null,null,null,"毎日薬を飲ませている",null,null,null,null,null,null,"その他（　　　　　　　　　　）"]
["酸素療法",null,null,"酸素カヌラを使用している",null,null,null,null,null,null,"酸素マスクを使用している",null,null,null,null,null,"酸素療法",null,null,"酸素カヌラを使用している",null,null,null,null,null,null,"酸素マスクを使用している"]
[null,null,null,"その他（　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他（　　　　　　　　　　）"]
["アレルギーの有無",null,null,"無",null,"有","⇒","(                                                                     )",null,null,null,null,null,null,null,null,"アレルギーの有無",null,null,"無",null,"有","⇒","( 卵・えび                                       )"]
["その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"相談票（裏）"]
["保育所における対象児童の支援の実施にあたり、以下の実施要件について、主治医の確認を得ていますか。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保育所における対象児童の支援の実施にあたり、以下の実施要件について、主治医の確認を得ていますか。"]
[null,1,"主治医が、対象児童が保育所において保育及び医療的ケアを受けることが可能であると判断すること",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1,"主治医が、対象児童が保育所において保育及び医療的ケアを受けることが可能であると判断すること"]
[null,null,null,"はい",null,null,"いいえ",null,null,"未確認",null,null,null,null,null,null,null,null,null,null,null,null,null,"はい",null,null,"いいえ",null,null,"未確認"]
[null,2,"主治医（医療機関）が、医療的ケアの手技を医療的ケア児施設担当看護師に指導すること",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2,"主治医（医療機関）が、医療的ケアの手技を医療的ケア児施設担当看護師に指導すること"]
[null,null,null,"はい",null,null,"いいえ",null,null,"未確認",null,null,null,null,null,null,null,null,null,null,null,null,null,"はい",null,null,"いいえ",null,null,"未確認"]
[]
["保育所における対象児童の支援の実施にあたり、以下の実施要件について、同意しますか。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保育所における対象児童の支援の実施にあたり、以下の実施要件について、同意しますか。"]
[null,1,"病状や医療的ケアに関する情報（主治医の意見や健康状態の変化等）を保育所と十分に共有すること",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1,"病状や医療的ケアに関する情報（主治医の意見や健康状態の変化等）を保育所と十分に共有すること"]
[null,null,null,"はい",null,null,"いいえ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"はい",null,null,"いいえ"]
[null,2,"医療的ケアに必要な機材・器具及び衛生用品等を不足ないように毎日持参し持ち帰り、準備、点検及び",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2,"医療的ケアに必要な機材・器具及び衛生用品等を不足ないように毎日持参し持ち帰り、準備、点検及び"]
[null,null,"整備を行うこと",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"整備を行うこと"]
[null,null,null,"はい",null,null,"いいえ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"はい",null,null,"いいえ"]
[null,3,"保育所において保育及び医療的ケアを実施するにあたり、物品の借用、費用の負担及び付き添いをお願い",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,"保育所において保育及び医療的ケアを実施するにあたり、物品の借用、費用の負担及び付き添いをお願い"]
[null,null,"することがあること",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"することがあること"]
[null,null,null,"はい",null,null,"いいえ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"はい",null,null,"いいえ"]
[]
["お子さまの現在の状況について",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"お子さまの現在の状況について"]
["病名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"病名"]
["障がい者手帳の有無",null,null,null,null,null,"身体障がい児手帳",null,null,null,null,"申請予定",null,null,"等級　（　　　　級）",null,null,null,null,null,"障がい者手帳の有無",null,null,null,null,null,"身体障がい児手帳",null,null,null,null,"申請予定",null,null,"等級　（　　　　級）"]
[null,null,null,null,null,null,"療育手帳",null,null,null,null,"申請予定",null,null,"判定　（　　　　　）",null,null,null,null,null,null,null,null,null,null,null,"療育手帳",null,null,null,null,"申請予定",null,null,"判定　（　　　　　）"]
[null,null,null,null,null,null,"精神保健福祉手帳",null,null,null,null,"申請予定",null,null,"等級　（　　　　級）",null,null,null,null,null,null,null,null,null,null,null,"精神保健福祉手帳",null,null,null,null,"申請予定",null,null,"等級　（　　　　級）"]
["かかりつけ医\n受診頻度",null,null,null,null,"（病院名：　　　　　　　　　　　　　　　　　　　医師名：　　　　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"かかりつけ医\n受診頻度",null,null,null,null,"（病院名：　　　　　　　　　　　　　　　　",null,"熊本大学病院",null,null,null,"医師名：",null,"〇〇　〇〇〇",null,null,"）"]
[null,null,null,null,null,null,"毎月",null,null,"3か月",null,null,"半年ごと",null,null,"1年ごと",null,null,null,null,null,null,null,null,null,null,"毎月",null,null,"3か月",null,null,"半年ごと",null,null,"1年ごと"]
["相談している保健師",null,null,null,null,null,"いる　　　（担当保健師名：　　　　　　　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,"相談している保健師",null,null,null,null,null,"いる　　　（担当保健師名：　　　　　　　　　　　　　　　　）",null,null,null,null,"〇〇　〇〇〇",null,null,"）"]
[null,null,null,null,null,null,"いない",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"いない"]
["相談している\n相談専門支援員",null,null,null,null,null,"いる　　　（担当保健師名：　　　　　　　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,"相談している\n相談専門支援員",null,null,null,null,null,"いる　　　（担当保健師名：　　　　　　　　　　　　　　　　）",null,null,null,null,"〇〇　〇〇〇",null,null,"）"]
[null,null,null,null,null,null,"いない",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"いない"]
["飲用しているお薬",null,null,null,null,null,"有",null,"朝",null,"昼",null,"夕",null,"寝る前",null,null,"臨時使用",null,null,"飲用しているお薬",null,null,null,null,null,"有",null,"朝",null,"昼",null,"夕",null,"寝る前",null,null,"臨時使用"]
[null,null,null,null,null,null,"無",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"無"]
["食事について",null,null,null,null,"種類",null,null,"離乳食（初期・中期・後期）",null,null,null,null,null,"普通食",null,null,"ミルク",null,null,"食事について",null,null,null,null,"種類",null,null,"離乳食（初期・中期・後期）",null,null,null,null,null,"普通食",null,null,"ミルク"]
[null,null,null,null,null,null,null,null,"その他",null,"（",null,null,null,null,null,null,"）",null,null,null,null,null,null,null,null,null,null,"その他",null,"（","栄養剤",null,null,null,null,null,null,"）"]
[null,null,null,null,null,"食べ方",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"食べ方",null,null,"経管栄養（経鼻栄養）"]
[null,null,null,null,null,"回数",null,null,null,"回/日　",null,"（　　　　　時・　　　時・　　　時・　　　時・　　　時　）",null,null,null,null,null,null,null,null,null,null,null,null,null,"回数",null,null,3,"回/日　",null,"（　　　　　時・　　　時・　　　時・　　　時・　　　時　）","８時　・　１２時　・　１８時　",null,null,null,null,null,"）"]
[null,null,null,null,null,null,null,null,null,"ｍｌ/1回　",null,"（１回の所要時間　　　　　　",null,null,null,null,"分くらい）",null,null,null,null,null,null,null,null,null,null,null,350,"ｍｌ/1回　",null,"（１回の所要時間　　　　　　分くらい）",null,null,25,"分くらい",null,"）"]
["けいれんについて",null,null,null,null,null,"有","　",null,"無",null,null,null,null,null,null,null,null,null,null,"けいれんについて",null,null,null,null,null,"有","　",null,"無"]
[null,null,null,null,null,"「有」の場合、１日何回くらいありますか。",null,null,null,null,null,null,"（　　　　　　回）",null,null,null,null,null,null,null,null,null,null,null,null,"「有」の場合、１日何回くらいありますか。",null,null,null,null,null,null,"（　　　　　　回）"]
[null,null,null,null,null,"持続時間",null,null,"単発",null,null,"2，3秒",null,null,"10秒くらい",null,null,"１分以上",null,null,null,null,null,null,null,"持続時間",null,null,"単発",null,null,"2，3秒",null,null,"10秒くらい",null,null,"１分以上"]
[null,null,null,null,null,"回数",null,null,"単発",null,null,"2，3回",null,null,"繰り返す",null,null,null,null,null,null,null,null,null,null,"回数",null,null,"単発",null,null,"2，3回",null,null,"繰り返す"]
[null,null,null,null,null,"対処方法",null,null,"何もしない",null,null,"酸素吸入",null,null,"座薬使用",null,null,"救急車要請",null,null,null,null,null,null,null,"対処方法",null,null,"何もしない",null,null,"酸素吸入",null,null,"座薬使用",null,null,"救急車要請"]
["発達",null,null,null,null,"首が座った時期",null,null,"（",null,null,"か月）",null,null,null,"まだ",null,null,null,null,"発達",null,null,null,null,"首が座った時期",null,null,"（",null,5,"か月）",null,null,null,"まだ"]
[null,null,null,null,null,"寝返り",null,null,"（",null,null,"か月）",null,null,null,"また",null,null,null,null,null,null,null,null,null,"寝返り",null,null,"（",null,8,"か月）",null,null,null,"また"]
[null,null,null,null,null,"はいはい",null,null,"（",null,null,"か月）",null,null,null,"まだ",null,null,null,null,null,null,null,null,null,"はいはい",null,null,"（",null,12,"か月）",null,null,null,"まだ"]
[null,null,null,null,null,"つかまり立ち",null,null,"（",null,null,"か月）",null,null,null,"まだ",null,null,null,null,null,null,null,null,null,"つかまり立ち",null,null,"（",null,null,"か月）",null,null,null,"まだ"]
[null,null,null,null,null,"歩き始めた",null,null,"（",null,null,null,"歳　　　か月ごろ　）",null,null,null,null,null,null,null,null,null,null,null,null,"歩き始めた",null,null,"（",null,null,null,"歳　　　か月ごろ　）"]
["移動",null,null,null,null,null,"自分で",null,null,"つかまり立ち",null,null,null,"歩行器",null,null,"バギー",null,null,null,"移動",null,null,null,null,null,"自分で",null,null,"つかまり立ち",null,null,null,"歩行器",null,null,"バギー"]
[null,null,null,null,null,null,"車いす（自走・補助・電動）",null,null,null,null,null,"抱っこ",null,null,"その他",null,null,null,null,null,null,null,null,null,null,"車いす（自走・補助・電動）",null,null,null,null,null,"抱っこ",null,null,"その他"]
["体を支えるために何か使用していますか",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"体を支えるために何か使用していますか"]
[null,null,"使用していない",null,null,null,null,null,"使用している　（　　　　　　　　　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,"使用していない",null,null,null,null,null,"使用している　（　　　　　　　　　　　　　　　　　　）"]
["お子さまが好きな事は何ですか",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"お子さまが好きな事は何ですか"]
[null,null,"音楽",null,null,"人の話し声",null,null,null,"食べる事",null,null,"体を動かされている時",null,null,null,null,null,null,null,null,null,"音楽",null,null,"人の話し声",null,null,null,"食べる事",null,null,"体を動かされている時"]
["その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他"]

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[null,null,"医療的ケア主治医意見書・指示書"]
["■基本事項"]
["園児氏名",null,null,null,null,null,"性別","男 ・ 女","生年月日",null,"　年　　月　　日"]
["診断名",null,null,null,null,null,null,null,"アレルギーの有無",null,"有　　・　　無"]
[null,null,null,null,null,null,null,null,"感染症の有無",null,"有　　・　　無"]
["状態・症状等",null,null,null,null,null,null,null," アレルギー及び感染症の内容と注意"]
["受診状況"]
["投与中の薬剤及び\n注意事項（副作用等）"]
[]
["■指示事項　",null,"期間",null,"　（令和　　　年　　　月　　　日　～　令和　　　年　　　月　　　日）"]
["　□","吸引",null,null,"口鼻腔内",null,"気管カニューレ内"]
[null,null,null,null,"その他（　　　　　　　　　　　　　　　）"]
["　□","気管切開ケア",null,null,"　気管カニューレ　（サイズ：　　　　　　　　　　、種類：　　　　　　　　　　　）"]
["　□","酸素吸入",null,null,"常時同じ条件での酸素吸入"]
[null,null,null,null,"体調の変化による酸素吸入",null,null,null,null,"鼻カニューラ",null,"酸素マスク"]
[null,null,null,"【実施の目安・酸素流量】"]
["　□","人工呼吸器",null,null,"人工呼吸器管理"]
["　□","噴霧吸入",null,null,"常時同じ条件での酸素吸入",null,null,null,null,"体調の変化による吸入"]
[null,null,null,"【実施の目安・薬剤名・量】"]
["　□","経管栄養",null,null,"胃ろう",null,"経鼻：チューブサイズ",null,null,"（　　　　　　　　fr、固定　　　　　　㎝）"]
[null,null,null,null,"腸ろう　（　　　　　　　　　　　　　　　　　　　　　　　　　）"]
[null,null,null,"【時刻と注入内容】"]
["　□","導尿",null,null,"導尿　実施時刻（　　　　　　　　　　　　　　　　　）"]
[null,null,null,null,"その他（　　　　　　　　　　　　　　　　　　　　　）"]
["　□","てんかん発作時の対応",null,null,"■ けいれん等の発作の有無",null,null,null,null,"けいれん有り",null,"けいれん無し"]
[null,null,null,null,"発作の状態",null,"（　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）　　　　　　　　　　　　　　　　　　　　　　"]
[null,null,null,null,"発作時の対応・指示内容",null,"（　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）　　　　　　　　　　　　　　　　　　　　　　"]
[null,null,null,null,"発作時の座薬の使用",null,"（座薬名：　　　　　　　　　　　　　）"]
[null,null,null,"【実施の目安・量】"]
["　□","保育所等での与薬",null,null,"【薬剤名・量・与薬時刻・与薬方法】別紙にて処方箋添付"]
[]
["　□","保育所等での生活上の注意及び配慮事項",null,null,"【保育の制限】",null,"制限なし：同年齢児と同じ強度・速度の生活および運動が可能"]
[null,null,null,null,null,null,"制限なし：本児のペースで、発達に応じた生活および運動が可能"]
[null,null,null,null,null,null,"制限あり"]
[null,null,null,null,"【保育上の配慮】",null,"必要としない",null,null,"部分的に必要とする",null,"常に必要とする"]
["　□","保育上必要とする特別な配慮の内容"]
[]
["　□","追加項目"]
["緊急時の連絡先"]
["不在時の対応法"]
[]
[null,"　この指示書に基づき、保育所等責任者が配置する看護師資格（看護師・准看護師）を有する者が、"]
[null,"該当行為を行うこといついて承諾いたします。"]
[]
[null,"事業所名：",null,null,null,null,null,null,null,"施設長　様","令和  　年　  月 　 日"]
[]
[null,"医療機関名：　　　　　　　　　　"]
[null,"所在地："]
[null,"電話：",null,null,null,null,"担当医師署名："]

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[null,null,null,null,null,null,null,null,"医療的ケア実施依頼書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療的ケア実施依頼書"]
[]
[null,null,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,null,null,null,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"]
[]
["　　　　　　　　施設長　",null,null,null,null,null,null,null,null,"様",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"〇〇保育園　施設長　",null,null,null,null,null,null,null,null,"様"]
[]
[]
[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,null,null,null,null,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,"○○保育園"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"児童氏名",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,null,null,null,null,null,"児童氏名",null,null,null,null,null,"八代　はな"]
[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,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,"2022-12-01"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保護者氏名",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,null,null,null,null,null,"保護者氏名",null,null,null,null,null,"八代　太郎"]
[null,null,null,null,null,null,null,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,null,null,null,null,null,null,null,null,null,null,null,null,"住所",null,null,null,null,null,"八代市○○町12-3"]
[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,null,null,null,null,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,"090-○○○○-××××"]
[]
[]
[null,"　上記児童の医療的ケアについて、",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"で従事される看護師（又は認定特定",null,null,null,null,null,null,null,null,null,null,null,null,null,"　上記児童の医療的ケアについて、",null,null,null,null,null,null,null,null,null,null,null,"○○保育園",null,null,null,null,null,null,null,null,null,"で従事される看護師（又は認定特定"]
[null,"行為業務の資格がある保育士）によって、実施してくださるよう依頼します。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"行為業務の資格がある保育士）によって、実施してくださるよう依頼します。"]
[]
[null,1,"依頼する医療的ケアの内容",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1,"依頼する医療的ケアの内容"]
[]
[null,null,null,"吸引　",null,null,"（",null,"口腔鼻腔内の吸引",null,null,null,null,null,null,null,"気管カニューレ内の吸引",null,null,null,null,null,null,null,null,null,"気管切開部の衛生管理",null,null,null,null,null,null,null,null,"）",null,null,null,"吸引　",null,null,"（",null,"口腔鼻腔内の吸引",null,null,null,null,null,null,null,"気管カニューレ内の吸引",null,null,null,null,null,null,null,null,null,"気管切開部の衛生管理",null,null,null,null,null,null,null,null,"）"]
[]
[null,null,null,"吸入",null,null,null,null,"酸素療法",null,null,null,null,null,"経管栄養",null,null,null,null,null,"導尿",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"吸入",null,null,null,null,"酸素療法",null,null,null,null,null,"経管栄養",null,null,null,null,null,"導尿"]
[]
[null,null,null,"その他",null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）",null,null,null,null,null,null,null,"その他",null,null,"（",null,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,"理由",null,null,null,null,null,null,null,null,null,null,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,"理由"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"本来両親共働きで、今までは母親が育休をとり家庭を保育していたが、主治医から集団保育が可能な状態と判断されたので、育休復帰をするため、保育所への入所・保育所での医療的ケアが必要である。"]
[]
[]
[null,3,"児童の健康状態　（現在及び通常の状況）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,"児童の健康状態　（現在及び通常の状況）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"病状や健康状態も安定しており、鼻チューブの自己抜去する頻度も少なくなっている。"]
[]
[]
[null,4,"主治医・医療機関",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4,"主治医・医療機関"]
[]
[null,null,"医療機関名",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,null,"医療機関名",null,null,null,null,null,null,"熊本大学病院"]
[null,null,"主治医氏名",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,null,null,null,null,null,"主治医氏名",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,null,null,null,null,null,null,null,null,null,null,null,null,"住所",null,null,null,null,null,null,"熊本市中央区本荘１-１-１"]
[null,null,"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,null,"電話番号",null,null,null,null,null,null,"096-344-2111"]

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["医療的ケア児等保育に関する重要事項説明書の同意書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療的ケア児等保育に関する重要事項説明書の同意書"]
[]
[null,"　本施設における保育の提供を開始するに当たり、重要事項説明書の内容について",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　本施設における保育の提供を開始するに当たり、重要事項説明書の内容について"]
[null,"説明を行いました。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"説明を行いました。"]
[]
[null,"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,"施設名：",null,null,null,"〇〇保育園"]
[]
[null,"説明者職名（施設長）",null,null,null,null,null,"氏名：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"説明者職名（施設長）",null,null,null,null,null,"氏名：",null,null,"園長　○○　○○○"]
[]
[]
[]
[null,"　私は、",null,null,null,null,null,null,null,"の重要事項説明書の内容について説明を受け、その",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　私は、",null,"〇〇保育園",null,null,null,null,null,"の重要事項説明書の内容について説明を受け、その"]
[null,"内容に同意します。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"内容に同意します。"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和６年〇月〇日"]
[]
[]
[null,null,"保護者住所：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保護者住所：",null,null,null,"八代市○○町12-3"]
[]
[null,null,"保護者署名：",null,null,null,null,null,null,null,null,null,null,null,"児童から見た続柄：",null,null,null,null,null,null,null,null,null,null,"保護者署名：",null,null,null,"八代　太郎",null,null,null,null,null,null,null,"児童から見た続柄：",null,null,null,null,"父"]
[]
[null,null,"児童氏名：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"児童氏名：",null,null,null,"八代　はな"]

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["医療的ケア児等保育に関する重要事項説明書"]
[]
["　保育園では、医師が必要と認め、医師による指示の範囲内で医療的ケアを行います。"]
["　医療的ケアの実施は、お子様の健康管理にとって極めて大切なものであるため、保護者様にも"]
["　下記の事項をご確認いただいた上で、ご協力をお願いします。"]
[]
[null,"【保育所等で実施する医療的ケアの内容】"]
[null,"医師による指示の範囲内で、園児と同様の時間帯に日常的に保護者が行っている医療的ケア"]
[null,"（医師の指示の範囲外の医療的ケアは、臨時的であっても行うことはできませんので、ご了承ください。）"]
[null,"※緊急時は除きます。"]
[]
[null,"【保育で医療的ケアを実施するに当たっての確認事項】"]
[null,1,"医療的ケアは、看護師（又は認定特定行為業務従事の資格を持った保育士）が行います。"]
[null,2,"医療的ケアの実施には、「医療的ケア主治医意見書・指示書」が必要です。"]
[null,3,"医療的ケアを実施できるのは、登園時間内です。"]
[null,4,"入園後は、医療的ケア実施の状況を確認するため、しばらく保護者の付き添いをお願いします。"]
[null,5,"看護師が不在の場合は、保護者の協力をお願いすることがあります。"]
[null,6,"登園の際にはお子様の体調を把握し、職員に伝えてください。体調がよくない場合の無理な"]
[null,null,"登園は控えていただくようお願いします。"]
[null,7,"緊急時を含め、保育園から連絡をする場合がありますので、必ず連絡が取れるようにしておいて"]
[null,null,"ください。"]
[null,8,"緊急時の対応について、主治医への協力依頼等、連携を図ってください。"]
[null,9,"感染症の流行があった際は、お知らせしますので、主治医への相談等、必要な対応をしてください。"]
[null,10,"医療的ケアに必要な医療機材や消耗品は、保護者がご用意ください。"]
[null,null,"また、医療機材は、毎日持ち帰ってください。"]
[null,11,"必要に応じて病院受診に同行させていただくことがありますのでご了承ください。"]
[null,12,"関係機関（医療機関・療育機関・教育機関・在宅医療・行政等）と連携していくため、情報の共有を"]
[null,null,"していきます。"]
[null,13,"医療的ケアの実施内容に変更がある場合は、速やかに「医療的ケア主治医意見書・指示書」を再"]
[null,null,"提出してください。"]
[null,14,"医療的ケアが医師の指示により、中止・終了した場合は「医療的ケア終了に関する届出書」を保護"]
[null,null,"者様が記載し、八代市役所こども未来課（又は保育所等）へ提出してください。"]
[null,15,"災害時に備えて、薬や栄養剤、医療的ケアに必要な物品（カテーテル等）は、１日分を保育園"]
[null,null,"に預けてください。"]
[null,16,"園外活動については、お子様の安全の確保が前提であることから、健康状態・想定される緊急時"]
[null,null,"の対応等を踏まえ、保護者に協力をお願いすることがあります。"]
[null,17,"1～16の他に必要なことがあれば、保育所等との間で取り決めをすることがあります。"]

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[null,"八代市長　様",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"八代市長　様"]
[null,null,null,null,null,null,null,null,null,"（保護者）",null,"住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（保護者）",null,"住所",null,"八代市○○町12-3"]
[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,null,null,null,null,null,null,null,null,null,"氏名",null,"八代　太郎"]
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[null,"医療的ケア終了に関する届出書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療的ケア終了に関する届出書"]
[]
[null,"　保育所等に通園する下記児童について、保育施設での医療的ケアの実施がなくなりましたので、",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　保育所等に通園する下記児童について、保育施設での医療的ケアの実施がなくなりましたので、"]
[null,"保育施設での医療的ケアを終了することを届けます。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保育施設での医療的ケアを終了することを届けます。"]
[]
[null,"記",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記"]
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[null,"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,"施設名",null,null,null,null,"○○保育園"]
[null,"対象児童名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"対象児童名",null,null,null,null,"八代　はな"]
[null,"実施していた\n医療的ケアの内容",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"実施していた\n医療的ケアの内容",null,null,null,null,"　経管栄養（経鼻栄養）"]
[]
[null,"終了年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"終了年月日",null,null,null,null,"2025-03-31"]
[null,"終了理由",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"終了理由",null,null,null,null,"栄養チューブを抜去でき、口からの食事が可能となった"]
[null,"医療機関名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療機関名",null,null,null,null,"熊本大学病院"]
[null,"主治医名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"主治医名",null,null,null,null,"○○　○○○"]

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["施設名",null,null,null,null,null,null,null,null,null,"看護師等氏名"]
["対象児童名",null,null,null,null,null,null,null,null,null,"学年齢",null,null,null,null,null,"歳児"]
["主な業務内容"]
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["成果\nと課題"]
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[null,"令和　　　年　　　月　　　日"]
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[null,null,null,null,null,null,null,null,null,"代表者",null,"理事長　　〇○〇〇　〇〇"]

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