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{"sheet":"訪問介護","index":0,"n_rows":39,"n_cols":31,"rows_kept":39,"cut":false,"hidden":false,"merged":[[15,1,16,6],[20,1,21,8],[20,9,21,15],[20,16,21,23],[20,24,21,30],[15,7,16,8],[15,11,16,12],[1,1,2,30],[5,7,6,30],[13,1,14,6],[9,1,10,6],[9,7,10,12],[9,13,10,30],[5,1,6,5],[15,21,16,22],[15,19,16,20],[15,17,16,18],[15,29,16,30],[15,9,16,10],[15,27,16,28],[15,25,16,26],[15,23,16,24],[15,15,16,16],[15,13,16,14],[22,9,23,15],[22,24,23,30],[24,1,25,8],[24,9,25,15],[30,9,31,30],[24,16,25,30],[22,1,23,8],[22,16,23,23],[26,1,27,23],[28,1,29,23],[28,24,29,30],[38,1,39,8],[38,9,39,30],[30,1,33,8],[32,9,33,30],[26,24,27,30],[36,1,37,8],[36,9,37,30],[34,1,35,8],[34,9,35,30]]}
[]
[null,"指定訪問介護事業所事前提出書類"]
[]
[]
[]
[null,"〇　事業所名"]
[]
[]
[null,"〇　利用者数"]
[null,"直近1ヶ月間の延べ\nサービス提供時間数",null,null,null,null,null,null,null,null,null,null,null,"　時間（提供票（利用表）の合計時間）"]
[]
[]
[null,"〇　サービスの提供状況"]
[null,"提供月",null,null,null,null,null,null,"年",{"$f":"IF(H14=\"\",\"\",IF(AND(H14=\"R3\",H15<12),\"R3\",\"R4\"))","v":""},"年",{"$f":"IF(J14=\"\",\"\",IF(AND(J14=\"R3\",J15<12),\"R3\",\"R4\"))","v":""},"年",{"$f":"IF(L14=\"\",\"\",IF(AND(L14=\"R3\",L15<12),\"R3\",\"R4\"))","v":""},"年",{"$f":"IF(N14=\"\",\"\",IF(AND(N14=\"R3\",N15<12),\"R3\",\"R4\"))","v":""},"年",{"$f":"IF(P14=\"\",\"\",IF(AND(P14=\"R3\",P15<12),\"R3\",\"R4\"))","v":""},"年",{"$f":"IF(R14=\"\",\"\",IF(AND(R14=\"R3\",R15<12),\"R3\",\"R4\"))","v":""},"年",{"$f":"IF(T14=\"\",\"\",IF(AND(T14=\"R3\",T15<12),\"R3\",\"R4\"))","v":""},"年",{"$f":"IF(V14=\"\",\"\",IF(AND(V14=\"R3\",V15<12),\"R3\",\"R4\"))","v":""},"年",{"$f":"IF(X14=\"\",\"\",IF(AND(X14=\"R3\",X15<12),\"R3\",\"R4\"))","v":""},"年",{"$f":"IF(Z14=\"\",\"\",IF(AND(Z14=\"R3\",Z15<12),\"R3\",\"R4\"))","v":""},"年",{"$f":"IF(AB14=\"\",\"\",IF(AND(AB14=\"R3\",AB15<12),\"R3\",\"R4\"))","v":""},"年"]
[null,null,null,null,null,null,null,null,"月",{"$f":"IF(H15=\"\",\"\",IF(H15=12,1,H15+1))","v":""},"月",{"$f":"IF(J15=\"\",\"\",IF(J15=12,1,J15+1))","v":""},"月",{"$f":"IF(L15=\"\",\"\",IF(L15=12,1,L15+1))","v":""},"月",{"$f":"IF(N15=\"\",\"\",IF(N15=12,1,N15+1))","v":""},"月",{"$f":"IF(P15=\"\",\"\",IF(P15=12,1,P15+1))","v":""},"月",{"$f":"IF(R15=\"\",\"\",IF(R15=12,1,R15+1))","v":""},"月",{"$f":"IF(T15=\"\",\"\",IF(T15=12,1,T15+1))","v":""},"月",{"$f":"IF(V15=\"\",\"\",IF(V15=12,1,V15+1))","v":""},"月",{"$f":"IF(X15=\"\",\"\",IF(X15=12,1,X15+1))","v":""},"月",{"$f":"IF(Z15=\"\",\"\",IF(Z15=12,1,Z15+1))","v":""},"月",{"$f":"IF(AB15=\"\",\"\",IF(AB15=12,1,AB15+1))","v":""},"月"]
[null,"利用者数"]
[]
[null,"（注）　利用者数は、介護報酬請求に係る実利用者数を記入してください。（直近12か月分）"]
[]
[]
[null,"初回加算",null,null,null,null,null,null,null,"有　・　　無",null,null,null,null,null,null,"生活機能向上連携加算",null,null,null,null,null,null,null,"有　・　　無"]
[]
[null,"認知症専門ケア加算",null,null,null,null,null,null,null,"有　・　　無",null,null,null,null,null,null,"特別地域訪問介護加算",null,null,null,null,null,null,null,"有　・　　無"]
[]
[null,"緊急時訪問介護加算",null,null,null,null,null,null,null,"有　・　　無"]
[]
[null,"中山間地域等における小規模事業所加算（地域に関する状況）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　該当　・　非該当"]
[]
[null,"中山間地域等における小規模事業所加算（規模に関する状況）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　該当　・　非該当"]
[]
[null,"特定事業所加算",null,null,null,null,null,null,null,"有［　　Ⅰ　・　　Ⅱ　・　　Ⅲ　・　　Ⅳ　・　　Ⅴ］・　　無"]
[]
[null,null,null,null,null,null,null,null,null,"体制要件　　・　　人員要件　　・　　重度要件"]
[]
[null,"介護職員処遇改善加算",null,null,null,null,null,null,null,"有［　　Ⅰ　・　　Ⅱ　・　　Ⅲ　］・　　無"]
[]
[null,"介護職員等特定処遇改善加算",null,null,null,null,null,null,null,"有［　　Ⅰ　・　　Ⅱ　］・　　無"]
[]
[null,"介護職員等ベースアップ等\n　　　　　　　　　支援加算",null,null,null,null,null,null,null,"有　　・　　無"]