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["　　　　　佐世保市きらっと元気教室訪問チェックシート",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"様式１－１　"]
["訪問日",null,null,null,null,null,"事業所名",null,null,null,null,null,"記入者名",null,null,null,null,null,null,"職種",null,null,null,"＜入力作業について＞"]
["被保険者番号",null,null,null,null,"氏名","　（　　　歳）",null,null,null,"住所",null,null,null,null,null,null,null,null,"電話",null,null,null,"※黄色のセルは入力漏れに気をつけてください"]
["現在の\n生活状況",null,"　　　　　　　　6時　　　　　　　　　　　　９時　　　　　　　　　　　　12時　　　　　　　　　　　　15時　　　　　　　　　　　　18時　　　　　　　　　　　　21時",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"家族",null,null,"独居","※太枠内を押すと○がつきます。○の位置の修正をしたいときは、まちがったところを「Back　Space」「Delete」で消してください"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"同居（長男）","※集計作業が自動化するために、項目の追加はお控えください"]
["本人の主訴・意向",null,null,null,null,null,null,null,null,null,null,null,"趣味活動"]
["家族の主訴・意向",null,null,null,null,null,null,null,null,null,null,null,"実施期間",null,null,null,null,null,null,null,null,null,null,"＜入力後の保存方法について＞　"]
[1,"主治医からの健康上の注意事項（運動制限等を含む）がある",null,null,null,null,"ない",null,"ある","身長　",null,"ｃｍ","体重",null,"ｋｇ","BMI\n（自動計算）",{"$f":"IF(OR(K8=\"\",N8=\"\"),\"\",N8/((K8/100)^2))","v":""},"自由記載欄\n\n",null,null,null,null,null,"1.このエクセル内に保存する方法"]
[2,"何かにつかまらずに歩くことができる",null,null,null,null,"できる",null,"つかまれば可能",null,null,null,"できない",null,null,null,null,null,null,null,null,null,null,"（１）１人目の「初回評価」の入力が終わったら、シート名「2.【原本】～～」を右クリックして「移動またはコピー」を左クリック"]
[3,"床からの立ち上がりが楽にできる",null,null,null,null,"できる",null,"つかまれば可能",null,null,null,"できない",null,null,null,null,null,null,null,null,null,null,"（２）「移動先ブック名」は触らない。「挿入先」で、シート名「2.【原本】～～」を左クリック。"]
[4,"家の中で滑ったり、つまづいたりすることがある",null,null,null,null,"ない",null,"時々",null,"ある",null,null,null,null,null,null,null,null,null,null,null,null,"「コピーを作成する」を左クリックし、チェックを入れる。コピーが挿入される。"]
[5,"上衣を一人で着脱できる",null,null,null,null,"できる　",null,"介助があればできる",null,null,null,null,"できない",null,null,null,null,null,null,null,null,null,"（３）（２）でコピーしたシートを右クリック。「名前の変更」を左クリック。入力して名前を変更"]
[6,"ズボン、スカートを立ったまま着脱できる",null,null,null,null,"できる",null,"つかまればできる",null,null,null,null,"できない",null,null,null,null,null,null,null,null,null,"（４）上書き保存をする。下にあるような警告画面が出るが、「OK」を選択"]
[7,"ボタンをかける動作",null,null,null,null,"簡単にできる",null,null,"難しい",null,null,null,null,null,null,null,null,null,null,null,null,null,"（５）保存完了　　　※不要なシート（手書き用や記入例）は削除していただいても構いません"]
[8,"浴槽のまたぎ動作",null,null,null,null,"なんともない",null,null,"ややきつい",null,null,"きつい",null,"浴槽は使用していない",null,null,null,null,null,null,null,null,"（６）保存し終わったら、原本に入力したものは消し、次の人を入力する"]
[9,"顔や髪、爪をきちんと整えることができる",null,null,null,null,"できる",null,"一部できる",null,null,"できない　　",null,null,null,null,null,null,null,null,null,null,null,"※注意！！　BMIのセルは消さない！身長と体重を消したら消えます",null,"　　　　　"]
[10,"睡眠は十分にとれている",null,null,null,null,"はい",null,"時々眠れない　",null,null,null,"いいえ",null,null,null,null,null,null,null,null,null,null,"（５）保存完了　　　※不要なシート（手書き用や記入例）は削除していただいても構いません","　　　　　　　　　　　　　",null,null,null,"（　　　　　　　　　　　　　　　）　"]
[11,"排便・排尿リズム",null,null,null,null,"問題なし",null,"問題あり",null,null,"便秘",null,"失禁",null,"頻尿",null,null,null,null,null,null,null,"（６）保存し終わったら、原本に入力したものは消し、次の人を入力する"]
[12,"歯の手入れ状況",null,null,null,"１）はみがきの頻度",null,null,2,"回/日"]
[null,null,null,null,null,"２）歯(義歯)不具合",null,null,null,"無",null,"有"]
[13,"食事回数",null,null,null,3,"食/日"]
[14,"以前に比べ、箸で細かいものをつかめなくなった",null,null,null,null,"はい",null,"いいえ"]
[15,"調理",null,null,null,null,"している",null,"行っていないが能力はある",null,null,null,null,"一部できる",null,null,"できない",null,null,null,null,null,null,"　　　　　　　　　　　　"]
[null,"調理中の姿勢",null,null,null,null,"立って",null,"時々休んで",null,null,"座って"]
[16,"掃除",null,null,null,null,"している",null,"行っていないが能力はある",null,null,null,null,"一部できる",null,null,"できない"]
[17,"洗濯",null,null,null,null,"している",null,"行っていないが能力はある",null,null,null,null,"一部できる",null,null,"できない　"]
[18,"買い物",null,null,null,null,"している",null,"行っていないが能力はある",null,null,null,null,"一部できる",null,null,"できない"]
[null,null,null,null,null,"重い物（2㎏程度）を持って",null,null,null,null,null,"歩ける",null,"歩けない"]
[19,"ゴミだし",null,null,null,null,"している",null,"行っていないが能力はある",null,null,null,null,"一部できる",null,null,"できない　"]
[20,"ゴミ出し場までの環境",null,null,null,"１）距離　",null,"　約",null,"ｍ"]
[null,null,null,null,null,"２）階段",null,null,"なし",null,"あり","3）坂道",null,null,"なし",null,"あり"]
[21,"住居環境",null,null,null,null,"持ち家　",null,"借家",null,"戸建て"]
[null,null,null,null,null,null,"集合住宅",null,null,"階","→","エレベーター",null,null,"なし",null,"あり"]
[22,"居住状況(屋内外）",null,null,null,"１）手すり",null,null,"なし",null,"あり","　（　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,")"]
[null,null,null,null,null,"２）階段",null,null,"なし",null,"あり","　（　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,")"]
[null,null,null,null,null,"３）トイレ",null,null,"和式",null,"洋式"]
[23,"自宅周囲の状況\n(坂や階段、公共交通機関状況など)",null,null,null,null,"問題なし",null,"問題あり"]
[24,"外出が自由にできず、苦になることがある",null,null,null,null,"いいえ",null,"時々",null,"はい"]
[25,"よく行くお店までの距離",null,null,null,"約",null,"ｍ","もしくは",null,"分","現在",null,"行ける",null,"行けない"]
[26,"交通手段",null,null,null,null,"徒歩",null,"自家用車",null,null,"公共交通機関"]
[27,"最寄りのバス停",null,null,null,"徒歩",null,"分","現在",null,"行ける",null,"行けない"]
[28,"視力・聴力に支障がある",null,null,null,null,"なし",null,"あり",null,"視力",null,"聴力",null,"その他："]
[29,"支援者の関わり",null,null,null,null,"家族","誰が",null,null,"その他","誰が",null,null,"いない"]
[30,"個人因子（性格・困難への対処能力）"]

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["　　　　　佐世保市きらっと元気教室訪問チェックシート",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"様式１－１　"]
["訪問日",null,"2025-04-01",null,null,null,"事業所名",null,"すみれ",null,null,null,"記入者名",null,"ななくさ",null,null,null,null,"職種",null,"理学療法士",null,"＜入力作業について＞"]
["被保険者番号",null,1000123456,null,null,"氏名","花咲　華　（　77歳）",null,null,null,"住所",null,"高砂町5-1",null,null,null,null,null,null,"電話",null,"080-1234-5678",null,"※黄色のセルは全て入力してください"]
["現在の\n生活状況",null,"　　　　　　　　6時　　　　　　　　　　　　９時　　　　　　　　　　　　12時　　　　　　　　　　　　15時　　　　　　　　　　　　18時　　　　　　　　　　　　21時",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"家族",null,"○","独居","※太枠内を押すと○がつきます。○の位置の修正をしたいときは、まちがったところを「Back　Space」「Delete」で消してください"]
[null,null,null,null,"起床","朝食",null,null,null,null,"昼食",null,"テレビ",null,null,"夕食","入浴","就寝",null,null,null,null,"同居（長男）","※集計作業が自動化するために、項目の追加はお控えください"]
["本人の主訴・意向",null,null,null,"階段を昇ってお寺に行けるようになりたい。",null,null,null,null,null,null,null,"趣味活動",null,"お寺通い、書道"]
["家族の主訴・意向",null,null,null,"不安なく外出してほしい。",null,null,null,null,null,null,null,"実施期間",null,"R7年4月7日～R7年6月30日",null,null,null,null,null,null,null,null,"＜入力後の保存方法について＞　"]
[1,"主治医からの健康上の注意事項（運動制限等を含む）がある",null,null,null,"○","ない",null,"ある","身長　",150,"ｃｍ","体重",45,"ｋｇ","BMI\n（自動計算）",{"$f":"IF(OR(K8=\"\",N8=\"\"),\"\",N8/((K8/100)^2))","v":20},"自由記載欄\n\n1.○○病院に月１回通院。高血圧治療の内服のみ",null,null,null,null,null,"1.このエクセル内に保存する方法"]
[2,"何かにつかまらずに歩くことができる",null,null,null,null,"できる","○","つかまれば可能",null,null,null,"できない",null,null,null,null,null,null,null,null,null,null,"（１）１人目の「初回評価」の入力が終わったら、シート名「2.【原本】～～」を右クリックして「移動またはコピー」を左クリック"]
[3,"床からの立ち上がりが楽にできる",null,null,null,"○","できる",null,"つかまれば可能",null,null,null,"できない",null,null,null,null,null,null,null,null,null,null,"（２）「移動先ブック名」は触らない。「挿入先」で、シート名「2.【原本】～～」を左クリック。"]
[4,"家の中で滑ったり、つまづいたりすることがある",null,null,null,null,"ない",null,"時々","○","ある",null,null,null,null,null,null,"4.何もないところで頻繁に躓いている",null,null,null,null,null,"「コピーを作成する」を左クリックし、チェックを入れる。コピーが挿入される。"]
[5,"上衣を一人で着脱できる",null,null,null,"○","できる　",null,"介助があればできる",null,null,null,null,"できない",null,null,null,null,null,null,null,null,null,"（３）（２）でコピーしたシートを右クリック。「名前の変更」を左クリック。入力して名前を変更"]
[6,"ズボン、スカートを立ったまま着脱できる",null,null,null,null,"できる","○","つかまればできる",null,null,null,null,"できない",null,null,null,null,null,null,null,null,null,"（４）上書き保存をする。下にあるような警告画面が出るが、「OK」を選択"]
[7,"ボタンをかける動作",null,null,null,"○","簡単にできる",null,null,"難しい",null,null,null,null,null,null,null,null,null,null,null,null,null,"（５）保存完了　　　※不要なシート（手書き用や記入例）は削除していただいても構いません"]
[8,"浴槽のまたぎ動作",null,null,null,null,"なんともない",null,"○","ややきつい",null,null,"きつい",null,"浴槽は使用していない",null,null,null,null,null,null,null,null,"（６）保存し終わったら、原本に入力したものは消し、次の人を入力する"]
[9,"顔や髪、爪をきちんと整えることができる",null,null,null,"○","できる",null,"一部できる",null,null,"できない　　",null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　"]
[10,"睡眠は十分にとれている",null,null,null,null,"はい","○","時々眠れない　",null,null,null,"いいえ",null,null,null,null,null,null,null,null,null,null,"（５）保存完了　　　※不要なシート（手書き用や記入例）は削除していただいても構いません","　　　　　　　　　　　　　",null,null,null,"（　　　　　　　　　　　　　　　）　"]
[11,"排便・排尿リズム",null,null,null,null,"問題なし","○","問題あり",null,"○","便秘",null,"失禁",null,"頻尿",null,null,null,null,null,null,null,"（６）保存し終わったら、原本は"]
[12,"歯の手入れ状況",null,null,null,"１）はみがきの頻度",null,null,2,"回/日"]
[null,null,null,null,null,"２）歯(義歯)不具合",null,null,"○","無",null,"有"]
[13,"食事回数",null,null,null,3,"食/日"]
[14,"以前に比べ、箸で細かいものをつかめなくなった",null,null,null,null,"はい","○","いいえ"]
[15,"調理",null,null,null,"○","している",null,"行っていないが能力はある",null,null,null,null,"一部できる",null,null,"できない",null,null,null,null,null,null,"　　　　　　　　　　　　"]
[null,"調理中の姿勢",null,null,null,null,"立って","○","時々休んで",null,null,"座って"]
[16,"掃除",null,null,null,"○","している",null,"行っていないが能力はある",null,null,null,null,"一部できる",null,null,"できない"]
[17,"洗濯",null,null,null,null,"している",null,"行っていないが能力はある",null,null,null,null,"一部できる",null,null,"できない　"]
[18,"買い物",null,null,null,null,"している",null,"行っていないが能力はある",null,null,null,"○","一部できる",null,null,"できない","18.重い物の買い物は長女と一緒に行う。"]
[null,null,null,null,null,"重い物（2㎏程度）を持って",null,null,null,null,null,"歩ける","○","歩けない"]
[19,"ゴミだし",null,null,null,null,"している",null,"行っていないが能力はある",null,null,null,null,"一部できる",null,"○","できない　"]
[20,"ゴミ出し場までの環境",null,null,null,"１）距離　",null,"　約",40,"ｍ"]
[null,null,null,null,null,"２）階段",null,null,"なし","○","あり","3）坂道",null,null,"なし",null,"あり"]
[21,"住居環境",null,null,null,null,"持ち家　",null,"借家",null,"戸建て"]
[null,null,null,null,null,"○","集合住宅",null,2,"階","→","エレベーター",null,"○","なし",null,"あり"]
[22,"居住状況(屋内外）",null,null,null,"１）手すり",null,null,"なし","○","あり","　（　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,")"]
[null,null,null,null,null,"２）階段",null,null,"なし","○","あり","　（　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,")"]
[null,null,null,null,null,"３）トイレ",null,null,"和式","○","洋式"]
[23,"自宅周囲の状況\n(坂や階段、公共交通機関状況など)",null,null,null,null,"問題なし","○","問題あり",null,null,null,null,null,null,null,null,"23.坂道、長い階段がある"]
[24,"外出が自由にできず、苦になることがある",null,null,null,null,"いいえ",null,"時々","○","はい"]
[25,"よく行くお店までの距離",null,null,null,"約",500,"ｍ","もしくは",20,"分","現在",null,"行ける","○","行けない"]
[26,"交通手段",null,null,null,"○","徒歩",null,"自家用車",null,null,"公共交通機関"]
[27,"最寄りのバス停",null,null,null,"徒歩",10,"分","現在",null,"行ける","○","行けない"]
[28,"視力・聴力に支障がある",null,null,null,null,"なし","○","あり",null,"視力","○","聴力",null,"その他：",null,null,"28.軽度難聴あり"]
[29,"支援者の関わり",null,null,null,"○","家族","誰が","長女",null,"その他","誰が",null,null,"いない",null,null,"29.市内在住の長女が週2～3回訪問、通院や買い物の支援"]
[30,"個人因子（性格・困難への対処能力）",null,null,null,"人と話すことが好き、几帳面"]