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[]
["診療情報提供書"]
["（肺がん術後地域連携クリニカルパス）"]
["　　年　　　月　　　日"]
["広島大学病院"]
[]
["　　　担当医　　　　　先生"]
["（FAX：082-257-1720　がん治療センター）　　　"]
[]
[]
[{"$nulls":6},"医師名：",{"$nulls":3},"㊞"]
[]
[{"$nulls":6},"※医師名欄は，署名もしくは記名押印"]
[]
["患者氏名",{"$nulls":6},"性別"]
[{"$nulls":7},"生年月日"]
[{"$nulls":3},"（当院ID　　　　　　　　　　　　　　　　　　　　　　　）"]
["住所"]
["電話番号"]
[]
["傷病名：",null,"ⅠA期肺がん術後（地域連携パス）　　手術日",{"$nulls":4},"　　　　　年　　月　　日"]
["受診日：",null,"　　　　　年　　　　月　　　　日　　",null,null,"（術後　　　　　　年　　　　ヶ月後）"]
["紹介目的：",null,"　共同診療計画に沿った診療"]
["既往歴："]
["症状経過・検査結果および治療経過"]
[{"$nulls":4},"コメント",{"$nulls":5},"コメント"]
["観察項目","全身倦怠感",null,"無　・　有",null,"検査","血液検査",null,"異常　（　無　・　有　）",null,"　　　　　　　"]
[null,"食欲低下",null,"無　・　有",null,null,"腫瘍マーカー","ＣＥＡ","異常　（　無　・　有　）",null,"　　　　　　　"]
[null,"体重減少",null,"無　・　有",{"$nulls":3},"ＳＬＸ","異常　（　無　・　有　）",null,"　　　　　　　"]
[null,"痛み",null,"無　・　有",{"$nulls":3},"シフラ","異常　（　無　・　有　）",null,"　　　　　　　"]
[null,"咳",null,"無　・　有",{"$nulls":3},"ＳＣＣ","異常　（　無　・　有　）",null,"　　　　　　　"]
[null,"息苦しさ",null,"無　・　有",null,null,"胸部Ｘ線検査",null,"異常　（　無　・　有　）",null,"　　　　　　　"]
["投薬","内服状況確認",null,"無　・　有",null,null,"胸腹部ＣＴ",null,"異常　（　無　・　有　）",null,"　　　　　　　"]
[null,"併用薬チェック",null,"無　・　有",null,null,"その他：",null,"異常　（　無　・　有　）",null,"　　　　　　　"]
[{"$nulls":6}," SPO2",null,null,"%","　　　　　　　"]
["コメント"]
[]
[]
["有害事象の発生なく、診療計画に沿い定期的な受診、検査が行えたので報告します。"]
["施行検査",null,null,"　□血液検査   　　   □胸部Ｘ線検査　　　　　　　□腫瘍マーカー  　　 　　　 □胸腹部CT     "]
["添付資料",null,null,"　□検査データ　　　 　□その他（　　　　　       　　　　）　"]
["現在の処方"]
{"$rows_empty":109}
[{"$nulls":13},1]