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[]
["診療情報提供書"]
["（肝臓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）　　　"]
[{"$nulls":5},"　　"]
[]
[{"$nulls":6},"医師名：",null,null,"㊞"]
[{"$nulls":5},"　　"]
[{"$nulls":6},"※医師名欄は，署名もしくは記名押印"]
[]
["患者氏名",null,null,"                                                                 ",{"$nulls":3},"性別　"]
[{"$nulls":7},"生年月日　　　　　　　　"]
[{"$nulls":3},"　（広島大学病院ID　　 　　　　　　　　　　　　　　　　）"]
["住所"]
["電話番号"]
[]
["傷病名：",null,"　肝臓がん術後（地域連携パス）　　手術日",null,null,"　　　　年　　　月　　　日"]
["受診日：",null,"　　　　　年　　　　月　　　　日",null,"（術後　　　　　　年　　　　ヶ月後）"]
["紹介目的：",null,"　共同診療計画に沿った診療"]
["既往歴：",null,"　"]
["症状経過・検査結果および治療経過"]
[{"$nulls":4},"コメント",{"$nulls":4},"コメント"]
["診察","黄疸",null,"無　・　有",null,"自覚症状","体重","　","Kg"]
[null,"腹部症状",null,"無　・　有",null,null,"腹部膨満感","無　・　有"]
[null,"消化器症状",null,"無　・　有",null,null,"下肢浮腫","無　・　有"]
[null,"下肢浮腫",null,"無　・　有",null,null,"全身倦怠感","無　・　有"]
["指導","食事指導",null,"無　・　有"]
[null,"生活指導",null,"無　・　有"]
["コメント"]
[]
[]
[]
[]
["有害事象の発生なく、診療計画に沿い定期的な受診、検査が行えたので報告します。"]
["施行検査",null,null,"　□血液検査   　 　       □腫瘍マーカー"]
[{"$nulls":3},"　□腹部エコー   　　       □GIF"]
["添付資料",null,null,"　□検査データ   　　       □その他（　　　　　       　　　　）　"]
["現在の処方"]