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["栄養情報提供書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記入日"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"所属名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当管理栄養士"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"連絡先TEL"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"連絡先FAX"]
[{"$f":"PHONETIC(F10)","v":""}]
["下記の患者様について栄養情報を提供します。よろしくお願いします。"]
["フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"性別",null,null,"主要疾患・既往歴"]
["氏名"]
["生年月日",null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日（",null,{"$f":"ROUNDDOWN(YEARFRAC(AP11,AC1,1),0)","v":121},null,"歳）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2021-07-06"]
[]
["身長",null,null,null,null,null,null,null,null,null,"cm（",null,null,null,null,null,"年",null,null,"月）",null,"褥瘡"]
["体重",null,null,null,null,null,null,null,null,null,"Kg（",null,null,null,null,null,"年",null,null,"月）",null,"体重の変化",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"kg"]
["BMI",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"嚥下障害"]
[]
["＜項目＞",null,null,null,null,null,null,null,"＜詳細＞",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"＜備考＞"]
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[null,null,null,null,null,null,null,null,"補助食品"]
[null,null,null,null,null,null,null,null,"食物アレルギー"]
[null,null,null,null,null,null,null,null,"禁止食品"]
[null,null,null,null,null,null,null,null,"嚥下コード"]
[null,null,null,null,null,null,null,null,"トロミの程度\n（水分）"]
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["摂取栄養量",null,null,null,null,null,null,null,"エネルギー",null,null,null,null,"kcal",null,"たんぱく質",null,null,null,null,"g","塩分",null,null,null,"g","水分",null,null,null,"ml"]
["特記事項"]