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[{"$nulls":4},"プロトコルに基づく変更報告書"]
[{"$nulls":15},"Ver1 2022年6月現在"]
[null,"　　診療科　　",{"$nulls":10},"　回答出来しだい　\n　(明日以降可）　　　"]
["患　者",{"$nulls":10},"発　信"," 令和　　　年　　　月　　　日"]
["ID番号",{"$nulls":10},"時　刻",null,null,null,"　　　　　時　　　　　 分"]
["患　者",{"$nulls":10},"診療科"]
["氏　名",{"$nulls":6},"     様　　男・女",{"$nulls":7},"　　　　　　　　　　　　科"]
["生　年","　大　・　昭　・　平　・　令",{"$nulls":9},"担　当"]
["月　日",{"$nulls":4},"          年　　　月　　　日",{"$nulls":5},"医師名",null,null,null,"　　　　　　　　　　　先生"]
["薬局名",{"$nulls":10},"薬剤師"]
[{"$nulls":11},"氏　名"]
["薬　局",{"$nulls":10},"　TEL","　　（　　　　　）　　　　　　－"]
["所在地",{"$nulls":10},"　FAX","　　（　　　　　）　　　　　　－"]
["　　静岡市立静岡病院との間で交わした「院外処方せんにおける疑義照会簡素化プロトコル」の合意書に基づき、以下の通り調剤したので報告します。　　　　　　　　　　　　　　　",{"$nulls":12},"合意番号：　　　　　　　　　　　"]
["【処方箋記載内容】",{"$nulls":10},"疑義照会不要項目番号："]
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[{"$nulls":12},"処方箋コピーを添付すること"]
["【変更後の調剤】"]
{"$rows_empty":12}
[{"$nulls":12},"調剤記録を添付すること"]
[]
[{"$nulls":4},"□","変更について確認しました。"]
[]
[]
[]
[{"$nulls":12},"　　　　　　回答者サイン"]
[{"$nulls":15},"静岡市立静岡病院"]