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{"sheet":"評価表整理（共通項目）","index":0,"n_rows":28,"n_cols":5,"rows_kept":28,"cut":false,"hidden":true,"merged":[[12,0,15,0]]}
["地域移行・地域定着部会　評価表整理"]
[]
["１．共通項目　　（知的と身体グループの内容をまとめたものです）"]
["本人、家族に関する項目",null,"身の回りの世話や日常生活等に関連する項目",null,"病気、障害に関する項目"]
["氏名",null,"食事（栄養）",null,"病名（障がい名）"]
["性別",null,"洗面",null,"病院名"]
["生年月日",null,"歯磨き",null,"入院経過（期間）"]
["住所（現住所、本籍地）",null,"入浴",null,"既往歴"]
["電話番号",null,"排泄",null,"現在の医療状況（病状）"]
["経済状況（年金、生保、金銭管理、収入源）",null,"危機の認知、対処方法",null,"服薬状況"]
["手帳",null,"調理",null,"服薬管理（服薬の理解）"]
["福祉サービスの受給歴（受給者証）",null,"掃除、整理整頓",null,"アレルギー"]
["家族状況\n（家族構成、家族との関係、家族の経済状況、成年後見人の有無、頼れる人（緊急連絡先））\nキーパーソンに◎をつける",null,"洗濯",null,"視力"]
[null,null,"買い物",null,"聴力"]
[null,null,"睡眠",null,"入院及び通院中の経過と内服薬"]
[null,null,"歩行（白杖、車椅子等）",null,"病識"]
[null,null,"移動",null,"治療への協力"]
[null,null,"衣服着脱",null,"治療目標と治療方針"]
[null,null,null,null,"身体状況"]
[null,null,"対人関係などに関連する項目"]
[null,null,"コミュニケーション",null,"その他"]
[null,null,null,null,"現在の課題"]
[null,null,null,null,"必要な支援"]
[null,null,null,null,"ストレス原因、対処法"]
[null,null,null,null,"喫煙"]
[null,null,null,null,"飲酒"]
[null,null,null,null,"暴力（自傷、他傷）"]
[null,null,null,null,"こだわり"]

{"sheet":"評価表整理（個別項目） ","index":1,"n_rows":36,"n_cols":7,"rows_kept":36,"cut":false,"hidden":true,"merged":[[20,0,21,0],[4,6,5,6]]}
["地域移行・地域定着部会　評価表整理"]
[]
["２．個別項目　（知的と身体グループの内容をまとめたものです）"]
["移動や動作等に関する項目",null,"行動障がいに関連する項目",null,"特別な医療に関連する項目",null,"触法行為などに関連する項目"]
["寝返り",null,"被害的・拒否的",null,"点滴の管理",null,"犯罪、非行内容（事件種別、審判又は裁判の内容）"]
["起き上がり",null,"作話",null,"中心静脈栄養"]
["座位保持",null,"感情が不安定",null,"透析",null,"釈放後に不足しそうな持ち物"]
["移乗",null,"昼夜逆転",null,"ストーマの処置",null,"出所時持ち物"]
["立ち上がり",null,"暴言暴行",null,"酸素療法"]
["両足での立位保持",null,"同じ話をする",null,"レスピレーター",null,"その他"]
["片足での立位保持",null,"大声・帰省を出す",null,"気管切開の処置",null,"衝動コントロール"]
[null,null,"支援の拒否",null,"疼痛の看護",null,"集団生活"]
["身の回りの世話や日常生活等に関連する項目",null,"徘徊",null,"経管栄養",null,"利用目的・目標"]
["電話等の利用",null,"落ち着きがない",null,"モニターの測定",null,"活動役割遂行"]
["日常生活の意思決定",null,"外出して戻れない",null,"褥瘡の処置",null,"社会的相互関係"]
[null,null,"1人で出たがる",null,"カテーテル",null,"注意サイン（対処方法等）"]
["意思疎通などに関連する項目",null,"収集癖",null,"褥瘡",null,"矯正施設でのトラブル"]
["説明の理解",null,"物や衣類を壊す",null,"嚥下（誤嚥、窒息）",null,"自殺企図"]
["言語能力（読み書き）",null,"不潔行為",null,null,null,"内省・洞察"]
["感覚過敏・感覚鈍麻",null,"異食行動",null,"本人、家族に関する項目",null,"コミュニティ要因"]
["対人関係（形成、終結、行動の制限、社会的ルール、社会的距離）",null,"ひどい物忘れ",null,"趣味",null,"現実的計画"]
[null,null,"多動・行動停止",null,"宗教",null,"コンプライアンス"]
[null,null,"不安定な行動",null,"感染",null,"批判"]
[null,null,"不適切な行為",null,"生活歴",null,"合図"]
[null,null,"突発的な行為",null,"共感性",null,"身体的接触"]
[null,null,"過食・反すう等",null,"知能",null,"日課（管理、達成）"]
[null,null,"躁鬱状態",null,"身長、体重",null,"性格（長所、短所）"]
[null,null,"反復的な行動",null,"現有資産の情報"]
[null,null,"対人面の不安緊張",null,"交友関係（反社会的集団との関係）"]
[null,null,"意欲が乏しい",null,"希望、自尊心・不安"]
[null,null,"話がまとまらない",null,"家族の希望・不安"]
[null,null,"集中力が続かない",null,"敬意と思いやり"]
[null,null,"自己の過大評価",null,"感謝"]
[null,null,"集団への不適応",null,"寛容さ"]
[null,null,"多飲水・過飲水",null,"薬物使用、物質乱用"]
[null,null,null,null,"ギャンブル依存"]

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["所属名　　　　　　　　　　　　　　　　","福井市障がい者基幹相談支援センター",null,null,null,null,null,null,"記入日","2018-01-30"]
["記入者名　　　　　　　　　　　　　　　","水野奈央"]
[]
["※全ての項目の記入はしなくても良いです。対象者の必要な項目のみ記入をお願いします。"]
["　　がついている項目は、チェックをお願いします。ストレングス視点での記入をして下さい。"]
[]
["氏名","福井太郎",null,"性別","　　　男\n　　　女","年齢",{"$f":"DATEDIF(J7,$J$1,\"Y\")","v":30},"歳","生年月日","1987-05-06"]
["住所\n（現住所）","〒918－〇〇〇〇\n福井市〇〇町〇〇ー〇〇"]
["居住地","〒\n同上"]
["電話番号","0776-〇〇-〇〇〇〇",null,null,null,"携帯番号","080-〇〇〇〇-〇〇〇〇"]
["病名（障がい名）",null,"知的障害\n統合失調症"]
["手帳所持","　あり","　なし","手帳種類（等級）",null,"療育手帳　　　Ａ1　　　Ａ2　　　Ｂ1　　　Ｂ2\n精神障害者保健福祉手帳　　　1級　　　2級　　　3級\n身体障害者手帳　　　1級　　　2級　　　3級　　　4級　　　５級　　　6級"]
["受給者証","　あり","　なし","申請中","備考","短期入所、居宅介護、就労継続支援Ｂ型事業利用予定"]
["経済状況","障害基礎年金　　1級　　2級\n障害厚生年金　　1級　　2級　　3級",null,null,null,"生保受給","　あり","　なし","その他\n収入源","重度心身障害者医療費助成制度利用"]
["金銭管理","　自立","　一部\n　介助","　全介助","　見守り","備考","月1万円を母から小遣いとして貰っている。小遣いの範囲内であれば、自己管理できる。"]
["現有資産の情報"]
[]
["生活歴"]
["教育歴",null,null,null,null,null,"職業歴"]
["保育園、小学校、中学校は地元の学校へ通う。（小学4年から特殊学級在籍。）\n高校は、特別支援学校へ進学。\n\n\n\n",null,null,null,null,null,"養護学校高等部卒業後は、オーシャン商店に就職。（個人経営食料品店。主に食品の陳列作業）\n3年前に解雇され退職。"]
["日中活動\n状況"]
["性格","長所","声掛け、指示があればできる事も多い。\n苦手な事、経験がない事でも、繰り返し経験することで、1人でできるようになる。"]
[null,"強み","ＰＣ，携帯に興味あり。アニメが好き。素直。"]
[null,"短所","飽きっぽい。\nお金は、あるだけすぐ使ってします。"]
["宗教"]
["趣味","アニメ（ＤＶＤ，雑誌を購入）。アニメはキュウレンジャー、トトロ等が好き。"]
["家族状況（ジェノグラム）",null,null,null,"家族との\n関係","母と２人暮らし。父は本人が幼いころに他界している。\n母の兄弟は、県外在住の為、支援等は期待できない。\n母は、1人では何もできないと決めつけており、本人が１人で自立できるようになるための経験をしていない。母との関係は良好。"]
[null,null,null,null,null,null,null,null,null,null,"ジェノグラムを作成する時に使用して下さい"]
[]
[]
[null,null,null,null,"家族の\n経済状況","一戸建ての持家。\n母は、パートで収入あり。"]
[]
["※キーパーソンに☆をつける"]
["その他\n家族状況\n（病歴）","父は、肺癌で他界。\n母は胃潰瘍になったことがある。\n\n\n\n\n",null,null,null,null,null,null,"成年後見人"]
[null,null,null,null,null,null,null,null,"　　　　　　　有　　　　　無"]
[null,null,null,null,null,null,null,null,"職業後見人の名称"]
[]
["頼れる人","母",null,null,null,"緊急連絡先",null,"０９０-〇〇〇〇-〇〇〇〇（母携帯）"]
["家族状況以外で\n相談できる人",null,"近所のしおじさん"]
[]
["本人","希望\n思い","退院後は、自宅で生活をしたい。\nお金を計画的に使い、楽しい生活を送りたい。"]
[]
[null,"不安\n課題","仕事はしたいけど、自信がない。（以前の仕事の経験から、恐怖心・自身の喪失がある。）\n欲しいものがたくさんあり、すぐにお金を使ってしまう。"]
[]
["家族","希望\n思い","仕事をして欲しい。将来的には、グループホームなどを利用し、自立して欲しい。（母）"]
[]
[null,"不安","何もすることがなく、浪費癖に繋がっていると思う。（母）"]
[]
["入院歴（入院期間）",null,null,null,null,"既往歴"]
["2017（平成29）年6月より、症状が酷くなり入院に至る。",null,null,null,null,"2014（平成26）年、幻聴がありＡ病院精神科に通院。服薬を処方され、定期的に通院を行う。\n2015（平成27）年に退職をした後、症状が徐々に悪化。Ａ病院の通院が滞ることあり。\n2017（平成29）年6月より、Ａ病院精神科に入院となる。"]
[]
[]
[]
[]
["入院した経緯"]
["症状が悪くなり、自宅を飛び出し、車と接触をする等のパニックがあり、入院をすることとなる。"]
["現在の医療状況（病状と経過）"]
["病棟では落ち着いて過ごしている。\nＯＴへの誘導もスムーズで、色々な事に取り組むことができている。\n\n\n"]
[]
[]
["服薬状況","　　朝","　　昼","　　夕","　　眠前","　　頓服","備考"]
["服薬の仕方\n（声掛け必要等）",null,"声掛けをすれば、自分で飲むことができる。"]
["服薬管理\n（服薬の理解）",null,"なぜ、服薬が必要かは理解できていないが、服薬拒否は見られていない。"]
["アレルギー","　あり","　なし","備考"]
["感染","　あり","　なし","備考"]
["自殺企図","　あり","　なし","備考"]
["病識\n（病気に対する想い）"]
[]
[]
["治療への協力","　あり","　なし","備考"]
["点滴の管理",null,"　あり","　なし","備考"]
["中心静脈栄養",null,"　あり","　なし","備考"]
["透析",null,"　あり","　なし","備考"]
["ストーマの処置",null,"　あり","　なし","備考"]
["酸素療法",null,"　あり","　なし","備考"]
["レスピレーター",null,"　あり","　なし","備考"]
["気管切開の処置",null,"　あり","　なし","備考"]
["疼痛の看護",null,"　あり","　なし","備考"]
["経管栄養",null,"　あり","　なし","備考"]
["モニターの測定",null,"　あり","　なし","備考"]
["褥瘡の処置",null,"　あり","　なし","備考"]
["カテーテル",null,"　あり","　なし","備考"]
["褥瘡",null,"　あり","　なし","備考"]
["嚥下（誤嚥、窒息）",null,"　あり","　なし","備考"]
[]
["◎以下自由記述欄は、出来ない場合や課題がある場合のみ記入をお願いします。"]
["危機の認知、対処方法（ストレス原因と対処法、注意サイン）"]
["戸締りは、母が行っているため、自分でできるように経験が必要。"]
[]
["コミュニケーション（対人関係の形成、終結、行動の制限、社会的ルール、社会的距離等）や意思決定"]
["コミュニケーションは苦手。会話の内容理解が不十分であり、職場での人との付き合いがうまくいっていなかった。周囲の理解や配慮が必要。\n返事はよいが、わからない事でも頷いてしまう傾向がある。分かりやすく、ゆっくり伝えることや、理解しているのかの確認等の配慮が必要。また、指示があれば仕事はできる。"]
[]
["暴力（自傷・他傷）"]
[]
[]
["こだわり"]
[]
[]
["交友関係（反社会的集団との関係等）"]
["民生委員との関わりは自宅では見られており、気にかけてくれていた。"]
[]
["共感性"]
[]
[]
["自尊心"]
[]
[]
["敬意と思いやり"]
[]
[]
["感謝"]
[]
[]
["寛容さ"]
[]
[]
["活動役割遂行"]
[]
[]
["犯罪、非行内容、犯罪・非行行為の原因、改善状態、現在の状態（事件種別、審判又は裁判の内容）"]
[]
[]
[]
[]
[]
["釈放後に必要な持ち物"]
[]
["出所後の持ち物"]
[]
["矯正施設でのトラブル"]
[]
[]
[]
["◎身体状況"]
["身長",170,"ｃｍ","体重",65,"Kg","視力","右　1.0","左　1.2"]
["聴力","右　30db","左　30db","体温","ＫＴ",36.1,"血圧","120/80","ｍｍＨｇ"]
["知能","IQ",50]
["食事","摂取","　自立","　一部\n　介助","　全介助","　見守り"]
[null,"嚥下障害","　あり","　なし","誤嚥","　あり","　なし","義歯","　あり","　　なし"]
[null,"栄養管理","支援者（母）が栄養面を考えて本人に提供する必要あり。\n好き嫌いが多く、食事が偏る傾向あり。揚げ物や肉が好きで、野菜が苦手。"]
["清拭","洗面","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"歯磨き","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"入浴","　自立","　一部\n　介助","　全介助","　見守り","備考","泡が残っていないか最後に支援者が確認を行えば、1人での入浴はできる。"]
["排尿排泄","トイレ","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"ポータブル","　自立","　一部\n　介助","　全介助","　見守り"]
[null,"おむつ","紙","はく\n　パンツ","　テープ止めおむつ",null,"　当て\n　　パット"]
["睡眠","　良眠","　入眠困難\n　（服薬有り）",null,"　中途覚醒","　早期覚醒","備考"]
["歩行","　自立","　車椅子","　歩行器","　杖","　　シルバー\nカー","　白杖","備考"]
["動作","寝返り","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"起き上がり","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"座位保持","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"移乗","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"立ち上がり","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"両足での立位保持",null,"　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"片足での立位保持",null,"　自立","　一部\n　介助","　全介助","　見守り","備考"]
["衣服着脱","　自立","　一部\n　介助","　全介助","　見守り","備考","声掛けや確認を行うことで、洋服を変えることができる。"]
[]
[]
["◎日常生活動作"]
["調理","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考","卵を混ぜたり、フライパンに火をかけたり、茶碗洗いの手伝いをしたり等は行っており、見守り・指示があればできることがある。"]
["掃除・整理整頓","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考","声掛けがあれば自室の掃除を行うことができる。"]
["洗濯","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考","ひとりでは不安がある。手伝って貰いながら、経験することで、1人でできる可能性もある。"]
["買い物","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考","買い物行為は、自分で行っているが、衝動買いをしてしまい、1ヶ月分の小遣いを1週間で使ってしまうことがある。"]
["電話等の\n利用","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考","緊急時の連絡は母の携帯に行うことができる。"]
["交通機関の利用","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考","初めて行く場所への1人での移動（バス等の利用）は困難だが、一度付き添って練習すれば可能になる。"]
["喫煙","　　吸う","1日","本","　吸わ\n　ない","備考"]
["飲酒","　　飲む","1日","杯","　飲ま\n　ない","備考"]
["1人暮らしの経験",null,"　あり","　なし","備考"]
["感覚過敏・感覚鈍麻",null,"　あり","　なし","備考"]
["被害的・拒否的",null,"　あり","　なし","備考"]
["作話",null,"　あり","　なし","備考"]
["感情が不安定",null,"　あり","　なし","備考"]
["昼夜逆転",null,"　あり","　なし","備考"]
["暴言暴行",null,"　あり","　なし","備考"]
["同じ話をする",null,"　あり","　なし","備考"]
["大声・奇声を出す",null,"　あり","　なし","備考","症状が悪くなると、妄想、幻聴があり、パニックになることがある。"]
["支援の拒否",null,"　あり","　なし","備考"]
["徘徊",null,"　あり","　なし","備考"]
["落ち着きがない",null,"　あり","　なし","備考"]
["外出して戻れない",null,"　あり","　なし","備考"]
["1人で出たがる",null,"　あり","　なし","備考"]
["収集癖",null,"　あり","　なし","備考"]
["物や衣類を壊す",null,"　あり","　なし","備考"]
["不潔行為",null,"　あり","　なし","備考"]
["異食行動",null,"　あり","　なし","備考"]
["ひどい物忘れ",null,"　あり","　なし","備考"]
["多動・行動停止",null,"　あり","　なし","備考"]
["不安定な行動",null,"　あり","　なし","備考"]
["不適切な行為",null,"　あり","　なし","備考"]
["突発的な行為",null,"　あり","　なし","備考"]
["過食・反すう等",null,"　あり","　なし","備考"]
["躁鬱状態",null,"　あり","　なし","備考"]
["反復的な行動",null,"　あり","　なし","備考"]
["対人面の不安緊張",null,"　あり","　なし","備考","初めての人や環境は、緊張し何も話せなくなってしまう。時間をかければ、ゆっくりと自分の言葉で表現ができる。"]
["意欲が乏しい",null,"　あり","　なし","備考"]
["話がまとまらない",null,"　あり","　なし","備考"]
["集中力が続かない",null,"　あり","　なし","備考"]
["自己の過大評価",null,"　あり","　なし","備考"]
["集団への不適応",null,"　あり","　なし","備考"]
["多飲水・過飲水",null,"　あり","　なし","備考"]
["説明の理解",null,"　　できる","　でき\n　ない","備考","簡単な日常会話であれば理解できる。わからなくても返事をすることがあるので、都度本人への理解の確認が必要。"]
["言語能力（読み書き）",null,"　できる","　でき\n　ない","備考","小学校中学年程度の読み書きであれば可能。"]
["日常生活の意思決定",null,"　できる","　でき\n　ない","備考"]
["衝動のコントロール",null,"　できる","　でき\n　ない","備考","症状が悪くなると、妄想、幻聴があり、パニックになることがあり、自分で感情をコントロールすることができない。"]
["集団生活","　経験　\n　あり","　経験　\n　なし","備考"]
["薬物依存","　あり","　なし","備考"]
["物質乱用","　あり","　なし","備考"]
["ギャンブル\n依存","　あり","　なし","備考"]
["アルコール\n依存","　あり","　なし","備考"]
[]
["◎その他（分類できないもの）"]
["利用目的・目標、社会的相互関係、内省・洞察、コミュニティ要因、現実的計画、コンプライアンス、批判、合図、身体的接触、日課（管理、達成）など、他にあれば記入をして下さい。"]

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["所属名　　　　　　　　　　　　　　　　",null,null,null,null,null,null,null,"記入日"]
["記入者名　　　　　　　　　　　　　　　"]
[]
["※全ての項目の記入はしなくても良いです。対象者の必要な項目のみ記入をお願いします。"]
["　　がついている項目は、チェックをお願いします。ストレングス視点での記入をして下さい。"]
[]
["氏名",null,null,"性別","　　　男\n　　　女","年齢",{"$f":"DATEDIF(J7,$J$1,\"Y\")","v":0},"歳","生年月日"]
["住所\n（現住所）","〒\n"]
["居住地","〒\n"]
["電話番号",null,null,null,null,"携帯番号"]
["病名（障がい名）",null,"\n"]
["手帳所持","　あり","　なし","手帳種類（等級）",null,"療育手帳　　　Ａ1　　　Ａ2　　　Ｂ1　　　Ｂ2\n精神障害者保健福祉手帳　　　1級　　　2級　　　3級\n身体障害者手帳　　　1級　　　2級　　　3級　　　4級　　　５級　　　6級"]
["受給者証","　あり","　なし","申請中","備考"]
["経済状況","障害基礎年金　　1級　　2級\n障害厚生年金　　1級　　2級　　3級",null,null,null,"生保受給","　あり","　なし","その他\n収入源"]
["金銭管理","　自立","　一部\n　介助","　全介助","　見守り","備考"]
["現有資産の情報"]
[]
["生活歴"]
["教育歴",null,null,null,null,null,"職業歴"]
["\n\n\n\n\n\n\n",null,null,null,null,null,"\n\n\n\n\n\n"]
["日中活動\n状況","\n\n\n\n"]
["性格","長所"]
[null,"強み"]
[null,"短所"]
["宗教"]
["趣味"]
["家族状況（ジェノグラム）",null,null,null,"家族との\n関係","\n\n\n\n\n"]
[null,null,null,null,null,null,null,null,null,null,"ジェノグラムを作成する時に使用して下さい"]
[]
[]
[null,null,null,null,"家族の\n経済状況","\n\n\n\n"]
[]
["※キーパーソンに☆をつける"]
["その他\n家族状況\n（病歴）",null,null,null,null,null,null,null,"成年後見人"]
[null,null,null,null,null,null,null,null,"　　　　　　　有　　　　　無"]
[null,null,null,null,null,null,null,null,"職業後見人の名称"]
[]
["頼れる人",null,null,null,null,"緊急連絡先"]
["家族状況以外で\n相談できる人"]
[]
["本人","希望\n思い"]
[]
[null,"不安\n課題"]
[]
["家族","希望\n思い"]
[]
[null,"不安"]
[]
["入院歴（入院期間）",null,null,null,null,"既往歴"]
[]
[]
[]
[]
[]
["入院した経緯"]
[]
["現在の医療状況（病状と経過）"]
[]
[]
[]
["服薬状況","　　朝","　　昼","　　夕","　　眠前","　　頓服","備考"]
["服薬の仕方\n（声掛け必要等）"]
["服薬管理\n（服薬の理解）"]
["アレルギー","　あり","　なし","備考"]
["感染","　あり","　なし","備考"]
["自殺企図","　あり","　なし","備考"]
["病識\n（病気に対する想い）"]
[]
[]
["治療への\n協力","　あり","　なし","備考"]
["点滴の管理",null,"　あり","　なし","備考"]
["中心静脈栄養",null,"　あり","　なし","備考"]
["透析",null,"　あり","　なし","備考"]
["ストーマの処置",null,"　あり","　なし","備考"]
["酸素療法",null,"　あり","　なし","備考"]
["レスピレーター",null,"　あり","　なし","備考"]
["気管切開の処置",null,"　あり","　なし","備考"]
["疼痛の看護",null,"　あり","　なし","備考"]
["経管栄養",null,"　あり","　なし","備考"]
["モニターの測定",null,"　あり","　なし","備考"]
["褥瘡の処置",null,"　あり","　なし","備考"]
["カテーテル",null,"　あり","　なし","備考"]
["褥瘡",null,"　あり","　なし","備考"]
["嚥下（誤嚥、窒息）",null,"　あり","　なし","備考"]
[]
["◎以下自由記述欄は、出来ない場合や課題がある場合のみ記入をお願いします。"]
["危機の認知、対処方法（ストレス原因と対処法、注意サイン）"]
[]
[]
["コミュニケーション（対人関係の形成、終結、行動の制限、社会的ルール、社会的距離等）や意思決定"]
[]
[]
["暴力（自傷・他傷）"]
[]
[]
["こだわり"]
[]
[]
["交友関係（反社会的集団との関係等）"]
[]
[]
["共感性"]
[]
[]
["自尊心"]
[]
[]
["敬意と思いやり"]
[]
[]
["感謝"]
[]
[]
["寛容さ"]
[]
[]
["活動役割遂行"]
[]
[]
["犯罪、非行内容、犯罪・非行行為の原因、改善状態、現在の状態（事件種別、審判又は裁判の内容）"]
[]
[]
[]
[]
[]
["釈放後に必要な持ち物"]
[]
["出所後の持ち物"]
[]
["矯正施設でのトラブル"]
[]
[]
[]
["◎身体状況"]
["身長",null,"ｃｍ","体重",null,"Kg","視力","右　","左　"]
["聴力","右　　db","左　　db","体温","ＫＴ",null,"血圧","/","ｍｍＨｇ"]
["知能","IQ"]
["食事","摂取","　自立","　一部\n　介助","　全介助","　見守り"]
[null,"嚥下障害","　あり","　なし","誤嚥","　あり","　なし","義歯","　あり","　　なし"]
[null,"栄養管理"]
["清拭","洗面","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"歯磨き","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"入浴","　自立","　一部\n　介助","　全介助","　見守り","備考"]
["排尿排泄","トイレ","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"ポータ\nブル","　自立","　一部\n　介助","　全介助","　見守り"]
[null,"おむつ","紙","はく\n　パンツ","　テープ止めおむつ",null,"　当て\n　　パット"]
["睡眠","　良眠","　入眠困難\n　（服薬有り）",null,"　中途覚醒","　早期覚醒","備考"]
["歩行","　自立","　車椅子","　歩行器","　杖","　　シルバー\nカー","　白杖","備考"]
["動作","寝返り","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"起き\n上がり","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"座位保持","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"移乗","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"立ち\n上がり","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"両足での立位保持",null,"　自立","　一部\n　介助","　全介助","　見守り","備考"]
[null,"片足での立位保持",null,"　自立","　一部\n　介助","　全介助","　見守り","備考"]
["衣服着脱","　自立","　一部\n　介助","　全介助","　見守り","備考"]
[]
[]
["◎日常生活動作"]
["調理","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考"]
["掃除・\n整理整頓","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考"]
["洗濯","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考"]
["買い物","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考"]
["電話等の\n利用","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考"]
["交通機関の利用","　経験\n　あり","　　経験\n　　なし","　自立","　一部\n　介助","　全介助","　見守り","備考"]
["喫煙","　　吸う","1日","本","　吸わ\n　ない","備考"]
["飲酒","　　飲む","1日","杯","　飲ま\n　ない","備考"]
["1人暮らしの経験",null,"　あり","　なし","備考"]
["感覚過敏・感覚鈍麻",null,"　あり","　なし","備考"]
["被害的・拒否的",null,"　あり","　なし","備考"]
["作話",null,"　あり","　なし","備考"]
["感情が不安定",null,"　あり","　なし","備考"]
["昼夜逆転",null,"　あり","　なし","備考"]
["暴言暴行",null,"　あり","　なし","備考"]
["同じ話をする",null,"　あり","　なし","備考"]
["大声・奇声を出す",null,"　あり","　なし","備考"]
["支援の拒否",null,"　あり","　なし","備考"]
["徘徊",null,"　あり","　なし","備考"]
["落ち着きがない",null,"　あり","　なし","備考"]
["外出して戻れない",null,"　あり","　なし","備考"]
["1人で出たがる",null,"　あり","　なし","備考"]
["収集癖",null,"　あり","　なし","備考"]
["物や衣類を壊す",null,"　あり","　なし","備考"]
["不潔行為",null,"　あり","　なし","備考"]
["異食行動",null,"　あり","　なし","備考"]
["ひどい物忘れ",null,"　あり","　なし","備考"]
["多動・行動停止",null,"　あり","　なし","備考"]
["不安定な行動",null,"　あり","　なし","備考"]
["不適切な行為",null,"　あり","　なし","備考"]
["突発的な行為",null,"　あり","　なし","備考"]
["過食・反すう等",null,"　あり","　なし","備考"]
["躁鬱状態",null,"　あり","　なし","備考"]
["反復的な行動",null,"　あり","　なし","備考"]
["対人面の不安緊張",null,"　あり","　なし","備考"]
["意欲が乏しい",null,"　あり","　なし","備考"]
["話がまとまらない",null,"　あり","　なし","備考"]
["集中力が続かない",null,"　あり","　なし","備考"]
["自己の過大評価",null,"　あり","　なし","備考"]
["集団への不適応",null,"　あり","　なし","備考"]
["多飲水・過飲水",null,"　あり","　なし","備考"]
["説明の理解",null,"　できる","　でき\n　ない","備考"]
["言語能力（読み書き）",null,"　できる","　でき\n　ない","備考"]
["日常生活の意思決定",null,"　できる","　でき\n　ない","備考"]
["衝動のコントロール",null,"　できる","　でき\n　ない","備考"]
["集団生活","　経験　\n　あり","　経験　\n　なし","備考"]
["薬物依存","　あり","　なし","備考"]
["物質乱用","　あり","　なし","備考"]
["ギャンブル\n依存","　あり","　なし","備考"]
["アルコール\n依存","　あり","　なし","備考"]
[]
["◎その他（分類できないもの）"]
["利用目的・目標、社会的相互関係、内省・洞察、コミュニティ要因、現実的計画、コンプライアンス、批判、合図、身体的接触、日課（管理、達成）など、他にあれば記入をして下さい。"]

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["記入者名",null,null,null,null,null,null,"記入日"]
[]
["所属",null,null,null,null,null,"(問合せ先)"]
[]
["※全ての項目の記入はしなくても良いです。対象者の必要な項目のみ記入をお願いします。"]
["　ストレングス視点（強みに着目して）での記入をして下さい。"]
["　ドロップリストから選択できる項目もあります。"]
["　"]
["氏名",null,null,null,null,"性別"]
[]
["生年月日",null,null,null,"年齢",{"$f":"DATEDIF(B11,I1,\"Y\")","v":0},"歳"]
[]
["住所\n(現住所)","〒",null,"－"]
[]
[]
["居住地","〒",null,"－"]
[]
[]
["電話番号",null,"－",null,"－"]
[]
["携帯番号",null,"－",null,"－"]
[]
["病名\n(障がい名)"]
[]
[]
["障害者\n手帳",null,null,null,"手帳",null,"種"]
[]
[null,null,null,null,"手帳",null,"種"]
[]
[null,null,null,null,"手帳",null,"種"]
[]
["受給者証",null,"区分",null,"（備考）"]
[]
["経済状況","年金",null,null,null,"年金",null,"級"]
[]
[null,null,null,null,null,"年金",null,"級"]
[]
[null,"生活保護",null,"（その他収入源）"]
[]
["金銭管理",null,"(備考)"]
[]
["現有資産\nの情報"]
[]
[]
["教育歴",null,null,"～"]
[null,null,null,"～"]
[null,null,null,"～"]
[null,null,null,"～"]
[null,null,null,"～"]
[null,null,null,"～"]
[null,null,null,"～"]
["職歴",null,null,"～"]
[null,null,null,"～"]
[null,null,null,"～"]
[null,null,null,"～"]
[null,null,null,"～"]
[null,null,null,"～"]
[null,null,null,"～"]
["日中活動\n状況"]
[]
[]
[]
["性格","長所"]
[]
[]
[null,"強み"]
[]
[]
[null,"短所"]
[]
[]
["宗教"]
[]
["趣味"]
[]
[]
[]
[]
["家族状況（ジェノグラム）",null,null,null,null,"成年後見人",null,null,null,null,"ジェノグラムを作成する時に使用して下さい"]
[]
[null,null,null,null,null,"後見人氏名"]
[]
[null,null,null,null,null,"職業後見人名称"]
[]
[null,null,null,null,null,"後見人連絡先"]
[null,null,null,null,null,null,"ー",null,"ー"]
[]
["※キーパーソンに☆をつける",null,null,null,null,"緊急連絡先"]
["頼れる人",null,null,null,null,null,"ー",null,"ー"]
[]
["家族状況（ジェノグラム）\n以外で相談できる人"]
[]
["家族との\n関係"]
[]
[]
[]
["家族の\n経済状況"]
[]
[]
[]
["その他\n家族状況\n(特徴）"]
[]
[]
[]
["本人","希望\n思い"]
[]
[]
[null,"不安\n課題"]
[]
[]
["家族","希望\n思い"]
[]
[]
[null,"不安"]

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["既往歴","感染"]
[]
[]
[]
[]
[]
[]
[]
["入院歴\n入院期間"]
[]
[]
[]
[]
["入院した\n経緯"]
[]
[]
[]
[]
[]
[]
["現在の医療状況（病状と経過）"]
["主治医",null,null,null,null,"科",null,"医師"]
["主治医",null,null,null,null,"科",null,"医師"]
["主治医",null,null,null,null,"科",null,"医師"]
[]
[]
[]
[]
[]
[]
[]
["服薬状況","朝","昼","夕","眠前","頓服"]
[]
["服薬名"]
[]
[]
[]
[]
["服薬の仕方\n（声掛け必要等）"]
[]
["服薬管理\n（服薬の理解）"]
[]
["アレルギー",null,"備考"]
[]
[]
["自殺企図",null,"備考"]
[]
[]
["病識\n（病気に対する想い）"]
[]
[]
[]
["治療への\n協力",null,"備考"]
[]
[]
["注射",null,"備考"]
[]
["中心静脈栄養",null,"備考"]
[]
["透析",null,"備考"]
[]
["ストーマの処置",null,"備考"]
[]
["酸素療法",null,"備考"]
[]
["レスピレーター\n(人工呼吸器)",null,"備考"]
[]
["気管切開の処置",null,"備考"]
[]
["疼痛の\n看護",null,"備考"]
[]
["経管栄養",null,"備考"]
[]
["モニターの測定",null,"備考"]
[]
[]
["褥瘡",null,"備考"]
[]
["カテーテル",null,"備考"]
[]
["嚥下\n（誤嚥、窒息）",null,"備考"]
[]
["喫煙",null,"1日",null,"本（箱）"]
[]
["飲酒",null,"1日",null,"杯"]

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["身長",null,null,"ｃｍ","体重",null,null,"Kg"]
[]
["視力","右",null,null,"左"]
[]
["聴力","右",null,"ｄｂ","左",null,"ｄｂ"]
[]
["知能","IQ",null,null,"体温"]
[]
["血圧",null,"/",null,"ｍｍＨｇ"]
[]
["ADL",null,null,null,null,"備考"]
["食事摂取","自立","一部介助","全介助","見守り"]
[]
["義歯","自立","一部介助","全介助","見守り"]
[]
["洗面","自立","一部介助","全介助","見守り"]
[]
["歯磨き","自立","一部介助","全介助","見守り"]
[]
["入浴","自立","一部介助","全介助","見守り"]
[]
["排泄","自立","一部介助","全介助","見守り"]
[]
["寝返り","自立","一部介助","全介助","見守り"]
[]
["起き上がり","自立","一部介助","全介助","見守り"]
[]
["座位保持","自立","一部介助","全介助","見守り"]
[]
["移乗","自立","一部介助","全介助","見守り"]
[]
["両足での立位保持","自立","一部介助","全介助","見守り"]
[]
["片足での立位保持","自立","一部介助","全介助","見守り"]
[]
["衣服着脱","自立","一部介助","全介助","見守り"]
[]
[]
[]
["睡眠","良眠","不眠","入眠困難","中途覚醒","早期覚醒","熟眠感あり","熟眠感なし","眠剤あり"]
[]
[]
[]
["歩行","自立","車椅子","歩行器","杖","シルバー\nカー","白杖"]
[]
["栄養管理"]

{"sheet":"日常生活動作","index":7,"n_rows":85,"n_cols":6,"rows_kept":85,"cut":false,"hidden":false,"merged":[[84,1,85,1],[84,2,85,9],[14,1,15,1],[14,2,15,9],[74,1,75,1],[74,2,75,9],[76,1,77,1],[76,2,77,9],[78,1,79,1],[78,2,79,9],[68,1,69,1],[68,2,69,9],[70,1,71,1],[70,2,71,9],[72,1,73,1],[72,2,73,9],[62,1,63,1],[62,2,63,9],[64,1,65,1],[64,2,65,9],[66,1,67,1],[66,2,67,9],[56,1,57,1],[56,2,57,9],[58,1,59,1],[58,2,59,9],[60,1,61,1],[60,2,61,9],[50,1,51,1],[50,2,51,9],[52,1,53,1],[52,2,53,9],[54,1,55,1],[54,2,55,9],[46,1,47,1],[46,2,47,9],[48,1,49,1],[48,2,49,9],[36,2,37,9],[38,1,39,1],[38,2,39,9],[40,1,41,1],[40,2,41,9],[42,1,43,1],[42,2,43,9],[24,2,25,9],[26,1,27,1],[26,2,27,9],[28,1,29,1],[28,2,29,9],[30,1,31,1],[30,2,31,9],[84,0,85,0],[14,0,15,0],[72,0,73,0],[74,0,75,0],[76,0,77,0],[78,0,79,0],[20,0,21,0],[22,0,23,0],[24,0,25,0],[26,0,27,0],[32,2,33,9],[28,0,29,0],[30,0,31,0],[22,1,23,1],[32,1,33,1],[44,1,45,1],[44,2,45,9],[12,1,13,1],[12,2,13,9],[16,1,17,1],[16,2,17,9],[18,1,19,1],[18,2,19,9],[20,1,21,1],[68,0,69,0],[70,0,71,0],[56,0,57,0],[58,0,59,0],[60,0,61,0],[62,0,63,0],[64,0,65,0],[66,0,67,0],[44,0,45,0],[46,0,47,0],[48,0,49,0],[50,0,51,0],[52,0,53,0],[54,0,55,0],[12,0,13,0],[16,0,17,0],[18,0,19,0],[10,3,11,3],[10,4,11,4],[10,5,11,5],[10,6,11,9],[6,4,7,4],[6,5,7,5],[6,6,7,9],[8,1,9,1],[8,2,9,2],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,6,9,9],[4,5,5,5],[4,6,5,9],[0,5,1,5],[0,6,1,9],[2,1,3,1],[2,2,3,2],[2,3,3,3],[2,4,3,4],[2,5,3,5],[2,6,3,9],[10,0,11,0],[6,1,7,1],[6,2,7,2],[6,3,7,3],[80,2,81,9],[82,2,83,9],[80,0,81,0],[82,0,83,0],[80,1,81,1],[82,1,83,1],[34,0,35,0],[36,0,37,0],[38,0,39,0],[40,0,41,0],[32,0,33,0],[42,0,43,0],[20,2,21,9],[22,2,23,9],[24,1,25,1],[34,1,35,1],[34,2,35,9],[36,1,37,1],[10,1,11,1],[10,2,11,2],[0,0,1,0],[2,0,3,0],[4,0,5,0],[0,1,1,1],[0,2,1,2],[0,3,1,3],[0,4,1,4],[6,0,7,0],[8,0,9,0],[4,1,5,1],[4,2,5,2],[4,3,5,3],[4,4,5,4]]}
["調理",null,"自立","一部介助","全介助","見守り"]
[]
["掃除\n整理整頓",null,"自立","一部介助","全介助","見守り"]
[]
["洗濯",null,"自立","一部介助","全介助","見守り"]
[]
["買い物",null,"自立","一部介助","全介助","見守り"]
[]
["電話等の\n利用",null,"自立","一部介助","全介助","見守り"]
[]
["交通機関の利用",null,"自立","一部介助","全介助","見守り"]
[]
["1人暮らし"]
[]
["集団生活"]
[]
["感覚過敏\n感覚鈍麻"]
[]
["被害的\n拒否的"]
[]
["作話"]
[]
["感情が\n不安定"]
[]
["昼夜逆転"]
[]
["同じ話\nをする"]
[]
["大声奇声を出す"]
[]
["支援の\n拒否"]
[]
["徘徊"]
[]
["落ち着き\nがない"]
[]
["外出して\n戻れない"]
[]
["1人で\n出たがる"]
[]
["収集癖"]
[]
["物や衣類を壊す"]
[]
["不潔行為"]
[]
["異食行動"]
[]
["ひどい\n物忘れ"]
[]
["多動・\n行動停止"]
[]
["不安定な行動"]
[]
["不適切な行為"]
[]
["突発的な行為"]
[]
["過食・\n反すう等"]
[]
["躁鬱状態"]
[]
["反復的な行動"]
[]
["対人面の不安緊張"]
[]
["意欲が\n乏しい"]
[]
["話が\nまとまらない"]
[]
["集中力が続かない"]
[]
["自己の\n過大評価"]
[]
["集団への不適応"]
[]
["多飲水・過飲水"]
[]
["説明の\n理解"]
[]
["言語能力\n（読み書き）"]
[]
["日常生活の意思決定"]
[]
["衝動の\nコントロール"]

{"sheet":"依存症・触法","index":8,"n_rows":39,"n_cols":1,"rows_kept":39,"cut":false,"hidden":false,"merged":[[26,0,30,7],[25,0,25,7],[32,0,37,7],[39,0,48,7],[31,0,31,7],[38,0,38,7],[10,0,24,7],[0,0,1,0],[2,0,3,0],[4,0,5,0],[6,0,7,0],[0,1,1,1],[2,1,3,1],[4,1,5,1],[6,1,7,1],[8,0,9,7],[0,2,1,7],[2,2,3,7],[4,2,5,7],[6,2,7,7]]}
["薬物依存"]
[]
["物質乱用"]
[]
["ギャンブル\n依存"]
[]
["アルコール\n依存"]
[]
["犯罪、非行内容、犯罪・非行行為の原因、改善状態、現在の状態\n（事件種別、審判又は裁判の内容）"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["釈放後に必要な持ち物"]
[]
[]
[]
[]
[]
["出所後の持ち物"]
[]
[]
[]
[]
[]
[]
["矯正施設でのトラブル"]

{"sheet":"その他","index":9,"n_rows":85,"n_cols":1,"rows_kept":85,"cut":false,"hidden":false,"merged":[[87,0,112,7],[75,0,80,7],[84,0,86,7],[74,0,74,7],[31,0,36,7],[39,0,44,7],[46,0,51,7],[53,0,58,7],[60,0,65,7],[67,0,72,7],[66,0,66,7],[30,0,30,7],[38,0,38,7],[45,0,45,7],[52,0,52,7],[59,0,59,7],[1,0,1,7],[2,0,7,7],[10,0,15,7],[17,0,22,7],[24,0,29,7],[16,0,16,7],[23,0,23,7],[8,0,9,7]]}
["◎以下自由記述欄は、出来ない場合や課題がある場合のみ記入をお願いします。"]
["危機の認知、対処方法（ストレス原因と対処法、注意サイン）"]
[]
[]
[]
[]
[]
[]
["コミュニケーション（対人関係の形成、終結、行動の制限、\n社会的ルール、社会的距離等）や意思決定"]
[]
[]
[]
[]
[]
[]
[]
["暴力（自傷・他傷）"]
[]
[]
[]
[]
[]
[]
["こだわり"]
[]
[]
[]
[]
[]
[]
["交友関係（反社会的集団との関係等）"]
[]
[]
[]
[]
[]
[]
[]
["共感性"]
[]
[]
[]
[]
[]
[]
["自尊心"]
[]
[]
[]
[]
[]
[]
["敬意と思いやり"]
[]
[]
[]
[]
[]
[]
["感謝"]
[]
[]
[]
[]
[]
[]
["寛容さ"]
[]
[]
[]
[]
[]
[]
[]
["活動役割遂行"]
[]
[]
[]
[]
[]
[]
[]
[]
["◎分類できないもの"]
["利用目的・目標、社会的相互関係、内省・洞察、コミュニティ要因、現実的計画、コンプライアンス、批判、合図、身体的接触、日課（管理、達成）、課題など、他にあれば記入をして下さい。"]

{"sheet":"リスト","index":10,"n_rows":30,"n_cols":13,"rows_kept":30,"cut":false,"hidden":true,"merged":[]}
[]
[]
[null,"性別","手帳所持",null,null,null,"受給者証","区分","障害基礎",null,"生活保護"]
[null,"男","あり",null,null,null,"あり",1,"障害厚生",1,"有り","自立"]
[null,"女","なし",null,null,null,"なし",2,null,2,"無し","一部介助"]
[null,null,"申請中",null,null,null,"申請中",3,null,3,null,"全介助"]
[null,null,null,null,null,null,null,4,null,null,null,"見守り"]
[null,null,null,null,null,null,null,5]
[null,null,null,null,null,null,null,6]
[]
[]
[]
[null,null,null,"後見人","弁護士","Ｂ型肝炎","病院",null,"紙パンツ","良眠","自立","熟眠感あり","眠剤あり"]
[null,"教育歴",null,"保佐人","社会福祉士","Ｃ型肝炎","医院",null,"はくパンツ","入眠困難","車椅子","熟眠感なし"]
[null,"幼稚園",null,"補助人","司法書士","ＨＩＶ","クリニック",null,"テープ止めおむつ","中途覚醒","歩行器"]
[null,"保育園",null,"無し","社会保険労務士","なし","診療所",null,"当てパット","早期覚醒","杖"]
[null,"こども園",null,null,null,null,null,null,null,null,"シルバーカー"]
[null,"小学校",null,null,null,null,null,null,null,null,"白杖"]
[null,"小学校（特別支援学級）","経験あり",null,"手帳種類"]
[null,"中学校","経験なし",null,"療育"]
[null,"中学校（特別支援学級）","－",null,"精神障害保健福祉","1級",1,null,"卒園","朝","〇","できる"]
[null,"高等学校",null,null,"身体障害者","2級",2,null,"入学","昼","－","できない"]
[null,"特別支援学校小学部",null,null,null,"3級",null,null,"卒業","夕"]
[null,"特別支援学校中学部",null,null,null,"4級",null,null,"転入","眠前"]
[null,"特別支援学校高等部",null,null,null,"5級",null,null,"編入","頓服"]
[null,"大学",null,null,null,"6級"]
[null,"短期大学",null,null,null,"Ａ１",null,"吸う","飲む"]
[null,"専門学校",null,null,null,"Ａ２",null,"吸わない","飲まない"]
[null,null,null,null,null,"Ｂ１"]
[null,null,null,null,null,"Ｂ２"]

{"sheet":"各評価表項目","index":11,"n_rows":154,"n_cols":7,"rows_kept":154,"cut":false,"hidden":true,"merged":[[46,3,46,4],[48,3,48,4],[49,3,49,4],[22,1,23,1],[22,2,23,2],[20,4,21,4],[36,3,36,4],[40,3,40,4],[41,3,41,4],[42,3,42,4],[43,3,43,4],[44,3,44,4],[116,3,116,4],[117,3,117,4],[118,3,118,4],[119,3,119,4],[120,3,120,4],[121,3,121,4],[122,3,122,4],[123,3,123,4],[72,3,72,4],[96,3,96,4],[73,3,73,4],[74,3,74,4],[75,3,75,4],[76,3,76,4],[77,3,77,4],[86,3,86,4],[87,3,87,4],[93,3,93,4],[94,3,94,4],[95,3,95,4],[97,3,97,4],[98,3,98,4],[88,3,88,4],[89,3,89,4],[131,3,131,4],[132,3,132,4],[26,3,26,4],[4,3,4,4],[5,3,5,4],[6,3,6,4],[11,3,11,4],[12,3,12,4],[13,3,13,4],[14,3,14,4],[15,3,15,4],[16,3,16,4],[17,3,17,4],[18,3,18,4],[22,3,23,4],[24,3,24,4],[106,3,106,4],[107,3,107,4],[109,3,109,4],[129,3,129,4],[130,3,130,4],[113,3,113,4],[114,3,114,4],[115,3,115,4],[50,3,50,4],[51,3,51,4],[52,3,52,4],[53,3,53,4],[54,3,54,4],[2,3,2,4],[7,3,7,4],[8,3,8,4],[9,3,9,4],[10,3,10,4],[19,3,19,4],[47,3,47,4],[25,3,25,4],[27,3,27,4],[28,3,28,4],[29,3,29,4],[30,3,30,4],[31,3,33,4],[34,3,34,4],[37,3,37,4],[38,3,38,4],[39,3,39,4],[35,3,35,4],[45,3,45,4],[60,3,60,4],[61,3,61,4],[62,3,62,4],[63,3,63,4],[64,3,64,4],[55,3,55,4],[56,3,56,4],[57,3,57,4],[58,3,58,4],[59,3,59,4],[65,3,65,4],[68,3,68,4],[69,3,69,4],[70,3,70,4],[71,3,71,4],[66,3,67,4],[83,3,83,4],[84,3,84,4],[85,3,85,4],[78,3,78,4],[79,3,79,4],[80,3,80,4],[81,3,81,4],[82,3,82,4],[90,3,90,4],[91,3,91,4],[92,3,92,4],[105,3,105,4],[110,3,110,4],[111,3,111,4],[112,3,112,4],[99,3,99,4],[100,3,100,4],[101,3,101,4],[102,3,102,4],[103,3,103,4],[65,6,67,6],[20,6,21,6],[22,6,23,6],[8,6,11,6],[146,3,146,4],[147,3,147,4],[148,3,148,4],[3,3,3,4],[141,3,141,4],[142,3,142,4],[143,3,143,4],[144,3,144,4],[145,3,145,4],[134,3,134,4],[135,3,135,4],[136,3,136,4],[140,3,140,4],[139,3,139,4],[124,3,124,4],[125,3,125,4],[126,3,126,4],[127,3,127,4],[128,3,128,4],[104,3,104,4]]}
["地域移行・地域定着支援部会　　各評価表　項目"]
[]
["障害支援区分　","ハウスやわらぎ","地域生活定着支援センター","保護観察所",null,"松原病院（クライシスプラン）","松原病院"]
["１．移動や動作等に関する項目"]
["寝返り"]
["起き上がり"]
["座位保持"]
["移乗"]
["立ち上がり",null,null,null,null,null,"転倒、転落"]
["両足での立位保持"]
["片足での立位保持"]
["歩行",null,"歩行","移動"]
["移動"]
["衣服の着脱","着替え","脱着衣","衣類着脱",null,null,"着衣、服飾"]
["褥瘡",null,null,null,null,null,"身体状況（褥瘡）"]
["嚥下",null,null,null,null,null,"嚥下障害・誤嚥、窒息"]
[]
[]
["2.身の回りの世話や日常生活等に関連する項目",null,null,"生活能力"]
["食事","食事（食習慣、好き嫌い）","食事","食事（体調の管理）"]
["口腔清潔","歯磨き、洗顔、髭剃り","洗面、歯磨き","洗面","身体快適性の\n確保",null,"入浴、清潔"]
["入浴","入浴","入浴","入浴"]
["排尿","排泄","排泄","排泄",null,null,"排泄"]
["排便"]
["健康・栄養管理",null,null,"健康の維持",null,null,"摂食、栄養"]
["薬の管理","服薬","服薬状況","処方薬"]
["金銭の管理","経済状況（収入源、金銭のやりくり）","金銭管理","経済生活（基本的、複雑な取引、収入源）",null,null,"金銭管理（経済、居住）"]
["電話等の利用"]
["日常生活の意思決定"]
["危険の認識",null,"危険の認知力","危機への対処"]
["調理","料理経験",null,"調理"]
["掃除","整理整頓、掃除","身辺整理","家事",null,null,"清掃と整理"]
["洗濯",null,"洗濯"]
["買い物",null,"買い物"]
["交通手段の利用",null,null,"交通の便"]
[]
["３．意思疎通などに関連する項目"]
["視力",null,"視力","視力"]
["聴力",null,"聴覚","聴力"]
["コミュニケーション",null,"意思伝達"]
["説明の理解"]
["読み書き",null,"言語能力（読み書き）"]
["感覚過敏・感覚鈍麻"]
[]
["４．行動障がいに関連する項目"]
["被害的・拒否的"]
["作話"]
["感情が不安定",null,null,"衝動コントロール"]
["昼夜逆転"]
["暴言暴行"]
["同じ話をする"]
["大声・帰省を出す"]
["支援の拒否"]
["徘徊"]
["落ち着きがない"]
["外出して戻れない"]
["1人で出たがる"]
["収集癖"]
["物や衣類を壊す"]
["不潔行為"]
["異食行動"]
["ひどい物忘れ"]
["こだわり"]
["多動・行動停止"]
["不安定な行動"]
["自らを傷つける行為",null,null,null,null,null,"暴力"]
["他人を傷つける行為",null,null,"非社会性、対人暴力"]
["不適切な行為"]
["突発的な行為"]
["過食・反すう等"]
["躁鬱状態"]
["反復的な行動"]
["対人面の不安緊張",null,null,"対人関係（形成、終結、\n行動の制限、社会的ルール、社会的距離）"]
["意欲が乏しい"]
["話がまとまらない"]
["集中力が続かない"]
["自己の過大評価"]
["集団への不適応",null,null,"共感性"]
["多飲水・過飲水"]
[]
["５．特別な医療に関連する項目"]
["点滴の管理"]
["中心静脈栄養"]
["透析"]
["ストーマの処置"]
["酸素療法"]
["レスピレーター"]
["気管切開の処置"]
["疼痛の看護"]
["経管栄養"]
["モニターの測定"]
["褥瘡の処置"]
["カテーテル"]
[]
[null,"氏名、性別","氏名、性別","氏名、性別"]
[null,"生年月日","生年月日（年齢）","生年月日"]
[null,"住所","現住所（帰省予定地、本籍地、住民票地）","住所（本籍地、逮捕地、出身地）"]
[null,"保証人","身元引受人情報","保護者名"]
[null,"連絡先、緊急連絡先","電話番号","電話番号"]
[null,"病名",null,"病名"]
[null,"病院名、主治医",null,"病院名"]
[null,"入院年月日",null,"入院経過"]
[null,"医療保険","医療状況（身長、体重、てんかん、喘息、皮膚疾患、虫歯、入れ歯、現在の疾病）","現在の病状",null,null,"身体的問題\n精神的健康"]
[null,"既往歴","既往歴","既往歴"]
[null,"年金","年金、生保","年金"]
[null,"手帳","障がい・要介護の状態","手帳"]
[null,"受給者証",null,"福祉サービス受給歴"]
[null,"家族状況\n（家族構成、本人と家族の関係、面会外泊状況）","家族構成","家族構成（家族・関係人の状況、家庭環境、居住地の生活環境、家族の経済状況）"]
[null,"入院及び通院中の経過と内服薬",null,"治療目標と治療方針",null,null,"治療への協力"]
[null,null,"生活歴","学籍（小学校、中学校等）、\n職業、就労先（入所前）"]
[null,null,null,"知能"]
[null,null,null,"身長、体重"]
[null,null,null,"現有資産の情報"]
[]
[]
[]
[null,"睡眠","睡眠",null,null,null,"睡眠、休息"]
[null,"病識"]
[null,"嗜好（タバコ、アルコール）","飲酒、喫煙"]
[null,"性格","性格（長所、短所）"]
[null,"趣味"]
[null,"宗教"]
[null,"アレルギー","アレルギー","アレルギー"]
[null,"感染"]
[null,"現在の問題点と必要なケア\n（入院中の様子、職員のかかわり、調子が悪くなる前の前触れ、過去の自傷他傷）"]
[null,"利用目的・目標\n（本人の目的・目標、看護側による処遇計画の内容）"]
[null,null,"薬物使用","物質乱用"]
[null,null,"ギャンブル依存"]
[null,null,"集団生活"]
[null,null,"犯罪の状況","犯罪、非行内容（事件種別、審判又は裁判の内容）"]
[null,null,"出所時持ち物","釈放後に不足しそうな持ち物"]
[null,null,null,"交友関係（反社会的集団との関係）"]
[null,null,null,"個人的支援（支援を必要とする事由）",null,"家族支援者に手伝って欲しい事"]
[null,null,null,"矯正施設でのトラブル"]
[null,null,null,"自殺企図",null,null,"自殺の危険度"]
[null,null,null,"内省・洞察"]
[null,null,null,"生活能力"]
[null,null,null,"衝動コントロール"]
[null,null,null,"コミュニティ要因"]
[null,null,null,"ストレス、対処方法\n（責任、ストレス）",null,"ストレス原因（身体的、生活上、対人関係、社会的）"]
[null,null,null,"現実的計画"]
[null,null,null,"コンプライアンス"]
[null,null,null,"敬意と思いやり"]
[null,null,null,"感謝"]
[null,null,null,"寛容さ"]
[null,null,null,"批判"]
[null,null,null,"合図"]
[null,null,null,"身体的接触"]
[null,null,null,"日課（管理、達成）"]
[null,null,null,null,null,"注意サイン（対処方法等）"]
[null,null,null,null,null,null,"活動役割遂行"]
[null,null,null,null,null,null,"社会的相互関係"]
[null,null,null,null,null,null,"希望、自尊心・不安"]
[null,null,null,null,null,null,"家族の希望・不安"]