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["狭山保健所　新型コロナウイルス感染症発生施設調査票"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"狭山保健所\n保健予防推進担当\n連絡先",null,null,null,"TEL：",null,"04-2954-6212"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FAX：",null,"04-2954-7535"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"e-mail：",null,"f5462129@pref.saitama.lg.jp"]
["①施設概要",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"報告日：",null,"令和",null,"年",null,"月",null,"日"]
["施設名"]
["施設所在地"]
["施設種別\n(該当する項目にþ)"]
[]
["担当者名",null,null,null,"　　　　　　",null,null,null,null,"職種",null,null,null,null,null,"管理者名"]
["電話番号",null,null,null,null,null,null,null,null,null,null,"メール\nアドレス"]
["FAX"]
["施設医・協力医",null,null,null,"(例：〇〇病院、△△クリニックなど）"]
[]
["対応可能範囲"]
[]
["利用者の特徴・傾向",null,null,null,"(例：3階の利用者は医療依存度が高い、2階の利用者は認知機能が低下している方が多い）"]
[]
[]
[]
["②初発患者情報"]
["属性",null,null,null,null,null,null,null,null,null,null,null,"発症日"]
["発生フロア(ユニット)",null,null,null,null,"（例：3階○×ユニット）",null,null,null,null,null,null,"診断日"]
[]
["隔離開始日"]
["備考",null,null,null,null,"※複数同時発生している場合は他の陽性者の情報を簡潔に記入してください。"]
[]
[]
["③報告時点の発生状況"]
["利用者"]
["階層",null,"フロア・\nユニット数",null,null,"在籍者数",null,null,"有症状者数",null,null,"陽性者数",null,null,"重症者数",null,null,"入院者数"]
["1階"]
["2階"]
["3階"]
[]
[]
[]
[]
["合計",null,null,null,null,{"$f":"IF(SUM(F32,F33,F34,F35,F36,F37,F38)=0,\"\",SUM(F32,F33,F34,F35,F36,F37,F38))","v":""},null,null,{"$f":"IF(SUM(I32,I33,I34,I35,I36,I37,I38)=0,\"\",SUM(I32,I33,I34,I35,I36,I37,I38))","v":""},null,null,{"$f":"IF(SUM(L32,L33,L34,L35,L36,L37,L38)=0,\"\",SUM(L32,L33,L34,L35,L36,L37,L38))","v":""},null,null,{"$f":"IF(SUM(O32,O33,O34,O35,O36,O37,O38)=0,\"\",SUM(O32,O33,O34,O35,O36,O37,O38))","v":""},null,null,{"$f":"IF(SUM(R32,R33,R34,R35,R36,R37,R38)=0,\"\",SUM(R32,R33,R34,R35,R36,R37,R38))","v":""}]
[]
["職員"]
["職種",null,null,"在籍者数",null,null,"有症状者数",null,null,"陽性者数"]
["医師"]
["看護師"]
["介護士"]
["事務"]
["リハビリ"]
[]
["その他"]
["合計",null,null,{"$f":"IF(SUM(D43,D44,D45,D46,D47,D48,D49)=0,\"\",SUM(D43,D44,D45,D46,D47,D48,D49))","v":""},null,null,{"$f":"IF(SUM(G43,G44,G45,G46,G47,G48,G49)=0,\"\",SUM(G43,G44,G45,G46,G47,G48,G49))","v":""},null,null,{"$f":"IF(SUM(J43,J44,J45,J46,J47,J48,J49)=0,\"\",SUM(J43,J44,J45,J46,J47,J48,J49))","v":""}]
[]
["発生状況の詳細\n及び\n推定される\n感染経路",null,null,null,"(例：1階〇〇フロアで職員1名入居者2名陽性。3階△△フロア、□□フロアでそれぞれ入居者２名陽性。)"]
[]
[]
["④施設の対応"]
["項目",null,null,null,null,null,"施設の対応"]
[]
["感染対策の強化",null,"感染症対策"]
[]
[]
[]
[]
[null,null,"手指衛生の\n使用物品"]
[null,null,"環境消毒の\n使用物品"]
["ゾーニング\n感染防護具",null,"陽性者に対する\nゾーニング"]
[null,null,"陽性者対応時の\n使用PPE"]
["報告・周知",null,"報告・周知"]
[]
["⑤備考・保健所に相談したいこと"]