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["医療的ケアの判定スコア",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名（　　　　　　　　 　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"第２号様式・別紙"]
["医療的ケア（診療の補助行為）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"基本スコア",null,null,null,"基本\nスコア",null,null,"見守りスコア",null,null,null,null,null,"見守りスコアの基準（目安）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日中",null,"夜間",null,null,null,null,"高",null,"中",null,"低",null,"見守り高の場合",null,null,null,null,null,null,null,null,"見守り中の場合",null,null,null,null,null,null,null,null,"見守り低の場合\n（0点）"]
["１　人工呼吸器（鼻マスク式補助換気法、ハイフローセラピー、間歇的陽圧吸入法、排痰補助装置、高頻度胸壁振動装置を含む）の管理\n注）人工呼吸器および括弧内の装置等のうち、いずれか一つに該当する場合にカウントする。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,10,null,"点",null,null,null,null,null,null,"自発呼吸がない等のために人工呼吸器抜去等の人工呼吸器トラブルに対して直ちに対応する必要がある場合（2点）",null,null,null,null,null,null,null,null,"直ちにではないが概ね15分以内に対応する必要がある場合（1点）",null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,null,null,2,1,null,false,false]
["２　気管切開の管理\n注）人工呼吸器と気管切開の両方を持つ場合は、気管切開の見守りスコアを加点しない。（人工呼吸器10点＋人工呼吸器）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8,null,"点",null,null,null,null,null,null,"自発呼吸がほとんどない等のために気管切開カニューレ抜去に対して直ちに対応する必要がある場合（2点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,null,null,2,null,null,false]
["３　鼻咽頭エアウェイの管理",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,5,null,"点",null,null,null,null,null,null,"上気道狭窄が著明なためにエアウェイ抜去に対して直ちに対応する必要がある場合（1点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,null,null,1,null,null,false]
["４　酸素療法",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8,null,"点",null,null,null,null,null,null,"酸素投与中止にて短時間のうちに健康及び患者の生命に対して悪影響がもたされる場合（1点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,false,null,1,null,null,false]
["５　吸引（口鼻腔・気管内吸引）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8,null,"点",null,null,null,null,null,null,"自発運動等により吸引の実施が困難な場合（1点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,null,null,1,null,null,false]
["６　ネブライザーの管理",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,null,"点",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,false]
["７　経管栄養",null,null,null,null,"（１）経鼻胃管、胃瘻、経鼻腸管、経胃瘻腸管、腸瘻、食道瘻",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8,null,"点",null,null,null,null,null,null,"自発運動等により栄養管抜去する／損傷させる可能性がある場合（2点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,null,null,2,null,null,false]
[null,null,null,null,null,"（２）持続経管注入ポンプ使用",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,null,"点",null,null,null,null,null,null,"自発運動等により注入ポンプを倒す可能性がある場合（1点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,null,null,1,null,null,false]
["８　中心静脈カテーテルの管理（中心静脈栄養、肺高血圧症治療薬、麻薬など）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8,null,"点",null,null,null,null,null,null,"自発運動等により中心静脈カテーテルを抜去する可能性がある場合（2点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,null,null,2,null,null,false]
["９　皮下注射\n注）いずれか一つを選択",null,null,null,null,"（１）皮下注射（インスリン、麻薬など）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,5,null,"点",null,null,null,null,null,null,"自発運動等により皮下注射を安全に実施できない場合（1点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,false,null,1,null,null,false]
[null,null,null,null,null,"（２）持続皮下注射ポンプ使用",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,null,"点",null,null,null,null,null,null,"自発運動等により持続皮下注射ポンプを抜去する可能性がある場合（1点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,false,null,1,null,null,false]
["１０　血糖測定（持続血糖測定器による血糖測定を含む）\n注）インスリン持続皮下注射ポンプと持続血糖測定器と連動している場合は、血糖測定の項目を加点しない。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,null,"点",null,null,null,null,null,null,"血糖測定とその後の対応が頻回に必要になる可能性がある場合（1点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,false,null,1,null,null,false]
["１１　継続的な透析（血液透析、腹膜透析を含む）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,8,null,"点",null,null,null,null,null,null,"自発運動等により透析カテーテルを抜去する可能性がある場合（2点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,null,null,2,null,null,false]
["１２　導尿\n注）いずれか一つを選択",null,null,null,null,"（１）利用時間中の間欠的導尿",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,5,null,"点",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,false]
[null,null,null,null,null,"（２）持続的導尿（尿道留置カテーテル、膀胱瘻、腎瘻、尿路ストーマ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,null,"点",null,null,null,null,null,null,"自発運動等により持続的導尿カテーテルを抜去する可能性がある場合（1点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,false,null,1,null,null,false]
["１３　排便管理\n注）いずれか一つを選択",null,null,null,null,"（１）消化管ストーマ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,5,null,"点",null,null,null,null,null,null,"自発運動等により消化管ストーマを抜去する可能性がある場合（1点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,false,null,1,null,null,false]
[null,null,null,null,null,"（２）摘便、洗腸",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,5,null,"点",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,false]
[null,null,null,null,null,"（３）浣腸",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,null,"点",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false,false]
["１４　痙攣時の坐薬注入、吸引酸素投与、迷走神経刺激装置の作動等の処置\n注）医師から発作時の対応として上記処置の指示があり、過去概ね１年いないに発作等の既往がある場合",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,null,"点",null,null,null,null,null,null,"痙攣が10分以上重積する可能性や短時間のうちに何度も繰り返す可能性が高い場合（2点）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"それ以外の場合",null,null,null,false,null,null,2,null,null,false]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（a）基本スコア合計",null,null,null,null,null,null,"（b）見守りスコア合計",null,null,null,null,null,null,null,null,"（a）＋（b）判定スコア",null,null,null,null,null,null,"（a）＋（b）判定スコア"]
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