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[null,"＊次のいずれかを選択し、下の申請書に必要事項を入力してください。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,"※神奈川県使用欄"]
[]
[null,"申請する事業所(施設）の種類",null,null,null,null,null,null,null,null,null,null,null,1,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,null,"事業所番号"]
[null,"申請者の法人の種類",null,null,null,null,null,null,null,null,null,null,null,5,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,null,"サービス種類",{"$f":"IF(Y6<>0,IF(N4=1,VLOOKUP(Y6,BQ132:BS138,3,FALSE),\"\"),\"\")","v":11}]
[null,"申請する事業の種類",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"異動区分"]
["かながわ自立支援給付費等支払システム　地域生活支援事業所・単独事業所登録シート",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"異動年月日"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"支払方法"]
["神奈川県国民健康保険団体連合会理事長",null,null,null,null,null,null,null,null,null,null,null,null,null,"殿"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日"]
[]
[null,null,null,null,"次のとおり、かながわ自立支援給付費等支払システムへの登録を依頼します。"]
[null,null,null,null,"また、自立支援給付費等の支払については、下記の指定口座に振り込みをお願いします。"]
[]
[]
["申請者（設置者）",null,"ﾌ　ﾘ　ｶﾞ　ﾅ"]
[null,null,"名　　　　称"]
[null,null,"所在地",null,null,null,null,null,null,"〒",null,null,null,null,null,null,null,null,"←半角数字７桁で記載"]
[null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,null,null,""]
[null,null,"連絡先",null,null,null,null,null,null,"電話番号",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,"FAX番号",null,null,null,null,""]
[null,null,"法人の種類",null,null,null,null,null,null,{"$f":"IF(N5<>0,VLOOKUP(N5,BQ107:BS121,2,FALSE),\"\")","v":"営利法人"}]
[null,null,"代表者",null,null,null,null,null,null,"役　職",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,"印"]
[]
["事業所・施設",null,"ﾌ　ﾘ　ｶﾞ　ﾅ"]
[null,null,"名　　　　称"]
[null,null,"事業所（施設）の\n所在地",null,null,null,null,null,null,"〒",null,null,null,null,null,null,null,null,"事業所(施設)所在地市町村番号",null,null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,"級地区分"]
[null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,null,null,""]
[null,null,"連絡先",null,null,null,null,null,null,"電話番号",null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,"FAX番号",null,null,null,null,""]
[null,null,"事業所番号",null,null,null,null,null,null,""]
[null,null,"サービスの種類",null,null,null,null,null,null,{"$f":"IF(N4=1,IF(Y6<>0,VLOOKUP(Y6,BQ132:BS138,2,FALSE),\"\"),IF(M6<>\"\",M6,\"\"))","v":"移動支援"},null,null,null,null,null,null,null,null,null,null,null,null,null,"サービス\n種類番号",null,null,null,{"$f":"AT5","v":11}]
[null,null,"定員",null,null,null,null,null,null,null,null,null,null,"報酬算定上の\n定員規模"]
[null,null,"主たる対象者",null,null,null,null,null,null,"身体",null,null,null,null,null,"知的",null,null,null,null,null,"児童",null,null,null,null,null,"精神"]
[]
[]
[null,null,null,null,null,null,null,null,null,{"$f":"IF(I7=\"\",\"\",I7)","v":""}]
[null,null,"適用年月日"]
[]
[]
["指定口座",null,"金融機関名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金融機関コード",null,null,null,null,null,null,""]
[null,null,"店舗名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"店舗コード",null,null,null,null,null,null,""]
[null,null,"口座番号",null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"預金種別",null,null,null,null,null,null,1]
[null,null,"名義人",null,null,"ﾌﾘｶﾞﾅ"]
[null,null,null,null,null,"氏名"]
[]
["委任状"]
[null,null,"　　申請者（債権者）は，口座名義人（受任者）に，上記事業費の受領に関する一切の権限を"]
[null,null,"　委任します。"]
[null,null,{"$f":"X14","v":"令和"},null,null,null,{"$f":"IF(AA14<>\"\",AA14,\"\")","v":""},null,null,"年",{"$f":"IF(AF14<>\"\",AF14,\"\")","v":""},null,null,"月",{"$f":"IF(AK14<>\"\",AK14,\"\")","v":""},null,null,"日"]
[]
[null,null,"委任者",null,null,null,null,null,null,{"$f":"IF(Y27<>\"\",Y27,\"\")","v":""},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,"印"]
[]
[]
[]
["振込エラー防止のため"]
[]
["ここに振込先の店番号，口座番号，口座名義人フリガナがわかる"]
[]
["通帳の写しを貼り付けるか，"]
[]
["以下に，取引金融機関の確認印を受けてください。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"上記口座が存在することを確認しました。"]
[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,null,null,null,null,null,null,"確認印"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金融機関名"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"確認年月日"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[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,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,null,null,null,null,null,null,null,null,null,null,1,"地域生活支援事業所"]
[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,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,null,null,null,null,null,null,null,null,null,null,2,"単独事業所"]
[]
[]
[]
[]
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[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,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,null,null,null,null,null,null,null,null,null,null,2,"社会福祉法人（社協）",2]
[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,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,null,null,null,null,null,null,null,null,null,null,3,"医療法人",3]
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[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,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,null,null,null,null,null,null,null,null,null,null,11,"地方公共団体（市町村）",11]
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[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,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,null,null,null,null,null,null,null,null,null,null,13,"非法人",13]
[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,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,null,null,null,null,null,null,null,null,null,null,14,"国立施設",14]
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[]
[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,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,null,null,null,null,null,null,null,null,null,null,1,"新規"]
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[]
[]
[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,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,null,null,null,null,null,null,null,null,null,null,1,"口座振替"]
[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,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,null,null,null,null,null,null,null,null,null,null,2,"納付書(納入通知書)"]
[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,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,null,null,null,null,null,null,null,null,null,null,8,"口座不払"]
[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,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,null,null,null,null,null,null,null,null,null,null,9,"納付書不払"]
[]
[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,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,null,null,null,null,null,null,null,null,null,null,1,"移動支援",11]
[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,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,null,null,null,null,null,null,null,null,null,null,2,"日中一時支援",21]
[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,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,null,null,null,null,null,null,null,null,null,null,3,"経過的デイサービス",31]
[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,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,null,null,null,null,null,null,null,null,null,null,4,"地域活動支援センター",41]
[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,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,null,null,null,null,null,null,null,null,null,null,5,"訪問入浴",51]
[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,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,null,null,null,null,null,null,null,null,null,null,6,"施設入浴",52]
[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,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,null,null,null,null,null,null,null,null,null,null,7,"単独グループホーム",61]
[]
[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,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,null,null,null,null,null,null,null,null,null,null,"'--2019/04/12 J020874 富士通（鈴木）　かながわシステム新元号対応（２次） ADD START"]
[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,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,null,null,null,null,null,null,null,null,null,null,"委任状元号＿事業所登録シート"]
[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,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,null,null,null,null,null,null,null,null,null,null,"順番","項目名称"]
[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,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,null,null,null,null,null,null,null,null,null,null,1,"令和"]
[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,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,null,null,null,null,null,null,null,null,null,null,2,"平成"]
[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,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,null,null,null,null,null,null,null,null,null,null,"'--2019/04/12 J020874 富士通（鈴木）　かながわシステム新元号対応（２次） ADD END"]

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["項目名称","出力用\n位置","取込用\n位置","変換\n方式","初期値","ﾄﾞﾛｯﾌﾟﾀﾞｳﾝ","備考",null,"項目名称","出力用\n位置","取込用\n位置","変換\n方式","初期値","ﾄﾞﾛｯﾌﾟﾀﾞｳﾝ","備考",null,"項目名称","出力用\n位置","取込用\n位置","変換\n方式","初期値","ﾄﾞﾛｯﾌﾟﾀﾞｳﾝ","備考",null,"項目名称","出力用\n位置","取込用\n位置","変換\n方式","初期値","ﾄﾞﾛｯﾌﾟﾀﾞｳﾝ","備考",null,"項目名称","出力用\n位置","取込用\n位置","変換\n方式","初期値","ﾄﾞﾛｯﾌﾟﾀﾞｳﾝ","備考"]
[]
[null,null,null,null,null,null,"備考",null,null,null,null,null,null,null,"備考",null,null,null,null,null,null,null,"備考",null,null,null,null,null,null,null,"備考",null,null,null,null,null,null,null,"備考"]
["交換情報識別番号",null,null,8,null,null,"※不要",null,"交換情報識別番号",null,null,8,null,null,"※不要",null,"交換情報識別番号",null,null,8,null,null,"※不要",null,"交換情報識別番号",null,null,8,null,null,"※不要",null,"交換情報識別番号",null,null,8,null,null,"※不要"]
["異動年月日",null,"AT8",null,null,null,null,null,"異動年月日",null,null,8,null,null,"※不要",null,"異動年月日",null,null,8,null,null,"※不要",null,"異動年月日",null,null,8,null,null,"※不要",null,"異動年月日",null,null,8,null,null,"※不要"]
["異動区分",null,"AT7",null,null,null,null,null,"異動区分コード",null,null,8,null,null,"※不要",null,"異動区分コード",null,null,8,null,null,"※不要",null,"異動区分コード",null,null,8,null,null,"※不要",null,"施設 サービス種類番号",null,null,8,null,null,"※不要"]
["異動事由",null,null,8,null,null,"※不要",null,"異動事由",null,null,8,null,null,"※不要",null,"異動事由",null,null,8,null,null,"※不要",null,"異動事由",null,null,8,null,null,"※不要",null,"施設 定員",null,"J37"]
["事業所番号",null,"AT4",null,null,null,null,null,"事業所番号",null,null,8,null,null,"※不要",null,"事業所番号",null,null,8,null,null,"※不要",null,"事業所番号",null,null,8,null,null,"※不要",null,"施設 定員規模",null,"T37"]
["申請者-氏名(ｶﾅ)",null,"J20",null,null,null,null,null,"法人名称",null,"I11",8,null,null,"※不要",null,"支払区分",null,"AT10",13,null,null,"初期値なし",null,"管理者-氏名（ｶﾅ）",null,null,8,null,null,"※不要",null,"施設 身体",null,"N38",3]
["申請者-氏名(漢字)",null,"J21",null,null,null,null,null,"郵便番号",null,"K13",8,null,null,"※不要",null,"申請先",null,null,8,null,null,"※不要",null,"管理者-氏名（漢字）",null,null,8,null,null,"※不要",null,"施設 知的",null,"T38",3]
["申請者-郵便番号",null,"L22",1,null,null,null,null,"所在地上段",null,"I14",8,null,null,"※不要",null,"所在地市町村番号",null,"AC31",null,null,null,null,null,"管理者-郵便番号",null,null,8,null,null,"※不要",null,"施設 児童",null,"Z38",3]
["申請者-住所(ｶﾅ)",null,null,8,null,null,"※不要",null,"所在地下段",null,"I16",8,null,null,"※不要",null,"事業所・施設の種類",null,"N4",null,null,null,"初期値なし",null,"管理者-住所（ｶﾅ）",null,null,8,null,null,"※不要",null,"施設 精神",null,"AF38",3]
["申請者-住所(漢字)",null,"J23",7,null,null,"住所分割",null,"代表者氏名",null,"I18",8,null,null,"※不要",null,"その他情報1",null,null,8,null,null,"※不要",null,"管理者-住所（漢字）",null,null,8,null,null,"※不要",null,"施設 適用年月日",null,"J42"]
["申請者-電話番号",null,"O25",null,null,null,null,null,"事業所名称",null,"I20",8,null,null,"※不要",null,"その他情報2",null,null,8,null,null,"※不要",null,"事業所-名称（ｶﾅ）",null,"J29"]
["申請者-FAX番号",null,"AE25",null,null,null,null,null,"事業所番号",null,"I22",8,null,null,"※不要",null,"その他情報3",null,null,8,null,null,"※不要",null,"事業所-名称（漢字）",null,"J30"]
["代表者-氏名(ｶﾅ)",null,null,8,null,null,"※不要",null,"金融機関名",null,"J45",null,null,null,null,null,"WAMサービス区分",null,null,8,null,null,"※不要",null,"事業所-郵便番号",null,"L31",1]
["代表者-氏名(漢字)",null,"Y27",null,null,null,null,null,"金融機関コード",null,"AG45",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所-住所（ｶﾅ）",null,null,8,null,null,"※不要"]
["代表者-職名",null,"M27",null,null,null,null,null,"店舗名",null,"J46",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所-住所（漢字）",null,"J32",7,null,null,"住所分割"]
["代表者-郵便番号",null,null,8,null,null,null,null,"店舗コード",null,"AG46",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所-電話番号",null,null,8,null,null,"※不要"]
["代表者-住所(ｶﾅ)",null,null,8,null,null,"※不要",null,"口座番号",null,"J47",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業所-FAX番号",null,null,8,null,null,"※不要"]
["代表者-住所(漢字)",null,null,8,null,null,"住所分割",null,"預金種別",null,"AG47",4,1,null,null,null,null,null,null,null,null,null,null,null,"サービス種類コード",null,"Y6",11,null,null,"初期値なし"]
["主たる事業所名称",null,null,8,null,null,null,null,"名義人ﾌﾘｶﾞﾅ",null,"J48",null,null,null,null,null,null,null,null,null,null,null,null,null,"サービス種類単位番号",null,null,8,null,null,"※不要"]
["法人種別コード",null,"N5",null,null,null,"VLOOKUPなし,初期値なし",null,"名義人氏名",null,"J49",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業実施区分",null,null,8,null,null,"※不要"]
["指定／基準該当等事業所区分コード",null,null,8,null,null,"※不要",null,"委任状年",null,"AA14",null,null,null,null,null,null,null,null,null,null,null,null,null,"地域区分コード",null,"AN31"]
["社会福祉法人等軽減申し出有無",null,null,8,null,null,null,null,"委任状月",null,"AF14",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業開始年月日",null,null,8,null,null,"※不要"]
["軽減開始年月日",null,null,8,null,null,"※不要",null,"委任状日",null,"AK14",null,null,null,null,null,null,null,null,null,null,null,null,null,"事業休止年月日",null,null,8,null,null,"※不要"]
["法人所轄庁",null,null,8,null,null,null,null,"委任者",null,null,8,null,null,"※不要",null,null,null,null,null,null,null,null,null,"事業廃止年月日",null,null,8,null,null,"※不要"]
["事業所・施設の種類　名称ｶﾅ",null,null,8,null,null,"※不要",null,"[委任状] 日","","",9,null,null,null,null,null,null,null,null,null,null,null,null,"事業再開年月日",null,null,8,null,null,"※不要"]
["事業所・施設の種類　名称漢字",null,null,8,null,null,"※不要",null,"[委任状] 委任者","","",9,null,null,null,null,null,null,null,null,null,null,null,null,"適用年月日",null,null,8,null,null,"※不要"]
["事業所・施設の種類　所在地郵便",null,null,8,null,null,"※不要",null,"[委任状] 委任者印","","",9,null,null,null,null,null,null,null,null,null,null,null,null,"施設等の区分",null,null,8,null,null,"※不要"]
["事業所・施設の種類　所在地住所",null,null,8,null,null,"※不要",null,"[注記] 金融機関名","","",9,null,null,null,null,null,null,null,null,null,null,null,null,"人員配置区分",null,null,8,null,null,"※不要"]
["事業所・施設の種類　事業開始予定年月日",null,null,8,null,null,null,null,"[注記] 確認年月日","","",9,null,null,null,null,null,null,null,null,null,null,null,null,"定員区分",null,null,8,null,null,"※不要"]
["事業所・施設の種類　備考",null,null,8,null,null,null,null,"[注記] 確認印","","",9,null,null,null,null,null,null,null,null,null,null,null,null,"送迎サービス実施の有無",null,null,8,null,null,"※不要"]
["既指定サービスの種類",null,null,8,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"利用定員数",null,null,8,null,null,"※不要"]
["既指定事業所番号",null,"J35",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"分場施設区分",null,null,8,null,null,"※不要"]
["既指定事業所名称",null,null,8,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"旧法施設定員数",null,null,8,null,null,"※不要"]
["受付番号",null,null,8,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"栄養管理体制加算の基準",null,null,8,null,null,"※不要"]
["事業所・施設の種類 電話番号",null,"O34",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"看護師加算の有無",null,null,8,null,null,"※不要"]
["事業所・施設の種類 FAX番号",null,"AE34",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"強度行動障害者特別支援加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"経過的給付の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"視覚・聴覚言語障害者支援体制加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"視覚・聴覚等障害者支援体制加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"自活訓練加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"重度障害者支援加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"重度障害者支援体制加算（基本）の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"重度障害者支援体制加算（重度）の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"重度重複障害者加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"就労移行支援体制加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"小規模事業加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"常勤医師加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"食事提供体制加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"通所事業所等食事提供体制加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"訪問訓練の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"自立生活支援加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"神経内科医加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"精神障害者退院支援施設加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"短期滞在加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"目標工賃達成加算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"夜間支援体制加算（小規模事業所以外）の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"夜間支援体制加算（小規模事業所）の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"大規模住居減算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"利用定員超過による減算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"職員欠如による減算の有無",null,null,8,null,null,"※不要"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"標準利用期間超過減算の有無",null,null,8,null,null,"※不要"]