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{"sheet":"企業確認書","index":0,"n_rows":98,"n_cols":61,"rows_kept":98,"cut":false,"hidden":false,"merged":[[95,1,96,61],[97,1,98,4],[97,5,98,25],[97,26,98,29],[97,30,98,61],[79,3,80,61],[82,2,83,8],[84,3,85,35],[86,3,87,35],[93,1,94,61],[84,36,87,45],[71,2,72,30],[73,2,74,2],[73,3,74,61],[75,2,76,2],[75,3,76,61],[77,2,78,2],[77,3,78,61],[53,48,54,56],[59,2,60,2],[59,3,60,61],[61,3,62,61],[63,3,64,61],[66,2,68,61],[53,17,54,32],[53,33,54,33],[53,34,54,35],[53,36,54,44],[53,45,54,45],[53,46,54,47],[51,33,52,33],[51,34,52,35],[51,36,52,44],[51,45,52,45],[51,46,52,47],[51,48,52,56],[45,60,46,60],[49,4,54,16],[49,17,50,32],[49,33,50,33],[49,34,50,35],[49,36,50,44],[49,45,50,45],[49,46,50,47],[49,48,50,56],[51,17,52,32],[45,36,46,42],[45,43,46,44],[45,45,46,49],[45,50,46,50],[45,51,46,52],[45,53,46,59],[40,2,42,11],[45,2,46,9],[45,10,46,10],[45,11,46,12],[45,13,46,21],[45,22,46,22],[45,23,46,24],[45,25,46,35],[36,2,37,15],[36,16,37,16],[36,17,37,18],[36,19,37,22],[36,23,37,24],[36,25,37,26],[34,2,35,15],[34,16,35,16],[34,17,35,18],[34,19,35,22],[34,23,35,24],[34,25,35,26],[34,27,35,33],[36,27,37,33],[36,34,37,60],[23,2,25,16],[23,17,25,33],[23,34,25,42],[23,43,25,60],[28,2,30,11],[32,2,33,15],[32,16,33,16],[32,17,33,18],[32,19,33,22],[32,23,33,24],[32,25,33,26],[32,27,33,33],[21,2,22,13],[21,14,22,14],[21,15,22,36],[21,37,22,38],[11,2,13,18],[11,19,13,60],[14,2,16,13],[14,14,16,14],[14,15,16,60],[17,2,18,13],[17,14,18,14],[17,15,18,60],[0,2,2,60],[4,2,5,12],[7,2,7,13],[7,15,7,60],[8,2,10,13],[8,14,10,14],[8,15,10,60],[19,2,20,13],[19,14,20,14],[19,15,20,60]]}
[null,null,"企業一般健診　《 確認書 》"]
[]
[]
[]
[null,null,"◆ 企業情報 ◆"]
[]
[]
[null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,"："]
[null,null,"事業所名",null,null,null,null,null,null,null,null,null,null,null,"："]
[]
[]
[null,null,"振込名義（事業所名と異なる場合）"]
[]
[]
[null,null,"所在地",null,null,null,null,null,null,null,null,null,null,null,"："]
[]
[]
[null,null,"電話番号",null,null,null,null,null,null,null,null,null,null,null,"："]
[]
[null,null,"FAX番号",null,null,null,null,null,null,null,null,null,null,null,"："]
[]
[null,null,"担当者名",null,null,null,null,null,null,null,null,null,null,null,"：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"様"]
[]
[null,null,"保険者番号（８桁）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保険証記号"]
[]
[]
[]
[]
[null,null,"◆ 送付先 ◆"]
[]
[]
[]
[null,null,"問診票・検査キット等",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,null,"会社",null,null,null,"・",null,null,null,"本人自宅"]
[]
[null,null,"健診結果（原本）",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,null,"会社",null,null,null,"・",null,null,null,"本人自宅"]
[]
[null,null,"結果控え（コピー）",null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,null,"不要",null,null,null,"・",null,null,null," 必要",null,null,null,null,null,null,"※ 事前に受診者への同意を得てください。"]
[]
[]
[]
[null,null,"◆ 支払方法 ◆"]
[]
[]
[]
[]
[null,null,"一般健診費用",null,null,null,null,null,null,null,"：",null,null,"後日会社請求",null,null,null,null,null,null,null,null,"・",null,null,"当日窓口支払→",null,null,null,null,null,null,null,null,null,null,"領収書宛名（",null,null,null,null,null,null,null,null,"会社名",null,null,null,null,"・",null,null,"受診者名",null,null,null,null,null,null,"）"]
[]
[]
[]
[null,null,null,null,"※後日会社請求の場合",null,null,null,null,null,null,null,null,null,null,null,null,"子宮がん検診費用",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,null,"後日会社請求",null,null,null,null,null,null,null,null,"・",null,null,"当日窓口支払"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"オプション検査",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,null,"後日会社請求",null,null,null,null,null,null,null,null,"・",null,null,"当日窓口支払"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他追加検査等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"：",null,null,"後日会社請求",null,null,null,null,null,null,null,null,"・",null,null,"当日窓口支払"]
[]
[]
[]
[]
[]
[null,null,"●","協会けんぽの補助を利用した生活習慣病予防健診は、胃部検査がセットとなっております。"]
[]
[null,null,null,"全ての検査項目を受けていただくことで費用補助の対象となります。"]
[]
[null,null,null,"胃部検査を希望しない場合は、補助が利用できないため企業一般健診をお申し込みください。"]
[]
[]
[null,null,"C2 コース→協会けんぽの一般健診から胃部検査を抜いた検査項目です。"]
[]
[]
[]
[]
[null,null,"◇　子宮がん検診について　◇"]
[]
[null,null,"★","当院には婦人科がないため、委託している病院での検査となります。"]
[]
[null,null,"★","婦人科検診を希望する方は、【希望オプション記入欄】にご希望の日程をご記入ください。"]
[]
[null,null,"★","受診対象年齢を満たす加入者のみご予約いただけます。"]
[]
[null,null,null,"（協会けんぽ補助対象者年齢一覧表をご確認ください。）"]
[]
[]
[null,null,"委託病院"]
[]
[null,null,null,"かみや母と子のクリニック（糸満市字阿波根１５５２－２）",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,"990円"]
[]
[null,null,null,"月・火・水・金曜日　午前 １１ 時半　/　月・水・金　午後 ３ 時"]
[]
[]
[]
[]
[]
[]
[null,"西崎病院　　健康管理センター　　お問い合わせ時間：月～金（午前10時～午後4時）"]
[]
[null,"TEL　(098)  992 - 0089 / FAX　 (098)  992 - 5995"]
[]
[null,"Mail",null,null,null,"nkenshin@iwakikai.net",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"HP",null,null,null,"https://iwakikai.net/nishizaki/medicalcheck"]