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[]
[]
[]
["臓器別・\n心理/社会的問題",null,"本症例の今後のフォローアップにおける特に重要項目","プロブレム\n本症例における\n移行時の合併症","治療の種類（本症例に該当する治療歴に☑）"]
[null,null,null,null,"放射線照射",null,null,"薬剤"]
[null,null,null,null,"CSI","TBI","その他の\n照射","アントラ\nサイクリン","白金","トポイソメラーゼ","アルキル化剤","ステロイド","メソトレキセート\n(大量・髄注)","その他"]
[null,null,"◎（最重要）\n◯（必要）\n空欄（低リスク）","自由記載\n(具体的な合併症名を記載ください)","□","□","□","□","□","□","□","□","□","□"]
["神経系",null,null,null,"〇","〇",null,null,null,null,null,null,"〇"]
["認知",null,null,null,"〇","〇",null,null,null,null,null,null,"〇"]
["内分泌系　","成長ホルモン",null,null,"〇","〇","〇（頭部）"]
[null,"副腎系",null,null,null,null,"〇（頭部）"]
[null,"甲状腺系",null,null,"〇","〇","〇（頭頚部）"]
[null,"肥満・高脂血症",null,null,"〇","〇","〇（頭部）",null,"〇",null,null,"〇"]
[null,"糖代謝",null,null,"〇","〇","〇（頭部）",null,null,null,null,"〇"]
[null,"高血圧",null,null,"〇","〇","〇（頭部）",null,"〇",null,"〇","〇"]
["骨・筋・軟部組織・皮膚",null,null,null,"〇","〇",null,null,null,null,null,"〇","〇"]
["口腔組織・歯牙",null,null,null,"〇","〇","〇（頭頚部）","〇","〇","〇","〇","〇","〇"]
["眼",null,null,null,"〇","〇",null,null,null,null,null,"〇"]
["耳・聴力",null,null,null,"〇",null,null,null,"〇"]
["心臓",null,null,null,"〇","〇","〇（胸部）","〇"]
["肺・呼吸器",null,null,null,null,"〇",null,null,null,null,"〇\n(Bu)",null,null,"〇\n(BLM)"]
["消化器・肝臓",null,null,null,"〇",null,"〇 (腹部/骨盤)"]
["腎・泌尿器",null,null,null,"〇","〇",null,null,"〇",null,"〇\n(CPM, IFO)"]
["妊孕性",null,null,null,"〇","〇","〇（骨盤）",null,null,null,"〇"]
["二次がん",null,null,null,"〇","〇","〇 (各照射部位)","〇",null,"〇","〇"]
["心理・社会的問題"]
["その他①"]
["その他②"]
["略語：CSI, craniospinal irradiation; TBI, total body irradiation; CRT, cranial radiation therapy; GH, growth hormone; IGF, iusulin-like growth factor; GHD, growth hormone deficiency"]
["臓器別・\n心理/社会的問題",null,"参照項目\n治療歴と関連する一般的な晩期合併症リスクとスクリーニングを示しています。本症例個別のリスク要因やスクリーニング頻度についてはシート④をご参照ください。"]
[]
[null,null,"本フォーマット（移行時情報提供フォーマット）参照項目",null,null,null,null,"移植患者LTFUスクリーニング項目リスト（JSTCTホームページ公開LTFUツール全国版）"]
[null,null,null,null,null,null,null,"対象症例（高リスク症例）",null,null,null,"小児期移植例における推奨項目"]
["神経系",null,"④晩期スクリーニング項目",null,"4．頭部MRI",null,null,"CRT/TBI施行例",null,null,null,"頭部MRI（1-5年毎）※２"]
["認知",null,"④晩期スクリーニング項目",null,"5．認知機能検査"]
["内分泌系　","成長ホルモン","④晩期スクリーニング項目",null,"6-1．内分泌検査",null,null,"1. 小児期に成長ホルモン分泌不全症(GHD)と診断されている症例\n2.TBI 非分割＞10Gy, 分割 12Gy\n3. GHDを疑う症状を認める場合※１",null,null,null,"IGF-1（1-5年毎）※２\n内分泌科コンサルト"]
[null,"副腎系","④晩期スクリーニング項目",null,"6-5．内分泌検査"]
[null,"甲状腺系","④晩期スクリーニング項目",null,"6-2．内分泌検査\n7．甲状腺がんスクリーニング"]
[null,"肥満・高脂血症","④晩期スクリーニング項目",null,"6-3．内分泌検査"]
[null,"糖代謝","④晩期スクリーニング項目",null,"6-4．内分泌検査"]
[null,"高血圧","②移植関連情報"]
["骨・筋・軟部組織・皮膚",null,"④晩期スクリーニング項目",null,"3．骨密度",null,null,"ステロイド投与例",null,null,null,"骨密度（1-5年毎）※２"]
["口腔組織・歯牙",null,"②移植関連情報"]
["眼"]
["耳・聴力"]
["心臓",null,"④晩期スクリーニング項目",null,"2．心臓",null,null,"アントラサイクリン投与例全例、胸部照射単独例は15Gy以上、妊娠時",null,null,null,"心エコー （2年もしくは5年毎）※３"]
["肺・呼吸器",null,"④晩期スクリーニング項目",null,"1．呼吸機能検査"]
["消化器・肝臓",null,"②移植関連情報"]
["腎・泌尿器"]
["妊孕性",null,"⑦妊孕性・生殖機能"]
["二次がん",null,"④晩期スクリーニング項目",null,"7．甲状腺がんスクリーニング",null,null,"高リスク群 - 甲状腺領域照射(5〜30Gy）かつ移植時低年齢（15歳以下）",null,null,null,"甲状腺がんスクリーニング（触診またはエコー）（3-5年毎）※２"]
["心理・社会的問題",null,"⑤説明状況と理解度/⑧看護師から"]
["その他①"]
["その他②"]
[]
["※１．メタボリックシンドロームに加えて、著明な易疲労感、睡眠障害、認知能低下、食欲低下、筋力低下、骨代謝異常、皮膚のひ薄化などを伴う場合"]
["※２．有症状例もしくは前回検査で異常が指摘された場合には、検査間隔を年１回とするなど適宜調整する"]
["※３．スクリーニング頻度詳細はLTFUスクリーニング項目リスト別表を参照"]

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[]
[]
[null,"　　※治療経過サマリーなどを添付いただいた場合に、そちらにある情報については省略可能です"]
["1. 基本情報"]
[]
[null,"◆診断名",""]
[]
[null,null,"→ 移植を要した原病"]
[]
[null,"特記すべき遺伝子変異","○無",null,null,"○有",null,""]
[]
[null,null,"→ 主に分子標的薬に関する遺伝子変異についての情報"]
[]
[null,"◆診断日あるいは診断時年齢","",null,null,"年","",null,"月","（","",null,"歳時）"]
[]
[null,"◆現在の原病の状況","○寛解",null,null,"○非寛解"]
[]
[null,null,"寛解",null,"",null,null,"年"]
[]
[null,"◆性別","○男性",null,null,"○女性",null,null,"※特記事項（",null,null,null,"",null,null,null,null,null,null,null,"）"]
[]
[null,"◆移植時年齢","",null,null,"歳"]
[]
[null,null,"→ 複数回移植の場合には最終移植時年齢"]
[]
[null,"◆既往歴・併発症",""]
[]
[null,null,""]
[]
[null,null,"→ 造血器/移植関連以外の併発症"]
[]
[null,"◆アレルギー歴（薬剤含む）",""]
[]
[null,"◆移行時身長/体重/BMI","",null,null,"cm",null,"",null,null,"kg",null,"BMI",{"$f":"IF(AND(C34>0,H34>0), H34/(C34/100)^2, \"\")","v":{"$error":"#VALUE!"}}]
[]
[null,"◆移行までの外来受診状況","主科",null,"",null,null,null,null,null,"科"]
[]
[null,null,"受診頻度",null,null,""]
[]
[null,null,"→ 〇か月に１回、１年に１回など"]
[]
[null,null,"処方薬",null,"",null,null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,"LTFU外来　","○受診あり",null,null,null,"○受診なし",null,null,null,"○施設にLTFU外来なし"]
[]
[null,null,"受診頻度",null,null,""]
[]
[null,null,"→ JSTCT実施のLTFU研修受講済み看護師の介入があるもの（移植後患者指導管理料算定あり）"]
[]
[]
[]
["2. 生活歴（移行時または移行までの状況）"]
[]
[null,"◆最終学歴","○中学校",null,null,"○高校",null,"○専門学校",null,null,"○短期大学",null,null,"○大学",null,"○大学院"]
[]
[null,null,"○卒業",null,"○中退",null,"○在学中"]
[]
[null,"◆移行時の就学有無","○無",null,null,"○有",null,""]
[]
[null,"◆移行時の就労状況","○無",null,null,"○有",null,""]
[null,null,"→ ご存じの範囲で仕事の内容など"]
[null,null,"雇用形態",null,null,"○正規雇用",null,null,null,"○非正規雇用",null,null,null,"(パート・バイト)"]
[]
[null,null,null,null,null,"○自由業・自営業",null,null,null,null,"○その他",null,null,"○不明"]
[]
[null,null,"→ ご存じの範囲で仕事の内容など"]
[]
[null,"◆同居家族","□祖父",null,null,"□祖母",null,null,"□父",null,"□母",null,"□兄（",null,"","人）",null,"□弟（",null,"","人）"]
[]
[null,null,"□姉（",null,"","人）",null,"□妹（",null,"","人）",null,"□配偶者",null,null,null,"□子供 （",null,null,"","人）"]
[]
[null,null,"□その他（",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,"→ 移行時までの同居家族、自由記載欄も併用"]
[]
[]
[]
[]
[]
[null,"◆キーパーソン",""]
[]
[null,null,"→ 移行時までの外来同席者や緊急時連絡対象"]
[]
[null,"上記キーパーソンの移行時の外来同席","○有",null,"○無"]
[]
[null,"診療時の問診・説明・意思決定(移行時)","○患者本人中心",null,null,null,null,null,"○キーパーソン中心"]
[]
[null,"◆婚姻状況","○未婚",null,null,"○既婚",null,null,"○未婚だがパートナーあり"]
[]
[null,"子供","○あり(実子)",null,null,null,"○あり(養子)",null,null,null,"○なし"]
[]
[null,"◆社会保障制度の利用状況","□特別児童扶養手当",null,null,null,null,null,null,"□障がい児福祉手当"]
[]
[null,null,"□療育手帳（愛護手帳）",null,null,null,null,null,null,"□身体障がい者手帳"]
[]
[null,null,"□難病医療費助成制度",null,null,null,null,null,null,"□利用なし"]
[]
[null,null,"→ 身体障碍者手帳、小児慢性特定疾患、指定難病等"]
[]
[]
[]
["3. 遺伝子検査関連"]
[]
[null,"→ 同意取得がされている場合など、可能な範囲で移行後に必要となると思われる情報を提供ください"]
[]
[null,"◆がんゲノム検査","○実施なし"]
[]
[null,"→ 可能な範囲の情報提供でOK","○実施あり（下記へ）"]
[]
[null,null,null,"検査方法 ",null,null,""]
[]
[null,null,null,"結果",null,null,"",null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,null,"説明内容",null,null,""]
[]
[null,"◆生殖細胞系列変異","○実施なし"]
[]
[null,"（例：TP53変異、Fanconi貧血）","○実施あり（検査項目）",null,null,null,null,null,null,""]
[]
[null,"→ 可能な範囲の情報提供でOK",null,"○変異なし"]
[]
[null,null,null,"○変異あり"]
[]
[null,null,null,"結果",null,"",null,null,null,"□別紙添付"]
[]
[null,null,null,"説明内容",null,null,""]
[]
[null,"遺伝カウンセリング　","○実施なし"]
[]
[null,null,"○実施あり　",null,null,null,"実施施設",null,null,""]
[]
[]
[]
["4. その他特記事項・備考欄"]
[]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]
[" "]

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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,"　　※治療経過サマリーなどを添付いただいた場合に、そちらにある情報については省略可能です"]
["移植に関する情報"]
[]
[null,"◆これまでの移植回数","同種移植 ",null,null,null,"",null,"回",null,"自家移植",null,null,null,"",null,"回"]
[]
[null,"◆直近の移植について（最終移植歴）"]
[]
[null,"▶移植日","",null,null,"年","",null,"月","",null,"日"]
[]
[null,"▶TRUMP ID",""]
[]
[null,"▶移植種類","○同種",null,null,"○自家 (→ドナー情報・GVHD予防不要)"]
[]
[null,"▶ドナー","○血縁",null,null,"○非血縁"]
[]
[null,"幹細胞ソース","○骨髄",null,null,"○末梢血幹細胞",null,null,null,null,null,"○臍帯血"]
[]
[null,"HLA","○適合",null,null,"○不適合（",null,null,null,"",null,null,null,null,null,null,"）","○半合致"]
[]
[null,"▶前処置（薬剤量はシート③に記載）"]
[]
[null,"○MAC","レジメン名",null,null,null,""]
[]
[null,"○RIC","TBI",null,"○無",null,"○有",null,null,"total",null,"",null,null,null,null,"Gy"]
[]
[null,"○その他","その他の放射線照射",null,null,null,null,null,null,"（","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,"▶GVHD予防","□シクロスポリン",null,null,null,null,"□タクロリムス",null,null,null,null,"□PTCy"]
[]
[null,null,"□MTX",null,null,"□MMF",null,null,"□ATG",null,null,"□その他",null,null,""]
[]
[]
[]
[null,"◆過去の移植について","（","",null,"回目の移植）"]
[]
[null,"▶移植日","",null,null,"年","",null,"月","",null,"日"]
[]
[null,"▶TRUMP ID",""]
[]
[null,"▶移植種類","○同種",null,null,"○自家(ドナー情報・GVHD予防不要)"]
[]
[null,"▶ドナー","○血縁",null,null,"○非血縁"]
[]
[null,"幹細胞ソース","□骨髄",null,null,"□末梢血幹細胞",null,null,null,null,null,"□臍帯血"]
[]
[null,"HLA","○適合",null,null,"○不適合（",null,null,null,"",null,null,null,null,null,null,"）","○半合致"]
[]
[null,"▶前処置（薬剤量はシート③に記載）"]
[]
[null,"□MAC","レジメン名",null,null,null,""]
[]
[null,"□RIC","TBI",null,"○無",null,"○有",null,null,"total",null,"",null,null,null,null,"Gy"]
[]
[null,"□その他","その他の放射線照射",null,null,null,null,null,null,"（","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,"▶GVHD予防","□シクロスポリン",null,null,null,null,"□タクロリムス",null,null,null,null,"□PTCy"]
[]
[null,null,"□MTX",null,null,"□MMF",null,null,"□ATG",null,null,"□その他",null,null,""]
[]
[]
[]
[null,"◆過去の移植について","（","",null,"回目の移植）"]
[]
[null,"▶移植日","",null,null,"年","",null,"月","",null,"日"]
[]
[null,"▶TRUMP ID",""]
[]
[null,"▶移植種類","○同種",null,null,"○自家(ドナー情報・GVHD予防不要)"]
[]
[null,"▶ドナー","○血縁",null,null,"○非血縁"]
[]
[null,"幹細胞ソース","□骨髄",null,null,"□末梢血幹細胞",null,null,null,null,null,"□臍帯血"]
[]
[null,"HLA","○適合",null,null,"○不適合（",null,null,null,"",null,null,null,null,null,null,"）","○半合致"]
[]
[null,"▶前処置（薬剤量はシート③に記載）"]
[]
[null,"□MAC","レジメン名",null,null,null,""]
[]
[null,"□RIC","TBI",null,"○無",null,"○有",null,null,"total",null,"",null,null,null,null,"Gy"]
[]
[null,"□その他","その他の放射線照射",null,null,null,null,null,null,"（","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,"▶GVHD予防","□シクロスポリン",null,null,null,null,"□タクロリムス",null,null,null,null,"□PTCy"]
[]
[null,null,"□MTX",null,null,"□MMF",null,null,"□ATG",null,null,"□その他",null,null,""]
[]
[]
[]
[null,"◆血液型","患者型",null,null,"",null,null,"Rh（","","）"]
[]
[null,null,"ドナー型",null,null,"",null,null,"Rh（","","）"]
[]
[null,null,"複数回移植の場合（",null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[]
[null,null,"現在の輸血型",null,null,null,null,"赤血球",null,null,"",null,null,"Rh（","","）"]
[]
[null,null,"血小板・FFP",null,null,null,null,"",null,null,"Rh（","","）"]
[]
[null,null,"1年以内の輸血の有無",null,null,null,null,null,null,null,"□あり",null,null,"",null,"月",null,"□なし"]
[]
[null,"◆キメリズム","最終評価日",null,null,null,"",null,null,"年","",null,"月"]
[]
[null,null,"結果（評価法）",null,null,null,null,null,""]
[]
[null,"◆免疫抑制剤投与状況","○終了",null,null,"終了日",null,null,"",null,null,"年","",null,"月"]
[]
[null,null,"○継続中",null,null,null,""]
[]
[null,"◆移植後合併症"]
[]
[null,"※現在活動性の合併症に関しては別項目にご記載いただきます"]
[]
[null,"耐性菌","○なし",null,null,"○あり",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"○不明"]
[]
[null,"急性GVHD","○なし",null,null,"○あり（下記へ）"]
[]
[null,null,null,"最大 ",null,"Grade（",null,null,"",null,null,"）"]
[]
[null,null,null,"→ 移植後急性期の経過についてご教示ください"]
[]
[null,null,null,"Stage",null,null,null,"皮膚（","","）",null,"肝（","","）消化管（",null,null,null,"","）"]
[]
[null,null,null,"治療",null,""]
[]
[null,null,null,"→ 移行までに行われた治療について主なものを自由記載にてご教示ください"]
[]
[null,null,"　","移行時の転帰",null,null,null,null,"○寛解",null,null,"○その他",null,null,""]
[]
[null,"慢性GVHD","NIH基準重症度",null,null,null,null,null,"○なし",null,null,"○軽症",null,null,"○中等症",null,null,null,"○重症"]
[]
[null,null,"臓器別スコア",null,null,null,null,"眼(","",")",null,"口腔(","",")",null,"皮膚(","",")",null,"肺(","",")",null,null,"消化管(","",")"]
[]
[null,null,null,null,"肝臓(","",")",null,null,null,"関節・筋膜(","",")",null,"性器(","",")","□その他",null,null,""]
[]
[null,null,"→ 移行時の重症度と臓器別スコアをご教示ください"]
[]
[null,null,"現在継続中の治療",null,null,null,null,null,null,""]
[]
[null,null,"→ 主なものを自由記載にてご教示ください"]
[]
[null,null,"現在寛解している過去の慢性GVHDについて"]
[]
[null,null,null,null,null,"発症臓器","",null,null,null,null,null,null,null,null,null,null,"主な治療",""]
[]
[null,"その他の合併症①",""]
[]
[null,null,"→ 移行後の治療継続が必要なものに関する詳細は下記“現在活動性の合併症”へ"]
[]
[null,"上記の転帰","○寛解（完治）",null,null,null,null,null,"○その他"]
[]
[null,"その他の合併症②",""]
[]
[null,null,"→ 移行後の治療継続が必要なものに関する詳細は下記“現在活動性の合併症”へ"]
[]
[null,"上記の転帰","○寛解（完治）",null,null,null,null,null,"○その他"]
[]
[null,"◆現在活動性の合併症"]
[]
[null,"※移行後の治療・フォローアップ継続が必要なものは必ずご記載ください"]
[]
[null,"合併症名１",""]
[]
[null,"担当診療科（併診有無）","○主科（血液内科）",null,null,null,null,null,null,null,"○他科",null,null,""]
[]
[null,"治療（投薬状況）",""]
[]
[null,"移行後に必要な検査項目",""]
[]
[null,"上記検査の推奨頻度","推奨頻度（",null,null,null,"",null,null,null,"）に一回"]
[]
[null,null,"→ 一般的に推奨されるスクリーニング以外に、本症例について個別に必要となるもの"]
[]
[null,"合併症名２",""]
[]
[null,"担当診療科（併診有無）","○主科（血液内科）",null,null,null,null,null,null,null,"○他科",null,null,""]
[]
[null,"治療（投薬状況）",""]
[]
[null,"移行後に必要な検査項目",""]
[]
[null,"上記検査の推奨頻度","推奨頻度（",null,null,null,"",null,null,null,"）に一回"]
[]
[null,null,"→ 一般的に推奨されるスクリーニング以外に、本症例について個別に必要となるもの"]
[]
[null,"合併症名３",""]
[]
[null,"担当診療科（併診有無）","○主科（血液内科）",null,null,null,null,null,null,null,"○他科",null,null,""]
[]
[null,"治療（投薬状況）",""]
[]
[null,"移行後に必要な検査項目",""]
[]
[null,"上記検査の推奨頻度","推奨頻度（",null,null,null,"",null,null,null,"）に一回"]
[]
[null,null,"→ 一般的に推奨されるスクリーニング以外に、本症例について個別に必要となるもの"]
[]
[null,"その他特記事項・備考欄"]
[]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]

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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,"※治療経過サマリーなどを添付いただいた場合に、そちらにある情報については省略可能です"]
["治療のまとめ（移植前処置薬剤を含む総投与量）"]
[]
[null,"◆投与薬剤"]
[null,null,"移植前処置薬剤を含む総投与量をご記載ください\n治療サマリーに総投与量が記載されている場合は添付で代用可"]
[null,"アントラサイクリン系",null,null,"○なし",null,null,"○あり(下記記載)",null,null,null,null,null,"○不明"]
[]
[null,"　ドキソルビシン換算総投与量",null,null,"",null,null,null,null,null,""]
[]
[null,"白金系",null,null,"○なし",null,null,"○あり(下記記載)",null,null,null,null,null,"○不明"]
[]
[null,"（","","）","",null,null,null,null,null,""]
[]
[null,"（","","）","",null,null,null,null,null,""]
[]
[null,"トポイソメラーゼ阻害剤",null,null,"○なし",null,null,"○あり(下記記載)",null,null,null,null,null,"○不明"]
[]
[null,"（","","）","",null,null,null,null,null,""]
[]
[null,"（","","）","",null,null,null,null,null,""]
[]
[null,"アルキル化剤",null,null,"○なし",null,null,"○あり(下記記載)",null,null,null,null,null,"○不明"]
[]
[null,"（","","）","",null,null,null,null,null,""]
[]
[null,"（","","）","",null,null,null,null,null,""]
[]
[null,"ステロイド投与歴",null,null,"○なし",null,null,"○あり(下記記載)",null,null,null,null,null,"○不明"]
[]
[null,"　投与理由"]
[]
[null,null,"□移植以前の原疾患治療"]
[]
[null,null,"□移植後GVHD"]
[]
[null,null,"□その他",null,""]
[]
[null,"　投与内容（投与量・期間等）"]
[]
[null,null,"□プレドニン",null,"投与量や期間の概要",null,null,null,null,null,null,""]
[]
[null,null,"□デキサメサゾン",null,"投与量や期間の概要",null,null,null,null,null,null,""]
[]
[null,null,"□その他",null,"投与量や期間の概要",null,null,null,null,null,null,""]
[]
[null,null,null,null,"終了時期",null,null,null,"",null,null,"年","",null,"月",null,"□現在継続中"]
[]
[]
[]
[null,"◆放射線治療歴（前処置以外）",null,null,null,"□なし"]
[]
[null,null,null,null,null,"□ 全脳全脊髄照射　＿＿＿＿Gy",null,null,null,null,null,null,"",null,null,null,"Gy"]
[]
[null,null,null,null,null,"□その他",null,null,null,"部位",null,"",null,null,null,null,"",null,null,null,"Gy","（","",null,"分割）"]
[]
[null,null,null,null,null,"□その他",null,null,null,"部位",null,"",null,null,null,null,"",null,null,null,"Gy","（","",null,"分割）"]
[]
[]
[]
[]
[]
[]
[]
[null,"◆手術療法",null,null,null,"○なし",null,null,"○あり(下記へ)"]
[]
[null,"手術１",null,null,null,"手術日",null,null,null,null,null,""]
[]
[null,null,null,null,null,"→ 手術年までで可"]
[]
[null,null,null,null,null,"病名",null,null,null,null,null,""]
[]
[null,null,null,null,null,"手術術式など",null,null,null,null,null,""]
[]
[null,null,null,null,null,"手術を行った病院",null,null,null,null,null,""]
[]
[null,null,null,null,null,"術後合併症などの問題点",null,null,null,null,null,null,null,null,""]
[]
[null,null,null,null,null,"→ 特に移行時問題となるもの"]
[]
[null,"手術２",null,null,null,"手術日",null,null,null,null,null,""]
[]
[null,null,null,null,null,"→ 手術年までで可"]
[]
[null,null,null,null,null,"病名",null,null,null,null,null,""]
[]
[null,null,null,null,null,"手術術式など",null,null,null,null,null,""]
[]
[null,null,null,null,null,"手術を行った病院",null,null,null,null,null,""]
[]
[null,null,null,null,null,"術後合併症などの問題点",null,null,null,null,null,null,null,null,""]
[]
[null,null,null,null,null,"→ 特に移行時問題となるもの"]
[]
[]
[]
[null,"その他特記事項・備考欄"]
[]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]

{"sheet":"④晩期スクリーニング項目","index":4,"n_rows":288,"n_cols":28,"rows_kept":288,"cut":false,"hidden":false,"merged":[[107,13,107,26],[123,21,123,22],[147,21,147,22],[127,13,127,26],[135,13,135,26],[147,8,147,15],[141,10,141,14],[125,7,125,26],[151,14,151,16],[151,18,151,19],[143,11,143,26],[141,24,141,25],[141,20,141,22],[157,21,157,22],[157,8,157,15],[163,11,163,26],[117,4,117,6],[117,8,117,9],[119,11,119,21],[123,12,123,15],[13,4,13,6],[13,8,13,9],[27,14,27,26],[37,4,37,6],[67,21,67,26],[37,8,37,9],[55,4,55,6],[55,8,55,9],[23,14,23,16],[29,13,29,26],[39,7,39,9],[39,15,39,21],[43,4,43,6],[43,8,43,9],[45,15,45,21],[45,5,45,7],[49,4,49,6],[49,8,49,9],[51,11,51,21],[53,8,53,26],[61,19,61,21],[63,19,63,21],[57,11,57,21],[105,12,105,26],[87,17,87,26],[77,16,77,18],[79,11,79,13],[63,8,63,13],[61,8,61,13],[101,14,101,16],[95,4,95,6],[95,8,95,9],[77,7,77,9],[97,11,97,21],[75,4,75,6],[75,8,75,9],[69,13,69,26],[83,14,83,16],[89,13,89,26],[171,18,171,20],[171,22,171,23],[153,11,153,26],[223,11,223,21],[161,20,161,22],[161,24,161,25],[177,8,177,15],[177,21,177,22],[173,11,173,26],[183,4,183,14],[183,20,183,22],[183,24,183,25],[189,8,189,15],[189,21,189,22],[199,8,199,15],[199,21,199,22],[211,18,211,20],[195,11,195,26],[185,11,185,26],[193,4,193,14],[193,20,193,22],[193,24,193,25],[167,8,167,15],[167,21,167,22],[227,7,227,26],[241,4,241,6],[241,8,241,9],[207,4,207,6],[207,8,207,9],[209,11,209,21],[221,4,221,6],[221,8,221,9],[235,3,235,26],[236,3,236,26],[237,3,237,26],[213,14,213,26],[215,13,215,26],[229,13,229,26],[225,18,225,20],[253,4,253,21],[255,4,255,6],[255,8,255,9],[257,11,257,21],[259,5,259,9],[243,11,243,21],[247,7,247,26],[239,4,239,21],[249,10,249,21],[245,5,245,9],[271,11,271,21],[273,5,273,9],[275,7,275,26],[277,10,277,21],[287,2,287,26],[261,7,261,26],[263,10,263,21],[267,4,267,21],[269,4,269,6],[269,8,269,9],[283,2,283,26],[284,2,284,26],[285,2,285,26],[286,2,286,26]]}
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null," "]
[null,null,"※治療経過サマリーなどを添付いただいた場合に、そちらにある情報については省略可能です"]
["小児LTFU等において行われた最終スクリーニング（過去のスクリーニング）と移行後のスクリーニングプラン"]
[]
[null,"本症例の治療歴に対応する合併症リスクについて、シート⓪「プロブレムリスト」もご参照ください"]
[]
[null,"JSTCT LTFUツール全国版「移植後LTFUスクリーニング項目リスト」には一般的な推奨項目を示しており、併せてご参照ください"]
[]
[null,"◆晩期合併症スクリーニング"]
[]
[null,1,"＜呼吸機能検査＞",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり(下記へ)"]
[]
[null,null,"最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"結果概要",null,"○正常",null,null,"○異常あり(下記へ)",null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,null,null,"□肺活量＜80%",null,null,null,null,null,"□一秒率＜70%",null,null,null,null,null,"□%一秒率＜75%"]
[null,null,null,null,"→ 別紙添付可"]
[]
[]
[null,null,"移行後スクリーニング継続の必要性"]
[]
[null,null,null,null,"○なし",null,null,"○あり ",null,null,null,null,null,"→ 推奨頻度（","",null,null,"）年に一回"]
[]
[null,null,"スクリーニング継続を要するリスク因子"]
[]
[null,null,null,null,"□BO・肺GVHD歴",null,null,null,null,null,null,"□その他",null,null,""]
[]
[null,null,"他科併診の必要性",null,"○なし",null,null,"○あり ",null,null,"併診科",null,null,""]
[]
[]
[]
[null,2,"＜心電図・心エコー・BNP/NT-proBNP等＞"]
[]
[null,null,"心電図",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり(下記へ)"]
[]
[null,null,"　最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"　結果概要",null,"QTc(F)値",null,null,"",null,null,null,"他特記事項",null,null,null,"",null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"心エコー",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり(下記へ)"]
[]
[null,null,"　最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"　結果概要",null,"EF","",null,null,"％",null,null,"他特記事項",null,null,null,"",null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"BNP/NT-proBNP",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり(下記へ)"]
[]
[null,null,"　最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"　結果概要",null,"○正常",null,null,"○異常あり",null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"その他",null,"検査項目",null,null,null,""]
[]
[null,null,"　最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"　結果概要",null,"○正常",null,null,"○異常あり",null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"移行後スクリーニング継続の必要性",null,null,null,null,"○なし",null,null,"○あり"]
[]
[null,null,null,null,null,null,null,"→ 検査項目","",null,null,null,null,null,null,null,null,null,"推奨頻度（","",null,null,"）年に一回"]
[]
[null,null,null,null,null,null,null,"→ 検査項目","",null,null,null,null,null,null,null,null,null,"推奨頻度（","",null,null,"）年に一回"]
[]
[null,null,"スクリーニング継続を要するリスク因子"]
[]
[null,null,null,null,"□アントラサイクリン系使用",null,null,null,null,null,null,null,null,"□胸部照射",null,null,null,null,"□その他",null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"→TBI含む"]
[null,null,"他科併診の必要性",null,"○なし",null,null,"○あり",null,null,"併診科",null,null,""]
[]
[]
[]
[null,3,"＜骨密度＞",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり(下記へ)"]
[]
[null,null,"最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"結果概要",null,"Zスコア",null,null,"",null,null,"%",null,null,"Tスコア",null,null,"",null,null,"％"]
[]
[null,null,null,null,"YAM(若年成人平均)",null,null,null,null,null,null,"",null,null,"％",null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"移行後スクリーニング継続の必要性"]
[]
[null,null,null,null,"○なし",null,null,"○あり ",null,null,null,null,null,"→ 推奨頻度（","",null,null,"）年に一回"]
[]
[null,null,"スクリーニング継続を要するリスク因子"]
[]
[null,null,null,null,"□ステロイド投与",null,null,null,null,null,"□GVHD",null,null,null,"□その他",null,null,""]
[]
[null,null,"他科併診の必要性",null,"○なし",null,null,"○あり",null,null,"併診科",null,null,""]
[]
[]
[]
[null,4,"＜頭部MRI＞",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり(下記へ)"]
[]
[null,null,"最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"結果概要",null,"○正常",null,null,"○異常あり",null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"移行後スクリーニング継続の必要性"]
[]
[null,null,null,null,"○なし",null,null,"○あり ",null,null,null,null,null,"→ 推奨頻度（","",null,null,"）年に一回"]
[]
[null,null,"スクリーニング継続を要するリスク因子"]
[]
[null,null,null,null,"□頭蓋照射歴",null,null,null,null,"□その他",null,null,""]
[null,null,null,null,"→ TBI含む"]
[null,null,"他科併診の必要性",null,"○なし",null,null,"○あり",null,null,"併診科",null,null,""]
[]
[]
[]
[null,5,"＜認知機能評価＞",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり(下記へ)"]
[]
[null,null,"検査項目",null,"□WISC",null,null,"□WAIS（16歳～成人）"]
[]
[null,null,null,null,"□新版K式発達検査2001",null,null,null,null,null,null,null,null,"□田中ビネーV"]
[]
[null,null,"最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"結果概要",null,"○正常",null,null,"○異常あり",null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"移行後スクリーニング継続の必要性"]
[]
[null,null,null,null,"○なし",null,null,"○あり → 検査",null,null,null,null,"",null,null,null,null,null,null,null,"推奨頻度（","",null,"）年に一回"]
[]
[null,null,"スクリーニング継続を要するリスク因子",null,null,null,null,""]
[]
[null,null,"他科併診の必要性",null,"○なし",null,null,"○あり",null,null,"併診科",null,null,""]
[]
[]
[]
[null,6,"＜内分泌検査＞","→ 性腺機能は別紙",null,null,null,null,null,"□別紙添付"]
[]
[null,null,"他科併診の必要性（内分泌障害全体について）"]
[]
[null,null,null,null,"○なし",null,null,"○あり",null,null,"併診科",null,null,""]
[]
[null,"6-1","下垂体・成長ホルモン",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり（下記へ）"]
[]
[]
[]
[null,null,"検査項目",null,"□IGF-1",null,null,"□その他",null,null,"",null,null,null,null,null,null,null,null,"（最終検査日","",null,null,"年","",null,"月）"]
[]
[null,null,null,null,"○正常",null,null,"○異常あり",null,null,null,""]
[]
[null,null,"移行後スクリーニング継続の必要性",null,null,null,null,"○なし",null,null,"○あり"]
[]
[null,null,null,null,null,null,null,"→ 検査項目","",null,null,null,null,null,null,null,null,null,null,null,"推奨頻度（","",null,"）年に一回"]
[]
[null,"6-2","甲状腺機能",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり（下記へ）"]
[]
[null,null,"検査項目",null,"□TSH",null,null,"□FT4",null,null,null,null,null,"（最終検査日","",null,null,"年","",null,"月）"]
[]
[null,null,null,null,"○正常",null,null,"○異常あり",null,null,null,""]
[]
[null,null,"移行後スクリーニング継続の必要性",null,null,null,null,"○なし",null,null,"○あり"]
[]
[null,null,null,null,null,null,null,"→ 検査項目","",null,null,null,null,null,null,null,null,null,null,null,"推奨頻度（","",null,"）年に一回"]
[]
[null,"6-3","脂質代謝",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり（下記へ）"]
[]
[null,null,"検査項目",null,"□T-chol",null,null,null,"□HDL",null,null,"□LDL",null,null,"□TG",null,null,null,null,"（最終検査日","",null,null,"年","",null,"月）"]
[]
[null,null,null,null,"○正常",null,null,"○異常あり",null,null,null,""]
[]
[null,null,"移行後スクリーニング継続の必要性",null,null,null,null,"○なし",null,null,"○あり"]
[]
[null,null,null,null,null,null,null,"→ 検査項目","",null,null,null,null,null,null,null,null,null,null,null,"推奨頻度（","",null,"）年に一回"]
[]
[null,"6-4","糖代謝",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり（下記へ）"]
[]
[null,null,"検査項目",null,"□空腹時血糖",null,null,null,null,null,"□HbA1c",null,null,null,null,null,null,"（最終検査日","",null,null,"年","",null,"月）"]
[]
[null,null,null,null,"○正常",null,null,"○異常あり",null,null,null,""]
[]
[null,null,"移行後スクリーニング継続の必要性",null,null,null,null,"○なし",null,null,"○あり"]
[]
[null,null,null,null,null,null,null,"→ 検査項目","",null,null,null,null,null,null,null,null,null,null,null,"推奨頻度（","",null,"）年に一回"]
[]
[null,"6-5","負荷試験（OGTTや下垂体機能等）"]
[]
[null,null,null,null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり（下記へ）"]
[]
[null,null,"検査項目",null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（最終検査日","",null,null,"年","",null,"月）"]
[]
[null,null,null,null,"○正常",null,null,"○異常あり",null,null,null,""]
[]
[null,null,"移行後スクリーニング継続の必要性",null,null,null,null,"○なし",null,null,"○あり"]
[]
[null,null,null,null,null,null,null,"→ 検査項目","",null,null,null,null,null,null,null,null,null,null,null,"推奨頻度（","",null,"）年に一回"]
[]
[null,"6-6","その他",null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり（下記へ）"]
[]
[null,null,"検査項目",null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（最終検査日","",null,null,"年","",null,"月）"]
[]
[null,null,null,null,"○正常",null,null,"○異常あり",null,null,null,""]
[]
[null,null,"移行後スクリーニング継続の必要性",null,null,null,"○なし",null,null,"○あり"]
[]
[null,null,null,null,null,null,null,"→ 検査項目","",null,null,null,null,null,null,null,null,null,null,null,"推奨頻度（","",null,"）年に一回"]
[]
[]
[]
[null,7,"＜甲状腺がんスクリーニング（甲状腺エコー）＞"]
[]
[null,null,null,null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり（下記へ）"]
[]
[null,null,"最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"結果概要",null,"○正常",null,null,"○異常あり",null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"移行後スクリーニング継続の必要性",null,null,null,null,"○なし",null,null,"○あり",null,null,"→ 推奨頻度（",null,null,null,null,"",null,null,"）年に一回"]
[]
[null,null,"スクリーニング継続を要するリスク因子",null,null,null,null,"□照射歴",null,null,null,"□その他",null,null,""]
[]
[null,null,"他科併診の必要性",null,"○なし",null,null,"○あり",null,null,"併診科",null,null,""]
[]
[]
[]
[null,8,"＜子宮頸がんスクリーニング＞",null,"○適応外",null,null,null,"○移植後検査なし",null,null,null,null,null,null,"○移植後検査あり（下記へ）"]
[]
[null,null,"最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"結果概要",null,"○正常",null,null,"○異常あり",null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"移行後スクリーニング継続の必要性",null,null,null,null,"○なし",null,null,"○あり",null,null,"→ 推奨頻度（",null,null,null,null,"",null,null,"）年に一回"]
[]
[null,null,"スクリーニング継続を要するリスク因子",null,null,null,null,""]
[]
[null,null,"他科併診の必要性",null,"○なし",null,null,"○あり",null,null,"併診科",null,null,""]
[]
[]
[]
[null,"◆上記以外に移行後スクリーニングを要する項目"]
[]
[null,null,null,"※本症例の投薬・治療歴等から将来発症リスクの高い合併症がありましたら、対応する推奨スクリーニングをご指示ください"]
[null,null,null,"※別シート “②移植・治療-現在活動性の合併症” に記載いただいているスクリーニング項目はこちらには記載不要です"]
[null,null,null,"※同様にJSTCT LTFUツール全国版「移植後LTFUスクリーニング項目リスト」に示される一般的な推奨項目（二次がん検診含む）についての記載は必須ではありません"]
[]
[null,null,"検査項目１",null,""]
[]
[null,null,"最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"結果概要",null,"○正常",null,null,"○異常あり",null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"スクリーニング推奨頻度",null,"（","",null,null,null,null,"）に１回程度"]
[]
[null,null,"スクリーニング継続を要するリスク因子",null,null,null,null,""]
[]
[null,null,"他科併診の必要性",null,"□あり",null,null,"併診科",null,null,""]
[]
[]
[]
[null,null,"検査項目２",null,""]
[]
[null,null,"最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"結果概要",null,"○正常",null,null,"○異常あり",null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"スクリーニング推奨頻度",null,"（","",null,null,null,null,"）に１回程度"]
[]
[null,null,"スクリーニング継続を要するリスク因子",null,null,null,null,""]
[]
[null,null,"他科併診の必要性",null,"□あり",null,null,"併診科",null,null,""]
[]
[]
[]
[null,null,"検査項目３",null,""]
[]
[null,null,"最終検査日",null,"",null,null,"年","",null,"月"]
[]
[null,null,"結果概要",null,"○正常",null,null,"○異常あり",null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,"□別紙添付"]
[]
[null,null,"スクリーニング推奨頻度",null,"（","",null,null,null,null,"）に１回程度"]
[]
[null,null,"スクリーニング継続を要するリスク因子",null,null,null,null,""]
[]
[null,null,"他科併診の必要性",null,"□あり",null,null,"併診科",null,null,""]
[]
[]
[]
[null,null,"その他特記事項・備考欄"]
[]
[null,null,""]
[null,null,""]
[null,null,""]
[null,null,""]
[null,null,""]

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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,"　　　※治療経過サマリーなどを添付いただいた場合に、そちらにある情報については省略可能です"]
["患者本人への説明内容とその理解"]
[]
[null,"記載者名、職種",""]
[]
[null,"【理解度の判断基準例】"]
[null,"・十分理解している","自分で説明できる"]
[null,"・ある程度理解している","キーワードは覚えているが、説明するには医療者や保護者の手助けが必要"]
[null,"・理解は不十分","こちらが説明しても何のことだかわかっていない/興味・関心がない/本人や家族の告知拒否がある"]
[null,null,"→ 十分に理解できていない場合にはその状況等について下記の自由記載欄も用いてご教示ください"]
[null,"※成人移行は基本的に告知が前提条件となりますが、告知拒否やNGワードがもしある場合には下記へのチェック、また詳細は備考欄にお示しください　"]
[null,null,"家族からの告知拒否",null,null,null,null,null,"○なし",null,null,"○あり"]
[null,null,"NGワード",null,null,null,null,null,"○なし",null,null,"○あり",null,null,""]
[]
[]
[null,"◆病名"]
[]
[null,"本人への説明","説明内容の概要",null,null,null,null,null,""]
[]
[null,"本人の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"家族の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"◆今までの治療歴・合併症・投薬内容"]
[]
[null,"本人への説明","用いた資料",null,null,null,null,null,""]
[]
[null,"本人の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"家族の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"◆原病の状態"]
[]
[null,"本人への説明","説明内容の概要",null,null,null,null,null,""]
[]
[null,"本人の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"家族の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"◆現在活動性の合併症"]
[]
[null,"本人への説明","説明内容の概要",null,null,null,null,null,""]
[]
[null,"本人の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"家族の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"◆将来起こりうる合併症と移行後スクリーニングの必要性（LTFUの必要性）"]
[]
[null,"本人への説明","説明内容の概要",null,null,null,null,null,""]
[]
[null,null,"用いた資料",null,null,null,null,null,""]
[]
[null,"本人の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"家族の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"◆妊孕性に関する情報"]
[]
[null,"本人への説明","説明内容の概要",null,null,null,null,null,""]
[]
[null,null,"用いた資料",null,null,null,null,null,""]
[]
[null,"本人の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"家族の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"◆遺伝子情報"]
[]
[null,null,"□該当せず"]
[]
[null,"本人への説明","説明内容の概要",null,null,null,null,null,""]
[]
[null,null,"用いた資料",null,null,null,null,null,""]
[]
[null,"本人の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[null,"家族の理解度","○十分理解",null,null,null,null,"○ある程度理解",null,null,null,null,null,"○理解が不十分"]
[]
[]
[]
[null,"その他特記事項・備考欄"]
[]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]

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[]
["◆移植後から移行時までの再接種状況（参照：JSTCTガイドライン　予防接種第3版）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null," "]
["※接種日については母子手帳・移植手帳などのコピー添付可（□未 □済は下記にお示しいただけますと幸いです）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□コピー添付"]
["※接種ワクチン名につきましては移行後の追加接種を検討するうえでも商品名を記載しておりますが、本フォーマットリリース後に新規適応となったワクチン等その他の情報に関しては備考欄にご記載ください"]
["※他施設からの移行症例など詳細不明の場合には右にチェックをお願いします",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□詳細不明・情報なし"]
["不活化ワクチン・トキソイド",null,"接種ワクチン名",null,null,null,null,null,null,null,null,"移植後推奨接種時期"]
[null,null,null,null,null,null,null,null,null,null,null,"初回",null,null,null,null,null,null,"１ヶ月後",null,null,null,null,null,null,"２ヶ月後",null,null,null,null,null,null,"４ヶ月後",null,null,null,null,null,null,"６ヶ月後",null,null,null,null,null,null,"１０ヶ月後"]
[null,"肺炎球菌","プレベナー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,"□未",null,null,"□済",null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,"□未",null,null,"□済"]
[null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日",null,null,null,null,null,null,null,"",null,"年","","月","","日","",null,"年","","月","","日"]
[null,null,"ニューモバックス🄬",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"●"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済"]
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[null,null,"バクニュバンス🄬"]
[]
[]
[null,"インフルエンザ菌ｂ型","",null,null,null,null,null,null,null,null,"●",null,null,null,null,null,null,null,null,null,null,null,null,null,"○",null,null,null,null,null,null,"●"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,"□未",null,null,"□済"]
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[null,"ジフテリア、百日咳、破傷風、不活化ポリオ","□テトラビック🄬",null,null,null,null,null,null,null,null,"○",null,null,null,null,null,null,null,null,null,null,null,null,null,"○",null,null,null,null,null,null,"●"]
[null,null,"□クアトロバック🄬",null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,"□未",null,null,"□済"]
[null,null,"□その他",null,null,"",null,null,null,null,null,"",null,"年","","月","","日",null,null,null,null,null,null,null,"",null,"年","","月","","日","",null,"年","","月","","日"]
[null,"ヒトパピローマウイルス（女性のみ）","□2価 サーバリックス🄬",null,null,null,null,null,null,null,null,"○",null,null,null,null,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価 ガーダシル🄬",null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,"□未",null,null,"□済",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済"]
[null,null,"□9価 シルガード9🄬",null,null,null,null,null,null,null,null,"",null,"年","","月","","日","",null,"年","","月","","日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日"]
[null,"インフルエンザ","",null,null,null,null,null,null,null,null,"最終接種年月日"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済"]
[null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日"]
[null,"B型肝炎","",null,null,null,null,null,null,null,null,"●",null,null,null,null,null,null,"○",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"初回接種から20～24週後"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,"□未",null,null,"□済",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済"]
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[null,"帯状発疹","",null,null,null,null,null,null,null,null,"●",null,null,null,null,null,null,null,null,null,null,null,null,null,"初回接種から1～2ヶ月後"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済"]
[null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日",null,null,null,null,null,null,null,"",null,"年","","月","","日"]
[]
["生ワクチン",null,"接種ワクチン名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"抗体価測定"]
[null,null,null,null,null,null,null,null,null,null,null,"初回",null,null,null,null,null,null,"１ヶ月後"]
[null,"麻しん、風しん","",null,null,null,null,null,null,null,null,"●",null,null,null,null,null,null,"○",null,null,null,null,null,null,"麻しん抗体検査",null,null,null,null,null,"□測定なし",null,null,null,"□測定あり",null,null,null,"（直近の値）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日","",null,"年","","月","","日"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,"□未",null,null,"□済",null,null,null,null,null,null,null,null,"□別紙添付",null,null,null,null,null,null,null,"抗体価",null,null,"",null,null,null,"抗体価",null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"測定法",null,null,"",null,null,null,"測定法",null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"風しん抗体検査",null,null,null,null,null,"□測定なし",null,null,null,"□測定あり",null,null,null,"（直近の値）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日","",null,"年","","月","","日"]
[null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日","",null,"年","","月","","日",null,null,null,null,null,null,"□別紙添付",null,null,null,null,null,null,null,"抗体価",null,null,"",null,null,null,"抗体価",null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"測定法",null,null,"",null,null,null,"測定法",null,null,""]
[null,"ムンプス","",null,null,null,null,null,null,null,null,"●",null,null,null,null,null,null,"○",null,null,null,null,null,null,"ムンプス",null,null,null,null,null,"□測定なし",null,null,null,"□測定あり",null,null,null,"（直近の値）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,"□未",null,null,"□済",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日","",null,"年","","月","","日"]
[null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日","",null,"年","","月","","日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"抗体価",null,null,"",null,null,null,"抗体価",null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"測定法",null,null,"",null,null,null,"測定法",null,null,""]
[null,"水痘","",null,null,null,null,null,null,null,null,"●",null,null,null,null,null,null,"○",null,null,null,null,null,null,"水痘",null,null,null,null,null,"□測定なし",null,null,null,"□測定あり",null,null,null,"（直近の値）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済",null,null,null,"□未",null,null,"□済",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日","",null,"年","","月","","日"]
[null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日","",null,"年","","月","","日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"抗体価",null,null,"",null,null,null,"抗体価",null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"測定法",null,null,"",null,null,null,"測定法",null,null,""]
[]
["新型コロナウイルスワクチン"]
[null,"新型コロナワクチン\n（COVID-19）","",null,null,null,null,null,null,null,null,"最終接種年月日"]
[null,null,null,null,null,null,null,null,null,null,null,null,"□未",null,null,"□済"]
[null,null,null,null,null,null,null,null,null,null,null,"",null,"年","","月","","日"]
[]
["◆今後の接種スケジュール"]
[null,"対象ウイルス","（","",null,null,null,null,null,null,null,"）"]
[null,"ワクチン名（指定あれば）","（","",null,null,null,null,null,null,null,"）"]
[null,"接種スケジュール",null,"",null,null,"年","",null,"月頃"]
[null,"対象ウイルス","（","",null,null,null,null,null,null,null,"）"]
[null,"ワクチン名（指定あれば）","（","",null,null,null,null,null,null,null,"）"]
[null,"接種スケジュール",null,"",null,null,"年","",null,"月頃"]
[null,"対象ウイルス","（","",null,null,null,null,null,null,null,"）"]
[null,"ワクチン名（指定あれば）","（","",null,null,null,null,null,null,null,"）"]
[null,"接種スケジュール",null,"",null,null,"年","",null,"月頃"]
[]
["その他特記事項・備考欄"]
[""]
[""]
[""]
[""]
[""]

{"sheet":"⑦妊孕性・性腺機能","index":7,"n_rows":100,"n_cols":25,"rows_kept":100,"cut":false,"hidden":false,"merged":[[29,2,29,23],[27,2,27,4],[7,2,7,23],[9,2,9,4],[9,6,9,7],[11,2,11,23],[17,2,17,23],[27,6,27,7],[19,2,19,4],[19,6,19,7],[21,2,21,23],[25,2,25,23],[41,2,41,23],[73,5,73,23],[89,5,89,23],[98,1,98,23],[99,1,99,23],[87,5,87,23],[53,2,53,23],[95,1,95,23],[75,5,75,23],[96,1,96,23],[97,1,97,23],[67,2,67,4],[67,6,67,7],[81,2,81,4],[81,6,81,7],[47,5,47,23]]}
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
[null,"　※治療経過サマリーなどを添付いただいた場合に、そちらにある情報については省略可能です"]
["妊孕性・性腺機能"]
[]
[null,"◆卵子・卵巣・精液・精巣組織保存","○なし",null,null,"○あり（下記へ）"]
[]
[null,"保存組織",""]
[]
[null,"保存時期","",null,null,"年","",null,"月"]
[]
[null,"担当施設・科名",""]
[]
[null,"◆性腺機能評価","○なし",null,null,"○あり（下記へ）"]
[]
[null,null,"→ AMH、精液検査などあれば",null,null,null,null,null,null,"女性：LH、FSH、エストラジオール",null,null,null,null,null,null,null,"男性：LH、FSH、テストステロン"]
[]
[null,"検査項目１",""]
[]
[null,"最終検査日","",null,null,"年","",null,"月"]
[]
[null,"結果概要",""]
[]
[null,null,"□別紙添付"]
[]
[null,"検査項目２",""]
[]
[null,"最終検査日","",null,null,"年","",null,"月"]
[]
[null,"結果概要",""]
[]
[null,null,"□別紙添付"]
[]
[null,"◆ホルモン補充療法","□別紙添付"]
[]
[null,"移行までのホルモン補充療法","○なし",null,null,"○あり（下記へ）"]
[]
[null,null,"→ 途中中止の場合も"]
[]
[null,"移行時継続の有無","○継続中",null,null,null,"○中止"]
[]
[null,"移行時点の製剤名・投与量",""]
[]
[null,"移行後のホルモン補充療法","○不要",null,null,"○必要（下記へ）"]
[]
[null,null,"□上記を継続"]
[]
[null,null,"□その他",null,null,""]
[]
[null,"◆不妊治療"]
[]
[null,"移行までの不妊治療","○なし",null,null,"○あり（下記へ）"]
[]
[null,"担当施設・科名",""]
[]
[null,"挙児希望","○なし",null,null,"○あり",null,null,"○不明"]
[null,null,"→ 現在または将来の挙児希望について"]
[null,"◆月経（女性）"]
[]
[null,"移植前の月経","○なし",null,null,"○あり"]
[]
[null,"移植後の月経","○なし",null,null,"○あり(順)",null,null,null,"○あり(不順)"]
[]
[null,"◆婦人科受診（女性）"]
[]
[null,"移行までの婦人科受診","○なし",null,null,"○あり（下記へ）"]
[]
[null,"最終受診日","",null,null,"年","",null,"月"]
[]
[null,"受診理由","□ホルモン補充",null,null,null,null,"□子宮頸がん検診",null,null,null,null,null,null,"□HPVワクチン"]
[]
[null,null,"□性器GVHD",null,null,null,null,"□不妊治療"]
[]
[null,null,"□その他",null,null,""]
[]
[null,null,null,null,"特記事項",""]
[]
[null,"◆泌尿器科受診（男性）"]
[]
[null,"移行までの泌尿器科受診","○なし",null,null,"○あり（下記へ）"]
[]
[null,"最終受診日","",null,null,"年","",null,"月"]
[]
[null,"受診理由","□ホルモン補充",null,null,null,null,"□不妊治療"]
[]
[null,null,"□出血性膀胱炎",null,null,null,null,null,"□腎機能障害"]
[]
[null,null,"□その他",null,null,""]
[]
[null,null,null,null,"特記事項",""]
[]
[]
[]
[null,"その他特記事項・備考欄"]
[]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]

{"sheet":"⑧看護師から","index":8,"n_rows":64,"n_cols":27,"rows_kept":64,"cut":false,"hidden":false,"merged":[[47,1,47,25],[51,1,51,25],[55,1,55,25],[29,3,29,25],[37,3,37,25],[45,3,45,25],[31,1,31,25],[39,1,39,25],[43,1,43,25],[35,1,35,25],[11,1,11,25],[15,1,15,25],[19,1,19,25],[23,1,23,25],[27,1,27,25],[59,1,59,25],[60,1,60,25],[61,1,61,25],[62,1,62,25],[63,1,63,25]]}
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ",null," "]
[]
["看護師から成人診療チームへの申し送り"]
[]
["シート⑤「説明状況と理解度」も必ずご参照ください。"]
[]
[null,"→ 医師による情報提供以外に、看護師より特記すべき情報がありましたら共有をお願いします。"]
[]
[null,"◆疾患・治療・検査","→","告知状況、本人の理解状況等、検査時の鎮静要否"]
[]
[null,""]
[]
[null,"◆感染予防、予防接種","→","重症感染の既往歴、理解状況、受診行動、具体的支援の内容等"]
[]
[null,""]
[]
[null,"◆GVHD","→","理解状況、ケアも含む"]
[]
[null,""]
[]
[null,"◆晩期合併症、二次がん","→","罹患状況、理解状況"]
[]
[null,""]
[]
[null,"◆内服管理","→","自己管理状況など"]
[]
[null,""]
[]
[null,"◆健康管理","→","具体的に行っていること（規則正しい生活、職場・市町村検診など）、理解状況、具体的看護支援の内容"]
[]
[null,""]
[]
[null,"◆精神心理面","→","不安、抑うつ、パニック障害など"]
[]
[null,""]
[]
[null,"◆妊孕性・性腺機能","→","理解状況、挙児希望や不妊治療、パートナーとの関わり等本人の思い、具体的看護支援の内容"]
[]
[null,""]
[]
[null,"◆家族","→","親やキーパーソンとの関係、婚姻等、親・きょうだいドナーの支援"]
[]
[null,""]
[]
[null,"◆就労・就学、将来の夢","→","現況（勤務内容、勤務時間、職場での困りごと・気がかり等）や希望、悩みの有無、受診への配慮の必要性、支援の内容"]
[]
[null,""]
[]
[null,"◆経済面","→","保険、社会保障の使用状況、困りごと・気がかり等"]
[]
[null,""]
[]
[null,"◆リソース","→","患者会の情報提供や利用状況の有無"]
[]
[null,""]
[]
[null,"◆その他","→","価値観、大切にしていること、NGワードや宗教上への配慮等本人と関わる上で配慮すること等"]
[]
[null,""]
[null,""]
[null,""]
[null,""]
[null,""]

{"sheet":"データ①","index":9,"n_rows":2,"n_cols":54,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["→ ①基本情報"]
["Timestamp","診断名","遺伝子変異","遺伝子変異2","診断日・年","診断日・月","診断日・年齢","原病の状況","原病の状況2 （年）","性別","性別2","移植時年齢","既往歴・併発症1","既往歴・併発症2","アレルギー歴","移行時身長","移行時体重","移行時BMI","主科","受診頻度","処方薬","LTFU外来","受診頻度","最終学歴","最終学歴2","就学有無","就学有無2","就労状況","就労状況2","同居家族","キーパーソン","キーパーソン同席","キーパーソン意思","婚姻状況","子供","社会保障制度","がんゲノム検査","検査方法","結果1","結果2","説明内容","生殖細胞系列変異","生殖細胞系列変異2","生殖細胞系列変異検査結果","生殖細胞系列変異検査結果2","生殖細胞系列変異検査結果3","生殖細胞系列変異検査説明内容","遺伝カウンセリング","遺伝カウンセリング2","その他","その他2","その他3","その他4","その他5"]

{"sheet":"データ②","index":10,"n_rows":2,"n_cols":123,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["→ ②移植関連情報"]
["Timestamp","移植回数1","移植回数2","移植年1","移植月1","移植日1","TRUMPID1","移植種類1","ドナー1","幹細胞ソース1","HLA1_1","HLA1_2","MAC1","RIC1_1","RIC1_2","その他1","GVHD予防1_1","GVHD予防1_2","GVHD予防1_3","移植何回目2","移植年2","移植月2","移植日2","TRUMPID2","移植種類2","ドナー2","幹細胞ソース2","HLA2_1","HLA2_2","MAC2","RIC2_1","RIC2_2","その他2","GVHD予防2_1","GVHD予防2_2","GVHD予防2_3","移植何回目3","移植年3","移植月3","移植日3","TRUMPID3","移植種類3","ドナー3","幹細胞ソース3","HLA3_1","HLA3_2","MAC3","RIC3_1","RIC3_2","その他3","GVHD予防3_1","GVHD予防3_2","GVHD予防3_3","血液型1","血液型2","血液型3","血液型4","血液型5","血液型6","血液型7","血液型8","血液型9","血液型10","血液型11","キメリズム1","キメリズム2","キメリズム3","免疫抑制剤投与状況1","免疫抑制剤投与状況2","免疫抑制剤投与状況3","免疫抑制剤投与状況4","耐性菌1","耐性菌2","急性GVHD1","急性GVHD2","急性GVHD3","急性GVHD4","急性GVHD5","急性GVHD6","急性GVHD7","急性GVHD8","慢性GVHD1","慢性GVHD2","慢性GVHD3","慢性GVHD4","慢性GVHD5","慢性GVHD6","慢性GVHD7","慢性GVHD8","慢性GVHD9","慢性GVHD10","慢性GVHD11","慢性GVHD12","慢性GVHD13","慢性GVHD14","慢性GVHD15","その他の合併症1","上記の転帰1","その他の合併症2","上記の転帰2","合併症名1","担当診療科1_1","担当診療科1_2","治療1","移行後に必要な検査項目1","上記検査の推奨頻度1","合併症名2","担当診療科2_1","担当診療科2_2","治療2","移行後に必要な検査項目2","上記検査の推奨頻度2","合併症名3","担当診療科3_1","担当診療科3_2","治療3","移行後に必要な検査項目3","上記検査の推奨頻度3","その他特記事項","その他特記事項2","その他特記事項3","その他特記事項4","その他特記事項5"]

{"sheet":"データ③","index":11,"n_rows":2,"n_cols":69,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["→ ③治療サマリー"]
["Timestamp","投与薬剤アントラサイクリン系1","投与薬剤アントラサイクリン系2","投与薬剤アントラサイクリン系u","投与薬剤白金系1","投与薬剤白金系2","投与薬剤白金系3","投与薬剤白金系3u","投与薬剤白金系4","投与薬剤白金系5","投与薬剤白金系5u","投与薬剤トポイソメラーゼ阻害剤1","投与薬剤トポイソメラーゼ阻害剤2","投与薬剤トポイソメラーゼ阻害剤3","投与薬剤トポイソメラーゼ阻害剤3u","投与薬剤トポイソメラーゼ阻害剤4","投与薬剤トポイソメラーゼ阻害剤5","投与薬剤トポイソメラーゼ阻害剤5u","投与薬剤アルキル化剤1","投与薬剤アルキル化剤2","投与薬剤アルキル化剤3","投与薬剤アルキル化剤3u","投与薬剤アルキル化剤4","投与薬剤アルキル化剤5","投与薬剤アルキル化剤5u","投与薬剤ステロイド投与歴","投与薬剤ステロイド投与理由1","投与薬剤ステロイド投与理由2","投与薬剤ステロイド投与理由3","投与薬剤ステロイド投与理由4","投与薬剤ステロイド投与内容1","投与薬剤ステロイド投与内容2","投与薬剤ステロイド投与内容3","投与薬剤ステロイド投与内容4","投与薬剤ステロイド投与内容5","投与薬剤ステロイド投与内容6","投与薬剤ステロイド投与内容7","投与薬剤ステロイド投与内容8","投与薬剤ステロイド投与内容9","投与薬剤ステロイド投与内容10","投与薬剤ステロイド投与内容11","投与薬剤ステロイド投与内容12","放射線治療歴1","放射線治療歴2","放射線治療歴3","放射線治療歴4","放射線治療歴5","放射線治療歴6","放射線治療歴7","放射線治療歴8","放射線治療歴9","放射線治療歴10","放射線治療歴11","手術療法","手術療法1_1","手術療法1_2","手術療法1_3","手術療法1_4","手術療法1_5","手術療法2_1","手術療法2_2","手術療法2_3","手術療法2_4","手術療法2_5","その他特記事項","その他特記事項2","その他特記事項3","その他特記事項4","その他特記事項5"]

{"sheet":"データ④","index":12,"n_rows":2,"n_cols":189,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["→ ④晩期スクリーニング項目"]
["Timestamp","呼吸機能検査1","呼吸機能検査2","呼吸機能検査3","呼吸機能検査4","呼吸機能検査5","呼吸機能検査6","呼吸機能検査7","呼吸機能検査8","呼吸機能検査9","呼吸機能検査10","呼吸機能検査11","心電図1","心電図2","心電図3","心電図4","心電図5","心電図6","心エコー1","心エコー2","心エコー3","心エコー4","心エコー5","心エコー6","BNPNT1","BNPNT2","BNPNT3","BNPNT4","BNPNT5","心電図その他1","心電図その他2","心電図その他3","心電図その他4","心電図その他5","心電図継続必要性1","心電図継続必要性2","心電図継続必要性3","心電図継続必要性4","心電図継続必要性5","心電図リスク因子1","心電図リスク因子2","心電図他科併診1","心電図他科併診2","骨密度1","骨密度2","骨密度3","骨密度4","骨密度5","骨密度6","骨密度7","骨密度8","骨密度9","骨密度10","骨密度11","骨密度12","頭部MRI1","頭部MRI2","頭部MRI3","頭部MRI4","頭部MRI5","頭部MRI6","頭部MRI7","頭部MRI8","頭部MRI9","頭部MRI10","頭部MRI11","認知機能評価1","認知機能評価2","認知機能評価3","認知機能評価4","認知機能評価5","認知機能評価6","認知機能評価7","認知機能評価8","認知機能評価9","認知機能評価10","認知機能評価11","認知機能評価12","認知機能評価13","内分泌検査1","内分泌検査2","下垂体成長ホルモン1","下垂体成長ホルモン2","下垂体成長ホルモン3","下垂体成長ホルモン4","下垂体成長ホルモン5","下垂体成長ホルモン6","下垂体成長ホルモン7","下垂体成長ホルモン8","下垂体成長ホルモン9","下垂体成長ホルモン10","甲状腺機能1","甲状腺機能2","甲状腺機能3","甲状腺機能4","甲状腺機能5","甲状腺機能6","甲状腺機能7","甲状腺機能8","甲状腺機能9","脂質代謝1","脂質代謝2","脂質代謝3","脂質代謝4","脂質代謝5","脂質代謝6","脂質代謝7","脂質代謝8","脂質代謝9","糖代謝1","糖代謝2","糖代謝3","糖代謝4","糖代謝5","糖代謝6","糖代謝7","糖代謝8","糖代謝9","負荷試験1","負荷試験2","負荷試験3","負荷試験4","負荷試験5","負荷試験6","負荷試験7","負荷試験8","負荷試験9","その他1","その他2","その他3","その他4","その他5","その他6","その他7","その他8","その他9","甲状腺がんスクリーニング1","甲状腺がんスクリーニング2","甲状腺がんスクリーニング3","甲状腺がんスクリーニング4","甲状腺がんスクリーニング5","甲状腺がんスクリーニング6","甲状腺がんスクリーニング7","甲状腺がんスクリーニング8","甲状腺がんスクリーニング9","甲状腺がんスクリーニング10","甲状腺がんスクリーニング11","子宮頸がんスクリーニング1","子宮頸がんスクリーニング2","子宮頸がんスクリーニング3","子宮頸がんスクリーニング4","子宮頸がんスクリーニング5","子宮頸がんスクリーニング6","子宮頸がんスクリーニング7","子宮頸がんスクリーニング8","子宮頸がんスクリーニング9","子宮頸がんスクリーニング10","上記以外検査1_1","上記以外検査1_2","上記以外検査1_3","上記以外検査1_4","上記以外検査1_5","上記以外検査1_6","上記以外検査1_7","上記以外検査1_8","上記以外検査1_9","上記以外検査2_1","上記以外検査2_2","上記以外検査2_3","上記以外検査2_4","上記以外検査2_5","上記以外検査2_6","上記以外検査2_7","上記以外検査2_8","上記以外検査2_9","上記以外検査3_1","上記以外検査3_2","上記以外検査3_3","上記以外検査3_4","上記以外検査3_5","上記以外検査3_6","上記以外検査3_7","上記以外検査3_8","上記以外検査3_9","その他特記事項","その他特記事項2","その他特記事項3","その他特記事項4","その他特記事項5"]

{"sheet":"データ⑤","index":13,"n_rows":2,"n_cols":35,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["→ ⑤説明状況と理解度"]
["Timestamp","記載者名","家族告知拒否","NGワード1","NGワード2","病名1","病名2","病名3","治療歴1","治療歴2","治療歴3","原病の状態1","原病の状態2","原病の状態3","合併症1","合併症2","合併症3","LTFU1","LTFU2","LTFU3","LTFU4","妊孕性1","妊孕性2","妊孕性3","妊孕性4","遺伝子情報1","遺伝子情報2","遺伝子情報3","遺伝子情報4","遺伝子情報5","その他特記事項","その他特記事項2","その他特記事項3","その他特記事項4","その他特記事項5"]

{"sheet":"データ⑥","index":14,"n_rows":2,"n_cols":59,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["→ ⑥予防接種"]
["Timestamp","コピー添付","詳細不明","肺炎球菌1","肺炎球菌2","肺炎球菌3","肺炎球菌4","インフルb型1","インフルb型2","インフルb型3","インフルb型4","ジフテリア1","ジフテリア2","ジフテリア3","ジフテリア4","ヒトパピローマウイルス1","ヒトパピローマウイルス2","ヒトパピローマウイルス3","ヒトパピローマウイルス4","インフル1","インフル2","B型肝炎1","B型肝炎2","B型肝炎3","B型肝炎4","帯状発疹1","帯状発疹2","帯状発疹3","麻しん風しん1","麻しん風しん2","麻しん風しん3","麻しん抗体1","麻しん抗体2","麻しん抗体3","風しん抗体1","風しん抗体2","風しん抗体3","ムンプス1","ムンプス2","ムンプス3","ムンプス抗体1","ムンプス抗体2","ムンプス抗体3","水痘帯状疱疹1","水痘帯状疱疹2","水痘帯状疱疹3","水痘抗体1","水痘抗体2","水痘抗体3","新型コロナ1","新型コロナ2","今後1","今後2","今後3","その他特記事項","その他特記事項2","その他特記事項3","その他特記事項4","その他特記事項5"]

{"sheet":"データ⑦","index":15,"n_rows":2,"n_cols":51,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["→ ⑦妊孕性・性腺機能"]
["Timestamp","卵子卵巣精液凍結保存1","卵子卵巣精液凍結保存2","卵子卵巣精液凍結保存3","卵子卵巣精液凍結保存4","卵子卵巣精液凍結保存5","性腺機能評価","性腺機能評価11","性腺機能評価12","性腺機能評価13","性腺機能評価14","性腺機能評価15","性腺機能評価21","性腺機能評価22","性腺機能評価23","性腺機能評価24","性腺機能評価25","ホルモン補充療法0","ホルモン補充療法1","ホルモン補充療法2","ホルモン補充療法3","ホルモン補充療法4","ホルモン補充療法5","ホルモン補充療法6","ホルモン補充療法7","不妊治療1","不妊治療2","不妊治療3","月経1","月経2","婦人科受診1","婦人科受診2","婦人科受診3","婦人科受診4","婦人科受診5","婦人科受診6","婦人科受診7","婦人科受診8","泌尿器科受診1","泌尿器科受診2","泌尿器科受診3","泌尿器科受診4","泌尿器科受診5","泌尿器科受診6","泌尿器科受診7","泌尿器科受診8","その他特記事項","その他特記事項2","その他特記事項3","その他特記事項4","その他特記事項5"]

{"sheet":"データ⑧","index":16,"n_rows":2,"n_cols":18,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["→ ⑧看護師から"]
["Timestamp","疾患治療検査","感染予防予防接種","GVHD","晩期合併症","内服管理","健康管理","精神心理面","生殖機能","家族","就労就学将来の夢","経済面","リソース","その他","その他2","その他3","その他4","その他5"]