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["様式第１号（記載方法・記載例）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"紙申請用"]
["【医療機関→国保連→都道府県】医療機関情報_新型コロナウイルス感染症従事者慰労金"]
[]
["施設概要"]
[]
[null,null,null,null,null,null,null,null,"助産所コードのない助産所は「9999999999」を入力してください"]
["申請日",null,"2020-07-31",null,null,"医療機関等\nコード\n（10桁）",null,null,1,2,3,4,5,6,7,8,9,0,"施設名称",null,null,"医療法人社団〇〇〇　△△病院"]
[]
[]
["管理者職名",null,null,"病院長",null,null,null,null,null,"管理者氏名",null,null,"厚生太郎"]
[]
[]
["連絡先",null,null,"担当部署",null,null,null,null,"担当者氏名",null,null,null,null,"連絡先電話番号",null,null,null,null,"連絡先メールアドレス"]
[null,null,null,"○○部",null,null,null,null,"○○○○",null,null,null,null,"03-xxxx-xxxx",null,null,null,null,"○○○○@○○.○○"]
[]
["所在地",null,null,"郵便番号",null,null,null,null,null,null,null,"都道府県名",null,null,null,"市区町村以降"]
[null,null,null,1,2,3,"ー",4,5,6,7,"東京都",null,null,null,"中央区日本橋〇－〇－〇"]
[]
["国又は自治体が設置する医療機関等において制度上の問題により、　　医療従事者への迅速な振込ができない医療機関である",null,null,null,null,null,null,null,null,null,null,null,null,null,"はい",null,"いいえ"]
[]
["新型コロナウイルス感染症患者の受け入れについて"]
[]
["当該都道府県における始期",null,null,null,null,null,null,null,null,null,"2020-03-01"]
[]
["施設類型について、該当する番号に〇をつけてください"]
["施設類型",null,null,null,null,null,null,null,null,null,1,"新型コロナウイルス感染症患者の入院受入を割り当てた医療機関"]
[null,null,null,null,null,null,null,null,null,null,2,"帰国者・接触者外来を設置する医療機関"]
[null,null,null,null,null,null,null,null,null,null,3,"地域外来・検査センター"]
[null,null,null,null,null,null,null,null,null,null,4,"宿泊療養受入施設での対応"]
[null,null,null,null,null,null,null,null,null,null,5,"自宅療養を行う場合の新型コロナウイルス感染症患者に対するフォローアップ業務"]
[null,null,null,null,null,null,null,null,null,null,6,"1～5以外の病院及び診療所"]
[null,null,null,null,null,null,null,null,null,null,7,"訪問看護ステーション"]
[null,null,null,null,null,null,null,null,null,null,8,"助産所"]
["施設類型２、３、４、５に該当する施設のみ、役割指定を受けた日を記載してください"]
["都道府県から役割指定を受けた日",null,null,null,null,null,null,null,null,null,"2020-03-10"]
[]
["新型コロナウイルス感染症患者を最初に受け入れた日",null,null,null,null,null,null,null,null,null,"2020-04-03"]
[]
["対象期間起点日",null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(K23=\"\",K35=\"\"),\"\",MIN(K23,K35))","v":"2020-03-01"}]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"紙申請用"]
["【医療機関→国保連→都道府県】医療機関情報_新型コロナウイルス感染症従事者慰労金"]
["口座情報"]
[]
["以下の質問について、「はい」もしくは「いいえ」どちらかに○をしてください。"]
["国保連合会に登録されている口座は債権譲渡されていない。\n（助産所コードのない助産所は、「いいえ」を選択してください）",null,null,null,null,null,null,null,null,null,null,null,"はい",null,"いいえ",null,"債権譲渡されていない場合は、「はい」を選択して下さい。債権譲渡されている場合は、国保連に登録されている口座への補助金の振込ができませんので、債権譲渡されていない口座の情報を提出していただく必要があります。"]
[]
[]
[null,null,null,null,"国保連合会による当該口座の債権譲渡の有無に関する確認結果が都道府県に共有されることに同意する",null,null,null,null,null,null,null,null,null,null,null,"はい",null,"いいえ",null,"国保連が保有している情報を用いて債権譲渡の有無に関して確認を行います。補助金交付過程において、その確認結果を都道府県に共有する必要があります。"]
[]
[null,null,null,null,"国保連合会に登録されている口座情報を本事業の振込に使用することに同意する",null,null,null,null,null,null,null,null,null,null,null,"はい",null,"いいえ",null,"同意いただける場合は、「はい」を選択して下さい。"]
[]
["債権譲渡されていない口座情報をご記載ください"]
["金融機関名",null,null,null,null,null,null,null,null,null,"金融機関\nコード",null,null,null,null,null,null,"支店名",null,null,null,null,null,null,"支店コード"]
[]
["預金種類",null,null,null,null,null,null,null,null,null,null,null,null,"口座番号（左詰め）"]
[]
["（フリガナ）"]
["取引口座名"]
[]
[]
[]
["※今回の慰労金は、所得税法の非課税規定に基づき、非課税所得に該当します。また、令和二年度特別定額給付金等に係る差押禁止等に関する法律に基づき、受給権について、譲り渡し、担保に供し、又は差し押さえることが禁止され、支給を受けた金銭についても、差し押さえることが禁止されています。"]
["※なお、本事業実施のために新たに入手・共有された情報は本事業のみに用い、その他の目的で使用されることはございません。"]
[]
["慰労金交付申請額"]
[]
[null,null,null,null,null,null,"科目",null,null,null,null,null,null,"人数",null,null,null,"申請額（円）"]
[null,null,null,null,null,null,"慰労金",null,null,null,null,null,null,15,null,null,null,2900000]
[null,null,null,null,null,null,"振込手数料",null,null,null,null,null,null,null,null,null,null,3000]
[null,null,null,null,null,null,"合計申請額（円）",null,null,null,null,null,null,null,null,null,null,2903000]
[]
[]
[null,"医療機関等からの申請は原則1回限りですので、委託先等も含め、対象となる\n従業員について、漏れのないようご留意ください。"]

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["様式第１号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"紙申請用"]
["【医療機関→国保連→都道府県】医療機関情報_新型コロナウイルス感染症従事者慰労金"]
[]
["施設概要"]
[]
[null,null,null,null,null,null,null,null,"助産所コードのない助産所は「9999999999」を入力してください"]
["申請日",null,null,null,null,"医療機関等\nコード\n（10桁）",null,null,null,null,null,null,null,null,null,null,null,null,"施設名称"]
[]
[]
["管理者職名",null,null,null,null,null,null,null,null,"管理者氏名"]
[]
[]
["連絡先",null,null,"担当部署",null,null,null,null,"担当者氏名",null,null,null,null,"連絡先電話番号",null,null,null,null,"連絡先メールアドレス"]
[]
[]
["所在地",null,null,"郵便番号",null,null,null,null,null,null,null,"都道府県名",null,null,null,"市区町村以降"]
[null,null,null,null,null,null,"ー"]
[]
["国又は自治体が設置する医療機関等において制度上の問題により、　　医療従事者への迅速な振込ができない医療機関である",null,null,null,null,null,null,null,null,null,null,null,null,null,"はい",null,"いいえ"]
[]
["新型コロナウイルス感染症患者の受け入れについて"]
[]
["当該都道府県における始期"]
[]
["施設類型について、該当する番号に〇をつけてください"]
["施設類型",null,null,null,null,null,null,null,null,null,1,"新型コロナウイルス感染症患者の入院受入を割り当てた医療機関"]
[null,null,null,null,null,null,null,null,null,null,2,"帰国者・接触者外来を設置する医療機関"]
[null,null,null,null,null,null,null,null,null,null,3,"地域外来・検査センター"]
[null,null,null,null,null,null,null,null,null,null,4,"宿泊療養受入施設での対応"]
[null,null,null,null,null,null,null,null,null,null,5,"自宅療養を行う場合の新型コロナウイルス感染症患者に対するフォローアップ業務"]
[null,null,null,null,null,null,null,null,null,null,6,"1～5以外の病院及び診療所"]
[null,null,null,null,null,null,null,null,null,null,7,"訪問看護ステーション"]
[null,null,null,null,null,null,null,null,null,null,8,"助産所"]
["施設類型２、３、４、５に該当する施設のみ、役割指定を受けた日を記載してください"]
["都道府県から役割指定を受けた日"]
[]
["新型コロナウイルス感染症患者を最初に受け入れた日"]
[]
["対象期間起点日",null,null,null,null,null,null,null,null,null,{"$f":"IF(AND(K23=\"\",K35=\"\"),\"\",MIN(K23,K35))","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,null,"紙申請用"]
["【医療機関→国保連→都道府県】医療機関情報_新型コロナウイルス感染症従事者慰労金"]
["口座情報"]
[]
["以下の質問について、「はい」もしくは「いいえ」どちらかに○をしてください。"]
["国保連合会に登録されている口座は債権譲渡されていない。\n（助産所コードのない助産所は、「いいえ」を選択してください）",null,null,null,null,null,null,null,null,null,null,null,"はい",null,"いいえ",null,"債権譲渡されていない場合は、「はい」を選択して下さい。債権譲渡されている場合は、国保連に登録されている口座への補助金の振込ができませんので、債権譲渡されていない口座の情報を提出していただく必要があります。"]
[]
[]
[null,null,null,null,"国保連合会による当該口座の債権譲渡の有無に関する確認結果が都道府県に共有されることに同意する",null,null,null,null,null,null,null,null,null,null,null,"はい",null,"いいえ",null,"国保連が保有している情報を用いて債権譲渡の有無に関して確認を行います。補助金交付過程において、その確認結果を都道府県に共有する必要があります。"]
[]
[null,null,null,null,"国保連合会に登録されている口座情報を本事業の振込に使用することに同意する",null,null,null,null,null,null,null,null,null,null,null,"はい",null,"いいえ",null,"同意いただける場合は、「はい」を選択して下さい。"]
[]
["債権譲渡されていない口座情報をご記載ください"]
["金融機関名",null,null,null,null,null,null,null,null,null,"金融機関\nコード",null,null,null,null,null,null,"支店名",null,null,null,null,null,null,"支店コード"]
[]
["預金種類",null,null,null,null,null,null,null,null,null,null,null,null,"口座番号（左詰め）"]
[]
["（フリガナ）"]
["取引口座名"]
[]
[]
[]
["※今回の慰労金は、所得税法の非課税規定に基づき、非課税所得に該当します。また、令和二年度特別定額給付金等に係る差押禁止等に関する法律に基づき、受給権について、譲り渡し、担保に供し、又は差し押さえることが禁止され、支給を受けた金銭についても、差し押さえることが禁止されています。"]
["※なお、本事業実施のために新たに入手・共有された情報は本事業のみに用い、その他の目的で使用されることはございません。"]
[]
["慰労金交付申請額"]
[]
[null,null,null,null,null,null,"科目",null,null,null,null,null,null,"人数",null,null,null,"申請額（円）"]
[null,null,null,null,null,null,"慰労金"]
[null,null,null,null,null,null,"振込手数料"]
[null,null,null,null,null,null,"合計申請額（円）"]

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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,"【施設類型】１～３",null,null,"【施設類型】４～５",null,null,"【施設類型】６～８"]
[null,"（記載方法・記載例）",null,null,null,null,null,null,null,null,null,null,"施設類型",null,null,"【Ｂ】",null,null,"勤務あり","勤務なし"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null," １　新型コロナウイルス感染症患者の入院受入を割り当てた医療機関",null,null," 陽性患者入院以降、勤務実績あり",null,null,"20万円","10万円",null,null,null,null,null,null,null,null," １　新型コロナウイルス感染症患者の入院受入を割り当てた医療機関"]
[null,null,null,null,null,null,null,null,null,null,null,null," ２　帰国者・接触者外来を設置する医療機関",null,null," 陽性・疑い患者来院以降、勤務実績あり",null,null,"20万円","10万円",null,null,null,null,null,null,null,null," ２　帰国者・接触者外来を設置する医療機関"]
[null,"紙申請用",null,null,null,null,null,null,null,null,null,null," ３　地域外来・検査センター",null,null," 陽性・疑い患者来院以降、勤務実績あり",null,null,"20万円","10万円",null,null,null,null,null,null,null,null," ３　地域外来・検査センター"]
[null,null,null,null,null,null,null,null,null,null,null,null," ４　宿泊療養受入施設での対応",null,null," 軽症者等入所以降、勤務実績あり",null,null,"20万円","－",null,null,null,null,null,null,null,null,null,null,null," ４　宿泊療養受入施設での対応"]
[null,"様式第２号",null,null,null,null,null,null,null,null,null,null," ５　自宅療養を行う場合の新型コロナウイルス感染症患者に対するフォローアップ業務",null,null," 軽症者等に対する、勤務実績あり",null,null,"20万円","－",null,null,null,null,null,null,null,null,null,null,null," ５　自宅療養を行う場合の新型ｺﾛﾅｳｲﾙｽ感染症患者に対するﾌｫﾛｰｱｯﾌﾟ業務"]
[null,null,null,null,null,null,null,null,null,null,null,null," ６　１～５以外の病院及び診療所",null,null," 陽性患者入院以降、勤務実績あり",null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ６　１～５以外の病院及び診療所"]
[null,null,null,null,null,null,null,null,null,null,null,null," ７　訪問看護ステーション",null,null," 陽性患者訪問日以降、勤務実績あり",null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ７　訪問看護ステーション"]
[null,null,null,null,null,null,null,null,null,null,null,null," ８　助産所",null,null," 陽性妊産婦患者入所以降、勤務実績あり",null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ８　助産所"]
[]
["【医療機関→都道府県】給付対象内訳_新型コロナウイルス感染症対応従事者慰労金",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"▼\n▼\n▼\n▼",null,null,null,null,null,null,null,null,null,"他医療機関等での、勤務実績あり　　（１番～３番）",null,null,"他医療機関等での、勤務実績あり　　（４番～５番）",null,null,"他医療機関等での、勤務実績あり　　（６番～８番）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"←　給付対象者の支給申請金額の合計額を記載して下さい。"]
[null,null,null,null,null,null,null,null,null,null,"合計申請額（円）","○○○○",null,null,null,null,null,null,null,null,null,"都道府県が債主登録を行う際に必要な情報",null,null,null,null,null,null,null,"申請する施設　以外",null,null,"申請する施設　以外",null,null,"申請する施設　以外"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"他施設と\n合算","申請施設","申請施設\n以外",null,null,null,null,null,null,null,null,null,"１番～３番の合算",null,null,"４番～５番の合算",null,null,"６番～８番の合算"]
[]
["管理番号\n1 からの\n自動連番","医療機関コード",null,null,null,null,null,null,null,null,null,"申請する\n医療機関等\n\n名称","給付申請\n金額","\n氏名\n（漢字）\n\n姓と名の間は空けてください。","\nフリガナ\n（カタカナ）\n\n姓と名の間は空けてください。","\n生年月日\n（令和○年○月○日）\n","\n性別\n\n男性\n女性","【Ａ】 \n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】\n申請する\n医療機関等\nでの\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","【Ｃ】\n\n他医療機関等\nでの\n勤務実績\n\n（有り／無し）","委任状\n徴収済","金融機関名","金融機関\nコード","支店名\n","支店番号\n(店番)","預金種別\n1：普通\n2：当座\n4：貯蓄","口座番号","口座名義\n（カタカナ）\n姓と名を空けてください","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 １～３\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】１～３\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 ４～５\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】４～５\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 ６～８\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】６～８\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）"]
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[2,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","女性","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
[3,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
[4,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","女性","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
[5,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
[6,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
[7,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
[8,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
[9,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","無し","無し","済"]
[10,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","無し","無し","済"]
[11,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","無し","無し","済"]
[12,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","無し","無し","済"]
[13,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","無し","無し","済"]
[14,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","無し","無し","済"]
[15,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○日","無し","無し","済"]
["～","～",null,null,null,null,null,null,null,null,null,"～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～"]
["○○",1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○年○月○日","○年○月○日","男性","○○日","無し","無し","済"]
["↑","↑",null,null,null,null,null,null,null,null,null,"↑","↑","↑","↑","↑","↑","↑","↑","↑","↑"]
["番号を１から連番で付して下さい。","医療機関コードを様式第１号から転記して下さい。",null,null,null,null,null,null,null,null,null,"医療機関名称を様式第１号から転記してください。","給付対象者の慰労金の額を記載してください。","給付対象者の氏名（漢字）を記載してください。","給付対象者の氏名（カナ）を記載してください。","給付対象者の生年月日を記載してください。","給付対象者の性別を記載してください。","給付対象者の起点日から6月30日までの勤務日数（他の医療機関での勤務実績を含める）を記載してください。","給付対象者の起点日から6月30日までのコロナ患者受け入れ後の勤務実績がある場合は「有り」、無い場合は「無し」を記載してください。","給付対象者が他の医療機関等での勤務実績がある場合は「有り」、無い場合は「無し」を入力してください。","給付対象者から委任状を徴収したら「済」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,"・様式第１号において、「国又は自治体が設置する医療機関等において制度上の問題により、医療従事者への迅速な振込ができない医療機関である」に「はい」を選択した場合、都道府県からの振込となるため、給付対象者の慰労金の振込先口座を記入してください。",null,null,null,null,null,null,"・他施設（施設類型１～３）で勤務実績が「有り」の場合、「医療機関等名称（複数ある場合はどこか１つ）」「起点日から６月30日までの延べ勤務日数」「他施設（施設類型１～３）以外の場合でのコロナ患者受け入れ以降の勤務実績の有無（「有り」「無し」）を記載してください。\n",null,null,"・他施設（施設類型４～５）で勤務実績が「有り」の場合、「医療機関等名称（複数ある場合はどこか１つ）」「起点日から６月30日までの延べ勤務日数」「他施設（施設類型４～５）以外の場合でのコロナ患者受け入れ以降の勤務実績の有無（「有り」「無し」）を記載してください。\n",null,null,"・他施設（施設類型６～８）で勤務実績が「有り」の場合、「医療機関等名称（複数ある場合はどこか１つ）」「起点日から６月30日までの延べ勤務日数」「他施設（施設類型６～８）以外の場合でのコロナ患者受け入れ以降の勤務実績の有無（「有り」「無し」）を記載してください。\n"]

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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,"【施設類型】１～３",null,null,"【施設類型】４～５",null,null,"【施設類型】６～８"]
[null,null,null,null,null,null,null,null,null,null,null,null,"施設類型",null,null,"【Ｂ】",null,null,"勤務あり","勤務なし"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null," １　新型コロナウイルス感染症患者の入院受入を割り当てた医療機関",null,null," 陽性患者入院以降、勤務実績あり",null,null,"20万円","10万円",null,null,null,null,null,null,null,null," １　新型コロナウイルス感染症患者の入院受入を割り当てた医療機関"]
[null,null,null,null,null,null,null,null,null,null,null,null," ２　帰国者・接触者外来を設置する医療機関",null,null," 陽性・疑い患者来院以降、勤務実績あり",null,null,"20万円","10万円",null,null,null,null,null,null,null,null," ２　帰国者・接触者外来を設置する医療機関"]
[null,"紙申請用",null,null,null,null,null,null,null,null,null,null," ３　地域外来・検査センター",null,null," 陽性・疑い患者来院以降、勤務実績あり",null,null,"20万円","10万円",null,null,null,null,null,null,null,null," ３　地域外来・検査センター"]
[null,null,null,null,null,null,null,null,null,null,null,null," ４　宿泊療養受入施設での対応",null,null," 軽症者等入所以降、勤務実績あり",null,null,"20万円","－",null,null,null,null,null,null,null,null,null,null,null," ４　宿泊療養受入施設での対応"]
[null,"様式第２号",null,null,null,null,null,null,null,null,null,null," ５　自宅療養を行う場合の新型コロナウイルス感染症患者に対するフォローアップ業務",null,null," 軽症者等に対する、勤務実績あり",null,null,"20万円","－",null,null,null,null,null,null,null,null,null,null,null," ５　自宅療養を行う場合の新型ｺﾛﾅｳｲﾙｽ感染症患者に対するﾌｫﾛｰｱｯﾌﾟ業務"]
[null,null,null,null,null,null,null,null,null,null,null,null," ６　１～５以外の病院及び診療所",null,null," 陽性患者入院以降、勤務実績あり",null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ６　１～５以外の病院及び診療所"]
[null,null,null,null,null,null,null,null,null,null,null,null," ７　訪問看護ステーション",null,null," 陽性患者訪問日以降、勤務実績あり",null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ７　訪問看護ステーション"]
[null,null,null,null,null,null,null,null,null,null,null,null," ８　助産所",null,null," 陽性妊産婦患者入所以降、勤務実績あり",null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ８　助産所"]
[]
["【医療機関→都道府県】給付対象内訳_新型コロナウイルス感染症対応従事者慰労金",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"▼\n▼\n▼\n▼",null,null,null,null,null,null,null,null,null,"他医療機関等での、勤務実績あり　　（１番～３番）",null,null,"他医療機関等での、勤務実績あり　　（４番～５番）",null,null,"他医療機関等での、勤務実績あり　　（６番～８番）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"←　給付対象者の支給申請金額の合計額を記載して下さい。"]
[null,null,null,null,null,null,null,null,null,null,"合計申請額（円）",null,null,null,null,null,null,null,null,null,null,"都道府県が債主登録を行う際に必要な情報",null,null,null,null,null,null,null,"申請する施設　以外",null,null,"申請する施設　以外",null,null,"申請する施設　以外"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"他施設と\n合算","申請施設","申請施設\n以外",null,null,null,null,null,null,null,null,null,"１番～３番の合算",null,null,"４番～５番の合算",null,null,"６番～８番の合算"]
[]
["管理番号\n1 からの\n自動連番","医療機関コード",null,null,null,null,null,null,null,null,null,"申請する\n医療機関等\n\n名称","給付申請\n金額","\n氏名\n（漢字）\n\n姓と名の間は空けてください。","\nフリガナ\n（カタカナ）\n\n姓と名の間は空けてください。","\n生年月日\n（令和○年○月○日）\n","\n性別\n\n男性\n女性","【Ａ】 \n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】\n申請する\n医療機関等\nでの\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","【Ｃ】\n\n他医療機関等\nでの\n勤務実績\n\n（有り／無し）","委任状\n徴収済","金融機関名","金融機関\nコード","支店名\n","支店番号\n(店番)","預金種別\n1：普通\n2：当座\n4：貯蓄","口座番号","口座名義\n（カタカナ）\n姓と名を空けてください","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 １～３\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】１～３\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 ４～５\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】４～５\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 ６～８\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】６～８\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）"]

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[]
["○○県　知事殿"]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金　代理申請・受領委任状"]
[]
["　　下記の者は、"]
["　①　今回の新型コロナウイルス感染症対応従事者慰労金の申請以外に、個人申請並びに\n　　　他の医療機関や介護・障害施設から慰労金の給付申請を行わないこと及び、"]
["　②　申請内容に虚偽があった場合又は複数機関等から慰労金の給付を受けた場合は、\n　　　不当利得として速やかに都道府県知事に慰労金を返還することを確認・誓約し、"]
["医療法人社団　△△病院",null,null,"病院長　厚生太郎",null,null,"を代理申請・受領者と定め、"]
["　新型コロナウイルス感染症対応従事者慰労金の申請及び受領に関する権限を委任します。"]
[]
["　（注意事項）"]
[]
["　・　この委任状は、都道府県への提出は不要です。ただし、慰労金の代理申請及び受領を\n　　　証するものとして、都道府県からの求めがあった場合に速やかに提出できるよう、\n　　　医療機関等において、適切に保管しなければなりません。"]
[]
["記"]
[]
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[3,"○○　○○",null,"印","○年○月○日",null,"○○○○",null,"○○○○"]
[4,"○○　○○",null,"印","○年○月○日",null,"○○○○",null,"○○○○"]
[5,"○○　○○",null,"印","○年○月○日",null,"○○○○",null,"○○○○"]
[6,"○○　○○",null,"印","○年○月○日",null,"○○○○",null,"○○○○"]
[7,"○○　○○",null,"印","○年○月○日",null,"○○○○",null,"○○○○"]
[8,"○○　○○",null,"印","○年○月○日",null,"○○○○",null,"○○○○"]
[9,"○○　○○",null,"印","○年○月○日",null,"○○○○",null,"○○○○"]
[10,"○○　○○",null,"印","○年○月○日",null,"○○○○",null,"○○○○"]
[11,"○○　○○",null,"印","○年○月○日",null,"○○○○",null,"○○○○"]
[12,"○○　○○",null,"印","○年○月○日",null,"○○○○",null,"○○○○"]
[13,"○○　○○",null,{"$f":"IF(A35=\"\",\"\",\"印\")","v":"印"},"○年○月○日",null,"○○○○",null,"○○○○"]

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[]
["　知事殿"]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金　代理申請・受領委任状"]
[]
["　　下記の者は、"]
["　①　今回の新型コロナウイルス感染症対応従事者慰労金の申請以外に、個人申請並びに\n　　　他の医療機関や介護・障害施設から慰労金の給付申請を行わないこと及び、"]
["　②　申請内容に虚偽があった場合又は複数機関等から慰労金の給付を受けた場合は、\n　　　不当利得として速やかに都道府県知事に慰労金を返還することを確認・誓約し、"]
[null,null,null,null,null,null,"を代理申請・受領者と定め、"]
["　新型コロナウイルス感染症対応従事者慰労金の申請及び受領に関する権限を委任します。"]
[]
["　（注意事項）"]
[]
["　・　この委任状は、都道府県への提出は不要です。ただし、慰労金の代理申請及び受領を\n　　　証するものとして、都道府県からの求めがあった場合に速やかに提出できるよう、\n　　　医療機関等において、適切に保管しなければなりません。"]
[]
["記"]
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["（記載方法・記載例）",null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"様式第3号の2"]
[]
["○○県　知事殿"]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金　代理申請・受領委任状"]
[]
[]
[null,null,null,null,"所　　属：",null,"医療法人社団　△△病院"]
[null,null,null,null,"氏　　名：（自署）",null,"○○　○○"]
[null,null,null,null,"住　　所：（自署）",null,"○○○○"]
[null,null,null,null,"生年月日：",null,"○年○月○日"]
[]
[]
[]
["　　私は、下記の事項を確認・誓約し、",null,null,null,"医療法人社団　△△病院",null,null,"病院長　厚生太郎",null,"を"]
["　代理申請・受領者と定め、新型コロナウイルス感染症対応従事者慰労金",null,null,null,null,null,null,"○○○○",null,"円"]
["　の申請及び及び受領に関する権限を委任します。"]
[]
[]
["記"]
[]
["　　１．今回の新型コロナウイルス感染症対応従事者慰労金の申請以外に、個人申請並びに他の\n　　　　医療機関や介護・障害施設から慰労金の給付申請を行わないこと。"]
[]
["　　２．申請内容に虚偽があった場合又は複数機関等から慰労金の給付を受けた場合は、不当利得として\n　　　　速やかに　○○県　知事に慰労金を返還すること。"]
[]
["　（注意事項）"]
[]
["　・　この委任状は、都道府県への提出は不要です。ただし、慰労金の代理申請及び受領を\n　　　証するものとして、都道府県からの求めがあった場合に速やかに提出できるよう、\n　　　医療機関等において、適切に保管しなければなりません。"]

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[null,null,null,null,null,null,null,"紙申請用"]
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[]
["　知事殿"]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金　代理申請・受領委任状"]
[]
[]
[null,null,null,null,"所　　属："]
[null,null,null,null,"氏　　名：（自署）"]
[null,null,null,null,"住　　所：（自署）"]
[null,null,null,null,"生年月日："]
[]
[]
[]
["　　私は、下記の事項を確認・誓約し、",null,null,null,null,null,null,null,null,"を"]
["　代理申請・受領者と定め、新型コロナウイルス感染症対応従事者慰労金",null,null,null,null,null,null,null,null,"円"]
["　の申請及び及び受領に関する権限を委任します。"]
[]
[]
["記"]
[]
["　　１．今回の新型コロナウイルス感染症対応従事者慰労金の申請以外に、個人申請並びに他の\n　　　　医療機関や介護・障害施設から慰労金の給付申請を行わないこと。"]
[]
["　　２．申請内容に虚偽があった場合又は複数機関等から慰労金の給付を受けた場合は、不当利得として\n　　　　速やかに　　　　　知事に慰労金を返還すること。"]
[]
["　（注意事項）"]
[]
["　・　この委任状は、都道府県への提出は不要です。ただし、慰労金の代理申請及び受領を\n　　　証するものとして、都道府県からの求めがあった場合に速やかに提出できるよう、\n　　　医療機関等において、適切に保管しなければなりません。"]

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[]
["○○県　知事殿"]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金　代理申請・受領委任状"]
[]
["　　下記の者は、"]
["　①　今回の新型コロナウイルス感染症対応従事者慰労金の申請以外に、個人申請並びに\n　　　他の医療機関や介護・障害施設から慰労金の給付申請を行わないこと及び、"]
["　②　申請内容に虚偽があった場合又は複数機関等から慰労金の給付を受けた場合は、\n　　　不当利得として速やかに都道府県知事に慰労金を返還することを確認・誓約し、"]
["医療法人社団　△△病院",null,null,"病院長　厚生太郎",null,null,"を代理申請・受領者と定め、"]
["　新型コロナウイルス感染症対応従事者慰労金の申請及び受領に関する権限を委任します。"]
[]
["　（注意事項）"]
[]
["　・　この委任状は、都道府県への提出は不要です。ただし、慰労金の代理申請及び受領を\n　　　証するものとして、都道府県からの求めがあった場合に速やかに提出できるよう、\n　　　医療機関等において、適切に保管しなければなりません。"]
[]
["記"]
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["　知事殿"]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金　代理申請・受領委任状"]
[]
["　　下記の者は、"]
["　①　今回の新型コロナウイルス感染症対応従事者慰労金の申請以外に、個人申請並びに\n　　　他の医療機関や介護・障害施設から慰労金の給付申請を行わないこと及び、"]
["　②　申請内容に虚偽があった場合又は複数機関等から慰労金の給付を受けた場合は、\n　　　不当利得として速やかに都道府県知事に慰労金を返還することを確認・誓約し、"]
[null,null,null,null,null,null,"を代理申請・受領者と定め、"]
["　新型コロナウイルス感染症対応従事者慰労金の申請及び受領に関する権限を委任します。"]
[]
["　（注意事項）"]
[]
["　・　この委任状は、都道府県への提出は不要です。ただし、慰労金の代理申請及び受領を\n　　　証するものとして、都道府県からの求めがあった場合に速やかに提出できるよう、\n　　　医療機関等において、適切に保管しなければなりません。"]
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["記"]
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["○○県　知事殿"]
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[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金　代理申請・受領委任状"]
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[null,null,null,null,"所　　属：",null,"医療法人社団　△△病院"]
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["　の申請及び及び受領に関する権限を委任します。"]
[]
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["記"]
[]
["　　１．今回の新型コロナウイルス感染症対応従事者慰労金の申請以外に、個人申請並びに他の\n　　　　医療機関や介護・障害施設から慰労金の給付申請を行わないこと。"]
[]
["　　２．申請内容に虚偽があった場合又は複数機関等から慰労金の給付を受けた場合は、不当利得として\n　　　　速やかに　○○県　知事に慰労金を返還すること。"]
[]
["　（注意事項）"]
[]
["　・　この委任状は、都道府県への提出は不要です。ただし、慰労金の代理申請及び受領を\n　　　証するものとして、都道府県からの求めがあった場合に速やかに提出できるよう、\n　　　医療機関等において、適切に保管しなければなりません。"]

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["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金　代理申請・受領委任状"]
[]
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[null,null,null,null,"所　　属："]
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[]
[]
["　　私は、下記の事項を確認・誓約し、",null,null,null,null,null,null,null,null,"を"]
["　代理申請・受領者と定め、新型コロナウイルス感染症対応従事者慰労金",null,null,null,null,null,null,null,null,"円"]
["　の申請及び及び受領に関する権限を委任します。"]
[]
[]
["記"]
[]
["　　１．今回の新型コロナウイルス感染症対応従事者慰労金の申請以外に、個人申請並びに他の\n　　　　医療機関や介護・障害施設から慰労金の給付申請を行わないこと。"]
[]
["　　２．申請内容に虚偽があった場合又は複数機関等から慰労金の給付を受けた場合は、不当利得として\n　　　　速やかに　　　　　知事に慰労金を返還すること。"]
[]
["　（注意事項）"]
[]
["　・　この委任状は、都道府県への提出は不要です。ただし、慰労金の代理申請及び受領を\n　　　証するものとして、都道府県からの求めがあった場合に速やかに提出できるよう、\n　　　医療機関等において、適切に保管しなければなりません。"]

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["（記載方法・記載例）",null,null,null,null,null,null,"様式第5号"]
[null,null,null,null,null,null,"（文書番号）"]
[]
[null,null,null,null,null,null,"令和２年×月××日"]
[]
[]
["医療法人社団　△△病院"]
[null,"病院長　厚生太郎",null,null,"殿"]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,"株式会社◎◎"]
[null,null,null,null,null,null,"◎◎◎◎"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["「新型コロナウイルス感染症対応従事者慰労金」の代理申請・受領委任について"]
[]
[]
[]
[]
["　貴院で委託業務に従事する別紙の者にかかる慰労金の申請及び受領について、"]
["貴職に委任いたしますので、事務手続き方よろしくお願いいたします。"]
[]
["（※委託会社等から同社の医療従事者等に慰労金の給付を行う場合は。以下を記載してください）"]
["　なお、","慰労金の入金があった際には、下記口座にお振込みいただくようお願い"]
["します。"]
[]
[]
["記"]
[]
[null,null,"◎◎銀行　◎◎支店"]
[null,null,"普通　　１２３４５６７","○○○○○○○"]
[null,null,"名義　◎◎◎◎"]

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[null,null,null,null,null,null,null,"様式第5号"]
[null,null,null,null,null,null,"（文書番号）"]
[]
[]
[]
[]
[]
[null,null,null,null,"殿"]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　"]
[]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["「新型コロナウイルス感染症対応従事者慰労金」の代理申請・受領委任について"]
[]
[]
[]
[]
["　貴院で委託業務に従事する別紙の者にかかる慰労金の申請及び受領について、"]
["貴職に委任いたしますので、事務手続き方よろしくお願いいたします。"]
[]
["（※委託会社等から同社の医療従事者等に慰労金の給付を行う場合は。以下を記載してください）"]
["　なお、","慰労金の入金があった際には、下記口座にお振込みいただくようお願い"]
["します。"]
[]
[]
["記"]

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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,"【施設類型】１～３",null,null,"【施設類型】４～５",null,null,"【施設類型】６～８"]
[null,"（記載方法・記載例）",null,null,null,null,null,null,null,null,null,null,"施設類型",null,null,"【Ｂ】",null,null,null,"勤務あり","勤務なし"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null," １　新型コロナウイルス感染症患者の入院受入を割り当てた医療機関",null,null," 陽性患者入院以降、勤務実績あり",null,null,null,"20万円","10万円",null,null,null,null,null,null,null,null," １　新型コロナウイルス感染症患者の入院受入を割り当てた医療機関"]
[null,null,null,null,null,null,null,null,null,null,null,null," ２　帰国者・接触者外来を設置する医療機関",null,null," 陽性・疑い患者来院以降、勤務実績あり",null,null,null,"20万円","10万円",null,null,null,null,null,null,null,null," ２　帰国者・接触者外来を設置する医療機関"]
[null,"紙申請用",null,null,null,null,null,null,null,null,null,null," ３　地域外来・検査センター",null,null," 陽性・疑い患者来院以降、勤務実績あり",null,null,null,"20万円","10万円",null,null,null,null,null,null,null,null," ３　地域外来・検査センター"]
[null,null,null,null,null,null,null,null,null,null,null,null," ４　宿泊療養受入施設での対応",null,null," 軽症者等入所以降、勤務実績あり",null,null,null,"20万円","－",null,null,null,null,null,null,null,null,null,null,null," ４　宿泊療養受入施設での対応"]
[null,"様式第５号別紙",null,null,null,null,null,null,null,null,null,null," ５　自宅療養を行う場合の新型コロナウイルス感染症患者に対するフォローアップ業務",null,null," 軽症者等に対する、勤務実績あり",null,null,null,"20万円","－",null,null,null,null,null,null,null,null,null,null,null," ５　自宅療養を行う場合の新型ｺﾛﾅｳｲﾙｽ感染症患者に対するﾌｫﾛｰｱｯﾌﾟ業務"]
[null,null,null,null,null,null,null,null,null,null,null,null," ６　１～５以外の病院及び診療所",null,null," 陽性患者入院以降、勤務実績あり",null,null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ６　１～５以外の病院及び診療所"]
[null,null,null,null,null,null,null,null,null,null,null,null," ７　訪問看護ステーション",null,null," 陽性患者訪問日以降、勤務実績あり",null,null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ７　訪問看護ステーション"]
[null,null,null,null,null,null,null,null,null,null,null,null," ８　助産所",null,null," 陽性妊産婦患者入所以降、勤務実績あり",null,null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ８　助産所"]
[]
["【委託・派遣業者→医療機関→都道府県】給付対象内訳_新型コロナウイルス感染症対応従事者慰労金（委託・派遣労働者分）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"▼\n▼\n▼\n▼",null,null,null,null,null,null,null,null,null,"他医療機関等での、勤務実績あり　　（１番～３番）",null,null,"他医療機関等での、勤務実績あり　　（４番～５番）",null,null,"他医療機関等での、勤務実績あり　　（６番～８番）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"←　給付対象者の支給申請金額の合計額を記載して下さい。"]
[null,null,null,null,null,null,null,null,null,null,"合計申請額（円）","○○○○",null,null,null,null,null,null,null,null,null,null,"都道府県が債主登録を行う際に必要な情報",null,null,null,null,null,null,null,"申請する施設　以外",null,null,"申請する施設　以外",null,null,"申請する施設　以外"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"他施設と\n合算","申請施設","申請施設\n以外",null,null,null,null,null,null,null,null,null,"１番～３番の合算",null,null,"４番～５番の合算",null,null,"６番～８番の合算"]
[]
["管理番号\n1 からの\n自動連番","医療機関コード",null,null,null,null,null,null,null,null,null,"申請する\n医療機関等\n\n名称","給付申請\n金額","\n氏名\n（漢字）\n\n姓と名の間は空けてください。","\nフリガナ\n（カタカナ）\n\n姓と名の間は空けてください。","\n生年月日\n（令和○年○月○日）\n","\n性別\n\n男性\n女性","法人名","【Ａ】 \n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】\n申請する\n医療機関等\nでの\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","【Ｃ】\n\n他医療機関等\nでの\n勤務実績\n\n（有り／無し）","委任状\n徴収済","金融機関名","金融機関\nコード","支店名\n","支店番号\n(店番)","預金種別\n1：普通\n2：当座\n4：貯蓄","口座番号","口座名義\n（カタカナ）\n姓と名を空けてください","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 １～３\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】１～３\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 ４～５\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】４～５\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 ６～８\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】６～８\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）"]
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[3,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○○○","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
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[6,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○○○","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
[7,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○○○","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
[8,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○○○","○○日","有り","有り","済",null,null,null,null,null,null,null,"○○○○","○○日","有り","○○○○","○○日","無し","○○○○","○○日","無し"]
[9,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○○○","○○日","無し","無し","済"]
[10,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○○○","○○日","無し","無し","済"]
[11,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○○○","○○日","無し","無し","済"]
[12,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○○○","○○日","無し","無し","済"]
[13,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○○○","○○日","無し","無し","済"]
[14,1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○○　○○","○年○月○日","男性","○○○○","○○日","無し","無し","済"]
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["～","～",null,null,null,null,null,null,null,null,null,"～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～","～"]
["○○",1,2,3,4,5,6,7,8,9,0,"○○○○","○○○○○○","○○　○○","○年○月○日","○年○月○日","男性","男性","○○日","無し","無し","済"]
["↑","↑",null,null,null,null,null,null,null,null,null,"↑","↑","↑","↑","↑","↑","↑","↑","↑","↑","↑"]
["番号を１から連番で付して下さい。","医療機関コードを様式第１号から転記して下さい。",null,null,null,null,null,null,null,null,null,"医療機関名称を様式第１号から転記してください。","給付対象者の慰労金の額を記載してください。","給付対象者の氏名（漢字）を記載してください。","給付対象者の氏名（カナ）を記載してください。","給付対象者の生年月日を記載してください。","給付対象者の性別を記載してください。","委託・派遣労働者の受託・派遣元の法人名（会社名）を記載してください。","給付対象者の起点日から6月30日までの勤務日数（他の医療機関での勤務実績を含める）を記載してください。","給付対象者の起点日から6月30日までのコロナ患者受け入れ後の勤務実績がある場合は「有り」、無い場合は「無し」を記載してください。","給付対象者が他の医療機関等での勤務実績がある場合は「有り」、無い場合は「無し」を入力してください。","給付対象者から委任状を徴収したら「済」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,"・様式第１号において、「国又は自治体が設置する医療機関等において制度上の問題により、医療従事者への迅速な振込ができない医療機関である」に「はい」を選択した場合、都道府県からの振込となるため、給付対象者の慰労金の振込先口座を記入してください。",null,null,null,null,null,null,"・他施設（施設類型１～３）で勤務実績が「有り」の場合、「医療機関等名称（複数ある場合はどこか１つ）」「起点日から６月30日までの延べ勤務日数」「他施設（施設類型１～３）以外の場合でのコロナ患者受け入れ以降の勤務実績の有無（「有り」「無し」）を記載してください。\n",null,null,"・他施設（施設類型４～５）で勤務実績が「有り」の場合、「医療機関等名称（複数ある場合はどこか１つ）」「起点日から６月30日までの延べ勤務日数」「他施設（施設類型４～５）以外の場合でのコロナ患者受け入れ以降の勤務実績の有無（「有り」「無し」）を記載してください。\n",null,null,"・他施設（施設類型６～８）で勤務実績が「有り」の場合、「医療機関等名称（複数ある場合はどこか１つ）」「起点日から６月30日までの延べ勤務日数」「他施設（施設類型６～８）以外の場合でのコロナ患者受け入れ以降の勤務実績の有無（「有り」「無し」）を記載してください。\n"]

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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,"【施設類型】１～３",null,null,"【施設類型】４～５",null,null,"【施設類型】６～８"]
[null,null,null,null,null,null,null,null,null,null,null,null,"施設類型",null,null,"【Ｂ】",null,null,null,"勤務あり","勤務なし"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null," １　新型コロナウイルス感染症患者の入院受入を割り当てた医療機関",null,null," 陽性患者入院以降、勤務実績あり",null,null,null,"20万円","10万円",null,null,null,null,null,null,null,null," １　新型コロナウイルス感染症患者の入院受入を割り当てた医療機関"]
[null,null,null,null,null,null,null,null,null,null,null,null," ２　帰国者・接触者外来を設置する医療機関",null,null," 陽性・疑い患者来院以降、勤務実績あり",null,null,null,"20万円","10万円",null,null,null,null,null,null,null,null," ２　帰国者・接触者外来を設置する医療機関"]
[null,"紙申請用",null,null,null,null,null,null,null,null,null,null," ３　地域外来・検査センター",null,null," 陽性・疑い患者来院以降、勤務実績あり",null,null,null,"20万円","10万円",null,null,null,null,null,null,null,null," ３　地域外来・検査センター"]
[null,null,null,null,null,null,null,null,null,null,null,null," ４　宿泊療養受入施設での対応",null,null," 軽症者等入所以降、勤務実績あり",null,null,null,"20万円","－",null,null,null,null,null,null,null,null,null,null,null," ４　宿泊療養受入施設での対応"]
[null,"様式第５号別紙",null,null,null,null,null,null,null,null,null,null," ５　自宅療養を行う場合の新型コロナウイルス感染症患者に対するフォローアップ業務",null,null," 軽症者等に対する、勤務実績あり",null,null,null,"20万円","－",null,null,null,null,null,null,null,null,null,null,null," ５　自宅療養を行う場合の新型ｺﾛﾅｳｲﾙｽ感染症患者に対するﾌｫﾛｰｱｯﾌﾟ業務"]
[null,null,null,null,null,null,null,null,null,null,null,null," ６　１～５以外の病院及び診療所",null,null," 陽性患者入院以降、勤務実績あり",null,null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ６　１～５以外の病院及び診療所"]
[null,null,null,null,null,null,null,null,null,null,null,null," ７　訪問看護ステーション",null,null," 陽性患者訪問日以降、勤務実績あり",null,null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ７　訪問看護ステーション"]
[null,null,null,null,null,null,null,null,null,null,null,null," ８　助産所",null,null," 陽性妊産婦患者入所以降、勤務実績あり",null,null,null,"20万円","5万円",null,null,null,null,null,null,null,null,null,null,null,null,null,null," ８　助産所"]
[]
["【医療機関→都道府県】給付対象内訳_新型コロナウイルス感染症対応従事者慰労金",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"▼\n▼\n▼\n▼",null,null,null,null,null,null,null,null,null,"他医療機関等での、勤務実績あり　　（１番～３番）",null,null,"他医療機関等での、勤務実績あり　　（４番～５番）",null,null,"他医療機関等での、勤務実績あり　　（６番～８番）"]
[null,null,null,null,null,null,null,null,null,null,null,null,"←　給付対象者の支給申請金額の合計額を記載して下さい。"]
[null,null,null,null,null,null,null,null,null,null,"合計申請額（円）",null,null,null,null,null,null,null,null,null,null,null,"都道府県が債主登録を行う際に必要な情報",null,null,null,null,null,null,null,"申請する施設　以外",null,null,"申請する施設　以外",null,null,"申請する施設　以外"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"他施設と\n合算","申請施設","申請施設\n以外",null,null,null,null,null,null,null,null,null,"１番～３番の合算",null,null,"４番～５番の合算",null,null,"６番～８番の合算"]
[]
["管理番号\n1 からの\n自動連番","医療機関コード",null,null,null,null,null,null,null,null,null,"申請する\n医療機関等\n\n名称","給付申請\n金額","\n氏名\n（漢字）\n\n姓と名の間は空けてください。","\nフリガナ\n（カタカナ）\n\n姓と名の間は空けてください。","\n生年月日\n（令和○年○月○日）\n","\n性別\n\n男性\n女性","法人名","【Ａ】 \n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】\n申請する\n医療機関等\nでの\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","【Ｃ】\n\n他医療機関等\nでの\n勤務実績\n\n（有り／無し）","委任状\n徴収済","金融機関名","金融機関\nコード","支店名\n","支店番号\n(店番)","預金種別\n1：普通\n2：当座\n4：貯蓄","口座番号","口座名義\n（カタカナ）\n姓と名を空けてください","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 １～３\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】１～３\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 ４～５\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】４～５\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）","医療機関等\n名称\n\n複数の場合は\nどこか、１か所","【Ａ】 ６～８\n起点日から\n6/30までの期間\nにおける\n延べ\n勤務日数\n","【Ｂ】６～８\n申請する\n医療機関等\n以外での\nコロナ患者受入\n以降の\n勤務実績（※）\n（有り／無し）"]

{"sheet":"様式第6号　都道府県宛交付申請書（紙申請用・記載方法） ","index":18,"n_rows":45,"n_cols":8,"rows_kept":45,"cut":false,"hidden":false,"merged":[[0,7,0,8],[1,7,1,8],[2,6,2,8],[4,6,4,8],[7,0,7,1],[13,6,13,8],[14,6,14,8],[15,6,15,8],[19,0,19,8],[20,0,20,9],[24,0,24,8],[29,0,29,8],[33,5,33,6],[34,1,34,7],[35,1,35,7],[37,1,37,8],[38,1,38,7],[39,1,39,9],[43,1,43,7],[44,1,44,7],[0,0,1,2]]}
["（記載方法・記載例）",null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"様式第6号"]
[null,null,null,null,null,null,"（文書番号）"]
[]
[null,null,null,null,null,null,"2020-07-31"]
[null,null,null,null,null,null,"　"]
[]
["○○県",null,"知事殿"]
[]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,"医療法人社団　△△病院"]
[null,null,null,null,null,null,"病院長　厚生太郎"]
[null,null,null,null,null,null,"（押　印　省　略）"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金給付申請書"]
[]
[]
[]
["　　標記について、次により交付金を給付されるよう関係書類を添えて申請する。"]
[]
[]
[]
[]
["記"]
[]
[]
[]
[null,"１．支給申請額",null,null,null,2903000,null,"円"]
[]
[null,"２．添付書類"]
[]
[null,"　・新型コロナウイルス感染症対応従事者慰労金計算書（様式第1号）"]
[]
[null,"　・新型コロナウイルス感染症対応従事者慰労金内訳（様式第2号）"]
[]
[]
[]
[]
[null,"以上"]

{"sheet":"様式第6号　都道府県宛交付申請書 ","index":19,"n_rows":45,"n_cols":8,"rows_kept":45,"cut":false,"hidden":false,"merged":[[0,7,0,8],[1,7,1,8],[2,6,2,8],[4,6,4,8],[7,0,7,1],[13,6,13,8],[14,6,14,8],[15,6,15,8],[19,0,19,8],[20,0,20,9],[24,0,24,8],[29,0,29,8],[33,5,33,6],[34,1,34,7],[35,1,35,7],[37,1,37,8],[38,1,38,7],[39,1,39,9],[43,1,43,7],[44,1,44,7]]}
[null,null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"様式第6号"]
[]
[]
[]
[null,null,null,null,null,null,"　"]
[]
[null,null,"知事殿"]
[]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　"]
[]
[null,null,null,null,null,null,"（押　印　省　略）"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金給付申請書"]
[]
[]
[]
["　　標記について、次により交付金を給付されるよう関係書類を添えて申請する。"]
[]
[]
[]
[]
["記"]
[]
[]
[]
[null,"１．支給申請額",null,null,null,null,null,"円"]
[]
[null,"２．添付書類"]
[]
[null,"　・新型コロナウイルス感染症対応従事者慰労金計算書（様式第1号）"]
[]
[null,"　・新型コロナウイルス感染症対応従事者慰労金内訳（様式第2号）"]
[]
[]
[]
[]
[null,"以上"]

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["様式第7号（記載方法・記載例）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"紙申請用"]
["【医療機関→都道府県】実績報告書_新型コロナウイルス感染症対応従事者慰労金"]
[]
["施設概要"]
[]
["医療機関コード\n（10桁）",null,null,{"$f":"IF('[2]（様式第1号）医療機関情報'!D10=0,\"\",'[2]（様式第1号）医療機関情報'!D10)","v":1},2,{"$f":"IF('[2]（様式第1号）医療機関情報'!F10=0,\"\",'[2]（様式第1号）医療機関情報'!F10)","v":"3"},4,5,6,7,8,9,0,"施設名称",null,null,"医療法人社団　△△病院"]
["連絡先",null,null,"担当部署",null,null,null,null,"担当者氏名",null,null,null,null,"連絡先電話番号",null,null,null,null,null,"連絡先メールアドレス"]
[null,null,null,"○○部",null,null,null,null,"○○　○○",null,null,null,null,"03-XXXX-XXXX",null,null,null,null,null,"○○○○＠○○．○○"]
[]
[]
["所在地",null,"都道府県名",null,null,"市区町村以降"]
[null,null,{"$f":"IF('[2]（様式第1号）医療機関情報'!K16=0,\"\",'[2]（様式第1号）医療機関情報'!K16)","v":"東京都"},null,null,"中央区日本橋○ー○ー○"]
[]
[]
["給付実績額"]
[]
[]
[null,null,null,null,null,null,"科目",null,null,null,null,null,null,"人数",null,null,null,"給付額（円）"]
[null,null,null,null,null,null,"慰労金",null,null,null,null,null,null,15,null,null,null,2900000]
[null,null,null,null,null,null,"振込手数料",null,null,null,null,null,null,null,null,null,null,3000]
[null,null,null,null,null,null,"慰労金給付済額（円）",null,null,null,null,null,null,null,null,null,null,{"$f":"R19+R20","v":2903000}]
[null,null,null,null,null,null,"慰労金給付決定額（円）",null,null,null,null,null,null,null,null,null,null,2903000,null,null,null,null,"交付決定通知を確認し、ご記載下さい。"]
[null,null,null,null,null,null,"精算額",null,null,null,null,null,null,null,null,null,null,{"$f":"R21-R22","v":0}]
[]
[]
["※こちらの実績書は、職員等への慰労金給付が終了したら1か月以内をめどに、各都道府県慰労金担当窓口に添付書類と合わせてご提出ください。"]
["◎給付後に提出いただく書類は以下の通りです。\n・慰労金を職員等に対して給付した際の証憑（個人ごとの振り込みの記録や現金で給付した場合の受領簿など給付額が分かるもの）\n （※委託業者等に雇用される者に委託業者等経由で給付を実施した場合は、当該委託業者等が委託業者等に雇用される者に給付を行ったことが確認できる証憑も必要）\n・慰労金の給付にあたって振込手数料を要した場合の、振込手数料がわかる書類　等"]

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["様式第7号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"紙申請用"]
["【医療機関→都道府県】実績報告書_新型コロナウイルス感染症対応従事者慰労金"]
[]
["施設概要"]
[]
["医療機関コード\n（10桁）",null,null,null,null,null,null,null,null,null,null,null,null,"施設名称"]
["連絡先",null,null,"担当部署",null,null,null,null,"担当者氏名",null,null,null,null,"連絡先電話番号",null,null,null,null,null,"連絡先メールアドレス"]
[]
[]
[]
["所在地",null,"都道府県名",null,null,"市区町村以降"]
[]
[]
[]
["給付実績額"]
[]
[]
[null,null,null,null,null,null,"科目",null,null,null,null,null,null,"人数",null,null,null,"給付額（円）"]
[null,null,null,null,null,null,"慰労金"]
[null,null,null,null,null,null,"振込手数料"]
[null,null,null,null,null,null,"慰労金給付済額（円）"]
[null,null,null,null,null,null,"慰労金給付決定額（円）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"交付決定通知を確認し、ご記載下さい。"]
[null,null,null,null,null,null,"精算額"]
[]
[]
["※こちらの実績書は、職員等への慰労金給付が終了したら1か月以内をめどに、各都道府県慰労金担当窓口に添付書類と合わせてご提出ください。"]
["◎給付後に提出いただく書類は以下の通りです。\n・慰労金を職員等に対して給付した際の証憑（個人ごとの振り込みの記録や現金で給付した場合の受領簿など給付額が分かるもの）\n （※委託業者等に雇用される者に委託業者等経由で給付を実施した場合は、当該委託業者等が委託業者等に雇用される者に給付を行ったことが確認できる証憑も必要）\n・慰労金の給付にあたって振込手数料を要した場合の、振込手数料がわかる書類　等"]

{"sheet":"（様式第8号）都道府県宛実績報告鑑（紙・記載）","index":22,"n_rows":47,"n_cols":8,"rows_kept":47,"cut":false,"hidden":false,"merged":[[0,7,0,8],[1,7,1,8],[2,6,2,8],[4,6,4,8],[7,0,7,1],[13,6,13,8],[14,6,14,8],[15,6,15,8],[19,0,19,8],[20,0,20,9],[24,0,24,8],[29,0,29,8],[33,5,33,6],[34,1,34,7],[35,1,35,7],[37,1,37,7],[39,1,39,7],[40,1,40,7],[41,1,41,7],[45,1,45,7],[46,1,46,7],[0,0,1,2]]}
["（記載方法・記載例）",null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"様式第8号"]
[null,null,null,null,null,null,"（文書番号）"]
[]
[null,null,null,null,null,null,"令和２年×月××日"]
[]
[]
["○○県",null,"知事殿"]
[]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,"医療法人社団　△△病院"]
[null,null,null,null,null,null,"病院長　厚生太郎"]
[null,null,null,null,null,null,"（押　印　省　略）"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金給付実績報告書"]
[]
[]
[]
["　　標記について、別紙により給付実績を報告いたします。"]
[]
[]
[]
[]
["記"]
[]
[]
[]
[]
[]
[null,"　添付書類"]
[]
[null,"　・実績報告書（様式第7号）"]
[]
[null,"　・慰労金を職員等に対して給付した際の証憑"]
[]
[null,"　・要した振込手数料にかかる証憑"]
[]
[null,"　・その他"]
[]
[]
[null,"以上"]

{"sheet":"（様式第8号）（医療機関→都道府県）都道府県宛実績報告鑑 ","index":23,"n_rows":47,"n_cols":8,"rows_kept":47,"cut":false,"hidden":false,"merged":[[0,7,0,8],[1,7,1,8],[2,6,2,8],[4,6,4,8],[7,0,7,1],[13,6,13,8],[14,6,14,8],[15,6,15,8],[19,0,19,8],[20,0,20,9],[24,0,24,8],[29,0,29,8],[33,5,33,6],[34,1,34,7],[35,1,35,7],[37,1,37,7],[39,1,39,7],[40,1,40,7],[41,1,41,7],[45,1,45,7],[46,1,46,7]]}
[null,null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"様式第8号"]
[]
[]
[]
[]
[]
[null,null,"知事殿"]
[]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　"]
[]
[null,null,null,null,null,null,"（押　印　省　略）"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["新型コロナウイルス感染症対応従事者慰労金給付実績報告書"]
[]
[]
[]
["　　標記について、別紙により給付実績を報告いたします。"]
[]
[]
[]
[]
["記"]
[]
[]
[]
[]
[]
[null,"　添付書類"]
[]
[null,"　・実績報告書（様式第7号）"]
[]
[null,"　・慰労金を職員等に対して給付した際の証憑"]
[]
[null,"　・要した振込手数料にかかる証憑"]
[]
[null,"　・その他"]
[]
[]
[null,"以上"]

{"sheet":"（参考様式第1号）他医療機関分勤務証明依頼 （紙・記載）","index":24,"n_rows":35,"n_cols":10,"rows_kept":35,"cut":false,"hidden":false,"merged":[[0,7,0,8],[1,7,1,8],[2,6,2,8],[4,6,4,8],[7,0,7,1],[13,6,13,8],[14,6,14,8],[18,0,18,9],[19,0,19,9],[24,0,24,8],[29,0,29,8],[0,0,1,2]]}
["（記載方法・記載例）",null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"参考様式第1号"]
[null,null,null,null,null,null,"（発翰番号）"]
[]
[null,null,null,null,null,null,"令和２年×月××日"]
[]
[]
["医療法人●●",null,"院長殿"]
[]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,"医療法人社団△△病院"]
[null,null,null,null,null,null,"病院長　厚労太郎",null,null,"㊞"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["「新型コロナウイルス感染症対応従事者慰労金」給付に係る勤務証明について（依頼）"]
[]
[]
[]
[]
["　下記の職員に係る標記について、別紙によりご証明くださるようお願いします。"]
[]
[]
[]
[]
["記"]
[]
[]
[null,null,"証明対象職員：●●●●"]
[null,null,"職名：〇〇〇〇"]
[null,null,"対象期間：●年●月●日～●年●月●日の間の勤務日数"]

{"sheet":"（参考様式第1号）他医療機関分勤務証明依頼","index":25,"n_rows":35,"n_cols":10,"rows_kept":35,"cut":false,"hidden":false,"merged":[[0,7,0,8],[1,7,1,8],[2,6,2,8],[4,6,4,8],[7,0,7,1],[13,6,13,8],[14,6,14,8],[18,0,18,9],[19,0,19,9],[24,0,24,8],[29,0,29,8]]}
[null,null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"参考様式第1号"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　"]
[null,null,null,null,null,null,null,null,null,"㊞"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["「新型コロナウイルス感染症対応従事者慰労金」給付に係る勤務証明について（依頼）"]
[]
[]
[]
[]
["　下記の職員に係る標記について、別紙によりご証明くださるようお願いします。"]
[]
[]
[]
[]
["記"]
[]
[]
[null,null,"証明対象職員："]
[null,null,"職名："]
[null,null,"対象期間："]

{"sheet":"（参考様式第2号）他医療機関分勤務証明回答 （紙・記載）","index":26,"n_rows":39,"n_cols":8,"rows_kept":39,"cut":false,"hidden":false,"merged":[[0,7,0,8],[1,7,1,8],[2,6,2,8],[4,6,4,8],[6,0,6,2],[7,1,7,2],[13,6,13,8],[14,6,14,8],[18,0,18,9],[19,0,19,9],[24,0,24,8],[29,0,29,8],[0,0,1,2]]}
["（記載方法・記載例）",null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"参考様式第２号"]
[null,null,null,null,null,null,"（発翰番号）"]
[]
[null,null,null,null,null,null,"令和２年×月××日"]
[]
["医療法人社団　△△病院"]
[null,"病院長　厚労太郎",null,"殿"]
[]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,null,null,"医療法人●●"]
[null,null,null,null,null,null,"院長　〇〇　〇〇　㊞"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["「新型コロナウイルス感染症対応従事者慰労金」給付に係る勤務証明について（回答）"]
[]
[]
[]
[]
["　令和〇年〇月〇日付けで貴職より依頼のありました標記について、下記の通り"]
["回答いたします。"]
[]
[]
[]
["記"]
[]
[null,null,"証明対象職員氏名：〇〇〇〇"]
[null,null,"所属部門・部署：○○○○"]
[null,null,"職種：○○○○"]
[null,null,"主な業務内容：○○○○"]
[null,null,"起点日から6月末までの勤務日数：〇〇〇〇"]
[null,null,"新型コロナウイルス感染症患者１例目受入以降６月末"]
[null,null,"までの勤務日数："]
[null,null,"施設類型："]

{"sheet":"（参考様式第2号）他医療機関分勤務証明回答","index":27,"n_rows":39,"n_cols":8,"rows_kept":39,"cut":false,"hidden":false,"merged":[[0,7,0,8],[1,7,1,8],[2,6,2,8],[4,6,4,8],[6,0,6,2],[7,1,7,2],[13,6,13,8],[14,6,14,8],[18,0,18,9],[19,0,19,9],[24,0,24,8],[29,0,29,8]]}
[null,null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"参考様式第２号"]
[]
[]
[]
[]
[]
[null,null,null,"殿"]
[]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　"]
[null,null,null,null,null,null,"　　　　　　　　　　㊞"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["「新型コロナウイルス感染症対応従事者慰労金」給付に係る勤務証明について（回答）"]
[]
[]
[]
[]
["　令和〇年〇月〇日付けで貴職より依頼のありました標記について、下記の通り"]
["回答いたします。"]
[]
[]
[]
["記"]
[]
[null,null,"証明対象職員氏名："]
[null,null,"所属部門・部署："]
[null,null,"職種："]
[null,null,"主な業務内容："]
[null,null,"起点日から6月末までの勤務日数："]
[null,null,"新型コロナウイルス感染症患者１例目受入以降６月末"]
[null,null,"までの勤務日数："]
[null,null,"施設類型："]

{"sheet":"（参考様式第3号）自医療機関分勤務証明（紙・記載）","index":28,"n_rows":39,"n_cols":9,"rows_kept":39,"cut":false,"hidden":false,"merged":[[0,7,0,8],[1,7,1,8],[2,6,2,8],[4,6,4,8],[13,4,13,8],[14,5,14,7],[18,0,18,8],[19,0,19,8],[24,0,24,8],[29,0,29,8],[0,0,1,2]]}
["（記載方法・記載例）",null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"参考様式第３号"]
[null,null,null,null,null,null,"（発翰番号）"]
[]
[null,null,null,null,null,null,"令和２年×月××日"]
[]
[]
[]
[]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　",null,null,null,"医療法人社団　△△病院"]
[null,null,null,null,null,"病院長　厚労太郎",null,null,"㊞"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["「新型コロナウイルス感染症対応従事者慰労金」給付に係る勤務証明"]
[]
[]
[]
[]
["標記について、以下とおり相違のないことを証明いたします。"]
[]
[]
[]
[]
["記"]
[]
[null,null,"証明対象職員氏名：〇〇〇〇"]
[null,null,"所属部門・部署：○○○○"]
[null,null,"職種：○○○○"]
[null,null,"主な業務内容：○○○○"]
[null,null,"起点日から6月末までの勤務日数：〇〇〇〇"]
[null,null,"新型コロナウイルス感染症患者１例目受入以降６月末"]
[null,null,"までの勤務日数："]
[null,null,"施設類型："]

{"sheet":"（参考様式第3号）自医療機関分勤務証明","index":29,"n_rows":39,"n_cols":9,"rows_kept":39,"cut":false,"hidden":false,"merged":[[0,7,0,8],[1,7,1,8],[2,6,2,8],[4,6,4,8],[13,4,13,8],[14,5,14,7],[18,0,18,8],[19,0,19,8],[24,0,24,8],[29,0,29,8]]}
[null,null,null,null,null,null,null,"紙申請用"]
[null,null,null,null,null,null,null,"参考様式第３号"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　"]
[null,null,null,null,null,null,null,null,"㊞"]
[]
[]
[]
["令和２年度新型コロナウイルス感染症緊急包括支援交付金（医療分）における"]
["「新型コロナウイルス感染症対応従事者慰労金」給付に係る勤務証明"]
[]
[]
[]
[]
["標記について、以下とおり相違のないことを証明いたします。"]
[]
[]
[]
[]
["記"]
[]
[null,null,"証明対象職員氏名："]
[null,null,"所属部門・部署："]
[null,null,"職種："]
[null,null,"主な業務内容："]
[null,null,"起点日から6月末までの勤務日数："]
[null,null,"新型コロナウイルス感染症患者１例目受入以降６月末"]
[null,null,"までの勤務日数："]
[null,null,"施設類型："]