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["学校生活管理指導表（アレルギー疾患用）",null,null,"名前",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"男",null,"・","女",null,null,null,null,null,null,null,null,null,null,null,null,"生",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"学校",null,null,null,null,null,null,null,null,null,null,null,null,"初回提出日",null,null,null,null,null,"令和",null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[null,null,null,"　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　1年（　　　　　）組、2年（　　　　）組、3年（　　　）組、4年（　　　　）組、5年（　　　）組、6年（　　　　）組"]
[]
[null,null,null,"食物アレルギー（あり・なし）　アナフィラキシー（あり・なし）",null,null,"病型・治療",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"学校生活上の留意点",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"【緊急時連絡先】",null,null,"★保護者"]
[null,null,null,null,null,null,"A．食物アレルギー病型（食物アレルギーありの場合のみ記載）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"A．給食",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話："]
[null,null,null,null,null,null,"１．即時型",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,null,null,null,null,null,null,null,null,"１．管理不要"]
[null,null,null,null,null,null,"２．口腔アレルギー症候群",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"２．管理必要"]
[null,null,null,null,null,null,"３．食物依存性運動誘発アナフィラキシー",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"B．食物・食材を扱う授業・活動"]
[null,null,null,null,null,null,"B．アナフィラキシー病型（アナフィラキシーの既往ありの場合のみ記載）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"１．管理不要",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"★連絡医療機関"]
[null,null,null,null,null,null,"１．食物",null,null,null,"（原因",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）",null,"２．管理必要",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療機関名："]
[null,null,null,null,null,null,"２．食物依存性運動誘発アナフィラキシー",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C．運動（体育・部活動等）"]
[null,null,null,null,null,null,"３．運動誘発アナフィラキシー",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"１．管理不要"]
[null,null,null,null,null,null,"４．昆虫",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"２．管理必要"]
[null,null,null,null,null,null,"５．医薬品",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"D．宿泊を伴う校外活動"]
[null,null,null,null,null,null,"６．その他",null,null,null,null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）",null,"１．管理不要"]
[null,null,null,null,null,null,"C．原因食物・診断根拠",null,null,null,null,null,null,null,null,null,null,null,null,"該当する食品の番号に○をし、かつ《　》内に診断根拠を記載",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"２．管理必要"]
[null,null,null,null,null,null,"１．鶏卵",null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,null,"》",null,null,null,null,null,null,null,null,"[診断根拠]該当するもの全てを( )に記載",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"E．その他の配慮・管理事項（自由記載）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話："]
[null,null,null,null,null,null,"２．牛乳・乳製品",null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,null,"》",null,null,null,null,null,null,null,null,"①明らかな症状の既往\n"]
[null,null,null,null,null,null,"３．小麦",null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,null,"》",null,null,null,null,null,null,null,null,"②食物負荷試験陽性\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記載日"]
[null,null,null,null,null,null,"４．ソバ",null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,null,"》",null,null,null,null,null,null,null,null,"③ＩgE抗体等検査結果陽性\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 令和　　年　　月　　日"]
[null,null,null,null,null,null,"５．ピーナッツ",null,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食べたことがない\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医師名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㊞"]
[null,null,null,null,null,null,"６．種実類・木の実類",null,null,null,null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,"》",null,null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"７．甲殻類（エビ・カニ）",null,null,null,null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,"》",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療機関名"]
[null,null,null,null,null,null,"８．果物類",null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,null,"》",null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"９．魚類",null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,null,"》",null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"１０．肉類",null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,null,"》",null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"１１．その他１",null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,null,"》",null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"１２．その他２",null,null,null,null,null,null,null,null,"《",null,null,null,null,null,null,null,null,null,"》",null,"（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　　　　　　　　TEL"]
[null,null,null,null,null,null,"D．緊急時に備えた処方薬",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"確認日",null,null,null,null,null,null,null,null,null,null,null,null,"医師名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"捺印"]
[null,null,null,null,null,null,"１．内服薬：抗ヒスタミン薬",null,null,null,null,null,null,null,null,null,null,null,null,"（商品名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"２．内服薬：ステロイド薬",null,null,null,null,null,null,null,null,null,null,null,null,"（商品名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[null,null,null,null,null,null,"３．内服薬：気管支拡張薬",null,null,null,null,null,null,null,null,null,null,null,null,"（商品名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"４．吸引薬：気管支拡張薬",null,null,null,null,null,null,null,null,null,null,null,null,"（商品名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[null,null,null,null,null,null,"５．アドレナリン自己注射薬",null,null,null,null,null,null,null,null,null,null,null,null,"（商品名　エピペン",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,"６．その他",null,null,null,null,null,"（商品名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[]
["大分県版",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,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",null,null,null,"月",null,null,null,"日"]
[]
[null,null,null,null,null,null,null,null,"アナフィラキシー時は緊急時連絡医療機関への連絡よりも、\nエピペン®投与や救急要請を優先してください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
[]
[]
[]
[]
[null,"（第２版）",null,null,null,null,null,null,null,null,null,null,null,"●学校における日常の取り組み及び緊急時の対応に活用するため、本表に記載された内容を全教職員及び関係機関等で共有することに同意しますか。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"１．同意する"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"２．同意しない",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"保護者署名："]