{"text_format":"2","workbook":"xls","n_sheets":7,"sheets":["海外療養費支給申請書","診療内容明細書","邦訳Ａ","領収明細書","邦訳Ｂ","疾病分類表","海外療養費について"],"not_rendered":{"charts":0,"images":0,"macros":0,"external_links":1,"defined_names":4,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"run_cost":"one","rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900","formulas":"cached_only"}

{"sheet":"海外療養費支給申請書","index":0,"n_rows":77,"n_cols":33,"rows_kept":77,"cut":false,"hidden":false,"merged":[[7,1,9,6],[5,7,6,16],[4,23,5,23],[4,24,5,24],[21,1,22,6],[21,7,22,32],[4,26,5,26],[4,28,5,28],[4,29,5,29],[4,30,5,30],[4,31,5,31],[4,25,5,25],[3,1,4,6],[4,20,5,20],[4,21,5,21],[0,10,1,22],[3,7,4,16],[3,17,3,32],[4,18,5,18],[4,19,5,19],[5,1,6,6],[7,26,9,26],[7,27,9,28],[7,29,9,29],[7,30,9,31],[7,32,9,32],[8,7,9,20],[7,7,7,20],[7,21,9,22],[7,23,9,25],[10,1,13,6],[11,17,11,32],[12,7,13,32],[14,1,15,6],[14,7,15,11],[14,12,15,12],[14,13,15,17],[14,18,15,18],[14,19,15,32],[16,1,18,6],[16,7,18,14],[16,15,18,16],[16,17,18,19],[16,20,18,20],[16,21,18,22],[16,23,18,23],[16,24,18,25],[16,26,18,26],[16,27,18,29],[16,30,18,32],[19,1,20,6],[19,7,20,17],[19,18,20,22],[19,23,20,25],[19,26,20,26],[19,27,20,28],[19,29,20,29],[19,30,20,31],[19,32,20,32],[23,1,24,6],[23,7,24,32],[35,24,36,32],[37,7,38,16],[25,1,27,6],[25,7,27,32],[28,1,31,6],[28,7,29,10],[28,11,29,32],[30,7,32,10],[30,11,32,32],[32,1,32,6],[62,23,63,23],[62,24,63,31],[33,1,34,6],[33,7,34,10],[33,11,34,32],[35,1,38,6],[35,7,36,16],[35,17,38,18],[35,19,38,20],[35,21,38,23],[60,20,61,21],[37,24,38,32],[39,1,41,6],[39,7,41,32],[42,1,51,6],[49,7,51,32],[42,7,43,32],[62,32,63,32],[53,1,56,5],[53,7,54,31],[55,15,55,19],[55,20,55,31],[58,1,63,2],[60,3,63,8],[60,9,63,10],[60,11,63,16],[60,17,63,19],[67,1,76,1],[68,2,69,6],[68,17,69,21],[68,22,69,32],[70,2,70,6],[60,22,61,24],[60,25,61,25],[60,26,61,31],[60,32,61,32],[62,20,63,22],[74,2,75,6],[65,2,67,6],[65,17,67,17],[65,21,67,21],[65,25,67,25],[65,29,67,29],[76,2,78,6],[76,7,76,10],[78,17,78,23],[78,24,78,32],[44,7,48,32],[70,17,71,21],[70,22,71,32],[71,2,71,6],[72,2,72,6],[73,2,73,6]],"flags":["formulas_cached_only"]}
[{"$nulls":6},"被保険者",null,null,null,"海外療養費支給申請書"]
[{"$nulls":6},"被扶養者"]
[]
[null,"被保険者等",{"$nulls":5},"記号",{"$nulls":9},"記号番号が分からない場合はマイナンバーを記入してください"]
[]
[null,"記号・番号",{"$nulls":5},"番号"]
[]
[null,"被保険者氏名",{"$nulls":5},"（フリガナ）",{"$nulls":13},"生年月日",{"$nulls":4},"\n年",null,null,"\n月",null,null,"\n日"]
[]
[]
[null,"被保険者の住所"]
[{"$nulls":7},"〒",null,null,null,"-",{"$nulls":5},"丁目、番地、アパート名等詳細に記入してください。"]
[]
[]
[null,"電話番号",{"$nulls":10},"-",{"$nulls":5},"-"]
[]
[null,"申請が被扶養者の\n場合はその者の氏名",{"$nulls":13},"生年月日",{"$nulls":4},"\n年",null,null,"\n月",null,null,"\n日","被保険者\nとの続柄"]
[]
[]
[null,"傷病名",{"$nulls":16},"発病又は負傷の\n年月日",{"$nulls":7},"年",null,null,"月",null,null,"日"]
[]
[null,"発病の原因"]
[]
[null,"傷病の経過"]
[]
[null,"仕事中又は第三者行為\nによる傷病ですか？",{"$nulls":5},"　□は　い　⇒　□仕事中（業務上・通勤途上）　□第三者行為（交通事故等）　\n　□いいえ"]
[]
[]
[null,"受診した医療機関等の\n名称、所在地及び\n診療した医師等の氏名",{"$nulls":5},"名称"]
[]
[{"$nulls":7},"所在地"]
[]
[null,"国名"]
[null,"（　　　　　　　　　　　　）",{"$nulls":5},"医師等の氏名"]
[]
[null,"診療又は手当の期間",{"$nulls":5},"年　　　　月　　　　日から",{"$nulls":11},"日間",null,"うち入院　した期間",null,null,"年　　　　月　　　　　日から"]
[]
[{"$nulls":7},"年　　　　月　　　　日まで",{"$nulls":16},"年　　　　月　　　　　日まで"]
[]
[null,"診療又は手当の内容"]
[]
[]
[null,"受診者の情報",{"$nulls":5},"（１）受診者の海外渡航期間　　令和　　年　　　月　　　日　　～　令和　　年　　　月　　　日　"]
[]
[{"$nulls":7},"　　　※海外渡航期間が確認できる書類として、以下のいずれかの書類を添付してください。\n　　　　　・パスポートの写し（①氏名、顔写真と②当該期間の出入国スタンプのページ）\n　　　　　・査証（ビザ）の写し（氏名と有効期限が記載されたもの）\n　　　　　・航空券の写し（eチケットの控えを含む）"]
[]
[]
[]
[]
[{"$nulls":7},"（２）診療を受けた期間における海外渡航（滞在）の理由を選んでください。\n　　　□海外勤務（同行家族を含む）　□旅行　　□留学　　□その他（　　　　　　　　　　　　　　）"]
[]
[]
[]
[null,"同意欄",{"$nulls":5},"療養を受けた海外の医療機関等に中部アイティ産業健康保険組合が文書等により当申請内容を照会することに同意します。"]
[]
[{"$nulls":15},"（被保険者氏名）"]
[]
[]
[null,"被保険者　　　　　銀行口座",null,"□マイナポータル等で事前登録した公金口座を利用します。（利用する場合は□にチェック、利用しない場合は下記の欄を記入。）"]
[null,null,null,"注）口座情報の反映には登録から数日を要します。また、受取代理人を指定する場合は、公金口座を利用できません。"]
[{"$nulls":9},"銀行\n金庫\n農協",{"$nulls":7},"本店\n支店\n出張所",null,null,"普通",null,"口座番号",null,null,"(",{"$nulls":6},")"]
[]
[{"$nulls":20},"口座名義",null,null,"(",{"$nulls":8},")"]
[]
[]
[null,null,"支　給　金　額",{"$nulls":14},"常務理事",null,null,null,"事務長",null,null,null,"係",null,null,null,"確認"]
[{"$nulls":7},"￥"]
[null,"健保組合処理欄"]
[null,null,"款　項　目",{"$nulls":14},"取　　得",{"$nulls":4},"　　　　　年　　　　　月　　　　　日　　"]
[]
[null,null,"支　給　決　定",{"$nulls":14},"喪　　失",{"$nulls":4},"　　　　　年　　　　　月　　　　　日　　"]
[null,null,"年　　月　　日"]
[null,null,"支　　　　　払"]
[null,null,"年　　月　　日",{"$nulls":24},"受  付  日  付  印"]
[null,null,"支給額計算"]
[]
[null,null,"備　　　　　　考",{"$nulls":4},"換算レート"]

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["Request to Attending Physician"]
["担当医へのお願い"]
[null,1,"Please fill in this form so that the patient may claim the social insurance benefit."]
[null,null,"この様式は患者の社会保険の給付の申請に必要ですので、証明をお願いします。"]
[null,2,"This form should be completed and signed by the attending physician."]
[null,null,"この様式は担当医が記入し、署名して下さい。"]
[null,3,"One form for each month and one form for hospitalization/outpatient (home visit) should be filled out."]
[null,null,"各月毎、入院・入院外毎につき、この様式1枚が必要です。"]
[]
["Attending Physician's Statement"]
["診　療　内　容　明　細　書"]
["Form A"]
["様 式　Ａ"]
[]
[1,"Name of Patient (Last, First)"]
[null,"患 者 名"]
[]
[null,"Age(Date of Birth)",{"$nulls":5},"Sex    (  Male  /  Female  )"]
[null,"年齢（生年月日）",{"$nulls":5},"性別   （  男  ・  女  ）"]
[]
[2,"Name of Illness or Injury preferablry with the number of International Classiffication of Diseases for "]
[null,"the use of Social Insurance (Please refer to the table attached to this form)."]
[null,"傷病名及び社会保険用国際疾病分類番号"]
[{"$nulls":11},"（Ｎo.                  )"]
[3,"Date of First Diagnosis : "]
[null,"初 診 日",{"$nulls":4},","]
[]
[4,"Days of Diagnosis and Treatment : ",{"$nulls":6},"days"]
[null,"診 療 日 数",{"$nulls":6},"日間"]
[]
[5,"Type of Treatment"]
[null,"治療の分類"]
[]
[null,"□","Hospitalization :",null,"From",null,null,"to",null,null,"（　　　　　）","days"]
[null,null,"入院",null,"自",null,null,"至",null,null,"（　　　　　）","日間"]
[]
[null,"□","Outpatient or"]
[null,null,"Home Visit"]
[null,null,"入院外"]
[]
[]
[6,"Nature and Condition of Illness or Injury (in brief)"]
[null,"症 状 の 概 要"]
[]
[]
[7,"Prescription, Operation and any other Treatments (in brief)"]
[null,"処方、手術その他の処置の概要"]
[]
[]
[8,"Was the treatment as a result of an accidential injury?",{"$nulls":7},"Ｙｅｓ","□","Ｎｏ","□"]
[null,"治療は事故の傷害によるものですか？",{"$nulls":7},"はい",null,"いいえ"]
[]
[9,"Itemized amounts paid to Hospital and / or Attending Physician : Fill in Form B"]
[null,"項目別治療実費　　/　　様式Ｂによる"]
[]
[10,"Name and Address of Attending Physician"]
[null,"担当医の名前及び住所"]
[null,null,"Name  名前　：",null,"Last　姓",null,null,"First　名",null,null,"Title　称号"]
[]
[null,null,"Address　住所：",null,"Home　自宅",{"$nulls":4},"Phone　電話"]
[{"$nulls":4},"Office　病院又は診療所",{"$nulls":4},"Phone　電話"]
[]
[]
[null,"Date　日付",{"$nulls":5},"Signature　署名"]
[{"$nulls":9},"Attending Physician　担当医"]
[]
[{"$nulls":6},"Reference Number of your Medical Record (if applicable)"]
[{"$nulls":6},"診療録の番号"]

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[]
[null,"邦　　訳　（Ａ）"]
[]
[null,"２．傷病名及び社会保険用国際疾病分類番号"]
{"$rows_empty":10}
[null,"６．症状の概要"]
{"$rows_empty":12}
[null,"７．処方、手術その他の処置の概要"]
{"$rows_empty":23}
[{"$nulls":13},"翻 訳 者 記 入 欄"]
[{"$nulls":13},"名前"]
[]
[]
[{"$nulls":13},"住所"]
[{"$nulls":19},"電話"]

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["Request to Attending Physician or Superintendent of Hospital / Clinic "]
["担当医又は病院事務長へのお願い"]
[null,1,"Please fill in this form so that the patient may claim the social insurance benefit."]
[null,null,"この様式は患者の社会保険の給付の申請に必要ですので、証明をお願いします。"]
[null,2,"This form should be completed and signed by either the attending physician or the superintendent of hospital/clinic."]
[null,null,"この様式は担当医又は病院事務長が記入し、署名して下さい。"]
[null,3,"One form for each month and one form for hospitalization/outpatient (home visit) should be filled out."]
[null,null,"各月毎、入院・入院外毎につき、この様式1枚が必要です。"]
[null,4,"If not in dollars, please specify the unit used."]
[null,null,"ドル以外の貨幣の場合はその旨を書いて下さい。"]
["Itemized Receipt"]
["診　療　内　容　明　細　書"]
["Form Ｂ"]
["様 式　Ｂ"]
[]
[-1,null,"Fee for Initial Office Visit",{"$nulls":4},"初診料"]
[]
[-2,null,"Fee for Follow-up Office Visit",{"$nulls":4},"再診料"]
[]
[-3,null,"Fee for Home Visit",{"$nulls":4},"往診料"]
[]
[-4,null,"Fee for Hospital Visit",{"$nulls":4},"入院管理料"]
[]
[-5,null,"Hospitalization",{"$nulls":4},"入院費"]
[]
[-6,null,"Consultation",{"$nulls":4},"診察費"]
[]
[-7,null,"Operation ",{"$nulls":4},"手術費"]
[]
[-8,null,"Professional Nursing",{"$nulls":4},"職業看護婦費"]
[]
[-9,null,"X-Ray Examinations",{"$nulls":4},"Ｘ線検査費"]
[]
[-10,null,"Laboratory Tests",{"$nulls":4},"諸検査費"]
[]
[-11,null,"Medicines",{"$nulls":4},"医薬費"]
[]
[-12,null,"Surgical Dressing",{"$nulls":4},"包帯費"]
[]
[-13,null,"Anaethetics",{"$nulls":4},"麻酔費"]
[]
[-14,null,"Operating Room Charge",{"$nulls":4},"手術室費用"]
[]
[-15,null,"Others (Specify)",{"$nulls":4},"その他（項目明記）"]
[]
[{"$nulls":12},"Ｕｎｉｔ　ｉｓ"]
[-16,null,"Total",{"$nulls":4},"合計",{"$nulls":4},"貨幣単位"]
[]
[null,null,"Important  :","Exclude the amount irrelevant to the treatment, i.e. , payment for a luxurious room charge."]
[null,null,"注　意　　：","高級治療室等治療に直接関係のないものは除いて下さい。"]
[]
["Name and Address of Attending Physician / Superintendent of Hospital or Clinic"]
["担当医又は病院事務長の名前及び住所"]
[]
[null,null,"Name  名前　：",null,"Last　姓",null,null,"First　名",null,null,"Title　称号"]
[]
[null,null,"Address　住所：",null,"Home　自宅",{"$nulls":4},"Phone　電話"]
[{"$nulls":4},"Office　病院又は診療所",{"$nulls":4},"Phone　電話"]
[]
[null,"Date　日付",{"$nulls":5},"Signature　署名"]
[{"$nulls":9},"Attending Physician　担当医"]
[]
[{"$nulls":6},"Reference Number of your Medical Record (if applicable)"]
[{"$nulls":6},"診療録の番号"]

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[]
[null,"邦　　訳　（Ｂ）"]
[]
[null,-15,"その他（項目明記）"]
{"$rows_empty":47}
[{"$nulls":13},"翻 訳 者 記 入 欄"]
[{"$nulls":13},"名前"]
[]
[]
[{"$nulls":13},"住所"]
[{"$nulls":19},"電話"]

{"sheet":"疾病分類表","index":5,"n_rows":151,"n_cols":10,"rows_kept":151,"cut":false,"hidden":false,"merged":[[1,0,1,14],[0,0,0,14]],"flags":["formulas_cached_only"]}
["Table of Internatioal Classification of Disease for the use of Social Insurance"]
["社会保険用国際疾病分類表"]
[]
["Ⅰ"," Certain infectious and parasitic diseases",{"$nulls":6},"0505","Neurotic, stress-related and somatoform disorders"]
[null,"感染症及び寄生虫症",{"$nulls":7},"神経症性障害、ストレス関連障害及び身体表現障害"]
["0101","Intestinal infectious diseases",{"$nulls":6},"0506","Mental retardation"]
[null,"腸管感染症",{"$nulls":7},"精神遅滞"]
["0102","Tuberculosis",{"$nulls":6},"0507","Other psychoses and disorders of action"]
[null,"結 核",{"$nulls":7},"その他の精神及び行動の障害"]
["0103","Infections with a predominantly sexual mode of transmission",{"$nulls":6},"Ⅵ","Diseases of the neｒvous system"]
[null,"主として性的伝播様式をとる感染症",{"$nulls":7},"神経系の疾患"]
["0104","Viral infections characterized by skin and mucous ",{"$nulls":6},"0601","Parkinson's disease"]
[null,"membrane lesions ",{"$nulls":7},"パーキンソン病"]
[null,"皮膚及び粘膜の病変を伴うウイルス疾患",{"$nulls":6},"0602","Alzheimer's disease"]
["0105","Viral hepatitis",{"$nulls":7},"アルツハイマー病"]
[null,"ウイルス肝炎",{"$nulls":6},"0603","Epilepsy"]
["0106","Other viral diseases",{"$nulls":7},"てんかん"]
[null,"その他のウイルス疾患",{"$nulls":6},"0604","Cerebral palsy and other paralytic syndromes"]
["0107","Mycoses",{"$nulls":7},"脳性麻痺及びその他の麻痺性症候群"]
[null,"真 菌 症",{"$nulls":6},"0605","Disorders of autonomic nervous system"]
["0108","Sequelae of infectious and parasitic diseases",{"$nulls":7},"自律神経系の障害"]
[null,"感染症及び寄生虫症の続発・後遺症",{"$nulls":6},"0606","Others"]
["0109","Other infectious and parastic diseases",{"$nulls":7},"その他の神経系の疾患"]
[null,"その他の感染症及び寄生虫症",{"$nulls":6},"Ⅶ","Diseases of the eye and adnexa"]
["Ⅱ","Neoplasms",{"$nulls":7},"眼及び付属器の疾患"]
[null,"新 生 物 ",{"$nulls":6},"0701","Conjunctivitis"]
["0201","Malignant neoplasm of stomach",{"$nulls":7},"結　膜　炎"]
[null,"胃の悪性新生物",{"$nulls":6},"0702","Cataract"]
["0202","Malignant neoplasm of colon",{"$nulls":7},"白　内　障"]
[null,"結腸の悪性新生物",{"$nulls":6},"0703","Disorders of refraction and accommodation"]
["0203","Malignant neoplasm of rectosigmoid junction and rectum",{"$nulls":7},"屈折及び調節の障害"]
[null,"直腸S状結腸移行部及び直腸の悪性新生物",{"$nulls":6},"0704","Other diseases of the eye and adnexa"]
["0204","Malignant neoplasm of liver  and intrahepatic bile ducts ",{"$nulls":7},"その他の眼及び付属器の疾患"]
[null,"肝及び肝内胆管の悪性新生物",{"$nulls":6},"Ⅷ","Diseases of the ear and mastoid process"]
["0205","Malignant neoplasm of trachea, bronchus and lung",{"$nulls":7},"耳及び乳様突起の疾患"]
[null,"気管、気管支及び肺の悪性新生物",{"$nulls":6},"0801","Otitis externa"]
["0206","Malignant neoplasm of breast",{"$nulls":7},"外　耳　炎"]
[null,"乳房の悪性新生物",{"$nulls":6},"0802","Other disorders of external ear"]
["0207","Malignant neoplasm of uterus",{"$nulls":7},"その他の外耳疾患"]
[null,"子宮の悪性新生物",{"$nulls":6},"0803","Otitis media"]
["0208","Malignant Lymphoma",{"$nulls":7},"中　耳　炎"]
[null,"悪性リンパ腫",{"$nulls":6},"0804","Other diseases of middle ear and mastoid"]
["0209","Leukaemia",{"$nulls":7},"その他の中耳及び乳様突起の疾患"]
[null,"白 血 病",{"$nulls":6},"0805","Disorders of vestibular function"]
["0210","Other Malignant neoplasms",{"$nulls":7},"メニエール病"]
[null,"その他の悪性新生物",{"$nulls":6},"0806","Other diseases of inner ear"]
["0211","Other benign neoplasms and other neoplasms",{"$nulls":7},"その他の内耳疾患"]
[null,"良性新生物及びその他の新生物",{"$nulls":6},"0807","Other disorders of ear"]
["Ⅲ","Diseases of the blood and blood-forming organs and ",{"$nulls":7},"その他の耳疾患"]
[null,"certain disorders involving the immune mechanism",{"$nulls":6},"Ⅸ","Diseases of the circulatoly system"]
[null,"血液及び造血器の疾患並びに免疫機構の障害",{"$nulls":7},"循環器系の疾患"]
["0301","Anaemias",{"$nulls":6},"0901","Hypertensive diseases"]
[null,"貧  血",{"$nulls":7},"高血圧性疾患"]
["0302","Other diseases of blood and blood-forming organs and ",{"$nulls":6},"0902","Ischaemic heart diseases"]
[null,"certain disorders involving the immune mechanism",{"$nulls":7},"虚血性心疾患"]
[null,"その他の血液及び造血器の疾患並びに免疫機構の障害",{"$nulls":6},"0903","Other forms of heart disease"]
["Ⅳ","Endrocrine, nutritional and metabolic diseases",{"$nulls":7},"その他の心疾患"]
[null,"内分泌、栄養及び代謝疾患",{"$nulls":6},"0904","Subarachnoid hemorrhage"]
["0401","Disorders of thyroid gland ",{"$nulls":7},"くも膜下出血"]
[null,"甲状腺障害",{"$nulls":6},"0905","Intracerebral hemorrhage"]
["0402","Diabetes mellitus",{"$nulls":7},"脳内出血"]
[null,"糖 尿 病",{"$nulls":6},"0906","Occulusion of precerebral and Cerebral arteries"]
["0403","Other diseases of endocrine nutrition and metabolism",{"$nulls":7},"脳梗塞"]
[null,"その他の内分泌、栄養及び代謝の障害",{"$nulls":6},"0907","Cerebral arteriosclerosis"]
["Ⅴ","Mental and behavioural disorders",{"$nulls":7},"脳動脈硬化（症）"]
[null,"精神及び行動の障害",{"$nulls":6},"0908","Other cerebrobascular diseases"]
["0501","Vascular dementia and Unspecified dementia",{"$nulls":7},"その他の脳血管疾患"]
[null,"血管性及び詳細不明の痴呆",{"$nulls":6},"0909","Atherosclerosis"]
["0502","Mental and behavioural disorders due to psychoactive ",{"$nulls":7},"動脈硬化（症）"]
[null,"substance use",{"$nulls":6},"0910","Haemorrhoids"]
[null,"精神作用物質使用による精神及び行動の障害",{"$nulls":7},"痔　核"]
["0503","Schizophrenia, schizotypal and delusional disorders",{"$nulls":6},"0911","Hypotension"]
[null,"精神分裂病、分裂病型障害及び妄想性障害",{"$nulls":7},"低血圧（症）"]
["0504","Mood (affective) disorders",{"$nulls":6},"0912","Other disorders of circulatory system"]
[null,"気分（感情）障害（躁うつ病を含む）",{"$nulls":7},"その他の循環器系の疾患"]
[]
[]
["Ⅹ","Diseases of the respiratory system",{"$nulls":6},"1306","Low back pain and sciatica"]
[null,"呼吸器系の疾患",{"$nulls":7},"腰痛症及び坐骨神経痛"]
["1001","Acute nasopharyngitis (common cold)",{"$nulls":6},"1307","Other dorsopathies"]
[null,"急性鼻咽頭炎（風邪）",{"$nulls":7},"その他の脊椎障害"]
["1002","Acute pharyngitis and tonsillitis",{"$nulls":6},"1308","Shoulder lesions"]
[null,"急性咽頭炎及び急性扁桃炎",{"$nulls":7},"肩の傷害"]
["1003","Other acute upper respiratory infections",{"$nulls":6},"1309","Disorders of bone density and structure"]
[null,"その他の急性上気道感染症",{"$nulls":7},"骨の密度及び構造の障害"]
["1004","Pneumonia",{"$nulls":6},"1310","Other diseases of skeletal muscles and connective tissues"]
[null,"肺　炎",{"$nulls":7},"その他の筋骨格系及び結合組織の疾患"]
["1005","Acute bronchitis and bronchiolitis ",{"$nulls":6},"ⅩⅣ","Diseases of the genitourinary system"]
[null,"急性気管支炎及び急性細気管支炎",{"$nulls":7},"尿路性器系の疾患"]
["1006","Vasmotor and allergic rhinitis",{"$nulls":6},"1401","Glomerular diseases"]
[null,"アレルギー性鼻炎",{"$nulls":7},"糸球体疾患及び腎尿細管間質性疾患"]
["1007","Chronic sinusitis",{"$nulls":6},"1402","Renal failure"]
[null,"慢性副鼻腔炎",{"$nulls":7},"腎 不 全"]
["1008","Bronchitis, not specified as acute or chronic",{"$nulls":6},"1403","Urolithiasis"]
[null,"急性又は慢性と明示されない気管支炎",{"$nulls":7},"尿路結石症"]
["1009","Chronic obstructive pulmonary disease",{"$nulls":6},"1404","Other diseases of urinary system"]
[null,"慢性閉塞性肺疾患",{"$nulls":7},"その他の尿路系の疾患"]
["1010","Asthma",{"$nulls":6},"1405","Hyperplasia of prostate"]
[null,"喘　息",{"$nulls":7},"前立腺肥大（症）"]
["1011","Other diseases of respiratory system",{"$nulls":6},"1406","Other diseases of male genital organs"]
[null,"その他の呼吸器系の疾患",{"$nulls":7},"その他の男性性器の疾患"]
["ⅩⅠ","Diseases of the digestive system ",{"$nulls":6},"1407","Menopausal and postmenopausal disorders"]
[null,"消化器系の疾患",{"$nulls":7},"月経障害及び閉経周辺期障害"]
["1101","Dental caries",{"$nulls":6},"1408","Other disorders of breast and female genital organs"]
[null,"う　蝕",{"$nulls":7},"乳房及びその他の女性性器の疾患"]
["1102","Gingivitis and periodontal diseases",{"$nulls":6},"ⅩⅤ","Pregnancy, childbirth and the puerperium"]
[null,"歯肉炎及び歯周疾患",{"$nulls":7},"妊娠、分娩及び産じょく"]
["1103","Other disorders of teeth and supporting structures",{"$nulls":6},"1501","Pregnancy with abortive outcome"]
[null,"その他の歯及び歯の支持組織の障害",{"$nulls":7},"流　産"]
["1104","Gastric and duodenal ulcer",{"$nulls":6},"1502","Oedema, proteinuria and hypertensive disorders in pregnancy, "]
[null,"胃潰瘍及び十二指腸潰瘍",{"$nulls":7},"childbirth and the puerperium"]
["1105","Gastritis and duodenitis",{"$nulls":7},"妊娠中毒症"]
[null,"胃炎及び十二指腸炎",{"$nulls":6},"1503","Single spontaneous delivery  "]
["1106","Alcoholic liver disease",{"$nulls":7},"単体自然分娩"]
[null,"アルコール性肝疾患",{"$nulls":6},"1504","Others"]
["1107","Chronic hepatitis, not elsewhere classified",{"$nulls":7},"その他の妊娠、分娩及び産じょく"]
[null,"慢性肝炎（アルコール性のものを除く）",{"$nulls":6},"ⅩⅥ","Certain conditions originating in the perinatal period"]
["1108","Liver cirrhosis",{"$nulls":7},"周産期に発生した病態"]
[null,"肝硬変（アルコール性のものを除く）",{"$nulls":6},"1601","Disorders related to length of gestation and fetal growth "]
["1109","Other disorders of liver",{"$nulls":7},"妊娠及び胎児発育に関連する障害"]
[null,"その他の肝疾患",{"$nulls":6},"1602","Others"]
["1110","Cholelithiasis and cholecystitis",{"$nulls":7},"その他の周産期に発生した病態"]
[null,"胆石症及び胆のう炎",{"$nulls":6},"ⅩⅦ","Congeneital malformations, deformations and chromosomal "]
["1111","Diseases of pancreas",{"$nulls":7},"abnormalities"]
[null,"膵 疾 患",{"$nulls":7},"先天奇形、変形及び染色体異常"]
["1112","Other diseases of digestive system",{"$nulls":6},"1701","Congenital anomalies of heart"]
[null,"その他の消化器系の疾患",{"$nulls":7},"心臓の先天奇形"]
["ⅩⅡ","Diseases of the skin and subcutaneous tissue",{"$nulls":6},"1702","Others"]
[null,"皮膚及び皮下組織の疾患",{"$nulls":7},"その他の先天奇形、変形及び染色体異常"]
["1201","Infections of the skin and subcutaneous tissue",{"$nulls":6},"ⅩⅧ","Symptoms, signs and abnormal clinical and laboｒatory findings, "]
[null,"皮膚及び皮下組織の感染症",{"$nulls":7},"not slewhere classified"]
["1202","Dermatitis and eczema",{"$nulls":7},"症状、徴候及び異常臨床所見・異常検査所見で他に分類されないもの"]
[null,"皮膚炎及び湿疹",{"$nulls":6},"1800","Symptoms, signs and abnormal clinical and labolatory findings, "]
["1203","Others",{"$nulls":7},"not slewhere classified"]
[null,"その他の皮膚及び皮下組織の疾患",{"$nulls":7},"症状、徴候及び異常臨床所見・異常検査所見で他に分類されないもの"]
["ⅩⅢ","Diseases of the musculoskeletal system and ",{"$nulls":6},"ⅩⅨ","Injury, poisoning and certain other concequences of "]
[null,"connective tissue",{"$nulls":7},"external causes"]
[null,"筋骨格及び結合組織の疾患",{"$nulls":7},"損傷、中毒及びその他の外因の影響"]
["1301","Inflammatory polyarthropathies",{"$nulls":6},"1901","Fracture"]
[null,"炎症性多発性関節障害",{"$nulls":7},"骨　折"]
["1302","Arthrosis",{"$nulls":6},"1902","Intracranial damege and internal organ damege "]
[null,"関 節 症",{"$nulls":7},"頭蓋内損傷及び内臓の損傷"]
["1303","Spondylopathies",{"$nulls":6},"1903","Burns and corrosions"]
[null,"脊椎障害（脊椎症を含む）",{"$nulls":7},"熱傷及び腐食"]
["1304","Interverteblal disc disorders",{"$nulls":6},"1904","Poisoning"]
[null,"椎間板障害",{"$nulls":7},"中　毒"]
["1305","Cervicobrachial",{"$nulls":6},"1905","Others"]
[null,"頸腕症候群",{"$nulls":7},"その他の損傷及びその他の外因の影響"]
[]
[{"$nulls":8},"Important  :  No.1503 with asterisk is not coverd by the social insurance."]
[{"$nulls":8},"1503番（＊印）は社会保険は適用されません。"]

{"sheet":"海外療養費について","index":6,"n_rows":40,"n_cols":6,"rows_kept":40,"cut":false,"hidden":false,"merged":[],"flags":["formulas_cached_only"]}
[null,"海外療養費について"]
[]
["海外で医療を受けたとき"]
[null,"海外で病気やケガの治療を受けたときは、保険証が使えないため、医療費を全額自己負担しな"]
[null,"ければなりません。後で、健保組合へ申請すると海外療養費として医療費の一部が払い戻されます。"]
[]
[null,"海外療養費が支給されるのは、日本国内でも健康保険の適用が受けられるものに限られます。"]
[null,"日本では健康保険で受けられない治療や、はじめから治療目的で海外へ渡航した場合には支給されません。"]
[]
["支給額"]
[null,"海外療養費として支給される額は、日本国内の場合と同額（本人・家族＝７割、未就学児＝８割、"]
[null,"高齢者＝７割または８割）ですが、日本での治療費を基準として算定されます。"]
[null,"　したがって、負担した額の7割が全部戻ってくるとは限りません。海外の物価や医療費水準によっては、実際に"]
[null,"支払った金額よりも支給額が大幅に少なくなることもあります。"]
[null,"支払った治療費がこれを下回った場合は、実際にかかった治療費の組合負担分（本人＝7割）が支給されます。"]
[null,"　なお、支給額の算定に用いる邦貨換算率はその支給決定日の外国為替換算率（売レート）が用いられます。"]
[]
["申請の手続き"]
[null,"申請には下記の申請書類を当健保までご提出ください。"]
[null,"申請書類は受診者、診療月、医療機関ごとにそれぞれ1枚ずつ証明をもらってください。"]
[null,"同じ医療機関でも入院と外来は別々に証明が必要です。"]
[]
["（申請書類）"]
[null,"・","海外療養費支給申請書"]
[]
[null,"・","診療内容明細書（様式A）",null,null,"担当医に証明をもらってください"]
[null,null,"邦訳A"]
[]
[null,"・","領収明細書（様式B）",null,null,"担当医又は病院事務長に証明をもらってください"]
[null,null,"邦訳B"]
[]
[null,"・","領収書（原本）"]
[]
["＊","様式Aの２、６、７と様式Bの（15）については邦訳が必要です。"]
[null,"邦訳A、Bにそれぞれの翻訳を付し、翻訳者の氏名、住所を記入してください。"]
[]
["海外から申請をするとき"]
[null,"海外から申請をするときは事業主（国内に残った留守家族も可）を経由してください。"]
[null,"当健康保険組合から直接海外への送金はいたしません。"]
[null,"被保険者以外が受取る場合は、支給申請書の受取代理人欄で受領の委任をしてください。"]