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[]
[null,null,"医療機関入力欄"]
[null,null,"請求先","○○都道府県国民健康保険団体連合会　御中"]
[null,null,"施設等区分","1:医療機関"]
[null,null,"医療機関等コード",1234567890]
[null,null,"医療機関名","厚労病院○○○○○○○○○○○○"]
[null,null,"請求年月","2019年○○月分","←毎月更新"]
[null,null,"医院所在地","○○県○○市○○町○丁目○番○号"]
[null,null,"代表者氏名","労働次郎"]
[null,null,"電話番号","○○○ー○○○ー○○○○"]
[]
[null,null,"消費税率","10","←消費税率改正時に修正"]
[]
[null,null,"【入力時の注意事項】"]
[null,null,"・医療機関コードは、半角10桁の番号で入力してください。"]
[null,null,"・医療機関名及び医師名は、１行あたり全角16文字以内におさめてください。"]
[null,null,"・市町村別の各請求書の欄外にて計算いただくと総括表まで仕上がる仕様です。"]
[]
[null,null,"①健診・HI法",1290]
[null,null,"②健診・EIA法",2680]
[null,null,"③HI法",4930]
[null,null,"④EIA法",6320]
[null,null,"⑤夜間休日・HI法",5430]
[null,null,"⑥夜間休日・EIA法",6820]

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[null,null,null,null,{"$f":"共通部分マスター!D8","v":"○○県○○市○○町○丁目○番○号"}]
[null,"　　　　",null,null,"代表者氏名",{"$f":"共通部分マスター!D9","v":"労働次郎"}]
[null,null,null,null,"電話番号",{"$f":"共通部分マスター!D10","v":"○○○ー○○○ー○○○○"}]
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[null,"　風しん対策　請求総括書（実績報告書）"]
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[]
[null,"施設等区分",null,null,{"$f":"共通部分マスター!D4","v":"1:医療機関"}]
[null,"医療機関・健診機関番号",null,null,{"$f":"共通部分マスター!D5","v":1234567890}]
[null,"医療機関・健診機関名称",null,null,{"$f":"共通部分マスター!D6","v":"厚労病院○○○○○○○○○○○○"}]
[null,"請求年月",null,null,{"$f":"共通部分マスター!D7","v":"2019年○○月分"}]
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[]
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[null,null,"区分",null,"請求件数","請求金額\n（税抜）","請求金額\n（税込）"]
[null,"抗体検査","①健診・HI法",null,0,0,0]
[null,null,"②健診・EIA法",null,0,0,0]
[null,null,"③HI法",null,0,0,0]
[null,null,"④EIA法",null,0,0,0]
[null,null,"⑤夜間休日・HI法",null,0,0,0]
[null,null,"⑥夜間休日・EIA法",null,0,0,0]
[null,null,"小計",null,{"$f":"SUM(E22:E27)","v":0},{"$f":"SUM(F22:F27)","v":0},{"$f":"SUM(G22:G27)","v":0}]
[null,"予防接種","通常",null,0,0,0]
[null,null,"予診のみ",null,0,0,0]
[null,null,"小計",null,{"$f":"SUM(E29:E30)","v":0},{"$f":"SUM(F29:F30)","v":0},{"$f":"SUM(G29:G30)","v":0}]
[null,"合計",null,null,{"$f":"E28+E31","v":0},{"$f":"F28+F31","v":0},{"$f":"G28+G31","v":0}]
[null,"※予診のみの費用を市区町村が設定していない場合（０円の場合）は、本総括書に"]
[null,"計上しないこと。その場合、予診票の原本を国民健康保険団体連合会に送付しない"]
[null,"こと。"]

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[null,"○○○市区町村長様"]
[null,"市区町村番号"]
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[null,"風しん対策　市区町村別請求書"]
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[null,"医療機関・健診機関番号",null,null,null,null,null,null,{"$f":"共通部分マスター!D5","v":1234567890}]
[null,"医療機関・健診機関名称",null,null,null,null,null,null,{"$f":"共通部分マスター!D6","v":"厚労病院○○○○○○○○○○○○"}]
[null,"請求年月",null,null,null,null,null,null,{"$f":"共通部分マスター!D7","v":"2019年○○月分"}]
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[]
[]
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[null,null,null,null,null,null,null,null,"請求件数","請求金額\n（税抜）","請求金額\n（税込）",null,null,null,null,null,null,"請求件数","税抜き単価","税込み単価","請求総額（税抜き）\n※システムエラーのチェック用","請求総額（税込み）"]
[null,"抗体検査",null,null,"①健診・HI法",null,null,null,{"$f":"R23","v":0},{"$f":"U23","v":0},{"$f":"V23","v":0},null,null,null,"抗体検査","①健診・HI法",null,null,{"$f":"共通部分マスター!D19","v":1290},{"$f":"ROUNDDOWN(S23*(1+(共通部分マスター!$D$12)/100),0)","v":1419},{"$f":"S23*R23","v":0},{"$f":"T23*R23","v":0}]
[null,null,null,null,"②健診・EIA法",null,null,null,0,0,0,null,null,null,null,"②健診・EIA法",null,null,{"$f":"共通部分マスター!D20","v":2680},{"$f":"ROUNDDOWN(S24*(1+(共通部分マスター!$D$12)/100),0)","v":2948},0,0]
[null,null,null,null,"③HI法",null,null,null,0,0,0,null,null,null,null,"③HI法",null,null,{"$f":"共通部分マスター!D21","v":4930},{"$f":"ROUNDDOWN(S25*(1+(共通部分マスター!$D$12)/100),0)","v":5423},0,0]
[null,null,null,null,"④EIA法",null,null,null,0,0,0,null,null,null,null,"④EIA法",null,null,{"$f":"共通部分マスター!D22","v":6320},{"$f":"ROUNDDOWN(S26*(1+(共通部分マスター!$D$12)/100),0)","v":6952},0,0]
[null,null,null,null,"⑤夜間休日・HI法",null,null,null,0,0,0,null,null,null,null,"⑤夜間休日・HI法",null,null,{"$f":"共通部分マスター!D23","v":5430},{"$f":"ROUNDDOWN(S27*(1+(共通部分マスター!$D$12)/100),0)","v":5973},0,0]
[null,null,null,null,"⑥夜間休日・EIA法",null,null,null,0,0,0,null,null,null,null,"⑥夜間休日・EIA法",null,null,{"$f":"共通部分マスター!D24","v":6820},{"$f":"ROUNDDOWN(S28*(1+(共通部分マスター!$D$12)/100),0)","v":7502},0,0]
[null,null,null,null,"小計",null,null,null,0,0,0,null,null,null,null,"小計",null,{"$f":"SUM(R23:R28)","v":0},null,null,{"$f":"SUM(U23:U28)","v":0},{"$f":"SUM(V23:V28)","v":0}]
[null,"予防接種",null,null,"通常",null,null,null,0,0,0,null,null,null,"予防接種","通常",null,null,null,{"$f":"ROUNDDOWN(S30*(1+(共通部分マスター!$D$12)/100),0)","v":0},{"$f":"S30*R30","v":0},{"$f":"T30*R30","v":0},"←予防接種関係の価格は市区町村で決定いたします。クーポンの下５桁に記載の金額を記載ください。"]
[null,null,null,null,"予診のみ",null,null,null,0,0,0,null,null,null,null,"予診のみ",null,null,null,{"$f":"ROUNDDOWN(S31*(1+(共通部分マスター!$D$12)/100),0)","v":0},{"$f":"S31*R31","v":0},{"$f":"T31*R31","v":0},"  ※税込単価は、１円未満の端数は切り捨て"]
[null,null,null,null,"小計",null,null,null,0,{"$f":"SUM(J30:J31)","v":0},{"$f":"SUM(K30:K31)","v":0},null,null,null,null,"小計",null,{"$f":"SUM(R30:R31)","v":0},null,null,{"$f":"SUM(U30:U31)","v":0},{"$f":"SUM(V30:V31)","v":0},"　※予診のみの費用を市町村が設定していない場合（０円の場合）は、本請求書に計上しないこと。その場合、予診票の原本を国民健康保険団体連合会に送付しないこと。"]
[null,"合計",null,null,null,null,null,null,0,{"$f":"J32+J29","v":0},{"$f":"K32+K29","v":0},null,null,null,"合計",null,null,{"$f":"R32+R29","v":0},null,null,{"$f":"U32+U29","v":0},{"$f":"V32+V29","v":0}]
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[null,null,null,null,null,null,null,null,null,"消費税率",{"$f":"共通部分マスター!D12","v":"10"},"％"]
[null,"※予診のみの費用を市区町村が設定していない場合（０円の場合）は、本請"]
[null,"求書に計上しないこと。その場合、予診票の原本を国民健康保険団体連合会"]
[null,"に送付しないこと。"]

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[null,"○○○市区町村長様"]
[null,"市区町村番号"]
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[null,"風しん対策　市区町村別請求書"]
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[null,"医療機関・健診機関番号",null,null,null,null,null,null,{"$f":"共通部分マスター!D5","v":1234567890}]
[null,"医療機関・健診機関名称",null,null,null,null,null,null,{"$f":"共通部分マスター!D6","v":"厚労病院○○○○○○○○○○○○"}]
[null,"請求年月",null,null,null,null,null,null,{"$f":"共通部分マスター!D7","v":"2019年○○月分"}]
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[null,null,null,null,"②健診・EIA法",null,null,null,0,0,0,null,null,null,null,"②健診・EIA法",null,null,{"$f":"共通部分マスター!D20","v":2680},{"$f":"ROUNDDOWN(S24*(1+(共通部分マスター!$D$12)/100),0)","v":2948},0,{"$f":"T24*R24","v":0}]
[null,null,null,null,"③HI法",null,null,null,0,0,0,null,null,null,null,"③HI法",null,null,{"$f":"共通部分マスター!D21","v":4930},{"$f":"ROUNDDOWN(S25*(1+(共通部分マスター!$D$12)/100),0)","v":5423},0,0]
[null,null,null,null,"④EIA法",null,null,null,0,0,0,null,null,null,null,"④EIA法",null,null,{"$f":"共通部分マスター!D22","v":6320},{"$f":"ROUNDDOWN(S26*(1+(共通部分マスター!$D$12)/100),0)","v":6952},0,0]
[null,null,null,null,"⑤夜間休日・HI法",null,null,null,0,0,0,null,null,null,null,"⑤夜間休日・HI法",null,null,{"$f":"共通部分マスター!D23","v":5430},{"$f":"ROUNDDOWN(S27*(1+(共通部分マスター!$D$12)/100),0)","v":5973},0,0]
[null,null,null,null,"⑥夜間休日・EIA法",null,null,null,0,0,0,null,null,null,null,"⑥夜間休日・EIA法",null,null,{"$f":"共通部分マスター!D24","v":6820},{"$f":"ROUNDDOWN(S28*(1+(共通部分マスター!$D$12)/100),0)","v":7502},0,0]
[null,null,null,null,"小計",null,null,null,0,0,0,null,null,null,null,"小計",null,{"$f":"SUM(R23:R28)","v":0},null,null,{"$f":"SUM(U23:U28)","v":0},{"$f":"SUM(V23:V28)","v":0}]
[null,"予防接種",null,null,"通常",null,null,null,0,0,0,null,null,null,"予防接種","通常",null,null,null,{"$f":"ROUNDDOWN(S30*(1+(共通部分マスター!$D$12)/100),0)","v":0},{"$f":"S30*R30","v":0},{"$f":"T30*R30","v":0},"←予防接種関係の価格は市区町村で決定いたします。クーポンの下５桁に記載の金額を記載ください。"]
[null,null,null,null,"予診のみ",null,null,null,0,0,0,null,null,null,null,"予診のみ",null,null,null,{"$f":"ROUNDDOWN(S31*(1+(共通部分マスター!$D$12)/100),0)","v":0},{"$f":"S31*R31","v":0},{"$f":"T31*R31","v":0},"  ※税込単価は、１円未満の端数は切り捨て"]
[null,null,null,null,"小計",null,null,null,0,{"$f":"SUM(J30:J31)","v":0},{"$f":"SUM(K30:K31)","v":0},null,null,null,null,"小計",null,{"$f":"SUM(R30:R31)","v":0},null,null,{"$f":"SUM(U30:U31)","v":0},{"$f":"SUM(V30:V31)","v":0},"　※予診のみの費用を市町村が設定していない場合（０円の場合）は、本請求書に計上しないこと。その場合、予診票の原本を国民健康保険団体連合会に送付しないこと。"]
[null,"合計",null,null,null,null,null,null,0,{"$f":"J32+J29","v":0},{"$f":"K32+K29","v":0},null,null,null,"合計",null,null,{"$f":"R32+R29","v":0},null,null,{"$f":"U32+U29","v":0},{"$f":"V32+V29","v":0}]
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[null,null,null,null,null,null,null,null,null,"消費税率",{"$f":"共通部分マスター!D12","v":"10"},"％"]
[null,"※予診のみの費用を市区町村が設定していない場合（０円の場合）は、本請"]
[null,"求書に計上しないこと。その場合、予診票の原本を国民健康保険団体連合会"]
[null,"に送付しないこと。"]

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[null,"○○○市区町村長様"]
[null,"市区町村番号"]
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[]
[null,"医療機関・健診機関番号",null,null,null,null,null,null,{"$f":"共通部分マスター!D5","v":1234567890}]
[null,"医療機関・健診機関名称",null,null,null,null,null,null,{"$f":"共通部分マスター!D6","v":"厚労病院○○○○○○○○○○○○"}]
[null,"請求年月",null,null,null,null,null,null,{"$f":"共通部分マスター!D7","v":"2019年○○月分"}]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"【計算スペース】※こちらに件数を記入すると請求書が埋まっていきます"]
[null,null,null,null,null,null,null,null,"請求件数","請求金額\n（税抜）","請求金額\n（税込）",null,null,null,null,null,null,"請求件数","税抜き単価","税込み単価","請求総額（税抜き）\n※システムエラーのチェック用","請求総額（税込み）"]
[null,"抗体検査",null,null,"①健診・HI法",null,null,null,{"$f":"R23","v":0},{"$f":"U23","v":0},0,null,null,null,"抗体検査","①健診・HI法",null,null,{"$f":"共通部分マスター!D19","v":1290},{"$f":"ROUNDDOWN(S23*(1+(共通部分マスター!$D$12)/100),0)","v":1419},{"$f":"S23*R23","v":0},{"$f":"T23*R23","v":0}]
[null,null,null,null,"②健診・EIA法",null,null,null,0,0,0,null,null,null,null,"②健診・EIA法",null,null,{"$f":"共通部分マスター!D20","v":2680},{"$f":"ROUNDDOWN(S24*(1+(共通部分マスター!$D$12)/100),0)","v":2948},0,{"$f":"T24*R24","v":0}]
[null,null,null,null,"③HI法",null,null,null,0,0,0,null,null,null,null,"③HI法",null,null,{"$f":"共通部分マスター!D21","v":4930},{"$f":"ROUNDDOWN(S25*(1+(共通部分マスター!$D$12)/100),0)","v":5423},0,0]
[null,null,null,null,"④EIA法",null,null,null,0,0,0,null,null,null,null,"④EIA法",null,null,{"$f":"共通部分マスター!D22","v":6320},{"$f":"ROUNDDOWN(S26*(1+(共通部分マスター!$D$12)/100),0)","v":6952},0,0]
[null,null,null,null,"⑤夜間休日・HI法",null,null,null,0,0,0,null,null,null,null,"⑤夜間休日・HI法",null,null,{"$f":"共通部分マスター!D23","v":5430},{"$f":"ROUNDDOWN(S27*(1+(共通部分マスター!$D$12)/100),0)","v":5973},0,0]
[null,null,null,null,"⑥夜間休日・EIA法",null,null,null,0,0,0,null,null,null,null,"⑥夜間休日・EIA法",null,null,{"$f":"共通部分マスター!D24","v":6820},{"$f":"ROUNDDOWN(S28*(1+(共通部分マスター!$D$12)/100),0)","v":7502},0,0]
[null,null,null,null,"小計",null,null,null,0,0,0,null,null,null,null,"小計",null,{"$f":"SUM(R23:R28)","v":0},null,null,{"$f":"SUM(U23:U28)","v":0},{"$f":"SUM(V23:V28)","v":0}]
[null,"予防接種",null,null,"通常",null,null,null,0,0,0,null,null,null,"予防接種","通常",null,null,null,{"$f":"ROUNDDOWN(S30*(1+(共通部分マスター!$D$12)/100),0)","v":0},{"$f":"S30*R30","v":0},{"$f":"T30*R30","v":0},"←予防接種関係の価格は市区町村で決定いたします。クーポンの下５桁に記載の金額を記載ください。"]
[null,null,null,null,"予診のみ",null,null,null,0,0,0,null,null,null,null,"予診のみ",null,null,null,{"$f":"ROUNDDOWN(S31*(1+(共通部分マスター!$D$12)/100),0)","v":0},{"$f":"S31*R31","v":0},{"$f":"T31*R31","v":0},"  ※税込単価は、１円未満の端数は切り捨て"]
[null,null,null,null,"小計",null,null,null,0,{"$f":"SUM(J30:J31)","v":0},{"$f":"SUM(K30:K31)","v":0},null,null,null,null,"小計",null,{"$f":"SUM(R30:R31)","v":0},null,null,{"$f":"SUM(U30:U31)","v":0},{"$f":"SUM(V30:V31)","v":0},"　※予診のみの費用を市町村が設定していない場合（０円の場合）は、本請求書に計上しないこと。その場合、予診票の原本を国民健康保険団体連合会に送付しないこと。"]
[null,"合計",null,null,null,null,null,null,0,{"$f":"J32+J29","v":0},{"$f":"K32+K29","v":0},null,null,null,"合計",null,null,{"$f":"R32+R29","v":0},null,null,{"$f":"U32+U29","v":0},{"$f":"V32+V29","v":0}]
[]
[null,null,null,null,null,null,null,null,null,"消費税率",{"$f":"共通部分マスター!D12","v":"10"},"％"]
[null,"※予診のみの費用を市区町村が設定していない場合（０円の場合）は、本請"]
[null,"求書に計上しないこと。その場合、予診票の原本を国民健康保険団体連合会"]
[null,"に送付しないこと。"]