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[]
[null,"（暫定様式）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1,null,"新規・変更","新規",{"$f":"VLOOKUP(Z2,AB2:AC3,2,FALSE)","v":1},"新規",1]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※受付番号",null,null,"",null,null,null,null,"事業所番号",null,null,"変更",2]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※指定市町村番号",null,null,"",null,null,null,null,"異動年月日","2018-04-01"]
[null,null,null,null,"障害児通所支援事業",null,null,null,null,null,null,null,"指定申請書",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"TEXT(Z4,\"yyyymmdd\")","v":"20180401"}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成　　年　　月　　日"]
[null,"（申請先）",null,null,null,null,null,"（申請者）"]
[null,"川崎市長",null,null,null,null,null,null,"所　在　地",null,null,{"$f":"G19&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"VLOOKUP(B8,AB8:AC12,2,FALSE)","v":141309},null,null,"神奈川県知事",0]
[null,null,null,null,null,null,null,null,null,null,null,{"$f":"G20&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"横浜市長",141002]
[null,null,null,null,null,null,null,null,"名　　　称",null,null,{"$f":"G17&\"\"","v":""},null,null,null,null,null,null,null,null,"印",null,null,null,null,null,null,"川崎市長",141309]
[null,null,null,null,null,null,null,null,"代表者氏名",null,null,{"$f":"G23&\"　\"&G24","v":"　"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"相模原市長",141507]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"横須賀市長",142018]
[null,"　児童福祉法に規定する",null,null,null,null,null,null,"障害児通所支援事業",null,null,null,null,null,null,"に係る指定を受けたいので、"]
[null,"下記のとおり、関係書類を添えて申請します。"]
[]
[null,"申請者（設置者）","ﾌ　ﾘ　ｶﾞ　ﾅ"]
[null,null,"名　　　　称",null,null,null,""]
[null,null,"主たる事務所の\n所在地",null,null,null,"〒",null,null,null,null,"←郵便番号を半角数字７桁で記載してください"]
[null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"G19&IF(G20<>\"\",\" \"&G20,\"\")","v":""}]
[null,null,null,null,null,null,""]
[null,null,"連絡先",null,null,null,"電話番号",null,null,"",null,null,null,null,"ＦＡＸ番号",null,null,""]
[null,null,"法人の種類",null,null,null,"社会福祉法人（社協以外）",null,null,null,null,null,null,null,"法人所轄庁",null,null,null,null,null,null,null,null,null,{"$f":"VLOOKUP(G22,AB22:AC36,2,FALSE)","v":1},"法人種別コード",null,"社会福祉法人（社協以外）",1]
[null,null,"代表者",null,"役　職",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会福祉法人（社協）",2]
[null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療法人",3]
[null,null,null,null,"住　所",null,"〒",null,null,null,null,"←郵便番号を半角数字７桁で記載してください",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社団・財団",4]
[null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"G26&IF(G27<>\"\",\" \"&G27,\"\")","v":""},null,null,"営利法人",5]
[null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"非営利法人（ＮＰＯ）",6]
[null,"指定を受けようとする\n事業所・施設の種類","ﾌ　ﾘ　ｶﾞ　ﾅ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"農協",7]
[null,null,"名　　　　称",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生協",8]
[null,null,"事業所（施設）\nの所在地",null,null,null,"〒",null,null,null,null,"※事業所(施設)所在地市町村番号",null,null,null,null,null,null,null,"※級地区分",null,"他",null,null,{"$f":"VLOOKUP(V30,AD30:AF37,3,FALSE)","v":20},"級地区分コード",null,"その他法人",9,"一","一級地","01"]
[null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"G31&IF(G32<>\"\",\" \"&G32,\"\")","v":""},null,null,"地方公共団体（都道府県）",10,"二","二級地","02"]
[null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地方公共団体（市町村）",11,"三","三級地","03"]
[null,null,"事業等の種類",null,null,null,"障害児通所支援",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,65,"サービス種類コード",null,"地方公共団体（広域連合・一部事務組合等）",12,"四","四級地","04"]
[null,null,null,null,null,null,"居宅訪問型児童発達支援",null,null,null,null,null,"指定申請をする事業等の\n事業開始予定年月日",null,null,null,null,null,"付表","備考",null,null,null,null,null,null,null,"非法人",13,"五","五級地","05"]
[null,null,null,null,null,null,null,null,null,null,null,null,"2018-04-01",null,null,null,null,null,6,null,null,null,null,null,{"$f":"TEXT(M35,\"yyyymmdd\")","v":"20180401"},"指定年月日",null,"国立施設",14,"六","六級地","06"]
[null,"主たる事業所名称",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他",99,"七","七級地","07"]
[null,"同一の法律において既に\n指定を受けている場合",null,null,null,null,"サービスの種類",null,null,null,null,null,null,null,null,"事業所番号",null,null,null,null,null,null,null,null,null,null,null,null,null,"他","その他",20]
[null,null,null,null,null,null,"事業所名称"]
[null,"※指定有効開始年月日",null,null,null,null,"2018-04-01",null,null,null,null,"※指定有効終了年月日",null,null,null,null,"2024-03-31",null,null,null,null,null,null,null,{"$f":"TEXT(G39,\"yyyymmdd\")","v":"20180401"},{"$f":"TEXT(Q39,\"yyyymmdd\")","v":"20240331"}]
[null,"※指定更新申請中区分",null,null,null,null,"非該当",null,null,null,null,"地域生活支援拠点等区分",null,null,null,null,"非該当",null,null,null,null,null,null,null,{"$f":"VLOOKUP(G40,AB41:AC43,2,FALSE)","v":1},{"$f":"VLOOKUP(Q40,AB41:AC43,2,FALSE)","v":1}]
[null,"※効力停止開始年月",null,null,null,null,null,null,null,null,null,"※効力停止終了年月",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(G41<>\"\",TEXT(G41,\"yyyymmdd\"),\"\")","v":""},{"$f":"IF(Q41<>\"\",TEXT(Q41,\"yyyymmdd\"),\"\")","v":""},null,"非該当",1]
[null,"共生型サービス支援区分",null,null,null,null,"無効",null,null,null,null,"※指定管理者制度適用区分",null,null,null,null,"非該当",null,null,null,null,null,null,null,{"$f":"VLOOKUP(G42,AB41:AC43,2,FALSE)","v":0},{"$f":"VLOOKUP(Q42,AB41:AC43,2,FALSE)","v":1},null,"該当",2]
[null,"※支所コード",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"無効",0]
[null,"（備考）"]
[null,"　　１　　「※」のついた欄には記載しないでください。"]
[null,"　　２　　「法人の種類」欄には、申請者が法人である場合に、「社会福祉法人」「医療法人」「社団法人」「財団法人」"]
[null,"　　　    「営利法人」等の別を記載してください。"]
[null,"　　３　　「法人所轄庁」欄には、申請者が認可法人である場合に、その主務官庁の名称を記載してください。"]
[null,"　　４　　「指定を受けようとする事業所・施設の種類」欄には、今回申請をするものについて必要事項を記載してください。"]
[null,"　　５　　「同一の法律において既に指定を受けている場合」欄には、神奈川県内において既に事業所としての指定を受け、番号"]
[null,"　　　     が付番されている場合に、その事業所に関する事項を記載してください。複数の番号を有する場合には、そのうちの"]
[null,"           一つのみを記載してください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ver.082"]

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["口座振込（変更）依頼書（兼　受領委任状）"]
[]
[]
["神奈川県国民健康保険団体連合会理事長　殿"]
[]
["以下の口座に，次に掲げる介護給付費等の振込を依頼します。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"平成",null,null,null,null,null,"年",null,null,null,null,null,"月",null,null,null,null,null,"日"]
[]
[]
["申請者（債権者）",null,"法人名称",null,null,null,null,null,{"$f":"様式第１号!G17","v":""}]
[]
[null,null,"郵便番号",null,null,null,null,null,"〒",null,{"$f":"様式第１号!H18","v":0},null,null,null,null,null,null,"←郵便番号を半角数字７桁で入力してください。"]
[null,null,"所在地",null,null,null,null,null,{"$f":"様式第１号!G19","v":""}]
[]
[null,null,null,null,null,null,null,null,{"$f":"様式第１号!G20","v":""}]
[]
[null,null,"代表者氏名",null,null,null,null,null,{"$f":"様式第１号!G24","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[]
[null,null,"事業所名称",null,null,null,null,null,{"$f":"様式第１号!G29","v":0}]
[]
[null,null,"事業所番号",null,null,null,null,null,{"$f":"様式第１号!Z3","v":0}]
[]
[null,null,"対象事業名",null,null,null,null,null,{"$f":"様式第１号!Y33","v":65},null,{"$f":"様式第１号!G34","v":"居宅訪問型児童発達支援"}]
[]
[]
["送付先",null,"郵便番号",null,null,null,null,null,"〒",null,{"$f":"IF(#REF!=\"\",\"\",LEFT(#REF!,3))","v":{"$error":"#REF!"}},null,null,"-",{"$f":"IF(#REF!=\"\",\"\",RIGHT(#REF!,4))","v":{"$error":"#REF!"}}]
[null,null,"送付先住所",null,null,null,null,null,{"$f":"IF(#REF!=\"\",\"\",#REF!)","v":{"$error":"#REF!"}}]
[]
[null,null,null,null,null,null,null,null,{"$f":"IF(#REF!=\"\",\"\",#REF!)","v":{"$error":"#REF!"}}]
[]
[null,null,"宛名",null,null,null,null,null,{"$f":"IF(#REF!=\"\",\"\",#REF!)","v":{"$error":"#REF!"}}]
[]
[null,null,"電話番号",null,null,null,null,null,{"$f":"IF(#REF!=\"\",\"\",#REF!)","v":{"$error":"#REF!"}},null,null,{"$f":"IF(I34=\"\",\"\",\"-\")","v":{"$error":"#REF!"}},{"$f":"IF(#REF!=\"\",\"\",#REF!)","v":{"$error":"#REF!"}},null,null,{"$f":"IF(M34=\"\",\"\",\"-\")","v":{"$error":"#REF!"}},{"$f":"IF(#REF!=\"\",\"\",#REF!)","v":{"$error":"#REF!"}},null,null,""]
[]
[]
["振込先",null,"金融機関名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金融機関コード",null,null,null,null,null,null,null,null,""]
[]
[null,null,"店舗名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"店舗コード",null,null,null,null,null,null,null,null,""]
[]
[null,null,"口座番号",null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,"預金種別",null,null,null,null,null,1]
[]
[null,null,"名義人",null,"ﾌﾘｶﾞﾅ"]
[]
[null,null,null,null,"氏名"]
[]
[]
["委任状"]
[null,null,"　　申請者（債権者）は，口座名義人（受任者）に，上記介護給付費等の受領に関する一切の権限を"]
[null,null,"　委任します。"]
[null,null,"平成",null,null,{"$f":"IF(X8<>\"\",X8,\"\")","v":""},null,null,"年",{"$f":"IF(AD8<>\"\",AD8,\"\")","v":""},null,null,"月",{"$f":"IF(AJ8<>\"\",AJ8,\"\")","v":""},null,null,"日"]
[]
[null,null,"委任者",null,null,null,null,null,{"$f":"IF(I18<>\"\",I18,\"\")","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[]
[]
[]
["振込エラー防止のため"]
[]
["ここに振込先の店番号，口座番号，口座名義人フリガナがわかる"]
[]
["通帳の写しを貼り付けるか，"]
[]
["以下に，取引金融機関の確認印を受けてください。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"上記口座が存在することを確認しました。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"確認印"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金融機関名"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"確認年月日"]
[]
[]
[]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"指定年月日"]

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["付表６　居宅訪問型児童発達支援事業所の指定に係る記載事項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※受付番号",null,null,null,{"$f":"様式第１号!T3","v":""}]
[]
["事業所",null,"ﾌﾘｶﾞﾅ",null,null,null,null,null,{"$f":"IF(様式第１号!G28<>\"\",様式第１号!G28,\"\")","v":""}]
[null,null,"名　　称",null,null,null,null,null,{"$f":"IF(様式第１号!G29<>\"\",様式第１号!G29,\"\")","v":""}]
[null,null,"所在地",null,null,null,null,null,"〒",null,{"$f":"IF(様式第１号!H30<>\"\",様式第１号!H30,\"\")","v":""},null,null,null,null,null,"←郵便番号を半角数字７桁で入力してください"]
[null,null,null,null,null,null,null,null,{"$f":"IF(様式第１号!G31<>\"\",様式第１号!G31,\"\")","v":""}]
[null,null,null,null,null,null,null,null,{"$f":"IF(様式第１号!G32<>\"\",様式第１号!G32,\"\")","v":""}]
[null,null,"連 絡 先",null,null,null,null,null,"電話番号",null,null,null,"",null,null,null,null,null,null,null,null,null,"ＦＡＸ番号",null,null,null,null,""]
["当該支援の実施について定めてある定款又は条例等"]
["管理者",null,"ﾌﾘｶﾞﾅ"]
[null,null,"氏　　名",null,null,null,null,null,""]
[null,null,"住　　所",null,null,null,null,null,"〒",null,null,null,null,null,null,null,"←郵便番号を半角数字７桁で入力してください"]
[null,null,null,null,null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"I14&IF(I15<>\"\",\" \"&I15,\"\")","v":""}]
[null,null,null,null,null,null,null,null,""]
[null,null,"当該障害児通所支援で兼務する他の職種（兼務の場合のみ記入）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,"他の事業所又は施設の従業者との兼務（兼務の場合記入）",null,null,null,null,null,null,null,null,null,null,null,"事業所等の名称",null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"兼務する職種",null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"勤務時間",null,null,null,null,null,null,null,""]
["児童発達支援管理責任者",null,"ﾌﾘｶﾞﾅ",null,null,null,null,null,""]
[null,null,"氏　　名",null,null,null,null,null,""]
[null,null,"住　　所",null,null,null,null,null,"〒",null,null,null,null,null,null,null,"←郵便番号を半角数字７桁で入力してください"]
[null,null,null,null,null,null,null,null,""]
[null,null,null,null,null,null,null,null,""]
["　従業者の職種・員数",null,null,null,null,null,null,null,null,null,"児童発達支援管理責任者",null,null,null,null,null,"訪問支援員"]
[null,null,null,null,null,null,null,null,null,null,"専従",null,null,"兼務",null,null,"専従",null,null,"兼務"]
[null,null,"従業者数",null,null,null,"常勤（人）"]
[null,null,null,null,null,null,"非常勤（人）"]
[null,null,"※基準上の必要人数（人）"]
[null,null,"多機能型の有無"]
[null,null,"他法との定員合算",null,null,null,null,null,"非該当",null,null,null,null,null,null,null,null,null,"合算先事業所番号"]
["主な掲示事項",null,"営業日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"処遇改善加算"]
[null,null,"営業時間",null,null,null,null,"平日",null,null,"",null,null,"～",null,"",null,null,"土曜",null,null,"",null,null,"～",null,null,"",null,null,null,null,null,null,null,null,null,{"$f":"VLOOKUP(K46,AO33:AP34,2,FALSE)","v":1},null,null,"無し",1]
[null,null,null,null,null,null,null,"日曜祝日",null,null,"",null,null,"～",null,"",null,null,"学校休業日",null,null,"",null,null,"～",null,null,"",null,null,null,null,null,null,null,null,null,"処遇改善キャリアパス区分",null,null,"有り",2]
[null,null,"利用料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他費用",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AL33=2,VLOOKUP(AA46,AO36:AP41,2,FALSE),0)","v":0}]
[null,null,"通常の事業\nの実施地域",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"処遇改善特別加算",null,null,"Ⅰ",6]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"VLOOKUP(K47,AO33:AP34,2,FALSE)","v":1},null,null,"Ⅱ",5]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"児発管欠如減算",null,null,"Ⅲ",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,{"$f":"VLOOKUP(K48,AO33:AP34,2,FALSE)","v":1},null,null,"Ⅳ（キャリアパス要件）",3]
[null,null,"その他参考となる事項",null,null,null,null,null,null,"第三者評価の実施状況",null,null,null,null,null,null,null,"2",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"減算適用開始年月日",null,null,"Ⅳ（職場環境等要件）",4]
[null,null,null,null,null,null,null,null,null,"苦情解決の措置概要",null,null,null,null,null,null,"窓口（連絡先）",null,null,null,"",null,null,null,null,null,"担当者",null,"",null,null,null,null,null,null,null,null,{"$f":"IF(K49<>\"\",TEXT(K49,\"yyyymmdd\"),\"\")","v":""},null,null,"Ⅴ（キャリアパス、職場環境等要件）",2]
[null,null,"協力医療機関",null,"名　称",null,null,null,null,null,null,null,null,null,null,null,null,"主　　な\n診療科名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"訪問支援員特別加算"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"VLOOKUP(AA48,AO33:AP34,2,FALSE)","v":1}]
[null,null,null,null,"名　称",null,null,null,null,null,null,null,null,null,null,null,null,"主　　な\n診療科名"]
[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,2]
["※加算等",null,"処遇改善加算",null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,null,null,"処遇改善ｷｬﾘｱﾊﾟｽ区分"]
[null,null,"処遇改善特別加算",null,null,null,null,null,null,null,"無し"]
[null,null,"児発管欠如減算",null,null,null,null,null,null,null,"無し",null,null,null,null,null,null,null,null,"訪問支援員特別加算",null,null,null,null,null,null,"無し"]
[null,null,"児発管減算適用開始年月日"]
["（備考）",null,null,"１．「※」のついた欄は、記入しないでください。"]
[null,null,null,"２．事業所の名称・所在地については、様式第１号から転記されます。"]
[null,null,null,"３．「主な掲示事項」欄には、その内容を簡潔に記載して下さい。"]

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