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[null,null,"被保険者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・黄色の部分に入力、チェックして印刷してください。入力、チェックされた箇所は、",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"副","に反映されます。"]
["◎※印欄は記入しないでください。","◎記入の方法は２枚目の裏面に書いてありますのでお読みください。","①記号",null,null,null,"②番号"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・印刷する際は、「A４　両面（短編綴じ）」で印刷してください。"]
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[null,null,"③被保険者の氏名",null,null,null,null,null,null,null,"④生年月日",null,null,null,null,null,null,null,"⑤性別",null,null,null,"⑥被保険者の住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・セルを結合したり、列や行を追加・削除しないでください。リセットボタンが正常に動作しなくなります。"]
[null,null,"(氏)",null,null,null,"(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,"℡"]
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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,null,null,null,null,null,null,null,null,null,null,null,null,null,"　方法で対応してください。"]
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[null,null,"(氏)",null,null,null,"(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,"℡"]
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[null,null,"(氏)",null,null,null,"(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,"前回入力した情報を保存している場合は、別人の情報が残るのを避けるため"]
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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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"下のリセットボタンを押して、全て消去してから入力してください。"]
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[null,null,"⑫適用除外の理由",null,null,null,null,null,null,null,"⑬該当・不該当の別",null,null,null,null,null,"⑭該当・不該当年月日",null,null,null,null,null,null,null,null,"⑮","入居施設\n名　　称"]
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[null,null,false,"　在留資格１年未満の外国人"]
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[null,null,"事業所名称"]
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[null,null,"電話"]
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[null,null,"2025-04-01"]
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["副"]
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[]
[null,null,"⑫適用除外の理由",null,null,null,null,null,null,null,"⑬該当・不該当の別",null,null,null,null,null,"⑭該当・不該当年月日",null,null,null,null,null,null,null,null,"⑮","入居施設\n名　　称",null,{"$f":"IF(AC21=\"\",\"\",AC21)","v":""},"","","","","","","","","","",""]
[null,null,null,"　国外居住者",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(Q22=\"\",\"\",Q22)","v":""},null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AC22=\"\",\"\",AC22)","v":""},"","","","","","","","","","",""]
[null,null,null,"　適用除外施設入所者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑯","入居施設所 在 地",null,"〒",{"$f":"IF(AD23=\"\",\"\",AD23)","v":""},"","",null,null,null,"℡",{"$f":"IF(AK23=\"\",\"\",AK23)","v":""},"","",""]
[null,null,null,"　在留資格１年未満の外国人",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AC24=\"\",\"\",AC24)","v":""},"","","","","","","","","","",""]
[]
[null,null,null,null,null,null,null,null,"〒",{"$f":"IF(J26=\"\",\"\",J26)","v":""},"","",null,null,null,null,null,null,null,null,null,null,null,null,null,"令和　　年　　月　　日　提出された介護保険適用除外該当・不該当届"]
[null,null,"事業所所在地",null,null,null,null,null,{"$f":"IF(I27=\"\",\"\",I27)","v":""},"","","","","","","","","","","","","",null,null,null,"に基づき、上記のとおり確認しましたので通知します。"]
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[null,null,"事業所名称",null,null,null,null,null,{"$f":"IF(I29=\"\",\"\",I29)","v":""},"","","","","","","","","","","","",""]
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[null,null,"事業主氏名",null,null,null,null,null,{"$f":"IF(I31=\"\",\"\",I31)","v":""},"","","","","","","","","","","","","",null,null,null,null,null,null,null,null,null,"令和　　年　　月　　日"]
[null,null,null,null,null,null,null,null,{"$f":"IF(I32=\"\",\"\",I32)","v":""},"","","","","","","","","","","","",""]
[null,null,"電話",null,null,null,null,null,{"$f":"IF(I33=\"\",\"\",I33)","v":""},"","","","","","","","","","","","","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"東京金属事業健康保険組合理事長"]
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["『届出書の説明』",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"『記入の方法』"]
[]
["１.","この届出書は介護第２号被保険者の資格のある者が、つぎに該当したときに",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"１.","健保の被保険者が適用除外に該当または不該当の場合は①～⑥と⑫～⑭欄に"]
[null,"届出て下さい。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"入力、チェックして下さい。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"２."]
[null,"①国内に住所を有しなくなったとき。(海外居住者)………………",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"該当届提出",null,null,"健保の被扶養者が適用除外に該当または不該当の場合は①～⑭欄に記入、"]
[null,null,"《国内に住所がある場合、介護保険第２号被保険者となります》",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"チェックしてください。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"３."]
[null,"②海外から戻り、国内に住所を有したとき………………………",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"不該当届提出",null,null,"⑫の適用除外の事由が（適用除外施設入所者）の場合は、⑮、⑯欄にも"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"入力して下さい。"]
["２.","在留資格または、在留見込期間１年未満の短期滞在の外国人……",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"該当届提出",null,"４."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※印欄は入力しないで下さい。"]
["３.","①身体障害者療護施設へ入所したとき。……………………………",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"該当届提出"]
[]
[null,null,"㋑身体障害者福祉法（昭和24年法律第283号）第30条に規定する身体"]
[null,null,"　障害者療護施設",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"『その他』"]
[null,null,"㋺児童福祉法（昭和22年法律第164号）第43条の4に規定する重症心身"]
[null,null,"　障害児施設",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"１.","健保組合が確認のため、住民票除票・住民票・施設入居証明書写などの添付"]
[null,null,"㋩児童福祉法第27条第2項の厚生労働大臣が指定する医療機関（当該",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"書類の提出が義務づけられています。"]
[null,null,"　指定に係る治療等を行う病床に限る）"]
[null,null,"㋥心身障害者福祉協会法（昭和45年法律第44条）第17条第1項第1号に",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"２.","この届をご提出する際は、併せて「住所変更届」もご提出ください。"]
[null,null,"　規定する福祉施設"]
[null,null,"㋭国立及び国立以外のハンセン病療養所"]
[null,null,"㋬生活保護法第38条第1項第1号に規定する救護施設",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"この届出書は届出る事実が発生したら速やかに\n提出して下さい。"]
[]
[null,"②身体障害者療護施設を退所したとき……………………………",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"不該当届提出"]