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{"sheet":"东京国际诊所体检申请表","index":0,"n_rows":44,"n_cols":34,"rows_kept":44,"merged":[[0,1,0,32],[1,1,1,32],[2,22,2,24],[2,25,2,31],[3,1,3,8],[3,9,3,18],[3,19,3,21],[3,22,3,33],[4,1,4,6],[4,7,4,18],[4,24,4,33],[5,1,5,5],[5,6,5,18],[5,19,5,29],[5,30,5,33],[7,1,7,7],[7,9,7,13],[7,15,7,19],[7,21,7,32],[8,1,8,4],[8,6,8,9],[8,11,8,15],[8,16,8,22],[8,23,8,26],[8,27,8,30],[8,31,8,32],[9,1,9,4],[9,5,9,15],[9,16,9,19],[9,20,9,21],[9,22,9,23],[9,25,9,28],[9,29,9,31],[10,1,10,7],[10,9,10,32],[11,1,11,9],[11,10,11,32],[12,1,12,7],[12,8,12,16],[12,17,12,23],[12,24,12,32],[13,1,13,7],[13,9,13,12],[13,14,13,17],[13,19,13,22],[13,23,13,32],[16,2,16,14],[16,16,16,33],[17,2,17,14],[17,16,17,33],[18,1,18,13],[19,2,19,8],[19,10,19,16],[19,18,19,24],[20,1,20,33],[21,1,21,33],[22,2,22,5],[22,6,22,31],[23,2,23,5],[23,6,23,33],[24,1,24,33],[25,4,25,15],[25,18,25,21],[26,1,26,33],[27,4,27,15],[27,18,27,21],[28,1,28,33],[29,2,29,5],[29,6,29,31],[30,2,30,33],[31,1,31,33],[32,2,32,5],[32,6,32,31],[33,2,33,33],[36,1,36,33],[37,1,37,4],[37,5,37,17],[37,18,37,22],[37,24,37,27],[37,29,37,32],[38,1,38,7],[38,8,38,17],[38,19,38,22],[38,23,38,32],[39,1,39,6],[39,7,39,16],[39,17,39,22],[39,23,39,32],[40,1,40,3],[40,4,40,16],[40,26,40,32]],"flags":["formulas_cached_only"]}
[null,"东 京 国 际 诊 所"]
[null,"精密体检服务申请表"]
[null,"致 东京国际诊所",{"$nulls":20},"(Case# ",{"$nulls":9},")"]
[null,"今后联系人（今後連絡先）：",{"$nulls":17},"E-mail："]
[null,"电话（電話）：",{"$nulls":17},"手机（携帯）："]
[null,"地址（住所）：",{"$nulls":17},"与体检人关系（健診者との関係）："]
[]
[null,"体检人姓名 (検診者名)　",{"$nulls":6},"汉字",{"$nulls":5},"拼音"]
[null,"性别 （性別）",{"$nulls":4},"男性(Male)　",{"$nulls":4},"女性(Female)",{"$nulls":4},"出生日期 (生年月日) ",{"$nulls":10}," 年龄(年齢)"]
[null,"国籍(国籍) ",{"$nulls":14},"身高(身長)",{"$nulls":5}," cm",null,null,"体重(体重)",{"$nulls":6}," Kg"]
[null,"现居住地地址 (現住所)  ",{"$nulls":6},"邮编"]
[null,"资料邮寄地址（資料郵送先）"]
[null,"固定电话(電話番号)",{"$nulls":15},"手机号码(携帯番号)"]
[null,"母语(母国語)",{"$nulls":7},"中文(中国語) ",{"$nulls":4},"英文(英語) ",{"$nulls":4},"其他(その他 )"]
[]
[null,"精密体检套餐（人間ドックプラン） "]
[null,null,"基础套餐（ライト）  1天"]
[]
[null,"希望体检日期（検診希望日）"]
[null,"①",{"$nulls":7},"②",{"$nulls":7},"③",{"$nulls":15},"※名额已满时，另调整"]
[null,"周六日及日本法定假日，体检医院不接受预约"]
[null,"既往病史 (既往歴) 特别是高血压，心脏病，糖尿病，肾功能障碍，支气管哮喘等"]
[null,null,"有（具体情况：",{"$nulls":29},"）"]
[null,null,"无（無）"]
[null,"过敏史(アレルギー) 特别是碘，造影剂等"]
[null,null,"有（",{"$nulls":13},"）",null,"无（無）"]
[null,"体内有无金属（体内金属の有無）避孕环，纹身*，假牙等"]
[null,null,"有（",{"$nulls":13},"）",null,"无（無）"]
[null,"现有的症状（現在お困りの症状）特别是高血压，心脏病，糖尿病，肾功能障碍，支气管哮喘等"]
[null,null,"有（具体情况：",{"$nulls":29},"）"]
[null,null,"无（無）"]
[null,"现服用的药物(服用薬) "]
[null,null,"有（具体情况：",{"$nulls":29},"）"]
[null,null,"无（無）"]
[null,"（限女性）怀孕的可能性 （妊娠の可能性）",{"$nulls":15},"（限女性）是否月经期（生理中）"]
[null,null,"有",{"$nulls":4},"无（無）",{"$nulls":10},"是(はい)",{"$nulls":4},"不是(いいえ)"]
[null,"紧急联系人信息（緊急連絡先）"]
[null,"姓名 (氏名)",{"$nulls":16},"性别 （性別）",{"$nulls":5},"男性(Male)　",{"$nulls":4},"女性(Female)"]
[null,"出生年月日 (生年月日) ",{"$nulls":17}," 年龄(年齢)"]
[null,"固定电话(電話番号)",{"$nulls":15},"手机号码(携帯番号)"]
[null,"E-mail：",{"$nulls":15},"与体检人关系(患者との続柄)：              　　　　　　     "]
[]
[null,"*曾经有过纹身（包括纹眉）即使目前已清除，也有可能无法接受MRI检查。"]
[null," 刺青(ｱｰﾄﾒｲｸ含む)を入れたことがあり現在除去したとしても、MRI検査を受けられない可能性があります。"]