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["「入院および通院共済金請求書作成支援ツール」の利用方法と注意事項（必ずお読みください）"]
["1.目的"]
[null,"　このツールは、主に入院と通院についての共済金請求における「共済金請求書」（以下「請求書」といいます。）の"]
[null,"作成を支援するため作られたものです。"]
[]
["2.ツールの特徴"]
[null,"このツールには以下の特徴があります。"]
[null,"・請求書の煩雑な記入事項について、入力項目をグループ分けしたことなどにより、記載漏れ等を防止することができます。"]
[null,"・日数の要件チェックや請求金額の自動計算といった機能で、ケアレスミスを防止することができます。"]
[null,"・このExcelブックで６件まで請求書を作成することができます。"]
[null,"・Excelの標準機能の組み合わせのみで構成されているので、マクロ禁止設定のPCでも操作が可能です。"]
[]
["3.注意事項"]
[null,"・障害共済金と死亡共済金、および供花料については、このツールで作成することはできません。"]
[null,"・Microsoft Office 2016以降のバージョンでご利用ください。"]
[null,"・動作環境によっては、印刷した際に罫線のずれや文字化け等が発生する場合がありますが、"]
[null,"　個々の動作環境に関する問い合わせには応じられませんので、あらかじめご了承願います。"]
[null,"・本ツールの内容には万全を期しておりますが、その内容を保証するものではありません。"]
[null,"　計算結果については必ず検算を行ってください。"]
[null,"・本ツールの利用に基づくいかなる損害に対しても一切の責任を負わないことをあらかじめご了承ください。"]
[null,"・必ず最新バージョンのツールをご利用ください。また、当会ホームページなどで利用中止がアナウンスされた場合は、"]
[null,"　直ちに利用を中止してツールを削除してください。"]
[]
["4.ツールの構成等"]
[null,"このツールは、次のシートによって構成されています。"]
[null,"シートの移動は、シート下の「見出し」（タブ）をクリックして行ってください。"]
[]
[]
[null,"（１）「利用方法・注意事項（必ずお読みください）」…シートの見出しの色【オレンジ】"]
[null,null,"本ツールの使用方法、注意事項等について記載しています。"]
[null,"（２）「入力シート」…シートの見出しの色【緑】"]
[null,null,"請求書に記載する項目について入力を行います。"]
[null,"（３）「請求１」～「請求６」…シートの見出しの色【青】"]
[null,null,"請求書の記載イメージが表示されます。"]
[null,"（４）参考 医療等の状況と請求日数【黄】"]
[null,null,"医療等の状況から請求書へ転記する請求日数について記載しています。"]
[]
["5.利用手順"]
[null,"請求書の作成にあたっては、以下の手順をご参考ください。"]
[null,"①　「入力シート」の必要な項目へ入力する。",{"$nulls":11},"入力が可能な項目",{"$nulls":5},"入力が必須の項目",{"$nulls":5},"確認を推奨する項目"]
[{"$nulls":3},"↓"]
[null,"②　入力に誤りがないかチェックする。欄の上部に「未入力の必須項目数」が表示される場合は再度ご確認ください。"]
[{"$nulls":3},"↓"]
[null,"③　「請求」の該当シートで内容をチェックする。請求ごとにシートが請求１から請求６まで分かれています。"]
[{"$nulls":3},"↓"]
[null,null,"月ごとの請求内容については「医療等の状況」ひと月分ごとに入力すると、同じ年月の箇所の色が変わります。"]
[null,null,"色が変わった場合は、受診した医療機関等を確認してください。"]
[{"$nulls":3},"※同日でも別の医療機関等の受診の場合はそれぞれご請求できますが、"]
[{"$nulls":3},"　同日に総合病院で複数の科を受診した場合のご請求はまとめて１日となります。"]
[{"$nulls":3},"↓"]
[null,"④　「請求」シートを印刷する。※シートごとに「ファイル＞名前を付けて保存」から保存画面を進み、ファイルの種類で"]
[null,"　　PDFを選択して保存すると、請求書ごとにPDFで保存することも可能です。"]
[]
[null,"※　入力データを保存する場合は、このExcelブックとは別名での保存をおすすめいたします。"]
[null,null,"（このExcelブックはテンプレートとしてご使用ください。）"]

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[null,"共済金請求書作成ツール（入院・通院）Ver.001"]
[]
[null,"契約者情報"]
[null,"契約者名（学校等名）",{"$nulls":25},"セルの色分け　…",{"$nulls":4},"入力が可能な項目",{"$nulls":5},"入力が必須の項目",{"$nulls":5},"確認を推奨する項目"]
[null,"代表者名"]
[]
[]
[{"$nulls":12},"請求１",{"$nulls":6},"請求２",{"$nulls":6},"請求３",{"$nulls":6},"請求４",{"$nulls":6},"請求５",{"$nulls":6},"請求６"]
[null,"被共済者情報"]
[null,"被共済者氏名"]
[null,"上記氏名のフリガナ"]
[null,"性別"]
[null,"生年月日（入力例 H20/12/25、2008/12/25など）"]
[null,"現在の学年・組"]
[null,"災害発生時の学年・組"]
[null,"共済金受取口座情報"]
[null,"口座名義人氏名"]
[null,"上記氏名のフリガナ"]
[null,"被共済者との続柄"]
[null,"金融機関名"]
[null,"本支店名（ゆうちょ銀行は通帳に記載されている【店名】）"]
[null,"本支店コード（半角数字で入力してください）"]
[null,"預金種目（選択してください）"]
[null,"口座番号（半角数字で入力してください）"]
[null,"請求内容 ①"]
[null,"入院・通院の別（選択してください）"]
[null,"災害発生年月日（入力例 H20/12/25、2008/12/25など）"]
[null,"災害発生時間（入力例 1時25分の場合は 1325 と入力）"]
[null,"この災害での受給歴（選択してください）"]
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[null,"請求内容 ②（今回診療を受けた月別の日数）"]
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[null,"備考"]
[null,"補足や伝達事項などがあればご入力ください"]
[null,"入力内容チェック"]
[null,"残りの入力必須項目",{"$nulls":10},{"$f":"IF(M10=\"\",\"\",\n  COUNTBLANK(M11:M15)+COUNTBLANK(M17:M24)+COUNTBLANK(M26:M29)+\n  IF(M29=\"あり\",COUNTBLANK(O30:O32)+COUNTBLANK(Q30:Q32)+COUNTBLANK(M33),0)+\n  (COUNTBLANK(M35)+COUNTBLANK(O35)+COUNTBLANK(Q35))+\n  SUMPRODUCT(((M36:M46<>\"\")+(O36:O46<>\"\")+(Q36:Q46<>\"\")>0)*1, ((M36:M46=\"\")+(O36:O46=\"\")+(Q36:Q46=\"\")))\n)","v":""},{"$nulls":6},{"$f":"IF(T10=\"\",\"\",\n  COUNTBLANK(T11:T15)+COUNTBLANK(T17:T24)+COUNTBLANK(T26:T29)+\n  IF(T29=\"あり\",COUNTBLANK(V30:V32)+COUNTBLANK(X30:X32)+COUNTBLANK(T33),0)+\n  (COUNTBLANK(T35)+COUNTBLANK(V35)+COUNTBLANK(X35))+\n  SUMPRODUCT(((T36:T46<>\"\")+(V36:V46<>\"\")+(X36:X46<>\"\")>0)*1, ((T36:T46=\"\")+(V36:V46=\"\")+(X36:X46=\"\")))\n)","v":""},{"$nulls":6},{"$f":"IF(AA10=\"\",\"\",\n  COUNTBLANK(AA11:AA15)+COUNTBLANK(AA17:AA24)+COUNTBLANK(AA26:AA29)+\n  IF(AA29=\"あり\",COUNTBLANK(AC30:AC32)+COUNTBLANK(AE30:AE32)+COUNTBLANK(AA33),0)+\n  (COUNTBLANK(AA35)+COUNTBLANK(AC35)+COUNTBLANK(AE35))+\n  SUMPRODUCT(((AA36:AA46<>\"\")+(AC36:AC46<>\"\")+(AE36:AE46<>\"\")>0)*1, ((AA36:AA46=\"\")+(AC36:AC46=\"\")+(AE36:AE46=\"\")))\n)","v":""},{"$nulls":6},{"$f":"IF(AH10=\"\",\"\",\n  COUNTBLANK(AH11:AH15)+COUNTBLANK(AH17:AH24)+COUNTBLANK(AH26:AH29)+\n  IF(AH29=\"あり\",COUNTBLANK(AJ30:AJ32)+COUNTBLANK(AL30:AL32)+COUNTBLANK(AH33),0)+\n  (COUNTBLANK(AH35)+COUNTBLANK(AJ35)+COUNTBLANK(AL35))+\n  SUMPRODUCT(((AH36:AH46<>\"\")+(AJ36:AJ46<>\"\")+(AL36:AL46<>\"\")>0)*1, ((AH36:AH46=\"\")+(AJ36:AJ46=\"\")+(AL36:AL46=\"\")))\n)","v":""},{"$nulls":6},{"$f":"IF(AO10=\"\",\"\",\n  COUNTBLANK(AO11:AO15)+COUNTBLANK(AO17:AO24)+COUNTBLANK(AO26:AO29)+\n  IF(AO29=\"あり\",COUNTBLANK(AQ30:AQ32)+COUNTBLANK(AS30:AS32)+COUNTBLANK(AO33),0)+\n  (COUNTBLANK(AO35)+COUNTBLANK(AQ35)+COUNTBLANK(AS35))+\n  SUMPRODUCT(((AO36:AO46<>\"\")+(AQ36:AQ46<>\"\")+(AS36:AS46<>\"\")>0)*1, ((AO36:AO46=\"\")+(AQ36:AQ46=\"\")+(AS36:AS46=\"\")))\n)","v":""},{"$nulls":6},{"$f":"IF(AV10=\"\",\"\",\n  COUNTBLANK(AV11:AV15)+COUNTBLANK(AV17:AV24)+COUNTBLANK(AV26:AV29)+\n  IF(AV29=\"あり\",COUNTBLANK(AX30:AX32)+COUNTBLANK(AZ30:AZ32)+COUNTBLANK(AV33),0)+\n  (COUNTBLANK(AV35)+COUNTBLANK(AX35)+COUNTBLANK(AZ35))+\n  SUMPRODUCT(((AV36:AV46<>\"\")+(AX36:AX46<>\"\")+(AZ36:AZ46<>\"\")>0)*1, ((AV36:AV46=\"\")+(AX36:AX46=\"\")+(AZ36:AZ46=\"\")))\n)","v":""}]
[null,"新規の請求における要件（通院５日、入院７日以上）",{"$nulls":10},{"$f":"IF(M10=\"\", \"\",IF(入力シート!M29=\"\", \"受給歴の欄が未入力\",IF(SUM(入力シート!Q35:Q46)=0, \"診療日数を入力してください\",IF(OR(入力シート!M29=\"あり\",AND(入力シート!M29=\"なし\", 入力シート!M26=\"入院\", SUM(入力シート!Q35:Q46)>=5),AND(入力シート!M29=\"なし\", 入力シート!M26=\"通院\", SUM(入力シート!Q35:Q46)>=7)), \"請求可\", \"診療日数を確認してください\"))))","v":""},{"$nulls":6},{"$f":"IF(T10=\"\", \"\",IF(入力シート!T29=\"\", \"受給歴の欄が未入力\",IF(SUM(入力シート!X35:X46)=0, \"診療日数を入力してください\",IF(OR(入力シート!T29=\"あり\",AND(入力シート!T29=\"なし\", 入力シート!T26=\"入院\", SUM(入力シート!X35:X46)>=5),AND(入力シート!T29=\"なし\", 入力シート!T26=\"通院\", SUM(入力シート!X35:X46)>=7)), \"請求可\", \"診療日数を確認してください\"))))","v":""},{"$nulls":6},{"$f":"IF(AA10=\"\", \"\",IF(入力シート!AA29=\"\", \"受給歴の欄が未入力\",IF(SUM(入力シート!AE35:AE46)=0, \"診療日数を入力してください\",IF(OR(入力シート!AA29=\"あり\",AND(入力シート!AA29=\"なし\", 入力シート!AA26=\"入院\", SUM(入力シート!AE35:AE46)>=5),AND(入力シート!AA29=\"なし\", 入力シート!AA26=\"通院\", SUM(入力シート!AE35:AE46)>=7)), \"請求可\", \"診療日数を確認してください\"))))","v":""},{"$nulls":6},{"$f":"IF(AH10=\"\", \"\",IF(入力シート!AH29=\"\", \"受給歴の欄が未入力\",IF(SUM(入力シート!AL35:AL46)=0, \"診療日数を入力してください\",IF(OR(入力シート!AH29=\"あり\",AND(入力シート!AH29=\"なし\", 入力シート!AH26=\"入院\", SUM(入力シート!AL35:AL46)>=5),AND(入力シート!AH29=\"なし\", 入力シート!AH26=\"通院\", SUM(入力シート!AL35:AL46)>=7)), \"請求可\", \"診療日数を確認してください\"))))","v":""},{"$nulls":6},{"$f":"IF(AO10=\"\", \"\",IF(入力シート!AO29=\"\", \"受給歴の欄が未入力\",IF(SUM(入力シート!AS35:AS46)=0, \"診療日数を入力してください\",IF(OR(入力シート!AO29=\"あり\",AND(入力シート!AO29=\"なし\", 入力シート!AO26=\"入院\", SUM(入力シート!AS35:AS46)>=5),AND(入力シート!AO29=\"なし\", 入力シート!AO26=\"通院\", SUM(入力シート!AS35:AS46)>=7)), \"請求可\", \"診療日数を確認してください\"))))","v":""},{"$nulls":6},{"$f":"IF(AV10=\"\", \"\",IF(入力シート!AV29=\"\", \"受給歴の欄が未入力\",IF(SUM(入力シート!AZ35:AZ46)=0, \"診療日数を入力してください\",IF(OR(入力シート!AV29=\"あり\",AND(入力シート!AV29=\"なし\", 入力シート!AV26=\"入院\", SUM(入力シート!AZ35:AZ46)>=5),AND(入力シート!AV29=\"なし\", 入力シート!AV26=\"通院\", SUM(入力シート!AZ35:AZ46)>=7)), \"請求可\", \"診療日数を確認してください\"))))","v":""}]
[null,"共済金受取人（支給時までに成年となる場合は請求可）",{"$nulls":10},{"$f":"IF(M10=\"\",\"\",IF(AND(M13<>\"\", DATEDIF(M13,TODAY(),\"Y\")<18, OR(M10=M17, M19=\"本人\")), \"現時点で成年に達していない本人\", \"請求可\"))","v":""},{"$nulls":6},{"$f":"IF(T10=\"\",\"\",IF(AND(T13<>\"\", DATEDIF(T13,TODAY(),\"Y\")<18, OR(T10=T17, T19=\"本人\")), \"現時点で成年に達していない本人\", \"請求可\"))","v":""},{"$nulls":6},{"$f":"IF(AA10=\"\",\"\",IF(AND(AA13<>\"\", DATEDIF(AA13,TODAY(),\"Y\")<18, OR(AA10=AA17, AA19=\"本人\")), \"現時点で成年に達していない本人\", \"請求可\"))","v":""},{"$nulls":6},{"$f":"IF(AH10=\"\",\"\",IF(AND(AH13<>\"\", DATEDIF(AH13,TODAY(),\"Y\")<18, OR(AH10=AH17, AH19=\"本人\")), \"現時点で成年に達していない本人\", \"請求可\"))","v":""},{"$nulls":6},{"$f":"IF(AO10=\"\",\"\",IF(AND(AO13<>\"\", DATEDIF(AO13,TODAY(),\"Y\")<18, OR(AO10=AO17, AO19=\"本人\")), \"現時点で成年に達していない本人\", \"請求可\"))","v":""},{"$nulls":6},{"$f":"IF(AV10=\"\",\"\",IF(AND(AV13<>\"\", DATEDIF(AV13,TODAY(),\"Y\")<18, OR(AV10=AV17, AV19=\"本人\")), \"現時点で成年に達していない本人\", \"請求可\"))","v":""}]
[null,"診療日が重複している可能性がある請求内容の有無",{"$nulls":10},{"$f":"IF(M10=\"\",\"\",IF(MAX(INDEX(COUNTIFS(M35:M46,M35:M46,O35:O46,O35:O46,M35:M46,\"<>\"),0))>1,\"同年月の診療を確認してください\",\"なし\"))","v":""},{"$nulls":6},{"$f":"IF(T10=\"\",\"\",IF(MAX(INDEX(COUNTIFS(T35:T46,T35:T46,V35:V46,V35:V46,T35:T46,\"<>\"),0))>1,\"同年月の診療を確認してください\",\"なし\"))","v":""},{"$nulls":6},{"$f":"IF(AA10=\"\",\"\",IF(MAX(INDEX(COUNTIFS(AA35:AA46,AA35:AA46,AC35:AC46,AC35:AC46,AA35:AA46,\"<>\"),0))>1,\"同年月の診療を確認してください\",\"なし\"))","v":""},{"$nulls":6},{"$f":"IF(AH10=\"\",\"\",IF(MAX(INDEX(COUNTIFS(AH35:AH46,AH35:AH46,AJ35:AJ46,AJ35:AJ46,AH35:AH46,\"<>\"),0))>1,\"同年月の診療を確認してください\",\"なし\"))","v":""},{"$nulls":6},{"$f":"IF(AO10=\"\",\"\",IF(MAX(INDEX(COUNTIFS(AO35:AO46,AO35:AO46,AQ35:AQ46,AQ35:AQ46,AO35:AO46,\"<>\"),0))>1,\"同年月の診療を確認してください\",\"なし\"))","v":""},{"$nulls":6},{"$f":"IF(AV10=\"\",\"\",IF(MAX(INDEX(COUNTIFS(AV35:AV46,AV35:AV46,AX35:AX46,AX35:AX46,AV35:AV46,\"<>\"),0))>1,\"同年月の診療を確認してください\",\"なし\"))","v":""}]
[{"$nulls":12},{"$f":"IF(M53=\"同年月の診療を確認してください\",\"同日でも別の医療機関等の受診の場合はそれぞれご請求できますが、同日に総合病院で複数の科を受診した場合のご請求はまとめて１日となります。\n同じ年月で同じ医療機関等の「医療等の状況」がある場合は診療日の重複についてご確認ください。\",\"\")","v":""},{"$nulls":6},{"$f":"IF(T53=\"同年月の診療を確認してください\",\"同日でも別の医療機関等の受診の場合はそれぞれご請求できますが、同日に総合病院で複数の科を受診した場合のご請求はまとめて１日となります。\n同じ年月で同じ医療機関等の「医療等の状況」がある場合は診療日の重複についてご確認ください。\",\"\")","v":""},{"$nulls":6},{"$f":"IF(AA53=\"同年月の診療を確認してください\",\"同日でも別の医療機関等の受診の場合はそれぞれご請求できますが、同日に総合病院で複数の科を受診した場合のご請求はまとめて１日となります。\n同じ年月で同じ医療機関等の「医療等の状況」がある場合は診療日の重複についてご確認ください。\",\"\")","v":""},{"$nulls":6},{"$f":"IF(AH53=\"同年月の診療を確認してください\",\"同日でも別の医療機関等の受診の場合はそれぞれご請求できますが、同日に総合病院で複数の科を受診した場合のご請求はまとめて１日となります。\n同じ年月で同じ医療機関等の「医療等の状況」がある場合は診療日の重複についてご確認ください。\",\"\")","v":""},{"$nulls":6},{"$f":"IF(AO53=\"同年月の診療を確認してください\",\"同日でも別の医療機関等の受診の場合はそれぞれご請求できますが、同日に総合病院で複数の科を受診した場合のご請求はまとめて１日となります。\n同じ年月で同じ医療機関等の「医療等の状況」がある場合は診療日の重複についてご確認ください。\",\"\")","v":""},{"$nulls":6},{"$f":"IF(AV53=\"同年月の診療を確認してください\",\"同日でも別の医療機関等の受診の場合はそれぞれご請求できますが、同日に総合病院で複数の科を受診した場合のご請求はまとめて１日となります。\n同じ年月で同じ医療機関等の「医療等の状況」がある場合は診療日の重複についてご確認ください。\",\"\")","v":""}]
[null,"（参考）必要な添付書類"]
[null,"※日本スポーツ振興センターが医療費を給付しない場合は\n　「共済事務の手引き」をご覧ください。",{"$nulls":10},{"$f":"IF(OR(ISBLANK(M10),M26=\"\",M29=\"\"),\"\",IF(M26=\"入院\",IF(M29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\nIF(M26=\"通院\",IF(M29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n　または訪問看護明細書（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":6},{"$f":"IF(OR(ISBLANK(T10),T26=\"\",T29=\"\"),\"\",IF(T26=\"入院\",IF(T29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\nIF(T26=\"通院\",IF(T29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n　または訪問看護明細書（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":6},{"$f":"IF(OR(ISBLANK(AA10),AA26=\"\",AA29=\"\"),\"\",IF(AA26=\"入院\",IF(AA29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\nIF(AA26=\"通院\",IF(AA29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n　または訪問看護明細書（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":6},{"$f":"IF(OR(ISBLANK(AH10),AH26=\"\",AH29=\"\"),\"\",IF(AH26=\"入院\",IF(AH29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\nIF(AH26=\"通院\",IF(AH29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n　または訪問看護明細書（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":6},{"$f":"IF(OR(ISBLANK(AO10),AO26=\"\",AO29=\"\"),\"\",IF(AO26=\"入院\",IF(AO29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\nIF(AO26=\"通院\",IF(AO29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n　または訪問看護明細書（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":6},{"$f":"IF(OR(ISBLANK(AV10),AV26=\"\",AV29=\"\"),\"\",IF(AV26=\"入院\",IF(AV29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\nIF(AV26=\"通院\",IF(AV29=\"なし\",\"・災害報告書（写）\"&CHAR(10),\"\")&\"・医療等の状況（写）\n　または訪問看護明細書（写）\n・医療費支払通知書（写）\n　または児童生徒別給付一覧（写）\",\"\")))","v":""}]

{"sheet":"請求１","index":2,"n_rows":36,"n_cols":46,"rows_kept":36,"merged":[[0,37,0,46],[4,28,4,46],[5,28,5,44],[5,45,5,46],[6,0,6,33],[6,35,6,37],[6,39,6,41],[8,32,8,46],[9,1,9,7],[9,8,9,26],[9,27,10,31],[9,32,9,36],[9,37,9,46],[10,1,10,7],[10,8,11,26],[10,32,10,36],[10,37,10,46],[11,1,11,7],[11,27,11,31],[11,32,11,46],[12,1,12,7],[12,8,12,16],[12,17,12,21],[12,22,12,26],[12,27,12,31],[12,33,12,41],[13,1,18,7],[13,8,13,10],[13,11,13,12],[13,13,13,15],[13,16,13,17],[13,18,13,20],[13,21,13,22],[13,23,13,25],[13,26,13,27],[13,28,13,30],[13,31,13,32],[13,33,13,35],[13,36,13,37],[13,38,18,40],[13,41,18,44],[13,45,18,46],[14,8,14,10],[14,11,14,12],[14,13,14,15],[14,16,14,17],[14,18,14,20],[14,21,14,22],[14,23,14,25],[14,26,14,27],[14,28,14,30],[14,31,14,32],[14,33,14,35],[14,36,14,37],[15,8,15,11],[15,13,15,16],[15,18,15,21],[15,23,15,26],[15,28,15,31],[15,33,15,36],[16,8,16,10],[16,11,16,12],[16,13,16,15],[16,16,16,17],[16,18,16,20],[16,21,16,22],[16,23,16,25],[16,26,16,27],[16,28,16,30],[16,31,16,32],[16,33,16,35],[16,36,16,37],[17,8,17,10],[17,11,17,12],[17,13,17,15],[17,16,17,17],[17,18,17,20],[17,21,17,22],[17,23,17,25],[17,26,17,27],[17,28,17,30],[17,31,17,32],[17,33,17,35],[17,36,17,37],[18,8,18,11],[18,13,18,16],[18,18,18,21],[18,23,18,26],[18,28,18,31],[18,33,18,36],[19,1,19,7],[19,12,19,18],[19,20,19,25],[19,26,19,27],[19,29,19,30],[19,31,19,37],[19,38,19,46],[20,1,20,7],[20,8,20,16],[20,17,20,46],[21,1,21,7],[21,9,21,15],[21,20,21,22],[21,24,21,25],[21,27,21,28],[21,29,21,31],[21,33,21,34],[21,38,21,40],[21,41,21,42],[22,1,27,7],[22,8,23,24],[22,25,23,40],[22,41,22,46],[23,41,23,46],[24,8,25,10],[24,11,25,24],[24,25,27,29],[24,30,25,30],[24,31,25,39],[24,40,25,40],[24,41,25,46],[26,8,27,10],[26,11,27,12],[26,13,27,14],[26,15,27,16],[26,17,27,18],[26,19,27,20],[26,21,27,22],[26,23,27,24],[26,30,27,40],[26,41,27,46],[28,1,28,7],[28,8,28,46],[30,2,30,6],[31,2,31,23],[31,24,31,45],[32,2,32,23],[32,24,32,45],[33,2,33,23],[33,24,33,45],[35,2,35,45]]}
[null,{"$f":"IF(入力シート!M26=\"\",\"\",IF(入力シート!M26=\"通院\",\"様式10\",\"様式9\"))","v":""},{"$nulls":35},{"$f":"TODAY()","v":"2026-02-09"}]
[]
[null,"一般財団法人岩手県学校安全互助会理事長 様"]
[]
[{"$nulls":22},"学校名等",{"$nulls":5},{"$f":"IF(入力シート!M4=\"\",\"\",入力シート!M4)","v":""}]
[{"$nulls":22},"学校長等名",{"$nulls":5},{"$f":"IF(入力シート!M5=\"\",\"\",入力シート!M5)","v":""},{"$nulls":16},"職印"]
[{"$f":"IF(入力シート!M26=\"\",\"\",\"一般財団法人岩手県学校安全互助会「\"&入力シート!M26&\"共済金」請求書\")","v":""},{"$nulls":33},"(",{"$f":"IF(入力シート!M26=\"\",\"\",\"新規\")","v":""},null,null,{"$f":"IF(入力シート!M26=\"\",\"\",\"・\")","v":""},{"$f":"IF(入力シート!M26=\"\",\"\",\"継続\")","v":""},null,null,"）"]
[null,"共済金受取人より申請がありましたので、共済金の請求をします。"]
[{"$nulls":32},"※ 受付番号"]
[null,"（フリガナ）",{"$nulls":6},{"$f":"IF(入力シート!M11=\"\",\"\",CONCATENATE(\"（　\",入力シート!M11,\"　）\"))","v":""},{"$nulls":18},"学年・組",{"$nulls":4},"請求時",{"$nulls":4},{"$f":"IF(入力シート!M14=\"\",\"\",入力シート!M14)","v":""}]
[null,"対象児童生徒等",{"$nulls":6},{"$f":"IF(入力シート!M10=\"\",\"\",入力シート!M10)","v":""},{"$nulls":23},"災害発生時",{"$nulls":4},{"$f":"IF(入力シート!M15=\"\",\"\",入力シート!M15)","v":""}]
[null,"氏名",{"$nulls":25},"性別",{"$nulls":4},{"$f":"IF(入力シート!M12=\"\",\"\",入力シート!M12)","v":""}]
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[null,"今回請求金額",{"$nulls":10},{"$f":"IF(入力シート!M26=\"\",\"\",IF(入力シート!M26=\"入院\",1300,500))","v":""},{"$nulls":6},"×","（合計日数）",{"$nulls":5},{"$f":"IF(入力シート!Q35=\"\",\"\",SUM(入力シート!Q35:'入力シート'!Q46))","v":""},null,"日","＝",null,{"$f":"IF(OR(入力シート!M10=\"\", SUM(入力シート!Q35:'入力シート'!Q46)=0), \"\",IF(OR(入力シート!M29=\"あり\",AND(入力シート!M29=\"なし\", 入力シート!M26=\"入院\", SUM(入力シート!Q35:'入力シート'!Q46)>=5),AND(入力シート!M29=\"なし\", 入力シート!M26=\"通院\", SUM(入力シート!Q35:'入力シート'!Q46)>=7)),SUM(入力シート!Q35:'入力シート'!Q46) * IF(入力シート!M26=\"入院\", 1300, 500),\"\"))","v":""},{"$nulls":6},{"$f":"IF(OR(入力シート!M10=\"\", SUM(入力シート!Q35:'入力シート'!Q46)=0), \"\",IF(OR(入力シート!M29=\"あり\",AND(入力シート!M29=\"なし\", 入力シート!M26=\"入院\", SUM(入力シート!Q35:'入力シート'!Q46)>=5),AND(入力シート!M29=\"なし\", 入力シート!M26=\"通院\", SUM(入力シート!Q35:'入力シート'!Q46)>=7)),\"\",\"入力内容や請求要件を確認してください\"))","v":""}]
[null,"【継続の場合】",{"$nulls":6},"共済金の受給月",{"$nulls":8},"受給期間及び日数"]
[null,"前回受給状況",{"$nulls":6},"（",{"$f":"IF(OR(入力シート!O30=\"\", 入力シート!M29=\"なし\"), \"\", 入力シート!M30 & 入力シート!O30 & \"年\" & 入力シート!Q30 & \"月\")","v":""},{"$nulls":6},"）",null,null,"（",{"$f":"IF(OR(入力シート!O31=\"\", 入力シート!M29=\"なし\"), \"\", 入力シート!O31)","v":""},null,null,"年",{"$f":"IF(OR(入力シート!Q31=\"\", 入力シート!M29=\"なし\"), \"\", 入力シート!Q31)","v":""},null,"月","～",null,{"$f":"IF(OR(入力シート!O32=\"\", 入力シート!M29=\"なし\"), \"\", 入力シート!O32)","v":""},null,null,"年",{"$f":"IF(OR(入力シート!Q32=\"\", 入力シート!M29=\"なし\"), \"\", 入力シート!Q32)","v":""},null,"月","）","（",{"$f":"IF(OR(入力シート!M33=\"\", 入力シート!M29=\"なし\"), \"\", 入力シート!M33)","v":""},null,null,"日分",null,"）"]
[null,"共済金振込先\n（共済金受取人\n　名義の口座）",{"$nulls":6},{"$f":"IF(入力シート!M20=\"\",\"\",入力シート!M20)","v":""},{"$nulls":16},{"$f":"IF(入力シート!M21=\"\",\"\",入力シート!M21)","v":""},{"$nulls":15},"店番号"]
[{"$nulls":41},{"$f":"IF(入力シート!M22=\"\",\"\",入力シート!M22)","v":""}]
[{"$nulls":8},"預金\n種目",null,null,{"$f":"IF(入力シート!M23=\"\",\"\",入力シート!M23)","v":""},{"$nulls":13},"（フリガナ）\n口座名義人",{"$nulls":4},"（",{"$f":"IF(入力シート!M18=\"\",\"\",入力シート!M18)","v":""},{"$nulls":8},"）","被災児童生徒等\nとの続柄"]
[]
[{"$nulls":8},"口座\n番号",null,null,{"$f":"IF(入力シート!M24=\"\",\"\",MID(TEXT(入力シート!M24,\"0000000\"),1,1))","v":""},null,{"$f":"IF(入力シート!M24=\"\",\"\",MID(TEXT(入力シート!M24,\"0000000\"),2,1))","v":""},null,{"$f":"IF(入力シート!M24=\"\",\"\",MID(TEXT(入力シート!M24,\"0000000\"),3,1))","v":""},null,{"$f":"IF(入力シート!M24=\"\",\"\",MID(TEXT(入力シート!M24,\"0000000\"),4,1))","v":""},null,{"$f":"IF(入力シート!M24=\"\",\"\",MID(TEXT(入力シート!M24,\"0000000\"),5,1))","v":""},null,{"$f":"IF(入力シート!M24=\"\",\"\",MID(TEXT(入力シート!M24,\"0000000\"),6,1))","v":""},null,{"$f":"IF(入力シート!M24=\"\",\"\",MID(TEXT(入力シート!M24,\"0000000\"),7,1))","v":""},{"$nulls":6},{"$f":"IF(入力シート!M17=\"\",\"\",入力シート!M17)","v":""},{"$nulls":10},{"$f":"IF(入力シート!M19=\"\",\"\",入力シート!M19)","v":""}]
[]
[null,"備考",{"$nulls":6},{"$f":"IF(AND(入力シート!M10=\"\",入力シート!M48=\"\"),\"\",IF(ISBLANK(入力シート!M48),\"\",入力シート!M48))","v":""}]
[]
[null,null,"添付書類"]
[null,null,"日本スポーツ振興センターが医療費を給付する場合",{"$nulls":21},"日本スポーツ振興センターが医療費を給付しない場合\n（義務教育諸学校等の要保護児童生徒等の災害）"]
[null,null,{"$f":"IF(入力シート!M26=\"\",\"\",IF(入力シート!M26=\"通院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n 　 又は訪問看護明細書（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\n\",IF(入力シート!M26=\"入院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":21},"【新規請求】\n１ 災害報告書（別紙１）\n２ 医療等の状況が分かる書類"]
[null,null,"【継続請求】\n１ 日本スポーツ振興センターに提出した医療等の状況（写）\n２ 医療費支払通知書（写）又は児童生徒別給付一覧（写）",{"$nulls":21},"【継続請求】\n１ 医療等の状況が分かる書類"]
[]
[null,null,"＜個人情報の取り扱いについて＞共済金受取人の方は、次の記載内容及び添付書類の提出にご同意の上、請求書等を提出してください。\n１ 共済事業に関する個人情報は、共済引受、共済掛金管理、共済金支給審査及び共済金の支払等のために利用します。\n２ 個人情報は、上記の利用目的の達成に必要な範囲内で、業務委託先、共済金請求・支払に関する関係先等に提供を行い、又は情報の提供を受けることがあります。ただし、保健医療等の特別な非公開情報の利用目的は、法令の規定により業務の適切な運営の確保その他必要と認められる範囲に限定します。"]

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[null,{"$f":"IF(入力シート!T26=\"\",\"\",IF(入力シート!T26=\"通院\",\"様式10\",\"様式9\"))","v":""},{"$nulls":35},{"$f":"TODAY()","v":"2026-02-09"}]
[]
[null,"一般財団法人岩手県学校安全互助会理事長 様"]
[]
[{"$nulls":22},"学校名等",{"$nulls":5},{"$f":"IF(入力シート!M4=\"\",\"\",入力シート!M4)","v":""}]
[{"$nulls":22},"学校長等名",{"$nulls":5},{"$f":"IF(入力シート!M5=\"\",\"\",入力シート!M5)","v":""},{"$nulls":16},"職印"]
[{"$f":"IF(入力シート!T26=\"\",\"\",\"一般財団法人岩手県学校安全互助会「\"&入力シート!T26&\"共済金」請求書\")","v":""},{"$nulls":33},"(",{"$f":"IF(入力シート!T26=\"\",\"\",\"新規\")","v":""},null,null,{"$f":"IF(入力シート!T26=\"\",\"\",\"・\")","v":""},{"$f":"IF(入力シート!T26=\"\",\"\",\"継続\")","v":""},null,null,"）"]
[null,"共済金受取人より申請がありましたので、共済金の請求をします。"]
[{"$nulls":32},"※ 受付番号"]
[null,"（フリガナ）",{"$nulls":6},{"$f":"IF(入力シート!T11=\"\",\"\",CONCATENATE(\"（　\",入力シート!T11,\"　）\"))","v":""},{"$nulls":18},"学年・組",{"$nulls":4},"請求時",{"$nulls":4},{"$f":"IF(入力シート!T14=\"\",\"\",入力シート!T14)","v":""}]
[null,"対象児童生徒等",{"$nulls":6},{"$f":"IF(入力シート!T10=\"\",\"\",入力シート!T10)","v":""},{"$nulls":23},"災害発生時",{"$nulls":4},{"$f":"IF(入力シート!T15=\"\",\"\",入力シート!T15)","v":""}]
[null,"氏名",{"$nulls":25},"性別",{"$nulls":4},{"$f":"IF(入力シート!T12=\"\",\"\",入力シート!T12)","v":""}]
[null,"災害発生日時",{"$nulls":6},{"$f":"IF(入力シート!T27=\"\",\"\",入力シート!T27)","v":""},{"$nulls":8},{"$f":"IF(入力シート!T27=\"\",\"\",CONCATENATE(\"（\",TEXT(入力シート!T27,\"aaa\"),\"曜日）\"))","v":""},{"$nulls":4},{"$f":"IF(入力シート!T28=\"\",\"\",TEXT(入力シート!T28,\"00!:00\")*1)","v":""},{"$nulls":4},"生年月日",{"$nulls":5},{"$f":"IF(入力シート!T13=\"\",\"\",入力シート!T13)","v":""},{"$nulls":8},"生"]
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[null,"今回請求金額",{"$nulls":10},{"$f":"IF(入力シート!T26=\"\",\"\",IF(入力シート!T26=\"入院\",1300,500))","v":""},{"$nulls":6},"×","（合計日数）",{"$nulls":5},{"$f":"IF(入力シート!X35=\"\",\"\",SUM(入力シート!X35:'入力シート'!X46))","v":""},null,"日","＝",null,{"$f":"IF(OR(入力シート!T10=\"\", SUM(入力シート!X35:'入力シート'!X46)=0), \"\",IF(OR(入力シート!T29=\"あり\",AND(入力シート!T29=\"なし\", 入力シート!T26=\"入院\", SUM(入力シート!X35:'入力シート'!X46)>=5),AND(入力シート!T29=\"なし\", 入力シート!T26=\"通院\", SUM(入力シート!X35:'入力シート'!X46)>=7)),SUM(入力シート!X35:'入力シート'!X46) * IF(入力シート!T26=\"入院\", 1300, 500),\"\"))","v":""},{"$nulls":6},{"$f":"IF(OR(入力シート!T10=\"\", SUM(入力シート!X35:'入力シート'!X46)=0), \"\",IF(OR(入力シート!T29=\"あり\",AND(入力シート!T29=\"なし\", 入力シート!T26=\"入院\", SUM(入力シート!X35:'入力シート'!X46)>=5),AND(入力シート!T29=\"なし\", 入力シート!T26=\"通院\", SUM(入力シート!X35:'入力シート'!X46)>=7)),\"\",\"入力内容や請求要件を確認してください\"))","v":""}]
[null,"【継続の場合】",{"$nulls":6},"共済金の受給月",{"$nulls":8},"受給期間及び日数"]
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[null,"共済金振込先\n（共済金受取人\n　名義の口座）",{"$nulls":6},{"$f":"IF(入力シート!T20=\"\",\"\",入力シート!T20)","v":""},{"$nulls":16},{"$f":"IF(入力シート!T21=\"\",\"\",入力シート!T21)","v":""},{"$nulls":15},"店番号"]
[{"$nulls":41},{"$f":"IF(入力シート!T22=\"\",\"\",入力シート!T22)","v":""}]
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[]
[{"$nulls":8},"口座\n番号",null,null,{"$f":"IF(入力シート!T24=\"\",\"\",MID(TEXT(入力シート!T24,\"0000000\"),1,1))","v":""},null,{"$f":"IF(入力シート!T24=\"\",\"\",MID(TEXT(入力シート!T24,\"0000000\"),2,1))","v":""},null,{"$f":"IF(入力シート!T24=\"\",\"\",MID(TEXT(入力シート!T24,\"0000000\"),3,1))","v":""},null,{"$f":"IF(入力シート!T24=\"\",\"\",MID(TEXT(入力シート!T24,\"0000000\"),4,1))","v":""},null,{"$f":"IF(入力シート!T24=\"\",\"\",MID(TEXT(入力シート!T24,\"0000000\"),5,1))","v":""},null,{"$f":"IF(入力シート!T24=\"\",\"\",MID(TEXT(入力シート!T24,\"0000000\"),6,1))","v":""},null,{"$f":"IF(入力シート!T24=\"\",\"\",MID(TEXT(入力シート!T24,\"0000000\"),7,1))","v":""},{"$nulls":6},{"$f":"IF(入力シート!T17=\"\",\"\",入力シート!T17)","v":""},{"$nulls":10},{"$f":"IF(入力シート!T19=\"\",\"\",入力シート!T19)","v":""}]
[]
[null,"備考",{"$nulls":6},{"$f":"IF(AND(入力シート!T10=\"\",入力シート!T48=\"\"),\"\",IF(ISBLANK(入力シート!T48),\"\",入力シート!T48))","v":""}]
[]
[null,null,"添付書類"]
[null,null,"日本スポーツ振興センターが医療費を給付する場合",{"$nulls":21},"日本スポーツ振興センターが医療費を給付しない場合\n（義務教育諸学校等の要保護児童生徒等の災害）"]
[null,null,{"$f":"IF(入力シート!T26=\"\",\"\",IF(入力シート!T26=\"通院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n 　 又は訪問看護明細書（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\n\",IF(入力シート!T26=\"入院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":21},"【新規請求】\n１ 災害報告書（別紙１）\n２ 医療等の状況が分かる書類"]
[null,null,"【継続請求】\n１ 日本スポーツ振興センターに提出した医療等の状況（写）\n２ 医療費支払通知書（写）又は児童生徒別給付一覧（写）",{"$nulls":21},"【継続請求】\n１ 医療等の状況が分かる書類"]
[]
[null,null,"＜個人情報の取り扱いについて＞共済金受取人の方は、次の記載内容及び添付書類の提出にご同意の上、請求書等を提出してください。\n１ 共済事業に関する個人情報は、共済引受、共済掛金管理、共済金支給審査及び共済金の支払等のために利用します。\n２ 個人情報は、上記の利用目的の達成に必要な範囲内で、業務委託先、共済金請求・支払に関する関係先等に提供を行い、又は情報の提供を受けることがあります。ただし、保健医療等の特別な非公開情報の利用目的は、法令の規定により業務の適切な運営の確保その他必要と認められる範囲に限定します。"]

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[null,{"$f":"IF(入力シート!AA26=\"\",\"\",IF(入力シート!AA26=\"通院\",\"様式10\",\"様式9\"))","v":""},{"$nulls":35},{"$f":"TODAY()","v":"2026-02-09"}]
[]
[null,"一般財団法人岩手県学校安全互助会理事長 様"]
[]
[{"$nulls":22},"学校名等",{"$nulls":5},{"$f":"IF(入力シート!M4=\"\",\"\",入力シート!M4)","v":""}]
[{"$nulls":22},"学校長等名",{"$nulls":5},{"$f":"IF(入力シート!M5=\"\",\"\",入力シート!M5)","v":""},{"$nulls":16},"職印"]
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[null,"共済金受取人より申請がありましたので、共済金の請求をします。"]
[{"$nulls":32},"※ 受付番号"]
[null,"（フリガナ）",{"$nulls":6},{"$f":"IF(入力シート!AA11=\"\",\"\",CONCATENATE(\"（　\",入力シート!AA11,\"　）\"))","v":""},{"$nulls":18},"学年・組",{"$nulls":4},"請求時",{"$nulls":4},{"$f":"IF(入力シート!AA14=\"\",\"\",入力シート!AA14)","v":""}]
[null,"対象児童生徒等",{"$nulls":6},{"$f":"IF(入力シート!AA10=\"\",\"\",入力シート!AA10)","v":""},{"$nulls":23},"災害発生時",{"$nulls":4},{"$f":"IF(入力シート!AA15=\"\",\"\",入力シート!AA15)","v":""}]
[null,"氏名",{"$nulls":25},"性別",{"$nulls":4},{"$f":"IF(入力シート!AA12=\"\",\"\",入力シート!AA12)","v":""}]
[null,"災害発生日時",{"$nulls":6},{"$f":"IF(入力シート!AA27=\"\",\"\",入力シート!AA27)","v":""},{"$nulls":8},{"$f":"IF(入力シート!AA27=\"\",\"\",CONCATENATE(\"（\",TEXT(入力シート!AA27,\"aaa\"),\"曜日）\"))","v":""},{"$nulls":4},{"$f":"IF(入力シート!AA28=\"\",\"\",TEXT(入力シート!AA28,\"00!:00\")*1)","v":""},{"$nulls":4},"生年月日",{"$nulls":5},{"$f":"IF(入力シート!AA13=\"\",\"\",入力シート!AA13)","v":""},{"$nulls":8},"生"]
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[null,"【継続の場合】",{"$nulls":6},"共済金の受給月",{"$nulls":8},"受給期間及び日数"]
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[null,"共済金振込先\n（共済金受取人\n　名義の口座）",{"$nulls":6},{"$f":"IF(入力シート!AA20=\"\",\"\",入力シート!AA20)","v":""},{"$nulls":16},{"$f":"IF(入力シート!AA21=\"\",\"\",入力シート!AA21)","v":""},{"$nulls":15},"店番号"]
[{"$nulls":41},{"$f":"IF(入力シート!AA22=\"\",\"\",入力シート!AA22)","v":""}]
[{"$nulls":8},"預金\n種目",null,null,{"$f":"IF(入力シート!AA23=\"\",\"\",入力シート!AA23)","v":""},{"$nulls":13},"（フリガナ）\n口座名義人",{"$nulls":4},"（",{"$f":"IF(入力シート!AA18=\"\",\"\",入力シート!AA18)","v":""},{"$nulls":8},"）","被災児童生徒等\nとの続柄"]
[]
[{"$nulls":8},"口座\n番号",null,null,{"$f":"IF(入力シート!AA24=\"\",\"\",MID(TEXT(入力シート!AA24,\"0000000\"),1,1))","v":""},null,{"$f":"IF(入力シート!AA24=\"\",\"\",MID(TEXT(入力シート!AA24,\"0000000\"),2,1))","v":""},null,{"$f":"IF(入力シート!AA24=\"\",\"\",MID(TEXT(入力シート!AA24,\"0000000\"),3,1))","v":""},null,{"$f":"IF(入力シート!AA24=\"\",\"\",MID(TEXT(入力シート!AA24,\"0000000\"),4,1))","v":""},null,{"$f":"IF(入力シート!AA24=\"\",\"\",MID(TEXT(入力シート!AA24,\"0000000\"),5,1))","v":""},null,{"$f":"IF(入力シート!AA24=\"\",\"\",MID(TEXT(入力シート!AA24,\"0000000\"),6,1))","v":""},null,{"$f":"IF(入力シート!AA24=\"\",\"\",MID(TEXT(入力シート!AA24,\"0000000\"),7,1))","v":""},{"$nulls":6},{"$f":"IF(入力シート!AA17=\"\",\"\",入力シート!AA17)","v":""},{"$nulls":10},{"$f":"IF(入力シート!AA19=\"\",\"\",入力シート!AA19)","v":""}]
[]
[null,"備考",{"$nulls":6},{"$f":"IF(AND(入力シート!AA10=\"\",入力シート!AA48=\"\"),\"\",IF(ISBLANK(入力シート!AA48),\"\",入力シート!AA48))","v":""}]
[]
[null,null,"添付書類"]
[null,null,"日本スポーツ振興センターが医療費を給付する場合",{"$nulls":21},"日本スポーツ振興センターが医療費を給付しない場合\n（義務教育諸学校等の要保護児童生徒等の災害）"]
[null,null,{"$f":"IF(入力シート!AA26=\"\",\"\",IF(入力シート!AA26=\"通院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n 　 又は訪問看護明細書（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\n\",IF(入力シート!AA26=\"入院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":21},"【新規請求】\n１ 災害報告書（別紙１）\n２ 医療等の状況が分かる書類"]
[null,null,"【継続請求】\n１ 日本スポーツ振興センターに提出した医療等の状況（写）\n２ 医療費支払通知書（写）又は児童生徒別給付一覧（写）",{"$nulls":21},"【継続請求】\n１ 医療等の状況が分かる書類"]
[]
[null,null,"＜個人情報の取り扱いについて＞共済金受取人の方は、次の記載内容及び添付書類の提出にご同意の上、請求書等を提出してください。\n１ 共済事業に関する個人情報は、共済引受、共済掛金管理、共済金支給審査及び共済金の支払等のために利用します。\n２ 個人情報は、上記の利用目的の達成に必要な範囲内で、業務委託先、共済金請求・支払に関する関係先等に提供を行い、又は情報の提供を受けることがあります。ただし、保健医療等の特別な非公開情報の利用目的は、法令の規定により業務の適切な運営の確保その他必要と認められる範囲に限定します。"]

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[]
[null,"一般財団法人岩手県学校安全互助会理事長 様"]
[]
[{"$nulls":22},"学校名等",{"$nulls":5},{"$f":"IF(入力シート!M4=\"\",\"\",入力シート!M4)","v":""}]
[{"$nulls":22},"学校長等名",{"$nulls":5},{"$f":"IF(入力シート!M5=\"\",\"\",入力シート!M5)","v":""},{"$nulls":16},"職印"]
[{"$f":"IF(入力シート!AH26=\"\",\"\",\"一般財団法人岩手県学校安全互助会「\"&入力シート!AH26&\"共済金」請求書\")","v":""},{"$nulls":33},"(",{"$f":"IF(入力シート!AH26=\"\",\"\",\"新規\")","v":""},null,null,{"$f":"IF(入力シート!AH26=\"\",\"\",\"・\")","v":""},{"$f":"IF(入力シート!AH26=\"\",\"\",\"継続\")","v":""},null,null,"）"]
[null,"共済金受取人より申請がありましたので、共済金の請求をします。"]
[{"$nulls":32},"※ 受付番号"]
[null,"（フリガナ）",{"$nulls":6},{"$f":"IF(入力シート!AH11=\"\",\"\",CONCATENATE(\"（　\",入力シート!AH11,\"　）\"))","v":""},{"$nulls":18},"学年・組",{"$nulls":4},"請求時",{"$nulls":4},{"$f":"IF(入力シート!AH14=\"\",\"\",入力シート!AH14)","v":""}]
[null,"対象児童生徒等",{"$nulls":6},{"$f":"IF(入力シート!AH10=\"\",\"\",入力シート!AH10)","v":""},{"$nulls":23},"災害発生時",{"$nulls":4},{"$f":"IF(入力シート!AH15=\"\",\"\",入力シート!AH15)","v":""}]
[null,"氏名",{"$nulls":25},"性別",{"$nulls":4},{"$f":"IF(入力シート!AH12=\"\",\"\",入力シート!AH12)","v":""}]
[null,"災害発生日時",{"$nulls":6},{"$f":"IF(入力シート!AH27=\"\",\"\",入力シート!AH27)","v":""},{"$nulls":8},{"$f":"IF(入力シート!AH27=\"\",\"\",CONCATENATE(\"（\",TEXT(入力シート!AH27,\"aaa\"),\"曜日）\"))","v":""},{"$nulls":4},{"$f":"IF(入力シート!AH28=\"\",\"\",TEXT(入力シート!AH28,\"00!:00\")*1)","v":""},{"$nulls":4},"生年月日",{"$nulls":5},{"$f":"IF(入力シート!AH13=\"\",\"\",入力シート!AH13)","v":""},{"$nulls":8},"生"]
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[null,"今回請求金額",{"$nulls":10},{"$f":"IF(入力シート!AH26=\"\",\"\",IF(入力シート!AH26=\"入院\",1300,500))","v":""},{"$nulls":6},"×","（合計日数）",{"$nulls":5},{"$f":"IF(入力シート!AL35=\"\",\"\",SUM(入力シート!AL35:'入力シート'!AL46))","v":""},null,"日","＝",null,{"$f":"IF(OR(入力シート!AH10=\"\", SUM(入力シート!AL35:'入力シート'!AL46)=0), \"\",IF(OR(入力シート!AH29=\"あり\",AND(入力シート!AH29=\"なし\", 入力シート!AH26=\"入院\", SUM(入力シート!AL35:'入力シート'!AL46)>=5),AND(入力シート!AH29=\"なし\", 入力シート!AH26=\"通院\", SUM(入力シート!AL35:'入力シート'!AL46)>=7)),SUM(入力シート!AL35:'入力シート'!AL46) * IF(入力シート!AH26=\"入院\", 1300, 500),\"\"))","v":""},{"$nulls":6},{"$f":"IF(OR(入力シート!AH10=\"\", SUM(入力シート!AL35:'入力シート'!AL46)=0), \"\",IF(OR(入力シート!AH29=\"あり\",AND(入力シート!AH29=\"なし\", 入力シート!AH26=\"入院\", SUM(入力シート!AL35:'入力シート'!AL46)>=5),AND(入力シート!AH29=\"なし\", 入力シート!AH26=\"通院\", SUM(入力シート!AL35:'入力シート'!AL46)>=7)),\"\",\"入力内容や請求要件を確認してください\"))","v":""}]
[null,"【継続の場合】",{"$nulls":6},"共済金の受給月",{"$nulls":8},"受給期間及び日数"]
[null,"前回受給状況",{"$nulls":6},"（",{"$f":"IF(OR(入力シート!AJ30=\"\", 入力シート!AH29=\"なし\"), \"\", 入力シート!AH30 & 入力シート!AJ30 & \"年\" & 入力シート!AL30 & \"月\")","v":""},{"$nulls":6},"）",null,null,"（",{"$f":"IF(OR(入力シート!AJ31=\"\", 入力シート!AH29=\"なし\"), \"\", 入力シート!AJ31)","v":""},null,null,"年",{"$f":"IF(OR(入力シート!AL31=\"\", 入力シート!AH29=\"なし\"), \"\", 入力シート!AL31)","v":""},null,"月","～",null,{"$f":"IF(OR(入力シート!AJ32=\"\", 入力シート!AH29=\"なし\"), \"\", 入力シート!AJ32)","v":""},null,null,"年",{"$f":"IF(OR(入力シート!AL32=\"\", 入力シート!AH29=\"なし\"), \"\", 入力シート!AL32)","v":""},null,"月","）","（",{"$f":"IF(OR(入力シート!AH33=\"\", 入力シート!AH29=\"なし\"), \"\", 入力シート!AH33)","v":""},null,null,"日分",null,"）"]
[null,"共済金振込先\n（共済金受取人\n　名義の口座）",{"$nulls":6},{"$f":"IF(入力シート!AH20=\"\",\"\",入力シート!AH20)","v":""},{"$nulls":16},{"$f":"IF(入力シート!AH21=\"\",\"\",入力シート!AH21)","v":""},{"$nulls":15},"店番号"]
[{"$nulls":41},{"$f":"IF(入力シート!AH22=\"\",\"\",入力シート!AH22)","v":""}]
[{"$nulls":8},"預金\n種目",null,null,{"$f":"IF(入力シート!AH23=\"\",\"\",入力シート!AH23)","v":""},{"$nulls":13},"（フリガナ）\n口座名義人",{"$nulls":4},"（",{"$f":"IF(入力シート!AH18=\"\",\"\",入力シート!AH18)","v":""},{"$nulls":8},"）","被災児童生徒等\nとの続柄"]
[]
[{"$nulls":8},"口座\n番号",null,null,{"$f":"IF(入力シート!AH24=\"\",\"\",MID(TEXT(入力シート!AH24,\"0000000\"),1,1))","v":""},null,{"$f":"IF(入力シート!AH24=\"\",\"\",MID(TEXT(入力シート!AH24,\"0000000\"),2,1))","v":""},null,{"$f":"IF(入力シート!AH24=\"\",\"\",MID(TEXT(入力シート!AH24,\"0000000\"),3,1))","v":""},null,{"$f":"IF(入力シート!AH24=\"\",\"\",MID(TEXT(入力シート!AH24,\"0000000\"),4,1))","v":""},null,{"$f":"IF(入力シート!AH24=\"\",\"\",MID(TEXT(入力シート!AH24,\"0000000\"),5,1))","v":""},null,{"$f":"IF(入力シート!AH24=\"\",\"\",MID(TEXT(入力シート!AH24,\"0000000\"),6,1))","v":""},null,{"$f":"IF(入力シート!AH24=\"\",\"\",MID(TEXT(入力シート!AH24,\"0000000\"),7,1))","v":""},{"$nulls":6},{"$f":"IF(入力シート!AH17=\"\",\"\",入力シート!AH17)","v":""},{"$nulls":10},{"$f":"IF(入力シート!AH19=\"\",\"\",入力シート!AH19)","v":""}]
[]
[null,"備考",{"$nulls":6},{"$f":"IF(AND(入力シート!AH10=\"\",入力シート!AH48=\"\"),\"\",IF(ISBLANK(入力シート!AH48),\"\",入力シート!AH48))","v":""}]
[]
[null,null,"添付書類"]
[null,null,"日本スポーツ振興センターが医療費を給付する場合",{"$nulls":21},"日本スポーツ振興センターが医療費を給付しない場合\n（義務教育諸学校等の要保護児童生徒等の災害）"]
[null,null,{"$f":"IF(入力シート!AH26=\"\",\"\",IF(入力シート!AH26=\"通院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n　  又は訪問看護明細書（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\n \",IF(入力シート!AH26=\"入院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":21},"【新規請求】\n１ 災害報告書（別紙１）\n２ 医療等の状況が分かる書類"]
[null,null,"【継続請求】\n１ 日本スポーツ振興センターに提出した医療等の状況（写）\n２ 医療費支払通知書（写）又は児童生徒別給付一覧（写）",{"$nulls":21},"【継続請求】\n１ 医療等の状況が分かる書類"]
[]
[null,null,"＜個人情報の取り扱いについて＞共済金受取人の方は、次の記載内容及び添付書類の提出にご同意の上、請求書等を提出してください。\n１ 共済事業に関する個人情報は、共済引受、共済掛金管理、共済金支給審査及び共済金の支払等のために利用します。\n２ 個人情報は、上記の利用目的の達成に必要な範囲内で、業務委託先、共済金請求・支払に関する関係先等に提供を行い、又は情報の提供を受けることがあります。ただし、保健医療等の特別な非公開情報の利用目的は、法令の規定により業務の適切な運営の確保その他必要と認められる範囲に限定します。"]

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[null,{"$f":"IF(入力シート!AO26=\"\",\"\",IF(入力シート!AO26=\"通院\",\"様式10\",\"様式9\"))","v":""},{"$nulls":35},{"$f":"TODAY()","v":"2026-02-09"}]
[]
[null,"一般財団法人岩手県学校安全互助会理事長 様"]
[]
[{"$nulls":22},"学校名等",{"$nulls":5},{"$f":"IF(入力シート!M4=\"\",\"\",入力シート!M4)","v":""}]
[{"$nulls":22},"学校長等名",{"$nulls":5},{"$f":"IF(入力シート!M5=\"\",\"\",入力シート!M5)","v":""},{"$nulls":16},"職印"]
[{"$f":"IF(入力シート!AO26=\"\",\"\",\"一般財団法人岩手県学校安全互助会「\"&入力シート!AO26&\"共済金」請求書\")","v":""},{"$nulls":33},"(",{"$f":"IF(入力シート!AO26=\"\",\"\",\"新規\")","v":""},null,null,{"$f":"IF(入力シート!AO26=\"\",\"\",\"・\")","v":""},{"$f":"IF(入力シート!AO26=\"\",\"\",\"継続\")","v":""},null,null,"）"]
[null,"共済金受取人より申請がありましたので、共済金の請求をします。"]
[{"$nulls":32},"※ 受付番号"]
[null,"（フリガナ）",{"$nulls":6},{"$f":"IF(入力シート!AO11=\"\",\"\",CONCATENATE(\"（　\",入力シート!AO11,\"　）\"))","v":""},{"$nulls":18},"学年・組",{"$nulls":4},"請求時",{"$nulls":4},{"$f":"IF(入力シート!AO14=\"\",\"\",入力シート!AO14)","v":""}]
[null,"対象児童生徒等",{"$nulls":6},{"$f":"IF(入力シート!AO10=\"\",\"\",入力シート!AO10)","v":""},{"$nulls":23},"災害発生時",{"$nulls":4},{"$f":"IF(入力シート!AO15=\"\",\"\",入力シート!AO15)","v":""}]
[null,"氏名",{"$nulls":25},"性別",{"$nulls":4},{"$f":"IF(入力シート!AO12=\"\",\"\",入力シート!AO12)","v":""}]
[null,"災害発生日時",{"$nulls":6},{"$f":"IF(入力シート!AO27=\"\",\"\",入力シート!AO27)","v":""},{"$nulls":8},{"$f":"IF(入力シート!AO27=\"\",\"\",CONCATENATE(\"（\",TEXT(入力シート!AO27,\"aaa\"),\"曜日）\"))","v":""},{"$nulls":4},{"$f":"IF(入力シート!AO28=\"\",\"\",TEXT(入力シート!AO28,\"00!:00\")*1)","v":""},{"$nulls":4},"生年月日",{"$nulls":5},{"$f":"IF(入力シート!AO13=\"\",\"\",入力シート!AO13)","v":""},{"$nulls":8},"生"]
[null,"今回請求日数",{"$nulls":6},{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AO35=\"\"),\"\",入力シート!AO35)","v":""},null,null,"年",null,{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AO36=\"\"),\"\",入力シート!AO36)","v":""},null,null,"年",null,{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AO37=\"\"),\"\",入力シート!AO37)","v":""},null,null,"年",null,{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AO38=\"\"),\"\",入力シート!AO38)","v":""},null,null,"年",null,{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AO39=\"\"),\"\",入力シート!AO39)","v":""},null,null,"年",null,{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AO40=\"\"),\"\",入力シート!AO40)","v":""},null,null,"年",null,"合計",null,null,{"$f":"IF(入力シート!AS35=\"\",\"\",SUM(入力シート!AS35:'入力シート'!AS46))","v":""},{"$nulls":3},"日"]
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[{"$nulls":8},{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AS41=\"\"),\"\",入力シート!AS41)","v":""},{"$nulls":3},"日",{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AS42=\"\"),\"\",入力シート!AS42)","v":""},{"$nulls":3},"日",{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AS43=\"\"),\"\",入力シート!AS43)","v":""},{"$nulls":3},"日",{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AS44=\"\"),\"\",入力シート!AS44)","v":""},{"$nulls":3},"日",{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AS45=\"\"),\"\",入力シート!AS45)","v":""},{"$nulls":3},"日",{"$f":"IF(OR(入力シート!AO10=\"\", 入力シート!AS46=\"\"),\"\",入力シート!AS46)","v":""},{"$nulls":3},"日"]
[null,"今回請求金額",{"$nulls":10},{"$f":"IF(入力シート!AO26=\"\",\"\",IF(入力シート!AO26=\"入院\",1300,500))","v":""},{"$nulls":6},"×","（合計日数）",{"$nulls":5},{"$f":"IF(入力シート!AS35=\"\",\"\",SUM(入力シート!AS35:'入力シート'!AS46))","v":""},null,"日","＝",null,{"$f":"IF(OR(入力シート!AO10=\"\", SUM(入力シート!AS35:'入力シート'!AS46)=0), \"\",IF(OR(入力シート!AO29=\"あり\",AND(入力シート!AO29=\"なし\", 入力シート!AO26=\"入院\", SUM(入力シート!AS35:'入力シート'!AS46)>=5),AND(入力シート!AO29=\"なし\", 入力シート!AO26=\"通院\", SUM(入力シート!AS35:'入力シート'!AS46)>=7)),SUM(入力シート!AS35:'入力シート'!AS46) * IF(入力シート!AO26=\"入院\", 1300, 500),\"\"))","v":""},{"$nulls":6},{"$f":"IF(OR(入力シート!AO10=\"\", SUM(入力シート!AS35:'入力シート'!AS46)=0), \"\",IF(OR(入力シート!AO29=\"あり\",AND(入力シート!AO29=\"なし\", 入力シート!AO26=\"入院\", SUM(入力シート!AS35:'入力シート'!AS46)>=5),AND(入力シート!AO29=\"なし\", 入力シート!AO26=\"通院\", SUM(入力シート!AS35:'入力シート'!AS46)>=7)),\"\",\"入力内容や請求要件を確認してください\"))","v":""}]
[null,"【継続の場合】",{"$nulls":6},"共済金の受給月",{"$nulls":8},"受給期間及び日数"]
[null,"前回受給状況",{"$nulls":6},"（",{"$f":"IF(OR(入力シート!AQ30=\"\", 入力シート!AO29=\"なし\"), \"\", 入力シート!AO30 & 入力シート!AQ30 & \"年\" & 入力シート!AS30 & \"月\")","v":""},{"$nulls":6},"）",null,null,"（",{"$f":"IF(OR(入力シート!AQ31=\"\", 入力シート!AO29=\"なし\"), \"\", 入力シート!AQ31)","v":""},null,null,"年",{"$f":"IF(OR(入力シート!AS31=\"\", 入力シート!AO29=\"なし\"), \"\", 入力シート!AS31)","v":""},null,"月","～",null,{"$f":"IF(OR(入力シート!AQ32=\"\", 入力シート!AO29=\"なし\"), \"\", 入力シート!AQ32)","v":""},null,null,"年",{"$f":"IF(OR(入力シート!AS32=\"\", 入力シート!AO29=\"なし\"), \"\", 入力シート!AS32)","v":""},null,"月","）","（",{"$f":"IF(OR(入力シート!AO33=\"\", 入力シート!AO29=\"なし\"), \"\", 入力シート!AO33)","v":""},null,null,"日分",null,"）"]
[null,"共済金振込先\n（共済金受取人\n　名義の口座）",{"$nulls":6},{"$f":"IF(入力シート!AO20=\"\",\"\",入力シート!AO20)","v":""},{"$nulls":16},{"$f":"IF(入力シート!AO21=\"\",\"\",入力シート!AO21)","v":""},{"$nulls":15},"店番号"]
[{"$nulls":41},{"$f":"IF(入力シート!AO22=\"\",\"\",入力シート!AO22)","v":""}]
[{"$nulls":8},"預金\n種目",null,null,{"$f":"IF(入力シート!AO23=\"\",\"\",入力シート!AO23)","v":""},{"$nulls":13},"（フリガナ）\n口座名義人",{"$nulls":4},"（",{"$f":"IF(入力シート!AO18=\"\",\"\",入力シート!AO18)","v":""},{"$nulls":8},"）","被災児童生徒等\nとの続柄"]
[]
[{"$nulls":8},"口座\n番号",null,null,{"$f":"IF(入力シート!AO24=\"\",\"\",MID(TEXT(入力シート!AO24,\"0000000\"),1,1))","v":""},null,{"$f":"IF(入力シート!AO24=\"\",\"\",MID(TEXT(入力シート!AO24,\"0000000\"),2,1))","v":""},null,{"$f":"IF(入力シート!AO24=\"\",\"\",MID(TEXT(入力シート!AO24,\"0000000\"),3,1))","v":""},null,{"$f":"IF(入力シート!AO24=\"\",\"\",MID(TEXT(入力シート!AO24,\"0000000\"),4,1))","v":""},null,{"$f":"IF(入力シート!AO24=\"\",\"\",MID(TEXT(入力シート!AO24,\"0000000\"),5,1))","v":""},null,{"$f":"IF(入力シート!AO24=\"\",\"\",MID(TEXT(入力シート!AO24,\"0000000\"),6,1))","v":""},null,{"$f":"IF(入力シート!AO24=\"\",\"\",MID(TEXT(入力シート!AO24,\"0000000\"),7,1))","v":""},{"$nulls":6},{"$f":"IF(入力シート!AO17=\"\",\"\",入力シート!AO17)","v":""},{"$nulls":10},{"$f":"IF(入力シート!AO19=\"\",\"\",入力シート!AO19)","v":""}]
[]
[null,"備考",{"$nulls":6},{"$f":"IF(AND(入力シート!AO10=\"\",入力シート!AO48=\"\"),\"\",IF(ISBLANK(入力シート!AO48),\"\",入力シート!AO48))","v":""}]
[]
[null,null,"添付書類"]
[null,null,"日本スポーツ振興センターが医療費を給付する場合",{"$nulls":21},"日本スポーツ振興センターが医療費を給付しない場合\n（義務教育諸学校等の要保護児童生徒等の災害）"]
[null,null,{"$f":"IF(入力シート!AO26=\"\",\"\",IF(入力シート!AO26=\"通院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n 　 又は訪問看護明細書（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\n\",IF(入力シート!AO26=\"入院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":21},"【新規請求】\n１ 災害報告書（別紙１）\n２ 医療等の状況が分かる書類"]
[null,null,"【継続請求】\n１ 日本スポーツ振興センターに提出した医療等の状況（写）\n２ 医療費支払通知書（写）又は児童生徒別給付一覧（写）",{"$nulls":21},"【継続請求】\n１ 医療等の状況が分かる書類"]
[]
[null,null,"＜個人情報の取り扱いについて＞共済金受取人の方は、次の記載内容及び添付書類の提出にご同意の上、請求書等を提出してください。\n１ 共済事業に関する個人情報は、共済引受、共済掛金管理、共済金支給審査及び共済金の支払等のために利用します。\n２ 個人情報は、上記の利用目的の達成に必要な範囲内で、業務委託先、共済金請求・支払に関する関係先等に提供を行い、又は情報の提供を受けることがあります。ただし、保健医療等の特別な非公開情報の利用目的は、法令の規定により業務の適切な運営の確保その他必要と認められる範囲に限定します。"]

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[null,{"$f":"IF(入力シート!AV26=\"\",\"\",IF(入力シート!AV26=\"通院\",\"様式10\",\"様式9\"))","v":""},{"$nulls":35},{"$f":"TODAY()","v":"2026-02-09"}]
[]
[null,"一般財団法人岩手県学校安全互助会理事長 様"]
[]
[{"$nulls":22},"学校名等",{"$nulls":5},{"$f":"IF(入力シート!M4=\"\",\"\",入力シート!M4)","v":""}]
[{"$nulls":22},"学校長等名",{"$nulls":5},{"$f":"IF(入力シート!M5=\"\",\"\",入力シート!M5)","v":""},{"$nulls":16},"職印"]
[{"$f":"IF(入力シート!AV26=\"\",\"\",\"一般財団法人岩手県学校安全互助会「\"&入力シート!AV26&\"共済金」請求書\")","v":""},{"$nulls":33},"(",{"$f":"IF(入力シート!AV26=\"\",\"\",\"新規\")","v":""},null,null,{"$f":"IF(入力シート!AV26=\"\",\"\",\"・\")","v":""},{"$f":"IF(入力シート!AV26=\"\",\"\",\"継続\")","v":""},null,null,"）"]
[null,"共済金受取人より申請がありましたので、共済金の請求をします。"]
[{"$nulls":32},"※ 受付番号"]
[null,"（フリガナ）",{"$nulls":6},{"$f":"IF(入力シート!AV11=\"\",\"\",CONCATENATE(\"（　\",入力シート!AV11,\"　）\"))","v":""},{"$nulls":18},"学年・組",{"$nulls":4},"請求時",{"$nulls":4},{"$f":"IF(入力シート!AV14=\"\",\"\",入力シート!AV14)","v":""}]
[null,"対象児童生徒等",{"$nulls":6},{"$f":"IF(入力シート!AV10=\"\",\"\",入力シート!AV10)","v":""},{"$nulls":23},"災害発生時",{"$nulls":4},{"$f":"IF(入力シート!AV15=\"\",\"\",入力シート!AV15)","v":""}]
[null,"氏名",{"$nulls":25},"性別",{"$nulls":4},{"$f":"IF(入力シート!AV12=\"\",\"\",入力シート!AV12)","v":""}]
[null,"災害発生日時",{"$nulls":6},{"$f":"IF(入力シート!AV27=\"\",\"\",入力シート!AV27)","v":""},{"$nulls":8},{"$f":"IF(入力シート!AV27=\"\",\"\",CONCATENATE(\"（\",TEXT(入力シート!AV27,\"aaa\"),\"曜日）\"))","v":""},{"$nulls":4},{"$f":"IF(入力シート!AV28=\"\",\"\",TEXT(入力シート!AV28,\"00!:00\")*1)","v":""},{"$nulls":4},"生年月日",{"$nulls":5},{"$f":"IF(入力シート!AV13=\"\",\"\",入力シート!AV13)","v":""},{"$nulls":8},"生"]
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[{"$nulls":8},{"$f":"IF(OR(入力シート!AV10=\"\", 入力シート!AZ41=\"\"),\"\",入力シート!AZ41)","v":""},{"$nulls":3},"日",{"$f":"IF(OR(入力シート!AV10=\"\", 入力シート!AZ42=\"\"),\"\",入力シート!AZ42)","v":""},{"$nulls":3},"日",{"$f":"IF(OR(入力シート!AV10=\"\", 入力シート!AZ43=\"\"),\"\",入力シート!AZ43)","v":""},{"$nulls":3},"日",{"$f":"IF(OR(入力シート!AV10=\"\", 入力シート!AZ44=\"\"),\"\",入力シート!AZ44)","v":""},{"$nulls":3},"日",{"$f":"IF(OR(入力シート!AV10=\"\", 入力シート!AZ45=\"\"),\"\",入力シート!AZ45)","v":""},{"$nulls":3},"日",{"$f":"IF(OR(入力シート!AV10=\"\", 入力シート!AZ46=\"\"),\"\",入力シート!AZ46)","v":""},{"$nulls":3},"日"]
[null,"今回請求金額",{"$nulls":10},{"$f":"IF(入力シート!AV26=\"\",\"\",IF(入力シート!AV26=\"入院\",1300,500))","v":""},{"$nulls":6},"×","（合計日数）",{"$nulls":5},{"$f":"IF(入力シート!AZ35=\"\",\"\",SUM(入力シート!AZ35:'入力シート'!AZ46))","v":""},null,"日","＝",null,{"$f":"IF(OR(入力シート!AV10=\"\", SUM(入力シート!AZ35:'入力シート'!AZ46)=0), \"\",IF(OR(入力シート!AV29=\"あり\",AND(入力シート!AV29=\"なし\", 入力シート!AV26=\"入院\", SUM(入力シート!AZ35:'入力シート'!AZ46)>=5),AND(入力シート!AV29=\"なし\", 入力シート!AV26=\"通院\", SUM(入力シート!AZ35:'入力シート'!AZ46)>=7)),SUM(入力シート!AZ35:'入力シート'!AZ46) * IF(入力シート!AV26=\"入院\", 1300, 500),\"\"))","v":""},{"$nulls":6},{"$f":"IF(OR(入力シート!AV10=\"\", SUM(入力シート!AZ35:'入力シート'!AZ46)=0), \"\",IF(OR(入力シート!AV29=\"あり\",AND(入力シート!AV29=\"なし\", 入力シート!AV26=\"入院\", SUM(入力シート!AZ35:'入力シート'!AZ46)>=5),AND(入力シート!AV29=\"なし\", 入力シート!AV26=\"通院\", SUM(入力シート!AZ35:'入力シート'!AZ46)>=7)),\"\",\"入力内容や請求要件を確認してください\"))","v":""}]
[null,"【継続の場合】",{"$nulls":6},"共済金の受給月",{"$nulls":8},"受給期間及び日数"]
[null,"前回受給状況",{"$nulls":6},"（",{"$f":"IF(OR(入力シート!AX30=\"\", 入力シート!AV29=\"なし\"), \"\", 入力シート!AV30 & 入力シート!AX30 & \"年\" & 入力シート!AZ30 & \"月\")","v":""},{"$nulls":6},"）",null,null,"（",{"$f":"IF(OR(入力シート!AX31=\"\", 入力シート!AV29=\"なし\"), \"\", 入力シート!AX31)","v":""},null,null,"年",{"$f":"IF(OR(入力シート!AZ31=\"\", 入力シート!AV29=\"なし\"), \"\", 入力シート!AZ31)","v":""},null,"月","～",null,{"$f":"IF(OR(入力シート!AX32=\"\", 入力シート!AV29=\"なし\"), \"\", 入力シート!AX32)","v":""},null,null,"年",{"$f":"IF(OR(入力シート!AZ32=\"\", 入力シート!AV29=\"なし\"), \"\", 入力シート!AZ32)","v":""},null,"月","）","（",{"$f":"IF(OR(入力シート!AV33=\"\", 入力シート!AV29=\"なし\"), \"\", 入力シート!AV33)","v":""},null,null,"日分",null,"）"]
[null,"共済金振込先\n（共済金受取人\n　名義の口座）",{"$nulls":6},{"$f":"IF(入力シート!AV20=\"\",\"\",入力シート!AV20)","v":""},{"$nulls":16},{"$f":"IF(入力シート!AV21=\"\",\"\",入力シート!AV21)","v":""},{"$nulls":15},"店番号"]
[{"$nulls":41},{"$f":"IF(入力シート!AV22=\"\",\"\",入力シート!AV22)","v":""}]
[{"$nulls":8},"預金\n種目",null,null,{"$f":"IF(入力シート!AV23=\"\",\"\",入力シート!AV23)","v":""},{"$nulls":13},"（フリガナ）\n口座名義人",{"$nulls":4},"（",{"$f":"IF(入力シート!AV18=\"\",\"\",入力シート!AV18)","v":""},{"$nulls":8},"）","被災児童生徒等\nとの続柄"]
[]
[{"$nulls":8},"口座\n番号",null,null,{"$f":"IF(入力シート!AV24=\"\",\"\",MID(TEXT(入力シート!AV24,\"0000000\"),1,1))","v":""},null,{"$f":"IF(入力シート!AV24=\"\",\"\",MID(TEXT(入力シート!AV24,\"0000000\"),2,1))","v":""},null,{"$f":"IF(入力シート!AV24=\"\",\"\",MID(TEXT(入力シート!AV24,\"0000000\"),3,1))","v":""},null,{"$f":"IF(入力シート!AV24=\"\",\"\",MID(TEXT(入力シート!AV24,\"0000000\"),4,1))","v":""},null,{"$f":"IF(入力シート!AV24=\"\",\"\",MID(TEXT(入力シート!AV24,\"0000000\"),5,1))","v":""},null,{"$f":"IF(入力シート!AV24=\"\",\"\",MID(TEXT(入力シート!AV24,\"0000000\"),6,1))","v":""},null,{"$f":"IF(入力シート!AV24=\"\",\"\",MID(TEXT(入力シート!AV24,\"0000000\"),7,1))","v":""},{"$nulls":6},{"$f":"IF(入力シート!AV17=\"\",\"\",入力シート!AV17)","v":""},{"$nulls":10},{"$f":"IF(入力シート!AV19=\"\",\"\",入力シート!AV19)","v":""}]
[]
[null,"備考",{"$nulls":6},{"$f":"IF(AND(入力シート!AV10=\"\",入力シート!AV48=\"\"),\"\",IF(ISBLANK(入力シート!AV48),\"\",入力シート!AV48))","v":""}]
[]
[null,null,"添付書類"]
[null,null,"日本スポーツ振興センターが医療費を給付する場合",{"$nulls":21},"日本スポーツ振興センターが医療費を給付しない場合\n（義務教育諸学校等の要保護児童生徒等の災害）"]
[null,null,{"$f":"IF(入力シート!AV26=\"\",\"\",IF(入力シート!AV26=\"通院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n 　 又は訪問看護明細書（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\n\",IF(入力シート!AV26=\"入院\",\"【新規請求】\n １ 日本スポーツ振興センターに提出した災害報告書（写）\n ２ 日本スポーツ振興センターに提出した医療等の状況（写）\n ３ 医療費支払通知書（写）又は児童生徒別給付一覧（写）\",\"\")))","v":""},{"$nulls":21},"【新規請求】\n１ 災害報告書（別紙１）\n２ 医療等の状況が分かる書類"]
[null,null,"【継続請求】\n１ 日本スポーツ振興センターに提出した医療等の状況（写）\n２ 医療費支払通知書（写）又は児童生徒別給付一覧（写）",{"$nulls":21},"【継続請求】\n１ 医療等の状況が分かる書類"]
[]
[null,null,"＜個人情報の取り扱いについて＞共済金受取人の方は、次の記載内容及び添付書類の提出にご同意の上、請求書等を提出してください。\n１ 共済事業に関する個人情報は、共済引受、共済掛金管理、共済金支給審査及び共済金の支払等のために利用します。\n２ 個人情報は、上記の利用目的の達成に必要な範囲内で、業務委託先、共済金請求・支払に関する関係先等に提供を行い、又は情報の提供を受けることがあります。ただし、保健医療等の特別な非公開情報の利用目的は、法令の規定により業務の適切な運営の確保その他必要と認められる範囲に限定します。"]

{"sheet":"参考 医療等の状況と請求日数","index":8,"n_rows":6,"n_cols":1,"rows_kept":6}
["（参考）医療等の状況と請求日数"]
["　・通院は７日以上、入院は５日以上から共済金をご請求いただけます。"]
["　・通院日数と入院日数は合算できません。"]
["　・同日でも別の医療機関等の受診の場合はそれぞれご請求できますが、同日に総合病院で複数の科を受診した場合のご請求はまとめて１日となります。同じ年月で同じ医療機関等の「医療等の状況」がある場合は診療日の重複についてご確認ください。"]
[]
["医療等の状況から請求書に転記する日数について"]