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{"sheet":"（別紙１）申請書","index":0,"n_rows":61,"n_cols":66,"rows_kept":61,"cut":false,"hidden":false,"merged":[[36,20,36,33],[43,2,44,34],[46,2,47,34],[51,2,52,34],[55,2,56,34],[57,2,59,34],[60,2,61,34],[1,0,1,34],[26,2,29,33],[32,2,34,33],[12,19,12,34],[3,25,3,26],[7,0,9,34],[11,1,11,5],[11,6,11,10],[11,19,11,34],[13,19,13,34],[14,19,14,34],[24,7,24,33],[39,2,40,33]]}
["（別紙１）"]
["貸付申請書"]
[]
[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,"令和",null,null,"年","　","　","月","　","　","日"]
[]
[null,"厚生労働省大臣",null,null,null,null,null,"殿"]
[]
["　新型インフルエンザ等対策特別措置法第六十四条の規定による医薬品等の譲渡等の特例の手続に関する省令（平成25年厚生労働省令第60号）第３条の規定に基づき、裏面に記載の条件に同意し、酸素濃縮装置の無償貸付の承認を受けたいので、申請します。"]
[]
[]
[]
[null,"都道府県名",null,null,null,null,null,null,null,null,null,null,null,"担当部署"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"担当者名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"メールアドレス"]
[]
["１．貸付を希望する酸素濃縮装置の台数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"台"]
[null,null,"（内訳：臨時の医療施設で使用予定",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"台","）"]
[null,null,"（",null,null,"入院待機施設で使用予定",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"台","）"]
[null,null,"（",null,null,"往診等で使用予定",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"台","）"]
[null,null,"（",null,null,"高齢者施設への貸出で使用予定",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"台","）"]
[null,null,"※","確保済（手配済）の酸素濃縮装置台数：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"台"]
[]
["２．",null,"酸素濃縮装置の使用目的及び使用場所"]
[null,"使用目的",null,null,null,null,"："]
[null,"使用場所（複数の場所で使用を予定している場合には、すべて記載ください。）："]
[]
[]
[]
[]
[]
["３．借受けを必要とする理由"]
[]
[]
[]
[]
["４．借受希望期間",null,null,null,null,null,null,null,"：","令和",null,null,"年","　",null,"月","　","　","日",null,"※令和５年３月31日までの間で記載してください。"]
[]
["５．その他特記事項"]
[]
[]
[]
["（裏面）"]
[null,null,"貸付酸素濃縮装置等の引渡し、維持、修理及び返納に要する費用は、厚生労働大臣が貸付けの性質によりこれらの費用を借受人に負担させることが適当でないと認めた場合を除き、借受人において負担すること。"]
[]
[null,null,"貸付酸素濃縮装置は、善良な管理者の注意をもって管理し、その効率的使用に努めること。"]
[null,null,"貸付酸素濃縮装置について修繕、改造その他貸付酸素濃縮装置の現状を変更しようとするときは、あらかじめ厚生労働大臣の承認を受けること。ただし、軽微な修繕については、この限りではない。"]
[]
[null,null,"貸付酸素濃縮装置に投じた改良費等の有益費は請求しないこと。"]
[null,null,"貸付酸素濃縮装置は、転貸し、又は担保に供しないこと。"]
[null,null,"貸付酸素濃縮装置は、貸付けの目的以外の目的のために使用しないこと。"]
[null,null,"貸付酸素濃縮装置について使用場所が指定された場合には、厚生労働大臣が特に承認した場合を除き、指定した場所以外の場所では使用しないこと。"]
[]
[null,null,"貸付酸素濃縮装置は、貸付期間満了の日までに、指定の場所において返納すること。"]
[null,null,"借受人が貸付条件に違反したときは、厚生労働大臣の指示に従って貸付酸素濃縮装置を返納すること。"]
[null,null,"厚生労働大臣が、特に必要があると認めて貸付期間満了前に返納を命じたときは、その指示に従って貸付酸素濃縮装置を返納すること。"]
[]
[null,null,"貸付酸素濃縮装置を亡失し、又は損傷したときは、直ちに詳細な報告書を物品管理官等を経由して厚生労働大臣に提出し、その指示に従うこと。この場合において、その原因が天災、火災又は盗難に係るものであるときは、亡失又は損傷の事実を証する関係官公署の発行する証明書を当該報告書に添付すること。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[]
[]
[null,null,"厚生労働大臣が、貸付酸素濃縮装置について、必要に応じて実地調査を行い、若しくは所要の報告を求め、又は当該酸素濃縮装置の維持、管理及び返納に関して必要な指示をするときは、これに応ずること。",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]

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["（別紙２）"]
["貸付延長申請書"]
[]
[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,"令和",null,null,"年","　","　","月","　","　","日"]
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[null,"厚生労働省大臣",null,null,null,null,null,"殿"]
[]
["　新型インフルエンザ等対策特別措置法第六十四条の規定による医薬品等の譲渡等の特例の手続に関する省令（平成25年厚生労働省令第60号）第６条の規定に基づき、令和●年●月●日付け貸付けの承認を受けた酸素濃縮装置について、延長して無償貸付の承認を受けたいので、申請します。"]
[]
[]
[]
[null,"都道府県名",null,null,null,null,null,null,null,null,null,null,null,"担当部署"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"担当者名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"メールアドレス"]
[]
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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,"別記",null,null,null,null,null,null,null,"高知県"]
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[null,null,"１．貸付酸素濃縮装置の品名及び数量、担当メーカー及び連絡先",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,"佐賀県"]
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[null,null,"２．使用目的及び使用場所",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,"大分県"]
[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,"宮崎県"]
[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,"鹿児島県"]
[null,null,"３．借受けの延長を必要とする理由",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,"沖縄県"]
[]
[]
[null,null,"４．借受希望期間（基本的には、令和４年４月１日から令和５年３月31日までとしてください。）"]
[]
[]
[null,null,"５．その他特記事項"]
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{"sheet":"（別紙３・４）承認書・借受書","index":2,"n_rows":102,"n_cols":40,"rows_kept":102,"cut":false,"hidden":false,"merged":[[58,3,59,33],[19,25,19,26],[21,1,23,34],[11,8,11,23],[9,8,9,23],[10,8,10,23],[37,3,38,33],[40,3,41,33],[43,3,44,33],[46,3,47,33],[49,3,50,33],[52,3,53,33],[55,3,56,33],[28,15,28,19],[3,0,3,34],[5,0,6,34],[18,0,18,34],[1,25,1,26],[8,1,8,5],[8,6,8,10]]}
["（別紙３）"]
[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,"令和",null,null,"年","　",null,"月","　","　","日",null,null,null,null,"北海道"]
[]
["貸付承認通知書"]
[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,"青森県"]
["　新型インフルエンザ等対策特別措置法第六十四条の規定による医薬品等の譲渡等の特例の手続に関する省令（平成25年厚生労働省令第60号）第６条の規定に基づき、令和●年●月●日付けの貸付申請を別記のとおり承認する。",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,"岩手県"]
[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,"宮城県"]
[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,"秋田県"]
[null,"都道府県名",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,null,null,null,"山形県"]
[null,null,"担当部署",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,"福島県"]
[null,null,"担当者名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"殿",null,null,null,null,null,null,null,null,null,null,null,null,null,"茨城県"]
[null,null,"メールアドレス",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,"栃木県"]
[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,"群馬県"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"厚生労働省大臣",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"埼玉県"]
[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,"千葉県"]
[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,"新潟県"]
[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,"富山県"]
["（別紙４）",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,"石川県"]
["借受書",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,"福井県"]
[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,"令和",null,null,"年","　",null,"月","　","　","日",null,null,null,null,"山梨県"]
[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,"長野県"]
[null,"令和　年　月　日付けで貸付けを承認された酸素濃縮装置の引き渡し及び使用方法について説明を受けました。酸素濃縮装置の運用と取扱については、別記に記載された事項に従います。",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,"岐阜県"]
[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,"静岡県"]
[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,"愛知県"]
[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,"三重県"]
[null,"厚生労働省大臣",null,null,null,null,null,null,"殿",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,"滋賀県"]
[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,"京都府"]
[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,"和歌山県"]
[null,null,null,null,null,null,null,null,null,null,"都道府県名",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,"鳥取県"]
[null,null,null,null,null,null,null,null,null,null,null,"担当部署",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,"島根県"]
[null,null,null,null,null,null,null,null,null,null,null,"担当者名",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,"岡山県"]
[null,null,null,null,null,null,null,null,null,null,null,"メールアドレス",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,"広島県"]
[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,"山口県"]
[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,"愛媛県"]
[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,"別記",null,null,null,null,null,null,null,"高知県"]
[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,"福岡県"]
[null,null,"１．貸付酸素濃縮装置の品名及び数量、担当メーカー及び連絡先",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,"佐賀県"]
[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,"長崎県"]
[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,"熊本県"]
[null,null,"２．貸付期間",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,"大分県"]
[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,"宮崎県"]
[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,"鹿児島県"]
[null,null,"３．貸付目的",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,"沖縄県"]
[]
[]
[null,null,"４．貸付期日及び引渡場所"]
[]
[]
[null,null,"５．使用場所"]
[]
[]
[null,null,"６．返納期日及び返納場所"]
[]
[]
[null,null,"７．時価よりも低い対価で貸し付ける場合は、貸付料の額"]
[]
[]
[null,null,"８．貸付条件"]
[]
[]
[]
[]
[]
[]
[]
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[]
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[]
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[]
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[]
[]
[null,1,"北海道"]
[null,2,"青森県"]
[null,3,"岩手県"]
[null,4,"宮城県"]
[null,5,"秋田県"]
[null,6,"山形県"]
[null,7,"福島県"]
[null,8,"茨城県"]
[null,9,"栃木県"]
[null,10,"群馬県"]
[null,11,"埼玉県"]
[null,12,"千葉県"]
[null,13,"東京都"]
[null,14,"神奈川県"]
[null,15,"新潟県"]
[null,16,"富山県"]
[null,17,"石川県"]
[null,18,"福井県"]
[null,19,"山梨県"]
[null,20,"長野県"]
[null,21,"岐阜県"]
[null,22,"静岡県"]
[null,23,"愛知県"]
[null,24,"三重県"]
[null,25,"滋賀県"]
[null,26,"京都府"]
[null,27,"大阪府"]
[null,28,"兵庫県"]
[null,29,"奈良県"]
[null,30,"和歌山県"]
[null,31,"鳥取県"]
[null,32,"島根県"]
[null,33,"岡山県"]
[null,34,"広島県"]
[null,35,"山口県"]
[null,36,"徳島県"]
[null,37,"香川県"]
[null,38,"愛媛県"]
[null,39,"高知県"]
[null,40,"福岡県"]
[null,41,"佐賀県"]
[null,42,"長崎県"]
[null,43,"熊本県"]
[null,44,"大分県"]
[null,45,"宮崎県"]
[null,46,"鹿児島県"]
[null,47,"沖縄県"]