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{"sheet":"【記載必須】変更申出確認依頼書","index":0,"n_rows":140,"n_cols":11,"rows_kept":140,"cut":false,"hidden":false,"merged":[[122,9,126,12],[133,2,133,4],[134,2,134,4],[135,2,135,4],[14,9,16,12],[18,9,22,12],[24,9,34,12],[113,1,113,8],[97,5,97,7],[72,9,79,12],[76,5,76,7],[36,1,36,8],[73,5,73,7],[74,5,74,7],[75,5,75,7],[77,5,77,7],[107,9,113,12],[46,5,46,7],[131,1,131,8],[127,1,127,8],[114,1,114,8],[118,1,118,8],[121,1,121,8],[92,5,92,7],[13,1,13,8],[17,1,17,8],[23,1,23,8],[35,9,35,12],[13,9,13,12],[17,9,17,12],[23,9,23,12],[33,5,33,7],[31,1,31,2],[27,1,27,2],[35,1,35,8],[125,2,125,4],[139,1,141,12],[55,9,60,12],[61,9,66,12],[67,9,71,12],[98,5,98,7],[99,5,99,7],[100,5,100,7],[101,5,101,7],[102,5,102,7],[93,5,93,7],[94,5,94,7],[112,5,112,7],[97,9,101,12],[92,9,96,12],[111,5,111,7],[103,5,103,7],[83,5,83,7],[84,5,84,7],[107,5,107,7],[59,5,59,7],[55,5,55,7],[56,5,56,7],[104,5,104,7],[69,5,69,7],[70,5,70,7],[71,5,71,7],[47,5,47,7],[60,5,60,7],[48,5,48,7],[49,5,49,7],[62,5,62,7],[50,5,50,7],[51,5,51,7],[52,5,52,7],[53,5,53,7],[54,5,54,7],[36,9,54,12],[37,5,37,7],[38,5,38,7],[39,5,39,7],[40,5,40,7],[41,5,41,7],[42,5,42,7],[43,5,43,7],[44,5,44,7],[45,5,45,7],[11,2,11,12],[132,9,135,12],[1,11,1,12],[3,2,3,12],[4,11,4,12],[5,11,5,12],[6,11,6,12],[7,11,7,12],[4,2,4,7],[6,2,6,7],[128,9,130,12],[131,9,131,12],[121,9,121,12],[108,5,108,7],[109,5,109,7],[110,5,110,7],[127,9,127,12],[118,9,118,12],[119,9,120,12],[102,9,106,12],[90,5,90,7],[91,5,91,7],[78,5,78,7],[57,5,57,7],[114,9,114,12],[115,9,117,12],[95,5,95,7],[96,5,96,7],[80,1,80,2],[92,1,92,2],[97,1,97,2],[102,1,102,2],[107,1,107,2],[112,1,112,2],[80,9,91,12],[80,5,80,7],[88,5,88,7],[86,5,86,7],[87,5,87,7],[105,5,105,7],[106,5,106,7],[89,5,89,7],[130,1,130,8],[37,1,37,2],[55,1,55,2],[56,1,56,2],[59,1,59,2],[61,1,61,2],[65,1,65,2],[67,1,67,2],[69,1,69,2],[72,1,72,2],[120,1,120,7],[63,5,63,7],[64,5,64,7],[65,5,65,7],[66,5,66,7],[81,5,81,7],[82,5,82,7],[85,5,85,7],[79,5,79,7],[72,5,72,7],[58,5,58,7],[61,5,61,7],[67,5,67,7],[68,5,68,7]]}
[]
[null,null,null,null,null,null,null,null,null,null,"申請日　　　　※"]
[]
[null,null,"変更申出確認依頼書"]
[null,null,"国立がん研究センター全国がん登録情報提供の窓口　殿",null,null,null,null,null,null,null,"提供番号　　　※"]
[null,null,null,null,null,null,null,null,null,null,"申出者所属　　※"]
[null,null,"下記のとおり変更がありますので、確認を依頼いたします。",null,null,null,null,null,null,null,"申出者　　　　※"]
[null,null,null,null,null,null,null,null,null,null,"確認依頼者　　※"]
[]
[null,null,"1．変更項目及び変更理由"]
[]
[null,null,"① 複数の変更項目がある場合は、それぞれの変更項目にチェックを入れて、それぞれの変更理由を対照的に記載してください。\n② 変更申出書に記載の変更内容と齟齬がないよう照合をお願いいたします。"]
[]
[null,"提供依頼申出者の変更",null,null,null,null,null,null,null,"変更理由"]
[null,null,"申出者の所属機関名・職名・役割の変更",false]
[null,null,"申出者本人の変更",false]
[]
[null,"利用者／事務担当者の変更",null,null,null,null,null,null,null,"変更理由"]
[null,null,"利用者の所属機関名・職名・役割の変更",false]
[null,null,"利用者の追加",false]
[null,null,"利用者の削除",false]
[null,null,"事務担当者の変更",false]
[]
[null,"利用する情報の範囲の変更",null,null,null,null,null,null,null,"変更理由"]
[null,null,"診断年次の追加",false]
[null,null,"地域の変更（都道府県の追加または削除）",false]
[null,null,"がんの種類の変更（がん種の追加または削除）",false]
[null,"生存確認情報の変更（下記①～③の追加等）"]
[null,null,"①生存しているか死亡しているかの別",false]
[null,null,"②生存を確認した直近の日又は死亡日",false]
[null,null,"③死亡の原因",false]
[null,"属性的範囲の変更"]
[null,null,"性別の変更（男女別の追加または削除）",false]
[null,null,"年齢の範囲の変更（異なる年齢階級の追加等）",false]
[]
[null,"利用する登録情報の変更",null,null,null,null,null,null,null,"変更理由"]
[null,"様式第2-1申出別紙の変更（提供項目の追加等）"]
[null,"基本提供項目",null,false,null,"1 行番号",null,null,false]
[null,null,null,null,null,"4 性別",null,null,false]
[null,null,null,null,null,"5 診断時年齢",null,null,false]
[null,null,null,null,null,"7 診断時患者住所都道府県コード",null,null,false]
[null,null,null,null,null,"12 側性",null,null,false]
[null,null,null,null,null,"13 局在コード（ICD-O-3）",null,null,false]
[null,null,null,null,null,"14 診断名（和名）",null,null,false]
[null,null,null,null,null,"15 形態コード（ICD-O-3）",null,null,false]
[null,null,null,null,null,"16 性状コード（ICD-O-3）",null,null,false]
[null,null,null,null,null,"17 分化度",null,null,false]
[null,null,null,null,null,"18 組織診断名（和名）",null,null,false]
[null,null,null,null,null,"19 ICD-10コード",null,null,false]
[null,null,null,null,null,"20 ICD-10（和名）",null,null,false]
[null,null,null,null,null,"23 診断根拠",null,null,false]
[null,null,null,null,null,"24 診断年",null,null,false]
[null,null,null,null,null,"69 DCI区分",null,null,false]
[null,null,null,null,null,"70 DCO区分",null,null,false]
[null,null,null,null,null,"73 統計対象区分",null,null,false]
[null,"発見経緯基本提供項目",null,null,null,"27 発見経緯",null,null,false]
[null,"小児がん基本提供項目",null,null,null,"6 診断時年齢（小児用）",null,null,false]
[null,null,null,null,null,"21 IARC-ICCC3コード（小児がん分類）",null,null,false]
[null,null,null,null,null,"22 ICCC（英名）",null,null,false]
[null,"多重がん基本提供項目",null,null,null,"2 提供情報患者番号",null,null,false]
[null,null,null,null,null,"3 多重がん番号",null,null,false]
[null,"生存率基本提供項目",null,null,null,"66 生死区分",null,null,false]
[null,null,null,null,null,"67 死亡日/最終生存確認日資料源",null,null,false]
[null,null,null,null,null,"68 生存期間（日）",null,null,false]
[null,null,null,null,null,"74 生存率集計対象区分",null,null,false]
[null,"生存率選択提供項目",null,null,null,"64 原死因（ICD-10）",null,null,false]
[null,null,null,null,null,"65 原死因（和名）",null,null,false]
[null,"診断日詳細基本提供項目",null,null,null,"25 診断年月日",null,null,false]
[null,null,null,null,null,"26 診断日精度",null,null,false]
[null,"病期基本提供項目",null,null,null,"28 進展度・治療前",null,null,false]
[null,null,null,null,null,"29 進展度・術後病理学的",null,null,false]
[null,null,null,null,null,"30 進展度・総合",null,null,false]
[null,"治療項目基本提供項目",null,null,null,"31 外科的治療の有無",null,null,false]
[null,null,null,null,null,"32 鏡視下治療の有無",null,null,false]
[null,null,null,null,null,"33 内視鏡的治療の有無",null,null,false]
[null,null,null,null,null,"34 観血的（外科的・鏡視下・内視鏡的）\n　 治療の範囲",null,null,false]
[null,null,null,null,null,"35 放射線療法の有無",null,null,false]
[null,null,null,null,null,"36 化学治療の有無",null,null,false]
[null,null,null,null,null,"37 内分泌療法の有無",null,null,false]
[null,null,null,null,null,"38 その他治療の有無",null,null,false]
[null,"受療動向基本提供項目",null,null,null,"71 患者異動動向\n（診断年2020年以降提供予定）",null,null,false]
[null,null,null,null,null,"72 患者受療動向",null,null,false]
[null,null,null,null,null,"39 初診病院コード",null,null,false]
[null,null,null,null,null,"40 初診病院都道府県コード",null,null,false]
[null,null,null,null,null,"44 診断病院コード",null,null,false]
[null,null,null,null,null,"45 診断病院都道府県コード",null,null,false]
[null,null,null,null,null,"49 観血的治療病院コード",null,null,false]
[null,null,null,null,null,"50 観血的治療都道府県コード",null,null,false]
[null,null,null,null,null,"54 放射線治療病院コード",null,null,false]
[null,null,null,null,null,"55 放射線治療病院都道府県コード",null,null,false]
[null,null,null,null,null,"59 薬物治療病院コード",null,null,false]
[null,null,null,null,null,"60 薬物治療病院都道府県コード",null,null,false]
[null,"病院地理情報選択提供項目　保健所区分",null,null,null,"41 初診病院保健所コード",null,null,false]
[null,null,null,null,null,"46 診断病院保健所コード",null,null,false]
[null,null,null,null,null,"51 観血的治療病院保健所コード",null,null,false]
[null,null,null,null,null,"56 放射線治療病院保健所コード",null,null,false]
[null,null,null,null,null,"61 薬物治療病院保健所コード",null,null,false]
[null,"病院地理情報選択提供項目　医療圏区分",null,null,null,"42 初診病院医療圏コード",null,null,false]
[null,null,null,null,null,"47 診断病院医療圏コード",null,null,false]
[null,null,null,null,null,"52 観血的治療病院医療圏コード",null,null,false]
[null,null,null,null,null,"57 放射線治療病院医療圏コード",null,null,false]
[null,null,null,null,null,"62 薬物治療病院医療圏コード",null,null,false]
[null,"病院地理情報選択提供項目　所在地",null,null,null,"43 初診病院住所*",null,null,false]
[null,null,null,null,null,"48 診断病院住所*",null,null,false]
[null,null,null,null,null,"53 観血的治療病院住所*",null,null,false]
[null,null,null,null,null,"58 放射線治療病院住所*",null,null,false]
[null,null,null,null,null,"63 薬物治療病院住所*",null,null,false]
[null,"患者診断時住所地理的属性選択提供項目",null,null,null,"8 診断時患者住所保健所コード",null,null,false]
[null,null,null,null,null,"9 診断時患者住所医療圏コード",null,null,false]
[null,null,null,null,null,"10 診断時患者住所市区町村コード",null,null,false]
[null,null,null,null,null,"11 診断時患者住所*",null,null,false]
[null,null,null,null,null,"75 集計用市区町村コード",null,null,false]
[null,"生存率選択提供項目",null,null,null,"76 死亡年月",null,null,false]
[null,"＊集計統計利用(匿名化が行われた情報の提供)において、○○病院住所、診断時患者住所については、他のがん登録情報との組み合わせによっては、匿名性が著しく低下する恐れがあるため、利用者と合意の上で、研究目的に応じてさらに匿名化して提供しております。これらの情報の追加を希望される場合は、十分に前もって事前相談をお願いします。"]
[null,"調査研究方法の変更",null,null,null,null,null,null,null,"変更理由"]
[null,null,"集計方法・集計表案の変更",false]
[null,null,"統計分析手法の変更",false]
[]
[null,"利用期間の変更",null,null,null,null,null,null,null,"変更理由"]
[null,null,"利用期間の延長",false]
[]
[null,"利用する場所及び環境の変更",null,null,null,null,null,null,null,"変更理由"]
[null,null,"利用場所の変更",false]
[null,null,"利用する環境の変更（PCの変更等）",false]
[null,null,"保管場所及び管理方法の変更",false]
[null,null,"組織的、物理的及び技術的安全管理措置状況の変更",null,null,false]
[]
[null,"公表方法の変更",null,null,null,null,null,null,null,"変更理由"]
[null,null,"公表物の秘匿処理方法の変更",false]
[null,null,"その他の公表方法の変更",false]
[]
[null,"その他の変更",null,null,null,null,null,null,null,"変更理由"]
[null,null,"その他の変更（下記に変更内容を記入）",false]
[null,null,"（　　　　　　　　　　　　　　　　　　　　　　）"]
[null,null,"（　　　　　　　　　　　　　　　　　　　　　　）"]
[null,null,"（　　　　　　　　　　　　　　　　　　　　　　）"]
[]
[null,null,"2．備考／留意事項等"]
[]
[null,"特になければ「特になし」と記載"]