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[]
["（別紙2）"]
[null,"介護予防・日常生活支援総合事業費算定に係る体制等状況一覧表（訪問型サービス・通所型サービス）"]
[]
[]
[{"$nulls":7},"事 業 所 番 号"]
[]
[{"$nulls":7},"事業所(施設)名"]
[]
[]
[]
[null,"提供サービス",null,"施設等の区分","人員配置区分","そ　 　　の　 　　他　　 　該　　 　当　　 　す 　　　る 　　　体 　　　制 　　　等",{"$nulls":8},"割 引"]
[null,"A1","訪問型サービス（みなし）",null,null,"サービス提供責任者体制の減算","１　なし　２　あり",{"$nulls":7},"１　なし　２　あり"]
[{"$nulls":5},"特別地域加算","１　なし　２　あり"]
[{"$nulls":5},"中山間地域等における小規模事業所加算（地域に関する状況）","１　非該当　２　該当"]
[{"$nulls":5},"中山間地域等における小規模事業所加算（規模に関する状況）","１　非該当　２　該当"]
[{"$nulls":5},"介護職員処遇改善加算","１　なし　５　加算Ⅰ　２　加算Ⅱ　３　加算Ⅲ　４　加算Ⅳ"]
[null,"A2","訪問型サービス（独自）",null,null,"サービス提供責任者体制の減算","１　なし　２　あり",{"$nulls":7},"１　なし　２　あり"]
[{"$nulls":5},"特別地域加算","１　なし　２　あり"]
[{"$nulls":5},"中山間地域等における小規模事業所加算（地域に関する状況）","１　非該当　２　該当"]
[{"$nulls":5},"中山間地域等における小規模事業所加算（規模に関する状況）","１　非該当　２　該当"]
[{"$nulls":5},"介護職員処遇改善加算","１　なし　５　加算Ⅰ　２　加算Ⅱ　３　加算Ⅲ　４　加算Ⅳ"]
[]
[null,"提供サービス",null,"施設等の区分","人員配置区分","そ　 　　の　 　　他　　 　該　　 　当　　 　す 　　　る 　　　体 　　　制 　　　等",{"$nulls":8},"割 引"]
[null,"A5","通所型サービス（みなし）",null,null,"職員の欠員による減算の状況","１　なし　２　看護職員　３　介護職員",{"$nulls":7},"１　なし　２　あり"]
[{"$nulls":5},"若年性認知症利用者受入加算","１　なし　２　あり"]
[{"$nulls":5},"生活機能向上グループ活動加算","１　なし　２　あり"]
[{"$nulls":5},"運動器機能向上体制","１　なし　２　あり"]
[{"$nulls":5},"栄養改善体制","１　なし　２　あり"]
[{"$nulls":5},"口腔機能向上体制","１　なし　２　あり"]
[{"$nulls":5},"選択的サービス複数実施加算","１　なし　２　あり"]
[{"$nulls":5},"事業所評価加算〔申出〕の有無","１　なし　２　あり"]
[{"$nulls":5},"サービス提供体制強化加算","１　なし　４　加算１イ　２　加算Ⅰロ　３　加算Ⅱ"]
[{"$nulls":5},"介護職員処遇改善加算","１　なし　５　加算Ⅰ　　２　加算Ⅱ　　３　加算Ⅲ　４　加算Ⅳ"]
[null,"A6","通所型サービス（独自）",null,null,"職員の欠員による減算の状況","１　なし　２　看護職員　３　介護職員",{"$nulls":7},"１　なし　２　あり"]
[{"$nulls":5},"若年性認知症利用者受入加算","１　なし　２　あり"]
[{"$nulls":5},"生活機能向上グループ活動加算","１　なし　２　あり"]
[{"$nulls":5},"運動器機能向上体制","１　なし　２　あり"]
[{"$nulls":5},"栄養改善体制","１　なし　２　あり"]
[{"$nulls":5},"口腔機能向上体制","１　なし　２　あり"]
[{"$nulls":5},"選択的サービス複数実施加算","１　なし　２　あり"]
[{"$nulls":5},"事業所評価加算〔申出〕の有無","１　なし　２　あり"]
[{"$nulls":5},"サービス提供体制強化加算","１　なし　４　加算１イ　２　加算Ⅰロ　３　加算Ⅱ"]
[{"$nulls":5},"介護職員処遇改善加算","１　なし　５　加算Ⅰ　　２　加算Ⅱ　　３　加算Ⅲ　４　加算Ⅳ"]
[]
[null,"※　実施するサービスに○を付け，全ての項目に対し該当する番号に○を付けてください。（変更の場合においても，変更のない項目を含め全て記載してください。）"]