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{"sheet":"禁煙サポート案内","index":0,"n_rows":80,"n_cols":19,"rows_kept":80,"cut":false,"hidden":false,"merged":[[12,11,12,16],[17,3,23,4],[14,11,15,16],[16,11,16,16],[35,11,35,16],[12,2,12,4],[12,5,12,10],[24,11,24,16],[24,5,24,10],[14,3,15,4],[13,11,13,16],[74,17,75,17],[66,2,67,4],[66,6,67,9],[66,11,67,16],[64,2,65,9],[68,7,69,14],[70,17,71,17],[72,17,73,17],[68,4,69,6],[66,5,67,5],[72,7,73,14],[70,8,71,9],[70,12,71,14],[13,2,13,4],[13,5,13,10],[14,2,23,2],[14,5,15,10],[20,17,20,18],[19,11,19,16],[19,17,19,18],[16,5,16,10],[16,3,16,4],[18,5,18,10],[18,11,18,16],[9,25,9,29],[9,20,9,24],[12,17,12,18],[17,17,17,18],[16,17,16,18],[13,17,13,18],[14,17,15,18],[64,13,65,18],[35,17,35,18],[66,17,67,18],[66,10,67,10],[33,5,34,10],[33,17,34,18],[62,4,63,6],[33,11,34,16],[61,0,61,6],[62,0,63,0],[62,1,63,2],[62,3,63,3],[24,17,24,18],[33,2,35,2],[33,3,34,4],[35,3,35,4],[32,2,32,4],[24,2,24,4],[32,5,32,10],[35,5,35,10],[32,17,32,18],[32,11,32,16],[69,0,71,0],[64,0,65,1],[66,0,67,1],[74,18,75,18],[61,11,63,18],[61,7,63,10],[72,1,75,3],[70,18,71,18],[72,4,73,6],[68,1,71,3],[74,8,75,9],[74,12,75,14],[72,18,73,18],[68,18,69,18],[68,17,69,17],[64,10,65,12]],"flags":["formulas_cached_only"]}
[{"$nulls":18},"豊田自動織機健康保険組合"]
[null,"タバコをやめたい方応援します！！"]
[null,null,null,"　"]
[]
[]
[]
[]
[null,null," 豊田自動織機健康保険組合では、タバコをやめたいと思っているみなさんが、禁煙にチャレンジ"]
[null,null,"しやすいように、「禁煙費用補助制度」を実施しています。"]
[]
[]
[]
[null,null,"項　目",null,null,"1.禁煙外来コ－ス",{"$nulls":5},"2.禁煙補助剤コ－ス"]
[null,null,"募集期間",null,null,"通 年",{"$nulls":5},"通 年"]
[null,null,"実　施　要　領","概　要",null,"　禁煙外来のある医療機関を\n受診（治療）しながら禁煙",{"$nulls":5},"　市販の禁煙補助剤\n（ニコチンパッチ・ガム）を使って禁煙"]
[]
[null,null,null,"禁煙期間",null,"12週間（約３か月）　5回通院",{"$nulls":5},"・ニコチンパッチは６～８ 週間の使用\n・ニコチンガムは３か月以内に中止"]
[null,null,null,"手　順",null," 1.「禁煙費用補助制度利用申込書」提出",{"$nulls":5}," 1.「禁煙費用補助制度利用申込書」提出"]
[{"$nulls":5}," 2.健保より提出書類受領",{"$nulls":5}," 2.健保より提出書類受領"]
[{"$nulls":5}," 3.「禁煙宣言書」提出※",{"$nulls":5}," 3.「禁煙宣言書」提出※"]
[{"$nulls":5}," 4.禁煙外来へ予約",{"$nulls":5}," 4.薬局にて\"禁煙補助剤\"購入"]
[{"$nulls":5}," 5.初回診察を含め通院５回",{"$nulls":5}," 5.「禁煙補助剤補助申請書」提出※"]
[{"$nulls":5}," 6.「禁煙外来補助申請書」提出※",{"$nulls":5},"　   （支援者ｻｲﾝ・領収書が必要）"]
[{"$nulls":5},"　  （医師の証明・印、領収書が必要）"]
[null,null,"<参考>禁煙成功率",null,null,"70%",{"$nulls":5},"50%"]
[null,null,"※ 健保受付後、「禁煙宣言書」と「禁煙外来補助申請書」をお送りします。"]
[null,null,"*「禁煙宣言書」に初回診察日を記入いただきます。宣言書の提出以降に病院にかかってください。"]
[]
[{"$nulls":5},"現在、喫煙中の被保険者（本人）・被扶養者（家族）"]
[]
[{"$nulls":5},"「禁煙費用補助制度利用申込書」、「禁煙宣言書」を提出した方で禁煙に成功した方のみ"]
[]
[null,null,"項　目",null,null,"1.禁煙外来コース",{"$nulls":5},"2.禁煙補助剤コース"]
[null,null,"費用","個人負担",null,"医療機関での窓口負担\n（12週間合計）約　20,000円　",{"$nulls":5},"ニコチンパッチ・ガム　\n各　3,000円～6,000円程度"]
[]
[null,null,null,"補助金額",null,"実費（上限　10,000円/人）",{"$nulls":5},"実費（上限　2,000円/人）"]
[null,null,"補助制限　･･･　各１回／年"]
[]
[]
[{"$nulls":5},"「禁煙費用補助制度 利用申込書」を提出    >>　通年申込可能　<<"]
[]
[]
[]
[null,"  1.「禁煙外来コース」"]
[null,"　　・禁煙を達成し、最終通院時に、健保へ提出する「禁煙外来補助申請書」を持参し、医師の証明・印　　　"]
[null,"　　　をもらってきてください。"]
[null,"　　・領収書の原本を提出してください（レシート不可）。　「禁煙外来・治療薬代」と分かる明細が必要。"]
[null,"  2.「禁煙補助剤コｰス」"]
[null,"　　・市販のニコチンガムやニコチンパッチの購入費用を補助します。"]
[null,"　　・領収書の原本を提出してください（レシート不可）。　「禁煙補助剤」と分かる明細が必要。"]
[]
[]
[]
[{"$nulls":18},"申請日 ： 　　　　年　　　月　　　日"]
["提出先 ： 豊田自動織機健康保険組合　保健事業G 宛"]
[" "]
[" "]
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[{"$nulls":5},"　"]
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["参加希望項目に　　　を付けて提出下さい。"]
["健 康 保 険 証",{"$nulls":6},"被保険者氏名\n(申込者)"]
["記号",null,null,"番号"]
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["会社名",{"$nulls":9},"内線 又は 外線"]
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["所　属",{"$nulls":4},"工場","　",null,null,null,"部","　",{"$nulls":5},"課・Ｇ"]
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[null,"禁煙外来",null,null,"禁煙申込者名",null,null,"　",{"$nulls":7},"喫煙年数：",null,null,"年"]
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[{"$nulls":5},"被保険者",null,"続柄：",null,null,"生年月日：",{"$nulls":4},"年齢：",null,null,"歳"]
[{"$nulls":5},"被扶養者"]
[null,"禁煙補助剤",null,null,"禁煙申込者名",null,null,"　",{"$nulls":7},"喫煙年数：",null,null,"年"]
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[null,"　"]

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[null,"　"]
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[" "]
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[{"$nulls":5},"　"]
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["参加希望項目に　　　を付けて提出下さい。"]
["健 康 保 険 証",{"$nulls":6},"被保険者氏名\n(申込者)",null,null,null,"健保　太郎"]
["記号","*",null,"番号","*****"]
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["会社名",null,"(株)豊田自動織機",{"$nulls":7},"内線 又は 外線",null,null,"***-****-****"]
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["所　属",null,"**",null,null,"工場","****",null,null,null,"部","******",{"$nulls":5},"課・Ｇ"]
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[null,"禁煙外来",null,null,"禁煙申込者名",null,null,"健保　太郎",{"$nulls":7},"喫煙年数：",null,"**","年"]
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[null,"禁煙補助剤",null,null,"禁煙申込者名",null,null,"　",{"$nulls":7},"喫煙年数：",null,null,"年"]
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