MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C6446A.D3A536C0" このドキュメントは単一ファイル Web ページ (Web アーカイブ ファイル) です。お使いのブラウザ、またはエディタは Web アーカイブ ファイルをサポートしていません。Microsoft Internet Explorer など、Web アーカイブをサポートするブラウザをダウンロードしてください。 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明

このプレゼンテーションの内容は、お使いのブラウザで正しく表示されない可能= 性があります。 このプレゼンテーションは、より新しいバージョンの Microsoft Internet Explorer 用に最適化されています。

続行する場合は、次をクリックしてください : ここ.

 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/master04.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis"
マスター テキストの書式設定
第 2 レベル
日付/時刻>
<= フッター>= ;
<#>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/master04.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/preview.wmf Content-Transfer-Encoding: base64 Content-Type: image/x-wmf AQAJAAAD/wIAAAYAKwAAAAAABAAAAAMBCAAFAAAACwIAAAAABQAAAAwCcAChAAMAAAAeAAcAAAD8 AgAAAABmAAAABAAAAC0BAAAIAAAA+gIFAAAAAAD///8ABAAAAC0BAQAOAAAAJAMFAP///////28A oABvAKAA////////CAAAAPoCAAAAAAAAAAAAAAQAAAAtAQIABwAAAPwCAAD///8AAAAEAAAALQED AAQAAAAnAf//HAAAAPsC/f8AAAAAAACQAQAAAAAAQAAAVGltZXMgTmV3IFJvbWFuAAAAAAAAAAAA AAAAAAAAAAAEAAAALQEEAAQAAAAuARgABAAAAAIBAQAFAAAACQL///8CCQAAADIKbACbAAEAAAAx sgIABAAAAC4BAAAcAAAA+wISAAgAAAAAAJABAAAAgAECAgJTeXN0ZW0AAAAAAAAAAAAAGAAAAAIA AADYOhUA5AQAAAQAAAAtAQUABAAAAPABBAAcAAAA+wL3/wAAAAAAAJABAAAAgAAAADGCbIJyIINT g1aDYoNOAAAAAAAAAAAAAAAAAAAAAAAAAAQAAAAtAQQABAAAAC4BGAAEAAAAAgEBAAUAAAAJAgAA ZgIQAAAAMgoxAAcABgAAAJW9kKyCUAkAAAAJAAAACgAAAAQAAAAuAQAABAAAAC0BBQAEAAAA8AEE ABwAAAD7Avf/AAAAAAAAkAEAAACAAAAAMYJsgnIgg1ODVoNig04AAAAAAAAAAAAAAAAAAAAAAAAA BAAAAC0BBAAEAAAALgEYAAQAAAACAQEABQAAAAkCAABmAgoAAAAyCjEAIwACAAAAglcJAAAABAAA AC4BAAAEAAAALQEFAAQAAADwAQQAHAAAAPsC9/8AAAAAAACQAQAAAIAAAAAxgmyCciCDU4NWg2KD TgAAAAAAAAAAAAAAAAAAAAAAAAAEAAAALQEEAAQAAAAuARgABAAAAAIBAQAFAAAACQIAAGYCKwAA ADIKMQAsABgAAACUTpN4kGaXw5Xxj1aJ/JLogsmCwoKigsQJAAAACQAAAAkAAAAJAAAACgAAAAkA AAAJAAAACQAAAAkAAAAJAAAACgAAAAoAAAAEAAAALgEAAAQAAAAtAQUABAAAAPABBAAcAAAA+wL3 /wAAAAAAAJABAAAAgAAAADGCbIJyIINTg1aDYoNOAAAAAAAAAAAAAAAAAAAAAAAAAAQAAAAtAQQA BAAAAC4BGAAEAAAAAgEBAAUAAAAJAv//AAIQAAAAMgoxAAcABgAAAJW9kKyCUAkAAAAJAAAACgAA AAQAAAAuAQAABAAAAC0BBQAEAAAA8AEEABwAAAD7Avf/AAAAAAAAkAEAAACAAAAAMYJsgnIgg1OD VoNig04AAAAAAAAAAAAAAAAAAAAAAAAABAAAAC0BBAAEAAAALgEYAAQAAAACAQEABQAAAAkC//8A AgoAAAAyCjEAIwACAAAAglcJAAAABAAAAC4BAAAEAAAALQEFAAQAAADwAQQAHAAAAPsC9/8AAAAA AACQAQAAAIAAAAAxgmyCciCDU4NWg2KDTgAAAAAAAAAAAAAAAAAAAAAAAAAEAAAALQEEAAQAAAAu ARgABAAAAAIBAQAFAAAACQL//wACKwAAADIKMQAsABgAAACUTpN4kGaXw5Xxj1aJ/JLogsmCwoKi gsQJAAAACQAAAAkAAAAJAAAACgAAAAkAAAAJAAAACQAAAAkAAAAJAAAACgAAAAoAAAAEAAAALgEA AAQAAAAtAQUABAAAAPABBAAcAAAA+wL7/wAAAAAAAJABAAAAgAAAADGCbIJyIINTg1aDYoNOAAAA AAAAAAAAAAAAAAAAAAAAAAQAAAAtAQQABAAAAC4BGAAEAAAAAgEBAAUAAAAJAv//AAIrAAAAMgpU ADIAGAAAAJW9kKyCUIJXlE6CUoyOglWT+oFpjI6BagUAAAAFAAAABQAAAAUAAAAFAAAABQAAAAUA AAAFAAAABQAAAAUAAAAFAAAABgAAAAQAAAAuAQAABAAAAC0BBQAEAAAA8AEEAAMAAAAAAA== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/master05.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/master05.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/master02.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis"
<ヘッダー>= 3;
<日付/時刻>
<フッター>= 3;
&l= t;#>= 3;
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0157.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
1 <= /span>
平成１８年度診療報酬改定について
平成１８年３月６日（月）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0562.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
2
平成１８年度診療報酬改定の経緯<= /b>
＜中医協での基本的考え方＞
◎ 『平成18年度診療報酬改= 閧ﾌ基本方針』= i社会= 保障審議会
　医療保険部会・医療部会）に沿って
◎４つの視点からの検討
（１）患者から見て分かりやすく、患者の生= の質（ＱＯＬ）を高める医療を実現する= 3;
（２）質の高い医療を効率的に提供するため= ﾉ医療機能の分化・連携を推進する
（３）わが国の医療の中で今後重点的に対応= ｵていくべきと思われる領域の評価の在り方= ﾉついて検討する
（４）医療費の配分の中で効率化余地のある= ﾆ思われる領域の評価の在り方について検討= ｷる　　　　 = ;
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0562_image001.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh3wE0AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0562_image002.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0518.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
3
具体的改定内容
（主なもの）
  スライド各ページの（p.○）は、
　該当す= 驕u改定診療報酬点数表参考資料」の点数告示、
　留意事= 通知、施設基準（告示・通知）等のページを示す
　
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0518_image003.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhugFvAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAAC5 AW4AgAAAAGb/ZgL/hI8Jwe0Po5y02ouz3rz7D4biSJZmo6RqerbuC8fyTNf2zaw64uz+DwwKh8Si 8YhMKpfMpvMJNfSIqKj1is1qt9yu93usAnPgsvmMTqvXbFZg/G7L5/S6/X4Wq8j4vv8PGAjIp0Ao eIiYqLi4ZHjgyBgpOUkpCBlXmam5yZmHKfXZKTpKWloUGmqquspKygfZGis7i4iZSoubqytHdrv7 CxyclQMrbHyMfLrgm9zs/Py4DD1N7fxWXJ2t3aq37f2t2g0+Tp4pXo6eXout3u4+d/4uP58WT3+P v2Wfz9/ftO8voMAhAAcaPOiGGcKFDAsyfBjQIcSJ+CRSvPjOIsaN/+g0cvz4zSPIkdVEkjxpjR3K ldNMsnz5yyXMmbRk0rzJyibOna5U8vzJzSfQoaV0Ej3KyCjSpYeUMn3qxynUqXWkUr3KxirWrZ4U cv3aRyvYsVrEkj0bxSzatUzUsn0bRijcucPk0r0LxS3evXvs8v0b1yvgwUj0EuZr+DDexIrpMm4M 9zFktpIno61smSzmzGA3c+bq+TPW0KKpki4N9TRqpqpXI23tmijs2EBn0+Zp+zbO3Lpp8u4N8zdw lsKHoyxunCTy5CCXM+fo/DnG6NIpUq8O8Tr2hn63a+7uvTP48KDHkx+t/XxEaeoXs2/v+D38yFLm z+0l2P5VW/n1T0T91J9/rAEYoICypWKegb4hWKCCO8GSoIPHKRShhM0Jlp6F0AiVoYbIeNShhzG5 9ICIyk2RBA4qrshiiy6+CGOMEgBRAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0564.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
4
全体大項目
１．医療費の内容の分かる= 領収証の交付の義務化
２．処方せん様式の変更&#= 13;
３．入院診療計画実施、院= 内感染防止対策実施、医療安全管理体制整備、褥瘡対策実施が入院基本料の算定要= 盾ﾆなる
※　別冊「Ｑ＆Ａ」参照 <= /div>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0564_image004.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh2gHAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0564_image005.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0541.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
5
全体大項目
１．医療費の内容の分= ｩる領収証の交付の義務化
　※　６か月間の経過措置
◎療養担当規則の改正
　「保険医療機関は患者から費用の支払いを受= ｯる時は、正当な理由がない
　限り、個別の費用ごとに区分して記載した領= 証を無償で交付しなければ
　ならない。」
◎各部単位で金額の内訳が分かるもの<= b>
　 初・再診料、入院料等、医学管理等、在宅医= 療、検査、画像診断、投薬、
　 注射、リハビリテーション、精神科専門療法= 、処置、手術、麻酔、
 &nbs= p; 放射線治療、食事療養、その他
◎さらに詳細な医療費の内容の分かる明細書の発行
　　患者から求めがあった時は、発行に努める<= /b>（努力規定）
　　社会的に妥当な金= zの徴収可
※　指導料を管理料に名称変更=
　　　「指導管理等」⇒「医学管理等」
(p.511〜514)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0541_image006.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAAIzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0541_image007.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0709.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
6
《領収証様式１》
= 3;
= 3;
円
円
保険外負担=
保険（食事）
円
合　計
保　険
その他= 3;
選定療養等=
円
円
= 3;
= 3;
領収額
合　計= 3;
= 3;
= 3;
円
= 3;
= 3;
負担額= 3;
（内訳）= 3;
（内訳）= 3;
保険外
適　用= 3;
点= 3;
食事療養= 3;
点
点
点
点
点
点
点
放射線治療= = 3;
麻　　酔= 3;
手　　術= 3;
処　　置= 3;
精神科専門療法= 3;
リハビリテーション= 3;
注　　射= 3;
点
点
点
点
点
点
点= 3;
投　　薬= 3;
画像診断= 3;
検　　査= 3;
在宅医療= 3;
医学管理等= = 3;
入院料等= 3;
初・再診料= = 3;
保　険= 3;
平成　年　月　日<= /span>
= 3;
区　分= 3;
本・家= 3;
負担割合= 3;
費　用　区　分= 3;
発　行　日= = 3;
領収書Ｎｏ．= 3;
入・外= 3;
受診料= 3;
平成　年　月　日　〜= @平成　年　月　日= 3;
様= 3;
請　求　期　間　（入= @の場合）= 3;
氏　　　名= = 3;
患者番号= 3;
領収印
東京都○○区○○　　○-○-○
○○○医院
領　　　　　収　　　　　証
(p.514)=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0709.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0709_image008.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCQJtAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALBEALQD2 AT8BgAAAAP///wL/jI+py+0Po5y02oszBrz7D4biSJZmqKXqyrbuC8fyTNfWief6Ptr+D7zxhsSi x2BMKpfM5i7gjDah0qr1iu0cslwTsgsOi3vjMoBqTqul2zX3647Leeh5tW7P64/wPbPvFyiHJ2hE WIg41pZYBMj4+AbZKEmZtViJ44i5mXTIKeL5KZpzOYoSapoKqkrG6kpS+qr5Souaakt7O6u6m8vr qwUMHOvaKyyKO5p8jEnMasy8ufw5HQ3pzFttzajdvP0cFC4+Ti5+XI6err7O3u4Oc/4uP58gDP19 fY6v2015v5+onz+Ayv5xMkgwkEBJCxMOQtisoUM3ErlNlAaxUsaL/4P0cfS3kWHFj4o8knyETdfJ fPZWogx5baTLSC1nIkppCqZNMDIL9dx5Rye3n0CjEPVztOgfoQGTKlXiNE/Up42Y3pxKdQjWjlnt 4CzY1avJsBSt+txK9gRaimnjfEW2tm2rYXLXvKUWty6IvGn46tViVlDgvzr8ljH89+5BxHoZh3Es l57kyZRTxKuMObPmzZzDXe4MOgbh0aRLmz6NOrXq1axbu34NO7bs2bSrhr6NO7fu3bx7+/4NPLhw zzz9DqZ5EXIX5YV5No17XC1zUh+nY7Gu1vlV6Maxe6k+NqD2s9wPey9xXk16owzHC47eo3t7juud 1EfhXiF8UPJZJv8Pf1N+SO13innz/VcTSgLuoRhU/SlIH4A+LahHg508aFGECWaI3HvlKXLfXuBt KN5yzz2GYYkI0uWfJScWZ2CLDoW4BI1HUCjVcDruyGOPPv4IZJBCDlkZijFCuKIvNgZj4nZGgnjg REsaEuV1Ly6XYoAasoiki07CCKWMCU05iZhW0GihIVlOuKWSVV6BJoF7rSnYiFxy6CV5T4ohJxt2 umnmHVe+QadCf+ZC5lpxfshnoofW8uaZg1pSKFKPyhKpoF9ieSSeM0pYZ5N6gtlopvuQSYSjonpI ZKuuvgprrLLOSmutP9SGa6667sprr77+Cmywwg5LbLHGumZrssr/Lstss84+C207ewYakzRdvnft gIxS+5K1nuqXLYN98qERXN6qeFa4FY4LWLl4navlVermuO283Xrz7YD2zpFmVe4uBi+b8ua7br0E V4svutge7BW7HDhsn7kJx5suw/xCDPEUEv9L8cIKa4titCKPTPIDIZeMcsoiT7tvUwGHOvDH4hos s0gvG+qyxQ/R3LFGqDJZ87otu4Xxzz9/kHHEOj80dFk8C4zRzZbmHHTDT8Mc9cRQe9zzzCwvXTHH W4MLtl1Fi+2z1AwO1bTZV+MMsNZYcz2216Ryy7bccIfddcFfV5032nvTPTfId7dNtuBTx9w3vX83 fq/ia1MN+cVv/y+eteQVBl75zo/XbbPemBM+uOGcDvSu6JMzDrrjh5edOOqAX4x4X2fLnjnuredY uxn9pmr0xroXri/stnOncvLKK/s58aFrLhXnu1vefOkgqb055dN7/vrsrOMtlvbOu366qZEPb724 vZt3+eq5mx+9+OmTTyj08huvnvTjW1396Gmrnr3vzY9/3eucAPHXF/0NkHoF3N4BvceVBwbQQ/1z X0SwFz8JZpCCDdyfAhHouw9a0HSEWp4JT/iqCk7wggDcIOn8Z7fygU+DHgwfDfk1qesEL3X2w+H9 RhjD+qHveUMEovpA2Kj2rfB/PYwg3xzoNBW6kIlFXGLxIOg2Kf/a8H0zdOILjUg/SjXxiwb0Yuyg mMUOLvCHZXSLCK3oNzXCkIjw2yIZpxhEMVbxjWhkCxvxGEcZro93LbTjGWtINCUCEmFj9OMNzZhH HTbyins0JCX7eDwt+jBuk8zfHy0ZSCHW8ZFghKPQkBgyTUKSjl104yc3yUFBopJphYTlHUEZRklW kpSm7GXDBpnEk6FwmMTkkTCLicxk8kaVrjyWM5/BTEc+c5rIiKZdqIlNaljTk9ns5iiX0klvijOB cizlOM/ZTFG2Ep3sfMw2ydnOeKZTj9+Upz0lVU5f3nOfmpIlFvkJ0E68M4QBLSicjqkZgyrUT8UB zUIf+oeBHgb/ohSlUj4XWdGMzkWdwNToQhWJS4+KFGgcneVIAQpSW550pWeQaElYCtOWXjSkMaVo SldZ04redJ451ehOpdlTn7qUT0Ed6U+vWVSPHpWbSdXpUN3Z1IwuFZ5RhehUCVpVqz4VR1nl57O6 CtawinWsZC2rWc+K1rSqda1sbatb3wrXuMp1O8qkx1DqqrytHrGNSP2nepa0KL2ekq9MxaTtOtpQ wRKSsFQ1rO8Am0M4Ha0wNqosYmfa11iWtBiW9WthD7nGRCr2l57FKmMfe9kSjpZ2pZ2oSf05x1xK 1h6dPa1pb6nSSM52GLV17G1BG1sCwjYbr+2Qb8PU2mBiloqI/+RpaImWWkpdlZefDS5GSZvcVDYU rxIornGBa07uDVcl2YVqeZfbWBLSE1G9ba5z92pb5Y43J+197nsHG1/tzhcs513VcUvlXclO94n2 zex/V6u0Ue1XeO41cIP/Gl0dDhi3970uTVnbX+kiGLoZzlN+NxzRTW0WHAEWMHdTBmKzlfhMJ1ZZ iiHcYSutOCgRFvCLDxvjg86YDZAV8XprUV/rXpiWOQ7KhMFrYZzqk8gfxtKRL1ng6gqZyQd28o1R W+R+NnnBSmYglzlZZf8+GMdZNsrtlBTk8OYWvmHWMHpZOeUKJ5nDZbbPmdm7Y/bk2c41ZvGT2Rzl 9AYay3Wewv+dgbxnjSUanIt20J/xO+bfDrpTbZbwlSk96ZcW2tB9NvKlkVtpGW+a0aN29KcBvOXv ZhrVqbb0mxkZah2X2kGd5vGjFxtrfM76QrU2M/JabLLnAJtkpy52c3Yt0Fd2WbwjJi6yy/Rs4PXa zrfGbq61fG0eT9vQ1cZwtvUcba30WMHNJm+rRX3u3Yb7CYeWRZqXvGwqRxpE3ZZ3nIE6b1B/m9vG /rKD741vKK86sa8+X76J2mhaJ1xN9abzvhW9bnZveykNL8vCLRpxyk68Ru3m7MWhnW4Wb9zUBefj muEtZ28/nOO/BgwcEOByNMD8YYuY+RlqjvOX51zmO4+5z2n/rvOg81zo7cr4sakrZdmKnLcfT9XI FW506VRcxVHPTtPF/XSG97vcQ075yXG9cpL7m4Uhx/bBt56JyC4dzVenQ9bV9HbgTR3GZWdo1b0w bs3+2N1tf0Lcpd13UnScxHdHz9+xHvhMDN7ZdQd34/mceKmjXZePh3jlSX15sXOdv5mHyuHpkHf9 zJ3MYfd85KXzecqOntClT3bhYRF69Up46LT/+c2JDvTa5972Nu99z3cP/NvrXvi8x/ldhz2yyau7 9RjvvK9+h3i2v36jzOcV9EFP29N/R/uwub7EmT79VXD/Nd7XOPid3/zq76r8gs9++PEzfmQt3tzq 10rqa8N+/8W7H/0gr3+u8o965+d/fhd/rQGAeLd/A3h0/Ld+80dfBQh/77caB4gek9V+Eog090cb FAh7CXh2XDVn8cSB8YF7xBd8vleCKDh8Klh8Kfh7JgiDLEhzEBiBH+WAnKeA1EGDqjGC/OGBAweC XSeCN8hgQChmRkhNPVggAviBRwhw7KSEc/KDTyhoVHhOUYg0Fqh/GHgjO5gaWEguTIiEHpaDswGG RSd9DGh/XogaZziDYmiFrsWFbUiEPFSGVjeHp+GGNzeFauZ18SZPe5g0mBaHmqaG/1eHYNaEqlaI 3oR873B8j/hVc0WJlWiJl4iJmaiJm8iJneiJnwiKoSiKo4tIiqVoijClAqdIiRWhhapoLDLRiq44 LLAoi23VE7FYi79yi7m4VrvIi2nli794VsEojGVFjMU4VseIjGGljMvYVc3ojFUFjdHYVNNIjUVl jdfYU9mojTXFjd2IipYHjkn1jeN4UuVojiKFjukoVCHGjkG1ju/oVDUij9jojvWYUxIxiPiYhBow BwUAADs= ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0672.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
7
《内科無床診療所の一= 例》
点
点
検　　査
点
点
点
点
　
　
注　　射
投　　薬
点
点
点
点
画像診断
在宅医療
医学管理等
初・再診料
= 3;
発  　行  　日=
平成　　　年　　　月　　　日
様
氏　　　　名
領　　　　　収　　　　　証
円
領 収 額
点
合計点数
領収印
東京都文京区本駒込○-○-=
○○○医院
<= span style=3D'font-family:"ＭＳ Ｐ明朝";mso-ascii-font-family:"ＭＳ Ｐ明朝";mso= -fareast-font-family: "ＭＳ Ｐ明朝";mso-hansi-font-family:"ＭＳ Ｐ明朝";font-size:75%;color:whit= e'>保   険
(p.514)=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0672.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0672_image009.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhEwEhAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0672_image010.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAAIdAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAgAAAD2 ARwBgAAAAP///wL/RI6py+0Po5y02ouzDqD7D4biSJbmiXrbyrbu63bwTNf2jVvpzvf+mQsKhzMD 54dMKpfMpvO5PEKnVJW0is1qtx/OgQsOi8fkK/kM+qLXbLHX3I7L51w4vW6/6/ekN/8PGNgnqKVG eHjnh7jIuJbXiGQIORmmSHmJ2fSYiSLJ+alpBDpKOli643mqCiS66sq5+doqS5s2W4tLGPuamutq 6Ru8t/tLLJwJfKzcZqzauwyaDD3ttvxMjSmNvY3VfHrNDakdTh6qDF6OOJ7O7uNdit4euC5fb/JO Gm8/fLvvX4JvlL5/c+gR/BcwWsKDY94QeQgxosQX1iZavEjECMaN/xw7DqnoMaRIHQMZtlsIC6XJ Ov1WElSZDabLbi1n7pNJqaTNajp3YsM5qafPLQaHhgMqDqlRJUWX/qzoVE7TqNCUMhJKFcrUrMes LsLKNRTYsLK8qjNLFmDNtFWhsuWJ9q04t3JZjq2bjy7eLFv3roor6K5fVoIHZ9NrWOvaxGURMxYL +DG/c5Hx9pUMyzHmJJc3X6r8p7BnA4tHC9Rsmkfn1FdRs+5U+vVhyrJ/rK4d2DXuEbd3h9bt25bo 4FKBE5cR+/gh0HyGb+6tvKDx49Cjx2E+DDvb6tbZaE/0nSz37mjCFzTPdTz5MtOJq19fjTb8LhpH 2r+P3wHI/Pzty//oD2CAG00jYIEXzYdgggouyGCDDj4IYYQSTkhhhRZeiGGGGm7IYYcefsiZgSKO SGKJJp64QnJTOJdTMOgx82J5LiJQRozXuSifLzY2RCOPBOLY1Y4NzchiJ0I6AqQwRS5HpHZLNnIk GFG6MSVLOvZI5Y865phLlYVgWYmX8XXJJS5idgOmlGdKmeSMSjZZo5ZkBvnmlU8CtKaVcyqZJxV9 apUmHnKaWWYtfz6RQJxtbUlnm4YGStShNDHKZ51dQvrloIYWSoukmmDKl6d+OnqppWaCiqamnXLa mJ1Oiroiqaea+uidfcCqGKVuysoLqlXYqg6vneLKFJw8oohsssr/LstsBIpaI2xZxHJmbJaL7rmr rrW+qmqrlUbrjK9+TmsOtlfSOiywIqirC7jFoCstu2mQywS9PdhrG76qVRtmt7yw+q+rz57j7l/6 osKvmv7+AjDDAvt4LaGNapsutxFvOrG5FQ/cVcHhwturvF0cbJvH35AM28PWQkvxrCYrJLIVC//V MM0q93vxqhlLfGnM/83sTM1B36xwzt5mq3G8FrOc9KMgF+OzigE3PezTBkcd9WRUS2t1uFijfO/L +YB9T8KCGj010jyf+jXQ3wj9NtFnM732uWKn1DbaDn/bcshLE9x31XcjI+6KZCMcONeDx5Q33Rjz vbXXf3eceK9d/5/cOOCRv7v4Z4UD6jY8cIsud6TNno566qrzV+Pqrr8Oe+w4cHw56ZDXvTHEjut8 ++NsT157Xjv7vi3tnbc4PO+/G1953L0rX7zumuPucvPwfI7o4Slov+7owvcM/PFBeX9a6ZnqbfPz R0e/8vTElyp+UplTvrnBwQuEvRNZ68F9CP3z9j9bmC9Uofue2t6nNObVz4B2s97Y5ne/aJBPggNM FfqGpr60sQ9nu1sf/ByIPwjGD0oT/EQArfA12alwhSxsoX6kRz/qOW2EV8nfpwpYvgzubXkwjKAJ S5iZCv7qhLyhYVJ8iLfwgZCCOkwfD9sXQwTOcIkmtGG9iNg9Kv/iD4mEE6EWkQFEMApxXDhk4gGh lzsocnE2TcTgEznoPjRWb4EhVCIdzdjAO1bRi3oMYhud98aidVCDH+xjF+0owx3mMZFXQ6QUFVlI RkpOgZIE5CIf2UhKYtKNl5Sj3zTpSUjOsZLX4yMpGRjJTWLOkaF0Yic9mMAeGjFYyYPlJ2X5RTae 0ZZQYyUvXZnKVk4Sl4bU5SsJGUs1zpJJtUTmLZWZy8+E0ZhphGMUhcm5aObEilHAov+W+RVvYjFR xDxlDnfpzF6C8pecDCY7V7nOdAJzlKospS/l2U56YtOe8RQlPrNZTM/Vx4UELahBD6oBECl0oQxt qEMfCtGISnT/ohStqEUvitGManSjHO2oRz8K0pCKB6EkLZFIwxYUb9pDpZjB1f5kw1LJuDSmJznp vlLKUJoyZqY5tSnijrhQnSaGp0H16fa22VOjsgKnRVVq2ZiqUKEahqhRdepTgVpVq5oCqyCS6mCo 2lWtbhVKXj2KWIsI1bCe9Ztp/VBZ9wJWt66VrVyV61zp01YPvdUySG3qXZGT1w7ttS5x1etfVdDX rB62sII97H9KCtkCOXagka0sfibLWA4NVi6Z3dBm39JZDX12O4lV62JLa9fTBlazmEWtYR0b2gyN Ni2xxdBsxePaxsI2t6zd7Wo929rfija4dX2taour2+OSNanK860hc/9a2wvdNizRtdB008Nb4PoW ub1tbjife9fqVui6WREvhchLFcuqNz+YXa97QzLZ+Mp3vvStr33vi9/86ne//O2vf/8L4AALeMAE LrDpWGBgkDqHmwnWq1nQ22BuxAXCES5jySo8UcBQGMPX/BWHIVqZDX84oDcdMXgnZWK/FiLFJ/Yw ixW74hebNsYyNi6Na9zdG+N4uHraMY+J4uMc8yXI2gUykWXLpiPbNslKti6Tm3zeJ0NZQiGe8nil bOUHVTnLVMYylxm05S9r2ctiTlCYy9wgDaMZQmpe85iH7GYH3UnEcV6u/l5aZ8vE4BAFAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0700.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
8
《領収証様式や交付についての解釈》※<= b> 別冊「Ｑ＆Ａ」参照
【様 式】
金額の内訳　⇒　 点数、金額のい= ずれかで表記する
２）個々の医療機関で算定す= 驍ｱとがない項目（例：入院料等、食事療養等）　⇒   様式から除外してもよい <= /b>
【交 付】
１）患者が「領収証は不要である」旨の意思表= ｦをした場合
　⇒ 　交付は不要 ※ 文書にて署名を記した表示を残すことが望ましい<= /b>
２）患者が医療費控除のために年末にまとめて交付することを希望 = ;
　⇒          ※ 文書にて署名を記した表示を残すことが望ましい
３）領収証に予め「領収証は再発行= ｵない」旨を明記してもよい
　　（不正利用の防止のため）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0700_image011.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8QEkAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0565.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
9
全体大項目
２．処方せん様式の変= X ※  別冊「Ｑ＆Ａ」参照
=
◎「備考」欄に「後発医薬品への変更可」の「= ﾛ険医署名」欄を設定
　@　医師が「すべての先発医薬品を= 續ｭ医薬品に変更しても可」と判断
　⇒ 「保険医署名」欄に署名 or 姓名= を記載し、押印する
  A　医師が「一部の先発医薬品については後発医薬品に= ﾏ更することは　不可」と判断
　⇒ 「処方」欄の先発医薬品名の後に「後発医薬品への変更不可」と記　B　医師が「<= /span>すべての先発医薬品につい= ﾄ後発医薬品に変更することは　不可」と判断
　⇒ 「保険医署名」欄等への記載不要= or 従来の様式を用いる
※ 従来の処方せん様式も使用可能（そのまま or 取り繕う）
※ 調剤薬局から情報提供が行われる
(p.565)=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0565_image012.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5AEgAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0565_image013.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0689.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
10
備考
　
　
　
公費負担医療の
受 給 者 番 号
保険薬局の所在
地 及 び 名 称
保険薬剤師氏名
　
　
　
公費負担者番号
平成　　　　年　　　　月　　　　日 <= /div>
調剤済年月日
　
　
　
　
　
　
　
　
　
　
　
　
　
　
備　　考
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
処　　　　　　  　　方
　
　
平成　年　月　日
処 方 せ ん の
使　用　期　間
平成　　 年 　　月 　　日
交付年月日
　
　
保 険 医 氏 名　　　　　        　　 <= /div>
被扶養者
被保険者
区　分
　
　
　
　
　
　
　
電 話 番 号
男・女
年　　 月  <= /span>　日 <= /div>
生年月日
　
　
　
　
　
　
　
保険医療機関の
所在地及び名称
　
氏　名
患　　者
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　
　　　　　　　・
被保険者証・被保険
者手帳の記号・番号
　
公費負担医療
の受給者番号
　
　
　
保 険 者 番 号
　
公費負担者番号
　
　
　
　
処　　　方　　　せ　　　ん
　
　
　
１．「処方」欄には、薬名、分量、用法及び用量を= L載すること。
２．この用紙は、日本工業規格 Ａ 列５番とするこ= ﾆ。
３．療養の給付、老人医療及び公費負担医療に関す= 髞用の請求に関する省令（昭和51年厚生省令第36号）第１条の公費負担医療につい= ては、
　「保険医療機関」とあるの= ﾍ「公費負担医療の担当医療機関」と、「保険医氏名」とあるのは「公費負担医療の= 担当医氏名」と読み替える
　　ものとすること。
（この処= 方せんは、どの保険薬局でも有効です。）
後発医薬品への変更可
保険医署名　
印
印
3D"テキス==
明大昭平　
特に記載= のある場合を除き、交付の日を
含めて４= 日以内に保険薬局に提出すること。
3D"テキスト
様式第二号（第二十= 三条関係）
(p.565)=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0689.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0689_image014.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhbAAQAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAQBq AA8AgAAAAP///wJARAKpy+0Po5wUHlOz3ryz64XiuIHkiaZmyrYl4sZytM72XN86m+/+2PsJOcGh kVI8Kh/JpVOBgD2nHyj1igEUAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0689_image015.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7QFqAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADs AWkBgAAAAP///wL/jI+py+0Po5y02ouz3rz7D4YiCJTmiabqyrbuC8fyTNf2jef6zvf+DwzyDMKi 8YhMKpfMpvMJZRGj1Kr1is1qt9zTtAsOi8fksvn3PavX7Lb7XUzD5/S6/S6W4/f8vv9/owc4SFho CCd4qLjI2AiV6BgpOUlJA1mJmanpeLnp+Ql61xlKWmqaF3Cqusq6NdoKGyu78zpre4urUpvL2wu7 6xssDAo8bHwsWYy8zEyo3AwdbfcsXW2tRn2tvc2Vzf0N/pi6MlJufo6err7O3u7+fi41rjs3/2Iv gx+jvx9owy/F3yGA5P4ZrEHwHkJLB3URTFgGopeGMyQWpJivokBD/xZNdETxceLCjRk1jnQYEFFJ hidZtlwJI6RIjiZd1rxpsx9OnSgvvvkos0RQAEOJkoSpEOOgojtjKkXqtGnSnvRUHmH6NEtRrGy4 RlXi9WpWog/rIQkLVctWRWhbtJ0KZujDslaNvIXb7ehSqS7uuh0jV17Kn2nx8sxZuC9fxQMXD3bs 8+XXw4kh+W0CdOxfzZsRd/b8J2RgyZNBfy5N2QtdwqlRu35tGHZV0qEhz7adgmlQmaOp5jbbOrbw 4YxN38Y9LUlv5L+NHw9O9nGbyzPB5tELiHr1s4DHWgZuF/N1znu0e2Rinpb3ufDau38PP778+fTh C448PfFp6MWd4//vzxwd6eUyl3Rd6WegbPvxl2CDxPExIC4F/rdGZrQBiKCDC2q4oR8R3jLhcxVm 6MNa5InIYYp4fGhLiM2xlldEAZ7XWDgdfleXK2aIhl1tNjqII4xxnHgFj0Qm9yOFQq3mhoX+ofig ii8qKCWSSU4JEpP5Magkhlx22SGUXvp4JUj3iSnjl1iquSab240Z5YpltrlklXGR2IOJF4ZJZ5yi zGkmOVoe2AWLORi5J4SAvunRoCMWuuOMQrG1KI2+BSqkEMuN5yajZC7qIqZN4ikqqaWaaimVYCpa qVGC2glpp5MmCmuqpupZiKGyhKpafb7+Cmywwg5LrAdntopssof/6qpss9F442y0ZUIrbbXhUGtt ttpgq223zzLrbbi/gCtuuadwa266vFhWbLvuvgtvvPKKcOypkqKBLLmP5Fuvp7ICoe8qATsx8Ln9 2vqkWK0WjB6/r64K5xIMlzKxdQsfPGuPDV9cY6W8InxviQ7TxPGl/qqqsMeUlpybo6gGUXEoMXPH cpa1nmyxyh2DirGrGks8cq5B2wwxn8oNvVfNqt0MsnhKZ4d0ow0iYDTNOpN8dctTdzLwzJ94Hd7T dSpJNdMii+1h1GNDSQR7874Nd9xyzx1CzwCVXXTKMlsB9pBoB3mk36R0vXLWRKMZcc57V9G3pmpH l3fkgi9OReMw/z8OOK1WUx6F5QBj7vK/+FLMd+E8P4x41XoTU/rOgH6cceCOk8646a/bfWjrg+su 9N+hoxz27rW7PifsPst+Oe2V21487jgQrnznzE/rvEMJQS/88sRTjzqdCZidpynY92740l0eoHrw nO+7/ZXG340++EOIz7szoGsI0fisD4/16SY3vQ+6CXCABCwg3aqHvM/JiVX9u1337PUyBf6JgeTz n9Yk1yegLbA803MfAjW3OgH1wXOjK5/UMAjBjU2Qg+1L0vtyxz8rbbCCDvxf7ECovjqQEIc6vB8K cXa0Ga6Qhs17IBDTN7keUtB+vgOf/kS4xKSZcG0Z9FMOocjCBv8W0YbH4+HshghGKVrwcFVMXBDD qEQtco+LBmyjG98Ix7l9kFBTTFsTf6iWx43Qh6nj1BjFWMML9jEMO5xEIed3x0HeCW17TGQZu8PI KK5RkI/0YyCZWMfM0fGPUHNkCiMVySxykoqfTFMdG5nJ35lylHZMpfzqt0UiTpKMpSTDISNxSx3k shEvzNElARlLWvYqjsQspjGP2Z45hkxdzGwlJWuJxGZK81PCBCDwpolNSZLyiK/MpjcfxUYYfnOc wDyhIitJznRuKZzPU6c7RVnNGybsnfSEJDt/Vs982vOZ3MSjPv8pPSNa04oALaj27plAgypUcfHs 4jwXClGGmu//nNCMqEU311Cs7PKi3uwlPjkK0i/yc6BmDKlJwydQeS7zpCwdjiZX2tKYsk2VJZWp TWHz0gjedKcAzKnoeLpTjyYUqDcVapZ8StSkphCp8aOoUm1q1Ik0taJP5WlUpZaIjVY1WlftlT+3 atKu/hSsIRXrNcnaUrMSFK0sVWtN2ZpWZeoUrhd1azTpClK7dhOvBdXrV/mqUL86FbAQFSw6CVtX uY4VsQA1LFUZG1HH9hOyhVXsWSlrUMmSFLORtexaOdtYz74VtH0V7V1Jm0/NqhS1FlWtQ1nbWtPu FbbZdK1WaVsN2+I2r7L9625r29vB/vabuh1uZ1P62rkaF5vF/11uYIN7WOcSF7qPlW5HqTtZ6wIX uRrVbmm5K07vpha7mxXvdhHqRfMys7nqfSd726vO98KXnPKd73TB2077xpe8q9XvNOvr3//yN7kB biaAC7zeAd8Wwa04MIPN5eAHiyvCEvYWhSusLbNeYsEYjl5G5THV7Ha4WRpG6oizJVa8RffEybow i53l4hcrK8Yy5uOKRVzjX5rzxuXNsSdx3GMfs9LEoxVyMCfK4/4aucUKXjKKm+zkatE4yj+aMpWv BeUrkzjLWmYyfj/a5SpzOcyu/CqHyazGbQY5yWh+1pjbPEskV3fOcJaGlevs5i8PFc/LuDOfmeHn PyPjfcgstP+hD43oDLxZ0N8INKOH4ehHByPSku4FpStNoEVjOrea3nSe0ftQTwvj0qLeVadL3edT o/oYXVUxm1dtaj0flaawnrRcXU3nWs+i1SHOta5jQepf00/WoRZ2rEENU2MPG9nKVbbBiJ1sZ69P zkBWsrRBpOpr7zrb2gY2t7vd4G+DW2DiHvezmb1Yc2sixRtW97pujes1u3t/6JbImecNyx1DMBXt xneLyu1vTwQ74IwYOME7CDnhEvjg2RuptYvM8EoYPOKYdPjCP0vxZAA84xqHdrM53kIinxbkBd84 yUvu8XSfvJxqfvjIV57mhLP53jAXaUYTjfOc6zzRAy6SHrX/+cNN/XQ3xSawyC155E7+S+iXlTdv 1jNb9p0S6E5lOsZdXl2ry9zXWKC50mUpwTOmd+yu9XkohWjzEOroQkcn5M/hmfYrrt00bV/k1OF+ Wq2/XHZar3us7o72vCdQN17sO62RHuevY1zvZiO6pMqebw+2sOqDz2+ADB/1J3idmiwvodiLXnTI x1DHnE+eROfOF7/HCPBoDDtGV596t+189rSvvQB7HnkXIpzyZLc8qjDv29EnvfQ3Y7w/HR9B0R+U lahsuvGFi/yl4174iSe+2UF/8XMCX+HXZz7VqQ97509/+aR3Jurd/vjxB5T1Mlz8njWYfPVL3ft4 L37lwZx1/6gHn/zDNz/Es897yPN0bHd46Md+aSR+vYd/2bV9r5Z7YjZ54Pd/WMeA+sd9D2gjmzeB n2d30pdyoHSAWBR+HZiA6AaC9Bd49jd2BBN68qd5b5eCQXd/AtiCH7hK5dd87qeANJh+NmhLMNh6 MriD6TWAdFeAJNh/OZhHKwiA+UeAmceCZxeEGNh1NWiCN5iE38d/f+eBbGR7XwiGYdguPVNz1oAu ZQgiGoiGTaKGa9gVbeiG2ACHcbgjc0iHtmSHd4gKengNZ8iHquCHfyg+eSiIrkCIhagVh4iIRaKI i8g4jeiInQOJkah5k0iJmGGJlygxmaiJysGJnXgVnwiKcV8giqMIM6VoimiAiqmYJ6vIirTgiq+4 LLIoIbFIi/9gi7doCbmoi/nAi70YE78IjH0hjMNIhsb4NcWIjBa3jAKnjM2ob9BIDM8ojYEojRBC jdBojde4ImLojd8IjvJSAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0689_image016.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhtAAdAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAACy ABwAgAAAAP///wKJjI+py+0Po5y0Wgay3rz7D4biSJbmiaacobbuC8fyy872jef6Vu/+DwzyAsKi 8UgjIpfM5krpjEqDvan1Oqtit9yTtgsOd77iMphsTl8v7Lb7DY/H1fQutI6X3vP85b4PKPQXSLgz WIhoc5jISNP4mAUp6ThZibJombmiyRmC2ZkpJzpKWmrKUAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0689_image017.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhDwANAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAAAM AAsAgAAAAP///wIYhINoC8HtzpNtLhcttjfPzUUek40KmXgFADs= ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0689_image018.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhDwANAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAQAM AAsAgAAAAP///wIXhINpG8vvYIts0mMvui+76UHAVlFJVgAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0689_image019.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhFwAfAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAsABwAE AA8AgAAAAP///wIOjI8GG9Ce1HJQJVZZQwUAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0689_image020.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhFQCLAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAQADQAJ AGsAgQAAAAAAAP///wECAwLKhGyXwg0WmghhyUQZrTI+GHFfBZDkw3zSVUbTtp7le9Q1OrXlQyHf v0otQpmgqkMyHjOcmsdUif5UwNVvs5lqtzgrD9vjdhUq5jRFDqYb2W+uupuGxfS6/ew9gBXkkcUx 9OLi9RemhGOG9vS1I0N1xPKFdbelNgLmSInC9XYm8gfINImSCcHleNgyCoSnIdemtUYo2BaJQAQn hGbT5dIzwSZCJGTipsTGhtHEMegK3GGqkeNgpuoHClkNvCgNWJi0nWZ2UjzGgklRAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0567.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
11
全体大項目
３．入院診療計画実施= A院内感染防止対策実施、医療安全管理体制整備、褥瘡対策実施が入院基本料の算定= 要件となる ※  別冊「Ｑ＆Ａ」参照
=
◎ 従来「減算」であった入院診療計画未実施（３５０点／入院）、院内感染防止対策未実施（５点／日）、医療安全管理体制未整備（５点／日）、褥瘡対策未実施（５点／日）を廃止
⇒ 入院基本料の算定要件とする　
　 <= /span>※ 未実施・未整備の場合、入院基本料そのものが算定できない
　 ※ 有床診療所も対象となるので体制・対策の整備が必要
　= 　
(p.4、41、444、459= )
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0567_image021.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5QFQAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0567_image022.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0563.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
12
基本= f療料
=
=
=
１．初・再診料および外来= 診療料の見直し
　　紹介患者加算の廃止 同一医療機関= E同一日の複数診療科受診時の評価２．電子化加算の新設
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0563_image023.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wHcAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0563_image024.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0474.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
13
基本診療料
１．初・再診料および= O来診療料の見直し
（１）病診格差の是正、紹介= ｦの廃止
１）初診料　病院の場合　：２５５点 ⇒ ２７０点（＋１５点）
　　　　　　診療所の場合：２７４点 ⇒ ２７０点（△４点）
        = ;    病院紹介患者加算 ⇒ 廃止
　　　　　　診療所紹介患者加算 ⇒ 廃止
２）再診料　病院の場合　：５８点 ⇒ ５７点（△１点）
　　　　　　診療所の場合：７３点 ⇒ ７１点（△２点）
　　        継続管理加算：５点 ⇒ 廃止
３）外来診療料：７２点 ⇒ ７０点（△２点）&= #13;
　　　　　　　　　　　　※ ヘモグロビンＡ１Ｃを包括から除外し出来高算定へ
(p.1〜3)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0474_image025.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgJBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0474_image026.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0539.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
14
基本診療料
１．初・再診料および= O来診療料の見直し
（２）診療所（再掲）
１）初診料：２７４点 ⇒ ２７０点（△４点）
　　※ 同一医療機関で同一日に複数の診療科を受診した場合
　　　　　　　　　　　⇒　２つ目の診= 療科の初診に限り１３５点を算定できる。
　　　紹介患者加算：５０点 = 廃止
２）再診料： = ; ７３点 ⇒   ７１点（△２点） =
　　  継続管理加算：　５点 ⇒ 廃止
(p.1)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0539_image027.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh3AFBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0539_image028.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0568.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
15
基本診療料
１．初・再診料および= O来診療料の見直し
　（３）病院（再掲）
１）初診料：２５５点 ⇒ ２７０点（＋１５点）
= @　　　※ 同一医療機関で同一日に複数の診療科を受診した場合
　　　　⇒　２つ目の診療科の初診に限= り１３５点を算定できる。
　　　紹介患者加算１：４００点 &#= 13;
　　　紹介患者加算２：３００点
　　　紹介患者加算３：２５０点
　　　紹介患者加算４：１５０点= 3;
　　　紹介患者加算５：  ７５点
　　　紹介患者加算６：  ４０点
２）再診料（一般病床２００床未満）：５８点 ⇒ ５７点（△１点）
　　  継続管理加算：５点 ⇒ 廃止
３）外来診療料（一般病床２００床= ﾈ上）：７２点 ⇒ ７０点（△２点）
= @　　※ ヘモグロビンＡ１Ｃを包括から除外
廃止
(p.1〜2)
(p.32)<= /div>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0568_image029.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5QFBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0568_image030.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAQDm ASYAgQAAAAAAAAD//wECAwL/hIWpy+0Po5y02ouz3rz7D4biSE7GeSDByrbuC8fyTNf2jef6zvf+ DwwKh8Si8ShToBAApPMJjUqn1Kr1iq0yT4JmAAUOi8fksvmMTqvX7Lb7DY/L5/S6/Y7Pt7eqr/4P GCg4SFhoeIiYeCjwpaL4CBkpOUlZaXkJpsLoh9np+QkaKjpap7lCipqqusra+mfK6So7S1tr2wl7 q7vL2+sLl/srPExcLBtsnKy8zKyI3AwdLT3N9kx9jZ3dbK3d7f1tyw0+Tl7+KW6err5uiM7+Dh8f 5y5fb3+fybiJz9/PT+8voEBvAAcaPAitIMKFDIUpbAgxIq2HEitaJEXxosaNa5YycvwIEpHHkCRL 6hlpMqVKYPpOrXwJE48mRjFr2mQZwNHNnTzNbNLZM6hQAPu2DD1qsw9Ro0ibplTKpYTUqVSrWr2K NavWrVy1ekGRs6vYsWTLmj2LNq1aL7FOZHkLN67cuXTr2r3r0kABADs= ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0568_image031.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhJgBfAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAQAl AF0AgAAAAADMzAKZjG+gy+0PAYq0vmRzxbq74IUMKIpk2Z1opq6bq7UwJM+f/eJRrSt8/9MFcUNb cXaEJV3LVRP1LEVNPVr1cr1lR1tu1/cFh6chssecCkvU6PRYLWnH4Ad6nY3gKPNVfV++A7jD9lb4 JUiBOGjYpWjFuOWIBZklqXVISHll2cDphanZlwlK2jhqGgp0Grm6mUrU6EckK5V3h1MAADs= ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0607.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
16
基本診療料
２．電子化加算の新設　※　医療のＩＴ化推進を時= ﾀ的に評価（平成２２年度まで）
=
◎電子化加算：３点（初診料の加算）
　※　必要的に具備す= ﾗき要件をすべて満たし、かつ、
　　　選択的に具備すべき要件のいずれか１つを実施して= いる場合に算定
(p.1)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0607_image032.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AEzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0607_image033.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0608.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
17
=
［必要的に具備す= ﾗき要件］
@ レセプト電算化= システムを導入していること = ;
A 個別の費用ごとに区分して記載した領収= 証（医科診療報酬点= 舶\又は歯科点数報酬診療表の各部単位で金額の内訳の分かるもの）を無償で交付し= ていること
B 試行的オンラインシステムを活用したレセプトのオンライン請求を行っていること= （４００床以上の病院に限る）（※　平成１９年度以降）
(p.444、459)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0609.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
18
=
［選択的に具備す= ﾗき要件］（いずれか１つを実施） <= /nobr>
@ レセプトの電算= 化（電子媒体による請求） （４００床未満= ﾌ保険医療機関に限る）
A 試行的オンラインシステムを活用したレセプトのオンライン請求を行っていること= （４００床以上の病院に限る）<= /span> （※　平成１８年度中のみ）
B 患者から求めがあった時に、詳細な医療費の内容の分かる明細証（個別の診療報酬点数の算定項目の分かるもの）を発行でき= る体制を整えていること
C バーコードタグ、電子タグ等による医療安全対策を実施していること
D インターネットを活用した電子予約を行っていること
E 診療情報提供について電子的に行っていること
F 電子紹介状を行= っていること
G 検査、処方、注射等に係るオーダリングシステムが整備されていること <= /span>
H 電子カルテによ= る病歴管理を行っていること
I 医用画像管理システムによる放射線診断業務を行っていること
J 遠隔医療支援システムを活用した離島・僻地および在宅診療を行っていること=
(p.444、459)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0569.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
19
入院料等
１．入院診療計画実施、院= 内感染防止対策実施、医療安全管理体制整備、褥瘡対策実施が入院基本料の算定要= 盾ﾆなる（再掲）=
２．看護職員等の配置に係= る情報提供の推進
３．有床診療所における入= 院医療の評価の見直し
４．紹介率を要件= とする入院基本料等加算の廃止５．急性期入院医療の実態= に即した看護配置の適切な評価
６．患者の状態像に応じた= 慢性期入院医療の評価
７= D特殊疾患療養病棟等の見直し
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0569_image034.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5AEVAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0569_image035.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0615.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
20
入院料等
８<= /b>．複合病= 棟の廃止
９<= /b>．新たな= 加算の設定10．地域加算の見直し =
11．臨床研= 修病院に係る評価の見直し
12．新たな= 特定入院料の設定13．標欠に= よる減額措置の簡素化
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0615_image036.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5AGzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0615_image037.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0570.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
21
入院料等
２．看護職員等の配置= ﾉ係る情報提供の推進
　※　入院患者に療養環境に= Wる情報を正しく伝える観点
１）入院基本料等について、
 「それぞれの勤務帯で実際に働いてい= る看護職員等の入院患
 者数に対する割合」により表記する
　（例）
２）日勤帯、準夜帯、深夜帯の各々で、看護職員１人が何人の
　入院患者を実際に受け持っているか病棟内に掲示
・平均して入院患者１０人に対し看護職員１人が実際に常時働いていることを意味している
・入院患者２人に対し看護職員１人を雇用していることを= 意味している
「看護職員の実質配置１０：１」
「= 看護職員配置２：１」
（改　定）
（現　行）
(p.444、460)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0570_image038.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgI/AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0570_image039.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0570_image040.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhwwFxAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADB AW8AgAAAAP///wL/jI+py+0Po5y02ouz3rz7D4YTQJbmiabqyrbuC8fyTNf2G9z6zvf+D/QdgsSi 8YhE5pLMpvPJHEKn1KrVtbxqt1yloQsOi2/ZsfmMBkjT7Pa27I7Lk+u5/Q6E4/d8Wb0PGLiiJ1gY +GeY2Eeo2CiH6BjpxihZOQZpmRlGqdlphekZSsUpWkr3ZZo6RaraKoTqGmvEKls7A2qbe6vLSwbb CxxDG0yMS3xMMozMa7wcrOxs2xzNTE09bS2d7Yy9HQvtndodrgpOLjp+Xmqu3pne7skOb/k+nylv H1mfL4nPr7jvXyN/AgsFLGiIIEJABxcecijuF8RQCifeEYExo8aN/xw7evwIMqRIDxbXlaQo8SQ9 le5SstT38p7LmABpVmpok03FnGZw8jyz8+emmUIXFU3k8yiYoEq1JG36BuoholIfVV1E9Wobplqf PO0KhSvYKFnH9jQ75ytaOmvjqG07C+7WsnKj1kXz9u4PsXp75O3Lgy9gHX8HkzE8VDDiGooX+6Hr OErkN5AnH2lsuUXhzFg4V9nseVDoVZVHCzHttTTqHZhXJ1Pt2kZr16Bjq7HtZTZt3Jdh8xb2u8jI 4cSLGz+OPLnyj8GFNw9SO7Zu1NF3P9/r+7po7X6zc0cx3XT11eFHj6f+PbD39CXKhz4vnj3h9fLd e4ZvXr4v+/f1y8Cmzx5/meH3nn+MAZiegJYR2J+BtyD4nYKTMciZhJFROKCDD1p4oYaPcegYiIhh uKCHwkDInYiGkTihiTCw2KGLWKConYqDwRiijDPaeKOOmtF4HY994biYkHoROaKPLCC5opKDAPmc kXcx2aOTKVAJmJR1YTmklVdC2ZyWcnF5pJfggRmcmHCROaWZJ7C5pZsmwDmmnO2h+ZuabdG5pp2v 6bmnn2rgyRugaPEZqJ+IrmWoWcs9Cmmkkk5KaaUTFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0613.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
22
入院料等
３．有床診療所におけ= 體院医療の評価の見直し
　※　急性期入院医療に係る= ]価
１）有床診療所入院基本料１（看護職員５人以上）
　　　イ　７日以内　　　　　：８１０点
　　　ロ　８日〜１４日以内　：６６０点
　　　ハ　１５日〜３０日以内：４９０点
　　　ニ　３１日〜　　　　　：４５０点
２）有床診療所入院基本料２（看護職員１人以上５人未満）
　　　イ　７日以内　　　　　：６４０点
　　　ロ　８日〜１４日以内　：４８０点
　　　ハ　１５日〜３０日以内：３２０点
　　　ニ　３１日〜　　　　　：２８０点
※　看護職員（看護師、准看護師）なしは算定不可となる（経過措置あり= j
３）医師等配置加算：４０点 ⇒ １００点（＋６０点）
(p.12、47、447、46= 2)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0613_image041.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgJBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0613_image042.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0571.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
23
入院料等
４．紹介率を= v件とする入院基本料等加算の廃止
　※　急性期入院医療に係る= ]価
◎廃止項目
 １）紹介外来加算・紹介外来特別加算= ：１００点、１４０点
 ２）急性期入院加算　　　　　　　　= ：１５５点
 ３）急性期特定入院加算　　　　　　= ：２００点
 ４）地域医療支援病院入院診療加算２= ：９００点
◎手当て
 １）特定機能病院：入院基本料の１４= 日以内加算の引上げ
 ２）地域医療支援病院：地域医療支援= 病院入院診療加算の引上げ：
４９０点 ⇒<= /b> １，０００点
 ３）救急医療加算：入院初日のみ ⇒<= /b> 算定できる時間帯を夜間または休日以外にも拡大し、７= 日まで延長
 ４）救命救急入院料・特定集中治療室= 管理料の引上げ
 ５）急性期入院医療の評価を行う=
(p.9、14、15、20、= 21)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0571_image043.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgJBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0571_image044.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0572.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
24
入院料等
５．急性期入院医療の実態に即し= ｽ看護配置の適切な評価
　１）一般病棟、専門病棟、障害者施設等、結核病棟、精神= 病棟、特定機能
    病院（一般病棟、結核病棟、精神病棟）について、現行の区分を簡素化し= A
    急性期医療に特化した体系を再構成
　　　４：１に相当
２０：１
区分Ｆ
　３．６：１に相当
１８：１
区分Ｅ
　　　３：１に相当
１５：１
区分Ｄ
　２．６：１に相当
１３：１
区分Ｃ
　　　２：１に相当
１０：１
区分Ｂ
　１．４：１に相当
７：１
区分Ａ
現行の看護職= 配置
看護職員の実= ｿ配置
※　区分Ｅ、Ｆ：結核病棟、精神病棟のみ
(p.4〜、444〜)=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0572_image045.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhEQJkAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0572_image046.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6AFFAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADm AUQBgQAAAAAAAAD//////wL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWM/xw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXin+v0LOLDgwYQLGz6MOLHi xYwbO34MObLkyZQrW76MObPmzZw7e/4MOrTo0aRLmz6NOrXq1axbu34NO7bs2bRr276NO7fu3bx7 +/4NPLjw4cSLGz+OPLny5cybO38OPbr06dSrW7+OPbv27dy7e/8OPrz48eTLmz+PPr369ezbu38P P778+fTr27+PP7/+/fz7+///D2CAAg5IYIEGHohgggouyGCDDj4IYYQSTkhhhRZeiGGGGm7IYYce fghiiCKOSGKJJp6IYooqrshiiy6+CGOMMs5IY42sDYBjjjruyGOPPv4IZJBCDklkkUYeiWSSSi7J ZJNOPglllFJOSWWOauBo0wBZZqllGljW1KVMYcb0JRplkrklmGOacSZMa7b0JkttljGnnGmKGecY da6UJ0p9nrSnGIECeieZf4IxqEmHjrSoSIl+8aijhbrZaAqRhlSpR5l2dCkKnXI6KZybGvApR6Nm dCpGpQKwqqqhynlqqxelOiuXV9JKEa4T6SrRqrLm+iqfsfL6ELEOGduQr8j/JrQsQs0epGywftrq 5bMEWTsQtgJFC6a0gA7rraLUmqntP+X6c24/3IoZLqPgdgsvnrdWSW+99t6Lb7767stvv/5KeWu7 kqoZcLxoElytwJiOe8avuyqs6bvsGkxpwRNfbKjFB2NcccIUw8kwm+nqM3I+JeOz7sYqd0wuxKAi 3PLHdsLc8Mn32EwPzvOk7KbLpkq8Msg0i+wzqiHTqbM8SceztDs8C82xqBr3LLOwU0MdNKxXzxy1 1h53zefRZDjca9GqAk012H4O+2/bbr8Nd9xyz033v1uHXfXad0+b97d7E9q3omhjnXbGX2eNt7yH F8641IsTDrnXMasNuOKT/yPOt+U1m13r0EhzDqznYzfdDunsmL7O01xj7vfjqzcu+eaBMyq2nqij c/s5uZujeuKsC/63uLM7OvjrkVvtuu+wI3/58pkb3vzxz7MsO+XCa0708AuLbjvoD3Mv6O7liC8O +eEoW3f66q/Pfvvuv89k8LRrH7H8A1vvrv3b40+8/pp636viKU96rYue8Q7IvOr9bn7Y+xz9XtbA 0QGwWLUL3wSPVcEwkI2CD/yZ/yC4wP4lb3oEBN4IKxdCTAmQhAjU2wmvl8L6vZCBMeTUClHovAIq MIcwpF72+Lc/6O2whDT0oQOB+D/wadB84GDiN5zIjd6xcICx+2ENTZVBRP9BcRtb1EYXs4E++Ilx jGQsoxnP6KQPYrGDqLphD4koQgNScY4ulOMU76hDK/KwiI6zIw7hqEI1Go2NZxOkqwg5KzfysYV5 POIVBxnB7iEydJG04CS/V8klXjBZWYTUF63xyWqEkhpS/CMjTejHN54yfzO83yML2cog7jGOQ1yl K40owUuWTYla3CSzOomDDWJQl8VS5C0BKcNULpKOjcwlEkGIS9uhcZrUrKY1ryk3Q3bumR6MZRK5 2UZtUvKViRQnJsmZK2PKEpk2NOcuwQlLZR7TloH0JjTZ2U15rpOeyawlM1WZQD3iE5JCFCg/71lF R85ynwFV6EAPmcleEnP4mBH1pC+dBUxLjXIaG5VGR59RSoDiEZX+HOky61hSU/6Tlfr8Jjp3pU6X LrSfBl3pPBvqzJe+s6AOPegaKxrMjzpDqM0gKjPCiM2kKnWpTG1qkNzJQXiW054/1WkxoUpRqx4r pgi1aT1b2lWT0rKmYmUoSsmq0rLStKdelWkfUyrStDZTklIdZzQtWddz3lWTE+UkLy3a11/+NagX hVZGPWXUZSQWGYs9RkhPKleSojWulGUpXCFb2bGyVa1hnStetepXoGq0sNc67AGEGVrQMourVZ1p O6lKUNfm87I35exsRebU3Op2t7wV47x6C9zgCne49/pCAQAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0610.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
25
入院料等
５．急性期入院医療の= ﾀ態に即した看護配置の適切な
　評価<= /u>
　２）夜間勤務等看護加算の廃止 → 看護職員配置の評価全= 体で評価する
　３）看護補助加算を現行の５区分の体系を３区分に簡素化=
=
=
４） 入院期間に応じた加算は、結核病棟・精神病棟について、入院初期を高く<= /span>評価す= ※  病棟= 謨ｪ別の点数（次頁参照）
（現行）&#= 13;
基本料２、３、４、５
15：１
５
基本料２、３、４、５
10：１
４
基本料３、４、５
６：１
３
基本料５
５：１
２
基本料５
４：１
１
算定できる入院基本料の区分
配置 = ;
基準
区分
（改定）
基本料Ｃ、Ｄ、Ｅ、Ｆ
15：１
５
基本料Ｃ、Ｄ、Ｅ、Ｆ
10：１
４
基本料Ｄ、Ｅ、Ｆ
６：１
３
２
１
算定できる入院基本料の区分
配置 = ;
基準
区分
(p.17、448)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0610.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0610_image047.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhEAJkAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0610_image048.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0610_image049.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9AGWAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAFQDy AX8AgQAAAABm/2bM/////wL/hI+py+0Po5y02ouzfqP7D4biSJbmiabqyrbuC8fyTNf2jd8b1O3I 4Av+hMSi8QjoCYHIDLMJjUoPT6QyWJ1Kstqud3f1cb+LMfmMLkfD4LTD7I6n2Rv4XI5328X7Sv/8 lydoFbg1aFB4qOi0lsiz6LgoaUGnESl1OanZkDlRyajYuTmq8IkhakWqetpIhJq6Gkv5OnRIK2vb ugSJ2xthenHr6ktcqovFW6z8I5wUuqzcXNYsjQy9DEz5fO1bnZDtl8xNDE7hXTfee05FLZ6OW+65 /b66jtg+Tx8bb5irr2ovCT5//+oNFBSwoLUm/H65U7ip4SOCECUFlMjhYUWL/wfzJNwIimFHjyAj jpTzsaQ2KBjfaFSJ8GSclDDlsZQ5syYknHd0krw5LJ9PPC05CR2K5iLPnkiJLgXUNCfQXUejAnpK hqZVY1MXDtK6dVrQr2GhdhXzsqyWogzAOlTrRelYsnCzYv3itqxcqhTrrr0b1+/aY2irChY59+dh loTbGF5shK2avpCL7PWKsDImwF3yhr1cmLJmy5wHj47cGN3j02BKT/G8VWmO2bRr276NWzJXuqz5 EkqsuLcr15iE+z6i+1ta406Ir2Ee+vfx4NDr5L6OPbt226ktLa/uxzlj8CGlY6ZOPph4hulZnXUs ur2n9bDkm+tePrN99cBR7v+//55q8f33Bn3IEdgPYtMRhaA5BqLWYEYBerdahMz0J5WFbeHn3oAa soOhHh9uOGF+6I144YIZokgFh8F8N2JytfDGIiIuruRhjA9aVuOM5kWnX48pnuefkM6U2CGNRsrY Yo4RvhJAgSGKaCSIKlIpJJRRtrVdl15+CWYKUyZVpZac7MhjlfeMaVaWOwQgwJaloMmmhkza6GSD UMbJZZ1ZqXlPmIIOSih3G8DJ55x+4gWoQIt2VmYCAUxKaaWWWipAot/QeSWKdx6pJItZIJppqaae iqqcVhJZpJqfwmbUkpKiSmutmq4K5Ik1vlrhk7PaCmypqjraKVNlcpqrp7//BgvssLz2aiey8PU4 KrPMqvpsnhZmGyS1y1pbK7bSTrvkuBS6iQCp4IaLK7m6imquicqmu66t4j4KKaDcvmvnt/Waem+x ZOobb5K7+vvvrcSyumK5+L4WKb0JA7zpwxATbPFzsko8scILJ9vqsRmPh+4Bl558srBzFspyyy7L MDJ7G2uA6LBrCtymyDgzOnMGNYu1M8+uFvxizxjAafPNDGN57MtOPw11ckj3GXRgGFdtWsk+J600 yA1nSTSO3h7K9cfuMnj10gNrjVzYYjuM9cVsR+Z2OGl7bezBSBat7ZN12zQ3aTHLPPTgBxpNt+GH Fx53cYgL3rjjjKuds94K/1JeOdiKpxn4cJtzrjPmQo99Od55ax45yaT/eHbIcItudedL/A146KZn Pq9IUe/Oe8ufp04eaK1/TS3tb8mOhfHH2z786bmzLmCoxfdOffXY3Wh333oqLyHyfPwOfHv7ou19 a+DDvv35zW+LPYDaIzi+66K2X3u3r9/+5+Oeh18f89Hzy769vQ2AH4of8WJEvwRJb1fcc4n+Zqe+ 9RWwgbEqn3Ui+D/UoS9rq2sbBs/lPxASUE8JXJ79NIi/0VkOeiIc4bYoSCILWgKGMQyhvA5YwEZY b4c8vM0HDTY/AWZvgfD6Id86mDj+Lc6GQJTf8zyoRAgNrYdUrCIMSjiR96gRyIBMWyEUN8jB+0kw fzJsjhGPKMYMOhGBQnQfET1Fw90gEXJglBsT0Ui+Oe6vjpK74wDXmMM21s+FfjvjEL2YRD5qbHIp jJ0eIRhF0KWxhYDslyAVeMLiGdKNiKRjIx05yRt2MYilGyMZ/XjIPHZyj5/MFyNNCUpSEsKKtKwl CzY5yCfSzZa87OUIcIlJWTYKOnFUzgOHeZpi+miVyEymL59Zy2ZWpwAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0670.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
26
［改正後の病棟区分別の点数・基準一覧］
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0670_image050.emz Content-Transfer-Encoding: base64 Content-Type: image/x-emz H4sIAAAAAAACC92dD1Ac133H9+2h6I+VSLaIQmyUIvuUMDHKnCQkYQ+NSU0ckiIb/XNUCxeSkRPc IpuoJMIZ2lxcNFHNpSKV7LlJyFjjyoBszZRJIJEnVENiKaFTRpFS6tuO1YpMcEZpsIPEdcxYCHqP /T7tsve424Xfz0l7mrPvx+O+n9++fb+3v/d+e4cwDKPecB7bQ4bRYDp27LOGcbjMMAo+ue0BwxDG 8TuE8Y0cw3iP4Xmkfmak3vs+YRj/6mnq/lCOMZEXMvJSr5fjZx/E6+npaSMXr9+bet6G19KFtann ktTzTud3p3U/W5b6/0oXT/2Om+Fm6/Tm+t0PpZ55Lu0dqWP8kvn70xB4Ko2PuH7ufqzDe4VLUz7m 6uvK1HOfS987DhRvrTHmokTv07/WP3akng3C5l2VB+h6tNkHEE09I+unN00XGJHpnsgPI69G/ili zPORd26VcWKdiMTPrjLyUs8l6GOJevuPnJ/P8Pe+eXDk3Kqb75vs+JeZPpKvv7RTRFpSdkXqteyz kvfli/B5W+/dOI7oq6uMridfi6xM+frFnF8cfPFrbx789d++efBvFi/7fnWqvSL1c+lfUer/b90l Ivu+MuPazTFgYoyoceUeY7e5xsmu1HNP6plvh7JxT+p5qxpbY7/4xO4v/9snVJsaM+7HNB5Vqdcf ++q6HStS/1/h0m3Ae7+p0W3wqfvOZ597wq0rx+wP8N6rGl3VlpNBV+oYDxY9fe7Ll+uUtpdxi7B1 HhDpDNWWjWFWR5899+XPP6djyDn4z6DzjxqGaluUgSH7uP257+9dFP3nx9Y/M5vhPZ5e6I1pWL0+ j6fqr0vqMvXZMtPW+aSZzlBt2Rhnmv/8qUyMGuh8W8Oo8cl46sC399b8xY3oXIwe6PxOw+gJwJD9 NRdjacjWKQ+lM1SbH4bsLy/DfR1xzwPuuFyNuAxr4nK1j7h8paHhMe94fhXvfUOjq9qyjecNRpGx eebfiplJLYQ5XD0VK0/YeveKdJZq88868qtMrJ9Ab0TD+kkAVnHq31bjW+czsepNW+/vzXSWavN/ XEbGPvwx9H6lYf3YDHpcmftwdcjWKwmls1SbH9am1H83GFsjOlamcS9j7nOpZ6GcM1PPLR4fVFu2 mHt+73/Htn3ria/NFdevQOd3GsYrPhlTez8w/caDyx6Uuss0DJlzS51ykc5QbQtlnIbOWxrGaSLG 501bJ26mM1TbQhk/hM6bGsYPiRjLQ7bOn4TSGaptvgw/Y/pejOkKzZi+1wf7loMHW4f+8ht/NVee 8gPoXNMwVFu22N1qRIxFM0foxKuOJXMrqfcpkc5Sbf5ZhwcysXqhd1XD6hW0xyVzE6n3HTOdpdr8 s5ZkZPVAb0zD6gnMWpSRJXMVqffJUDpLtflnlZToWH5ioBIx8IgmBip9xEDhZz//3BuPOTmNLgYq EQOPaGKg0tf16x7jjcfeePDQ9g2bs8VAJWLgEU0M+GFtSvWpzco8Vnqhd1XD6vXJ2pjKNPyw5Div RAw8ookBf6wSsL5+NFsMVCIGHtHEQDBW9hioRAw8oomBYKyNy4LGgMrpa5DT79fk9DULyOlrkNPv 1+T0NT7zto2pK+M9xqqsOX0Ncvr9mpw+GOtxkYm1H3pHNKz9gVmLjGzrhxqsH/Zr1g9+WRtSrA3G UjMT6wOmrXePmc5Sbf6OK5I6rs8Z2dYqNVir7NesVYL1Yfa1Sg3WKvs1a5VgfVgcybZWqcFaZb9m rRKsD8PmfNcqB3BNi2quaQcWuFZR17QDuKZFNde0Az6Oc2rvBnmlmcl/VhjpOZD7mnYA17So5poW jCUysmqh165h1Qra4+qF3lUNqzcw67kXMrHkHprUe8BMZ6k2/6wVGY+rBnrf0bBqArM2LsvE6oHe mIbVY9KeL3k9PoBrdVRzrQ7GWp2jY/mJ7UOI7aOa2D5EtGY7hNg+qontQ4HycpF1zXYIsX1UE9uH CNdRtdBr17BqBe1x9ULvqobVS3xcMn4PIbaPamI7GGtx1jz8EGL7qCa2KY+rB3pjGlYPMUvG7yHE 9lFNbAdjPfD0fNeiccR2hya240Rr0Thiu0MT23Ff640NWG8cfS5bbMcR2x2a2I77WotuAmvueJPP r0Lv6xqWahNZ1jDrkYu7YziOGO7QxHA80Po2ewzHEcMdmhgOxgpljeE4YrhDE8PxQGvO7DEcRwx3 aGI4GGu9yBbDccRwhyaGKVh+1tIvYy39imYt/fIC1tIvYy39imYt/bLPdYVcVWzMsuaU6+WXsZZ+ RbOWpmTth94RDWt/YNbc68Da1PNn0PsvDUu1hbLMr/cYxTfXm179n5q2xn+a6fqqzZ++GXi9dwbX jUHNdeMM0XrvDK4bg5rrxhmfue+mmdx3adb13hlcNwY11w1KVi302jWsWmJWL/Suali9xCw5t57B vDuomXcpWH7G5UWMy8uacXmRaK1yEePysmZcXgyUtxWa2fKZixiXlzXjMhhrn5ltrXIR4/KyZlwG Y3WZ2dYqFzEuL2vGZTDWFTNbPnAR4/KyZlwGY0VC882zRzAur2nG5QhRnj0C/WuacTniKxcpRi7S mXUNPYJxeU0zLkd85dlbsrJUnj2CPPuaJs8e8ZVnr03Ls0cw/q5pxt9IoLxtLGs+OoLxd00z/oL1 lZ7lJ0d8GzniIpGeI749jxxR5h8DeO9lja5qy55/bE6NujFtfnNA2Bp/J9L1VZs//c4587O3kZ95 9X/mU78k9W/LHPlZvmlrbDLT9VVbdv1I6t/YnPnf28j/vPo/NYP4r++fO0K2xsZQur5qy66/KS1/ 9TNfLhP2fJkn0udL2UaRXy5D/HsZqs1PvrJ5Jl8xs+Z8M8cj0lmqjYrVC72rGlYvMUvuE0g9uYfg Zak2KlYP9MY0rB5illy7Sz25rveyVNtCWX5iYA1i4G5NDKwRNLnsGsTA3ZoYWOPjOItv5kZjWffC 1yAG7tbEACWrF3pXNaxeYpYc52sQA3drYoCS1QO9MQ2rxydrq0+WHOdrEAN3a2KAguUnBiKIgY9r YiAiaPLmCGLg45oYiPg4zi03719amzWXlXoyl/WyVFv2XDYqlrg0f473vabR/LlvTdNwa4ZN+313 m+maqi275pr3uDXP433/rtE871tzpenWvCtkv++joXRN1eb32P3k0PcLO4fersmh7xfzy6Flninf K3PQ7Zoc9H6RPcfamrrSbDWWzpmDSg2Zg27X5KD+9Dek1jtLA+dwDyN292li92GCHE7O5Q9jnt+n mecf9nmdLjHsOSpTTrDEtPUqzHSWasvOunU6b9phLZvH/dOPo08Pavr0cYKcQPbb4+jTg5o+fTzQ 9Wxt1mvn47h2HtRcOylYfvq0GX36jKZPmxd4jVFzdDPm6Gc0c3Szr3kqIbxzdDPm6Gc0c7Q/zTHf c98RzH3f1cx9RxYw9x3B3Pddzdx3xOfctMlTv3DPfUcw931XM/f50d+SmltLjEoz6Nz3AsZUt2ZM vUA0972AOO3WxOkLvuajjbg3aG3Wdd4LiNNuTZxSsPz0aS/69FVNn/YSzX296NNXNX3aG2g+yl5/ 70WfvqrpUwqWnz4dQJ++punTAaK5bwBz32uauW/A1zxlpOWnA5j7XtPMfUE0/cx9r2Pu+41m7ntd zH/v9HXUP36j2Tt93cfctHkm8wu+t/YWzvmk5py/RbS39hbWVJOaNdVbvvdPPvrF6BPGvOcLYdrH ucJMP07ZRrF/IrCv72WoNn8xbB/nfGM4F8d5p+Y4c82Fx/AF6CQ0DNVGGW8fMe1422ymx5tsm2+u Id8rcw2vrmrLHm+bjUiGvX6pIXMNr75qm4++r89U4vxXaM7/vSZNriF1rop0hmrzd/2fO57d10Wp J6+LXpZqWyjLT59uQ5/u1fTpNpMm19iGPt2r6dNtBHOHu0+3oU/3avp027s0T9WiT5/Q9GmtSZNr 1CIn8DJU23xyDfk+mWt4NVXbQuc+93fhZHstP/6iXr839Vr3PU2697m/a8n9/U3ytfv7m+R3MO2U 4z6DL7rvaRKuuVBy5Hc/lc7MabP7TLVlmwvXTstPmafiCOd4mft+QcP+/h+p/ynv/YJoy34P38dS Y/r26Vun0+/hW+bjPPy+zs+jOD+d8zw/Mhbfj89L3af5LNX7fX5e685p+5Mly43Zc6w6R5LdIu8v Tj3/wcNQbdnO0W3T8vxMfGVnjX1Olnj2y/5Qz9FJnKPxBZyj1bjH8T7N/Y+rfd5jede0fUfdLZpz 1CRrPMjt/lTeA+G9fxltizMwqmfug/mYscVwzpMulv7Qz9f/4HzdJxYWU7Iu/HHN/QTv93nPQnja XvXckiGm8oUdUx8V6TGV72Ndter/aEx9QtjnqFUsLKbkPv19mprEap81iXXTdsUgU0zVCTumviLS Y0q2ZYupTf8PYuqbOF+JBZ4vubf4x5p91NU+91E/PG2vBpZmiKkexNRPNDHV4yOmcucRU9z9/x/o /7vM7PnaB+S9epi7FnlyXNWWLV976sC6HTKXWuHK196tY11n2sf6pM9jvd+0j3W75ljvN/0d622e Y3Xn9lzHLR9zfdfqu8FUD+/3u4bw8/7+/lnHL39e6NJXmvL3Puh6Pdf3vn7YsL/v0/v9sfI9br/v MGZ/x+4Wly2PW/1uat6Nqu+S9Z5XZYubfTX/75LV+bbL49uuAL7tYvbtpMe3kwF8O8ns25THt6kA vk0x+7ZTzPZN2n59U+/l8q3L41tXAN+6mH274fHtRgDfbjD7tsOc7Zu0/fqm3svlW6fHt84AvnUy +zbp8W0ygG+ThL6pa1KOw5jlc44x9/dNu79nXD62h2b7JW37u98X3nfua2NOhmujrq+VX1tctt++ 9h7TH0Jf34ZjWOWxF9rXKn9YlJ7L3fRR5fbKl73Ikao99kJ9UYzl0MwFQ9lLCRl50CwAI4+BEYZm ERhhBkYEmiVgRBgYpdAsB6OUgVEBzSowKhgYu6FZjeduhrFbC806MGoZjqMemo1g1DMwmqAZBaOJ gdECzRgYLQyMNmjGwWhjYLRD8wQY7QyMl6DZDYayFxMyeqDZB0YPw3H0Q3MAjH4GxiA0h8AYZGBY 0BwGw2JgjEBzFIwRBsYYNCfAGGNgTEJzEgxlC0LGNDRzhM1Q9nsIGUuErbkSDGVT9lUuNPPByGVg FECzEIwCBkYRNIvBKGJglECzDIwSBkY5NCvBKGdgVEFzOxjKNgkZu6C5BwxlLyJkVENzHxjVDH1V B80GMOoYGI3QbAajkYERheZhMKIMjBg0j4ERY2DEoXkcjDgD4wQ0O8BQdoiQcRKap8BQdg4hoxua p8HoZuirPmieBaOPgTEAzQtgDDAwhqB5CYwhBsYwNK+AMczAGIVmEoxRBsYENK+DMcEwdqegKQWr XTZlDOaYtuZyMJRN2VcroZkHxkoGRj40w2DkMzAKoRkBo5CBUQzNUjCKGRhl0KwAo4yBUQnNKjCU TZn77ITmLjCUTZnD7YFmLRh7GPpqHzTrwdjHwGiAZhMYDQyMZmi2gNHMwDgMzTYwDjMwjkGzHYxj DIzj0HwRDGVTrp27oNkFhrIp9wBOQbMHjFMMfXUamv1gnGZgnIXmIBhnGRgXoGmBcYGBcQmaI2Bc YmBcgeYYGFcYGElovgOGsin3XmUiNVOLCNkMZVMex3Jo5oKxnIGRB80CMPIYGGFoFoERZmBEoFkC RoSBUQrNcjBKGRgV0HwIDGVT1rzkHN4JzS6PTVkTlpq5YCibuiYsNQvAyGNghKFZBEaYgRGBZgkY EQZGKTTLwShlYFRAswqMCgbGbmhWg7GbYezWQrMOjFqG46iHZiMY9QyMJmhGwWhiYLRAMwZGCwOj DZpxMNoYGO3QPAFGOwPjJWh2g6Fs6pqw1OwDo4fhOPqhOQBGPwNjEJpDYAwyMCxoDoNhMTBGoDkK xggDYwyaE2CMMTAmoTkJhrKpa8JSU9aEu1w2dU1Yaq4EQ9nUNWGpmQ9GLgOjAJqFYBQwMIqgWQxG EQOjBJplYJQwMMqhWQlGOQOjCprbwVA2dU1Yau4BQ9nUNWGpuQ+Maoa+qoNmAxh1DIxGaDaD0cjA iELzMBhRBkYMmsfAiDEw4tA8DkacgXECmh1gKJu6Jiw1T4GhbOqasNQ8DUY3Q1/1QfMsGH0MjAFo XgBjgIExBM1LYAwxMIaheQWMYQbGKDSTYIwyMCageR2MCYaxOwVNKdjlsqlrwlJzORjKpq4JS808 MFYyMPKhGQYjn4FRCM0IGIUMjGJoloJRzMAog2YFGGUMjEpoVoGhbMrcR312egcYyjax5qGqO0u/ d4GhbOq6s9SsBWMPw/nYB816MPYxMBqg2QRGAwOjGZotYDQzMA5Dsw2MwwyMY9BsB+MYA+M4NF8E Q9nUdedO/L/LZVPXnaVmDxinGPrqNDT7wTjNwDgLzUEwzjIwLkDTAuMCA+MSNEfAuMTAuALNMTCu MDCS0HwHDGVT151n6h0hm6Fs6rrzTO0OjOUMjDxoFoCRx8AIQ7MIjDADIwLNEjAiDIxSaJaDUcrA qIDmQ2Aom7ruPA7NpMemrDtLzVwwlE1dd5aaBWDkMTDC0CwCI8zAiECzBIwIA6MUmuVglDIwKqBZ BUYFA2M3NKvB2M0wdmuhWQdGLcNx1EOzEYx6BkYTNKNgNDEwWqAZA6OFgdEGzTgYbQyMdmieAKOd gfESNLvBUDZ13Vlq9oHRw3Ac/dAcAKOfgTEIzSEwBhkYFjSHwbAYGCPQHAVjhIExBs0JMMYYGJPQ nARD2dR1Z6kp685Jl01dd5aaK8FQNnXdWWrmg5HLwCiAZiEYBQyMImgWg1HEwCiBZhkYJQyMcmhW glHOwKiC5nYwlE1dd5aae8BQNnXdWWruA6Oaoa/qoNkARh0DoxGazWA0MjCi0DwMRpSBEYPmMTBi DIw4NI+DEWdgnIBmBxjKpq47S81TYCibuu4sNU+D0c3QV33QPAtGHwNjAJoXwBhgYAxB8xIYQwyM YWheAWOYgTEKzSQYowyMCWheB2OCYexOQVMKJl02dd1Zai4HQ9nUdWepmQfGSgZGPjTDYOQzMAqh GQGjkIFRDM1SMIoZGGXQrACjjIFRCc0qMJRNmft0QbMLDGVT17zGUfNKumzqmtc4al5Jl01d8xpH zSvpsqlrXuOoeSVdNnXNaxw1r6TLpq55jaPmlXTZ1DWvcdS8ki6buuY1jppX0mVT17zGUfNKumzq mtc4al5Jl01d8xpHzSvpsqlrXuOoeSVdNnXNaxw1r6TLpq55jaPmlXTZ1DUv+Td4lmCvwW1T1ryk Zi4YyqaueUnNAjDyGBhhaBaBEWZgRKBZAkaEgVEKzXIwShkYFdCsAqOCgbEbmtVg7GYYu7XQrAOj luE46qHZCEY9A6MJmlEwmhgYLdCMgdHCwGiDZhyMNgZGOzRPgNHOwHgJmt1gKJu65iU1+8DoYTiO fmgOgNHPwBiE5hAYgwwMC5rDYFgMjBFojoIxwsAYg+YEGGMMjEloToKhbMr14A3kJlNg3HCtN6VN wdgBn+XfhZGaOwQ9Q9YiZN/sAUPZ1LUJqbkPDGVT1yakZgMYdQyMRmg2g9HIwIhC8zAYUQZGDJrH wIgxMOLQPA5GnIFxApodYCibujYhNU+BoWzq2oTUPA1GN0Nf9UHzLBh9DIwBaF4AY4CBMQTNS2AM MTCGoXkFjGEGxig0k2CMMjAmoHkdjAmGsTsFTSkoGVMMMShrEVJzORjKpq5NSM08MFYyMPKhGQYj n4FRCM0IGIUMjGJoloJRzMAog2YFGGUMjEpoVoGhbMrcpwOfgesEo8Okz+G64HcXGMqmrn9IzR4w TjGcj9PQ7AfjNAPjLDQHwTjLwLgATQuMCwyMS9AcAeMSA+MKNMfAuMLASELzHTCUTbnPcB0xNwnG dYYYlBe8mb29kK2pbOoay8w+NRjLGRh50CwAI4+BEYZmERhhBkYEmiVgRBgYpdAsB6OUgVEBzYfA UDZ1jaUVmjEx26assbSixhITjk1dY2lFjSUmHJu6xtKKGktMODZ1jaUVNZaYcGzqGksraiwx4djU NZZW1FhiwrGpayytrr/3spth7NZCsw6MWobjqIdmIxj1DIwmaEbBaGJgtEAzBkYLA6MNmnEw2hgY 7dA8AUY7A0PuJbVibykmHJt6b6kVe0sx4djUe0ut2FuKCcem3ltqxd5STDg29d5SK/aWYsKxqfeW WrG3FBOOTb231Iq9pZhwbOq9pVbsLcWEY1PvLbUiUY8Jx6beW2rF3lJMODb13lIr9pZiwrGp95Za sbcUE45NvbfUir2lmHBs6r2lVuwtxYRjU+8ttWJvKSYcm3pvqRV7SzHh2JR7SzI0Esh1LDHbpszb E8jbLeHY1Hl7Anm7JRybOm9PIG+3hGNT5+0J5O2WcGzqvD2BvN0Sjk2dtyeQt1vCsanz9gTydks4 NnXenkDebgnHps7bE8jbLeHY1Hl7Anm7JRybOm9PIG+3hGNT5+0J5O2WcGzqvD2BvN0Sjk19b1QC 90ZZwrGp741K4N4oSzg29b1RCdwbZQnHpr43KoF7oyzh2NT3RiVwb5QlHJv63qgE7o2yhGNT3xuV wL1RlnBs6nujErgnyhKOTVkr6oRel7AZnS59S9CtnRNYO1vCsanXzgmsnS3h2NRr5wTWzpZwbOq1 cwJrZ0s4NvXaOYG1syUcm3rtnMDa2RKOTb12TmDtbAnHpl47J7B2toRjU47dScTcDTAmGWJwCn5L UUs4NvX6PIH1uSUcm3p9nsD63BKOTb0+T2B9bgnHpl6fJ7A+t4RjU6/PE1ifW8KxqdfnCazPLeHY 1OvzBNbnlnBs6u9Dlp+H2gGGsqX+rwn3AO4y7XVT2JxtU+4BSM1cMJRNvQcgNQvAyGNghKFZBEaY gRGBZgkYEQZGKTTLwShlYFRAswqMCgbGbmhWg7GbYezWQrMOjFqG46iHZiMY9QyMJmhGwWhiYLRA MwZGCwOjDZpxMNoYGO3QPAFGOwPjJWh2g6Fs6j0AqdkHRg/DcfRDcwCMfgbGIDSHwBhkYFjQHAbD YmCMQHMUjBEGxhg0J8AYY2BMQnMSDGVTfz5K5lNTYChb6j9o0O0BSL9PIa9WNvUegNQ8DYayqfcA pOZZMPoYGAPQvADGAANjCJqXwBhiYAxD8woYwwyMUWgmwRhlYExA8zoYEwxjdwqaUlAylE29Ppea y8FQNvX6XGrmgbGSgZEPzTCe+QyMQmhGwChkYBRDsxSMYgZGGTQrwChjYFRCswoMZVOuz90P+bdx pvGQ+gdMor9XhDX6LjCUbcIm+fwHNE9Cs4uB0Ym5Q+7pz/wdIdiU1/NJaN4AY5KBsR3jSO7JSIay KRmy75+U2iGb4bbJvrc2ZOsqhrIpzvk67PnI60QhXudgj0a+7u/vNz7oeq1+X/LvkPM1dL6U8mOL y5YxpX53kSYOVfyp9wpoUhyL27ddHt92BfBtF7NvJz2+nQzg20lm36Y8vk0F8G2K2Tf5HQlu36Tt 1zf1Xi7fujy+dQXwrYvZtxse324E8O0Gs29yjnb7Jm2/vqn3cvnW6fGtM4Bvncy+TXp8mwzg2ySz b/J65fZN2n59U+9lG28hu+3mHBKa/bsZxxt+l9O3VR7fVgXwbRWzb+s8vq0L4Ns6Zt+2enzbGsC3 rcy+fdrj26cD+PZpZt+qPb5VB/Ctmtm3Jz2+PRnAtyeZfXva49vTAXx7mtm3Zz2+PRvAt2eZfevy +NYVwLcuZt9+5PHtRwF8+xGzb+c9vp0P4Nt5Zt9+6fHtlwF8+yWzb0mPb8kAviWZfVssZvsmbb++ LRa8vt3u8e32AL7dzuzbeo9v6wP4tp7ZtzKPb2UBfCtj9m2nx7edAXzbyezbFzy+fSGAb19g9u0p j29PBfDtKWbfYh7fYgF8izH79rzHt+cD+PY8s2/f8/j2vQC+fY/Zt3Me384F8O0cs2+WxzcrgG8W s2+/9fj22wC+/ZbZtymPb1MBfJti9u1Wc7Zvt5r+fbuVea8m7PEtHMC3MLNvWz2+bQ3g21Zm3z7j 8e0zAXz7DLNvj3p8ezSAb48y+9bg8a0hgG8NxL7lpH5ZvV6cel3o8kP9/L2pn9+J19KPtYZ9b61q l7VCdx3PXd/7EOp9yucd2Ht1673PsO8JN9An8vX/AqwZL8WgGwEA ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0670_image051.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7wFGAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAQDu AUQBgQAAAAAAAMDAwP///wL/nI+py+0Po5y02ouz3rz7D4YiKAzBiabqyrbuab7yTMP1jaNxzstG D3TtgkRb8RgYInvKZe7nBEKjT16sGcS+tEYWlyu1aptgb23MFKpxU3PrS00jy1s6sf2260wI2KE7 o7eX4Jf0dyNo2OdHqLioMqbguDjhtfMHMXj4M8TZFqmz17XA+JgS2Qg1RTqJB3h6VUo5yZhkuwJ6 26p6WaiLm3vFOiycx1ZqxIko9km7jIhZDNwImUdJXL1qGUoqyQ1L2Mf3Kisu6brrNn2disVabfme fO6Na22eXQl8Tz3f3i8K2j9lZ5gpqUcjkTk+3sKpgzSQXUN0hrhF1CSuEENb/9rMtONYThimh+BS OQop61coewyjHeLIThFJGy15vay5cdw2lrSoMaD5EhabehkLDjUJ0Ae/hTYlBl25jhe8n/J8wWR6 85EnTyfJwZwGklhSlaKcNt2EEOo+XToxuiSrFiKgtl/BgVy7s9fBmijxBsJpEe4bK3dPyTnD9avL se4cZKuYka5QoFhFas2JL67blmEhb2W8lHNk0VW9Lqas8e5be2C1ygw5MhdEvlc3yzQV0OisW4IU km7wrOBGoPM8sx586SBxyJ3l+vNpeFRbzNHzxarYWZXG4dXtXrM6vFji7o9j4aHenIya6dhR15Vs laf5Tp99URyBP7/+/fz7+///D2CAAg6oTxzBGXgggoEoCA2DRjmoFIQLSrgFhXVYKEQiBmqIIIdx eEgFRRiCGAWJJWI4GIp+qRgfiyCaVUWCS2hoojEskjehWh7WOOMxH8aoIxMKwTNXgzd6ldBsuEWY 0F6cvZZjk3bdJqJzRwpmY5BQMnllb06+9tQaiBHJW5WTSeldckYeSaNPOfn4YHY0ycikTuPAl+GV SIrZXkdJ6onlQ3fyFiiZf4LXy5h0Xrfniiq2qSWefEYpZ2FcHqpac38BSuM3hfUGaKGGDmpenIfa ydaamNqHY55dPuEmQXTyKQ2qq+ZYKnZ6mClhp8jsdquLcJY5p6iNqsPUsWf/YnpdJ6oKe8yg3wz5 TK1qmrqgNLp6yWkViSYzLJs+WpsbpdlGOtS4tfzC7avR9mknqIQ5sWOJPB5RL72h5tvjvDPyO8e9 d+zbrZ68QijwwAW722XCWTh8GMPiGgxxxDdWbDG0DXPqK1svEmwwxwtPHHLJG1OcbjpdmbuLZYuZ 5U6d6jHa4kxEomNruTtJjGzMNPOKsb8ptufpXixXhzOhy+7cs0evAD2ktMphm2qZ4dzUl6FKnpar zjbbtptkZh7sIBjdbFJszcfxvHV9XautdUmnEWr0haF19TbRWU4o3tTBplTOr58tGWjOSj8dZqtF I00e4XCPWOHPWiIz6cWR/xfJrpIVrod55iW56rTnolO+tw/4NDOrM638KjcaF6KeN9CmE52o2GWQ zeDt3FVNl+wjbwN72o9rJhfqdFtZevHOglu33VFytTzVKk8k6+pfl/Wt4Xpfv12QNG+PvOWvf5up 12uTbIyf2vuep5/lm7+08t4jvmnEJJrNrkmZpkV8YNnnWpr+EYd82nHZfYIWrnxUjVU4ERECE2gY WV0rXmNp1JvmAkD+Pe6C+StWAIfXqyxpJzo2yZriOoeXjgnKeb75HZnMRr6joQh/AnTf31CYwpSt EHSQYpvG0HexB0oPci58lMhQ5sPz/chkbBLiDS3kxCdSKIqzQ+Kq4CA9h/9MLz4BtEP0ABi+uO3w eB0EHRDFVLvDDY+Klxoa79QIPgG+cCWGq9LBvujBMMavdI2RV1S2grfUvOdrWrRV7GjYGlQ1S3h2 ZGPlaqEMQwovjsoKYTwIIklLUVIw0SDjIunjvK15knl6hJ+gYujHthnQgBG8D+eOR0DNXW+Rmore ykpJRDeUij1xcZwjH5nHWjYucViipbRG50s4fHKBKklmcCRlrD25KZC0u80slea2SdpxDc3iy9sa WURwKWYkmtxmOMuXzXIikjXdPMk3YfjKvmGymfB8kC8XRT1qfqI0yiwSqegHTGxGMD17NCUUuTmK SjWPewdFjj8JWlBpinP/TlKLKCXrqFBcbnIqCT2hEjHiweSQU46uq2b3VKPBkprUOGFJ6S8JeSY1 FdCEcmzocYyXGAoSTqU4Dc9VdlrSnurKakBloiidcZ7zbC5gNfWoGJoKQksytZJULRu9YrjUqUYT d/WL5kYRBrIkjuilH51hWM/4KLJqVKoM1ZdRXaRWp7IVrWa1YhPfuqyfWG+vYlQjUeBYTDd6bBbf K2Zc+4cKrBUWi3hl5l8XC0xbNgSwXwhq6xbnUa5u6G7c0ZZId2ojtECla/y0BnP6REqafhWs8YBk 9tJW2nBmRn2w5R8q3pPGT9k2sdsabUgZc9jAemxdqO1ezBxKrI52FLLx/wRP52hp0SlezrOTgy5U WetQ6j53oiQNKR0ZR1n8xcu33wXsanPH2XQgJG8SBRN0PqWpGhpSf+w5pkGlO7Q7vbe+mvQqelOE FtfA177tdW/YUkXgi67rr/vr73kV5LOEHlN9I+3r8mjLqFWoh53YTGOGrxXduZK3s5iFV1nryuHk Ilg6XrOsisGIKEeJU7voBHGIrQrgabUUNwkWroYvE0zN3BZe33kfOTS72XXYZ5pGJktwTbMaosBY yJdc8EeaTIY+PknKFI0bkkOUoaJoK301c5gNt2dmrLriy2C+qpA33FgpqBnOWs2yjB/WSy2fBXAX QWpl+OwUQAd4z34etP/LUkKPPyf6ZQ1c3aIPXWhC93nSgY40pCltaEFLutKY3nSme3I1RYea0Y4e 9aVhFudc0nWs57SpWF0dxCOuWtXiO9mr8ZtqXN/Vrj88CishOKlYps6NeHzWpYQ9RMEiW4bEvhmw lT05KZ5v2VU0VbEVNeusqizZ4Ysy2Vo4CNfuql3hDjC3kffjB4PbtVY7t868vSsdElnd5EY0catd a8QAuXrM/ug8twokHRc2edoW5MDbOirYDnsmiqQqtYrH3YIfW+HYDtZMtxrcHnoOmginMia/HXBi Pamrt7ogMU8M7dOm8oozBrmMTO7yBImnqlydmT8q3uu/XIbf/U64X93/3Z3cYjxc1o030We88LUJ HeAy567Rmy5QnE/852jKtnwyx3GUc3ghUb3utMyNu5pTZssrP5d0Dt5xOhZZ3eriOtvfdXaaU8ub NsZ3zpXS2fECva8Zk7a8k/5siWchDG4NeREAhi/EHz7jZ813rHMt4rujeNe2drzljchrydP68pN/ fOU1v3nMfx70urY6dimPeji5jw56NvTgXH/cpi0XjuaU/cb9Wk/ZX5j267zZa7Hce6QJe33BH+3v iS/44WKujrm/qeSAH0p+9EUqt0PWc+ZG1MQlVrSR1Gbxpzfzd0YfbOH3vuCx0X11nn8iqTnk+j+S ftu9v8jxLyPB1Vt+//WbMb9BjnpAYzVoVJJSyOUs3yRLZYVRZIRBB0SA5dU7ByhGGGWAnwNTzzeB miBYJdZgeeZKobN7lkIfDOiBDjg6txRi0xQ8hVJZWSER+XNP6VOAebRQJzYeAiV++ycUHQFGM2hh u9Nw+peB2ENCMqhRlVVNO1iE7fOBP7hGRqiDRGhR7CNTS9hG0zcQLkhMThiDEGVQWjiEXLhJDkRi sARQQXhSRPg9tbcPKVhRUaiEAwWGYfiGJMh84yeESId8OBgVAyR8zNY79EU3FYQG1UMuKAUaHvGA S0ZRLoUcvNRbhghaiLhxtZJ9SSOJX0SJq1SBiSgVkKh9jSg6nahfwP8Fiv/DQKr1YEGnMCmUhkum iQgoV8X1N7bEQlKHQyI0K7SIi1kUi7J4NLq4M2V3i7tIcqrYVfVGeqWXjAjzZM3YeMtYNs3IeK2m jGlFjZEneqYXjbKGcgWINnXBd15HeLfWK84IedgYejMkjaA4Gxi4YiolN5XYTrahddsFfQE1R6kF SnqodN+Vht93U/5Yhh1XbHlohvk4Sm7ILAJpf0xDKwzJgwVlXcOFagiYaPqkSAO3fQnpfpEFPcF0 g/dXSFEnfx75JplUkmbYSTDWkSopZiRJT++ncjC5jyL5ksYUk/xYYMDiZXcDfqYwchZmg44FgSeE k46IhfeHTvDFgfD/+IX/hEMvqEukRG1SyRNkGJVZiFBYiUxZ2E9cSYvO5JAcRRt8JV9ZgZGthCdf KU9MuEZb2ZYKGIZsuR3zFJE1xDzeZH7/13LutJcHOV9+CYTX1GGC+Yd2CJJ6OZh3xpNYhySx1zoi kZabQWeP4Zht2IVwOVCYOZfNJXC8l3zQ9U//GJpOl1EKOYKfSZp8+XNQWZNjqYGjOZB35i2wN0uE hSgVVjj5hYlD9YoRmFd3OIpFZXsUmUGHqHSmeHFdRGy9uZwDWJxT+FuRmJx9OFNdFFTOeZzEuWqU 1o6Z5WY0Zy/XxWbBCHjYJox4Jp7/4nVpRp4Jc2Y6WY3ZyHmsdo44/3af/zV61kiO6AhrcHWNp6eN +pl6APpqVGSO+9l50IifAwph63igIRgRn9WB/Rg4/VdgCGk92mNYsrUUGpihRokUR3Z+OgIdzAVT JoqbTsaPBHSiT4OY/4kSY0hhyNmOGjZig7UkQyZaeEiPN9agU9JJs0eha2Za7kWHP6o4s3V8Ohom txUeuTUdu3UPj/hGvwmkELaV2wJi0gmZKSaLBUmiD1lcYupkCeo0NGamlVkeufF8/geeekeUSMd3 GVRes3em0+VcyxdxXUegkflTpMaQQnl2WDNg/WWErviN/AUf5WmChudbjZZalWKURQOIeuFgWOR6 gwqVlWplB4apjf+qqWfhYV3WGHiVM51ao5LCU25aYjjakzUGkW5qZ43lYa/1YS3Gfy8WZLAKnIUp YSxWZruqXalad3FkTLhaHGrjqHOwpbKZFj2mZYUKq+tjkZK5oVN2ZGjqjqQaENbqZT2arRj6pYLz a74Jo+FaQuOKZTLmdlwWX3DRrPgSZuQ0ZsAzrOGZp+EIK29GmzKqnvvai+jpruO5rfWoQ7WapVUX kdTjaQ97aA57ap/WaRMLsYhmao32aBqbsaVGsZwGsh8rshdraZpmsSdrsilbsivbsRvrsaTmshWL ium4oPRpoP0ZpKFSn1AEoQ6qpfn5oAGaszprs/ypoACrc+e6dyz/WoJVqG2/Z4uV86Z+53P+JY5E m2QBh1VVV6A1e0UahI/oNor3lnzBSEFbEqN+EUnr2nNgEXeBh7UCqm9va2xGu7OXhKM8V7YWOkIO ByRTNm7DQonkGSODq0Jx67Wb41NWO6+JB7S+yF57m48jl55odHNeJXb+GJ8HGWa6dbiIi7R1IEGa 1biL97hSpreSa4xL17bgtYVR22xvdJ4sERSfC7r+aTq126+Zl7jZdZlwy1GP6DgIC4d5e3JrFbyi eLwDWy7H2rq3eyJPJax/d7N3Kx8y5adWW1VUy6/Uy73f2yHQ27tT1LPWi7vny4xC+6fiO7TqyI0M ur5F676Pm7Xs/yu3dut55nu/41uO6vuz9ru/9nm0FjpUfvtHpNpACEyYZQqiauh75GVk4MSbymWQ C/yE5AqQABy9tqesDfmv5Cslr5d3rGd98rgyWIpY7GdNixmBKrzCh9mi9FBuf0lIKmyvOcm5Gtwv B5ybcinBA9xLh+M3/7dzAcholniVklWCVlm8jdOVIpjEQRyWWpmaD9WUOazD9FrFzfTEstG14Qq5 JCx9F1oUF0qDPlgWNHzGKzWTr0mb4wFKLXmbK2WXSZjF/7uGkuWWP/zFzsZScOqSE8o6bgGYaLxL s9mDJnXIHoxLcEyViCyiR9hlOJx2dyw08pOkP9N8+Su6fEi3+P/4h6A6dhWqQBeWUyYMi4RYbrvE iJdofD6Fwo95Wjf3nDZqyRtcysIHy9u2sB0CMCYiG327rLYJi1C1uSnqcFsLm01rnrxozMpcybec i714zMibvjjbvjTLs/4bvtLcZkDcv/0pRNxavfobv968in28zTjCWD+Vly1sr5NFO9DJJaVKycQr ppqcttWFwaq7QNoqh+hcePU8q11YvlvyFCyYYYjKWfUhcstRrva2lCy8pB850TBskzd8lHacSBAl x8Qr0LNo0SjJyL28IbGHlFOowBU9oUoblJW6TFVJxVMJlkHnlZ45YcNEyskrTFcczSHNmjEdbWI5 enHcM8LsxGP/7Bkj1Ay6KVHtdJMcnWJxGZLLLKtRjZpTvdRuGdBAfXiaudU+vMnlPDXHNZyE3Cpi MZmwQYOtGYcO/JSbGcFjHZunmZk59o73iMVeLUNFZ9edaVdiJsxbCI8r+JwgNcTFTMe7zMuIFZwn NZzal53WuZ2feErGh66Nvb18jcyLja7Y+b4DU5FnuWnf2V3suZ6oPXSqXbnSi7mcnc6Om8yhzb/o m83rjM14DNuQOr/gfNuhO58C7LP1u9vAe82+fc6bPXj0+yHkLL/F7bTCzcnPPc8SW6QqqcuKNaad LaHLuca2mt3agKIgDd2OraJoM97WvI1J1A1l+j+2HG7Kd6VK//qY63rBU5oUpRvbM+zIkxpb5Z2L 9i2lTrpmB/3cuQolFDbLcdql/ExZerqna/rB/snKECy7bArgZTthSzfg6p0708jDCcxXkdtP1+3f 8dqhHyfKpjrhogvMaPR6nIriT6azXvhrpDXjBl6zqVpL782qACaumCrfRrp1y5qQJubhup2jGDa9 RJ7hFpeYBY3kJt3ccbbQowkQ0lplBP6ttHetn9qj4Erl30yBgprZia290M2j3nrmWqPfAVuf52Dk ZIZmBiuwV1ttCntftk2wYUTjz3gHc9bi0RiyJHsREquyMsuyhR6xLevoogbpL5PojD7pI4uyi27p lQ6hh/7oMP/b6TGu6B8E3ME96sc93EvE3GQ+3fhL3aX+2+Gc292c6ri86r1tzrIEtmHLPRyi49Gt eM/DvHiOTH1X2wEp7Eh2bbt76vRUQXv9nYZq3Ot9FAtG7OuhX2T7vBaxttrr3HiXU6TbKSW0vFZN 6njrpdEukM4b3bitGyhV7c3VY+tu7RgKvsQtHJRat3g3GbwO4n0+qfWO3g4m77AuEJ7M251MJYwr JN598K5+oxad7wi/1K5963tVxkvbxMPr7B8eBpCG7vpoXv5MQgBd76heLSRvd3wjxBQPv/ge7xtP q8Ge5iHC7656yU2CrePevR2dvTJv8gVvbt6bu+zG8q1+vWn//HaxftLcbO8t3/S2XusOn9xS78tM //MV//TSXc5Gz+dKzupc/+pdL+vqDMJKn/VUv/SzPtDLTutb//WngnaPpFdnY90R3eRRnNVRP0Fb 3NXO53GQjJd7apl3qdxXj9mmgXsxuvd4b9BJq4lsK3FSumhqB99WCElqvPMcb+4jLJd9D6hc2vlw bfmXT9HCrur0mG5VzZgyTPopSe5EGqxPt4dk/BZ6BZySk4DuSN5VX8Xa6iRO2X+c+fvYbYFUp/uZ 7/URHPwUyJgrr/zMj7zKac++XsRNgYU7nYO7x9WiD/XZH6mhD5A1uMiuv8Y4tYF3LVbir2MgSNdn GKqYf4KY/y3elbR9bH7xYOuFi1PBu5/2wDPg+08AsecUc/IaCnEutyyG7claqY7RINI80VO0OOV5 QW80L/KqPzhk1VVzcK3Oy2dTfRhAWAykLCIzN9esFnIWnyntdvIUlqi6pPJnlIKr4q6zXD7L0hIi G5Pl3o1uCpwoX5PrvLqQhvqYrrDsaKbwGAM3ZDzS5gAz2iJphrgUGztxLDFtNLcEwVCCNvNCRU1T ODvxSld/Rl1loTJbT19hSXt/64CFcYcbP4uNkXt5lS+b75ifIaWho6WtqbGftZuPqU+/U8N9x13L bc93c1WbquSwtLjF09npeeyd8XX1Z+3lkb3pC5gjUCF3fv9uuSBDCYgkEYjyOXqIhqDCI/wsqpoo qeK0eo4IUVziMWKrjQRHzvgokBwcP1AGqrzo8tA9VhdXFPozpmEwWmwaAuqjI+W+Emd2oLRZEl/M LzWVZlzpMMYSNSR9tkFa8arMrBiJJRmkxipMOwOBviyb82xbjT0TzoL4By6dd3FHrA2pqxIosGiT RqiFqy/IjGL2nBwz9SBikyzQgjXKUenghz0fmeGY2HBhrBS1tjOI2bBCzDfgyuSwp3RVqgtffm7d FF7g1TvYzpyy9nZU2UYD5w0a26tfjFnKjh3OpLjUYFZ7dx20rmDRiUWB/xSKuvHlK183pD7qmvBZ yc3pXCf/n3tR9Y6Cof5eBRuma+vmzyOnjDD+9JtuIoEvKfn8+6U3ugJCTqgcRmMtrMkYlKiFQ74D jx+nVIPEHYYSbM8/nTbkqcO3JJzOCrtm84edT0BErMKlSjQFNbVedO7CTOqqCzLjeFxmMHDy+8cm ZoSUikhlUGnpLyR/pE6YJOMpEhgpnzzvQX+oNNDKLLXMb0suYYkpHTDD3PJLM71EUzIyjWEzFjfn YWobNf+CM87jrLySHjtJ4TPKNP9DcJLTUJztpBcHhNBPdABdkk48gzxzTVHSShLKuXqkK0KaEqux nz0XBXLSR2+M1FRHQwtDJz7GKgm+TffiNJRQeyCVJVub/5J0TVoZ++62oFCUbr4JORRpPAf1HPMf z6AxkLRknBXTnEbblFYdH62tddQoXHr1w/CQnY8KlTQZKQgfeA0U0m3ZXbdOXd21pFz7CvXW0BlF nCZRYtKlBVcV/90T3uPS2y7HQRniCUERISr44F8T1lRih7kDdqF+q/tV4YkNRnhjiiMG+eOOQyZ5 5IMlFdlXoFi+2GWLYa645IezDQdjC/PM+dZ249XZZ1Cp7fnnoW0OWGCikR6n5m+4Idmam5Pmeedl IBQ16qsBgvpT3QRtFuuvh8EmR7G8fnPCNaAFW+0wtU424xbdTnHtuT30mjWxy8QEb7r5/lNqbetj Lp6+Cf/nuiXOYsk78MQLbxzGqaOshL47HS9cm+TiznTaWBmv3PGls0ncXns399zytL9FPU5KVDed b9CvEf1DKyh3fe62M1fadsvbxj333YfG3Xffgfek9zyJL75zVP9WPmrY5zTa+eClPyf56f1O+6DM E6mw4bkwlRv7n/Ujt1u98cuKRYk6am7r8XXOtuWL3yldRofmR8PT9+FHntLtmuAb9w3LYUfBzeOq 1r+cyY9bsQqX5uziPYsJCh4KfJ5mAjc6yOBlX6O42wblZEHkvUJyZzOI/Uxzro6ZhVm/E2GuWLE+ tElHTF44Gx+2wp4QvnBXg+OBpd5nQ5CxzjvPSiAPhSb/nN3wpzyGUyL71oNA/iGRNpGTwhtOaLXn pLAxKCnUEakIw+d8cIZk2V9YniIjYNHoi9cLI/QW54n/bI8qaOsazsLIPJCQsEl1e8wm+rjDPGIp aKUaZPV0h8hDKu14ilwk0xwJyUf2sHniq9Ik9WjISmKSkTwq3114k6m03NEQDBMkJ0O3ovv1p0B4 jKMH29dKzaHSZmzxzo4WExJkCdFlO4kQUcRFSzH65IpcIY4sUzQUtWxGilMUZtYugThWOS0n/6NZ sQyIl2dKMjOOsQwImdJF8sTRl67c5jbQBaJoigc8CiKUL0vZDjSec0wA8uJOaJi+JXIlOsesIT2t txFY/xJTNOA6RvcMBk/VhM+ZAKWae8xlH/Q5kT7qeZUOT+lQZ+1oDgHaZ0LcGaLZLadqbqTiJy9F LAZ98UqrmqYZWWpSJMLRDNeEoMla+Sx9ajR6YQtkRvsExoby9E2FhBxRARLJVCK1G400KlO7tMl6 QpVJT3XhQ6laDOH5L6tadaq/DEqzsE6lq607qibL6iOjNix1KY1pWi8pVevBdUpflZe+zqXGVpmT rig861/7mr0ksvV7fRHWVQM7VHAqjm00VWxikQmwBs6rU2p8wywhS9ajWTWzYM0kaCQKMW5VsLNK SuIwS3utz+YLOuqI52MTu1WlQlaCDzuZxzRVW9yKjP9j7EztLma2W5zylrjDNa5j+4rcsHH1t1pE 62mbS6C5zja21O1GdFUL3R4g7GnYdWLnLidHoGI2usqN6/LuaFrvWrIg5ILd5bgTQPSuV7rleFoE 0+hD+pLXGdUsWyq89cDvrte8UyqqRwXnV/qG1yTdLepFoSdTHhY4qn0q4WX1u1+h+gVz6p2WSPem 4fomEsCCI51z9xtiHM43ciM164Ltag4T0s7DC7YukkRsI8BKNsey5Wx5Y/zcFN84qTke4FR/3Fwf y/W3cFyVYigKvpXp1oiIrS6JMhjLf2LZvx3cqYathQgqx4200Mkf/pgl4Rfy0rYH1PG9CljMBG/Z yGH/Vk8TyYwjFaIsZlVWswgFcR/i2FKbHRQgoTWLXTvndX3YkRN+V1jEyBi5pTd0s4Po/AgZkgXP iQYyozQ0UBJak7uLkbQ2CZwLIEbxzYoyobEE7Ucwc6LRJ7rhgE2cnmWe0cqBDbStTQTTNNd0pYYA 8Rn/bMEIs/e7eSWMqkzJ1/KqEtRH6m9QnZlsBVIYq0xO7ZJXS+Ag71jRRNYqpSNbugMBU9q9rnGq k2xfdGc6POA6X6Er6r2FvpXSn3TgMlvdD8XAMtaeVrKC+BJq7pJ2gxNc0F5V2u4mt6eYycH0l/UX Fb0E3N10jQxKfdsaNi88X9k0+MTB6s0/2jucFmcO/5RbqO3+AcbPCCHUsK2p8NaanOEirs1m+jln jAdHOTlsZsfhSmf/AhxnCB3bw1nEUKSnFaHvkWinXbUci7KS3rNeLjUfvaBSjrKk8/ZQSk1U7Jpj +aVsxHmdx93bOJhmljKHX5agpGC2bdju4+M2Y8PtXXBr99OVDFXfsTd4IcPYqlGncoNQLXhzL7ff 4yasB2sh9amXVfHkLny4zdVR8ymx52Ce/Hl9bnlfda1Gh0X89JZV5dpVA7mvd97fxTvZYxEi8yTl L8q9XbTKPzWiAlrYEks/5HiTuMdxXz2sYlgc2yuv86id9XGFa9vcFlf73M/+94MrWtwTrvvYD/9t z/8v9+DOO+48Jjy64a+s5Qs/+PG3Pzrnn8KSz9799/d/QPOPL3jt5OjOjmRP1v4vAbOh/bSD0QRs vEzsmDJMASkQ/+ov7w4LAcEh81xo+iqwq8aPxbbr5h4QAiMqlvTuA1XQePLP+HaP/6jjMl5sBWmw GlpQviDO2uqvBnlwxOhvB3uqB4VQsBbP+jxvCJEwBP8r8JAMCZ3Qs4RGzExJCtMrmTzC36pww56Q BpWwdkRtyjCP397G2GQGXR7EA7fwmbrw3SCNz8pwRLaoPmwtNcQwDdNwDSeQi8YKn7gI1fCFmfYB 2exwEPFQwaQs0vqQrP4QKiDNjn5vED9QflLi4fj/xzxODRBFK5z26jVaS/PQEBIxSRJ1LQdHzbPo aFNsCo+gzI9k6BFBUQHDTDQ0ZhUhcKmY8BUjkRfoaHLy7PQqDBd7cNHKKb9KEcVwLACBMf5qJsD2 oxczRu26ow+TjyaoEX3qMBlrcBnv57XycAor5jXqZ56IjdOOb58kDhvvrxCN8RCdZjcmTdOYCfKI Yu3QMRudr4QUqkBWQxxHixNbcQ9dsR7Zr5AOMR8dr40a0KPmsN7oUSBVUB0HTNfGjhf1pHxaEeog Zhod8v8gUgPVzyt0CtdU5x+1cCObDxmD8P1McviAMCWLcCWVsf0OzxdhMrM6UrMOsh33LyBjpyZh /1H1KgXzLOvtbtEnU4/4WMUR0Q7DYOsYjdL/brLlgnJ+No0fjaf2npIjg2xAXDB1+LAWXTIrWRL0 7q0q6iXBmrLIxDImiW+UuPGHpI8m15LzvC/9VKYu0S8vP3Iv75J+Bqn8ABP89BIv+fIABY8Bm9Dn 5BLwvK4lr6vfFjP3TrIldRIGy80pLXMGRfLzVLKdBhAsr4z2xIIpjRG4yuiqPtF2ovIc929GoiE1 Xae7yNHBmuWiFAs2TWc1AxIDJXAzlSwZHKMD5cgFVewoL7ANhRMy7UbjRBAnyHEJG7MokU8Ofwc3 PUdsXGrZ2sS9JNM4pfNY1CndWLOzqq//Ugwxp/+rziJTMxUNPeVNOR0TM72zM39QMVHyMeGOINmx z0huPG3y7CbRODwRQPVGQAVxLKMQNAorDInSPsdQYTLRHEWptlplfx7IOitHN5PpwtwwIzVS8uyJ PTISlKbR0OZR7Bo0Ok+rDQeFhWQPQz9H1e5sFQ/UX6qSnMqR2b6NjwKEnXSR1LCJF3kNRhsH4VYt YspII//wC2/OEXW0tEQRI++pNHMN6rwo5sxOD4pNOfwxReuHdbj0l2p0Mo9gFisqiObIOqAtC9PS 46jNfkhSLnQUoz60PbGtiHAUNPGzx9azOQ/TFg4kgN7ylPiESE/nPuVTRct0L8yM1nKOQ3Yu2nj/ krbqhgM7Y0w5DIoE8BoV9ezGQzx7pWUMEjcczVDJj+KIcyd7s6XyAuAs9AwH8m/2s9RMTk+T6yZU Lto0RhVdrlMk0ksZr3nwa1TdMVxMtW9+7p4M621cxZiKjkY59Tz1M87EIyeN6FhfRzusbiFHEw71 L0C5NUlt1ePukQ7dy/cqMkvXaSi7tCFB4SKrdUT9k7bKVbhwqezgk/JIok5HkhaxlW40tCRt0UG/ sz471QiPEPgKlpvIFLpmMl/pk2Hn8yWtlVZz9EnJs0+hU1pldfUspfei1cYQVS0btghDj2y80jXH Nek0NjMPbq08Fgyrkl9/E1uWpa6wEkGFjCvHTsmtLlRdF3ZgD9Y898P4IpSJJjU0g7Yn81NY3fLI cnBelTZihfY8xexqsTZrtXZrubZrvfZrwTZsxXZsybZszfZs0TZt1XZt2bZtz7YAAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0611.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
27
入院料等
６．患者の状態像に応= ｶた慢性期入院医療の評価
　１）療養病= 藷院基本料の見直し
※　認知機能障害加算５点（医療区分２・ＡＤＬ区分１）
医療区分３
医療区分２
医療区分１
１，７４０点
１，２２０点
７６４点
ＡＤＬ区分１
１，７４０点
１，３４４点
７６４点
ＡＤＬ区分２
１，７４０点
１，３４４点
８８５点
ＡＤＬ区分３
（現行）
　１）療養病棟入院基本料１：一般１，２０９点、老人１，１５= P点
　２）療養病棟入院基本料２：一般１，１３８点、老人１，０８= O点
　３）その他包括する加算
　　　日常生活障害加算、認知症加算、特殊疾患入院施設管理加= Z、
　　（準）超重症児（者）入院診療加算　等
（改定）
　　医療の必要性、ＡＤＬの状況による区分
= ;
(p.5〜7)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0611_image052.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wE7AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0611_image053.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0611_image054.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhYQFnAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAABf AWUAgAAAAP///wL/jI+py+0Po5y02ouz3rz7AITiSJbmiabqioLsC8dy6s72jZt1zvev4QsKW8Ni cWdM5pDKZgzojMqY0qrOiqVltyQo90v9SsPiKLms9KKt5/XRjW3Dg+p5U27n4fNL/n3vZwMY+ESY NGjIUpfYg8io9UgX6bM4KWiph5mpeVPJ+fN5GTrjGOo5CokKqgpT+nnKWuLKOUsbq1irmWu5y3u7 Avsb0htJXCxMY/yonMjcjNzibCgdSF0NfRIsbM3H3Y2t450nPkdeDi5rDqe+xt6O3uWOJi9GXw8/ ov1rz8Xfjy9C3y1/WQgWBDjMYByEABSyYSgwlsMxDBtC/IAxo8aN/xw7evwIMmTFiWZGXjSJkGTJ lCqdtEyDEmBEVi8PxcQ3U1VNIzt5noQINKjMnm9S3oSXExVRIUuZ/jQKNSrOppKk4nwqU2hWlkfR UaWE9apVpGHJjvVaFu1ZcF/1tN20dS20pKPe4rB7Ny1brWKHdt3L1yveToHV+i2MbbCow3KRKSal NzFiyVwnO/6bOKTmzZw7e/4MGiPmuaMdP55i+XLlxttKbztdiHXr1XH71kYKu1Xq2YxvG/bNNvcq 4IB72zYre6BwRbv3RSadfOBz1cQpG0d+HDtu186bS1wOzLvE6byz/94uXid35evHp1cKXkV8Iu/r zqdfHfr18/z7Z6duTxOAOt2XTX11kdddftRNFVqDDj4IYYQSTiCgUhXad6EpGb5C4BXRubdfceaJ iN6H6hnI4Ya2oEhLh7KwuGKI1o04Y4kKJngjezBi4mIXCEpn4oky6kcjkTYWWR6S+/SYz448/gii kjgeqZ1/NQqmoi5Z8shkQE76QpuUUYpJU5fDfDmJmXRpGKSFYVZJIpz/obnMlryYaVGbB7I0YZ9+ /glooBsUAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0612.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
28
入院料等
６．患者の状態像に応= ｶた慢性期入院医療の評価
　２）有床診= ﾃ所療養病棟入院基本料の見直し
※　認知機能障害加算５点（医療区分２・ＡＤＬ区分１）
医療区分３
医療区分２
医療区分１
９７５点
７６４点
５２０点
ＡＤＬ区分１
９７５点
８７１点
５２０点
ＡＤＬ区分２
９７５点
８７１点
６０２点
ＡＤＬ区分３
（現行）
　１）有床診療所療養病棟入院基本料１：一般８１６点、老人７= X８点
　２）その他包括する加算
　　　日常生活障害加算、認知症加算、特殊疾患入院施設管理加= Z、
　　（準）超重症児（者）入院診療加算　等
（改定）
　　医療の必要性、ＡＤＬの状況による区分
= ;
(p.13〜14)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0612_image055.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+AE7AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0612_image056.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0612_image057.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhYQFnAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAABf AWUAgAAAAP///wL/jI+py+0Po5y02ouz3rz7AITiSJbmiabqioLsC8dy6s72jZt1zvev4QsKW8Ni cWdM5pDKZgzojMqY0qrOiqVltyQo90v9SsPiKLms9KKt5/XRjW3Dg+p5U27n4fNL/n3vZwMY+ESY NGjIUpfYg8io9UgX6bM4KWiph5mpeVPJ+fN5GTrjGOo5CokKqgpT+nnKWuLKOUsbq1irmWu5y3u7 Avsb0htJXCxMY/yonMjcjNzibCgdSF0NfRIsbM3H3Y2t450nPkdeDi5rDqe+xt6O3uWOJi9GXw8/ ov1rz8Xfjy9C3y1/WQgWBDjMYByEABSyYSgwlsMxDBtC/IAxo8aN/xw7evwIMmTFiWZGXjSJkGTJ lCqdtEyDEmBEVi8PxcQ3U1VNIzt5noQINKjMnm9S3oSXExVRIUuZ/jQKNSrOppKk4nwqU2hWlkfR UaWE9apVpGHJjvVaFu1ZcF/1tN20dS20pKPe4rB7Ny1brWKHdt3L1yveToHV+i2MbbCow3KRKSal NzFiyVwnO/6bOKTmzZw7e/4MGiPmuaMdP55i+XLlxttKbztdiHXr1XH71kYKu1Xq2YxvG/bNNvcq 4IB72zYre6BwRbv3RSadfOBz1cQpG0d+HDtu186bS1wOzLvE6byz/94uXid35evHp1cKXkV8Iu/r zqdfHfr18/z7Z6huTxOAOt2XTX11kdddftRNFVqDDj4IYYQSTiCgUhXad6EpGb5C4BXRubdfceaJ iN6H6hnI4Ya2oEhLh7KwuGKI1o04Y4kKJngjezBi4mIXCEpn4oky6kcjkTYWWR6S+/SYz448/gii kjgeqZ1/NQqmoi5Z8shkQE76QpuUUYpJU5fDfDmJmXRpGKSFYVZJIpz/obnMlrxMiGeeeu7JZ59+ /glooIJCUAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0673.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
29
入院料等
= ７．特殊疾患療養病棟等の見直し　
（現= s）
　・特殊疾患療養病棟入院料１：１，９８<= /span>０点= 3;
　・特殊疾患療養病棟入院料２：１，６００点= 3;
　・特殊= ｾ患入院医療管理料　：１，９８０点
（改定）
１）療養病床：廃止
　・患者分類を用いた新しい療養病棟入院基本料を適用
　　  ※　現に入院している難病患者および障害者の医療の= K要性に配慮
　　  ※　療養環境加算新設（一定以上の病棟床面積を有す= 髀鼾）
２）一般病床・精神病床：平成２０年３月３１日限り
　   ※  長期にわたり療養が必要な患者は、本来、= 療養病床で対応すべき
  ・特殊疾患療養病棟入院= 料１：１，９８<= /span>０点 ⇒ １，９４３点= （△３７点）
　・特殊疾患療養病棟入院料２：１，６００点 ⇒ １，５７０点（△３０点）
　・特殊= ｾ患入院医療管理料　：１，９８０点 ⇒ １，９４３点= （△３７点）
　　　
(p.24、25)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0673_image058.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+AEmAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0673_image059.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0614.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
30
入院料等
= ８．複= 病棟の廃止
=
=
=
◎平成１８年９月３= O日限りで廃止
　　※　病床数１００床未満で療養病棟への移行が困難と認めら= 黷髟a院についての特例措置として、一般病床と療養病床とを併せて１病棟とするこ= とを認めたもの
　　※　複合病棟における看護職員の配置基準は、一般病床につ= ｢ては平成１８年３月以降、医療法上の人員配置基準を下回ることとなるため廃止す= る
　　
(p.537)=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0614_image060.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhIwFBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0614_image061.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0616.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
31
入院料等
= ９．新= ｽな加算の設定
=
１）がん診療連携拠点病院加算（入院初日）    ：    ２００点 <= /nobr>
２）栄養管理実施加算（１日につき）        = ;  ：      １２点
３）医療安全対策加算（入院初日）        = ;    ：      ５０点
４）褥瘡患者管理加算（入院中１回）        = ;  ：      ２０点
５）褥瘡ハイリスク患者ケア加算（入院中１回）：    ５００点 <= /nobr>
６）ハイリスク分娩管理加算（１日につき）    ：１，０００点=
　　
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0616_image062.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhmQFBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0616_image063.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0674.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
32
１= jがん診療連携拠点病院加算：２００点（入院初日）&#= 13;
　※　がんの集学的治療、セカンド・オピニオン提供、緩和医療提供、地域= 纓ﾃとの連携、専門医師、専門的コメディカルの配置、相談支援センター等を備えた= 体制を評価　　
（施設基準）<= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";font-size:110%;text-shadow:none;display:none'> =
　『がん対策推進アク= ションプラン２００５』
　　　※　厚生労働省= がん対策推進本部 =
  <= /span>・が= ん患者や地域医療機関からの相談対応を担う「相談支援セン =
　 ター」の設置を要件とする「地域= がん診療拠点病院」等の整備を =
 &n= bsp; 推進することとされている
　
(p.20、54、449、46= 8)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0674_image064.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wFaAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0674_image065.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wGYAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0678.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
33
２= j栄養管理実施加算：１２点（１日につき）&#= 13;
　※　入院時食事療養費「特別管理加算」の１つの要件= 再編　　
　※　個々の患者の栄養状態、健康状態等に着目した栄養管理　
=
= （施= 設基準） =
= ・常= 勤の管理栄養士１名以上 =
= ・入= 院時に患者ごとの栄養状態の評価 =
= ・医= 師、管理栄養士、薬剤師、看護師その他の医療従事者が共同して、栄= 養状態、摂食機能、食形態を考慮した栄養管理計画を作成 =
・栄= 養管理計画に基づき、患者の栄養状態を定期的に評= 価し、必要に応じて計画の見直しを行う　
(p.20、54、450、46= 8)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0678_image066.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJaAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0678_image067.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8gGpAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0679.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
34
３= j医療安全対策管理加算：５０点（入院初日）&#= 13;
　※　急性期医療の高度化・複雑化に対応できる、医療安全管理対策の実施= ﾌ制を評価　　
= （施= 設基準） =
<= nobr>・専従の医療安全管理者を配置
<= nobr>　　= ※ 医療安全対策の研修を受= けた薬剤師、看護師等 =
= ・院= 内に医療安全管理部門を設置= ｵ、組織的に医療安全対策を実施する体制の整備
= ・患= 者相談窓口を設置　
(p.20、55、450、46= 8)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0679_image068.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0679_image069.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/gGOAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0677.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
35
４= j褥瘡患者管理加算：２０点（入院中１回）&#= 13;
　※　褥瘡対策実施が= 院料算定の要件となったことに伴い、入院基本料等加算として評価　　
（対象者） =
　　褥瘡に関する危険因子のある患= ﾒおよび既に褥瘡= を有する患者 <= /nobr>
（施設基準）<= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";font-size:110%;text-shadow:none;display:none'> =
　・適切な褥瘡対策の診療計画の作成、実= {および評価の体制
　・褥瘡対策を行うにつき適切な設備を有する
　・褥瘡対策の基準を満たしている
(p.20、55、450、46= 9)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0677_image070.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh4QFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0677_image071.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh2AGZAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0676.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
36
５= j褥瘡ハイリスク患者ケア加算：５００点（入院中１回）&#= 13;
　※　急性期医療の高度化・複雑化に対応できる、より重点的な　　褥瘡管理対策の実施を評価　　
（対象者） =
　　褥瘡リスクアセスメントの結果= 踏まえ、特に重点的な褥瘡= ケアが必要な患者
（施設基準）<= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";font-size:110%;text-shadow:none;display:none'> =
・褥瘡ケアに係る専門の研修= を受けた専従の看護師等が<= /span>褥瘡= 管理者として配置
・褥瘡管理者は院内の= 褥瘡対策チームと連携し、予め定められた方法に基づ= ｫ、患者= ごとに褥瘡リスクアセスメントを行う =
・特に重点的な褥瘡ケ= アが必要な患者には、主治医、その他の医療従事者が共同して褥瘡= の発生予防等に関する計画= を個別に立案作成し、計画に基づき重点的な褥瘡ケアを継続実施 =
・褥瘡の早期発見、重= 症化予防のための総合的な= 褥瘡管理対策を行う体制 =
等　
(p.20、55、450、46= 9)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0676_image072.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhGAJLAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0675.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
37
６= jハイリスク分娩管理加算：１，０００点（１日につき）
　※　産科の体制が整っている病院におけるハイリスク分娩の妊産婦に対す= 髟ｪ娩管理　　
　※　８日を限度とし= て入院基本料に加算 =
（対象者） =
　　保険診療<= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";font-size:110%;text-shadow:none'>の対象となる合併症を有し= ﾄいる妊産婦であって、 =
　リスク要因を持つ患者
・専= ら産婦人科または産科= に従事する医師３= 名以上 =
・年= 間分娩実施件数１２０件以上 =
・年= 間分娩実施件数等の情報を院内掲= 示 =
・助= 産師３名以上
・妊= 娠２２〜２７週の早産 =
・４= ０歳以上の初産婦 =
・分娩前のＢＭＩが３５以上の初= 産婦 =
・糖= 尿病合併妊娠 =
・妊= 娠高血圧症候群重症
・常位胎盤早期剥離
（施= 設基準）
（リ= スク要因）
(p.20、56、450、46= 9)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0675_image073.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhBwI8AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0617.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
38
入院料等
10．地域加算の見直し =
　※　国家公務員給与の地域= 闢魔ﾄの支給地域および支給割合に
　　係る人事院規則が公布さ= 黷ｽことを受けて、見直しを行う
=
例）
　　
（改定）
（現行）
= ３点
= 札幌市、和歌山市等
= ６級地
= ６点
= 仙台市、伊丹市等
= ５級地
<= /span>
１０点
= 京都市、福岡市等
= ４級地
= ５点
= 札幌市、仙台市等
= ４種地域
= １２点
= さいたま市、横浜市等
= ３級地
= ９点
= 伊丹市、福岡市等
= ３種地域
１５点
= 武蔵野市、大阪市等
= ２級地
= １５点
= 横浜市、大阪市等
= ２種地域
= １８点
= 東京都特別区
= １級地
= １８点
= 東京都特別区
= １種地域
(p.17、51、66)=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0617.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0617_image074.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0617_image075.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0617_image076.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9gGcAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAD0 AZoAgAAAAP///wL/jI+py+0Po5y02osP2Lz7D4biGGbmiabqyrbkC8fyTNf2jeevofcz7wsKh8Si sQc8KpfMphOQfOai0qr1it0Fstyud0j9jsLisvkMI6PXbKua/W7L5+4t/Y4nxtH7vP+P0wc4SChY ZkiYqMiBuOi41ugV+UhJN1mJiXWZtZnp+dX5KXoUWjd6eleKujplh6fKGgvmKlu7BPuEa7tbo8v7 u+HLJAxcDEJsLItMSpvsHLT8fBpdRC29a32dmS3Erc3q/e0YjtQsfk5Cjj6o3rr+PmYO/9weKD// Xo8/p2/Tv8/uHsBf/2gUHJjnIEIxCmM0XCinhcSJFCtaTOHnosaN/xw7eow4UGA1kXxISjEJkdFJ lJxCrszIsklMiDN1PPxQM1lOezAPpXT4ss3OYkP9Fb3S8Og8pT+YKnFaC2oaqTKpTvmZJigcl7ms 3vJ6A+w1scfIIuHq5GY6sz+w7tAKCW3VngzdpoPLR+4wtrN82hXBl1HgsHq/0gX1FzDeM4MrNVYb z29inIvNNKb0+LJNzYonU+4KEmDmw5I8f07LWUZqRaMTrj5tOlhlyfhav3rtATe42XVF84akW2Vs 4ahD77OdKrjs4cuLCy38VLlD6dJHIc/rG7Rr2rGvM4bOjHSX6qK8WwZvBDJg6sybz32e3flt7qYz e7yPP79+9SX2+///DyBHxtX2W0n0eWbegeskCAd77TGIWHzvzdcbcxCWJuFe4nFB3icXjofeSBu2 9GCBIGZo2HYVDvchhyHq0WFkK3ZnoosoRjeiJu1BUSOJx/XIkIMWAonUi32pGOGQ2m11Y3hIYqik fHE1mV6M6ymYWIs+Erhkclj+paWOVIr45IlRTjjlj11aIiSLRLphZDdW9velXWEWOSaMOeJ5pobw qSklm3W6dSeceR5JYZJurvndoXLuaWifKTIJKJqCzljfSgFuymmnDsDkaaiijprAgEu9OV6bNDJ6 nqPQzFnWoFgVWgWslFrKj6qZsirrWKhyqCuCv+YS56uQ1rojrSf/FesDf7FiKiyv0C44rCbBTqYs sa42a2tu12ZZrUzMlnPssiVKq+ip6Bo4LbjrmslloLn2mlK2aY27WbnaSorjn/HiGtG3YIY7DL7u lGkjv07eqq68AdNLE8G3GMwTwluu6jDEztiLlMB2SvwUxWF120FSyWpKasoqbwTqyi6/3JGp8HBs SrsDv5vwv34mCuWiGdssDs21ekwoyKSIbJS+9577c7ozG900skwDrLFOUFPNp89YO53P1Tv3jPHW YD+N8yFEz+o1GEj3QrJgVa9tEKxttxo1Y2f/JHTI25JrsZgKVylz12UH+fbe+frbsNh2F17p19g1 PqmXQBc9eNaJ/zs+7+RoVx6pzpFfyjW2aXcDd1NKizs15nR73i/P8IatOuMEjb7w2NHWnfPln2ce uru4X0z274RrjjftzZau2txQ3F0vyjA/D70FLUdPffUYBE4t56nKrnvrabJeO+i2i669uZB7L/7r uwpvefCKW8Z8xOXvCz7gfbd/+/vAC86+JPEvlLejGe5grsvd+vTnt/qRqYD7I1//pHa+8PFufL5D IP6y90Bgcc99sSOeNAKYwfScbH5Li6D9GJhA2O1udd2T4MM8KL8QllCBerpf51SIvkaZcIGS693N ZIi6HdYQhResYAd9GDTj8VB9+TsiBc8BQgtOLHUr3KAtouhE8/hpLYsG5J8UtwdDACrRJsibzukK RsXoWG+NbHQWTtoIxziWCnEcrGKDrIjBL2qxhSfs4RM/RsIg0hBRfmSiA/VIPz4ucYKGNKIdkfgN LD4SglucZCOhOEZCXhKQQESjEDXJyC4ekosNRIckc1jKHyJyhoocYiFF6UhU4lEZmXxUGBFySmiU cSpnnOLfFsnCOsryjrfcpRawZ8paGquYA6wYw4TpQqH8D5fK9Icx19JLvf3SlY8bpC2JeMMDkjKF 0Oxj+mCpynEWEZOBrBkkN9dJX3pzmeCkJA6jyUxg5NKc6OTkKgXZSlC+8J3F64ocD+qy6SF0oc8r AAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0617_image077.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMABFAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEABAAu AEAAgQAAAABm/wDMzAECAwLPhI+pmxEMo1Ru2tse3jMIzYXUJ5aIB5qiR6qr0Locm8oXG9sWXusR nvNBgD3hCBY0HpE9h/MJjUqlSFizis1qt9sr9wvuNsLkcg1YTmfP6rY2hXa34fJ6Lm43H/D5MIjf 9/UX6KYBSCgGcIj4psio9rD4WBU5meZgSVaZCbbJyeX5uWYgaWkomlj6OIiKxdrKtAcbKzt7Z3s7 y6Y7xnsyBRwc5ao0RFy8gFaETITM0Oy8tOzME51Ma31ilX00Tb3Nre39Pc6cxF0RnqG+HlEAADs= ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0618.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
39
入院料等
11．臨床研修病院に係る評価見直し
　※　臨床研修病院に係る評= ｿ充実
=
（現行）
◎臨床研修病院入院診療加算（入院初日）：３０点 = ;
（改定）
１）単独型または管理型臨床研修指定病院の場合：４０= 点
２）協力型臨床研修指定病院の場合　　　　　　：２０= 点
 ※　研修実施期間中の入院初日 <= /span>
　　
(p.15、48、448、46= 4)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0618_image078.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhhAFBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0618_image079.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0619.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
40
入院料等
12．新たな特定入院料の設定　※　急性期の脳卒中患者に= ﾎして行う専門的な治療管理
=
◎脳卒中ケアユニット入= 院医療管理料：５，７００点（１日につき）
（対象者）
　　脳梗塞、脳出血及びくも膜下出血の= 患者
=
※　上記対象= 患者が概ね８割以上入院している一定の基準を満たす専用病床で専門の医師職が急= ｫ期医療およびリハビリテーションを組織的・計画的に行った場合
※　発症後１４日を限度として算定
※　治療室単位で算定（看護師常時３：１以上、常勤の理学療法士または作業療法士が１名以= 上配置）
(p.22、58、450、47= 1)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0619_image080.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0619_image081.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0671.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
41
入院料等
13．標欠による減額措置の簡素化
　※　医師数・看護師数　⇒= @医師数のみ
(p.522)=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0671_image082.emz Content-Transfer-Encoding: base64 Content-Type: image/x-emz H4sIAAAAAAACC+1dDXBVxRXefQkkhh9jHiZhoBTTAFGUPuQvCEKgSgcFxAaEsSTEFIyKRYszoTY6 pq1NkyJC7egwjFaT1rHVOgi105/pdOgkTjOtjFbIT4mChARqphlsx3EoQ/O6J++cvPM2e2/ue7nL C7Z35ubec3ffObtnv7N7zrk/kUKIB0Vkk2pvCwhRIMXAdmKjECn5Qky9dfUKqHHLk0KMSRUiXWib uiZShChSv/1YL+tMFdU/TxGKgbhe7VPVrtjNlKryZHWeCbIzD3eA2DLcoe4mta/FunlFqWIsspui fkfn+ez8mqK0gfNQUaCfb2o/Vb00tUgMlOWK6PlEPA+Hw2ICno9TexaeB4CviPQ3L1o3bLqWgX2h jepwGVy2iZ9T3SnYbtraVcNmyOTxkLgTjxnsOt+m4W8l4wmbk65XqX0L4w94nM6YTlUYu0mCbjnK qpeaz83bV9T+sIzI+xg6yLa9EVnVAKEbwnPCU0Uo/Gbo16HG0IGQSGD7Zv/fNvnJU/NmVyvgTzp0 MFSTntENV19qCooH3wr21wGBZ9NUX1+YN/t5dV1i+Xh1nHtvm4Tz3ldF6Pdb2+S76hx0VpZ1JPD2 kWC/7he/JUJHXvvd+8C3oDHYTwsRFNm17+wUH/7niXXq2t3qfII6XgfX1FaTOqm//xO0cct06Eu6 +u1jZW1ynzpWpL638+Unenee+W7vzm3jMmrBVt9V16F9b6rjyk9FaEtlZJqYxsY3l+GKxiElSePw zPiMUri6tiMoJr8/eBxWdUTGAcphHLb8sU3COYzDPw63yeqOyDisDR4JlH0QFNeirDf+FhS/3JUW KrqlTab3BqP6U+dwrR/Hx5UOVR26BnPHxa+3yTHqeN3rB0Njt0frwfak1rbJxyNtq1M7jcML4zNu hXGoVmXQvi3HzeOQwufAt2Ptm8YE5s1PLtGYQJ8E9tvJNvrlf7V3J7cN0NnarVHbaN8StY2/XxWx jenJt43vk21A+5xsI1WzDT4m/Dqfl7PY3LoO9VmGa+wetS8YaPuFZbBTWRrOs3wL4wZtLVTq+aKY rf6GxPd2h0Kj1TXTPhblPqb2F5H3cYNcKkuPQ273mjFr3ORy2V3I//NysOwuj7LnJyj7Whnhv8Ug m8qGkj0vTtlko6MuExvNrYja6Ev3Rm20HdevguTbaB3ZKLTPyUZHxdhirB/pZMdkl59T+1LEwW0a TqgsPrs0Y4TbJfhR5ch7t0EulaW6yAU+k7av3vdAaEOI8Adr1BVMxivI56hBxitxyLjmG1EZY5kM svGlaOO3GWx8qQc7my1uHNAfyIvHxpeijd9msHFvsufFLRtw8xryP26QTWV+4ma4WAd95ai9GOep Uq3NVGZjLSC8FyPeSw14Lx4m3mmtK8a1rtSw1hVbxGIX8gc7KDXYgTfZhQnbQTHaQanBDrzIvlHJ TUT2y8j/Q4Psl6UdTDn5YBznFYjzHQacV1j0O+5G/s8aZN/tUXaiGHwR+R83yH7Rs+zChPFfgfjf YcB/hScMzk0Y/xWI/x0G/HuTvSBh/Fcg/ncY8G8Da17wX4X4rzHgv8qC78vxX4X4rzHgv8rSmkz4 r0L81xjwX2VxHuxC/oD/GgP+qyxiEDBehfivMeDfi+w5bLzjxX8V4r/GgH8bWHPDP8XazRhrHzXE 2s1x+2apwmus3Yz4O2rAX7PlWLsZ8XfUgL9mYTfWbkb8HTXgr9kCBvyK/TqwXWcMsV+HBZyQL9yB vvAZgy/c4VPs14E4PGOI/TqGGfuB/s4in8lysIyzHvU3J2bWCXuKva6XEd73GORSWXxyvcd8HRjz nTHEfPHjJe2SxHzn0Be4YPAFzlmO+c4hzi8YcH5umDiHMWlAPm0GGVSWNuS8x7EwyhMWziJvwP4F A/bjlys8Y/8cYv+CAfvxy/3RZq/r/Dlc5y8Y1vlzSYrzUmQE2+PlYGxDmY01D8ahBPk/Y5BNZfHN QYcPe5HbgLzbDHIbPMpNBHdnkTfgXZd7NiG54bBXvAPvewxyqczv/hLegfeHBrlUloy4LgfxnmfA e460E9cR3nMQ73kGvOfEjfcbpFe85yDe8wx4z7GI9xzEe54B77bkAqZzEO95BrzHLzcY8Ir3HMR7 ngHvNrBl8mN0X2datE71tOizKdWmZ2M4D9PzLfz+LfCmZ2a6VaV2wHhA/U6an4Ghe7l71f5PRfwb 7nGr+qmarqhsjIuuwDdayPJs5yuLN28P/fbhh7e63wPQ90uhm9JARDetHnWzLRDp/58NuqGyoXWz wKCbYEK60f3iRHSW6kln4ZhnsH6s9vvVyQHhrrNf4HMf9Wr/A9JcZ1SW6aIzeE7wL9NEqPO5Tzet rCoqL9jwwR3fem5R8fLKzQ80PLs9NHdj+rqx2KexCe6XQm97ZERv8GzZAW1+cNPhKoNOuA5/qIif YLmTDlclyCvTgZcJc+OY7rhubF+3OWbw7NghAU8EROYH231yw8E6rPOO2q/EPBwfOyqTLjiA51rH 7GyQYzWeJ5DnRwaeJzzw3LkrGNB59iLP8waevR54frsuuoYTz4vIM00O5nnRA89T62LtPRmYmoCY Wq/2Fh/ngWxYl3yaB3ReTvOALX3xZ37vQn3dpyo3anOPm75q1f4ztf8K/dnDGg6pLMNFX5BPX1Q8 s7T7OxtCd4QeCj207a+PAq3nDNOGWFc+i3MjPPMF41IvR8bc+IyMzH8vyMFzI5UNPTfGzjnwuxPI 8yMDT29zY/ognr3I87yBZyJzI/zuIvLU50Yq82tuDCSIr0ACfqZEPzM4xPiDj7gPZbyn9qs0vVLZ KBcdbARbD/c9IkKram8OXxFIx3lvDB6dbMWmjXWhjUF80jiEDmC+mx6IzGnPBgbPd1R2Kea7ZMS5 oKsmjHNbhtAV5ARSVL0/qeOSQAQzMXEJlg2VE1iQ4H092zFtE2LGix4ex77+xqCHxz3qYd4I1EMD 2s5p6a+f9VPpn5+l8/LTzxoVp58FuFmMuKnT7NdLXqQE8yL3icF5kRIPeZFC9lzMSM8ZFaCeFnq0 r5loX/MN9jXTon0lIz8E/no2+uszPKxZ4IdPQh99usFHn/R/H31Y+YtszF/UiZGRv5iDMfwSQ15g TgI+OvxuOfJcbeC53JOPPpjnnchzk4HnnQnmL8qQ5zYDzzJPPno4PBLyF9mYv1joc/5ilo/5i1lx rKv6u4mJ6DHFy3r7dmw+mN419hLfZAci9gz3ZfT4hsqGjm8WbhWhr227ORxpu1t887+S44U8Rjbm MUbCHAnx+hyM5ZcY8gOJzJHwu+XIc7WBZyJzJPzuTuS5ycAzkTkSfleGPLcZeHqbI5Of421ATEHs sdDn2GOWj7HHLEuxR7w53i7UF/jUM+LM8UJeYyLmPPINOY+Jn+GcB9zbX4w5jzrh7d5+Ca4hepxG ZUPfvw5dFnEaYKoAdeMlTkvBWGyJIU5L8RinLfDhGRGbMb7+/ZRLIZM2/Zsto/H64cOHY/oP1wsY f+IJ9Sayc6dvuUAMOVkM/iYM/Ia3m86VXVfT91/0MSWaeA3n+y/xyr5fJk/200mUDf6wX7IJa2lR GTFtShPO37mg9gUwfn5ANehqRt+P35DxQzcc82kumI9Xl8Ek4nd9EmXvT6Lsk0mUnS9Hhu3w+dtp PuZxpcQ8XybmD2eIyBqcyfKIpv5T3QqsQ3QWxtaX0ja99DkRG65P4lx8OomySwKXP5bXY65sPqMX OvR/PcurFTIa+H3BR91T28B/uom1bR3SprZR3WI8El0khm9nJGMD6gbW2UWMnuDjOsv7f1rGjg3F 6qb+n2bxfCGjbY0N5A/42HRK57GhuqfwSLQfY+OEmzUabta44GYN4mYNo221bT/O1fMZ7TSmVHc/ 2hvREp8f8bttJ7W2nXRpG9U9iW07ablt+TK2bfkutkB189EWiLbVtg0a3sAfcMIb1a3AOkRfJe3g rSQQqzfKNZjaRnXhWMhoW3oDWyvX7LTcxU7pO0XljLZlpxu0tsGYlruMaTmOaTmjbY0p9L1S01ul i94qUW+VjLapt0pNb5UueqtEvVUy2g+98di4DtfsXYz2IzbmfmEQ9bAL/cMg3m971IKOg5rPpt87 5zoOsvvrtYwGfo/41P91uE7chf0nOgVxZ2MNXaytoXUua+hiPNYyWuK9eBtr6GJtDa1zWUMX47GW 0bbali9j25YvndtGdeFYy2hbbavXfN16l7bVs/uhtYz2E9Od6F904bxBtJ+YTnbcPvUzEL+WBGIx TfeZnPwbuhdVy2g/MZ3sMd0/wnLT96Ft0vpLdAqu9X6t8QdQxkFG+7nG78Zn/PdgP4j2Y40nGXBv ORuft9nFaD90Ndx8Z6Pm0zW65Dsb0adrZHSWJV8YclCHtPxVi0v+it5rO8Zom/mrVs1Pb3Xx01tx bWlltN/5qxa0kzZG28xfHdLyVy0u+St6Fv4Yo23mr1q1/FWrS/6qFfNXrYy2mb/q0XDT44KbHsRN D6Nt5q+aNN+7xcX3bsLjMUbbzF81ab53i4vv3YTHY4y2mb9q0nzvFhffuwmPxxhtM3/Vo83vPS4x ew/O7z2Mtpm/atL8uxYX/47erzrGaJv5qz7NTvtc7LQP7bSP0TbzMH3amPa5jGkfjmkfo23mr8Af 4HrLks56y8LvWGfJKG1Tb7xtoDentlHdCqxDtN/5K3h3Gdbs6TJK+52/OkC+oYzEEgcs568Oafmr adI5f0Xft8iXUdrv/FUL+qrQf6Jt5q/atTXUqf9Udz/2n2ib+at2bQ11ahvVPYltO2m5bfkytm35 0rltVBeOtPvVNh7bHhJR2yTaz9h2N37DaA/KINqWbdZrPnu9i47r2fcVQL/10n/b7EQ/qQv7T7Qt 2ywJxGKMvknm5G/Qd8ug/0T7iTHIARwS0f/3R7SfGNuL8yrIuJrRKy3FhV0y9vkpeqbepGOq24J1 iP6Xj3FxN+Z2of+LGP2JsNP/Bhl7v7jT5X4x1T2FR6Jt+T8NMva+Z6fLfU+qewqPRNtsW6XWtkqX tlVi2yoZ7Wc+ZS/eo6B8HdErffTN9uJ8DzIOMtqmbTZqttnoYpuNaJuNjPbbNluw/22MtmmbPRrG elww1oMY62G0Tfz3aW3rc2lbH7atj9E228bjpk6XuInqnsIj0X7bJqzbtG4S7afdpKrK/F5PPO+n eP22EL2T4nSdv2MSwvMrlfxxIvZ9uRV4DwDy/l++ZeWXAuweRjfe06B6z4vIu1jw/6WvK4q8s5br oqf0IhGYi/zh/1ULEfNeTRHeklpGZaCT9CKZQnzhen+dIphDJoin5Q/6O3l1kWT/qzr6f6PLGf5u Z/0Evebjrtp3M2vrwDnI2Swizzel4VGwowjI/v/Dze936eOeFjuW1RtQ5i4ZyTOdUcenUFbhlELZ nrsvndsBf6eJtXcZa+8y3l6OMY6rFTiemThW/H95r8DcSTqOd8oQGOgaNgYCCWAgxYiBpxUGTg9g IGUAA4HLCAPdDAPtuYWyYMrIxsABbPMMORwMpCaAgVEO88AbCgdq5u7HwKgBDKReJhh4HeeBAknz wPmM9tyNWSMdA13DxsDoBDCQ5jAPvKHmAcJA2gAGRl9GGOhmGGjPPZ9RMGVkYOB29AVDqKupzLfI NPgZOu303Af3jbi/o7eVMOKAq+rIHj03jTf5ek/JyPu1NH8RDf/vLludXyteTdjXc9NxgOl4POpY sHsc/wV1ZhT3RIQAAI== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0671_image083.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wHXAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAgD5 AdQAhQAAAAAAABgYGAgICBAQEB8fHwDM/yAgIDAwMDg4OCgoKEBAQEhISFBQUFhYWGhoaHh4eGBg YHBwcGVlZZeXl4eHh5+fn4CAgI+Pj7+/v7e3t6+vr6enp6ysrNfX18/Pz8fHx///AOXl5f///wEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwb/QEBgSCwaj8ikcslsOp/QqHRKrVqv2Kx2yyUauuCw uCgcm8/HkXqoHgXa66Ub7n7H0fi8fs8PGP5Df4BfTIKGgH6IfYtMZYyPUnVEdZKSSJaXkJqbnIuE Rl+fTqJFpJ2LjqeqbEaUcEpzcquztLVPpn6Jiku4ubZ7qb+QmJSTcnR3b8LLzKqih6GF0Ui9zVzB 1nuWbXbcScnKRZjZ5OViz17TSoSGoOZh2O9mxGyv3/Ti8vr7Vui56knYBeSnJR5BLsSKjWvFMN/B hxDdeQlEsVDFI9UiNtIIZhu3WLIcGuNIcp8/gRZ9YSwZxSDLSCJdLWQlkubLm82eHUq0Dtqu/4w4 h7gM2sRbvUkzbYarl5SoU02CQH0C2pMqzqFPs2rdyvUR1q5gIwoYIOxA2IfI0qpdy7at27dw48qd S7eu3bt44WLJy7ev37+AAwseTLiw4cOIExPeq7ix48eQBRcddhYsuClqPJiFxYjCg6aVm11OQzn0 1tFR1CzIEJIPAw1LTZtDXbMPaNkkaT9ZUwECZz4CPgiIzQgZU3tztmVaWsleNzvH46TVpFupbdxZ qxd1MwAEgm99NjSwvggkU5vGyVcaCZ30HfPPiRe/fXuesPTTlSVbWAy9848yeZNfLdoxEQcCIJBF 2h4RWMDeI3SwkpxyDT044VrnNSegfgWeof9dfWOACGFsG0a3XoUntsfQeyRKt0yHsEgCQQXL5XGA BwrKZ1uEr0gXoXUUhpMcc0Oa2E2Rw9BXmi0/xmKUfPhI2FaGSG044X0i3lNEBgssmAcICdRWnn9r vPdklMwZSSVNGiIJoZIj/mJcjwGyWNOJQzan4pwAYslYETfmSN4YF1xQ4Yh5QuejUngaI2CZCvHI 4aQwhghncfeRiaRzxAVZp4ZpEgmpn1eA0+ChZiSQgaA68gEOnfoxeqaUPTLqXyt9UnfpmHJSqqgr trLpqI9FXlimr6PKmeUl42jAgJhhDPCBAl6++aOFT4J3D6f9HZntsmJ8uCSBCY0Kkkf70fr/UbB6 ipMrk+DiekRwww0Khmc1YpeNuHHCe62s/DLLrabfvhivu0g0sMGDYrymrb777rpjZBRXbPFbfyJh QQT2bkHvtheHLDJfk/VrMqbU6ZrxEQR8YNbBT4j320swWxMwr+OinPOOKx+xWqtanDozSzWLJrGr mxSdhdJ7qVxqU70xjUSgrYURwhRXhyH1EVlL0TVCR2uDGRRX5lv1bk6ACG59bFNBX9G6Sbu1EWAa eEUIeAeQNxFdZ73333oP0TfehJd6t99988034oIH7jjhhVtx83XMHoWe5Wa6GVO7oS4aq6izYu6p 6BKy+S+RlpNI+uefIvw0EwiMwKoWhZZs/8XVfiuuN+6C544770XsbXgViT/ee+O7N/6748f3/DDO +ZxrupDdOqmt9EIeBWysx7ru0PZ4nquQot5/P1L14pfefepIOX+JoV2oOnu1VACfu+KMB1588MxX UXPevuPf4wKIPPy5j35Iq9z4HIW587TGRZ8rXXvMMw74UA97ygFfqBiIIunRQ4MpkmD7Xmegum1B WtSyHfGM1z/7EVB4uvva2LAAuK/dr4bNiyEJz5bAFWUvgw301kwWuEAJumh75jtfEIE4Qeo1BE1N /GADkSisEUqOPlTTAr7SdjfkAc+AyRtg/wo4vPo1D4YsBFzyZChD/7XJTjr7HhVZ1x9IDf9RWHNM nxMruBwQ+rCJ5INW9ibIRw0GkmHsc9sb1/MACmjBYWi73eLIKMYw+s6GWvgf49g4SUsqb387TA/Q 8DBEYOHDc9abmZk6tbpIQatdEDyfITf1sEXxkZB4DKEV3Vglo9TBWVj4WCQ1gUbdNW0TxRwjL4UY S+h1oU5mW9odEXjAaYItmipaplpoIswqyIxsOJkbudyVrpM585yUe1PPBjYEB3DACkID503ESYty BmliI8unPhWzzmANYWNUyOJu9knQgmJIiOQ0qEIXylBRavNfDY2oRA2TUEGSkp4wgVgeKlW5Xtbm Z1GoXSQwqlFLVRSReuCo1pLG0iStM3T/RcCABKAgP8yQdBU3PcXktJFTLqbsp+rc4dCGgEInFNWm 4Zxn2HjImWxls4PDgmPHLMq5CyVylFO16Oaies+hqnI9/4Fb2Gpaoy1mwqkqnY1SVThCqYJPJk+N a0Ktiq5B2i1GAFofQrGqumyGL3U8WtehkEghz3nrSJ0SK1vrYahyvgE2qExW+UrSU05kzpfuGaSe ZhnBXUYPOU0aX9vOClpuYfau5LNT92xZ2oJpD6pvPexerzrSXkpVQiCoXj0EwFkLylUjlU1agPoq ryIaMVJJoY0tOdSorHZsuWXb665SxMQjmpK5gw0iB6372uj+lmzD7Wo9FCA7u25Aj96V/9c816om KLGOlSA83Xfxg9gq8hVo9DXtbfNF3ehNsUn1tZB/B2xd5AT4uwO1rS6558j+NAi9s/VsbtjrUfWs jsCuRGtyS/ve+CwYpdGh0iIvx18Sbxe5xOqs6uZIR3XBFT5pnex/FqQGZ4EkUBC2YxqC21KijXhQ y33idX1LWzrmKV1OcqogxXdksDI5uZ/VqxNTm6H0Fta3sWXyrzyyMlHyxxUECEfdsqxiCXOExy5l JoiPeTrUmOu1xJXnjgO5WhHKWZp0xp5zwZtnu8a4rV5ugjuJINKQtBnNOwOuaMWbUkRjs4fmdJVi ucfoI3DAAQEg6wGBy97A7jlcjqYmpP/jWJ5Je/q+BPBAAaa1hT/vi8J4naisZ02xTc8VMkml2VIv 2uNIj5pnQn3eEhYgggdcc726Xmyje01qdPLU1msuQqpXnUI8I9vHCo62h0KNKmeLLc1XzPaeL53p VWWS2+mk7I/vG6+mKNeKVgWST5XtJSSflt5QVZdWtc0eFoW1y9e6TQQkUWjUdpRmFD4WdQnbbz9e 8FHHyCuM66zCqsoSsK1l5cX7feHAShl1Jp7yZemq3nB3t+GWO8AIwsyGDCQAlZoNba6x3V7RVhGC RzykX+8YWtCqb97c3SPpAg7R9sEYzqx9FKd+SEukm7K1+5n0bG2ujAw0h7xkybleoz7/c3WbKJZ1 LuwUGUbBDZ/8tB+ulthPLKWxw3TKK/7v2V8VE3nHd+5cJuE2UUcJCHywwUWUYpEjgu5nK1GJHkxi zp9axw0beMYbrNraj+tiJzuWewKO7+NdS2LBF9hKZ5K6XX8opNyuiEuLpzvciQbr+Nw8j9MTem2U y2EMgn1ozWU7czPX2erC979KV3EIsSxy2a4r7yavkuK5c5k5CMADOLdgQrqeG4vfSucgx/meSv7H Ps0qybq5smuh60AdCxiQG1d4lV1vusXL8eTPMf/gEwxYlNtBArdUg4O0f1tX26z1j5Z8s1dKfdYt 99Vt4bY+FHeAaZModLZvqeGAC+h//zsVACDFBOQ2WUByMG2UBACEQx2IBGwEQAYXBSFoBB+YOF+0 BG1UOCeIYJ+mNYUXgyHCbMAmgMIWAKlWL0ywg4rEgvnDPEH4Ny44ScIDOVwTOUhYgsEzOMaUP0RI gkY4OGi0hLuTTOXDTqVmg+nWbJL2Upc3BBnoBJBUWx6oP150PC80QJikggUEOUfYOyc4E/aDgmp4 Rmxoh27IhpHjRVgYdWFoeIn2a114g8t0HLURT09gVnx2hp7UhsrzSWh4hUrIQi20RisoamHkSWBU Q7xDhZV4QwL0gcoEb0RXMcxEa6qYTwAXVqioBEu4gnWIOL+TTGsoh0pIil4VifwDif+WlIIheItw SIWbOGc1F1SD+G3JuFFSF2hEwCVUkAAgYIYiOIlVaDy0yIvDqI1M8IlMmIZBqI3ZOImUiEOl2Ivn iHGQt4VA5WvKOB+teG8zYgUFtx1AeIej6ITYiItEWIzL44RY2DFHmIlQKIqg2I9xKIVqOIfDx28M qFUdMlp+FWBqA3QZdG/fWG+WV2kIWCP+5kvNWHcBgCDzw1fd8R3R5n9NMI52yIJrJIkBmVMs2ZJn qJD/GIIjt1Xbd32ppyaOBUexFWKIhSbWJ3JvhIhR4lbpd5S1km8lEns52ZRmFoG2lQ9yw3BLGQBY 13g+d21e50+N93pQ6Su7tEqTInv/STdynhJ4Tqc9rhg6R/Z+WQZ1p4R+mzV0dKmB1Dg6GMBZbakf fTlxeslpyXZXgnV0xadLZXcntnJ3UcR+a9mYcveYb4eVlHeW6sd5ndN9rkRloQdtbLAah/l7UQSN ggeDBzGDzFgyDieWLbZ8jBl3URRwByZ2BphjtKmFmCeZs7l5qtd5nFl5+jaVjSgHHsBbY4dhEnIA H6B6LHZmAEhjF+aa1zWAIul5KAYqiOmaumcsyred4RWcu/diGreZ4umd8dcioPkGmBaUykk9FgBF KskMqslrqBVk9sd/iil+zjlk5eddkXlK/ulhAIqIo2eURrZlQraAWall8oeaBgIa/wMHaO6FS0Li AP1Xn6QUnR2Jgxt4TQqoZ1vzZkjnkAm2Wnr2kBFagNfnoYDSnB0xAt2UWNR3ZruGBvNZRu6YUk7j os+4ACRVhgfHeoXJVKvZjl5IiIJ4iEcwjzfFiNxHWRwKgSaFpN7Go+DGpEVAkioaBQOgGVrildW3 HatYpmYqGcFGVKyWio1Ro4qGbziqmnLKhUv6g0cgUyZqBb0xpFJapLt4pMu4UXS6bGl6gV0qBSdp jAjnpzlIqIG6oVb6hcHmg3lqBQrwAaySo5nCqAFIpZoIoexWlhQ5TA90kfvVqBrJVVRakfX3b8E2 hnvWbkQwj4NJeFOan/3VSjHXlf8t+ld7knFJOTpQeZRD6ZRA2XF08nGw1JAWelhSOX8NWASKyJPM CnNcCXFiaqOseXiztGjqaYry1mdbppbmY1jVmZbrxnTsgl7o6VCkV0dGh5dK95k7xJwsl0SaFa+U OXH3qqm9wqmpalxhGUGn+ZO3mZh+VJn4+prFsmj3lKuX2bCURpSk954SC361Sn8BAI0Ba2cMG3lv MKHQmpq3+qG9N5awt3qn+bGBppuTx7K5qbAhh5u+SbHGBbM1m7HRGgC0Sj/uF7GrpwznNbIEoaHb tq3NSp1wRnZrR3eax3vg+UfdKVvpKawgS7MpJn3Dmlm9mbXfGm5c2kfTCbTY5wb/H+OvTFKy2ae1 unqWNIpyAgp/EAeXmBW3VEagkImUZDd0F6SgOqmsfPtiACpWR+WR1fl+gNR0CgOq+2C083Cjdooq mkqiD0iDKxqifgai6XOwrSaBIipWePqnLioJG4O2BKK26Ga6GfWoONqjbsQaRnoGX6q6s+C4VRq7 cTqoWMq6j8sYPIiqaACktluDunamxnu8h8EYyLu8zNu8zvu8d6G80Du9tPYVJXW92Ju91mC92tu9 3vu9kMC94Du+5Fu+XSC+5pu+6ru+G8G+7vu+8KsE6Bu/9Fu/1zu/9pu/+lsZ+Lu//vu/TtG/ADzA BKwRAlzACJzA73DACtzADvwL/wz8wBI8wZsQwRR8wRicBxacwRzcwdfgwSAcwqhQYeDxdvYVYRXk cb+6dCsGfiy8IiYswjK8DGXAaLBCtRHWIjOWYXi0Y3k5IKO6wzM8xDTsT1FGrGp2YMI3lG9GdPVF Vy1beehDxFQ8CzW8ZD3XfDA8mm1ldPP6kcRyJanUYcYSb1V8xpxwxSjlZac4r5QCkrXCxeiSVwiV m68HTWicx+FrxF4cxuRasQaIsFayfXWbWkL8cLenx4rcB44QyOKWwxh0c7hiR4TFHw+YK/+mnyG3 yJx8BqnwbjgcV9rHdKo1LG4pKUnmmSCrJXjcya48Bhv8yrL8v7E8y7Zsv9Sby/+6rGQRuMu+/MvA HMyveEXCXMzGfMzIbBfSm8zMjBhw2rq3vLNXBEyiawYD4HLDO74VuLvRfAy+KxzVTCiNtcjbLKjK QpedCWQmdoqEhM7K8ieLC7xjII2WK4Pu7LY6oltCGX+tk8TIGM4ekil1BTr7BbGjQUsDnc1RilQB AFCdGi1geqjPpMMEs2AGbcn+Rk71LIPPHNDnrHWBaLNTkp5CibHvTEItsxkdKgYOLdFgM8gxLNJs sSbGh12uK8/Q7C8S184YSVw87JbZdsPwsjKGWqlYEM8b/Uwe17DrCJZtt1kjJtT/jNMenbags8Jd JaxsTEGawrjwKFR7utJdMKP/c3rVlzV718nOuSfVX427OX26iZIszbTWBFosdYwsmlO7ole4ST0F 1GzUKxXXEuvTlxN8n5eZqUy7xQnQ9nHSHqV+OmybktJXnIOUCk2cGjsEYdvXUdBInwqolt1hBppL TTl5r/IuU/3QVU0ubXZSsetQ6NPapOKhBVdZlzo7cuquc4xvsF3RUNTWjE283ezNaRoAJuTST3DN YfLZMlzOkDrcMXJAWdRT9QjYGezccdrMyLxpno3cTUDPIKPdZdrRjc275b2j9umjAQBMN/WlKs3c RYu65i3c6P3cwB258yIcN9XSqh3fACvWq02qdsPLrJoa85aRbh2rbmOPxU0E/+5EUkhN1ZLkNeEy Bi8IixyN4PbtOsfarKitkzuJoKLd29Ppqz0JyRS6rsnZz0RL3EoQn2Iwo/0Ni7r4hmd0i+V44Rq+ kkP4hFCYRnDY4J5a4ZkFr+IKVq1CRGKZsNKXf9p1rt6KfPhq5EdOlldFgaBBACPw3lvw18GN4fcj Rj/+jyio4+TtiGmEh4/4kp0k5NbdaqxsZxDGfobbw1Nr0RonxxZ7tRV6yefJ59Pn5i0HBt294yuZ 5p1IQMqUiTNEPLM4ingISuSopTNO5D4ksMWXw4hn50DLYpzrl52eSIEc6FrrcM6pswwuB6GrBbd9 4GYkiokujlxDSat7O4oO5P+yDunJ54xe6J5k+6CKF7RzDrjS+Zh7XrbXM7Yfi+yKeohextdWoNwC TuH7iI6cqJDGpKPU3o+6rkbYno5UeYy+hp9bu5u1dJeIq8lrnOJ2q+5JTqH511sfhuWP7AabTY/w 4+rUzokx9OP6g0lLczj46ONqvjy0bqd7V3gk1cpDntmvFKOPJk4HzacMnfBDUN1SAN7TvghYaOZn fga2eG6u7d3afqXmPN8ZLoBaeNxT4N4Gnq1venicfUwov1KRWqcMfcKSIFBSwN/6Dp2FCdviPfRt qncQRfRIjzEkTPJulPTBDIZd5eVOIONk6vSzNvKpW9Y13xE3nfO1aQRUvwT/Ui/NREpzCX679f3W SeqolI5Ag/YEhR7ui2r2Xx6D6TVf8Daqq/pVqirKz1zgYHxLwW1xS0fv3+jzItHqpJXCbkp4YWOu 6S64ze7DlEzRjtypSx3ZzSRsSunhyUpkb7tB5vr5+Sx6jaoGw/GT2PxWea3YqnDZxzZ1RW5fKNrD jL/4fpywPz+e7aX3kif67Gp88iWbmY6uvd/i0S3u0WN1nTcCF9BbUAL7CNFpggVkibfnvDxf/ol2 Dml2nvnHRzPqCIt30fTpk4nYt29yz/plfWlfLyfIyT/3Xyn7l+6xWNt8jgd6pazg4Y1irh3+QBAI jIRFInGIPI6YTOHSWTRK/5/V6fCpTDa1XGryGxZnjVwklnocjBRo5MBzJGPN5/IYn9fv+X17HzBQ cC+qrPDPTQlRDowO6qsQ0muLzqrJCi0M0TDqknHrMnMzMxGy1DHUk/TK8k+rEarT6fNusJaT9Yop Yy3TIoKxEyxUKtL2GDlwNJm5+bYut3bWFFaOtng0ePZxyppYU0x7ibJqGnTM9fp0WnH8O9qcVbaS cntxme/QLHpOOKBhwzprq245M3gQ30GFgGTtw4Qwyztjd8xVLCYomzsyr9TpSZhP47CHI21tK/Wq 4KCGkwh+AZGgiIAPAvK0MzZxYU5lOnli7NKIZE9sQj0SrWkUz8eeOBn+jP/0UcGHAUI0MGjGFClS pVlzrhzX0ihWrVzBkU1jdigyr7D2PKAQwK0zsWi70s06FyxRvEK38uyr8+/CvUk/btUwQarcwHbV Mg5buE5kyZMpV7Z8GXNmzZs5d/b8GXQyvKBJD3Ys+jTfwnRNA3a8WCFsg601rd5zoQOH2bJT++nt 9wy0oI9fF2fM+ypyoMLzSkkAIsAvxb/9Uu8a3GHzpcqZcUd9/LhyfSw/wjkQgIAHmt29W6fmfjdF UYRUEkb37NxIpbaPziknsb+i/IvlvXDywY8l/0rCjh7tojtjgQwORKc9+Pix8JjxiGFwOXkUKaeV ScTaxws7VHFwlad0+TD/opVaSicXFjUkMJs0gvNwwBJPtFE07MiTBokGTMRAgnnosclIDK9SMrkW RQSRo36kDElBpmJBUsYGk7poPpGqAcXHd0iJcqN+rnRyExMtkfJLh5hLySc0/RloCJmwW6MNYagE ik8mM/SzRy7VLFNLjn7ST5Rl5vHmxi4DJGfMdb6sREwT/elmyg8ZLSuihwz9r0xu0spw0EG9HEED V4bgRU94EgX0O1hVSqfUIyOVlEVdFLTxyR8d3VLXSLNkjsCzdFV1WDfzM3bNWtkSrthRF+RV0CMp QPaCC1rt81NZS/J2VvzWnDTYOa+BMRwR2QkRE0WrRTbTDddl9pSLkk1l/156cx1XT3XplDbcAcsl QoGJ5ADB3BR5BBcjhpXhb1FmjeyiUThBrEdUSpfllM0VQ+10GIN5XMTMI00SM8VzgTTZHYPFg1iR BEhOQqo5OwTYYQFzJoS/6QrskyJt3OCSoSbjsYhotUJCOmlSTw1mYacfLSLbtt7COWVbQuAjhK27 3joAr8PmmoqvxwZWELDz6DpstoUQW2084n6b7bmjvg8t2gQzzq4KA5Ya7SKe6yODBf4Ow223zz5b 8cTNVrtuyM0ue/Kv7f5ZisYTLwJsx+muO3OvJVf889EvlzZBv5vimzXWzdL77tSpMK8PATwgIE4x 4F68c7HH7pxx0n3//f9tzi2H/HO8vxied7qDL773uYf3PfrJi2/79Ke+KY377r3/Hvzwxe8sUFw4 Gb+yMYDfnHPG3Qe9+s2Bvx560RfnOHP654fe+d93L11+14tb79p2v6gRizWqaxh4GJjA8oGpYv8I iCA44ICHye1x9CPeBh9nvfxx0HiWSx7pMBfC9t2PetHD3unWJ8DjmZCEo0Jg3hS4kwa2rm8vO1/F ZLKeQKTHhzxTHwel977kEVGEIJTbBpVXtuYZMIVHnN4LlThE5klihxcizg3z5jqywE6G2TlDVY4R odWpj4BFLGD/WrhCzwmvgJJbo4F0hzwosnF+U0xi5NoHOuPNEYue0iL/vXxDIZ2hTUUJctB+ChKt 4QxSYjdSpHa2wiFUoAtwpkJCXOiYBwo8oGl3y4kKl7e2ONYPkIRUCClLacXpxTF7YdJkrio2saFB cFc3E8j5WvSi2HlsOf7qCCZLRUsdxYOQh8BRMD2xI6ydEUwXiUqSikkGPBlKXTsrpDZrEsFGZUlS z/JSleDVil2KMTsxahehFkWedArylk/biDBx4ixwthNfkwSjuNo1gAzcUz7P+icttMdN+hjUPv05 EUHN2aByAi2eJgOVOCuFDW/ialiQitGlLtavj6HMUii5pUdFkrFcXrAm2VqowoZVtYfuU1Y1pM5o GspQXO2qW8ZS0702/7QxeIpUaJdUpj7fdRae9queRR3Yf3pVKR3WBDoZtdeU/HmThiK0iVgVZVlk pKpwIjNrgionUsejpZ+yNF5lVUc1jZrWdpj1p149aqfW+tQxrOE8XTXFPUfwAa9aTKuPxCpNS/ZX WzoCHvdQWJsSoSmRpUWummrsPGcWULF+DGMaTexiGftWewQScGKwAIfAuks3XCuCEA0sirRJ2Pj8 DKZBe5VIWdvNcTJNsH5YGtRUGa6K8BawusUDQFTnhMI1LbaAkulvXPvF5U6ob17kSmyx0kOZ2g53 6Vot/rbb3Ok+96DR5aJzH/gFMi7XAbrR7nZ7G1jv3gW8h+zieL9bXv8pcPK5FVwveyGJ0NGgD8AB FvCACcw9+wohKlOBYIGT66f4vqZn9aXvdKUL3wP7Eya5ZYYZQcvf2ubsvVp5cODmK14HKu0LVetv Mz7ZYf6OOIfy7WTRDDm1TiYSQDbmFI6tSmLlDbWiPr6xJCViVyEMLpTcPegAPtCGZ7rXwyeNpMDa JVUs5VKZNZVlL9P0Sy3z8hxdluFlmWmPjoTVUdQ85jCNTDuiUZPM27qyaqEcZcJ+s6ZTGiefrPrN oJpZlpWNp2Tb5E6iliug+PSKmPnFJkXP+ckgkYJ0dIpodjqFoJaKsoa56VqL2PNQaD0pUDGq5yCD TFiZMvVjQTZWin3/NKmGOOuzJGtSOktaCADZMdRcfbEU/TO4WoXxiUm8LX4dqsf7ClZHKfajQzca U7R29qmH1muhNpvR1a6WtFPh01sLMQA9xJ+xmV3uYkxTynX28J1Ltu2E/RWn8Z4rXQlSK2ufid6C VrZEhZpvjim7W/hWhWJRHAAycrXdU2XLnrEgAQykW9ib9jShl2mzLMMJrHoVB2VhS1uNTzZkgmb4 OSf72Y5zNmKetTV1icDJXRMqzlHK8nEbzKRh01DGB0Yzio8GXE57hEq4/bAhfxvRn9u26B5/WYKz yp6yYLfmSrr56yJs4QnfpcIi7lEGMjxjpERgtFN/ncSrrvWrj+XsM3p52QV0TBQORB1DYpewkLdo Yhzaneo6b69QCAB3C8kdvgwW/OAJX3jB98jwiVf84gcfBAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0671_image084.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwI/AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0671_image085.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6AEYAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADm ARUBggAAAAAAAABm/wDMzAD//wECAwECAwECAwP/CKrU/jDKSau9OOvNu/9gKI5kaZ5oWi0so75w LM90bd94freAE/zAoHBILBqPyKRyyWw6n9CodEqtWq/YrHaLbLC8QJ54TC6bz+i0es1uu9/wuHxO r9vv+Pw84HX99ICBgoOEhYaHiImKiH0Ef4uQkZKTlJWWl5gLDXyOAZmfoKGio6SldpubpqqrrK2u r4GOqbC0tba3uKKyjrm9vr/AwXG7nsLGx8jJtcTKzc7P0JLM0dTV1tdv09jb3N3W2t7h4uO+4OTn 6Omk5urt7u+K7PDz9PV08vb5+vtj+Pz/AOn5C0iwILmBBhMq/Map2MKHEKshjEixYq6JFjNqZIVx /6PHj586ghxJEpLIkihTCjqpsqXLOSxfypyZJibNmzi/NMzJs+eZVLx8Ch3qp0dQokhxEgBQ7GjS py43Ne0DtSpJB0xZcNLBtavXr2DDih1LtpNDBUDKql3Ltq3bt3A/CBnDpa7du3jz6t3Lt6/fv3ut Ch5MuLDhw4gTK17MuLHjx5AjS55MubLly5gza97MubPnz6BDix5NurTp06hTq17NurXr17Bjy55N u7bt27hz697Nu7fv38CDCx9OvLjx48iTK1/OvLnz59CjS59Ovbr169iza9/Ovbv37+DDix9Pvrz5 8+jTq1/Pvr379/Djy59Pv779+/jz69/Pv7////8ABijggAQWaOCBCCao4IIMNujggxBGKOGEFFZo 4YUYZqjhhhx26OGHIIYo4ogklmjiiSimqOKKLLbo4oswPiZAjCTNSCNIAth440Y57uhRjz5qJMAA OgZJ0ZBFGrlPjkw22SSRSv4z5ABUVmlllUlGWc+UV3ZJZZZawsOll1eCGaY7Y5KJ5Zn2pKnml2zS 4+abZsZ5zpxq1mnnOHiSqeee4fTp5Z+AdiNol4QWus2hZSqqDqNrOpoOpHBKig6lUFp6p5Oc5pip pvkgCao+oo7aZqKmkgNkqnKiymqgrr5qqKxy0mrrrbjmquuuvPbq66/ABivssMQWa+yxyCar7LLF zDbr7LPQRivttNRWa+212Gar7bbcduvtt+CGK+645JZr7rnopqvuuuy26+678MYr77z01mvvvfjm q+++/Pbr778AByzwwAQXbPDBCCes8MIMN+zwwxBHLPHEFFds8cVsrIoxGRpvLEbHHrdQasg8jEwy CyafrEDKEXfaaaUTYxprwTJXjOmnLb+JKMU3zzxwzzzrvLPEQMcstJU+C1w00UdHynTTSSvdNM45 Q22xy05SrTLLJ3NNstchg7x11BCL3bVvCQAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0697.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
42
入院= 梵H事療養費
１= D食事の費用の算定単位の見直し２= D特別食加算の見直し３= D特別管理加算の見直し４= D選択メニュー加算の廃止
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0697_image086.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhkgF8AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0697_image087.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0698.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
43
入院時食事療養費
１．食事の費用の算定= P位の見直し
　※　１日単位→１食単位　　
（現行）
１）入院時食事療養（T）：１，９２０円（= P日につき）
２）入院時食事療養（U）：１，５２０円（= P日につき）
　　　　　患者一部負= 担金：　　７８０円（１日につき）
（改定） =
１）入院時食事療養（T）：　　６４０円（= １食につき）
２）入院時食事療養（U）：　　５０６円（= １食につき）
　　　　　患者一部負= 担金：　　２６０円（１食につき）
(p.523〜530)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0698_image088.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhqgFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0698_image089.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6AEdAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0699.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
44
入院時食事療養費
２．特別食加算の見直し
 １）１日単位→１食単位 =
　　 特別食加算：３５０円（１= につき）⇒ ７６円（１食につき） = ;
 ２）対象の見直し
　　「経管栄養のための濃厚流= ｮ食」を除外
３．特別管理<= /u>加算の見直し
 １）適時・適温の食事提供
　　 入院時食事療養（T）の算= 阯v件とする
 ２）常勤の管理栄養士配置の要件 = ;
　　 栄養管理実施加算（１日に= ﾂき）：１２点（新設）
　　 特別管理加算（１日につき）    ：２００円（廃止）= 3;
４．選択メニュー<= /b>加算の廃止<= /u>
 １）選択メニュー加算（１日につき）= ：５０円（廃止）
 ２）特別メニューの食事の取扱いを弾= 力化（患者負担）　
=
(p.523〜530)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0699_image090.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCwI3AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0699_image091.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0558.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
45
医学管理等
１．名称変更「指導料」を= 「管理料」に
２．診療情報提供料の簡素= 化、セカンド・オピニオンの推進
３．生活習慣病指導管理料= の見直し
４．ニコチン依存症指導管= 理料の新設
５= D手術前医学管理料・手術後医学管理料の評価の見直し６．地域連携クリティカル= パスの活用
７．その他の指導管理等に= 係る技術の評価
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0558_image092.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5AHkAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0558_image093.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0542.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
46
医学管理等
１．名称変更「指導料= vを「管理料」に
　※　国民が理解できる診療= 酬体系
　※　= 日医 社会保険診療報酬検討委員会からの提言
１）指導管理等 ⇒ 医学管理等
２）特定疾患療養指導料 ⇒ 特定疾患療養管理料
= 　「治療計画に基づき療養上必要な指導を行った場合に、月２回に限り算定する」
　　　　　　　　　　　　　　　　　　↓
= 　「治療計画に基づき療養上必要な管理を行った場合に、月２回に限り算定する」&#= 13;
３）生活習慣病指導管理料 ⇒ 生活習慣病管理料
        = ;            &n= bsp;  
        = ;            &n= bsp;  
(p.69、82)
(p.75、94)
(p.69〜)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0542_image094.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7QFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0542_image095.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhEQItAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALBAAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0543.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
47
医学管理等
２．診療情報提供料の= ﾈ素化、= セカ= 塔h・オピニオンの推進
　※　患者の視点の重視
（現行）
１）診療情報提供料（Ａ）診療所→診療所、病院→病院等：２= ２０点
２）診療情報提供料（Ｂ）診療所→病院、病院→診療所等：２= ９０点
　　　逆紹介加算：２３０点
３）診療情報提供料（Ｃ）病院−診療所（退院時）等：５００= 点
　　　逆紹介加算：２０点
４）診療情報提供料（Ｄ）特定機能病院等から：５２０点 = ;
（新体系）
１）診療情報提供料（T）：２５０点
　　　退院時に診療情報提供書に退院後の治療計画、検査結果、画像の写等= を添付した場合の加算：２００点
２）診療情報提供料（U）：５００点
　　　セカンドオピニオンの評価（新設）
(p.80、100)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0543_image096.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0543_image097.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7gFRAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAcAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0543_image098.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhOgAXAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAUAAQAw ABUAgQAAAABm/wDMzAECAwJhhI8Wy+3PkpwyiIuz3iLQP1ncuHngqZAqZqKguJKtS8ExN9PVLeuf zcvkfAdg8DIkAozHJJEZdPqgPKmOerPSsDGti7vyQh7H0rhRbJSj6BdjbV4oFepse157C+/4K19Z AAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0544.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
48
医学管理等
３．生活習慣病指導管= 摎ｿの見直し
　※　生活習慣病等の重症化= \防
１）服薬よりも運動習慣の徹底、食生活の改= Pを基本とする
　◎生活習慣病管理料
　　・処方せんを交付する場合= 3;
　　　　イ 高脂血症：１，０５０点 = ⇒ 　  ９００点（△１５０点）
　　　　ロ 高血圧症：１，１００点 = ⇒   　９５０点（△１５０点）= 3;
　　　　ハ 糖尿病　：１，２００点 = ⇒ １，０５０点（△１５０点= ）
　　・処方せんを交付しない場合&= #13;
　　　　イ 高脂血症：１，５５０点 = ⇒ １，４６０点（△９０点）=
　　　　ロ 高血圧症：１，４００点 = ⇒ １，３１０点（△９０点）=
　　　　ハ 糖尿病　：１，６５０点 = ⇒ １，５６０点（△９０点）=
２）療養計画書の様式変更
　　 ※　達成すべき目標や具体的な改善項目を明確にするために
　　　
(p.75、94)
(p.606)=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0544_image099.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgJBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0544_image100.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9wFTAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALA8AAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0548.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
49
医学管理等
４．ニコチン依存症指= ｱ管理料の新設
　※　生活習慣病等の重症化= \防
◎ニコチン依存症指導管理料&= #13;
　　初回　　　：２３０点
　　２〜４回目：１８４点（２週目、４週目= A８週目）
　　５回目　　：１８０点（１２週目） =
　対象者：スクリーニングテスト（ＴＤＳ）等でニコチン依存= 症と診断された
　　　　　者で、ブリンクマン指数200以上で、直ちに禁煙治= ﾃを希望する者
　・「禁煙治療のための標準手順書」（日本循環器学会、日本肺癌学会、日本癌学会）に則る
　・禁煙の成功率を地方社会保険事務局長へ報告 =
　・禁煙治療の経験を有する医師１名以上勤務
　・禁煙治療に係る専任の看護職員を１名以上配置
　・呼気一酸化炭素濃度測定器を備えている
　・医療機関の構内が禁煙　　　等
(p.75、95、477、49= 0)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0548_image101.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhfwFBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0548_image102.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/gFPAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0554.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
50
医学管理等
= ５．手術前医学管理料・手術後医学管理料の評価の見直し
　※　検体検査料、薬剤料の実勢価格に基づく点数の見直しに　　伴= い、検査料・薬剤料を包括する点数の見直し
１）手術前医学管理料= ：１，３１０点 ⇒ １，１９２点（△１１= ８点） =
２）手術後医学管理料= =
　　　　病　<= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";font-size:110%;text-shadow:none'>  院    ：１= ，３４０点 ⇒ １，１８８点（△１５= ２点） =
　　　　診 療 所    ：１= ，１９０点 ⇒ １，０５６点（△１３= ４点） =
　 ※　同一の手術について= 、同一月に手術前医学管理料を算定する =
　　 場合は、手術後医学管= 理料を算定する３日間は、９５／１００ =
　　 に相当する点数を算定= する。
(p.75、77)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0554_image103.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgJGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0554_image104.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+AETAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALA8AAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0545.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
51
医学管理等
６．地域連携クリティ= Jルパスの活用
　※　地域における疾患ごと= ﾌ医療機関の連携体制を評価
１）地域連携診療計画管理料= i入院時）　　　：１，５００点（新設）
２）地域連携診療計画退院時= w導料（退院時）：１，５００点（新設）
［対象疾患］
　大腿骨頸部骨折の患者=
　= 　　※ 大腿骨頸部骨折骨接合術、大腿骨頸部骨折人工骨頭置換術等を実施
 [算定要件]
<= span style=3D'mso-spacerun:yes'>  ・ 複数の連携医療機関間で共有する疾患ごとの地域連携パス= 現に有し、
     その具体的および実施例数を地方社会保険事務局長に事前に届出
    ・ １種類の地域連携パスにつき、複数の医療機関と連携　　等　　
(p.79、98、478、49= 2)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0545_image105.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCQJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0545_image106.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAgI0AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALA8AAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0702.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
52
医学管理等
７．その他の指導管理= 凾ﾉ係る技術の評価
　※　医療技術に係る評価
１）ウイルス疾患指導料に加= Z：２２０点（新設）
　「ロ」後天性免疫不全症群等に対する加算&= #13;
　　・専任医師、専従看= 護師、専任薬剤師、社会福祉士（または精神保健福祉士）の配置
　　・= プライバシーの保護に配慮した診察室、相談室が準備
２）特定薬剤治療管理料（適応拡大）　　・= 躁うつ病または躁病：バルプロ酸ナトリウム、カルバマゼピン =
    ・= 関節リウマチ　　　：タクロリムス水和物&#= 13;
３）喘息治療管理料に加算（= V設）
　 １月目：２，５２５点、２月目以降６月目まで：１，９７５点
　　・= ２０歳以上の重度喘息患者に対する治療管理の評価
　　　（ピークフローメーター・１秒量等計測器を用いて検査値等を毎日計= 測させ、週１回以上報告させた上で指導等）
　
(p.69、83、477= 、490)
(p.83)<= /div>
(p.73、91、477、49= 0)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0702_image107.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhwgFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0702_image108.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9QFYAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALA0AAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0546.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
53
在宅
１．在宅療養支援診療所の= 設置
２．入院から在宅への円滑= な移行の促進
３．２４時間対応体制の評= 価の見直し
４．患者の重症度等を反映= した訪問看護の評価見直し
５．ターミナルケアおよび= 看取りの評価の見直し
６．施設入所者の終末期に= おける訪問診療・訪問看護の見直し
７= D在宅療養指導管理材料加算の項の新設
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0546_image109.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wHLAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0546_image110.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0573.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
54
在宅
１．在宅療養支援診療= 鰍ﾌ設置
　※　在宅医療= ﾌ中心的役割を担う診療所
　（患者からの連絡を一元的に受け、患= ﾒへの診療情報を集約する等）
◎要件
１）２４時間連絡を受ける医師または看護職員を配置し、連絡先を文書で= ｳ家に提供
２）２４時間往診が可能な体制を確保し、往診担当医の氏名、担当日等を= ｶ書で患家に提供（他の保険医との連携も可）
３）２４時間訪問看護の提供が可能な体制を確保= ｵ、担当職員の氏名、担当日等を文書で患家に提供（他の保険医療機関、訪問看護ス= テーション等との連携も可）
４）在宅療養患者の緊急入院の受入れ体制= 確保（他の保険医療機関と= ﾌ連携も可）
５）地域において他の保健医療・福祉サービスとの連携= ｲ整を担当する者との連携
６）看取り数の報告　等<= /div>
(p.113、477、491)<= /b>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0573_image111.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0573_image112.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6AFSAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0574.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
55
在宅療養支援診療所とその他の保険= 医療機関での評価の比較
○（U）
○（T）
退院時
（T）６００
（U）１４０
寝たきり老人退院時共同指導料
○（U）
○（T）
退院時
（T）２９０
（U）３６０
　退院時共同指導加算 <= /div>
○
◎
○（U）
○（T）
入院中
（T）３１０
（U）１４０
在宅患者入院共同指導料
○
○
退院時
１５０
退院時共同指導料
−
−
○
○
退院時
３００
退院指導料
その他の
保= ｯ医療機関
在宅療養
支援診療所
病院
診療所
現行点数
項目
改正
現行
注）　 「= 掾vはその他の保険医療機関より高い評価となるもの、「○」は現行並の評価となる= もの、
　　　 「= ~」は算定できないもの、「−」は廃止となるもの。
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0574.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0574_image113.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh4QDfAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0574_image114.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhBAL5AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAC AvcAgAAAAP///wL/hI+py+0Po5y02ouzBqH7D4biSJbmiabqyrbuC8fiRtf2jef6/nT8D0wEgsSi UTg8KpfMphPhe0ohyan1isRqt1xrtOsFi5XfsfmMrpTTxyr7vVnD5/SuvL5z4/eOO/8PCOQXGEdo aDB4qLgokcg4ofdI5yhZ+Uhp2RCZmYbJ+cnnCXqwOSomapqKhjpaqrrF+ioL6zrLYXtai7urFfup y8vkG0xMNJwJXGx0rNyMw1yZ7CwoPW2dAy1ZfY29zf2dkX0JviROfq5gvuiNHs7eDr+grvgeTzFv /41vWJ8fse9vGsBA/QL2kYEwocKFDBs6fJjCWUGDDCBavIgxo8aN/xw7evwIMqQMipooTrxxEluo SwODpdz1kkZMGzOFsaypDOcrnRd4hlvJyAPJiiax+MRw1NjNofKKXklqAaqgpUyFOA0DC+i6lryk cvJKhQvYPFSrkro6Zew/rfS4wkQrRW3YPXKXucVVN6hRsWwPCTV71mDedHzplgU8mN7erIaD3rWV 2O/iXn35PZ4Vmd/kzZMOm81MCPQtxnhE6/gLeHRA0aYRVQ59WVbr101mz1bjuert0pyx8na8W7Lg 3mlpA0KNGO4T28b/IP+s3AnzxluDax7+tPDv6qldY/dN/I31OLF3Rq+tvc54Dc91n7dJWn1upuvF h1/ePFR5VfXZsP9O3xlw3anmz3/xBchdd/11cp90+dG1XyoLrtIgetS1NeF2BVYIn4Z+RWhKhmYY SNmFH4qI4IbZHTgHio2A2Mp75QDY4nxDuQgGiRyOaCNJONqxIxkPlgYjKD/S6CCLcBx5EJMUflec kvYJqKCMQkrpX49WkqPjih5a5uQZYXoZZYlfwjbmGGmWySaZKZ444JpxBdnGkOoV+cuWyyA5ZYKp yYmfm+C9CaZIhh6KaKKKLspoo466EKeJbQZqpnxU/inpnIJOuqSWUNZYqaahgupncmdSyqmolpYK 3alJDgprp5eauuqmFo4qK6vuuXprqqgSimakvHbo66u1wlnlsDP/2vorqRgKe2yxV+La57PJRqtq trFWiyymyk4rLbHAEoTnV5k2ayyzDM7aKrbo9qruk7rSd26679677rw31gsvvv3maq237tpLsLYA d0vruAWLu22W7O468L8S+yump6vxy/DCGsuL4aMefwxyyCKrYOck5SKD8bINb1zxw/R+W2e8GXML JrQKT6wynTlarGLEM//MMo8u7wvznjLnfLN+gPKZ79FFTFd0iydb8mNrXa7MMcLtJo00xV0fXPO1 XINrcNkO6+tjymR7vTbYwYrtLNYxU3t2wAnHHa7RdDetNcRjz5132zS/LfDfegcOuOFSL41l1ogH AbXPEDK+d8s6/0/VuOOE3+0220plbrndW+Nt9tela04u5ZeDLjjQOKN+3NTRqJ2454crvqTs2tB+ u+1Pl7y4zaT7/kPkuIun+zhRfy636XX3/bLkrTsftJo851M1679rf8r19mRfee2PAzl02stDvjr6 vAcPd+fVM59++ESq7vTO8m9/f/fl66l//KcxzbewFW5471Nf/uyHNv4hsH4G9B8Dc0e/5vXvgcUD IOycM7IManCDHOygBz8oPPe9TnynCx30iCY9ErpuhUJL4KdEyEL8OVCCJovg+LgnwxJS74JKC+Hg iMcD4xEQgzbU4QRp2EAK4hCCPnzeDYNoQRMKkHM/LCDmDkg+F/9e7HxXfGIXj+ef5OmFixVU4heH 2MP2VXGEvfPiDNUkxnWsD35GVGEANzc6GO7Qjmy03v5euMYY0hGJWRSd39C4xzbWcYEnNF8KFSlI SN4xdU2cpBXLiMUozq+SPExkDgmpyTsVEYhvfEYpTTlH5I3ykpk8IytdGcjJcVKKi4QlKU9phzgq hoxQNCMmH8m+AepxesSMZCEbqcBjulElSwxlDWfZQl8ys5XUXIUuhQPMQb7yl2DsxDWvk80k3rKX vBTTN0OTSlt6ko+0pKQanVhLboKymWFcZR8ZuUxUVlOaIzonQdIpz22SM5z1hKYfcVkIeu6zn/Y0 pkIHGk9xDlP/lAY9Yj5R4kx84vGQE5VkMdepUXcKM5Yf/eRFI+rNhoI0o9q8p0fbGTuVljSkAtUn Qh1a0Hda0qXq5ClLVVlRmvoUovNcKBw/iNSkKnWpJgAeE3XayZlKFKU37YU/jwNQotb0f1k1p0zZ eVB+YvShYs3FV18a1qJy1ahU9WpQldlWm5Z1nAx96097ClapwlWkVIQnXcfK1r+a1a5kXetJ5YrI TUIVpkMlS2EPm8uzmtSvW6XJXQMbWcJitgZXg2xjrSnZlu4Up47dLGlBq9mqske1q+1qXRcbTbVO k7VopShs0+rZ1pp2pUC9rUXjCljaTjamqZ2rZY173HK+dqSU//3sbJF7Wrf6VqjRRWxueZtT5o4W u6UVrmiJWFzZGha4z02sbbUb1bx+17niPWp4r6tb+Ma3m6id7l4ry9nLenc5V3WOa8uL3+DSV7ro ZWx1Bdxe8uaov059rHXZO17zPtO++u2ughHc0WD2dbt6DeiFITxYCjsYwyB+cHPTWODYyjcqFU7w gkM7VQ6rN8YBLnFmRbzb+QrWxDKecIpx+2Edr3i44MXxfu9xZCT/N8Q//u2OZdLiIceFwUuuMZSh e2XlutfIWBayjZNL0JS+N8gJdTGJTyxLLps5v132Mprnx9Q4y3nOGWxwdjec3tqu98BkNgqVtfxk Nq9Z0GGub/+TqcvdCEuZxijGs4ETDeA+z/iph77vl91sZUgv19EqljSLR5xpP8MYr0AONKYvrekt VzrKPO4wox+t2FWDmtCeRoqdxazmRSt50FkuNIE5XepQ94TVprbqqD3cYyK7mtTBLrKsc/yTNkcb 0C8ec7FPPek9d5qveSRptrVaa22fF9hOFvanoa1nDXf7zd+2MK+XbWhyIxrekb52u+O97mSLe9/p tnSj851nZd8b3Oz2sbz9nWowS1vgsT44sRVu72n7etMAh/XAW83niKflzxMPN24WPuwq3/jZSW5E yU0ucrFwfMC6hsTJ15JyWhyb4AHnN7Mv3nJhrFzCCKc3xhOGrvEpz9zd3u43ss3N8HFXfNtI3/XL 6+1sh8+61x7/OLVHLnV0h/zd2GZ61Jfe7IxTnetGvzPYy41qW08d6Fg/+7xxDvGcE53bHC160m2O 97WL2tpNt7rcYX51lQ9d0QW/+6vZnvan7DzDD6d10M/dcSZn/el9oHzlY25sOmt+85zvvOczUgAA Ow== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0684.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
56
在宅療養支援診療所とその他の保険= 医療機関での評価の比較
注）　 「= 掾vはその他の保険医療機関より高い評価となるもの、「○」は現行並の評価となる= もの、
　　　 「= ~」は算定できないもの。
○
◎
○
○
１回につき
（時間内）３２５
（夜間）６５０
（深夜）１,３００ <= /div>
　緊急往診加算
　（時間内、夜間、深夜）= <= /div>
○
○
○
○
３０分ごと
１００
　診療時間加算 <= /div>
○
○
○
○
死亡日
２００
　死亡診断加算 <= /div>
○
○
○
○
１回につき
６５０
往診料
○
○
○
○
月１回
３００
訪問看護指示料
○
○
○
○
死亡日
２００
　死亡診断加算 <= /div>
○
◎
○
○
死亡日
１,２００
　在宅ターミナルケア加算= <= /div>
○
○
○
○
３０分ごと
１００
　診療時間加算 <= /div>
○
○
○
○
１日につき
８３０
在宅患者訪問診療料
×
○
×
×
　＊特定施設入居者生活介護の指= 閧受けているケアハウスや有料老人ホームの入居者で末期= ﾌ悪性腫瘍の者 <= /span>
×
○
×
×
　＊特別養護老人ホームの入所者= ﾅ末期の悪性腫瘍の者 <= /div>
その他の
保険医療機関 <= /div>
在宅療養
支援診療所
病院
診療所
現行点数
項目
改正
現行
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0684.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0684_image115.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhEAIqAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAO AigBgAAAAP///wL/hI+py+0Po5y02ouz3hyED4biSJbmiabqyrbuC8dsR9f2jef6zitfD3QEgsQi bWhMKpfMZvPn5CGj1OW0is1qt9Yrd+P9ijnhsfmMTkPTljL7zXDD5/R6bm0X5vcevv8P+IAXaCBH +GV4qLg4NkiYyFgFGUlZ2RU5aWmlydl5yZjpSRQqWmpK4RhIeqqzyvoKW+j6NhvbUWuby5kKiKuL 4fsrrMj7Fzw8cYy8vFfsp8ysFz3d6cwHTe2TvU1p3cx9gw0+Lim+Zc6NTr6u5J2nng3PPg/kbic/ jU+/j2Nfp89MhsCBBAsaPIgwocKFDBs6fAgxosSJFCtavIgxo4h2/6PgACwCgl+Nj+tIIiBp8pYq fyIFtezHMUhKMitnRrO5zSZKjzVf0vQ5MmY9nr1YAtV2VGWSnbR6Jr2AM57QHlGBOX1aoWq+qVKI GjOKtU/YDDo7Ni2qVVjagFx3rEV1dWyEt8jKyvT6DCxWusPsDj37lW8swb/8UsV7Te9TwroMdwWc lzErybYcu0XcTHFSyoPbtsL8TvNRzrAsf4acmLQo1ZM93wF9TzRQ1qdMv0admfYuuVaXmmWje65s n8FXu4aJO3TxSsurHQ8H+9/wl813+76bPHZ1ULyhPrdRfPuCkN0hiGf+PWh26ecPtceU/kh0OuTL S7MvwTZy4HHxI//1b158SvGHlkYGHohgggouyGCDDsoAYBzWrXcZdgQGFuF4E14I0m9q9JehWJYs px90FM5RX4iFbPjhdX9xmJqKJ7GIRongzYfidC29lx+KAv4EY24yHsDjXD66eNiJHukoUpEB4njb iy1iOKSI6EG5X5JBKlelld0caQRTW2rXpZMuYWmilDWCmKGZ9435mJpnOJmiim42QOKPYKCpBpP8 3Ckhn+rJaQadfu4DqIaCymfhlJGVSeOcemoQHpsRJvofnBUS2oilAGKaQJ5Ixuloag+eimqqqq7K aqsJQqqJqGF6uCZasI4IZoeN1krlkKDOuOiAWpYqZJW/EpkrrZv/EsulsZEWOilZwTZyKD3Hrjjt nrtKaquzsSa77Wma5njtuKqAy2mWvD7qLa7ZUqostN36+mynoy67boztXqmkuvhy26uM5cqqa7qI eOrfwOgOS2q+xdL77bvShmtvwHbWK4aNgzJL5r5fStybwVwYWi7HxCzc8L/yWhyiwiB7R3HGCOPn cr9pMgwwuxC7a/ONMR88r8AYAz3rzyPPbF/N5vorrsn0VTuP0k43nfLKOgsdcc8bV13x1RdnvfTN XMsc9Nc8h+2zyOcgXZ7UDqvNKNo1Qs2O2znHG+XUS5b89iIE48101/ruzK/cceNs9eBYn6134I4T 7XXLQx99L9V3/z+8eOGNi62y4JibrXnfY3Oe+OeSg7152oh73izhH2t9+OiUs9zm5GtXnrfoT/N9 OXcvtwE45IqD/rrhwsp+O+2X2q6FxrH33rHr8P2eVfCzR1476rpbzj3r0WdefOpbd0628p8yn4Xz x0PP3q2hs08+6d637/H0sK/fffnYL689/PnLrz9TuWqABCygAQ+IwAe5L3zby138rje80zGugY9T HQWBQ7eSoA8L6gOS+OaUQXLYrXRww9/8drdA+xnPg8hrHtu6M8IT/s+C/ttbCn13PxY+MHn7O1// SLi6CvIwgtmbYA2F+Dwg0k96OFyhtkrIwRfyJoYBNNr4lIjC+v818YMmRGL6pCgXKgrPikmUoQ21 6DeU7bCMVWwd+FTIRR3OcIimK+L7sDhHNo7RjcSD4wVpmMcvlk2CdzSjF+VoSAwmcJGMbKQjHwlJ E9wwjdSDCxkFab6EbVAS0QpZHDMWwnGIEYKXRGQbv9fHLf7xig7E4xmZSMkcPjGIe0QlIRl4RADq kpR8vKUfcwnIViayT7xzZS/UGEhT1nKJb1QlMFl5SE4O0o64NOYuobnMLMLyZJVMhvXo2Etq/tKa wYwmFUg2SW7KEl6llGYmabbJc3YSZk5ERCjBMUpw0rKc2SRXOt2DTGGaMwroRKM66zkxKLqzh5r8 4TCxyU9eaif/khStqEUvitGL/PMRAR2oJ1cJwmI+9Bvd7FE75TlN/hmRnBBtqQtT6sOVjrSL13zp O5MWT4LOE3jrHNk905FTJ3RwliAt1E9zEtQn7LR6PT3HUaXi0FO2kKYSZWYqY4nQj64RkwyFZ1T7 KdCacpWIKi2kVLeqzKpqs5lY/SQ7FYrSm7YtqUwY6lvd6lORnpWjJTXSSXUK04bKdK9hjag+repL Z7JUj4a1aVdx+lW1JpOozwzpRs/V1yfBFbCByahnPwva0IqWBJc9ZmbPtFmhgnEs+XTsNxl72LVe 9aB41epk4/rYuUY2trdNaG2b91RqtHasf7XtTKmlV7Catqn0/9wnb1/JVtoWNa0uJW44y1rN41K2 t6oNrFcHq1yxUte1dcTuOLV716lG0buQBa9kC1vd9coVhnTdBO48qlT26ta9z8UvT7MK3OS+d7kA /q9zyXvdmJo1vI2lan8VWVpjdFS820VvXiP8jAk3eLzWnehoPwziEIt4gBi+hobjW2HC0iK4W9kt gg/s4BcjVpyKtbBx/Wvf+U6xvku9MYVxS1YFZ1fFP/btdEEp4Adn+LRvUu9CgyzYBQ+4yD6eMjFL TFLmGtjJQC6vkM9L5A2nmMFzS7KMAcpkPL22wzM2b43DjOL0VtaoZmYzmrXM1NTmV8dh5PF90Tpm K5cZy+84Mf9sD21nfxr0zgXOM4zlm1v6ujjR8EU0pKH8XSkrOc5GnjNyCX0PQ8d41JfOzYhPjepU q7oioP6HqDkM6yd7OcpDJrOlA71pyy6ar3i2pJ7rutqwDLfUv3b0ke1ZZ2K39did5u6eI73jSSub y822cYBbTZ9X4/rWXU4wrcFsa1Jvm9IrTras3xzuWMt5sXTGtrafvWZ1cxbafZb2uR897mnLNrHL 9nS+/91tW9K43+yWd5Vz3e5dY7bX3iwuvGed6VoLmtvVhrOut8no324Z0AFv85fRPXFxr9va6WPx TfxctJTju+O7W7XLXw7zmLegSzQPVY8b3uhymLvmZ3b2xgv/jmSe89yuFU930IVOc6IfvOfQRXp0 OV70kH/a6QrHsa81zkGTU30ZSm8us526860/vNhX//q1xT5bqC+d3BBGO7+pvXZ9K9rtbl551BE+ dbp/3O5xv7fH9c7am5s05+fUOuA782cxs3zuh99vwfg+doE3XtiC9yvhCWr4ydem8prFus417/h4 A3zemAY9dTiPWs8XPuym9/ndKd5dPre+bqhvsr+RPfvAJ57Tsad37kVYezUzHPOs/z3vR9/3xTfd +KffPewj/3fmRy34gbq8UGWO/exr/+Xf5vXCHw936O+73iDPtvNFTnqIb0bi5ld5+IGt39mw/92v R3/vSz+a//mnufqQh7/sm6R/w2d5/ZdjvgeA4OZq52dw4sd4klZ+9Jd89Sd3y0d+BJdl4Kd2DEiB uveA+6coZKeAgxZxGSdhIThyFpdw7WWBhWaCEuh348eBKxhqLRiB96d++YeA7YeBrkd9dZV5rZGD EOh1Geh/BvgnAWh9nfd+BYh/8heEHpgpS9iDXVB8BGh2Uod8Qwh0yLZ9XeiFX5hR0oeD7keETHiD YohPU2hzAvgEP4iG0gWCg6d6xPeGzUeGPEiDR1eHR5iHP0dyWVeFe2hsDueHKJh3gjh9fTiIW3hh iGgtaggsSeiDgeiIAyh6J2h0uFeJtKeIZXd7jbiJwNeJOE03h9dHiaEofHdYaWx3ZagoSpCILGw4 ia74iqMoh1cIiLSYhrZoiZ8IdroIVLyohL54dsAoXLCILZJIhcYIVapodcK4emAojdNIjQRUAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0685.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
57
在宅療養支援診療所とその他の保険= 医療機関での評価の比較
○※２
◎
×
○
○※２
◎
×
○<= /div>
１００
　緊急時入院体制加算
×
○<= /div>
（T）１,４００
（U）１,４００
（V） 　４１０
　２４時間連携体制加算
×
○<= /div>
死亡日
１,２００
　在宅ターミナルケア加算
−
−※３
×
○<= /div>
月１回
処方せんあり&= #13;
２,２９０点&= #13;
処方せんなし&= #13;
２,５７５点
寝たきり老= 人在宅総合診療料
○
○<= /div>
１日につき
（１週間を単位として算定）
処方せんあり&= #13;
１,４９５点&= #13;
処方せんなし&= #13;
１,６８５点
在宅末期医= 療総合診療料
○※２
◎
○<= span lang=3DEN-US style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-famil= y:"ＭＳ Ｐゴシック"; font-size:80%;text-shadow:none;mso-fareast-hint:yes;color:yellow;mso-color= -index: 3;mso-fareast-language:JA'>※１
○<= span style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"ＭＳ Ｐゴ= Vック";mso-special-format: lastCR;display:none'>
月１回
３,３６０
在宅時医学= 管理料
その他の = ;
保険医療機関
在宅療養支援診療所
病院&#= 13;
診療所&#= 13;
現行点数
項目
改正
現行
注）　 「= 掾vはその他の保険医療機関より高い評価となるもの、「○」は現行並の評価となる= もの、
　　　 「= ~」は算定できないもの、「−」は廃止となるもの。
※１） 許= ﾂ病床数が２００床未満の病院に限る。
※２） 在= 時医学管理料と寝たきり老人在宅総合診療料の再編により、２００床未満の病院が= 追加となる。
※３） 在= 療養支援診療所の要件とし、高く評価することとする。
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0685.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0685_image116.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh4QDfAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0685_image117.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCAITAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAG AhEBgAAAAP///wL/hI+py+0Po5y02ouz3in4D4biSJbmiabqyrbuC8ciR9f2jef6jgf8z/EBh0Se p4hMKpfMorAJfUKnVMCxis1qtzkp9+f9im/XsfmMxobTtDX7DSnD5/Q6xm2n4PN0Of8PaLcX2DBI eOZ3qLioZcho4PjYGClZaWlDuZh52ZTI+Qm6sXk4GupUappqigrIqrrj+So7ayXrSot5i7vLpyvI OxULPPzoW2dMXCGczNxq25y0DD09h1xNTSSNvW1mDefN3QEeTg77XN41jr7eds5eo/0u7+Q+rxFv n6+jjsYfLgMwoMCBBAsaPIgwocKFDBs6fHhC3wV/2CjGYWKRDKMP/xItZIT2sRDGa5rwdTwQklnK BSshkVTE8eSElsNoIqBp885GkzJz7vJZawlQZTuH1pN5MdjIb0WRSjB6VOjSN1BzVU11FSsVnC9J 8TyZddXWqWzCivra0SwooFyZllTLCW7csVLdwkQrUe4ltmTT6PWIV9/fSnzrUm3qNGniB4WVDEaJ eLFIyQ4aR+tKKCZllpsnR+nbL3Lnm6M5KzVcVnTpoKshn3aMOZDm1o+L0YVt12ttTa1Jv76cO3Pg fLt5/0ayu3ic4faUk7oN/PDb3i6ps+4EGpHq0s4zQ0ceuxXzed1lf6cXXPZ4eeWdHUcv/W77Xtav Zx+SfPvo+fTfZ/8L/wdEAg5IYIEGHohgggou6JB183VnGXjpicffLwHmESF8qU1H3YMYnvffhAGu 946HFn6Gml/6dWbiMSDiB2AvJLLTYh8vApEfh73VGKOGEsanm4PuuegfjCLKWCGR/SmJXYqh6Ujb kDYWiWOPgsy4Do9H+sildlCupiWQ91W55ZVJTrkkmk3iJqZ6Z1qp4olrRrehfEJeKOeYYMDZB5bo hFnnnD8GKtybZcbJpJ5G8FmNn+UAiqigXXaz4maQPokim4S6eWeajC7qpJfyMUhqqaaeimqqqq6a UKcf5hmqkW1S6Cqss9I5aKSF1prooWRqqiunHUr5qTmxjmHobGD/EuvrnseKkayj5FwqqqQh3ook r2oWu4+iXERrKLbiVuttt81+I+0/zI4rK66YBjksnr0COymylVJGLaVUOstun+Fuuu25xtJLrrA7 rguwu9cmnG28ngpsLsH62unwq/Mq3G6wtFZsK8P18uuxmdpy28iNIGs84r8oQ1zyvqD226jK73a8 8scvh3xMutzka6/LA+Ps78gsZ5HhwjWLzPHFR2ds87f3SsYztCbfvHTQSQcMM9VNbwGu0Fk77XPE QMfs9dhfFM10wRsfLC/WGP9qNlU6bxP12VP/XDXZV5NM9N1i542uzGrzrYbfXRDezdwVIQw43lu3 TDHbD3/99+N9/3/JHeMzP6v14A1LbrHbuVpeOOb7ae456Zggjqzi1NQNdqZvS206i6hPbG3auO+6 99Clyz566kiDTvPmEsPdeFmuTwM714b3wDq0y4N0e8/Aq/683ILvrrTxs3fO/dpRth19EOVCDi/x 3QuvO/Lefz7+5HFXbvT7GE7fTPPonw+974lvb73QlU8U/Ptd+uInQP/Bo4BV6FrvKLc/zjmOff5i lQUviMEManCDHHRB2ZIXweOdzH7DQ2DxKDjC+qEwcB8kYfi+N8EXwm9Z5FNgOyTovNpZqnq0u54K ZXg/APYwgRDsnwjtpkN88RCJPmzfEHmnPtG50H0/DCAUTbg+IP9WMYVazJkQmUjE+R0OhyFMWQtX GLvcUbGLVoviABk4xiOm8Yo0lB8IjQjDHEYOi1JEI/2cCEY6Zq6GRdQIGS+3xzqG8Y6GlKMeD6jI E7KRi2u0osH4+MZDxrCST7xkJLNoSUfGUYz9wJ9KljhHTa7OhmczZTL0h0g1UrKT4vtkHycJPk4G 0pODtOMUZ5lLWprxgaQ0IBxvWMj/nRGXqRQlHhmpTGJCM3t/1GUzh+lGVspyi8HcZS17uchfdnOT wpwhOCUZyjyOcprS++I1tXnMRqozloI8HSGLuUpnGpOX9vSlH9eJvbDpLZvJpCZAufnOIC4znew0 nyoNWkp3PhL/neUMqEML2s6FVvSfz7ToNr2oUW/ic4EPFSgLpSnOhCK0mhsFKUo5uk995nOkGX0p Myda0ovStJUSLSM8czrT4N3UL64kBixjOk95NvRbRa0JKnEqU5JilKchVelQO7pSnyrUpgxNKUvH CVVsYvKnUcUqIK3axrFO9aPW/CpaB6rWnbIVmOQUqTn7GU6YBtWj8YwmQeXaV6kmtYFPW8xRCWtS pXqVqD2lJyhb2taDXhURTQXGYSGq2Kw69pt4pahd+ZqBHI2qg6QtrWlPi9rUEqSqYV3qPQIL1NY1 FqlkHaxkI7tZsdoyk2XN7Flbu9W/uja2yLRtYpU3W8T6c7J7/9UsbYMb1+H2trm/1WoJd1tboWqX rsC97jkf+1nnUrer3u0seN8K1ttCFq7YXStsdbrd8LpUuIvNbXzril7tsda6zBXsfbs73+jW97ni 9e+A/SpgvWJ2vNzlb1rbC1jiwhe005Xtfu17YAMX+LiMvTCB+1vc/zqYvd+9JXmra9YTP7jEvDWu b3H74RWb18TrTW+Ka6xfruIYwDBmsHxlbLt7Snci73UxgiE8ZBHb+MU77rCOf9zkGy9ZuZBkcXYp TEAJG9nCT84vjxssZS87mb4K5nCY3frlk5IZxE1UMpOhrOYEs3muU9bwnLlWWV5c1sxvxm+ac7xm FUe5z2gecf+ckZxhPvvYz4YGtJwFDWdGn7nRyFWtpS+N6UxrmlUepnKLPVJkNyO30wsudYixLOox P3rQntYyqK8cjDz/5KmUVm+dFc3lQLPa1BPecJuhi+gy/9rXWXbvJJLL62SHOrTLJnauVx3pPxd6 0hgub5CXC2lJE7rWESU1rr/daxTHmMQz/jSqme3qcxNN1rjY87DFvWhpqzrYd063TuwN73lb2dgV PrWz8d1AdtPC3XTWdry5TVlkg1vZACdKw2+dcG+/O9vT3na1A0xviiP84NQe96H3HeF+h7vHDF+3 wicu7IJXnOMe196mXw7zmCfI3LE+ucqjvXE7k3zheLZ5s3//nuqOs7zVnL12Xut9b5Fvuaa6xvnF dz7yXTMd2mJ+Opgt3vJRd1neVod4sUOuBoHPguBAd7jSgx7xreec5+g+u7rD7vOHo53oS0862AMe d7ffvOsG17nUqap2vnMd60MvOdwlvves27rvbDc54sv+76h7HfJREHtUaOx0wvs980cGeZLf/mq9 57vbgVe84Be/csPj/fFyh3rh/Y30w5ee7p/XA+VTT/qmV930moe9xnNP9cHTHvQREG2Vyw3r0fde 8rvvPPL5Xfevz/32GLH8K8je+uJTX+j6fv7diW/77HMf+Bn/e+Jfz3zhP7v8nFe92aM//amzv/nu D7/oXb9+lM8nGuWTb/v3a8569wd+M7F9y+d8RudZ9Od7Vzd81rZDQrZ/0jeAuJd2uqd+jUdk4meA +ed9tad86CeBKddzAQh/GlgZBQiCHIiA53WB6Yd6awd4FgiD57d5jMd/jjZ/LUiDC9h/AgiAs1d/ H1iDFLiDMRh8M4iCnlGCkcdUebeESTh+G+h/HtgJMmeFV4iFWaiFBQAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0575.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
58
在宅
２．入院から在宅への= ~滑な移行の促進
　※= 　退院指導料、退院時共同指導料等の再編・統合（紹介元= ﾌ医療機関が算定）
（現行）
◎在宅患者入院共同指導料（T）：３１０点（退院時共同指導= 加算：２９０点）
　※　診療所で在宅時医学管理料、在総診等を算定している患= 者が急変等により　病院に入院し、入院先の医師と共同して指導した場合および退= @に際して　共同で指導した場合（※ 診療所が算定する）
（改定）
◎地域連携退院時共同指導料（T）在宅療養支援診療所の場合= ：１，０００点
　　　　　　　　　　　　　　　　それ以外の場合　　　　　= ：　　６００点
　※　退院後の療養を支援する医師が、入院医療= 機関の医師および連携する訪問看護ステーションの看護師等と共同して、退院予定= ﾌ患者の在宅療養に関し、患者または家族等に説明・指導を行い、その内容について= 文書提供した場合
　※　寝たきり老人退院時共同指導料（T）６０= ０点は本点数に統合
(p.78、97、478、48= 2)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0575_image118.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0575_image119.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AE6AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0576.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
59
在宅
２．入院から在宅への= ~滑な移行の促進
　※= 　退院指導料、退院時共同指導料等の再編・統合（入院先= ﾌ医療機関が算定）
（現行）
◎在宅患者入院共同指導料（U）：１４０点（退院時共同指導= 加算：３６０点）
　※　診療所で在宅時医学管理料、在総診等を算定している患= 者が急変等により　病院に入院し、入院先の医師が主治医と共同して指導した場合= ｨよび退院に際して共同で指導した場合（※ 入院先の病院が算定する）
（改定）
◎地域連携退院時共同指導料（U）在宅療養支援診療所と連携= ：５００点
　　　　　　　　　　　　　　　　それ以外の場合　　　　　= ：３００点
　※　入院医療機関の医師・看護師等が、退院後= の療養を支援する医師および連携する訪問看護ステーションの看護師等と共同して= A退院予定の患者の在宅療養に関し、患者または家族等に説明・指導を行い、その内= 容について文書提供した場合、入院先の医療機関が算定
　※　寝たきり老人退院時共同指導料（U）１４= ０点は本点数に統合
(p.78、97、478、48= 2)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0576_image120.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0576_image121.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AFOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0577.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
60
在宅
２．入院から在宅への= ~滑な移行の促進
　 ※= 　退院指導料、退院時共同指導料等の再編・統合（訪問看= 療養費）
（現行）
◎退院時共同指導加算：２，８００円
　※　保険医療機関等に入院中、または介護老人保健施設に入= 所中で、訪問看護を受けようとする患者に対し、退院または退所に当たり、主治医= 竦E員と訪問看護ステーションの看護師等が共同で、居宅における療養上必要な指導= を行った場合
（改定）
◎地域連携退院時共同指導加算　 在宅療養支援診療所と共同= F６，０００円
　　　　　　　　　　　　　　　 それ以外の場合　        ：４，２００円
　※　保険医療機関等に入院中、または介護老人= 保健施設に入所中で、訪問看護を受けようとする患者に対し、退院または退所に当= ｽり、主治医および訪問看護ステーションの看護師等が共同して、居宅における療養= 上必要な指導を行った場合
(p.531〜535)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0577_image122.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0577_image123.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AFVAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0578.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
61
在宅
３．２４時間対応体制= ﾌ評価の見直し
　※　在総診、在医管の再編<= /span>
（現行）
◎寝たきり老人在宅総合診療料（月１回）= 3;
　　イ　処方せんを交付　　　：２，２９０= _
　　ロ　処方せんを交付しない：２，５７５= _
　　２４時間連携体制加算
　　（T）：１，４００点（同一医療機関内= ﾌ複数の医師）
　　（U）：１，４００点（入院医療機関と= ﾌ連携）
　　（V）： 　 ４１０点（地域医師会等に= 謔髦A携）
◎在宅時医学管理料（月１回）：３，３６０= _
　　常時、往診、訪問看護または電話等によ= 閨A対応できる体制&= #13;
(p.106、118、478、= 493)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0578_image124.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh3gFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0578_image125.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AFVAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0579.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
62
在宅
３．２４時間対応体制= ﾌ評価の見直し
　※　在総診、在医管の再編<= /span>
（改定） =
◎在宅時医学総合管理料（月１回）
　（１）在宅療養支援診療所の場合
　　イ　処方せんを交付　　　：４，２００= _
　　ロ　処方せんを交付しない：４，５００= _（投薬包括）
　（２）それ以外の診療所または病院（２０= O床未満）の場合
　　イ　処方せんを交付　　　：２，２００= _
　　ロ　処方せんを交付しない：２，５００= _（投薬包括）
　= ｦ在医総管・支援診療所の両方を届け出た診療所は、要件を満たした患者の場合には= （１）を、満たさなかった場合には（２）を算定できる。　
　　　但し、居宅において療養を行っている患者であって、通院困難なもの= に対して、訪問診療を月２回以上行った場合に算定する
◎重症者加算（月１回）：１，０００点 =
　= ｦ　一定の重症患者に対し、往診または訪問診= 療を月４回以上行った場合
(p.106、118、478、= 493)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0579_image126.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMgJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0579_image127.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAQJ2AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0580.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
63
在宅
３．２４時間対応体制= ﾌ評価の見直し
　※　往診料の評価
◎往診料：６５０点
１）緊急加算
　　　50/100（３２５点）     ⇒  在宅療養支援診療所：６５０点 =
　　　　　　　　　　　　　　     それ以外：        = ;  ３２５点
２）夜間加算
　　 100/100（６５０点）     ⇒  在宅療養支援診療所：１，３００点&= #13;
　　　　　　　　　　　　　　　   それ以外        = ;  ：    ６５０= 点
３）深夜加算
　　 200/100（１，３００点） ⇒  在宅療養支援診療所：２，３００点&= #13;
　　　　　　　　　　　　　　　   それ以外        = ;  ：１，３００点
 
(p.105、115)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0580_image128.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7QFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0580_image129.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAQJTAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0581.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
64
在宅
３．２４時間対応体制= ﾌ評価の見直し
　※　訪問看護の評価=
◎在宅患者訪問看護・指導料（１日につき）
= １）保健師、助産師または看護師による場合
= 　　　イ　週３日目まで：５３０点
= 　　　ロ　週４日目以降：６３０点
= ２）准看護師による場合
　　　イ　週３日目まで：４８０点
= 　　　ロ　週４日目以降：５８０点
◎緊急訪問看護加算（１回につき）：２６５点（新設）
 　 ※　緊急の患家の求= めに応じて、在宅療養支援診療所の医師の指示により、保険医療機関等の看護師等= ｪ訪問した場合、１日１回につき算定できる
(p.106、122)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0581_image130.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5QFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0581_image131.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAQIxAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0582.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
65
在宅
３．２４時間対応体制= ﾌ評価の見直し
　※　訪問看護の評価（訪問= ﾅ護療養費）
◎訪問看護療養費（T）
= 　　看護師等：５，３００円
= 　　准看護師：４，８００円
= ◎緊急訪問看護加算：２，６５０円（新設）
 　 ※　緊急の患家の求め= に応じて、在宅療養支援診療所の医師の指示により、訪問看護ステーションの看護= t等が訪問した場合、１日につき算定できる
(p.531〜535)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0582_image132.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/gFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0582_image133.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAQIEAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0583.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
66
在宅
３．２４時間対応体制= ﾌ評価の見直し
　※　在宅末期
◎在宅末期医療総合診療料（１日につき）= 3;
= 　（算定要件の変更）
　　= 　現行：常時、往診、訪問看護または電話等により対応できる体制を有する保険医療機関
　　　 改定：在宅療養支援診療所であること
(p.106、119)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0583_image134.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+AFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0583_image135.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8QHnAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0584.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
67
在宅
４．患者の重症度等を= ｽ映した訪問看護の評価見直し
　※　重症度、処置の難易度= 凾ﾌ高い患者は評価引上げ
◎重症者管理加算　：２，５００円／月 ⇒ ５，０００円／月
(訪問看護療養費）
◎在宅移行管理加算：　　２５０点／月 ⇒ 　　５００点／月
（評価引上げされたもの）
　・在宅悪性腫瘍患者指導管理= ｿ算定患者
　・在宅気管切開患者指導管理= ｿ算定患者
　・気管カニューレを使用して= ｢る状態にある者
　・留置カテーテルを使用して= ｢る状態にある者
※　上記以外は従前どおり
(p.107、123、478、= 483、531〜536)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0584_image136.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAQJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0584_image137.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6wEgAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAQAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0585.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
68
在宅
５．ターミナルケアお= 謔ﾑ看取りの評価の見直し
　※　ターミナルケア加算の= ]価引上げ（訪問診療）
（現行）
◎在宅患者訪問診療料
　　ターミナルケア加算：１，２００点 <= /div>
= 　　　※　１か月以上訪問診療を実施し、ターミナルケアを行った場合に算定 =
（改定）
= 　　ターミナルケア加算（T）：１０，０００点
= 　　ターミナルケア加算（U）：　１，２００点
　　　※　死亡日前１４日以内に２回以上の往診また= は訪問診療を実施し、
　　　　ターミナルケアを行った場合（U）を算定
      ※　さらに、在宅療養支援診療所の医師が、死亡前２４時間以内に訪問して、= 死亡診断した場合は（T）を算定
(p.107、122)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0585_image138.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0585_image139.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AE5AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0586.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
69
在宅
５．ターミナルケアお= 謔ﾑ看取りの評価の見直し
　※　ターミナルケア加算の= ]価引上げ（訪問看護）
（現行）
◎在宅患者訪問看護・指導料
　　ターミナルケア加算：１，２００点 <= /div>
　　　※　１か月以上訪問看護を実施し、その死亡前２４時間以内にタ= ーミナルケアを行った場合に算定
（改定）
= 　　ターミナルケア加算（T）：１，５００点
= 　　ターミナルケア加算（U）：１，２００点
　　　※　死亡日前１４日以内に２回= 以上訪問看護を実施し、かつ、その死亡前２４時間以内にターミナルケアを行った= 鼾（U）を算定できる。
      ※　ただし、在宅療養支援診療所の医師の指示により実施した場合は　（T）= を算定できる。
(p.107、122)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0586_image140.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6AFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0586_image141.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AFJAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0587.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
70
在宅
５．ターミナルケアお= 謔ﾑ看取りの評価の見直し
　※　ターミナルケア加算の= ]価引上げ（訪問看護療養費）
（現行）
◎訪問看護療養費
　　ターミナルケア療養費：１２，０００円
= 　　　※　１か月以上ターミナルケアを行い、在宅で看取った場合に算定
（改定）
= 　　ターミナルケア療養費（T）：１５，０００円
= 　　ターミナルケア療養費（U）：１２，０００円
　　　※　死亡日前１４日以内に２回以上訪問看護を= 実施し、かつ、その指示により実施死亡日２４時間以内にターミナルケアを行った= 鼾（U）を算定できる。
      ※　ただし、在宅療養支援診療所の医師が、死亡前２４時間以内に訪問して看= 取った場合は（T）を算定できる。
(p.531〜535)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0587_image142.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0587_image143.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AFJAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0588.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
71
在宅
５．ターミナルケアお= 謔ﾑ看取りの評価の見直し
　※　在宅末期（入院医療の= 謌ｵいの見直し）
◎在宅末期医療総合診療料（１日につき）= 3;
= 　（算定要件の変更）
= 　　　現行：在宅医療と入院医療が混在した週は算定できない
　　　改= 定：在宅療養支援診療所に入院し、ターミナルケアを継続している場合は、算定できる=
(p.106、119、478、= 493)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0588_image144.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh1wFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0588_image145.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8QHkAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0594.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
72
在宅
６．施設入所者の終末= における訪問診療・訪問看護の見直し
　※　多様な居住の場におけ= 驛^ーミナルの推進
◎訪問診療の算定要件緩和
　　ケアハウス・有料老人ホーム（特定施設入居者生活介護の= 指定を受けている施設）、の入所者であっても、末期の悪= ｫ腫瘍の患者については、特別養護老人ホーム、在宅療養= 支援診療所に係る医師が訪問診療を行う場合には、在宅= 患者訪問診療料が算定できる
◎訪問看護の算定要件緩和
　　特別養護老人ホームの入所者であっても、末期の悪性腫瘍の患者については、在宅療養支援診療所に係る医師の指示に基づき訪問看護を行う場= 合には、在宅患者訪問看護・指導料等が算定できる
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0594_image146.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9QFMAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0594_image147.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AE8AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAgAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0595.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
73
在宅
６．施設入所者の終末= における訪問診療・訪問看護
　 の見= 直し
　※　多様な居住の場におけ= 驛^ーミナルの推進
◎医療保険による訪問看護の給付対象を統一&= #13;
　　・訪問看護が医療機関からなのか or 訪問看護ステーショ= ンからなのか
　　・訪問看護の提供先が自宅、ケアハウス、有料老人ホーム、グループホ= ーム等のいずれであるか
= 　　によって、
　　・急性増悪等により医師の特別指示書が出ている場合（１４日間を限度= ）に限られるのか
= 　　・末期の悪性腫瘍および難病等の場合も対象となるのか
⇒　分かれ= ﾄいた取扱いを改め、上記のすべての場合について、末期の悪性腫瘍
　および難病等の場合も、医療保険による訪問看護の給付対= ﾛとする　　
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0595_image148.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/gFLAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0595_image149.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AEtAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAsAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0638.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
74
在宅
７．在宅療養指導管理材料加算の項の新設
　※　点数表の簡素化
◎従来、= 在宅療養指= ｱ管理料各点数の「注」の各加算をまとめて表記１）血糖自己測定器加算　　　　　　= @　　13）在宅成分栄養経管栄養法用栄養管
２）注入器加算　　　　　　　　　　= @　　　セット加算
３）間歇注入シリンジポンプ加算　　= @　　14）間歇導尿用ディスポーザブルカテ
４）注入器用注射針加算　　　　　　= @　　　ーテル加算
５）紫外線殺菌器加算　　　　　　　= @　　15）人工呼吸器加算
６）自動腹膜灌漑流装置加算　　　　= @　　16）経鼻的持続陽圧呼吸法用治療加算
７）透析液供給装置加算　　　　　　= @　　17）携帯型ディスポーザブル注入ポン
８）酸素ボンベ加算　　　　　　　　= @　　　プ加算
９）酸素濃縮装置加算　　　　　　　= @　　18）疼痛管理用送信器加算
10）液化酸素装置加算　　　　　　　　　　19）携帯型精密輸液ポンプ加算
11）在宅中心静脈栄養法用輸液セット加算　20）気管切開患者用人工鼻加算
12）注入ポンプ加算
　　
(p.110、134)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0638_image150.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhxgFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0638_image151.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCwJKAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALA8AAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0547.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
75
検査
１．外来迅速検査の評価&#= 13;
２．検体検査の評価見直し=
３．生体検査の評価見直し=
４．コンタクトレンズに係= る診療の評価
５= D病理診断の評価
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0547_image152.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9AGLAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0547_image153.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0559.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
76
検査<= /span>
= １．外= 迅速検査の評価
　※　患者の視点の重視　
◎外来迅= 速検体検査加算の新設：１点（５項目を限度）　　外来患者に対して、検体検査を行= い、 =
　すべての検体検査項= 目について同日内に結果が報告され、 =
　当該検査の結果に基= づく診療が行われた場合に、検体検査実施料 =
　の各所定点数に加算= =
　　要件：検査結果を= ｳ者に書面で交付 =
　（対象外）
　　　尿中一般物質定性半定量検査
　　　尿沈渣顕微鏡検査
　　　赤血球沈降速度測定
　　　血液ガス分析
　　　心筋トロポニンＴ定性
　　　インフルエンザウイルス抗原精密測定　等
(p.138、170、479、= 483)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0559_image154.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhDwFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0559_image155.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wFTAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0561.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
77
=
検査<= /span>
= ２．検= ﾌ検査の評価見直し
=
（１）実施料の市場実= 勢価格を踏まえた適正化
（２）判断料の点数見= 直し =
　　・生化学的検査（U）判断料：１３４点⇒１３５点（＋１点） =
　　
=
３．生体検査の評価見= ｼし
　※= 　検査の難易度・機器の費用等= を考慮した評価の見直し　
=
（１）経皮的動脈血酸素飽和度測= 閨i１日につき）：
１００点⇒３０点（△７０点）
（２）脈波図、心機図、ポリグラ= t検査判断料：１４０点⇒廃止
（３）超音波検査：腹部エコー５５０点⇒５３０点
　　　　　　　　　心エコー　８００点= ⇒７８０点 =
　　
(p.138〜)
(p.151)=
(p.156)=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0561_image156.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhkAEzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0561_image157.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AFaAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0561_image158.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhowEzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0561_image159.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0561_image160.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/gGGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0596.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
78
検査<= /span>
４．コンタクトレンズ= ﾉ係る診療の評価
　※　保険給付の= ﾍ囲の明確化と個別指導の重点的実施　
１）初診時にコンタクトレンズの処方を目的= ﾆして、屈折異常の患者に対して眼科学的検査等を行うことは、保険給付の対象となる。
２）コンタクトレンズの処方を行った後、コ= 塔^クトレンズ装用者に自他覚症状があるなど、疾病に罹患していることが疑われる= 場合に眼科学的検査等を行うことは、再診として保険給付の対象となる。
３）コンタクトレンズの処方を行った後、疾= aに罹患していることが疑われないにもかかわらず、定期的にコンタクトレンズ装用= 者に眼科学的検査等を行うことは、保険給付の対象とはならない。
４）コンタクトレンズの処方に係る診療につ= ｢ては、屈折異常の患者に対する診療が継続しているものとして、初診= 料は第１回の診療の時にの= ﾝ算定できる。
　
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0596_image161.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhxgFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0596_image162.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9QFCAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0597.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
79
検査<= /span>
４．コンタクトレンズ= ﾉ係る診療の評価
　※　検査を包括= Iに評価し、適正化を図る　
◎コンタクトレンズ検査料の= V設
１）コンタクトレンズ検査料（T）
　　　　　　初診時：３８７点、再診時：１= P２点
２）コンタクトレンズ検査料（U）
　　　　　　初診時：１９３点、再診時：　= T６点
 ※　定型的に実施されるすべての眼科学的検査に係る費用を= 括
 ※　コンタクトレンズ診療患者が７０％以上の= 纓ﾃ機関は（U）を算定
 ※　初診時の点数は患者１人につき１回を限度= ﾆして算定
 ※　初診料、再診料は別に算定できる
(p.160、214、479、= 495)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0597_image163.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhxgFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0597_image164.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wE+AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0598.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
80
検査<= /span>
= ５．病理診断の評価
　※　病院内で病= 搖w的検査を実施する体制の評価充実　
◎病理診断料：２５５点 ⇒ ４１０点（＋１５５点）&#= 13;
◎算定要件の緩和
　（現行）
　　病理学的検査は専ら担当する常勤医師
　（改定）
　　保険医療機関内で非常勤の病= 理医が診断を行った場合も算定= ﾂ
　　
(p.152、200)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0598_image165.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhxgFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0598_image166.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wEHAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0549.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
81
画像診断
１．ＰＥＴ／ＣＴの評価&#= 13;
２= D画像診断= 機器の性能に応じた評価
３．コンピューターによる= 画像処理の評価
４．マンモグラフィーの評= 価
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0549_image167.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9AGLAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0549_image168.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0599.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
82
画像診断
１．ＰＥＴ／ＣＴの評= ｿ
　　
◎ポジトロン断層・コンピュ= [ター断層複合撮影（新設）
 １）１５Ｏ標識ガス剤を用いた場合（一連の検査につき）：７，６２５点=
 ２）１８ＦＤＧを用いた場合（一連の検査につき）　　   = @：８，６２５点
(p.226、237、479、= 496)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0599_image169.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhxgFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0599_image170.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wHeAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0601.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
83
画像診断
２．画像= f断機器の性能に応じた評価　　
◎コンピューター断層撮影（一連につき）
（現行）
　１）単純ＣＴ撮影
　　　　頭部：６２０点、躯幹：８３０点、= l肢：５７０点
　２）特殊ＣＴ撮影（管腔描出を行った場合= j
　　　　頭部：７１０点、躯幹：９５０点、= l肢：６６０点
（改定） =
　１）単純ＣＴ撮影
　　　　マルチスライス型の機器の場合：８= T０点
　　　　それ以外の場合　　　　　　　：６= U０点
　２）特殊ＣＴ撮影（管腔描出を行った場合= j：９５０点
　
　　
(p.227、240、479、= 496)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0601_image171.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhlgEwAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0601_image172.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6gFUAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAMAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0602.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
84
画像診断
２．画像= f断機器の性能に応じた評価　　
◎磁気共鳴コンピューター断層撮影（一連に= ﾂき）
（現行）
　１）単純ＭＲＩ撮影
　　　　頭部：１，１４０点、躯幹：１，２２０点、四肢：１= ，１６０点
　２）特殊ＭＲＩ撮影（管腔描出を行った場合） =
　　　　頭部：１，５００点、躯幹：１，６００点、四肢：１= ，５２０点
（改定）
　１）単純ＭＲＩ撮影
　　　　１．５テスラ以上の機器の場合： １，２３０点 =
　　　　それ以外の場合　　　　　　　： １，０８０点 =
　２）特殊ＭＲＩ撮影（管腔描出を行った場合）：１，５３０= 点
　
　　
(p.227、241、479、= 496)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0602_image173.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhhAEzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0602_image174.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6gFEAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAMAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0603.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
85
画像診断
２．画像= f断機器の性能に応じた評価　　
◎ＣＴ、ＭＲＩを同一月に２回以上行った場=
（現行）
　２回目以降の断層撮影の費用は撮影部位に= 桙ｶて
　　頭部（一連につき）：６００点
　　躯幹（一連につき）：８１０点
　　四肢（一連につき）：５６０点
　
（改定） =
　２回目以降の断層撮影（一連につき） ：６= ５０点
　
　　
(p.226、239)
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0603_image175.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhhgEzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0603_image176.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6gExAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAMAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0604.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
86
画像診断
３．コンピューターに= 謔驩鞫恟理の評価
１）画像情報を電子媒体に保存した場合の評= ｿ
　　　コンピューター画像処理加算の新設：= U０点
　　　（核医学診断、コンピューター断層撮= e１回につき）
２）機器の普及を踏まえた適正化
　　　デジタル映像化処理加算 <= /nobr>
　　　　イ　単純撮影の場合：　　　　７５= _ ⇒ ６０点（△１５点） <= /span>
　　　　ロ　特殊撮影の場合：　　　　９５= _ ⇒ ６４点（△３１点） <= /span>
　　　　ハ　造影剤使用撮影の場合：１２０= _ ⇒ ７２点（△４８点） <= /span>
　　
(p.226、240）<= /span>
(p.224）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0604_image177.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhrAEwAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0604_image178.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9wEoAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAMAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0605.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
87
画像診断
４．マンモグラフィー= ﾌ評価
１）デジタル映像化処理加算
　　　乳房撮影の場合：６０点（新設） =
２）写真診断
　　　乳房撮影（一連につき）：２５６点= 3;
３）撮影
　　　乳房撮影（一連につき）：１９６点= 3;
　　　※　当該撮影専用の機器を用いて、原= ･両側の乳房に対し２方向以上の撮影を行うものをいい、両側について一連として算= 定
　　　　
(p.224、230）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0605_image179.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhxgEwAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0605_image180.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8wEnAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAMAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0600.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
88
投薬<= /span>
１．処方料・処方せん料の見直し２= D処方せん= 様式の変更（再掲）=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0600_image181.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9AGLAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0600_image182.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0560.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
89
投薬<= /span>
１．処方料・処方せん料の見直し
　※　適切な長期= 竃の推進　
１）処方料
　　　特定疾患処方管理長期投薬加算：４５点 ⇒ ６５点（＋２０点） =
２）処方せん料
　　@　内服薬７種類以上の投薬
　　　イ　後発医薬品を含む　：４３点 ⇒ ４２点（△１点）
　　　ロ　イ以外の場合　　　：４１点 ⇒ ４０点（△１点）
　　A　内服薬７種類未満の投薬
　　　イ　後発医薬品を含む　：７１点 ⇒ ７０点（△１点）
　　　ロ　イ以外の場合　　　：６９点 ⇒ ６８点（△１点）
　　特定疾患処方管理長期投薬加算：４５点 ⇒ ６５点（＋２０点）
(p.242、243）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0560_image183.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5AFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0560_image184.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wFEAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0606.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
90
投薬<= /span>
= ２．処方せん様式の変更（再掲）
　※　後発医薬品の使用促進　
◎「備考」欄中に「後発医薬品への変更可= 」の「保険医署名」欄を= =
　設けた処方せん様式に変更 =
◎「処方」欄に先発医= 薬品の銘柄名を記載した処方せんを交付した =
　医師が、当該先発医= 薬品を後発医薬品に変更しても差し支えない =
　と判断した場合は、= その意思表示として「後発医薬品への変更 =
　可」の「保険医署= 名」欄に= 署名する =
◎「後発医薬品への変= 更可」の「保険医署名」欄に= 署名のある処方 =
　せんを受け付けた保険薬局は、患= 者に後発医薬品の情報提供し、 =
　患者が選択した後発医薬品または= 先発医薬品を調剤する。　
(p.565）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0606_image185.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhkQFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0606_image186.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wE5AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0550.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
91
リハ= rリテーション
１．リハビリテーションの疾患別体系への見直し２= D急性期リハビリテーションの評価３= D従事者１人１日当たりの実施単位数の上限の緩和４= D回復期リハビリテーション病棟入院料の見直し５= D退院後早期の訪問リハビリテーションの評価６．その他のリハビリテー= ションに係る評価の見直し
７．消炎鎮痛等処置の同一月内逓減制の廃止
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0550_image187.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAAKzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0550_image188.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0662.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
92
リハ= rリテーション
１．リハビリテーションの疾患別体系への見直し
　※ 理学療法、作業療法、言語聴覚療法を４つの疾患別体系へ再編　
=
１５０日
９０日&= #13;
１５０日&= #13;
１８０日&= #13;
算定日数上限
１００点&= #13;
８０点&= #13;
８０点&= #13;
１００点&= #13;
リハビリテーション料（U）
２５０点&= #13;
１８０点&= #13;
１８０点&= #13;
２５０点&= #13;
リハビリテーション料（T）
急性心筋梗塞
開心術後
慢性心不全で左心駆出率４０％以下　　　　　大血管術後         等
肺炎・無気肺
慢性閉塞性肺疾患であって重症後分類U以上の状態の患者
等
上・下肢の外傷・骨折の手術後
熱傷瘢痕による関節拘縮 = ;
等
脳血管疾患
脳外傷
脳腫瘍
神経筋疾患
脊髄損傷　　　　= @等
対象疾患
C心大血管疾患　リハビリテーション
B呼吸器 = ;
リハビリテーション
A運動器 = ;
リハビリテーション
@脳血管疾患等<= span style=3D'font-family:"ＭＳ Ｐゴシック";mso-fareast-font-family:"ＭＳ Ｐゴ= Vック";font-size: 80%;display:none'>
リハビリテーション&#= 13;
※　集団療法の廃止、機能訓練室の面積要件の緩和
(p.258、261、480、= 483、497）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0662_image189.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCAJGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0662_image190.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAAI6AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAD+ ATkBgQAAAAAAAAD//////wL/hI+Zwu0Po5y02ouz3rz7D4biSJbmiUbKyrZLCsfyTNf2jef67fYu AwgIh8Si8YhMKpfMpvMJjUqn1Kr1is1qt9yuVwn0iQ8M4viMTqvX7Lb7DY/L5/S6/Y7PG4TheFmo Fyg4SFhoeIiYqLhIJiD3xxgpOUlZaXmJSVfmB5jp+QkaKjpK2iMQwIlausra6voKm3aq6jYbe4ub q7u7aPvmyxssPExcvALchmy8zNzs7Km8Fv1MXW19XTct24nd7f0NzqKNNh5ufo4eXD62nu7+Dh/a 7jMfb3+Pf1j/w53v/w8w0L4WAwMaPIhQQcFj/RI6fAjRwEKFDSNavJhv4oKK/xg7ejynEUHIjyRL 7hopkaPJlSyJoQTwsqXMmZhexqSJM6cimyp1+vxpiSctoESLShJqNKlSREiXOn2KpynUqVRr9Txz s6pWo1K3ev1KcSibTWDLgoX065TZtVvRpmULFyoQscn6xL0LtMFVNTv6+v0LOLDgwYQLNwhC9w0f w4wbO34MObLkD2bufLmMObPmzZw7e/4MOrRnvKRLmz6NOrXq1axbu34NO7bs2bRr276NO7fu3bx7 +/4NPLjw4cSLGz+OPLny5cybO38OPbr06dSrW7+OPbv27dy7e/8OPrz48eTLmz+PPr369ezbu38P P778+fTr27+PP7/+/fz7+///D2CAAg5IYIEGHohgggouyGCDDj4IYYQSTkhhhRZeiGGGGm7IYYce fghiiCKOSGKJJp6IYooqrshiiy6+CGOMMs5IY4023ohjjrwNwGOPPv4IZJBCDklkkUYeiWSSSi7J ZJNOPglllFJOSWWVVl6JZZZabslll15+CWaYYo5JZplmZpnOAOiouWaaa/Lo5jlsyhmnOT3WGc6c duIJzp1t0vknoHbCGWiefPb5pp6GCrpnoX0Syiiijko6qKKULhrppY9a+g2n3Xj66aHe+JnpqKKa Kiekja7KKqZ5quqqprJ2muip2IB6q63XkNoqrZP6Wqmu1uC6q7DV8BorsL3/KrupsdQQO6yzzyA7 a6i/ohrstblqu222pVr7LbivQnsst8Waeyys1Xa7LLbjSusMuc/C2wy1zN6Lr7vNojsvv/162y67 yeZ7q7oEnxuuwJ0arO/BCAe8K8Pirquww+nKO62/GWtcr8QVT0zxw/smHC3H9dZq8jIYx0svM/Y2 DHPMII/qscgWl5uyMS/PzHPPHxe88skklzz0szUTPbDMP0d8ZtNOPw111FJPTXXVSrasMtZZpxq0 yznrrHUxOy+NdNI+D3s0zhDbfPO0af9rNtllL9z11mvP3Xa8b298t9p9u1032EXDHTfagYv9NeKJ DzM222fjrbThYRNzOOWT/zO+N8uD8/233pUzvjjooQfTOORy+134xZcL8znrq5OeudCda755x62T Pjruue9SOup50z67y7F7Xbvswas8vN2p+/678Lfz8rwu0Uv/OvTJC3688ssDXj3v3XvP9fe5TD++ +Lj0TnjzxBePPPnn7w4++zpfr3j22NtPOf2Wy3//9p6bfwv3BRCAsUAf50JmutNxD37lY2ADAeY/ 40VQgnQjICwEWEALvsKAwEMg8yKnOgcOUIQjhKAHD3hCFNIMgxckYQZduEH9iQ5/++Nf/li4QRjm UIet4CAFQfjBxxkNh64gIiuMeEQNFlGGrrNhDWnIOibqDopNdGIUkbgKLP+SQotbVGIPpQg9HvbQ i0cEY/wmuD4qWo+Lo2BjKNz4RjJm0YzUs2IV1cg7Oj4QjdpLoe3kWAo4gkKQnyBkJnyYRj/+EIgL tGMYxZjE8EEykICkpCQdeUY+9q+Ck+xiJz1pQvVtUpSj/JQe34fJTCqyfZVsYytdeUk81jGVs3zX J0VhyEO+8o2nLKEm6yfL8fXyhcHc4y8xl0tMJNMSy2TmLgc5zBbS0pirnF8zK3HNSWRTm88sZDR3 WExUTjOA3yziLXHZTU8gso+MVGE7/3jOQaZTnSgbJzHD6cuR4VOa9rynPo95R4AGlJP9BOc++WnL gpoznvKMpUAfqdCFhvL/nYmsZimBNk9lZlSjDrXoEx8K0YQeVKIjJek/PTrDko6xo6T8KEpTetKW wvSlA13hRp3J0ELWU6VZvClOJypEdwZVqEzzKSW2KQmkRkKpi1jnRR031A4SlKeWjOhKK2W1rGp1 q1ztqle/SiajcjOn9GQpRdl5VrRilKwctWokgapAqcp0pjZl6yWY2lSxJrWcVwWpKucKO7wqQrCI IGxh9bpUvr7Vr7Vk7PkU21O3RlayW4RsVR0rTqpW1rCH4GwhPPtZxDLCqcCk6RQ120bLghKz+TRt HkFLCNgKQrazFW1TVQtL1OZWt7ykbSB8mwfgBte2g8UtOim7WtZe0Lhx/0TubpUbQ+HiQbp2oG51 iZsI0ro0rU+FalHt+lPeNheu3k1gec0bQueOV7wNxSpY3wvf+Mp3vvR1GnYPC97wxpS72+Vvf9eq 3vayV6dmjWpFAXva/RpYrXGVqymtWwcIz0HCE75vZ5krYNf+1b9XtLAhKCwHEMdBxG/QLl0XzODz DtHDoc0vNncKXZNquLFTjXFfbXzjGs84szherIIbfGAO1/TBLI5tkY1cYCCnGL1B/G6ACfxkKIu0 x5elcpV1jOANo7i76R2wLl18VBjvuLVZ1rKTvdxWNKf5xyomapvdfLH6ynnOdK6zne185NqCeazk ZTKcm/xmeEb5y4Mm9JmUx+xPRCe6roW+a5713GdAS3rS6WO0mvWraISy2c8O3nJpsSzkkFo5uaD2 9IlNfeozj/q4jXZ0kgMdZFQPGcCXfvGekyrmMlNT17sm8q1H++jf5jrUZoZ1rFWdaRnzmselVjKX Kf3nRtY6zL8G9qs5vUhZJ7jZxn52pYktPQxLOdnKBrcwSVziaudV3dm9s7vfDe94y1tMBQAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0661.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
93
リハ= rリテーション
２．急性期リハビリテーションの評価
 １）発症後早期について、患者１人・= １日当たりの算定単位数の
　　上限を６単位まで緩和する
 ２）早期リハビリテーション加算：廃= 止　
３．従事者１人１日当たりの実施単位数の上限の緩和=
　 ※  医療機関ごとの弾力的な運用を可能= ﾉ
（現行）
　リハビリテーション従事者= P人・１日当たり１８単位まで（個別療法）
（改定）
　リハビリテーション従事者= P人・１日当たり１８単位までを標準とし、
 週１０８単位まで
　　※= @１日当たり単位数：１８単位を標準とし、２４単位を上限
　　※= @１週間当たりの単位数：非常勤従事者は常勤換算で１人当たりと
　　　 して計算= @
(p.258、261）<= /span>
(p.262〜）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0661_image191.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9gFdAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0661_image192.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhBwJPAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALBAAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0660.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
94
リハ= rリテーション
４．回復期リハビリテーション病棟= 院料の見直し
　※  更なる普及を図るため　
１）「算定対象となるリハ= rリテーションを要する状態」の拡大
　　大腿骨、骨盤、脊椎、股関節または膝関節= の神経・筋・靱帯損傷後
　１ヶ月以内の状態
２）算定上限の変更
　 ⇒ 　一律１８０日までの= 設定を、リハビリテーションを要する状態ごとに
６０日
四　大腿骨、骨盤、脊椎、股関節又は膝関節の神経・筋・靱帯損傷後１ヶ月以= 烽ﾌ状態
９０日
三　外科手術又は肺炎等の治療時の安静により生じた廃用症候群を有しており、手術後又は発症後２ヶ月以内の状態
９０日
二　大腿骨、骨盤、脊椎、股関節又は膝関節の骨折又は手術後２ヶ月以内の状= ﾔ
１８０日
（高次脳機能障害を伴った重症脳血管障害、重度の頸髄損傷及び頭部外傷を= ﾜむ多発外傷の場合）&#= 13;
１５０日
一　脳血管疾患、脊髄損傷等の発症又は手術後２ヶ月以内の状態
(p.451、455）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0660_image193.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCAI6AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0660_image194.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAAJUAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAD+ AVMBgQAAAAAAAAD//////wL/hI9pwu0Po5y02ouz3rz7D4biSJbmiUbKyrZJCsfyTNf2jec67vYu AwgIh8Si8YhMKpfMpvMJjUqn1Kr1is1qt9yuVwn0iQ8M4viMTqvX7Lb7DY/L5/S6/Y7PG4TheFmo Fyg4SFhoeIiYqLhIJiD3xxgpOUlZaXmJSVfmB5jp+QkaKjpK2iMQwIlausra6voKm3aq6jYbe4ub q7u7aPvmyxssPExcvALchmy8zNzs7Km8Fv1MXW19XTct24nd7f0NzqKNNh5ufo4eXD62nu7+Dh/a 7jMfb3+Pf1j/w53v/w8w0L4WAwMaPIhQQcFj/RI6fAhxQUNpEyNavIhvocKK/xg7ejSn8QXHjyRL UguJAKXJlSxbqZRIq6XMmbteArBJM6fOXiPP4NwJNKjAnuyICj2K1JDNn0mbOiVnlF7Up1Srslk6 1arWrfxiXs3KNaxYrF7Fmj2bEqy4U2jbtoX0i63buWHhxqWL1yqQslf75P0rtIFaUzsKGz6MOLHi xYwb7+Xrho/jyZQrW76MOfMHM3e+eP4MOrTo0aRLmz6NujTg1axbu34NO7bs2bRr276NO7fu3bx7 +/4NPLjw4cSLGz+OPLny5cybO38OPbr06dSrW7+OPbv27dy7e/8OPrz48eTLmz+PPr369ezbu38P P778+fTr27+PP7/+/fz7+///D2CAAg5IYIEGHohgggouyGCDDj4IYYQSTkhhhRZeiGGGGm7IYYce fghiiCKOSGKJJp6IYooqrshiiy6+CGOMMs5IY4023ohjjjruyGOPPv4IZJBCDklkkUYeiWSSSi7J ZJNOPglllFJOSWWVVl6JZZZabslll15+CWaYYo5JZplmnolmmmquyWabbr4JZ5xyzklnnXbeiWee eu7JZ59+/glooIIOSmihhh6KaKKKLspoo44+Cmmkkk5KaaWWXopppppuymmnnn4Kaqiijkpqqaae imqqqq7KaquuvvrOALLOSmuttt6Ka6667sprr77+Cmywwg5LbLHGHotsssr/Lstss84+C2200k5L bbXWXottttpuy+2zsLIwACyzfrtCuK+MS24C5rqCbroHrNtKu+4CAC8r8rpb7yr3pptvKfuS2y8p /34b8CgDw1qwKAe/mnAoC7vaMCgPtxrxJxOzWrEnF6+acSYbq9oxJh+nGvIlI6NasiUnn5pyJba+ 2y6tMMs687oyG3AzvTHvTDPOPNv8c81C+9yzzkXnjHTQRAN9tNJGMw310E9LnXTTVke9NNVOV431 1Fl/7XXYXGt9Ndldjw022k+bq3bbW7999cqmtkyJ3KXSPYndpOItid6j8h2J36ICzojgoRK+iOGg Iq6I4p8ynojjnkKOiOSd/1J+iOWcYm6I5ptyXojnmoJOiOiZkj6I6ZiiLojql7IeiOuWwq6H7JXS noftlOKOh+6T8n6H75ICb4fwkRJfh/GQIk+H8o8yP4fzjkIvh/SNUh+H9YxiD4f2i3L/hveKgu+G +ImS34b5iKLPhvqHsr+G+4bCr4b8hdKfRrf6789///7/D8AAClBY83qXuIo2L/yhwX6EUuAZGDgo B44BgoKSoBgoGCgL+gCDgNJgDzj4Jw+6AIR+EmELSNgnE4ILgfg6oAr19EIFoJBPMVQXC/nlwgLi LIc6rCECZrgnH85Mh/TiYQGFSDQiInFtA2yiE58IxShKcYrYUqIRE3jFFs6e64YAyyIOt7jEOS0R iDD0YhfBaEU09tCMBGMjwtzIMDhCTI4UoyPG7MgxPIJMjyTjI8r8yDJAzk2QdyPk3gz5N0QOTpGH Y+TiHPk4SE5Okpej5OYs+TlMjs6FVOykJz8JylCKkn9pZBcX26jGI2rydKtcXStf98rZxfJ2s9xd LX93y+Hl8ni7XF4vn/fL6QXzesPcXjG/d8zxJfN8y1xfM9/3zPlF837TbGA1I3jNCmYzg9vsYDdD +M0ShjOF46QhJ0eJznSqc53sTGcBAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0663.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
95
リハビリテーション<= /div>
= ５．退院後早期の訪問リハビリテーションの評価
◎在宅訪問リハビリテーション指導管理料= 3;
　（現行）
　　　５３０点（１日につき）週３回まで= 3;
　（改定）
　　　３００点（１単位につき）週６単位ま= ﾅ
　　　　※　退院後３月以内の患者は週１２= P位まで
(p.107、123）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0663_image195.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0663_image196.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wEEAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0664.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
96
リハビリテーション<= /div>
６．その= ｼのリハビリテーションに係る評価の見直し
　※  障害児、障害者に対するリハビリテーションの評価　等
１）障害児(者)リハビリテーション料の新設<= /span>（１単位につき）
　　　６歳未満　　　　：１９０点
　　　６歳〜１８歳未満：１４０点
　　　１８歳以上　　　：１００点
　　　※　脳性麻痺等の発達障害児（者）、肢体不自由児施設= 等の入所・通所者
      ※　１日= U単位まで
　　　※　脳血管疾患等リハビリテーションを算定した場合は= 算定できない
２）摂食機能・嚥下機能障害リハビリテーシ= ン
　　　算定上限の緩和
　　　　月４回まで ⇒ <= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";text-shadow:none'>月４回まで（治療開始から３か月以内は毎日算定可= j <= /span>
(p.259、268、480、= 484、500）
(p.259、267）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0664_image197.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJMAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0664_image198.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wE1AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0665.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
97
リハビリテーション<= /div>
７．消炎鎮痛等処置の同一月内逓減制の廃止　※　患者に分かりにくい逓減制の撤廃の一環
　※  リハビリテーションの体系変更に対=
◎消炎鎮痛等処置
    イ　マッサージ等の手技による療法　　　　　：３５点
　　ロ　器具等による療法　　　　　　　　= @　　：３５点
　　ハ　湿布処置　１　半肢の大部にわたる= 烽ﾌ他：３５点
　　　　　　　　　２　その他のもの　　　= @　　：２４点
　 ⇒ &nb= sp; 規= 閨uロおよびハの療法について、合わせて５回以上行った
        = ;  場= は５回目以降については所定点数の５０／１００で
        = ;  算= 閧ｷる」を廃止
(p.291）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0665_image199.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0665_image200.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+wEsAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0627.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
98
処置・手術
１．消炎鎮痛等処置の同一月内逓減制の廃止（再掲）= ２．創傷処置・皮膚科軟膏= 処置
３．熱傷処置
４<= /b>．重度褥= 瘡処置の新設
５<= /b>．不合理= な処置点数の是正
６<= /b>．手術の= 施設基準の廃止
７= D麻酔に係る技術の評価
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0627_image201.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/gGzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0627_image202.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0628.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
99
処置
= ２．創= 搶置・皮膚科軟膏処置
　※　項目の変更= ｨよび点数見直し　
（現行）
  １）手若しくは指又は足若しくは指にわたる範囲のもの　　　　　　：  ４２点
  ２）半肢の大部又は頭部、頸部および顔面の大部にわたる範囲のもの：  ４９点
  ３）１肢又はこれに準ずる範囲のもの　　　　　　　　　　　　　　：  ７５点
  ４）２肢若しくは全腹又はこれに準ずる範囲のもの　　　　　　　　：１= S０点
  ５）身体の大部にわたる範囲のもの　　　　　　　　　　　　　　　：２= T０点
（改定）
  １）１００㎠未満　　　　　　　　　　 ：  ４５点（= {３点）
  ２）１００㎠以上５００㎠未満　　　   ：  ４９点 =
  ３）５００㎠以上３，０００㎠未満     ：  ７５点 =
  ４）３，０００㎠以上６，０００㎠未満 ：１４０点
  ５）６，= O００㎠以上        = ;         ：２５０点
= (p.282、287、294）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0628_image203.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhVgFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0628_image204.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhDgJEAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALBcAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0629.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
100
処置
３．熱傷処置<= /span>
　※　術後創傷処= uから独立　　
◎熱傷処置（１日につき）
　１）１００㎠未満　　　　　　　　= @　：　　１３５点
　２）１００㎠以上５００㎠未= 栫@　　  ：　　１４７点 =
　３）５００㎠以上３，０００㎠= ;未満    ：　　２２５点
　４）３，０００㎠以上６，０００= 3216;未満：　　４２０点
　５）６，０００㎠以上        = ;        ：１，２５０点
 ※　初回の処置から２か月まで算定、= それ以降は創傷処置
(p.282、295）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0629_image205.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhSQFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0629_image206.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AHzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAUAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0708.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
101
処置
４．重度褥瘡処置の新= ﾝ
　※　技術評価　　
◎重度褥瘡処置（１日につき） <= /nobr>
　１）１００㎠未満　　　　　　　　= @　：　９０点
　２）１００㎠以上５００㎠未= 栫@　　  ：　９８点
　３）５００㎠以上３，０００㎠= ;未満    ：１５０点
　４）３，０００㎠以上６，０００= 3216;未満：２８０点
　５）６，０００㎠以上        = ;        ：５００点
 ※　初回の処置から２か月まで算定、= それ以降は創傷処置
(p.283、295）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0708_image207.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhzwFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0708_image208.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7QHxAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAUAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0658.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
102
処置
５．不合理な処置点数= ﾌ是正
　１）外来管理加算より低い= 置料の格差緩和　　
◎４２点の処置点数を４５点に引上げ
（例）
　１）創傷処置、皮膚科軟膏処置
　２）ドレーン法（ドレナージ）「持続的吸= を行うもの」
　３）高位浣腸、高圧浣腸、洗腸、４）干渉= 瘤波による膀胱等刺激法
　５）子宮頸管内への薬物注入、６）子宮出= 月~血法「分娩外のもの」
　７）胎盤圧出法、８）クリステル胎児圧出= @、９）霰粒腫の穿刺
　10）鼻涙管ブジー法、11）涙嚢ブジー法（= 浄を含む）、
　12）副鼻腔手術後の処置（片側）、13）耳= ﾇブジー法（片側）
　14）唾液腺管ブジー法（片側）、15）滋養= ｯ腸
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0658_image209.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlheQFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0658_image210.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8QEiAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAUAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0659.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
103
処置
５．不合理な処置点数= ﾌ是正
　２）点数評価の是正= 　　
◎軟属腫摘除：１００点 ⇒ １０箇所未満　　　　　　= ：１００点
　　　　　　　　　　　　　１０箇所以上３= O箇所未満：２００点
　　　　　　　　　　　　　３０箇所以上　= @　　　　：３００点
◎鶏眼・胼胝処置
　　１７０点（一連につき）⇒ １００点（月１回） <= /span>
◎少数睫毛抜去　　：２５点 ⇒ 睫毛抜去　少数の場合：２= ５点
　睫毛抜去（多数）：３１点　　　　　　  多数の場合：４５点
= 3;
(p.288）
(p.288）
(p.289）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0659_image211.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhRAFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0659_image212.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7gEPAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAUAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0631.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
104
手術<= /span>
６．手術の施設基準の廃止<= /u>
　※　相関関係の= ｲ査・検証を前提　　
◎医師の経験年数、年間症例数による５／１= O０加算の廃止
　　人工関節術、ペースメーカ移植術、冠動= ｬ、大動脈バイパス術、
　体外循環を要する手術、経皮的冠動脈形成= p、頭蓋内腫瘤摘出術、
　黄斑下手術、鼓室形成手術、肺悪性腫瘍手= p、靱帯断裂形成手術、
　水頭症手術、肝切除術、子宮附属器悪性腫= 手術　等
⇒　加算を上乗せした点数に改定
⇒　手術実績がある場合の年間手術症例数を院内掲示する =
⇒　<= /span>今後、年間手術症例数、患= ﾒの重症度等と手術成績との相関関係を調査・検証
(p.318、481、507）=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0631_image213.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhgQFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0631_image214.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AEjAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAUAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0632.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
105
麻酔<= /span>
７．麻酔に係る技術の評価
　※　技術評価　　
１）麻酔管理料の引上= げ =
　・硬膜外麻酔または脊椎麻酔：１００点 ⇒ １３= ０点（＋３０点） =
　・マスクまたは気管内挿管による閉鎖循環式全身麻酔
　　　 　　　　　　　　　　 ：５８０= _ ⇒ ７５０点（＋１７０点= ） =
２）麻酔料（重症患者= に対する全身麻酔の評価） =
（現行） =
　・マスクまたは気管内挿管による閉鎖循環式全身麻酔：６，１００点
（改定= ）　・重症の患者に対して行う場合：８，３００点
　・その他の場合　　　　　　　：６，１００点
(p.424、429）<= /span>
(p.423、427、481、= 484）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0632_image215.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhMAFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0632_image216.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wE7AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAcAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0551.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
106
精神= 纓ﾃ
１．精神病床における急性期の入院医療の評価の見直し=
２= D精神病床における入院期間に応じた評価の見直し３= D老人性認知症疾患治療病棟等の人員配置の見直し４= D通院精神療法の見直し５= D入院精神療法の見直し６= D精神科デイ・ケアの見直し７= D精神科訪問看護・指導料および精神科退院前訪問指導料の見直し８= D精神病床における認知症患者に対する入院= 医療の充実９= D重度認知症デイ・ケア料の見直し10．小児に対する心身療法の評価
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0551_image217.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAAIaAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0551_image218.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0642.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
107
精神= 纓ﾃ
１．精神病床における急性期の入院医療の評価の見直し
※　精神科救急入院料、精神科急性期治療病棟入院料= ﾉおける　　　入院早期の評価引上げ１）精神科救急入院料：２，８００点 = ﾋ <= /span>入院後３０日以内：３，２００点
　　　　　　　　　= @　　　　　　　    入院後３０日超　：２，８００点
２）精神科急性期治= ﾃ病棟入院料１：１，６４０点
　　　　　　=         = ;            &n= bsp;  ⇒ 入院後３０日以内：= P，９００点
　　　　　　　　        = ;            &n= bsp; 入院後３０日超　：１，６００点 =
３）精神科急性期治= ﾃ病棟入院料２：１，５８０点
　　　　　　=         = ;            &n= bsp;  ⇒ 入院後３０日以内：= P，８００点
　　　　　　　　        = ;            &n= bsp; 入院後３０日超　：１，５００点
(p.26、62）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0642_image219.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAQItAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0642_image220.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0643.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
108
精神= 纓ﾃ
= ２．精神病床における入院期間に応じた評価の見= ｼし
<= span lang=3DEN-US style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"= lＳ ゴシック"; mso-fareast-font-family:"ＭＳ ゴシック";font-size:92%;mso-fareast-hint:yes; color:#FF9933;mso-fareast-language:JA'>※　精神病棟入院基本料の入院期間に= 桙ｶた加算の見直し
<= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";font-size:92%;mso-fareast-hint:yes;color:#FF9933'>　（入院= 早期：引上げ、長期入院：引下げ）
１）= ｸ神病棟入院基本料
　　= @１４日以内　　　　　：４３９点 ⇒ ４５９点（＋２０点）
　　　１５日〜３０日以= 内　：２４２点 ⇒ ２４２点
　　　３１日〜９０日以= 内　：１２５点 ⇒ １２５点
　　　９１日〜１８０日= 以内：　４０点 ⇒ 　２０点（△２０点）
　　１８１日〜１年以内= 　　：　２５点 ⇒ 　１０点（△１５点）
２）= V人精神病棟入院基本料
　　= @１４日以内　　　　　：２３３点 ⇒ ４５９点（＋２２６点）
　　　１５日〜３０日以= 内　：２３３点 ⇒ ２４２点（＋９点）
　　　３１日〜９０日以= 内　：１１５点 ⇒ １２５点（＋１０点）
　　　９１日〜１８０日= 以内：　５５点 ⇒ 　２０点（△３５点）
　　１８１日〜１年以内= 　　：　３２点 ⇒ 　１０点（△２２点）
３）精神療養病棟入院料２ ⇒ 廃止
(p.8）<= /div>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0643_image221.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5QEfAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0643_image222.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0644.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
109
精神= 纓ﾃ
３．老人性認知症疾患治療病棟等の人員配置の見直し=
１）老人性認知症疾患治療病棟入院料１
　　　　　　　　　　　　　　　９０日以内 ：１，２９０点 ⇒ １，３００点（＋１０点）
　　　　　　　　　　　　　　　９０日超 ：１，１８０点 ⇒ １，１９０点（＋１０点）&= #13;
　　　　　　　　　　　　　　・ 看護職員配置　６：１ <= /span>⇒ 看護職員の実質配置　２０：１
　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　（現= 行の看護職員配置　４：１）
　　　　　　　　　　　　　　・ 看護補助者配置　５：１ ⇒ 看護補助者の実質配置　２５：１
　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　（現= 行の看護補助者配置　５：１）
２）老人性認知症疾患治療病棟入院料２
　　　　　　　　　　　　　　　９０日以内 ：１，１６０点 ⇒ １，０６０点（△１００点）
　　　　　　　　　　　　　　　９０日超 ：１，１３０点 ⇒ １，０３０点（△１００点）&= #13;
　　　　　　　　　　　　　　・ 看護職員配置　６：１ <= /span>⇒ 看護職員の実質配置　３０：１
　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　（現= 行の看護職員配置　６：１）
　　　　　　　　　　　　　　・ 看護補助者配置　５：１ ⇒ 看護補助者の実質配置　２５：１
　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　（現= 行の看護補助者配置　５：１）
(p.27、64、453、47= 5）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0644_image223.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwIqAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0644_image224.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0645.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
110
精神= 纓ﾃ
４．通院精神療法<= /b>の見直し　※　病診格差是正
１）診療所の場合：３７０点 ⇒ ３６０点（△１０点）
２= j病　院の場合：３２０点 ⇒ ３= ３０点（＋１０点）
=
５．入院精神療法<= /b>の見直し　※　要件緩和（入院中２回）= 3;
◎　当該保険医療機関に初めて入院する統合= ｸ調症の患者であって
　「家族関係」が疾患原因= または増悪の原因の場合、患者の家族に対し精神療法を行った場= には、入院精神療法を算定できることとする
(p.270）
(p.270、274）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0645_image225.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+QFgAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0645_image226.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9wENAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALA0AAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0646.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
111
精神= 纓ﾃ
６．精神科デイ・ケア<= /u>の見直し　※　短時間の= Pアについて新たに診療報酬上の評価
　※　精神障害者の地域復帰= 支援　
◎精神科ショート・ケア（新設）
 １）小規模の場合：２７５点
 ２）大規模の場合：３３０点
　= ※　= 開始後３年超の患者は週５日を限度
　= ※　= １日３時間以上を標準
(p.271、278、480、= 501）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0646_image227.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhjgFCAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0646_image228.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0654.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
112
精神= 纓ﾃ
= ７．精神科訪問看護・指導料および精神科退院前訪問　<= /b>指導料の見直し　※　算定回数上限を緩和= 　
１）= 精神科訪問看護・指導料
　（現行）週３回まで算定可
　（改定）退院後３か月以内の患者は週５回まで算定可&= #13;
２）精神科退院前訪問指導料
　（現行）入院３か月超の患者に入院中３回に限り算定可
　（改定）入院６か月超の患者に入院中６回まで算定可&= #13;
(p.272、280）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0654_image229.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJIAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0654_image230.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0655.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
113
精神= 纓ﾃ
８．精神病床における認知症患者に対する入院<= /u>医療の充実　
◎重= 度認知症加算：１００点（新設）
　= ※　= 精神病棟入院基本料を算定する重度の認知症患者について、
　= 　入院後３か月以内に限り加算
◎重度認知症患者入院治療料：廃止
◎認知症老人入院精神療法料：廃止
　= ※　= 老人性認知症疾患治療病棟入院料の中で評価されている
(p.8、45、446、462= ）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0655_image231.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0655_image232.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0656.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
114
精神= 纓ﾃ
９．重度認知症デイ・ケア料の見直し　※　簡素化および介護保険との= 割分担の明確化　
１）重度認知症の定義
　= ⇒　認知症の評価尺度を導入し、介護保険との役割分担を明確化 =
２）重度認知症患者デイ・ケア料（T）と（U）を統合
（現行）
　・重= 度認知症患者デイ・ケア料（T）４〜６時間未満= ：　　７０５点
　　　　送迎な= し　　　　　　　　　６時間以上　　：１，０６０点
　・重= 度認知症患者デイ・ケア料（U）４〜６時間未満= ：　　９５３点
　　　　送迎あ= り　　　　　　　　　６時間以上　　：１，３０８点
（改定）
　・重度認知症患者デイ・ケア料　６時間以上：１，０００点=
(p.273、281、480、= 502）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0656_image233.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0656_image234.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0657.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
115
精神= 纓ﾃ
10．小児に対する心身療法の評価 =
　※　発達障害児、引きこもり、= s登校等の児童の患者および思春期の患者に対する精神医療の充実　
◎心身医学療法の２０歳未満加算の新設
　　※　１００／１００点を加算
(p.271）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0657_image235.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0657_image236.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0552.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
116
小児= 纓ﾃ・産科医療
１．乳幼児深夜加算等の新設および評価の充実２= D小児入院医療の評価の見直し３= D地域連携小児夜間・休日診療料の見直し４= D小児医療における手術の通則加算の見直し５<= /b>．小児医療における検査、処置等の技術評価の引上げ６= D小児食物アレルギー患者への対応７<= /b>．ハイリスク分娩管理加算の新設（再掲）= ８= Dハイリスク妊産婦共同管理料の新設
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0552_image237.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/AH8AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0552_image238.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0633.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
117
小児= 纓ﾃ
１．乳幼児深夜加算等の新設および評価の充実　※　診療報酬体系の簡素化の観点から= A初再診料の時間外加算等について、 <= /nobr>
　　乳幼児を対象とする新点数を創設お= 謔ﾑ深夜の評価充実
※小児科外来診療料には従来どおり、<= /span>85点、250点、480点の加= 算のみ
= ６９５点
= （＋１００点）
〔深夜〕 =
= 乳幼児深夜加算
７２点
４８０点
４３点
（計５９５点）
〔深夜〕 =
乳幼児加算
深夜加算
乳幼児加算の時間外による評価分<= /span>
３６５点
〔休日〕 =
= 乳幼児休日加算
７２点
２５０点
４３点
（計３６５点）
〔休日〕 =
乳幼児加算
休日加算
乳幼児加算の時間外による評価分<= /span>
２００点
〔時間外〕 =
= 乳幼児時間外加算
７２点
８５点
４３点
（計２００点）
〔時間外〕 =
乳幼児加算
時間外加算
乳幼児加算の時間外による評価分<= /span>
改　定
現　行
(p.1）<= /div>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0633_image239.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJEAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0633_image240.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6AFQAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADm AU8BgQAAAAAAAAD//////wL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWM/xw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXin+v0LOLDgwYQLGz6MOLHi xYwbO34MObLkyZQrW76MObPmzZw7e/4MOrTo0aRLmz6NOrXq1axbu34NO7bs2bRr276NO7fu3bx7 +/4NPLjw4cSLGz+OPLny5cybO38OPbr06dSrW7+OPbv27dy7e/8OPrz48eTLmz+PPr369ezbu38P P778+fTr27+PP7/+/fz7+///D2CAHg1AYIEGHohgggouyGCDDj4IYYQSTkhhhRZeiGGGGm7IYYce fvihGyCOSGKJJp6IYooqrshiiyqKOEBxBMoWYxszEncjbDWykaNwPbq24xo/Ajcka0GqUaRvSap2 ZBpL8vYkak2iEaVuVZo25RlX4rYlaVma0aVtYYr2ZRlj0nYmaGWSkSaNa572phhtxjZnZ3GGUedr eW52Jxh7tvZnZn1+4WKhhh6KaKKKLsooozA2Cmmkkk5KaaWWcgijjIOSmSmOm4b2KQqBrjbqZaEe UGpqqVZ2qgGrwtmqnZ0O9+pksdZaGq6R3Rqrnr3yOauPv2rGq6Y0BhucrpD/FevpsTYOayS0mDFL q7SmIkuktZZRK6yzPGorJbiUcZusuLZi+5uyj5GbrbdCmpsrvLuiq6S8y9Lbm7qOsZuuveviC6W/ +wK8m76N8Vuvu0gKrCbDjCGcr8OLQRywwk5KbCfGiVFcsMaIcWylx4eBnJvBDxMcssVUiiwoy4WR zKXLhMF8m8kTo1yyzIPRLKbOgvFcm82KAY2mz4ERPZvQG+Mcs8paGm0r1H8h7abTYEq9K9ZTUU2n 1lJxraPXTYHtq9Vmin0w2kiRDaTaR7ENqNtDwR2t2WzKvTHeQdFNqt498c2k3zwBrqrgOxEert1j KM2n4TchDqvicjq+M+U1/0GOpeUyYR6v5HhqDhjjIzNdM+gwce6l6S2hPprohrFOpuoswQ6q7Cvx emnuuu/Oe+++e0h6z577afvYxZ9Ee8PDE3r82s2PlPxnrr8cfNDPixS9Z9PPXH3Ry+Ow/bbXh5R9 xt+nED6r4w/YfdLrd1Q+Z+kf3X7VdNbf9fmivj84/xnF3zj9ocp/jyPgRQBILANSBIEtE6CrFLg5 CEqEgdOS4EMoaCoLOgSD4nMgAOYXNQ+CUDIj9AsH1SdCDc5OhQk54bhYiBAXhvB+zzIWDb9lQx3h L2wpzKGedli2G77Lh0ACYtt62CwhLoyIgDJi3JBYLSh2S4kXY6KRnFg3Kv+uzIqkwmLfpFguMLZL i0/jIpO8GDgx9kuNCSPj1cyoKjQWjo0Ro2PF3Hg2OEpJjonD4930CCc+Rs6Pi4Mh8gxJEBmSEJED UWTW7NgxSKaMkJMDJJYEmTlJ5kyTTaPk5yyZq0f9bpSkLKUpT+moZ6FylaxspStfGSFMds6TxAOl l2SZOk6WTpfCoyXzbNk6XLaOkQJx5LKI+Q9jrguZ/lDmvpjZD2emjZfWo6b3fAk+aHKkhFsTZuys 6T5w2k+HNUwiOXFozh+WM4rYRJ82//dOfEjzYfG8xzwnVk963HNo+ZzHPvMmzvy1c3/A5NQ6p3jO IaaziAcN40AHWFBQebPBdgHl4UMfGFE1TVR5F/1gPyf40Xj882MhdcdIR1bSdpz0dSllx0pf1tJ1 vHRmMUXHTCtX0SAmdIkLbWJDx7jTKvb0ij9dY0e5ucycHvGoNU1kU81x0589tRxRPdpUxVHV0F01 HFmd2lbB0VUTfvUbYd3aWLlR1q+ddRtpNZ5Sn8jUjEpvo9JbqzbayhSkjo2u2rNrNvDqvLdmMahb HGoXi9pGwpbRsGdEbB2ZCsvISnaylN2dKCuL2cxqdrMmMkABAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0641.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
118
小児= 纓ﾃ
= ２．小児入院医療の評価の見直し　※　= 小児入院医療管理料の評価充実・要件緩和
１）小児入院医療管理料の評価引上げ= =
= @・小児入院医療管理料１：３，０００点 ⇒ ３，６００点（＋６００点）
　・小児入院医療管理料２：２，６００点 ⇒ ３，０００点（＋４００点）
２）プレイルーム、保育士等加算：８０= 点 ⇒ １００点（＋２０点）=
３）小児科の医師の常勤要件の緩和 =
　　 複数の小児科の医師が= 協同して常勤の場合と同等の時間数を勤務 =
　⇒ 「常勤」として取扱う
　
(p.24、60、451、47= 2）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0641_image241.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0641_image242.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCQIkAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALBAAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0640.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
119
小児= 纓ﾃ
= ３．地域連携小児夜間・休日診療料の見直し　※　= 算定要件緩和と２４時間診療体制の評価充実
１）要件緩和
　「近隣の保険医療機関を主たる勤= 務先とする専ら小児科を担当する医師が３名以上いること」 =
↓
　「近隣の保険医療機関を主たる勤= 務先とする専ら小児科を担当する医師が３名以上おり、うち２名以上は専ら小児科を担当する医師であること<= /span>」⇒１名は= 小児科医でなくてもよい
２）２４時間診療体制の評価充実：４５= ０点（新設）　・小児を２４時間診= 療することができる体制 =
　・小児科を担当する= 医師が常時配置
(p.74、477、490）<= /b>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0640_image243.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhzQFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0640_image244.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wE3AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALBAAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0639.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
120
小児= 纓ﾃ
= ４．小児医療における手術の通則加算の見直し　※　= 新生児、乳幼児に対する手術評価引上げ
１）新生児：２００／１００　⇒　３００／１００
　　乳幼児：　５０／１００　⇒　１００／１００
２）極低出生体重児（１，５００ｇ未= 満の児）への加算新設 =
　　　４００／１００
　
(p.319）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0639_image245.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0639_image246.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wHpAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAYAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0637.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
121
小児= 纓ﾃ
= ５．小児医療における検査、処置等の技術評価の引上げ　 ※　新生児加算、乳幼児加算の評価充実　　　
１）検査、処置の新生児加算、乳幼児= 加算 =
（例）
　・心臓カテーテル法による諸検査：新生児加算等の引上げ
　・非還納性ヘルニア徒手整復法  ：新= 生児加算等（新設）
２）注射の乳幼児加算 =
（例）
　・静脈内注射、点滴注射：乳幼児加算２１点 ⇒ ４２= 点（＋２１点） =
　・中心静脈注射：乳幼児加算５００点（新設）
　 =
　
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0637_image247.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJLAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0637_image248.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wFEAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAYAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0636.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
122
小児= 纓ﾃ
= ６．小児食物アレルギー患者への対応
　※　診断・治療= ﾌ評価　　
１）小児食物アレルギー負荷検査：１= ，０００点（新設） =
  <= /span>※　年= ２回に限り算定 =
　※　小= 児科を標榜する保険医療機関で小児科を担当する医師が =
　　９歳未満の入院患者に対= して、問診、血液検査等から =
　　食物アレルギーが= 強く疑われ、原因抗原を診断するために、 =
　　または耐性獲得の= 確認のために、食物負荷検査が必要と判断された =
　　者に対して実施した場合<= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";font-size:110%;text-shadow:none;display:none'> =
２）外来栄養食事指導料・入院栄養食= 事指導料の対象追加 =
　※　小児食物アレルギー患者に= ﾎする「小= 児食物アレルギー食」 =
　 =
　
(p.162、218、479、= 495）
(p.87、477、482）<= /b>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0636_image249.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhogFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0636_image250.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wFOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAYAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0635.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
123
産科= 纓ﾃ
= ７．ハイリスク分娩管理加算の新設（再掲）
　※　産科の体制が整っている病院におけるハイリスク分娩の妊産婦に対す= 髟ｪ娩管理について、入院基本料に加算　　
◎ハイリスク分娩管理= 加算：１，０００点（１日につき） =
　※　８日を限度とし= て入院基本料に加算 =
（対象者） =
　　保険診療<= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";font-size:110%;text-shadow:none'>の対象となる合併症を有し= ﾄいる妊産婦であって、 =
　リスク要因を持つ患者
・専= ら産婦人科または産科= に従事する医師３= 名以上 =
・年= 間分娩実施件数１２０件以上 =
・年= 間分娩実施件数等の情報を院内掲= 示 =
・助= 産師３名以上
・妊= 娠２２〜２７週の早産 =
・４= ０歳以上の初産婦 =
・分娩前のＢＭＩが３５以上の初= 産婦 =
・糖= 尿病合併妊娠 =
・妊= 娠高血圧症候群重症
・常位胎盤早期剥離
（施= 設基準）
（リ= スク要因）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0635_image251.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0635_image252.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7QHJAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAYAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0635_image253.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9gGdAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0634.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
124
産科= 纓ﾃ
= ８．ハイリスク妊産婦共同管理料の新設
　※　ハイリスク分娩の妊産婦に対して、複数の医療機関が共同で診療に当= ｽれるような診療報酬上の評価　　
◎ハイリスク分娩の妊= 産婦について、入院先の病院の医師と、 =
 紹介= 元の医療機関の医師が共同で診療に当たった場合に算定 =
１）ハイリスク妊産婦= 共同管理料（T）：５００点 =
　　※　紹介元の医療= 機関が算定 =
２）ハイリスク妊産婦= 共同管理料（U）：３５０点 =
　　※　入院先の病院= が算定 =
（施設基準）<= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";font-size:110%;text-shadow:none;display:none'> =
（T）：
　・（U）を算定する保= ｯ医療機関と連携し、産科・産婦人科を標榜
　・年間分娩件数、ハイ= 潟Xク分娩管理を共同で行う保険医療機関の名称等を　院内掲示
（U）：ハイリスク分娩管理加算の施= ﾝ基準を満たすこと
(p.79、97、478、48= 2、492）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0634_image254.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0634_image255.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wFPAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAYAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0557.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
125
ＤＰ= b
１．ＤＰＣによる支払対象病院の拡大２= D診断群分類および点数の見直し３= D入院期間Tの設定方法の見直し４= D包括評価の範囲の見直し５= D調整係数の見直し
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0557_image256.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhvAGkAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0557_image257.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0666.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
126
ＤＰ= b
１．ＤＰＣによる支払対象病院の拡大　　
１）ＤＰＣ対象病院
　　 現行：８２病院に加えて
　 =   @ 試行的適用病院：６２病院
　 =   A 調査協力病院：２２８病院のうち一定の基準を満たす病院 =
２）ＤＰＣ準備病院
　@ 上記Aで対象とならなかった病院のうち= 引き続き適用希望する病院
　A 新たに適用希望する病院のうち一定の基= 準を満たす病院
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0666_image258.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0666_image259.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/QEOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAgAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0667.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
127
ＤＰ= b
２．診断群分類および点数の見直し　※　医療資源の同等性、臨床的類似性、分類の簡素化= E精緻化、
　　アップコーディング防止= 凾ﾌ観点から　　
１）診断群分類　３，０７４ ⇒ 約２，５００ =
　
２）見直し方針
　@「手術」による分岐の簡素化
　A「手術・処置等２」による分岐の精緻化&= #13;
　B「検査入院」「教育入院」の廃止
　C「副傷病」の検証　　等
　
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0667_image260.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJPAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0667_image261.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6AEiAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0668.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
128
ＤＰ= b
= ３．入院期間Tの設定方法の見直し　※　より短期の入院を評価する仕組み<= span style=3D'font-family:"ＭＳ ゴシック";mso-ascii-font-family:"ＭＳ ゴシック"= ;mso-fareast-font-family: "ＭＳ ゴシック";font-size:120%;text-shadow:none;color:#FF9933;mso-special-= format: lastCR;display:none'>
◎　平成１６年度改定で、悪性腫瘍に対する= ｻ学療法などの短期入院のある分類については、入院日数の２５パーセンタイル値ま= での点数の１５％加算を、５パーセントタイル値までに繰り上げて設定する見直し= 行った。
◎　今回改定では、悪性腫瘍以外の診断群分= ﾞのうち、短期入院が相当程度存在する脳梗塞、外傷等についても同様の見直しを= sう　
　
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0668_image262.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhAwJAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0668_image263.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7gEPAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAcAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0669.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
129
=
ＤＰ= b
= ４．包括評価の範囲の見直し
　※　ＤＰＣ評価分科会での= 沒｢結果等を踏まえて　　
= =
１）包括評価の対象外とする：画像診断管理= ﾁ算
２）包括評価の対象とする　：手術前医学管= 摎ｿ、手術後医学管理料
３）出来高算定とする患者
　 @ 平成１７年度「７月から１０月までの退院患者に係る調= 査」終了以降に、
　　 新規に薬価収載等された高額な薬剤等を使用する患者= 3;
　 A 自家末梢血幹細胞移植、自家造血幹細胞移植、臍帯血輸= 血を受ける患者
= ５．調整係数の見直し　　
=
◎平成１８年度診療報酬改定率を踏まえ、Ｄ= oＣによる支払対象
　病院の包括範囲に係る収入が△３．１６％= ｺがるように設定
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0669_image264.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AE1AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0669_image265.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhDwL5AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALBcAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0669_image266.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7QE4AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0620.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
130
医療技術の評価・再評価
１= D新規技術= の保険導入
２= D既存技術= の再評価
３= D高度先進= 医療の保険導入
４．廃止・統合
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0620_image267.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9AF8AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0620_image268.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0687.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
131
=
医療技術の評価・再評価
１．新規技術の保険導=
　※　５０技術を導入（医療= Z術評価分科会での検討結果）　　
=
 １）ＰＥＴ／ＣＴ検査
 ２）小児の弱視・斜視治療のための眼鏡・コンタクトレンズ
 ３）小児食物アレルギー負荷検査
 ４）高周波熱凝固法
 ５）髄腔内薬剤投与用植え込= み型ポンプ
 ６）胃局所切除術
 ７）ＣＴ・ＭＲにおける先進画像加算
 ８）両方向グレン手術
 ９）肝膵同時切除術
10）多臓器提供管理料
11）小切開水晶体再建術
12）大動脈縮窄/離断と他の心疾患との一期的修復手術&#= 13;
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0687_image269.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AE1AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0687_image270.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8QFOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0703.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
132
=
医療技術の評価・再評価
１．新規技術の保険導=
　※　５０技術を導入（医療= Z術評価分科会での検討結果）　　
=
13）左室形成術
14）心室中隔穿孔手術
15）褥瘡処置=
16）= 一期的乳房再建術（乳房切除後）
17）二期的乳房再建術（乳房切除後）
18）免疫関連遺伝子再構成
19）PAIｇG測定
20）終夜経皮的動脈血酸素飽和度測定
21）外陰・膣血腫除去術
22）膣断端挙上術（膣式・腹式）
23）扁桃処置=
24）= 間接喉頭鏡下喉頭処置=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0703_image271.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AE1AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0703_image272.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8QFiAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0621.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
133
=
医療技術の評価・再評価
１．新規技術の保険導=
　※　５０技術を導入（医療= Z術評価分科会での検討結果）　　
=
25）= 鼓室処置=
26）= マグネットカテーテルによる食道・胃内異物摘出<= span style=3D'font-family: "ＭＳ Ｐゴシック";mso-ascii-font-family:"ＭＳ Ｐゴシック";mso-fareast-font= -family:"ＭＳ Ｐゴシック"; mso-hansi-font-family:Arial;font-size:120%;text-shadow:none;display:none'>=
27）= 腹腔鏡補助下腹腔内停留精巣陰嚢内固定術=
28）= 経内視鏡的噴門部縫縮術=
29）= 内視鏡的粘膜下層剥離術=
30）= 髄液MBP・IgGインデックス・髄液オリゴクローナルバンド= 測定
31）= 脊椎固定術・前方後方同時手術=
32）= 寛骨臼移動術・大腿骨近位部（転子間を含む近位部）骨切= り術・大腿骨頭回転骨切り術
33）= 神経交差縫合術=
34）= 内視鏡下脊椎前方固定術=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0621_image273.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AE1AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0621_image274.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh+gFOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0686.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
134
=
医療技術の評価・再評価
１．新規技術の保険導=
　※　５０技術を導入（医療= Z術評価分科会での検討結果）　　
=
35）= 内視鏡下椎間板前方摘出術 =
36）= 内視鏡下椎間板後方摘出術=
37）= 整形外科内視鏡手術=
38）= 内視鏡下椎弓切除術=
39）= 内痔核に対する四段階注射法=
40）= 直腸腫瘍摘出術の自動吻合器又は自動縫合器加算<= span style=3D'font-family: "ＭＳ Ｐゴシック";mso-ascii-font-family:"ＭＳ Ｐゴシック";mso-fareast-font= -family:"ＭＳ Ｐゴシック"; mso-hansi-font-family:Arial;font-size:120%;text-shadow:none;display:none'>=
41）= 胸腔鏡下膿胸掻爬術=
42）= 乳腺悪性腫瘍に対する腋窩郭清を伴わない乳房切除術=
43）= 定位脳手術・脳刺激装置植込術・頭蓋内電極植込術の両側手術の新設=
44）= ダーモスコピー=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0686_image275.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AE1AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0686_image276.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wFOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0704.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
135
=
医療技術の評価・再評価
１．新規技術の保険導=
　※　５０技術を導入（医療= Z術評価分科会での検討結果）　　
=
45）= 密封小線源前立腺癌永久挿入療法=
46）= 輸血管理料=
47）= 自己血貯血（液状保存)
48）= 自己血貯血（凍結保存）=
49）= 膵頭十二指腸切除術における自動吻合器・縫合器加算=
50）= HIV-１ジェノタイプ薬剤耐性検査<= /div>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0704_image277.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AE1AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0704_image278.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8QHeAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0680.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
136
=
医療技術の評価・再評価
２．既存技術の再評価<= /u>
　※　８６技術を再評価（医= ﾃ技術評価分科会での検討結果）　　
=
 1）持続緩徐式血液濾過術=
 2）後腹膜気体造影の廃止=
 3）経尿道的前立腺手術=
 4）潰瘍性大腸炎に対する遠心分離式による白血球= 除去療法
 5）環境アレルゲンや薬疹の原因薬剤検査のための= 貼布試験（パッチテスト）
 6）血漿交換療法（中毒性皮膚壊死症等）への適応= 拡大
 7）関節リウマチに対するインフリキシマブ点滴注= 射に係る外来抗体製剤 療法加算の新設
 8）Picture archiving= and communication system(PACS)運用費の評価
 9）エックス線乳房撮影の単純撮影からの独立
10）コンピュータ画像撮影機器の性能別の評価=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0680_image279.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0680_image280.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wFiAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0705.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
137
=
医療技術の評価・再評価
２．既存技術の再評価<= /u>
　※　８６技術を再評価（医= ﾃ技術評価分科会での検討結果）　　
=
11）エタノールの局所注入の適応拡大
12）肝切除術
13）気管支形成を伴う肺切除術
14）食道悪性腫瘍手術
15）食道悪性腫瘍手術の有茎腸管加算追加
16）大動脈瘤手術　８．胸腹部大動脈瘤
17）肺切除術
18）副甲状腺全摘出、自家移植
19）弁形成術
20）FDG-PETの婦人科癌への適応拡大=
21）FDG-PETの食道癌への適応拡大
22）内視鏡下手根管開放術
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0705_image281.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0705_image282.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wFiAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0690.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
138
=
医療技術の評価・再評価
２．既存技術の再評価<= /u>
　※　８６技術を再評価（医= ﾃ技術評価分科会での検討結果）　　
=
23）関節鏡下半月板縫合術
24）オフポンプ冠動脈バイパス手術時のスタビライザーの特定保険医療材料と= しての評価=
25）植込み型補助人工心臓
26）組織拡張器による再建手術
27）結核菌核酸同定精密検査、結核菌群核酸増幅同定検査=
28）呼吸器疾患心肺運動負荷試験
29）CA125精密測定
30）NSTの外来使用
31）骨盤位娩出術
32）腟洗浄
33）耳管処置
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0690_image283.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0690_image284.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wFOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0691.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
139
=
医療技術の評価・再評価
２．既存技術の再評価<= /u>
　※　８６技術を再評価（医= ﾃ技術評価分科会での検討結果）　　
=
34）内耳機能検査
35）鼻腔通気度検査
36）標準語音聴力検査
37）補聴器適合検査
38）偽関節手術
39）脳性麻痺等の発達障害に対するリハビリテーション=
40）腹腔鏡補助下胃悪性腫瘍手術
41）外来化学療法加算のクローン病患者に対する抗TNFα抗体製剤使用への適= 條g大=
42）瀉血療法
43）止血（補助用）デバイスの算定要件の見直し=
44）ポツリヌス毒素筋肉注射手技料の新設
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0691_image285.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0691_image286.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wFOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0706.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
140
=
医療技術の評価・再評価
２．既存技術の再評価<= /u>
　※　８６技術を再評価（医= ﾃ技術評価分科会での検討結果）　　
=
45）ボツリヌスキシンを用いた顔面神経ブロック=
46）両室ペースメーカー移植術
47）脊髄誘発電位測定の適応拡大（側弯症手術）=
48）難治性骨折超音波治療法
49）同一術野における複数手術の見直し
50）言語聴覚療法の算定対象に嚥下訓練を追加=
51）吸着型血液浄化器を用いたβ2-ミクログロブリン除去療法の算定要件の見直し=
52）連続携行式腹膜灌流腹腔内留置カテーテルの処置加算から手術への変更=
53）腹腔鏡下結腸悪性腫瘍手術
54）同種皮膚移植
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0706_image287.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0706_image288.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/wFOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0692.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
141
=
医療技術の評価・再評価
２．既存技術の再評価<= /u>
　※　８６技術を再評価（医= ﾃ技術評価分科会での検討結果）　　
=
55）熱傷処置（６，０００㎠以上）
56）血管内手術
57）膀胱及び前立腺に対する組織試験採取、切採法（廃止）=
58）前立腺針生検
59）限界線療法（廃止）
60）軟属腫摘除
61）精神科作業療法の要件見直し、点数引上げ等=
62）経鼻的下垂体腺腫摘出術
63）頸動脈血栓内膜摘除術
64）HER2遺伝子
65）電子顕微鏡検査
66）病理組織迅速顕微鏡検査
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0692_image289.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0692_image290.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8QFOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0693.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
142
=
医療技術の評価・再評価
２．既存技術の再評価<= /u>
　※　８６技術を再評価（医= ﾃ技術評価分科会での検討結果）　　
=
67）免疫抗体法
68）両側子宮附属器癒着剥離術（腹腔鏡下）=
69）腹腔鏡下卵巣部分切除術
70）腹腔鏡による子宮外妊娠手術
71）腹腔鏡下子宮筋腫核出術
72）腹腔鏡下子宮内膜病巣除去術
73）腹腔鏡下膣式子宮全摘術
74）抗悪性腫瘍剤に係る無菌処理加算の点数引上げ=
75）鶏眼・胼胝処置
76）腹腔鏡下複数臓器手術
77）アルブミン・グロブリン比測定の廃止
78）フルクトサミン測定（廃止）&#= 13;
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0693_image291.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0693_image292.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8QFOAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0707.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
143
=
医療技術の評価・再評価
２．既存技術の再評価<= /u>
　※　８６技術を再評価（医= ﾃ技術評価分科会での検討結果）　　
=
79）ヘモグロビンA1測定（廃止）
80）ポールバンネル反応（廃止）
81）ロゼット法によるリンパ球サブセット検査（廃止）=
82）過酸化脂質測定（廃止）
83）検体検査
84）検体検査管理加算
85）総脂質測定（廃止）
86）部分トロンボプラスチン時間測定（廃止）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0707_image293.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh7AFGAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0707_image294.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh8QEbAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAkAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0622.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
144
医療技術の評価・再評価
３．高度先進医療の保= ｯ導入
　※　普及性、効率性、有効= ｫ、安全性等を踏まえた導入　　
１）悪性腫瘍の遺伝子診断
２）進行性筋ジストロフィーのＤＮＡ診断= 3;
３）腹腔鏡下前立腺摘除術
４）ＣＴ透視ガイド下生検
５）脳死肝= 臓移植手術
６）心臓移= 植手術
７）膵臓移= 植手術
８）脳死肺= 移植手術　=
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0622_image295.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh4wFAAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0622_image296.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh6AEZAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0623.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
145
医療技術の評価・再評価
４．廃止・統合
　※　医療現場ですでに実施されていない、臨床的な意義が= 無くなっていると考え
　　られる項目の削除
  ※　点数表の簡素化のために、同様の手技等と考えられる項目を統合する&= #13;
〔検査の例〕　　
ビタミンB１定量
ビタミンB１定量精密測定
D007　4= 1
D007　4= 1
トリプシン
トリプシン精密測定
D007　3= 6
D007　3= 6
ミオグロビン
ミオグロビン精密測定
D007　3= 1
D007　3= 1
第[因子様抗原
第[因子様抗原精密測定
D015　1= 5
D015　1= 5
ＰＩＶＫＡU
ＰＩＶＫＡU精密測定
D006　1= 6
D009    8
旧検査項目名 <= /span>
旧区分 <= /span>
ビタミンB１定量
<= /div>
D007　3= 8
トリプシン
D007　3= 4
ミオグロビン
D007　2= 9
第[因子様抗原
D006　1= 7
ＰＩＶＫＡU
D006　1= 6
新検査項目名
新区分
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0623.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0623_image297.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhEAJsAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0623_image298.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0623_image299.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wG9AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAADm AbwAgQAAAABm/2bM/////wL/hI+py+0Po5y02ouz3nH4D4biSJbmiabqyrbuC8fyTNf2jefcbuT+ DwwKh8Si8YiM8XaepVMxeEqn1AaoigVEs9yu19L8PsLiy7aMTh+u6s25DY9zyHK63HrPU9n6ybsP GNjzB2cnqHWYCPah6EDYCClm2DYZ+BiJqcWYiXDJ+elUmSba5wl6yPdpesqKQVr2mrfaqpfKOUub CxH7xVun22ibiQtcnODbhVxojLoJSsxsrJw1rQYd3eusis3NUF31jXbdTa19S44+WDtunV5nPuxO Hj5FLylfCI/Jjh9p//TPC79+TPT5Ixgt4BKFXAYi1CBs30NpDqUwpDZRkkFI/xUzrvvI0aPAjcFE 5ro4p6NAkw1JKlLJkhJMHijBxcQS8eDNZzML6txp0WWinkBHgixZFKBQVEmHEXXzdE/TUEsFRZ1a 76orrQCx0qxqyWswrot+is2QM+TZZkdfroUIFhDZt2jnUqgpla6ZuKX0yrXrB/Acv4vwriQsS3AH xRAR3+Vby/Edw1vNSnYEWdblOJT3Wt68IC1S0KMYjzHtijTmzhhVi0NtBTYY194yT6YNS3Zo3Xdx Q7H9y7fRxJ9xi3YrPBnvY0maO38OPbr06dR1EFebXBNrnNlbth3aXftytOFxjl9zflf44+DL70mv qTht9kzdZ/1ePzt9q/bvX/8fndx+YfWnFH78dSegXAQW+B9y+gHH2YJUGTjgg9vZJOFXFCqIIITL ZOhTg+1ZCF8FJfp1YWDyuZZgXyCmtKGLJLJyol4pSnCjG+t5SMmLMIqYX4A8tuMjXDFG1mGOXRVZ 15GaJVkjjkw2CeSBM54S5VtKnraiai0iOWVZVVYo5JYLhenZmBxe+QyaYk6W5TE7mkmTmybCR+ds UNJo52NO3rYnln2qqKaMZcY5xqA44onoGnM2ioeiuzDaJWlfPikpZn8Gx+Y2mWqaWHWijvocn5/G tmmEUJLKaquuupDqh52ec2ptsfYYaJu17nYrkbPGs+tvvY7yqKnBdkIpdof/GnusOoWCuaygzaI3 rDjFSjttfM9iGq2u2ebJq7LCXQrot8kCOO6QxGarrRQBvOlgt56aS8W7d1YKGrmcTktZAPYSiq5v +qpK7xT+3iuuwOpay26//y6K72YDy8qvVgEI8PCkEV82Ma4Fu4uxnwkbtzAs7Lb7xMUZcznyfCXf 07DFAoQMccssvtzLyaT4y3PPPv/s78w0L7axZB37WrEDFwvNdNNOO72yrTZ7ifNhHy+w9NNaax11 uAGTDK6OMSu9ddlQ1/y1y2E3NnYDWZsNd9fMFe3Y0etercDbcJctN7J0I2Y3w3gnoPfeW/ftbNo3 r01e2wwUbvjTiKM8ory0/w6OAOSRNz35q55/XgOzze68edwsK04146k5jnXpfGs8taWgz067q2S7 zjXsqMuuuhk6m6K565NTHmS6veuJ+QHBlz788Y5c623SbuMuOdGx51t1Mr/fTr3QwxNvpeXAJm/A 8pF/73ykv0rEet7dew9wvMZD6s32bgONP9Azfw8+mfOLfqx+7S9+lfsftqQHMv71b03iYx/5NqAy ke0Oe+nzg/0SKEH5KayCUmrfEg6WwQJukH6huWDKFLhAQxkweqOzGLxECDYSQsGETkBhCqG1wnkh MGUvLN4IARis43FwhrnSYQurZbIiXm6HnKGfDGmUvYbQMB9/I0zgkvjA3P9UEUVRbE0WNbJFG3WR Ox6USRjpckWYfTEbZ9TSGDG0xuFMUGJvzEscldPGtaQxZ2W0Ru3+CEgRAHFXQnQi9IwYwHNpMIaB bKQjh4BENTYwjz4qJCXFskerMZGK16PjENXTx9Jc0iuZ1F4oXzNKrJRSiqfUYic5Vsd6TNGMrzRa LC0ySz+mciqr9OImaTlHWH4yUa0EYy3rdssl3dE7xwRcMkORS1E204rPPFMx2ThNLg7zedeU4yLV 9sRORBOV2RTjNtX3S12WE43VrFM38bhON56zfu9kZjBtOc8S1rMcu2xKL8m4TH7GU4/tZMI4XXlP ZOaTiAE1Tz+T8k84plP/mgl15kLltE+HDvQsEbXjRMlZUWpeVJwZBYchlTi+jyL0m4sLp6NK+p5H ytRzg6yVJTeKyYIOBqb+Cak2ZwrUoCphW+WaJE5BdFOfmtOlPTioMZXKzpG+tKEmfWhROipLngbF qkDBKi61yiCoypOpiADrhI6qSp2Kjarv4epOvKpMlT6VpakjK1ljklS68s6uTsWmWAkq1aaadSEn XZ9by5NXGIKzpqdKrA9jyNhPOTZ8OVziEYm6r8qm9LJwOixe1co2tvZUrxTk62A1hFZegrZxot1q av252tW1Nqyk9aRpZ3vWv3I0tr47bYh0m9PAlhW3hPUsS+AKTd/+CLikMOQt8uTq19oK87bQ9aZi WxrZTBVSqNydTnYlJdyTBaa75C1vCMSLDvOq17zoJUcBAAA7 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0694.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
146
医療技術の評価・再評価
４．廃止・統合
　※　医療現場ですでに実施されていない、臨床的な意義が= 無くなっていると考え
　　られる項目の削除
  ※　点数表の簡素化のために、同様= ﾌ手技等と考えられる項目を統合する　　
ヒト胎盤性ラクトーゲン（ＨＰＬ）
ヒト胎盤性ラクトーゲン（ＨＰＬ）精密測定
D008　1= 2
 D008　12
黄体形成ホルモン（ＬＨ）
黄体形成ホルモン（ＬＨ）精密測定
D008　1= 1
D008　1= 1
プロラクチン（ＰＲＬ）
プロラクチン（ＰＲＬ）精密測定
D008　= @8
D008　= @8
17-ﾊｲﾄﾞ= ﾘｷｼｺﾙﾁｺｽﾃﾛｲﾄﾞ（17-ＯＨＣＳ）
17-ﾊｲﾄﾞ= ﾘｷｼｺﾙﾁｺｽﾃﾛｲﾄﾞ（17-ＯＨＣＳ）
　　　　　　　　　　　　　　　　　　　精密測定
D008　= @3
D008　= @3
11-ﾊｲﾄﾞ= ﾛｷｼｺﾙﾁｺｽﾃﾛｲﾄﾞ（11-ＯＨＣＳ）
11-ﾊｲﾄﾞ= ﾛｷｼｺﾙﾁｺｽﾃﾛｲﾄﾞ（11-ＯＨＣＳ）
　　　　　　　　　　　　　　　　　　　精密測定
D008　<= /span>  2
D008　<= /span>  2
旧検査項目名 <= /span>
旧区分 <= /span>
ヒト胎盤性ラクトーゲン（ＨＰＬ）
<= /div>
D008　1= 4
黄体形成ホルモン（ＬＨ）
D008　1= 2
プロラクチン（ＰＲＬ）
D008　1= 0
17-ﾊｲﾄﾞ= ﾘｷｼｺﾙﾁｺｽﾃﾛｲﾄﾞ（17-ＯＨＣＳ）
D008　= @3
11-ﾊｲﾄﾞ= ﾛｷｼｺﾙﾁｺｽﾃﾛｲﾄﾞ(11-ＯＨＣＳ）
<= /div>
D008　= @2
新検査項目名
新区分
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0694.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0694_image300.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCwJOAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0694_image301.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0694_image302.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhDwLPAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAO As0AgQAAAABm/2bM/////wL/nI+py+0Po5y02ouzHqD7D4biSJbmiabqyrbuC8fuRtf2jef6/sz8 DwwKh8SG7CjiIJfMpvP5VLIM0Ji0is1qt9YDd/oNi8ffq4pKLpnT7Lb7hHgn5fQ6fY1C2/H2vr8a 58f3R1goM6iGmKZo2OiYqLf3OEmZ5yNYmanpEdjHuAkq2RJ5F2ra2Cl6uoo5+in2yiq7lVoXO4sL eOmZ20tWW+orXLarOnwMBSx3i9x8VmzrLL2k/MY8jR1yDUC6nP3t2u0NTp6yLe62Xe5cnb7+TnKu jjUPL9zeVm/vK9+6b4+Pjb5/uPrxIggv4CKEAKEFY1hO4S+I7wwao5hN4piB/xhDWYzW8ZtGWCHB fXxYUtrIMBxTVjo5ziU7L/5kNoNpzeZMdO503nQY0+c9mgeFDsPZ0yg/oheVFgSa02mvlcSkToWa 1KosqlxaagU5xSu1r7O40iJbFms+tKzMahHLVqBauXFNuc0Ct+7GuQv1grpLz69HvhMFawKsy/Bh wnsVv2QK1vEkpGslT4aM0jIqxiQ1OyoCOrTo0aQX+CiNOrXq1Rb+5PUchTNL2KgwB6XtWnZV3K5t R+Wd21VN4LZ8ZyUe+cxrK8g9Ga/cPLm55TCoRw/LE/r13yuy992e7jld8MenDye/Ufx39OuVn2df Rn1h+PO7W59B/5f8xvk7h/993x89+/kXYFe6GVhgVwPOliCC/xXVoIDetRdhMgeeVaGE9+GXYWDC QdhhE4hZGCKJDzZV4hEjxpaiE5SN1yISK7oYo4gXvlUjNQvuluMhN+LVo4o7OhhkdT96WOQLM9qY pJEfothkHkNiGOUoRyZWpX0T1pelOVea2KWUW/IXpiVPSlfmCEsysWGEL1KYZhJT4hgnHF+yWGc8 cwKZpxp30tinmnsiGag2fzJZKAhrjpWooWdm1uiiMjbq6IloFiqpipQqeiibm3IyKJafvsllpKGC uSmpZFKaqY+fdqAqgayeiueonTI6Kq2Avhorg7mOKSurt07Kq66I2vrobab/AusrspZCmmirzL3K zbCaFsssj6la6+qvrH0LbripcTutt+Kei266OpymbrvuvitBcLyS66S38jprH4CBSlsvvu6BuGyb YFDbq7YB37ttstzNmi2RCT+rbLTGekowCgEoKvAz2Gas8bwnXPxBw3Taq+++FmNccp78KklttR+j DLDEIo/s7wggg5pynStz6LEJAdzMDcdmkhxztBYDPTOhDAs9dM0i/Bwy0yZIDd/OVlb8MdJUx0Pw xLgi+3PYYosddc5xWj2wxwEIwHbbbrN9c9KiLo2wsACs/XbecW+tZtdyz2033nm7vbfZaaLdXctK CD443DgXva/XxKrdOOGP/0MZ+d+oBl655UEbXibiHYPdedsga75rqpJfS3npApzO9xwb1x1pB4xX DjvoYYruJda3N5475H3y3nTCvw8ePObDr94t6a4nf2nmscveeunQQ4sp8+U633nhwqusfb/GP395 9Mujnvr41pePvfS0G303+bBOz+nsuu9u+9hjOz7//VkSbyes+Uxr/qsSAKemuKOV7Xs6Cx/LBFgC qLEvYtlD37EeFkECMvBsDuSZ00Igwf5t8HAdvFrPIggz5YEPXixsoQtPtkAVNtCCFDshCYAWNBfq cIfneh+mYDjBhR2sgAak1wOJJkOdGdGDdCNilArmsCGO8HBLNKHqaPg1DP/+K4kkxOLkPjg1+oXM b2IcIwS3aL4VlpETCVRYeWS2Rli1EWJChKMPTeZG7TRxiqGrYtquGEeX2dA8fOzSAf10RkJyMXQl /KMWFZnGGQYykMSBIpUAecfh+TFx9iukITc5uj0uso95hJEoI6nEUsKpgpOcY748acBGcnKQUnJi kg7JtUTWEpZPlGUo7UbHN7IykyoDZe+QiMqzGbN4Uhwl/lRZKjjycJrULA27qonNbAaBmKkMph6b mUwqQnNV4GwfHr1pynJS8IfjDJYdbXnLZQYQmebUZDubdcp6FvOeBnsnL58oTwR20pmf5GcU/UnQ /wUUkfRc5zlfmdBeepH/dWBMBDyDhMu+6RIOcaQkbzJKvYrq6aI9AmmlRCookubIpPWjJUdVWiOW mtGlYYRpjGTKxo3W9J+39OUxUSonm7YIp3LUqUV5WiSiChKo2ugoGbmpTINeMp8OtSc6V+k+oQ51 oblsaB3hd9VoDlOrKbIkzaj6VXaGlZzS1KZb32oDrmrUq8JUq5bgite8toasJTIrn+j6zdpJ9azq TOtD0ahPDk60eY/cZUSbpFSPflSuIUVrXQ8LycR2sZVGHSlSMepTZgp2re4c62cxStmTWjawYIVo OHcX2nkyNYWvNWRsBUrToz62p4vdXmNfetqV3pahs41hbf833K4WN4iXZFUjVMVJWnwWtrn7jG4/ TbvbeA72r5jka4j8qrTpstauiK2qJJ9LSuseFLvHVeh2w4vQ9hbxvYCLr2ah69r7wra34gNmfs2r WM7m1rPZBS1/j7hcERa4pHptsIMhcM0HS7jBBQAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0695.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
147
医療技術の評価・再評価
４．廃止・統合
　※　医療現場ですでに実施されていない、臨床的な意義が= 無くなっていると考え
　　られる項目の削除
  ※　点数表の簡素化のために、同様= ﾌ手技等と考えられる項目を統合する　　
トランスフェリン
トランスフェリン精密測定
D015　　7 D015　　7
補体蛋白（Ｃ３）
補体蛋白（Ｃ３）精密測定
D015　= @8
D015　= @8
抗Ｓｍ抗体
抗Ｓｍ抗体精密測定
D014　1= 1
D014　1= 1
抗ＲＮＰ抗体
抗ＲＮＰ抗体精密測定
D014　1= 0
D014　1= 0
プレグナンジオール
プレグナンジオール精密測定
D008　1= 9
D008　1= 9
エストロジェン
エストロジェン精密測定
D008　1= 6
D008　1= 7
旧検査項目名 <= /span>
旧区分 <= /span>
トランスフェリン
<= /div>
D015　= @7
補体蛋白（Ｃ３）
<= /div>
D015　= @8
抗Ｓｍ抗体
<= /div>
D014　1= 1
抗ＲＮＰ抗体
D014　1= 0
プレグナンジオール
<= /div>
D008　2= 1
エストロジェン
D008　1= 8
新検査項目名
新区分
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0695.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0695_image303.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCwJOAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0695_image304.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0695_image305.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhDwLRAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAO As8AgQAAAABm/2bM/////wL/nI+py+0Po5y02osr2Lz7D4biSJbmiabqyrbuC8PZTNf2jee6Eb/7 DwwKh8Ra78gZIJfMpjOmfJp4Ula0is1qt9MDF3X9isfk8JhKDpnT7LZb7X171vK6fdpG1+n3vp+J 4Mf3R7iXN5iGWLjISBLYp9goqRVZpSdXOalZ+HiXuQl69Ol0+TYainpYapra+nQKCIsl61o7G+dp qwt1CLn7q0prCUycItyzmle8vNVpd8yMCi0zDRh9/Yr7jM29Ue2SzPbdze1sSH49bqWOjO7eYo75 zsyuEp44n38Sz6oPXG8MoA9/BOHcw1dQl8B9C+ElfOhN2zmIrRqWOHiGYkJ+/24sahwmzqO9jwQ5 KiMZSqQIjGJUohQkUd7LTS5BsPxSc+aemP10Sso5B6gjn+5MiiP6s1cupN2MImTKSek2qNiclqEa NaQvrNGsZuQqSOpEsMS8tiS7NZHQEWvRWuLZ0e1UtWnlKoR70m5crUv12jKL0+9eun0FV8R71PDT Mm3VKHYFmEtjwY1vSn582PJlzGf5zuVME/Fi0FkqT/5wmrQ90VdVUxIr0/XPIrRr274dJBju3bx7 +/4RVvYs2D2FL4rczDhIwp+V/0H+2jkp4oOlw9Sc3Lo1z2O1P2P91bso6nnF78Qe3Twv7rHVmwLf 2f1A9sXlh0Rf2v585t31n/+BH5h/VpCXmICM4TecgSPRV52CkgG4mYP7EDiahKVBmJ2FF1HYmoaU YJiehytxGJ6IbyG4nIk2kRifitmgKEVqdplWl4tNQJefjaixGKCON4KYo49J8BihkEjgmKCRANBY mJJQAJmkkUw256QPUKYo5JT9VQnPlTFWqWV7XILj5StgEpnhmGTCaKaTYdan5gpIYunjmw3GuRqb 07mJZoh45iljB4G6ZWd5fwak541nMmjooQz9BmmkkubGaIGOgjFppppuaoFunH4KaqhG1Fhnn0Fe +uig3izKn5ioOlLmnkoWaumrsCa63aymRmkrW7EqymelFfZq06+5SrkrncT/ombsEqqSReuwywra 7JGsMkbqtNTi6uy1/2WrbUTcWhtsq3CGK+6zz4IVbYfobquuty2puq52c35ZLrZNvrtktePl++2+ 797bpq7Custvv+P+a7C5dw7sbzsAzwtuuATLiuzBJSZ8MbAN60slxAtL/DESATBUsbYdH5ulEyd3 kfK0K3c7cQ8BvAxrzMvOTG7JR9wMs8Do8sxwxkwEIADOK9GbMLzB+Wxz0hcx3XS6Txu9BNJS+6oz sUSTjLXJAmy9dNe9iop22pG6PLbSxaoNd9xxX92yBzffjXfeeus9NtnFmm3r1+v5rHXfhh+OeOJ+ Mwv4q4LLIG/hik8+udvU/zaO6uP7hQ2A5JR/brjlSVBdtebgRA566oeL3i/ml5ru0MSeq/456yND XrXC8cpOe++i3745xxEPzvnsvVf+t9AWD4874cer/jvpTcM+IO/Pp2458KfnTr2cqF8PevbSC6/9 9s6DT3n0rjva/YLno6+4+sqrzHzwpdoNf/xwrH9o+8Z8n7/V7W9+Mquf+YoXQAEOMGRDM2Ds3pfA xV2OgDtzYPUgmEDWtY6CXrOg92S3txCKMHRc4+DZPOg+zkWtbSVk4PLK90AVxkBrGowI//7kPzDI a4U13KAL6QfDC8oQBkjroQ+31MAgfhBqM5Qg40wYOBT+r2YzNOIRXSWy3f8xkYhWVOIUSydFHVKR iCiDouPCOKExvsCKVzxXEuUGxzjmwFNyrKMdcUO3+zmsUVnMo47atTF+5TCNW/zQDfE0SDyo8UKH jFMiN7TIWzRSTY8cSiTfMskxVZItO3xQJrm0yRFdMkbjEyQaFVlIRpoxc6eEZColucrXtdKSr8Rk LNk3S06OMhufBFMuRVlLUvbSTb90zC5JUco+DtM7gGwR+bQ4REPesn/FXNExf7RMKVVzR9eMRTaz tM05dLIZyXyjH23UzB5NL5yCGqc0f1hAL34xmqqEZwXlKcZg8nKaOGTnkLrprHK+EJp122OtTIlP QtITlvbsYEJRuVBbNvT/hHesqEUfQMeLanSjNDini9JZpGd6VEUgTZNIvymdkvoJoQTVI8iQONCR mkilpzopP/VDU16xVKYiyqmyzIlS5/gUX2B8qCsjKsybOtKfqwLokQQKxJb+MVlEXadRaYnUfU40 ilfVpT6RGVR0MnVJ7qwnTKPKUw8NtWBWlSo6qcpWm25VQmvFmFzPOlO42nWnYTVOXT3W1rRq6K8s 46tS5UNYmhXVrR/VK2DvisW3asyZhp2rgxLbs8D2VTiYLRpk3djYyarzsw+TrEGlNVCOqtaOGV2t a18L29jGsbWyrS1HBWuhzoKNtHw07UsjG9PNyka3xOPtQacq2pBWFq89rXVsYZV5WPcQt3maja56 pms/6FpWQdg9oHFRS1LnKra62zVQd2P4XYS5NGDlpWZXgZlVsFrXl+815lexOV9i1tea9/Vmfmc1 1nph5bxCTG8gkXta9WqXuWoVb2YNTFkE/xa0aBWuawi8RPIyeLAO9uxygRve5Jr0wxTOq4hXumAQ mzjBBwbqf+3V4d2SuLShZXGEXdxe/2A4hRAe7Xop9mJw2nbIm6ItkY8MxwIAADs= ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0696.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
148
医療技術の評価・再評価
４．廃止・統合
　※　医療現場ですでに実施されていない、臨床的な意義が= 無くなっていると考え
　　られる項目の削除
  ※　点数表の簡素化のために、同様= ﾌ手技等と考えられる項目を統合する　　
結核菌核酸同定精密検査
結核菌群核酸増幅同定検査
D023　= @4
D023　= @6
頸管膣分泌液中癌胎児性ﾌｨﾌﾞﾛﾈｸﾁﾝ
頸管膣分泌液中癌胎児性ﾌｨﾌﾞﾛﾈｸﾁﾝ
　　　　　　　　　　　　　　　　　　　精密測定
D007　3= 7
D007　3= 7
α１-マイク= ログロブリン
α１-マイク= ログロブリン精密測定
D007　3= 1
D007　3= 1
β２-マイク= ログロブリン（β２-ｍ）
β２-マイク= ログロブリン（β２-ｍ）精= 密測定
D015　= @9
D015　1= 0
補体蛋白（Ｃ４）
補体蛋白（Ｃ４）精密測定
D015　= @8
D015　= @8
旧検査項目名 <= /span>
旧区分 <= /span>
結核菌群核酸増幅同定検査
<= /div>
D023　= @9
頸管膣分泌液中癌胎児性ﾌｨﾌﾞﾛﾈｸﾁﾝ
<= /div>
D015　1= 8
α１-マイク= ログロブリン
D015　1= 3
β２-マイク= ログロブリン（β２-ｍ）
<= /div>
D015　1= 1
補体蛋白（Ｃ４）
D015　= @8
新検査項目名
新区分
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0696.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0696_image306.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCwJOAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0696_image307.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0696_image308.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhDwLBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAO AsAAgQAAAABm/2bM/////wL/nI+py+0Po5y02ouzVqD7D4biSJbmiabqyrbuC8fpRtf2jef6Tsn8 DwwKh8SB7CgyIpfMpvMJ/ShhhijVis1qtyYEdzX9isdkbdhVLZPO6rbb7X2H2PK6XU4H59v7u/9P dQDYB1houER4knaXeOj4GOfX+EhZOTK5hsmladnJJ/jH6TlaKAqyaGdKuooVycgK66nqgVo3G4t7 5Jqa22t4C1CL50u8tWtbnDwcI/wGrAw9ByoZXS0G3AxnvR2Yrc0NDoX97EQeTny8fL6u62PO9M4e m+4sb/8yHnq/Hzz9yg+wizt9AdnR+1YwoZSB1BSGO8jHocR8DSVug6gmnkVc/xT/bayGsYzGj6w6 8iIZLSSZkShHmUTWUpnKMSxjWnqpzqavmdd02sNZz+dOfyeFngOK0Og8ojCVgkMa0elSb1GlXmTo 0Sopnl9qas2Kxiu+r6u4biILEmtRtDeZ5mSLTm1TuJTMGqObDGpGvJXsmuEbl5lYNIAhuQ1amKPc t4klHU7auOxixJEdU91bueRkyJnxPK7aWdZm0KGdFTmNOrXq1Q/csX4NO7bsBoNKuxyN2bbpyyJ1 d9Lb2zecz7mFOwK+0vgn3smVH8cd3DlN4tGl1xZM0HpX6s21Z8c3uEV477S40yT/PWx69FH8ZhnP fgb07vHbm+9ZnzEL5vjzi/+735V/lKlXkYBNuNeKgaSJB58KDXqHoBUPKrgQdgVSqAuAZ2F4noVg cdjNhCiIiCFyHYLoGokCobhhIOuxuJ+Gd8H4l4dr0Rgjf/3h2N58J/Koh44BAtmjjXMROaKMNSJZ jo87MtmFku9B2aSR+lEpjZAtYtmOlQNymaWKJYhpoIlPgnmKlAmi6YOTQ7IZ5nVwjuUlZ3NGWOSc hNW54J1qSqgnnS5eqCee4gS656Af+jlbo44++qibWwYKaaWWXlpEiphuymmnhj5BpoBmvonop1Ui CoakM6Jq6oGo7qfqkqX+meerI8Y65autwmOrg7iuySqth/Z6K5/FUSosqMT/FqvojYUme+qya/wK qK7QuirtmNTWiqyWq2abxLbDBuutrOCeIq6y1pab67lzpBttt6GG6+67xlYnr5z10gIvtuTOa+++ /N5LX74vujvqpM+yC6zAwfTL67oAo+twBwl/azCh9V5s7sITV1ixJgFIczCbuyJSscUrjJxmyWie jMTH7InMcnkugwlzlyGvXLPFMj8ssb4C09yyxnDm3GbKREvx88+ZIc1MykCnEEDP/dzMJdRXKL2y AD0zzK3Hno5NdtkABuA102avzbZqQu97RtVyzy132jYbbfK1Ee/8AdoC/A144Hb7jDWWWgvqcNyC Lz741Xi/rDfKXPfN+OI1/4M97qyYZz40CH5XDvjlTdt6eKKJew564KIXTmXp4kmteOp/r/44zpHH DDvqsg++ebwev72x7ruz3Lu/mjvtNITCy0786EGz3mvszN+96NG363w65cNT7yyjyOeu/fSE1571 9Unz7cHnqdNefd7FG995+Otzf+Tv0JO+POjsd2/9+3tnn77t0e9K7vve5AIovvG1D3L+kxz6OkC3 CKLta877F/AQ1jUK3g9JroPVAVEwQaZtkEgdTNUHT1C1oi3Qdg3E3QlNkEIRks9w5ovaC0sQwwF+ yXsXPNfSdGin/hnwgSi0WgvPd7wegktkJJth62q4NSLCsIkrLF/brohF2f9oKotc7KIGlJgtjrUr iSMsFcQcSEYnRu+MLrRgGSnFRuxlrIrLEmPD5sg/H8YRiXisX/AI9qM+EnCJe7ShG9WIP0CeiYdv LFQho5hGOhLLjtU6pCTXqEhSCXKHGMykwhiJSF09EnGbDKIePYkx+4WSVaM0XSn71Mlm+VGIYJQW JcMGyksmUpaDZOEQAQieRtKohL66oR6ECSNiyseYDqpgJPNISFR2LJfQDGMrX/e8VZpRmmN85bHg dk0PWrKatgynCcc5y1PykpMFrGUdzVlMdPaynNy8oyp1Kcp6VvKZ6YzmOk3JwF/G75+wbCcyTQbP ZcqTnf4MpjZ5pExmAZP/QPgkIRRJCU594pKWB31ZQiXqTXxllKDfpGY/ralRzonNiyxtKQ626NKY yvSirhypQysKpIgqAnwkFalJ5/nOlKproQBFaU8Ldk9yBvWogUzqSenJ1EVy9KGOFKrvfspQo95U qU88Ih9tSlGuQkmnK5JijDoKIrJqi5kzcGZIkfrHqGrSqUCd5Ed3mk2cwtGq8KNrVqG61afS0KuG nCiD0MohtU6LrUlCbIloik2zHpOqw4SsOA17Vsom07LnxOxk9YojxV6Cp4Gt61g5G0/PNtOxFBIt vSS7Ws2yyLUBU21bWasg2lIMtreVLYp0CzLbNta3aUWtQoWrCLf6taiAEQ2rYLs60+hKFwIwna51 2VYAADs= ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0556.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
149
その= ｼ
１= D透析医療の適正な評価２= D酸素の価格引下げ３= D長期の投薬が不適切になされた事例の取扱い　= @（不適切な“超長期投薬”への対応）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0556_image309.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9AFvAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0556_image310.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0626.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
150
その他
= １．透析医療の適正な評価
　
= P）慢性維持透析患者外来医学管理料：２，４６０点 ⇒ ２，３０５点
（△１５５点）
２）人工腎臓（入院中以外の場合）　：１，= X６０点 ⇒ ２，２５０点
　　　※　エリスロポエチン製剤を包括 =
３）夜間加算・休日加算：５００点 <= span style=3D'font-family:"ＭＳ Ｐゴシック";mso-ascii-font-family:"ＭＳ Ｐゴシ= bク";mso-fareast-font-family: "ＭＳ Ｐゴシック";mso-hansi-font-family:"ＭＳ Ｐゴシック";font-size:120%;t= ext-shadow:none; color:#66CCFF'>⇒ ３００点（△２００点）
(p.72、226、240）<= /b>
(p.286、299 p.480= A484）
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0626_image311.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh9QG+AHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0626_image312.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0630.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
151
その他
２．酸素= ﾌ価格引下げ
　※　告示価格の適正化　= 3;
◎定置式液化酸素貯槽（ＣＥ）に係る酸素の= P価のみ改定
　・離島以外：０．２０円／１Ｌ ⇒ <= /span>０．１８円／１Ｌ
　・離島　　：０．３０円／１Ｌ ⇒ <= /span>０．２７円／１Ｌ
　※　購入単価の区分ごとの加重平均は現行= 錘ｦ価格から最大３２％乖離
　※　加重平均単価に告示価格の１５％を加えた値が、= ｻ行告示価格を下回る場合は、当該価格を告示価格とする
　※　離島等の地域の告示価格：
　　　現行どおり、離島以外の地域における= 錘ｦ価格の１．５倍に設定
　　　&#= 13;
(p.314、564）<= /span>
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0630_image313.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCwIEAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0630_image314.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0711.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
152
その他
= ３．長期の投薬が不適切になされた事例の取扱い
　　
事 　務　 連　 絡
平成１８年３月３日　
各地方社会保険事務局保険課（部）
都道府県民生主管部（局）
　国民健康保険主管課（部）　　　　　御中
都道府県老人医療主管部（局）
　老人医療主管課（部）
厚生労働省保険局医療課
長期の投薬が不適切になされた事例の取扱いについて
　標記について、別添のとおり社会保険診療報酬支= ･基金及び（社）国民健康保険中央会あて連絡し= ｽので、お知らせ致します。&= #13;
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0711_image315.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh/gE7AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0711_image316.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0711_image317.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCgBSAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAQAK AFAAgAAAAP///wJNRAKpi+vtEoyTRlXZldv0jH3iBnLkeJXeyaao1cJu/Lw1reGhvs/kkQKpSkNb zidL3pBL5dHZg5qYz6a1io1etdmpdEXlerdjcfkAKgAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0712.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
153
その他
= ３．長期の投薬が不適切になされた事例の取扱い
　　
事 　務　 連　 絡
平成１８年３月３日　
社会保険診療報酬支払基金
　　　　　　　　　　　　　　　御中
（社）国民健康保険中央会
厚生労働省保険局医療課
長期の投薬が不適切になされた事例の取扱いについて
　薬剤の投薬量については、保険医療機関及び保険= 纓ﾃ養担当規則（昭和32年厚生省令第15号）第20条= 1項第2号ホの規定において、特に定めるものを除き、予見することができる必要= 間に従ったものでなければならないとされているところであるが、一回の処方に= ﾄ長期の投薬が不適切になされる事例が散見されている。
　ついては、そのような不適切な事例が疑われる場= には、各審査委員会において、医学的判断に基づき= K切に審査していただくようお願いする。&= #13;
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0712_image318.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCwI7AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0712_image319.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlh5wEoAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAEAAADm AScAgQAAAAAAAAD//wECAwL/hC+py+0Po5y02ouz3rz7D4biSJbOgaLmyrbuC8fyTNdzaiRAwPf+ DwwKh8Si8YhMKpfMpvMJjUqn1Kr1iiXqVAIf7gsOi8fksvmMTqvX7Lb7DY/L5/S63c3bAhK9u/8P GCg4SFhoeIhYuMUXkOj4CBkpOUlZaYnQtcdzydnp+QkaKkqX2dU4ipqqusraemdq6io7S1tr+wm7 ebvL2+v7y5Z7CkxcbHzsKoy8zNzs/Kj8LD1NXb0WbZ2tvT2Nzf0NHr7rLV5ufg5Kjr7O3n6o7h4v Pw8HT3+Pn/9lr9/vH8/vn8CB4QISPIiwWx5dCRs6lGbwocSJtiJSvIgxlcWMcBw7XtroMaTIRCBH mjz5pyTKlSzfqGwJM2aZlzJr2kSwcNjNnTzDwMrUM6jQPT91Dj0qkxFRpExj6jiloKnUkwoYErWB NavWrVy7ev0KVsAOo3nCmj2LNq3atWw5ePmSJa7cuXTr2r2LN6/evXhRFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0712_image320.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCgAwAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAK AC8AgAAAAP///wIyTICppg3nEIzT1XZXlPv1nIDcJnrkh57qanUmyWBgKdIpdbcslvO79gv1gLjg KxRrFAAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0713.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明
154
その他
= ３．長期の投薬が不適切になされた事例の取扱い
　　
（事務連絡　つづき）
　なお、長期の投薬が不適切になされた具体的事例= ﾉついて、下記にまとめたので参考にされたい。
記= 3;
症状の経過及び副作用等の状況に応じ処方すべき。
査定
５６日
腫瘍用薬
事例３
症状の経過及び副作用等の状況に応じ処方すべき。
査定
９０日
不整脈用薬
事例２
医学的必要性を踏まえつつ、症状の経過に応じ処方すべき。
査定
１４０枚
経皮吸収型消炎鎮痛貼付剤=
事例１
備　　　考&= #13;
審　査
結　果
処　方
期　間
薬　剤　名
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0713_image321.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhDAI7AXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAB AAEAgAAAAAECAwICRAEAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/slide0713_image322.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhBAJPAXcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAAC Ak0BgQAAAAAAAAD//////wL/hI+Jwu0Po5y02ouz3rz7D4biSJbmiUbKyrZtCsfyTNf2jec67va+ wQAEhsSi8YhMKpfMpvMJjUqn1Kr1is1qt9yu97sM/sYJRpGMTqvX7Lb7DY/L5/S6/Y7Po4fiunmo Fyg4SFhoeIiYqLh40Df3xxgpOUlZaXmJSWfmB5jp+QkaKjpK2iMQwIlausra6voKm3aqKjcbe4ub q7u7aPvYyRssPExcvOJbC2y8zNzs/IkcF/1MXW19fTf9po3d7f0NvqAMxx1ufo4+XM62nu7+Dj/a rjYfb3+Pn1iPtp/v/w9Q2rhtAwMaPIiQX8E2/RI6fAiw4Q+JECtaTEfR1MKL/xw7osvoAqTHkSSJ iWRxsqTKlbBSKnDJMqZMUDDF0ZqJM2fLjWtq6vwJlJBPIDyDGj2qaCgApUibOpVVFOrNp1Sr4lHK 1KpWq1ijbv0K9oVXMlnDmv2J9dTZtWzLpJ3aNu5XSJoEyL071y5cco7w+j3aYCy9HYQLGz6MOLHi xYyDCFbDp7HkyZQrW76M+cOZQGA6e/4MOrTo0aRLmz5N+q/q1axbu34NO7bs2bRr276NO7fu3bx7 +/4NPLjw4cSLGz+OPLny5cybO38OPbr06dSrW7+OPbv27dy7e/8OPrz48eTLmz+PPr369ezbu38P P778+fTr27+PP7/+/fz7+///D2CAAg5IYIEGHohgggouyGCDDj4IYYQSTkhhhRZeiGGGGm7IYYce fghiiCKOSGKJJp6IYooqrshiiy6+CGOMMs5IY4023ohjjjruyGOPPv4IZJBCDklkkUYeiWSSSi7J ZJNOPglllFJOSWWVVl6JZZZabslll15+CWaYYo5JZplmnolmmmquyWabbr4JZ5xyzklnnXbeiWee eu7JZ59+/glooIIOSmihhv44QKKKLspoo44+Cmmkkk5KaaWWXopppppuymmnnn4KaqiijkpqqaZu GskA/6gaCquTuNreoqmuKgqss74nKyO22rMrJr0q8it6uS4SrDvFUnKsIcn/kjcssLS2Wsmy4zWb iLThWEtstPBRiwi233hbrba4KnprPuB2K6573B5yLjbtKpturOTq+iwo79pxr3brwutPvoP4OwfA 1+1biMDNGJwHwm8oPB3BhDBcDMR1SLwGxc85/G+9n1icBsfNYSyIx7uIvHC87IEcCMm5qNwGyz24 fBzKesAMC80dm7yezAlr7InNK/g8nM54AM0K0T8YfQDSvwl9h9KjON2C01DzxjS+PGci9bbzZttv rTirV/XEV/v6dXph0zG1vV4jq3Wi5eKTtgJZj+s2vV1DyzbdRMfd89qvtr332JfMre7Wzt6tdt6F 1821uX5LwjduZwcsuCWE/8vL+OGO4/233m/fE3nSZQtreLiIbzz6eZPLEfrgj3+ec+nont634pgH TjvWqZu3ehytW/663YvjvnninQ8Pezy/X37yqc4/D3300k9PffXWX4999p4mD8/yu5fXOxy/fw85 +dPKzm7l5mfsufBwB9/47dy/473tzWduevGo2x87/rPrX7vjyc99oIOf5gYYvwJyrnztSyCvDJg/ BB5QgcZjIPII+MAFzk916OMXAHXHP7B1sGDqC+EE+0e892kQgyL0X/pyRzYTks6FHlRhBTfIuxE+ rIQCxCH4dMi+D8awhyj04TnqR8QWppCC+0ui2YAYMh5acIr3W2IGb8jCJ//SkIQwdJ0MObjFHXYR eF/MYRiDaMMmUrGIWaQfBP8nwQgyMYBrVKIRzYHEOmrRisp74wsv6MA+rjCQe7zjtfxYwyoaEhx5 XCR4wleyMa4vig08oSCxSMgZ8rF7iOQiIC3JyUGCUpOO9EYj2wjGTbpRlHJkYyaN1UkxfrKVl1Rj Kb0DSTeMr4xOpGUhUZmOU77SjNorpjGPicxkKnOZzGwmqoCJDmGOMpW3dFcs0ahIaB7xmpScJRzn CMJeUlObeORmygBXzWtI05ekJOchWflNV04zmOacGTrdych67qyS7IQlPP8Yx3jWko7p3E4uWybF goqNnwINJSbn+cMzdjP/jQTF5yOheE5J8tKTAQUoOIeox3YOM5r6HNo9R7rNfyZSnv2kp0o5mk2U lvOlsuzoSgcazpCOU6bvfGhLI6pKf/q0oSKFaEqH6lGWElWotrTodw7Khl2Kc6M1jalRZ4rUm/6S p/mkKTaVmlScglSh2YFqxRLq1H16M6wObSpXLyrRjArRi1MFKlmfsc6lEvOuzsgrW4v606O69ari MasapKpTqn7Vjmm1plcnatXAYnWwki0sRu2p0brCFKxaXWVWN8vYt5qypE07KWG7+tmqcha0ba2o aHHpzNjKdra0ra1tb4tMvh6MtFZj6F+Z6trTwjWoLk3tYrcq3NE+Vq42/2WtZymrV7s2Vp28Xeha OwvcnOq2Ooa9WWYTi929Ttcafg2vdF/rWONCdrWqFStdwcusy6qVotodr77ka9LvbjeS13Vudsdq 37Lit7T6DTDlfGtewQa3suHpLhoQu18Ca/Z8ccXsXMk4YctWeL4ffW+EpeNgMkDYwMz9cHRCPIYR ozfB7UUug79VXbSZ9sXKVW+J2Xvc5y44uvHdcH4vPMkbhza53Sivf8W7YvLG+MD9bbGO65vk+/pY wvQFcJQFPOXeAlmx6x0yjYu8ZNbNmMeT3fFvkUzk9EL3zOdNM3WXa+HmOvm/HiaxdVB8NLRemcly zjGdMQxfChOXpHDmMDaOu9xaKLvZoAPWcpXrvOeBNdq6jwa0iaGDZx+oeNFzZnOPB61gRX+5O7gt talPjepUq7qZBQAAOw== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/master01.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis"
<ヘッダー>= 3;
<日付/時刻>
マスター テキストの書式設定
第 2 レベル
第 3 レベル
第 4 レベル
第 5 レベル
<フッター>= 3;
&l= t;#>= 3;
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/master04_stylesheet.css Content-Transfer-Encoding: base64 Content-Type: text/css Ym9keQ0KCXt3aWR0aDo1MzRweDsNCgloZWlnaHQ6MzY5cHg7fQ0KLlRCDQoJe21zby1zcGVjaWFs LWZvcm1hdDpub2J1bGxldFwyMDIyO30NCi5UDQoJe3RleHQtYWxpZ246Y2VudGVyOw0KCWZvbnQt ZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1hc2NpaS1mb250LWZhbWlseToiVGltZXMg TmV3IFJvbWFuIjsNCgltc28tZmFyZWFzdC1mb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsN Cgltc28taGFuc2ktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJdGV4dC1zaGFkb3c6 YXV0bzsNCglsYXlvdXQtZmxvdzp2ZXJ0aWNhbDsNCgljb2xvcjp5ZWxsb3c7DQoJbXNvLWNvbG9y LWluZGV4OjM7DQoJZm9udC1zaXplOjE5MSU7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5z b2t1LW92ZXJmbG93OjE7fQ0KLkJCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldG47DQoJ Y29sb3I6eWVsbG93Ow0KCW1zby1jb2xvci1pbmRleDozOw0KCWZvbnQtZmFtaWx5OiJNb25vdHlw ZSBTb3J0cyI7fQ0KLkINCgl7dGV4dC1hbGlnbjpsZWZ0Ow0KCWZvbnQtZmFtaWx5OiKCbIJyIIJv g1ODVoNig04iOw0KCW1zby1hc2NpaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCglt c28tZmFyZWFzdC1mb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28taGFuc2ktZm9u dC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJdGV4dC1zaGFkb3c6YXV0bzsNCglsYXlvdXQt Zmxvdzp2ZXJ0aWNhbDsNCgljb2xvcjp3aGl0ZTsNCgltc28tY29sb3ItaW5kZXg6MTsNCglmb250 LXNpemU6MTA0JTsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9 DQouQjFCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldFwyMDEzOw0KCWNvbG9yOndoaXRl Ow0KCW1zby1jb2xvci1pbmRleDoxO30NCi5CMQ0KCXt0ZXh0LWFsaWduOmxlZnQ7DQoJZm9udC1m YW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWFzY2lpLWZvbnQtZmFtaWx5OiJUaW1lcyBO ZXcgUm9tYW4iOw0KCW1zby1mYXJlYXN0LWZvbnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0K CW1zby1oYW5zaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgl0ZXh0LXNoYWRvdzph dXRvOw0KCWNvbG9yOndoaXRlOw0KCW1zby1jb2xvci1pbmRleDoxOw0KCWZvbnQtc2l6ZTo4NiU7 DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLkIyQg0KCXtt c28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMDBCQjsNCgljb2xvcjp3aGl0ZTsNCgltc28tY29s b3ItaW5kZXg6MTt9DQouQjINCgl7dGV4dC1hbGlnbjpsZWZ0Ow0KCWZvbnQtZmFtaWx5OiKCbIJy IIJvg1ODVoNig04iOw0KCW1zby1hc2NpaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsN Cgltc28tZmFyZWFzdC1mb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28taGFuc2kt Zm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJdGV4dC1zaGFkb3c6YXV0bzsNCglsYXlv dXQtZmxvdzp2ZXJ0aWNhbDsNCgljb2xvcjp3aGl0ZTsNCgltc28tY29sb3ItaW5kZXg6MTsNCglm b250LXNpemU6MTA0JTsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6 MTt9DQouQjNCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpidWxsZXRuOw0KCWNvbG9yOnllbGxvdzsN Cgltc28tY29sb3ItaW5kZXg6MzsNCglmb250LWZhbWlseToiTW9ub3R5cGUgU29ydHMiOw0KCWZv bnQtc2l6ZTo2NSU7fQ0KLkIzDQoJe2ZvbnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1z by1hc2NpaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tZmFyZWFzdC1mb250 LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28taGFuc2ktZm9udC1mYW1pbHk6IlRpbWVz IE5ldyBSb21hbiI7DQoJdGV4dC1zaGFkb3c6YXV0bzsNCglsYXlvdXQtZmxvdzp2ZXJ0aWNhbDsN Cgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouQjRCDQoJe21z by1zcGVjaWFsLWZvcm1hdDpidWxsZXRcMjAxMzsNCgljb2xvcjp3aGl0ZTsNCgltc28tY29sb3It aW5kZXg6MTt9DQouQjQNCgl7Zm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWFz Y2lpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1mYXJlYXN0LWZvbnQtZmFt aWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1oYW5zaS1mb250LWZhbWlseToiVGltZXMgTmV3 IFJvbWFuIjsNCgl0ZXh0LXNoYWRvdzphdXRvOw0KCWxheW91dC1mbG93OnZlcnRpY2FsOw0KCW1z by1jaGFyLXdyYXA6MTsNCgltc28ta2luc29rdS1vdmVyZmxvdzoxO30NCi5OQg0KCXttc28tc3Bl Y2lhbC1mb3JtYXQ6bm9idWxsZXRcMjAyMjt9DQouTg0KCXt0ZXh0LWFsaWduOmxlZnQ7DQoJZm9u dC1mYW1pbHk6IoJsgnIggm+WvpKpIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRpbWVzIE5l dyBSb21hbiI7DQoJbXNvLWZhcmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+WvpKpIjsNCgltc28t aGFuc2ktZm9udC1mYW1pbHk6QXJpYWw7DQoJbGF5b3V0LWZsb3c6dmVydGljYWw7DQoJY29sb3I6 YmxhY2s7DQoJbXNvLWNvbG9yLWluZGV4OjE7DQoJZm9udC1zaXplOjUyJTsNCgltc28tY2hhci13 cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouTjFCDQoJe21zby1zcGVjaWFsLWZv cm1hdDpub2J1bGxldFwyMDIyO30NCi5OMQ0KCXt0ZXh0LWFsaWduOmxlZnQ7DQoJZm9udC1mYW1p bHk6IoJsgnIggm+WvpKpIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21h biI7DQoJbXNvLWZhcmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+WvpKpIjsNCgltc28taGFuc2kt Zm9udC1mYW1pbHk6QXJpYWw7DQoJbGF5b3V0LWZsb3c6dmVydGljYWw7DQoJY29sb3I6YmxhY2s7 DQoJbXNvLWNvbG9yLWluZGV4OjE7DQoJZm9udC1zaXplOjUyJTsNCgltc28tY2hhci13cmFwOjE7 DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouTjJCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpu b2J1bGxldFwyMDIyO30NCi5OMg0KCXt0ZXh0LWFsaWduOmxlZnQ7DQoJZm9udC1mYW1pbHk6IoJs gnIggm+WvpKpIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJ bXNvLWZhcmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+WvpKpIjsNCgltc28taGFuc2ktZm9udC1m YW1pbHk6QXJpYWw7DQoJbGF5b3V0LWZsb3c6dmVydGljYWw7DQoJY29sb3I6YmxhY2s7DQoJbXNv LWNvbG9yLWluZGV4OjE7DQoJZm9udC1zaXplOjUyJTsNCgltc28tY2hhci13cmFwOjE7DQoJbXNv LWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouTjNCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxl dFwyMDIyO30NCi5OMw0KCXt0ZXh0LWFsaWduOmxlZnQ7DQoJZm9udC1mYW1pbHk6IoJsgnIggm+W vpKpIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNvLWZh cmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+WvpKpIjsNCgltc28taGFuc2ktZm9udC1mYW1pbHk6 QXJpYWw7DQoJbGF5b3V0LWZsb3c6dmVydGljYWw7DQoJY29sb3I6YmxhY2s7DQoJbXNvLWNvbG9y LWluZGV4OjE7DQoJZm9udC1zaXplOjUyJTsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNv a3Utb3ZlcmZsb3c6MTt9DQouTjRODQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldFwyMDIy O30NCi5ONA0KCXt0ZXh0LWFsaWduOmxlZnQ7DQoJZm9udC1mYW1pbHk6IoJsgnIggm+WvpKpIjsN Cgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNvLWZhcmVhc3Qt Zm9udC1mYW1pbHk6IoJsgnIggm+WvpKpIjsNCgltc28taGFuc2ktZm9udC1mYW1pbHk6QXJpYWw7 DQoJbGF5b3V0LWZsb3c6dmVydGljYWw7DQoJY29sb3I6YmxhY2s7DQoJbXNvLWNvbG9yLWluZGV4 OjE7DQoJZm9udC1zaXplOjUyJTsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3Zl cmZsb3c6MTt9DQouT0INCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0XDIwMjI7fQ0KLk8N Cgl7dGV4dC1hbGlnbjpsZWZ0Ow0KCWZvbnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1z by1hc2NpaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tZmFyZWFzdC1mb250 LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28taGFuc2ktZm9udC1mYW1pbHk6IlRpbWVz IE5ldyBSb21hbiI7DQoJbGF5b3V0LWZsb3c6dmVydGljYWw7DQoJY29sb3I6d2hpdGU7DQoJbXNv LWNvbG9yLWluZGV4OjE7DQoJZm9udC1zaXplOjEwNCU7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1z by1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLk8xQg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxs ZXRcMjAyMjt9DQouTzENCgl7Zm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWFz Y2lpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1mYXJlYXN0LWZvbnQtZmFt aWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1oYW5zaS1mb250LWZhbWlseToiVGltZXMgTmV3 IFJvbWFuIjsNCglsYXlvdXQtZmxvdzp2ZXJ0aWNhbDsNCglmb250LXNpemU6MTA0JTsNCgltc28t Y2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouTzJCDQoJe21zby1zcGVj aWFsLWZvcm1hdDpub2J1bGxldFwyMDIyO30NCi5PMg0KCXtmb250LWZhbWlseToigmyCciCCb4NT g1aDYoNOIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNv LWZhcmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWhhbnNpLWZvbnQt ZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCWxheW91dC1mbG93OnZlcnRpY2FsOw0KCWZvbnQt c2l6ZToxMDQlOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29rdS1vdmVyZmxvdzoxO30N Ci5PM0INCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0XDIwMjI7fQ0KLk8zDQoJe2ZvbnQt ZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1hc2NpaS1mb250LWZhbWlseToiVGltZXMg TmV3IFJvbWFuIjsNCgltc28tZmFyZWFzdC1mb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsN Cgltc28taGFuc2ktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbGF5b3V0LWZsb3c6 dmVydGljYWw7DQoJZm9udC1zaXplOjEwNCU7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5z b2t1LW92ZXJmbG93OjE7fQ0KLk80Qg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMjAy Mjt9DQouTzQNCgl7Zm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWFzY2lpLWZv bnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1mYXJlYXN0LWZvbnQtZmFtaWx5OiKC bIJyIIJvg1ODVoNig04iOw0KCW1zby1oYW5zaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFu IjsNCglsYXlvdXQtZmxvdzp2ZXJ0aWNhbDsNCglmb250LXNpemU6MTA0JTsNCgltc28tY2hhci13 cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouQ0JCDQoJe21zby1zcGVjaWFsLWZv cm1hdDpub2J1bGxldG47DQoJY29sb3I6eWVsbG93Ow0KCW1zby1jb2xvci1pbmRleDozOw0KCWZv bnQtZmFtaWx5OiJNb25vdHlwZSBTb3J0cyI7fQ0KLkNCDQoJe2ZvbnQtZmFtaWx5OiKCbIJyIIJv g1ODVoNig04iOw0KCW1zby1hc2NpaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCglt c28tZmFyZWFzdC1mb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28taGFuc2ktZm9u dC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJdGV4dC1zaGFkb3c6YXV0bzsNCglsYXlvdXQt Zmxvdzp2ZXJ0aWNhbDsNCglmb250LXNpemU6MTA0JTsNCgltc28tY2hhci13cmFwOjE7DQoJbXNv LWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouQ0IxQg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxs ZXRcMjAxMzsNCgljb2xvcjp3aGl0ZTsNCgltc28tY29sb3ItaW5kZXg6MTt9DQouQ0IxDQoJe2Zv bnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1hc2NpaS1mb250LWZhbWlseToiVGlt ZXMgTmV3IFJvbWFuIjsNCgltc28tZmFyZWFzdC1mb250LWZhbWlseToigmyCciCCb4NTg1aDYoNO IjsNCgltc28taGFuc2ktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJdGV4dC1zaGFk b3c6YXV0bzsNCglmb250LXNpemU6ODYlOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29r dS1vdmVyZmxvdzoxO30NCi5DQjJCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldFwwMEJC Ow0KCWNvbG9yOndoaXRlOw0KCW1zby1jb2xvci1pbmRleDoxO30NCi5DQjINCgl7Zm9udC1mYW1p bHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWFzY2lpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcg Um9tYW4iOw0KCW1zby1mYXJlYXN0LWZvbnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1z by1oYW5zaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgl0ZXh0LXNoYWRvdzphdXRv Ow0KCWxheW91dC1mbG93OnZlcnRpY2FsOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29r dS1vdmVyZmxvdzoxO30NCi5DQjNCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldG47DQoJ Y29sb3I6eWVsbG93Ow0KCW1zby1jb2xvci1pbmRleDozOw0KCWZvbnQtZmFtaWx5OiJNb25vdHlw ZSBTb3J0cyI7DQoJZm9udC1zaXplOjY1JTt9DQouQ0IzDQoJe2ZvbnQtZmFtaWx5OiKCbIJyIIJv g1ODVoNig04iOw0KCW1zby1hc2NpaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCglt c28tZmFyZWFzdC1mb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28taGFuc2ktZm9u dC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJdGV4dC1zaGFkb3c6YXV0bzsNCglsYXlvdXQt Zmxvdzp2ZXJ0aWNhbDsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6 MTt9DQouQ0I0Qg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMjAxMzsNCgljb2xvcjp3 aGl0ZTsNCgltc28tY29sb3ItaW5kZXg6MTt9DQouQ0I0DQoJe2ZvbnQtZmFtaWx5OiKCbIJyIIJv g1ODVoNig04iOw0KCW1zby1hc2NpaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCglt c28tZmFyZWFzdC1mb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28taGFuc2ktZm9u dC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJdGV4dC1zaGFkb3c6YXV0bzsNCglsYXlvdXQt Zmxvdzp2ZXJ0aWNhbDsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6 MTt9DQouQ1RCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldFwyMDIyO30NCi5DVA0KCXtm b250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRp bWVzIE5ldyBSb21hbiI7DQoJbXNvLWZhcmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KD TiI7DQoJbXNvLWhhbnNpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCXRleHQtc2hh ZG93OmF1dG87DQoJbGF5b3V0LWZsb3c6dmVydGljYWw7DQoJZm9udC1zaXplOjIwOCU7DQoJbXNv LWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLkhCQg0KCXttc28tc3Bl Y2lhbC1mb3JtYXQ6bm9idWxsZXRuOw0KCWNvbG9yOnllbGxvdzsNCgltc28tY29sb3ItaW5kZXg6 MzsNCglmb250LWZhbWlseToiTW9ub3R5cGUgU29ydHMiO30NCi5IQg0KCXt0ZXh0LWFsaWduOmxl ZnQ7DQoJZm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWFzY2lpLWZvbnQtZmFt aWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1mYXJlYXN0LWZvbnQtZmFtaWx5OiKCbIJyIIJv g1ODVoNig04iOw0KCW1zby1oYW5zaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgl0 ZXh0LXNoYWRvdzphdXRvOw0KCWxheW91dC1mbG93OnZlcnRpY2FsOw0KCWNvbG9yOndoaXRlOw0K CW1zby1jb2xvci1pbmRleDoxOw0KCWZvbnQtc2l6ZTo4NiU7DQoJbXNvLW1hcmdpbi1sZWZ0LWFs dDowOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29rdS1vdmVyZmxvdzoxO30NCi5IQjFC DQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldFwyMDEzOw0KCWNvbG9yOndoaXRlOw0KCW1z by1jb2xvci1pbmRleDoxO30NCi5IQjENCgl7Zm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7 DQoJbXNvLWFzY2lpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1mYXJlYXN0 LWZvbnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1oYW5zaS1mb250LWZhbWlseToi VGltZXMgTmV3IFJvbWFuIjsNCgl0ZXh0LXNoYWRvdzphdXRvOw0KCWZvbnQtc2l6ZTo3OCU7DQoJ bXNvLW1hcmdpbi1sZWZ0LWFsdDoyODg7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1 LW92ZXJmbG93OjE7fQ0KLkhCMkINCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0XDAwQkI7 DQoJY29sb3I6d2hpdGU7DQoJbXNvLWNvbG9yLWluZGV4OjE7fQ0KLkhCMg0KCXtmb250LWZhbWls eToigmyCciCCb4NTg1aDYoNOIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBS b21hbiI7DQoJbXNvLWZhcmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNv LWhhbnNpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCXRleHQtc2hhZG93OmF1dG87 DQoJbGF5b3V0LWZsb3c6dmVydGljYWw7DQoJbXNvLW1hcmdpbi1sZWZ0LWFsdDo1NzY7DQoJbXNv LWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLkhCM0INCgl7bXNvLXNw ZWNpYWwtZm9ybWF0OmJ1bGxldG47DQoJY29sb3I6eWVsbG93Ow0KCW1zby1jb2xvci1pbmRleDoz Ow0KCWZvbnQtZmFtaWx5OiJNb25vdHlwZSBTb3J0cyI7DQoJZm9udC1zaXplOjY1JTt9DQouSEIz DQoJe2ZvbnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1hc2NpaS1mb250LWZhbWls eToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tZmFyZWFzdC1mb250LWZhbWlseToigmyCciCCb4NT g1aDYoNOIjsNCgltc28taGFuc2ktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJdGV4 dC1zaGFkb3c6YXV0bzsNCglsYXlvdXQtZmxvdzp2ZXJ0aWNhbDsNCgltc28tY2hhci13cmFwOjE7 DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouSEI0Qg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6 YnVsbGV0XDIwMTM7DQoJY29sb3I6d2hpdGU7DQoJbXNvLWNvbG9yLWluZGV4OjE7fQ0KLkhCNA0K CXtmb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6 IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNvLWZhcmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+DU4NW g2KDTiI7DQoJbXNvLWhhbnNpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCXRleHQt c2hhZG93OmF1dG87DQoJbGF5b3V0LWZsb3c6dmVydGljYWw7DQoJbXNvLWNoYXItd3JhcDoxOw0K CW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLlFCQg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6bm9i dWxsZXRuOw0KCWNvbG9yOnllbGxvdzsNCgltc28tY29sb3ItaW5kZXg6MzsNCglmb250LWZhbWls eToiTW9ub3R5cGUgU29ydHMiO30NCi5RQg0KCXt0ZXh0LWFsaWduOmxlZnQ7DQoJZm9udC1mYW1p bHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWFzY2lpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcg Um9tYW4iOw0KCW1zby1mYXJlYXN0LWZvbnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1z by1oYW5zaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgl0ZXh0LXNoYWRvdzphdXRv Ow0KCWxheW91dC1mbG93OnZlcnRpY2FsOw0KCWNvbG9yOndoaXRlOw0KCW1zby1jb2xvci1pbmRl eDoxOw0KCWZvbnQtc2l6ZTo3OCU7DQoJbXNvLW1hcmdpbi1sZWZ0LWFsdDowOw0KCW1zby1jaGFy LXdyYXA6MTsNCgltc28ta2luc29rdS1vdmVyZmxvdzoxO30NCi5RQjFCDQoJe21zby1zcGVjaWFs LWZvcm1hdDpub2J1bGxldFwyMDEzOw0KCWNvbG9yOndoaXRlOw0KCW1zby1jb2xvci1pbmRleDox O30NCi5RQjENCgl7Zm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWFzY2lpLWZv bnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1mYXJlYXN0LWZvbnQtZmFtaWx5OiKC bIJyIIJvg1ODVoNig04iOw0KCW1zby1oYW5zaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFu IjsNCgl0ZXh0LXNoYWRvdzphdXRvOw0KCWZvbnQtc2l6ZTo2OSU7DQoJbXNvLW1hcmdpbi1sZWZ0 LWFsdDoyODg7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0K LlFCMkINCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0XDAwQkI7DQoJY29sb3I6d2hpdGU7 DQoJbXNvLWNvbG9yLWluZGV4OjE7fQ0KLlFCMg0KCXtmb250LWZhbWlseToigmyCciCCb4NTg1aD YoNOIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNvLWZh cmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWhhbnNpLWZvbnQtZmFt aWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCXRleHQtc2hhZG93OmF1dG87DQoJbGF5b3V0LWZsb3c6 dmVydGljYWw7DQoJbXNvLW1hcmdpbi1sZWZ0LWFsdDo1NzY7DQoJbXNvLWNoYXItd3JhcDoxOw0K CW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLlFCM0INCgl7bXNvLXNwZWNpYWwtZm9ybWF0OmJ1 bGxldG47DQoJY29sb3I6eWVsbG93Ow0KCW1zby1jb2xvci1pbmRleDozOw0KCWZvbnQtZmFtaWx5 OiJNb25vdHlwZSBTb3J0cyI7DQoJZm9udC1zaXplOjY1JTt9DQouUUIzDQoJe2ZvbnQtZmFtaWx5 OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1hc2NpaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJv bWFuIjsNCgltc28tZmFyZWFzdC1mb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28t aGFuc2ktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJdGV4dC1zaGFkb3c6YXV0bzsN CglsYXlvdXQtZmxvdzp2ZXJ0aWNhbDsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Ut b3ZlcmZsb3c6MTt9DQouUUI0Qg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6YnVsbGV0XDIwMTM7DQoJ Y29sb3I6d2hpdGU7DQoJbXNvLWNvbG9yLWluZGV4OjE7fQ0KLlFCNA0KCXtmb250LWZhbWlseToi gmyCciCCb4NTg1aDYoNOIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21h biI7DQoJbXNvLWZhcmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWhh bnNpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCXRleHQtc2hhZG93OmF1dG87DQoJ bGF5b3V0LWZsb3c6dmVydGljYWw7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92 ZXJmbG93OjE7fQ0KLlRibEINCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0bjsNCgljb2xv cjp5ZWxsb3c7DQoJbXNvLWNvbG9yLWluZGV4OjM7DQoJZm9udC1mYW1pbHk6Ik1vbm90eXBlIFNv cnRzIjt9DQouVGJsDQoJe3RleHQtYWxpZ246bGVmdDsNCglmb250LWZhbWlseToigmyCciCCb4NT g1aDYoNOIjsNCgltc28tYXNjaWktZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNv LWZhcmVhc3QtZm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWhhbnNpLWZvbnQt ZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCXRleHQtc2hhZG93OmF1dG87DQoJbGF5b3V0LWZs b3c6dmVydGljYWw7DQoJY29sb3I6d2hpdGU7DQoJbXNvLWNvbG9yLWluZGV4OjE7DQoJZm9udC1z aXplOjg2JTsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQou VGJsMUINCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0XDIwMTM7DQoJY29sb3I6d2hpdGU7 DQoJbXNvLWNvbG9yLWluZGV4OjE7fQ0KLlRibDENCgl7Zm9udC1mYW1pbHk6IoJsgnIggm+DU4NW g2KDTiI7DQoJbXNvLWFzY2lpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1m YXJlYXN0LWZvbnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1oYW5zaS1mb250LWZh bWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgl0ZXh0LXNoYWRvdzphdXRvOw0KCWZvbnQtc2l6ZTo3 OCU7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLlRibDJC DQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldFwwMEJCOw0KCWNvbG9yOndoaXRlOw0KCW1z by1jb2xvci1pbmRleDoxO30NCi5UYmwyDQoJe2ZvbnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04i Ow0KCW1zby1hc2NpaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tZmFyZWFz dC1mb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28taGFuc2ktZm9udC1mYW1pbHk6 IlRpbWVzIE5ldyBSb21hbiI7DQoJdGV4dC1zaGFkb3c6YXV0bzsNCglsYXlvdXQtZmxvdzp2ZXJ0 aWNhbDsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouVGJs M0INCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0bjsNCgljb2xvcjp5ZWxsb3c7DQoJbXNv LWNvbG9yLWluZGV4OjM7DQoJZm9udC1mYW1pbHk6Ik1vbm90eXBlIFNvcnRzIjsNCglmb250LXNp emU6NjUlO30NCi5UYmwzDQoJe2ZvbnQtZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1h c2NpaS1mb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tZmFyZWFzdC1mb250LWZh bWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28taGFuc2ktZm9udC1mYW1pbHk6IlRpbWVzIE5l dyBSb21hbiI7DQoJdGV4dC1zaGFkb3c6YXV0bzsNCglsYXlvdXQtZmxvdzp2ZXJ0aWNhbDsNCglt c28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouVGJsNEINCgl7bXNv LXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0XDIwMTM7DQoJY29sb3I6d2hpdGU7DQoJbXNvLWNvbG9y LWluZGV4OjE7fQ0KLlRibDQNCgl7Zm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNv LWFzY2lpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1mYXJlYXN0LWZvbnQt ZmFtaWx5OiKCbIJyIIJvg1ODVoNig04iOw0KCW1zby1oYW5zaS1mb250LWZhbWlseToiVGltZXMg TmV3IFJvbWFuIjsNCgl0ZXh0LXNoYWRvdzphdXRvOw0KCWxheW91dC1mbG93OnZlcnRpY2FsOw0K CW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29rdS1vdmVyZmxvdzoxO30NCi5kZWZhdWx0Qg0K CXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMjAyMjt9DQouZGVmYXVsdA0KCXt0ZXh0LWFs aWduOmNlbnRlcjsNCglmb250LWZhbWlseToigmyCciCCb4NTg1aDYoNOIjsNCgltc28tYXNjaWkt Zm9udC1mYW1pbHk6IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWZhcmVhc3QtZm9udC1mYW1pbHk6 IoJsgnIggm+DU4NWg2KDTiI7DQoJbXNvLWhhbnNpLWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9t YW4iOw0KCWZvbnQtd2VpZ2h0Om5vcm1hbDsNCglmb250LXN0eWxlOm5vcm1hbDsNCgl0ZXh0LWRl Y29yYXRpb246bm9uZTsNCgl0ZXh0LXNoYWRvdzphdXRvOw0KCXRleHQtZWZmZWN0Om5vbmU7DQoJ bXNvLWZhcmVhc3QtaGludDpubzsNCglsYXlvdXQtZmxvdzp2ZXJ0aWNhbDsNCgljb2xvcjp3aGl0 ZTsNCgltc28tY29sb3ItaW5kZXg6MTsNCglmb250LXNpemU6ODYlOw0KCW1zby10ZXh0LXJhaXNl OjAlOw0KCW1zby1saW5lLXNwYWNpbmc6IjEwMCAwIDAiOw0KCW1zby1tYXJnaW4tbGVmdC1hbHQ6 MDsNCgltc28tdGV4dC1pbmRlbnQtYWx0OjA7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5z b2t1LW92ZXJmbG93OjE7DQoJZGlyZWN0aW9uOmx0cjsNCgltc28td29yZC13cmFwOjE7DQoJbXNv LXZlcnRpY2FsLWFsaWduLXNwZWNpYWw6YmFzZWxpbmU7DQoJbXNvLWZhcmVhc3QtbGFuZ3VhZ2U6 SkE7DQoJbXNvLWFuc2ktbGFuZ3VhZ2U6RU4tVVM7fQ0KYTpsaW5rDQoJe2NvbG9yOiNGRjAwMzMg IWltcG9ydGFudDt9DQphOmFjdGl2ZQ0KCXtjb2xvcjojRkYzM0NDICFpbXBvcnRhbnQ7fQ0KYTp2 aXNpdGVkDQoJe2NvbG9yOiMzMzY2RkYgIWltcG9ydGFudDt9DQp= ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/script.js Content-Transfer-Encoding: quoted-printable Content-Type: application/javascript; charset="shift_jis" function LoadSld() { var sld=3DGetObj("SlideObj") if( !g_supportsPPTHTML ) { =09 sld.style.visibility=3D"visible" return } if( MakeNotesVis() ) return runAnimations =3D _InitAnimations(); =09 if( IsWin("PPTSld") ) parent.SldUpdated(GetSldId()) g_origSz=3DparseInt(SlideObj.style.fontSize) g_origH=3Dsld.style.posHeight g_origW=3Dsld.style.posWidth g_scaleHyperlinks=3D(document.all.tags("AREA").length>0) if( g_scaleHyperlinks ) InitHLinkArray() if( g_scaleInFrame||(IsWin("PPTSld") && parent.IsFullScrMode() ) ) document.body.scroll=3D"no" _RSW() if( IsWin("PPTSld") && parent.IsFullScrMode() ) FullScrInit(); =09 MakeSldVis(); ChkAutoAdv() if( runAnimations ) { if( document.all("NSPlay") ) document.all("NSPlay").autoStart =3D false; if( sld.filters && sld.filters.revealtrans ) setTimeout( "document.body.start()", sld.filters.revealtrans.duration * = 1000 ); else document.body.start(); } } function MakeSldVis()=20 { var fTrans=3Dg_showAnimation && SldHasTrans() if( fTrans )=09 { if( g_bgSound ) { idx=3Dg_bgSound.indexOf(","); pptSound.src=3Dg_bgSound.substr( 0, idx ); pptSound.loop=3D -(parseInt(g_bgSound.substr(idx+1))); } SlideObj.filters.revealtrans.Apply()=09 } SlideObj.style.visibility=3D"visible" if( fTrans ) SlideObj.filters.revealtrans.Play() } function MakeNotesVis()=20 { if( !IsNts() ) return false=20 SlideObj.style.display=3D"none" nObj =3D document.all.item("NotesObj") parent.SetHasNts(0) if( nObj ) {=20 nObj.style.display=3D"" parent.SetHasNts(1) } return 1 } function ChkAutoAdv() { if(SldHasTrans()) SlideObj.onfilterchange=3DAutoAdv else AutoAdv() } function AutoAdv() { if(!IsWin("PPTSld") || !gUseSldTimings )return var sld=3DGetCurSld() if( (sld.mAdvDelay>0) && !parent.IsFramesMode() ) setTimeout("parent.GoToNextSld()",sld.mAdvDelay) } function GetObj(id) { if(g_supportsPPTHTML) return document.all(id); else return document.getElementById(id); } function SldHasTrans() { return SlideObj.style.filter !=3D ""; } function GetSldId()=20 { var regExp =3D /file:\/\/\//i var pos =3D location.href.search(regExp) if (MHTMLPrefix !=3D "" && pos !=3D -1) sId =3D location.href.substring(pos) else { sId =3D RemoveFilePrefixFromHref(location.href); var regExp =3D /\// var fixedHref =3D sId var pos =3D -1 =09 pos =3D fixedHref.search(regExp) while (pos !=3D -1) { fixedHref =3D fixedHref.replace(regExp, "\\") pos =3D fixedHref.search(regExp) } =09 if (g_fBaseHyperlink =3D=3D true) sId =3D "file:///" + fixedHref; else sId =3D fixedHref.substring(fixedHref.lastIndexOf('\\') + 1) } =09 return sId } function HideMenu() { if( frames["PPTSld"] && PPTSld.document.all.item("ctx= tmenu") && PPTSld.ctxtmenu.style.display!=3D"none" ) { PPTSld.ctxtmenu.styl= e.display=3D'none'; return true } return false } function IsWin( name ) { return window.name =3D=3D name } function IsNts() { return IsWin("PPTNts") } function IsSldOrNts() { return( IsWin("PPTSld")||IsWin("PPTNts") ) } function SupportsPPTAnimation() { return( navigator.platform =3D=3D "Win32"= && navigator.appVersion.indexOf("Windows")>0 ) } function SupportsPPTHTML() { var appVer=3Dnavigator.appVersion, msie=3DappVer.indexOf("MSIE "), ver=3D0 if( msie >=3D 0 ) ver=3DparseFloat( appVer.substring( msie+5, appVer.indexOf(";",msie) ) ) else ver=3DparseInt(appVer) return( ver >=3D 4 && msie >=3D 0 ) } function _RSW() { if( !g_supportsPPTHTML || IsNts() || ( !g_scaleInFrame && (!IsWin("PPTSld") || !parent.IsFullScrMode()) ) ) return var padding=3D0; if( IsWin("PPTSld") && parent.IsFramesMode() ) padding=3D6 cltWidth=3Ddocument.body.clientWidth-padding cltHeight=3Ddocument.body.clientHeight-padding factor=3D(1.0*cltWidth)/g_origW if( cltHeight < g_origH*factor ) factor=3D(1.0*cltHeight)/g_origH newSize =3D g_origSz * factor if( newSize < 1 ) newSize=3D1 s=3DSlideObj.style s.fontSize=3DnewSize+"px" s.posWidth=3Dg_origW*factor s.posHeight=3Dg_origH*factor s.posLeft=3D(cltWidth-s.posWidth+padding)/2 s.posTop=3D(cltHeight-s.posHeight+padding)/2 if( g_scaleHyperlinks ) ScaleHyperlinks( factor ) } function _InitAnimations() { animRuntimeInstalled =3D ''+document.body.localTime !=3D 'undefined'; isFullScreen =3D (window.name =3D=3D "PPTSld") && !parent.IsFramesMode(); g_animUseRuntime =3D g_showAnimation && animRuntimeInstalled && !(isFullSc= reen && parent.IsSldVisited()); if( g_animUseRuntime ) { collSeq =3D document.all.tags("seq"); if( collSeq !=3D null ) { for(ii=3D0;ii numSlds ) gSldJumpIdx =3D numSlds; if ( gSldJumpIdx >=3D 0 ) { if ( gSldJumpIdx =3D=3D 0 ) gSldJumpIdx =3D 1; var jumpTo =3D parseInt(gSldJumpIdx); gSldJump =3D 0; gSldJumpIdx =3D ""; win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref ) } } } function _KDH() { if( event.keyCode =3D=3D 8 ) { event.returnValue =3D 0; parent.GoToPrevSld(); } } function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && !parent.IsFramesMode() ) || (event && (event.keyCode=3D=3D32) ) ) parent.GoToNextSld(); } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"スライド ショーの最後です。 クリックすると終了します。"= , SCREEN_MODE=3D"Frames", gIsEndShow=3D0, NUM_VIS_SLDS=3D154, SCRIPT_HREF= =3D"script.js", FULLSCR_HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var g_fBaseHyperlink =3D false; var gMainDoc=3Dnew Array(new hrefList("slide0157.htm",1,-1,1),new hrefList(= "slide0562.htm",1,-1,1),new hrefList("slide0518.htm",1,-1,1),new hrefList("= slide0564.htm",1,-1,1),new hrefList("slide0541.htm",1,-1,1),new hrefList("s= lide0709.htm",1,-1,1),new hrefList("slide0672.htm",1,-1,1),new hrefList("sl= ide0700.htm",1,-1,1),new hrefList("slide0565.htm",1,-1,1),new hrefList("sli= de0689.htm",1,-1,1),new hrefList("slide0567.htm",1,-1,1),new hrefList("slid= e0563.htm",1,-1,1),new hrefList("slide0474.htm",1,-1,1),new hrefList("slide= 0539.htm",1,-1,1),new hrefList("slide0568.htm",1,-1,1),new hrefList("slide0= 607.htm",1,-1,1),new hrefList("slide0608.htm",1,-1,1),new hrefList("slide06= 09.htm",1,-1,1),new hrefList("slide0569.htm",1,-1,1),new hrefList("slide061= 5.htm",1,-1,1),new hrefList("slide0570.htm",1,-1,1),new hrefList("slide0613= .htm",1,-1,1),new hrefList("slide0571.htm",1,-1,1),new hrefList("slide0572.= htm",1,-1,1),new hrefList("slide0610.htm",1,-1,1),new hrefList("slide0670.h= tm",1,-1,1),new hrefList("slide0611.htm",1,-1,1),new hrefList("slide0612.ht= m",1,-1,1),new hrefList("slide0673.htm",1,-1,1),new hrefList("slide0614.htm= ",1,-1,1),new hrefList("slide0616.htm",1,-1,1),new hrefList("slide0674.htm"= ,1,-1,1),new hrefList("slide0678.htm",1,-1,1),new hrefList("slide0679.htm",= 1,-1,1),new hrefList("slide0677.htm",1,-1,1),new hrefList("slide0676.htm",1= ,-1,1),new hrefList("slide0675.htm",1,-1,1),new hrefList("slide0617.htm",1,= -1,1),new hrefList("slide0618.htm",1,-1,1),new hrefList("slide0619.htm",1,-= 1,1),new hrefList("slide0671.htm",1,-1,1),new hrefList("slide0697.htm",1,-1= ,1),new hrefList("slide0698.htm",1,-1,1),new hrefList("slide0699.htm",1,-1,= 1),new hrefList("slide0558.htm",1,-1,1),new hrefList("slide0542.htm",1,-1,1= ),new hrefList("slide0543.htm",1,-1,1),new hrefList("slide0544.htm",1,-1,1)= ,new hrefList("slide0548.htm",1,-1,1),new hrefList("slide0554.htm",1,-1,1),= new hrefList("slide0545.htm",1,-1,1),new hrefList("slide0702.htm",1,-1,1),n= ew hrefList("slide0546.htm",1,-1,1),new hrefList("slide0573.htm",1,-1,1),ne= w hrefList("slide0574.htm",1,-1,1),new hrefList("slide0684.htm",1,-1,1),new= hrefList("slide0685.htm",1,-1,1),new hrefList("slide0575.htm",1,-1,1),new = hrefList("slide0576.htm",1,-1,1),new hrefList("slide0577.htm",1,-1,1),new h= refList("slide0578.htm",1,-1,1),new hrefList("slide0579.htm",1,-1,1),new hr= efList("slide0580.htm",1,-1,1),new hrefList("slide0581.htm",1,-1,1),new hre= fList("slide0582.htm",1,-1,1),new hrefList("slide0583.htm",1,-1,1),new href= List("slide0584.htm",1,-1,1),new hrefList("slide0585.htm",1,-1,1),new hrefL= ist("slide0586.htm",1,-1,1),new hrefList("slide0587.htm",1,-1,1),new hrefLi= st("slide0588.htm",1,-1,1),new hrefList("slide0594.htm",1,-1,1),new hrefLis= t("slide0595.htm",1,-1,1),new hrefList("slide0638.htm",1,-1,1),new hrefList= ("slide0547.htm",1,-1,1),new hrefList("slide0559.htm",1,-1,1),new hrefList(= "slide0561.htm",1,-1,1),new hrefList("slide0596.htm",1,-1,1),new hrefList("= slide0597.htm",1,-1,1),new hrefList("slide0598.htm",1,-1,1),new hrefList("s= lide0549.htm",1,-1,1),new hrefList("slide0599.htm",1,-1,1),new hrefList("sl= ide0601.htm",1,-1,1),new hrefList("slide0602.htm",1,-1,1),new hrefList("sli= de0603.htm",1,-1,1),new hrefList("slide0604.htm",1,-1,1),new hrefList("slid= e0605.htm",1,-1,1),new hrefList("slide0600.htm",1,-1,1),new hrefList("slide= 0560.htm",1,-1,1),new hrefList("slide0606.htm",1,-1,1),new hrefList("slide0= 550.htm",1,-1,1),new hrefList("slide0662.htm",1,-1,1),new hrefList("slide06= 61.htm",1,-1,1),new hrefList("slide0660.htm",1,-1,1),new hrefList("slide066= 3.htm",1,-1,1),new hrefList("slide0664.htm",1,-1,1),new hrefList("slide0665= .htm",1,-1,1),new hrefList("slide0627.htm",1,-1,1),new hrefList("slide0628.= htm",1,-1,1),new hrefList("slide0629.htm",1,-1,1),new hrefList("slide0708.h= tm",1,-1,1),new hrefList("slide0658.htm",1,-1,1),new hrefList("slide0659.ht= m",1,-1,1),new hrefList("slide0631.htm",1,-1,1),new hrefList("slide0632.htm= ",1,-1,1),new hrefList("slide0551.htm",1,-1,1),new hrefList("slide0642.htm"= ,1,-1,1),new hrefList("slide0643.htm",1,-1,1),new hrefList("slide0644.htm",= 1,-1,1),new hrefList("slide0645.htm",1,-1,1),new hrefList("slide0646.htm",1= ,-1,1),new hrefList("slide0654.htm",1,-1,1),new hrefList("slide0655.htm",1,= -1,1),new hrefList("slide0656.htm",1,-1,1),new hrefList("slide0657.htm",1,-= 1,1),new hrefList("slide0552.htm",1,-1,1),new hrefList("slide0633.htm",1,-1= ,1),new hrefList("slide0641.htm",1,-1,1),new hrefList("slide0640.htm",1,-1,= 1),new hrefList("slide0639.htm",1,-1,1),new hrefList("slide0637.htm",1,-1,1= ),new hrefList("slide0636.htm",1,-1,1),new hrefList("slide0635.htm",1,-1,1)= ,new hrefList("slide0634.htm",1,-1,1),new hrefList("slide0557.htm",1,-1,1),= new hrefList("slide0666.htm",1,-1,1),new hrefList("slide0667.htm",1,-1,1),n= ew hrefList("slide0668.htm",1,-1,1),new hrefList("slide0669.htm",1,-1,1),ne= w hrefList("slide0620.htm",1,-1,1),new hrefList("slide0687.htm",1,-1,1),new= hrefList("slide0703.htm",1,-1,1),new hrefList("slide0621.htm",1,-1,1),new = hrefList("slide0686.htm",1,-1,1),new hrefList("slide0704.htm",1,-1,1),new h= refList("slide0680.htm",1,-1,1),new hrefList("slide0705.htm",1,-1,1),new hr= efList("slide0690.htm",1,-1,1),new hrefList("slide0691.htm",1,-1,1),new hre= fList("slide0706.htm",1,-1,1),new hrefList("slide0692.htm",1,-1,1),new href= List("slide0693.htm",1,-1,1),new hrefList("slide0707.htm",1,-1,1),new hrefL= ist("slide0622.htm",1,-1,1),new hrefList("slide0623.htm",1,-1,1),new hrefLi= st("slide0694.htm",1,-1,1),new hrefList("slide0695.htm",1,-1,1),new hrefLis= t("slide0696.htm",1,-1,1),new hrefList("slide0556.htm",1,-1,1),new hrefList= ("slide0626.htm",1,-1,1),new hrefList("slide0630.htm",1,-1,1),new hrefList(= "slide0711.htm",1,-1,1),new hrefList("slide0712.htm",1,-1,1),new hrefList("= slide0713.htm",1,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function RemoveFilePrefixFromHref(href) { var regExp =3D /^file:\/\/\//i; return href.replace(regExp, "") } function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix();=20 function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') {=20 href=3Dnew String(document.location.href)=20 Start=3Dhref.indexOf('!')+1=20 End=3Dhref.lastIndexOf('/')+1=20 if (End < Start)=20 return href.substring(0, Start)=20 else=20 return href.substring(0, End)=20 } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { // Clear any sounds playing before launching another browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if (MHTMLPrefix !=3D "") href =3D RemoveFilePrefixFromHref(href) if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; =09 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(obj.mSldHref= )) else PPTSld.location.replace(obj.mSldHref) =09 if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(href)) else PPTSld.location.replace(href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('


' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"次へ",sPrev=3D"前へ",sEnd=3D"スライド ショーの終了",sFont=3D"= lＳ 明朝",sArrow=3D"矢印",sFreeform=3D"フリーフォーム",sRect=3D"四角形",sOv= al=3D"楕円" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; s.fontFamily=3DsFont s.fontSize=3D"9pt" s.paddingLeft=3D2 } function CreateSeparator( node ) { var sObj=3DCreateItem( node ) SetCMBorder(sObj,"menu","menu") var s=3DsObj.style s.borderTopColor=3D"threedshadow" s.borderBottomColor=3D"threedhighlight" s.height=3D1 s.fontSize=3D"0px" } function CreateItem( node ) { var elem=3DPPTSld.document.createElement("DIV") node.insertBefore( elem ) return elem } function SetCMBorder( o,ltClr,rbClr ) { var s=3Do.style s.backgroundColor=3D"menu" s.borderStyle=3D"solid" s.borderWidth=3D1 s.borderColor=3DltClr+" "+rbClr+" "+rbClr+" "+ltClr } ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/fullscreen.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/buttons.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhWAESAPf4AAAAAIAAAACAAICAAAAAgIAAgACAgICAgAQEBISEBASEBISEhAQEhMTExAQE /KTM9Pz8/ERERPz8BAT8/KSkpGRkhMTcxCRkxAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAMDAwP8AAAD/AP//AAAA//8A/wD//////yH5BAEAAPgALAAAAABYARIA QAj/APEJHEiwoMGDCBMqXMiwocOHECNKnEixosWLGCEiQKCRo8YDIEHig2DxAD4LKD1avDDhgUuV GUOGbHBR5QGYFBG4fHAB58EKECJEwCfUYAWPFGAygLCRKQIIUKM6WAohKUGgCikcFWh1INWoYKVS 7SrQ41GbIhGYLAuVQVOoC+IyXUuUAkG1HE3KFDhAwkgJc5/qDZmxsOHDiBMrXsy4sePDGyP7lChT 5MULmDPnlDw5YmW6FTNrfgi0aNGEZPEtbfo2bNTUpYeeRph69dPWrqvCNFuBIGG1A59CYPAVQtwF cw0OxWdTIOiBCQAjaAB17fOFII8voGmRc+eOkilm/z9OvTtnjN4hYk1YoT3H2rnBOphPAB9skgq3 2lcaX/5YnJVt9BloAar12UEIRGCZdQghMABI1Tn32IQUVthYexhmqGGGMBHAgIfEhSiiiATAtOGJ GnYI4ogsEldicAYOGNJGZaml3Y0L3NTZUBz1xlB0PUoUI0jlVWRSVN89xBKSGB1YU1TMoRfVBEle hR9HQs1GEHxQ3RZZbveZthxt/LEmXHyp5XWABSCpaRJwbM13gAACPHVccgJFgF+NEhqUAEkQSCfc ddhVhh5dVTaEAEsTUNlkZUWKN9BNGDE6QU8OrSdbllzpxyVTTrU21Uj3scfhp7nNpyoDaTIEJ3P9 If8J2kbLNYegg9JRBwGhFvbq66+ZUiDssMQWK2yHxiZLrInKNotss8l+B5yBrr5p2UIJvortANoC 6+234IbLla/elRtZjeamh5CC3Sb0YLvixivvYkDFGlZqBNh7r4n6goVvv6/ZlCicN+kL71ALTnpQ dCIZp7CihkLA3UQmoWRBogyxtBPGCTnZncVR1rSTo5nuydC/Eo8kUH+lOoTyyvjoCuZu+PjYIKLD rZybtrM1d10C0QXKEVz48GrQkEeWdFJKlbb0UmEeV0SzyC6RvNB646LWIVjUNeC1zAFb+RDKXksM 9r531bwmpQW9+hQDDsx5pqwDRWBXcFES2hc+gEn/wJGdEEWdE6LoWcoxQweaTNmkhydkKaYMYY2Q p1unbLl/pPKbn3v7EZRvrKvqlja2ONvrtoIw9tn2g32/tQBlhtYkU+MNikZ7QYlPDPuMldpOmuJX nVo5VF3HjI+q89mteX5IDd/fVFClma5kiE4f2XUJhlz09gj2NbTDRifkmu7zXjR++RVJ/lPznuvr QH2iD6S+UewP9Dnon6d2NLwN8n90BB6hC68cFMCHoe+ACASP9c4DowUyEF0OPFcDI0ij/VXPaAKC UfhS95AKGoQ7IBRICI1HwhGaUIQoLGEKT6jCFrLwhSuMoQtlCMMZ2rCGOKShDm+4wxzy8Ic+DGIP B4cIRCKGMCAAOy== ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/frame.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis" 平成１８年度改定説明 ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="shift_jis"
 ノ= ート
スラ= Cド ショー
アウトライン
------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/oledata.mso Content-Transfer-Encoding: base64 Content-Type: application/x-mso 0M8R4KGxGuEAAAAAAAAAAAAAAAAAAAAAPgADAP7/CQAGAAAAAAAAAAAAAAABAAAAAQAAAAAAAAAA EAAA/v///wAAAAD+////AAAAAAAAAAD///////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// ///////////////////////////////////////////////////////////////////////////9 /////v///wMAAAAEAAAABQAAAAYAAAAHAAAACAAAAAkAAAAKAAAACwAAAAwAAAANAAAADgAAAA8A AAAQAAAAEQAAABIAAAATAAAAFAAAABUAAAAWAAAAFwAAABgAAAAZAAAAGgAAABsAAAAcAAAAHQAA AB4AAAAfAAAAIAAAACEAAAAiAAAAIwAAACQAAAAlAAAAJgAAACcAAAD+////KQAAACoAAAArAAAA LAAAAC0AAAAuAAAALwAAADAAAAAxAAAAMgAAADMAAAA0AAAANQAAADYAAAA3AAAAOAAAAP7///// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// /////////////////////////////////////////////////////////////////////////1IA bwBvAHQAIABFAG4AdAByAHkAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAWAAUA//////////8BAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAJCe/WYfRMYB /v///wAAAAAAAAAANAA1ADAANAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAoAAgH/////AgAAAP////8AAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAACAAAA90oAAAAAAAA0ADUANAA3AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAACgACAP///////////////wAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAACgAAABDIQAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA//////// ////////AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAIwB AHic7X0LmJTFlWj9/X7NMO8Z5tkzMDwUxobh/ZAB8YEigmgwAQURlDcEEEGjGTAxDhFj1qvJdb0J uu6u95qsLho1a0JwJVlXNxuzN6B7zcZElpssN/cGEzcxWWXuOace/1/919/9d08PkpX+v+ruOv85 dU6dOqeq/vrr8doPKn/6yF83/oxlfc5nQXaqP84iDlhABPpUMBaCHwvCqf7+fgQFIbRC6D/7+aP5 XMk2w7WdpdmFbBP8bmW7sk0h56eOhVV5oy2kY9xCDvHbFzlxF16x7Wv/PuN71gxpLPBZAty3svVs JcmxviDe+KliASsskkMZ/NAgl4/dyf9b7ALgu5FtYVeADOuK4a/Zux+aBIQt4n+YLWY3A/+N7HrS /TwohRtJJwjZztbC/0050hoF+UcfRV/0yx/xfyT+T4Pwwek1udP+OeUI0xmvrzDPPfB/NoQ5EC6A MBfChYwb7cUQLoEwD8KlEC6DMB/C5RAWQLgCwkIIiyBcCWExhKsgXA3hYxDWsoHXg2uErGiVMyFs gLARAtrDZmFDn4SwFcI2CNsh3AxhB4RbIOyEgN58K4TbIHwKwu0Q7oDwaQi9JPvp8/+elklPo/9H MfIh+n+Mffj+v1b8/7D8/zXxX8qNOvwgy1cQLy7kTUJIQSiDUA5hCKMuAKskHTBWDaEGQi1Dm2Cs HkIDhKEQGiE0QWiG0AKhTfBKw287hA4IwyAMh9AJYQSEkZQ3xkZDOAfCuRDGQBgLoQvCeRAyEMZB GA+hG8IECBMhTIIwGcIUCN9gH15/5Brg/XEIn4CwFMIyCNdCuA7CcggrIFwPYSWEGyCsgrAawo0Q /isE6f+D+cH00WODwobCgif6aEyUP8aTp0GWs5/T/wlDq7cZrA/roNXUAhRWH00pov7DdmKUJf9f Ae3aaj9kxk8C6j/kizbslz9+asRvQPBfCDlcDa1ohi7/n4Yi8r8EwokJBTDJ8ymUv/PzJ1vvv2F3 z5cW9/0//uyGekyz+2/A/1i/X772hq2bt22+cXv6wp03rN7AegDWe9Nvf/Y/Jn3Pov9/+a0D2KYH s9K9Ze2q7WumjZuwZfvI82dsvXnlrvN//vDnf/H152Zs23L9pvS27bs2rJ45ctXabRbUKsEEz0N2 36HFzT995xd2L71zwZ0fg++bqCGbs/bGG6dQk0QIXYvXrF69vWsKe3fqgU8a8nv+jPNImhnnbV91 flkinZ6xfVV66+ZbUKyZ49M3bLh+27aZOzeMn3r+sd5eDemGzRsIaYIDSWZk5eatq1ZvHbt17U1r tk8b1zVxy/b0ts0b1q5K37Jm7fbV08XtDatv3D4Nk9u0edNqqZbj97xw/PknstWyZcP1u6ZJtO3n H9vz2LE9z4Ho20FwRFXZoO9ffP7PKQFM2zuNOx81JGA5Hunl5+TnvppAnk8cu/PpY3ue8Wb7F7uP nwKLC1uuJMjHA0e+f+ThrqaK+78UY+eO+f1foV+9x3ibgvex/4z9CGwnsb/Qy3g/425he/cx3q/4 MuN9iv2M9z8eZ7wv8kNhr48Fue2ivexee+9ru9fd/4cHb7v72L3b+361u+eBN+958u5jX3qp700G ULTT2YkE8WGCn+m3tYK3idgOkkmNs/+Ot/92s1QFF6JVCKcZKKbAPcOrKHLp76ef/eqvf3/Fmoon vgj6G/n0P2eEDqLifg/jbTY+p2Bbjf0L7IutEfrpFSLd49CjU1+Y13gM5I+E2UUN34++CAQRQPgZ YD0VepFw36Z0tyC/9On8zCEZrifNHALmM6GXawEsyB6G73L2E8gx5hEcPzWUJK2i72r6fpLovkXf M+HOWLiWj5pXOYP0ZrFrAj2Et4++O+i7HL4t9hzR/C+CjIOa8Mfw2//p+5As2Mti1tj+bui3Zvqf yTyXeSnzZOZMxNnpK50Q6A9xrJw4w/PioD/n5vWMD3me8ZHOSZ+8ynykMyoHTmuoAfrB4DEdyzqG jRk2LDMd/iwbS39bQy3Q7DQ47i29cvWqa50IreCgQ22EroyTHmKtoWFgvK06RlYqhDYZnnzg2WZ5 GuDnpAm+PD1dRAWiDegY20GRnuXp1lAXPDiNRlInnU6URTELHq+m6cxACBc/DQYJzJplJzEJntLG OZhKXBexi7IR6n94clw2nIs3evqyUeL/stGtoTbQd6PzLilLQ0mDxpsUCvJxpAFRxOmERNJZOHpK hPhT0Tf8d3o+lZ9DaYRbEv6uP3igQDj7CMItLBSmw8Pg54T/ng7Hlu9d7OO+m40/wogfBj83wyMe 8JgRHvPgq+RP63Dew4G2eGdHR1+oL8RCtQ54Rw44fpng6Y5eczqBvhDE3OkEqJ/lTifQa8TvQK6m dPjHnQ7rNeJ39PaFek356mXMBE/39hrxO2Ie+Yp55CtmzlcgFjfi3+2RfoD+G/A99BPojRvzdbeH HjrSHvpJe+gn7dRPQtpbTLe3hMSfUlnZk+5Ju+G1tWZ4pQd8kQe81iP9RV58F3nw9YAv8oBXLGIu eJoPETr0kJTwNdJuYw59uuEqnUt0uPLrHh2eVH69qJL7rwu+yAyv9IDX1nrAPdKv9UrfI51KLzk1 fEd9ZbDzKg+/bkT43eBHaQM+wHs84IdM6UD6zAPfmL4X/iiP9LV6MiHxp4TDPVTIh7LgFWGwNwM8 LEzChS/aABf+wh6648JfCFAD3PKQZ6GHPJaHPAs95LE85FlokCdX/eBVz1TUuv00V31iLYL8+vR3 hC80wM/xqN/O8aivzvGolypxOBMHJQz60euZlLI3xO/N8q9GD79u9PDrxkHz6zK73rjaDK/0gi8y w031W4eHnB0uOR3pXG3GX2RIp9LRD8nOrw4vN5TL/YEQq+gN9+NvZW+Mfqt6I/Rb3Ruk35reKP3W 9oboF3or9FvXG+9fQSMCn4W015FHRcR4EEJeneiAjEfIdYsdkO574Al6EVwvWjEIjK1Ya7H/wz6B o14nryTBIyfxLRncpmcCni8eUFfdLHkSR3S+Aw1+jO22oAaLHcJx11gPa32ngmPFwBpj9RB+x1jF +2xu+WiLv3gNsDAOm3Xd2nklKiVCL8dAJ+y5zPHMP2cOZwTCH5Y8uElH+HrmeUD5TSbEwvjSjS0Y s+e7N7+1xoL2FpGwkxRnj8HD8g8B6X9mfp75i8zLEBgxDUHAbyINLOt94Ls3r3xQJ30ByN5WpI/B PydpmIXxFd/DDz69NNz77dVj96LLcuIEXM8R0deA7LnMMQgvQE6QPAiPB0Gb88Lbp6xxC/3XIPQT 8IyfU+iDn7pul5v0BeKYI7/YGdm19aGly9d90Gux4YI0CtfLwPF7QP71zD+6yc4RZCiwBQ8ynAwL XJJJoT0IUVwzoRTZSSgK/ZtbtqzWC/17gPhNEE/k5KtLT9xz+Rc3fVrPyfMgynOg8B9Ayi9mC4Qv bpO33PL5H63/3DZ0Z04WgesJSPuZzD9lToiyClBJqVyMWrLyweOrUSBnLp4FHmgbrwLPb7r1htxO La3vP74gsUDn9h0ifJ7KiZE7BaRh4TvoySzDwoKsgcgsUoBNEuTI+EJ6HJvKjq8+vuCzi7BDyHnA LfYqZP+xzCsQGA0cBpxE3cChYKLxgFYE0ZTCiLjWxqGAvvSm8RpXjCq6ixOwu3ABu9mkYjQ4oTgB JxYmIFrehEIsb1KhRiQFm1KYYJyssr/BpydpZOOLMSSuvXNu6t2k5wzJ3sr8RFRYDqJGpTtOVCd0 F4RLEmjpo1h+04+zMLak7f1YmSTAxruAV2N/Zb8F/TxePeLn5UyCI3b0c/9JsKp+RHtvx+LlOuqr GShWRB2bDU/xJIb1cwtPgPV1QUF7JSM4Du/nGkuwak+OIuXOfm4BCUg9V8pmAZ+VHEf0cx0mWI0H x2czQY66a2vnldm60m5WuW5GeYlOAQbnsXH0xv2z+/RSfVHYDr71ibFwQxb68QVJMLkaQYB1+2PQ QiJ6QKJPKgx9ok/0EPfkpk2Xf3ldZklG9+MDYFpfczTUZI2I2v5JRHXaokR9xdGsUVabqdEZr4RB ci8uQn5OMrFwkimFkmATUDDJ5EJJuh1l4ZvLBN8kCd6/nL743OuO71mSuSKzObN5/Q93YVz2NIPU 2cHO09sQnqBuFC+nAJVTELBCss+HXZ7dfT+7Su8p8S7PL7T+bVB2Q7DynN5/ahvLzL97Zr9eef4F 9JEOZ/5KOIAlHEK5wWSfhprkXaupDnT04k0Z3vNzdrS+LfqzsgcoLT1uJzPFYV7FJFPBwji97dVO lnn7wd8um3dbz8pRS/7lilsfnL54zo7l6x59YFNmwjUxUOEKSjAKlUEdO0HJYcA+P3YH34S+8G/g 9wRp5+sZVPJrmUdFW4gKDoEi0L+wXo/Cd0qwT8J3Nb3kjUoj82MvYZtgkm8CpfoppVD9VIcDFZOM aBSn909dzTI3rEdzc1ZEj2b+LfMdelJwGls/uxSS/XGlmElQzdhT8FTZWMvYpUHGvgdPEL+Fx+RN YJBfiTD290MZ+30UiqAJPBEeUu8FfR1MMLamlbEvp/gMUj7ToEKbaVBGzpSC71XwTBygZ318Dq4A 3u//93f+6fKVC2ctJ/g5BD+XvvcQpNceBGed+MzOyq3dcOfFkJyHeidhf4a+L2d3BHF290K2mF3B FoAG5sP/seRNeF3A/HysEAv+mO0PBL+Kuoqzh5ITYqvgX9QaY6FMY2hW22yoi9JUVWbobTz+x0JM 07y6Yj9Wnvv7aRIJn4oyxuKSjLEsNiH2UJJ/4wzTVSC1RU5if6IsoaJWD9YjYyg/+AlpPAJZcYvm izrjaDvnqtTxAVPOzssn/0ftg68T+ZuG8QXTzp0/f8H1G1d3j5954cLLxk2dPPuCLgDZ993zifx9 LMM/XBWxosj0nJ9HoJGLs1VUx3AbY8LHfzpL/lrsaqrQboc6ARu8/YkhVK3fTtV4HOL1FGeBckqz nb6xdokFKsT/Fi66NSSNMItg5RJGeAEDLGiAhQzphQ2wiAEWNcBiBljcAEsYYEkDLGWAlRlg5QbY EAOswgCrNMCqDLBqA6zGAKs1wOoMsHoDrMEAG2qANRpgTQZYswHWYoC1GmBtWbAPqNT4mgfGPhBv DoaS/fFYgPF5ajwWBCmDKhaCeyEVC0MsrGIRiEVULAp0URWLwb2YisUhl3ERQ76LaVUFj1mQW8T5 NpQeel8zs7bc0NNC31BnByLUKjSzIHgW1urN7N0PfrTz30b8bha/FwHIHQFMKcoEFWHGHJgcEgd9 rTj+Wsebv3+XaDHPl5IU2EK2kSXzWABi5SoWhPaRxu8DvOvSJuBhgcXhEQWPCnwei2lpxaFmkDRB xT9I/FMCK0j8h6gY8h+iaCT/IPG34REFjwp8HotpaSF/SYPlehnBQ/SOo0xg4QNfB/kcjwWhtCoV TQjucXgY/lUpeETBo4BfrahjALdjcXgSkTG0pPm0tobHLNbJLRBKCzurnezn/4HV77uzOCQIHUsd EnLhhAHyhzvWfWv7/b8WkAhAfg11eMU1vxGQqCudmIsqzkYqKswf2vnlJGdEs5UIlVWNimFZ2bGQ di+sxSJaLKrRxbR7WGY1Qs9RJUdUs5moZjNRZTM8FtLuhbVYRItFNbqYds9pO+jbCwge02wnRrZT q2JoO3UqhrbTqWLSfngsosWip2Vt1EPA708hPAzhv0H4CgToQNNc5kcgPArhz1jp1hc9C2k9B+F5 CN+E8DcQXoDwLar/4MmE4Rs1RusMXoTwtxBegnAYwk3so7V+3a5DYlodEtPqkDjVISNUzFmHxKkO uejZ30Ar8M4sDsE6RIeEHDjYjsSpDmGP7+s5SClGaPpBlPF76BF4D30gTh6B/xLKKxNa7ZAgr6xX MfRKOxbS7oVF7CDFJFd+LybucV6Sa1JxTWp1QVKrC5JaXZDU6oKkqgsOUszJNam8n/OSXFPK81Oa 56fI84eqGHp+g4oh104VQ67VgmtK45oirg2Ca4q4IryMynmkSKFMlTOWShmVM3uNl0oZ5ffbkEYZ cB1F8NGMPfV5/GZ9PRHGsaKEVQX/sPbH+5D6lL09cbpfrnRbrpVoOem2UchXTrw4PMTOITiPheFZ 045FRIzTRBVNTKTFY5hXiTVE8R+ile0Q4t+ksCT/IcS/SWEhfzsWETFOE1U0zvp9iFa/V6hSrtBK uYJKuVlhSf74TDJGlTA+jYx1xCIixmmiiibmaA8qyK9lrJLKe5SKyfI+CJrAkZg0XSEqwUrKLXv8 cz3w3XMXlDDHihJOO+MlWqU0WqVKFPGqHKnxu5hai+BcRbprVbh6mtUqzWpVSohXnZVmtVYe1ao8 OK6eZo3SfI3SPOLVZKVZQ2mOFmnWUJqjFa6dJt7F9vgKWq3MYyir1GZtljZrIV1I55K70F/u+4zQ Zm2WlHUq53WaNuuypKwjKdsE5zqSsk3h6mnWqzTrNW3WZ6VZr2mzXtNmfVaaDUqbDZo2cXXkMEea DWSxUpsNZLGjFa6uTazjFtK6bx5z1kVDeV303m5oPWogFhSSpzWpGlVOG7XapZG8O018a+g5zETd pKibtLqhiajbBXWTB3Wz0kiz5tnN5NmjBXWzgRqx0C8W0Xp3HnNaUkuWJbXwljSzu4d/RwSWXkKt KjetmiW1ZpV6K7UaHYJzK/VbOxSunmabSrNNs6S2rDTbKM12kWYbpdmucO00X2dz2WGoGjcE7mF7 WS9dX2N303UX20HXFgG/kl1Fl/ydw86nC+P4fI6l63w+R3kRdiXJkAZ5u5SVpkHe8+gKibth1qWs FMfKu5SVYguKmBmSNyImFJ8fqGLP0r8eZn/201NdCMpiiNzuAuUBMeLHQeAYPXLjJyyGsuOkQhwW 54NZlWKAsFYMKwwls8KFjmn6/RU94ExkZwfYzw6wnx1gz/6cHWDPPcCOnxWBcWqAHal6YnYch972 O+JY1+wP2XEcxnDS4wOkkz4OtdL+qB1PQtgfHaIN4A+jb/wvB/DLhY87B/DL7Yq8Qg7gl2cNyAZ1 2owcwM+GhQ2wiAEWNfCNGfjGDXgJA17SwCNlgJUZYOUG2BAD3yqC6S8xqg2y1Bhoaw14dQa8egOP BgNsqCG9RkN6TQa8ZgNeiwGv1YDXliXLB4wPzG9guO3cQT6UCjF5zYTS5zhRsNILFQ76iLx6oFQ+ YHxQfSPDLcT4oLjFbhHwAPybRrTlVEffAtetKm0cNHfSxaAbw+Fx+GfTJSC2hW0lfgdpWAM3+9oJ dz5gfMD8AtoAiceCEOtSsRDEzlOxMPQvMox3WXDQfCak80ngy+/G2c20oRgfUk9AjMOT8I9TYSwF 3S2URA6ibyIsbH9mKylwEH0ubcLEY0F2MdW2PBaCWLeKhdk82qLpIMW4TFFxL6alGWfboCsnh9wT bLuAJ+HfLJVCiu1S8oWUfCGST+oFB9kvVPJhd+wSJREOsl9CvSceCwPdJJF6SJMvRPJ10b0KGl7f BpJsd/APK/5h4i9LIkz8u1Us6OAYJv5TVQz5Txb8wxr/MPE/T/APG/hjDbaZcNG+eNnzWIBdRFrn MbSZSSqGNjNZxdBmpgj+EeK/WfDHgWhpTxU0VO7kfxDaHawtZxov7JRL/8H68zbqIh+Evhr2f29T 10z2KcclKeKax8WVx+Ggo+05OODIPUd6XFzzOBxQlHRxjS7b4xKaxyU0j0toHpfQPC6heVxClN5O 4XEJzeMSyuMSmsclNI9LKotKah6X1DwuqXlckjxutoqhx81m9rCjbVFJzeOSVKIXMDkIKT0uSR43 V6Xg9LiUki+leVxK87gUWfwcFQtpMbT4OcweoLTlS2kelzJYfJniX6Z5XBnxn61iTv5lGv8yjX+Z xr9M87gyA/9y5XHlmseVk8fNVjG0mTkqFtJiaDOSf7nmceWax5UbPA7b/1nGq4euMjGwhtudypYP h+TWq2uG8BUcbpM42IeIOXBS5KnVlIqTcr2Gw4fG8OWJ9DgcVFsh4AG2UnlcDehjBVw3KO44iOak iym6uKJL0VI8TpcibWFvZQ27XvgpDq5NV9ZcCzymKnusBZ1PVdaBw27TlJ/WggwzKJ2YuIv9Z+mn tQBZLeBJgGcUPMVuVMNza9Tw3GQlAQ7PdSsfqAN5JigfrQN5JqgWAQfuJqpWsU7IExX3YlqacXaV ahXrAHK1gCfZJ6hV5PAUW6qG+daoYb7JSh84zDdJyVYPso1X0tSDbONV+4QDgJNVi1ivyVZPsnWJ Uq0H2T7GlrBl7FqsDcSA4Bo1IDhZ6b+BuHerWNDBr4G4T1Ux5C7bwwaNewNxP09wb3Bxx77nWjVs OE35Jg4bTlGt4VCyk0kqFqIxBBlDO5Gt4VDivlZwxykX0obKIRZn17CPs+vYcuEt2MudYbzq4UqJ QUTG1omWsIoGGNepS3pGk+aXTVl+yQcTnT7XrHyuWfO5ZpfPNWs+16x8rlnzueYsn2vRfK5F87kW zedaNJ9r0XyuJcvnWjSfa1E+16L5XIvyuVZlWa2az7VqPteq+Vwr+dxsFUOfk+1iq2ZZrZrPtZLP yXaxVflcK/ncXAWXPtemZGvTfK5N87k2svo5KhbSYmj1sk1o02Rr03yuTbP618GWzocmYW7gEujP 7GX7xTDpCEhbj1/EhkMrdxd7mN1B13CA8LgcNs1+kmtn7ievDh1WIYdXee7Tms+nKfezVcyZ+7SW +7SW+7SW+7Tm82mXz7crn2/XfL6dfH62iqGdzlGxkBZDO5Xc2zWfb9d8vt3l86iPccZrCFxYPgm2 zML9KlDnv2R/i6OxJ18O0UjsSewX0wa7IdwQL3jyKfoNncQXc/CMeJKPjOgfeG4jOnz0wacPxMft i+dYHI4Dtj0JHKNNnkS5+RLiuRY+KX3awnS/Y+EI8yFaVPyqte5SxvqtBqhNvxPk+4tU0NJje7u5 OL3sw08l7qAFmm+EtpBPJ6tcgZD31l+qhrV+Cb3qbJmCfEZlSWViHjIFhUw/3eCU6TMk06ccMoWF TE+DTFj2fGNsb8nqSLKmrgD7oYUJc/lmBbEks6UsZ38H0IeB59X065YyLKTcuTG35iIlLc24KM0h Rs1FhEyv5ZEpWtLSjItglikqZHp5U+7SjA1iaQ6B8qyk0jwWqDSWZkxIuWKzU8oNJOUqh5RxUZrb QMpzcmquB0TotyoM0qDOakQ5Nhp1FhfSvB/NLU1C6Kw00jAPaRJCmndjuaVJlkg3zUI3HUZpkkKa +fHc0qRKpJtmoRuzNCkhTe91tjT0SpFOX+lh9gdfKX4c+kXilaKsBuFf6jjbY2UgY3xYA3+TYlAe G4gqeojjv1EBj9KDNR+IRxqLjIYvGYrTDJqoYBsmeJyGNhKEywcv+CB/jGYgRigeoGHElHgFEabq hJGUAYJxheADXS3R1dCDHj6K1VJatfSwlSK6KM2+5AucuGwp4oN4ARrGxMefoeoX6Zqoax2mX85n KPGsofkYFvFDuRCO6TeLNQTN9JYdZ0k3032E4/1WauwT9JukTnELydNMnWXszrbQ/RbqsKbOqFey j/BumsVfCEXIIrJfCIXFCyH5QsZ+MWV+p531Lhs/epad/7Hc/K6rtUeq8TCGGAvRm6U4246J+F3z KAe0twvyJCf3L4Mc957vGPfeSInhuPcFaJB+Vy2HAmNpePwSHJL2tVw4MJESuVAS+F00zAlDQAh5 LWTpMCcM87kIhSwgtofwN+K8Z1JPrFD1zKOR/q04vjnQRaryRcE2kWwSK2yUZWCLVuV7hpuVPYSU PYTIHmJ6hnMuHAd7wPKaV4g94BuLi4opVoQKQv+LvDlhmOerkKXe9isTaQ8hsocC1CPfrGyFotvm 0HhYaTwsNe53ZT9mJ0waL0KBYVvzhSkwLDVfyJJ0Tqg073/FvP2ySGo+LDXvV03ynVK25rHh3kRJ or/OLaQixezg76WFViycEN9pFGiBnDAkCf0rkBOGef4K2XjAfk22SWgeX5MVpCb5Ns2p+dxv02bD hVihwD7qCuzEicNnwqJ6+UJvp7pm0ktweXGhp1IneAOmV+imCfL932ZI5jJivxm7rAPfxEG+QMTz pz5JLxC5nNGByBlTcsZLK2dCyDnf8cJyI+3PjxaI3ZeLC2uFx1Ebd3FhLdk4qu8vLqwyHkdVVYEO Il+m2p3CRDGdwoTqFCaK6RQmtE5hUjVJyWI6hclCO4XJ4jqF3fQ++EIUz3uvi7PnP320P2fPfzr9 5z/hy9r9Z+j5T+jzazavX71p7Djm9wwolvjxpDHT9DOgSnH+03CN9xU33rj2htUDPQbq7PlP/3nP f0qzPOc/Md7O/e/a5B/t+U+PsfznP20Q+vmMEEnq8eEsfaUEXWcwwO61nmLHrBE0sD3WijL+G6Lf k1aMfkdCTYu/OBEZZagLjbTeCFiML1KIB7D6wX8W/eMpxMVvQKXATwl3xkyfBbMX4NG79ITFr5SQ GEc5xyf+BaRAO+o+b1wmc8/ze2/9GzdmtcB8ArdXZlMyiPonz0Sy0uSyM/UPZa8jynfAKhOK8u6X +/4mm9bm8g5bSbpEUfa8vOcb8i6dsaWkfoc9SrFJOaSWmD/3jck1kQtT5ufPrez87GY4tozjxtxe PgvhLgifY9wP+yDshfB5xs8R2wfhXghfEHb1RQh/AuF+CP8FwgMQHoTwJcb99ml2+tbT49lPeN7r 2fX/hX1k398SeZe10fmXMXY7VBTXTeCLsVjwvEa06Ml0FymCVoy8Jqn8JxUYZf1zQPcpuz4IWWX0 G7ACzF0PZMdsWju9/Bh2zTTY+Ba9mGbsfVV987pO5lpCnLlGb+yJt9MZZPiZZqWpCsQXhP8ROCn6 b3Q2WS+EzJ4Ne7am92y+c/GdH7tz5Z0LWPaHc8yugbmkPM13i0wzYEzTq6YPgAy8JhzDVrBc9W2d wPqqj7pV4v4r4U7yhTua6riJOXEHppmg0gLLskxda1wfs+iNobc+JFbu9kNi/aXCevBpGyslsOoE FtfXuPGySfDW1yyhr3ETc+FK7rlb0sK0w/kvLqCNXZxHRzLFr/rO/WKpqSl+cLmmxo/zg+tuad24 3j2Pm4RW/Fj8TewTvvN7k9SNj/zeJHQzfoIfXKGbyX5wuW5y581bN7cJ3eT2cIkrdJPTuiUu142f 8r1N6sZHfm8TuunO+MH9cx+1l0k33ENe9lX3vlxA3ftyAXXvy77q3mLq0Dd91aFv+qpD38xTh9YK LN7/zvV8ITH9Pom8OQj1568KqD9/5esZ5Ve+n1F+5fsZ5Ve+n1F+NcCaM2j5qTlrBe61Pss4aPnV SdDyq5Og5VcnQWtgNWa95afGrBW4fnVS71sn9b51Uu9bJ/VWYTWlu58se+79NGgqxzt4z7BKzLPi PUMrEAgs3rVt+2qxt0S/Pcza2zClltnphw3PM8hVfy6we9RSjrpQNXsdnie+YOnPC5bIbYDVBTC3 uzf2vb+7576nd2+iCYbCd/E35qgjnLKULh7KmceAjzz2sUesOtBpKeRx6oha4kQ3+xN65Nr7XSx5 DpsjYPf80oYtErAv7bBhKwTs7n+36+HS538qOwb5f9TSrdKZkyhJ08Ueo7cjzljFAKWQ6cGTKzsa qGP/atnSZUvRSXyHshEBfEuC46j3/mzPN/Z8fc/3732g72WMZ7eZUUfcGdwtmp9cBHPokilbujYw gx13+UsbyX4te8dCr5hKtcMX997/4J5/uH/5ff/FVEe45R24dFNBulGgY7M3n8uC5M2TffSTnDWW H+n81TVraU6oV13zZcbrmnte2N2zb5ufumbgvvESWOUBg8a4LX7jjLbFI1Dahz1L++8KKO1SyHIU ZLku4CXL7QG/PfRSyHLMOuCjvntFq+9eKaC+85ZCpoc1xVGoKa4L6OVuqjPW0xY0UyZ+WHXGUagz vEru3AJKLlBgneHHP0eyNdB2fcyjrWhij7PS+OeZ2GuppgXdg9VrCTF3r4XD9F4Lh+m9Fg4b7F7L 1ZD/GpbPi7vIUpkWk148GLVup3Vt4A3PHsDvZQ9gyofjzZ3WUZDO7c1SOl7XTJ1cjHSD4d9PQp/g K4Y+wWSS9xHapxL6BH+6u+dLf3b/5+7/r1/Yu+9f5Jv1z/fsPbrnH75wYt/nUMaYh3/7CaXLzeuB r8DTVD6b/TP2RUfLw2MVLu2eeXVSp1XNDgxanfQDQ530E0Od9H8NddL7p6VOOgJ10gEfddIrWp30 ilYnDfxJ6iVoEw9Am5jvSeob/4lbx07rEdDBYD3T/8DwTP8TwzP9/zU807+f85k+e2SoBM/V4o1w KdOTMRynOnTokJKWL0Q6ackRLrzHU8J/ui5pdR/7g3hHLe8jbyfc1kSU7M35jlou9ZN0ufHWWv7w 7vWJ93rANFIXM76Jzk4hCNJUq3pSai3mqbX80lT7xLvaJ95DPvHe8ok33PKvLWlDTjuwWz1uWzWB kaKGqw7gM4AXd4tVWSPF84EfTWfz9V8Cj/i0m2M+8a4twL78aawOSp9rbKqyAzf3YQyf7a7Oop0m WrVq+HeVJ63Fehhiuu29xprKlrjkOWZJeY55liCXx9aalOdRS8rzdo7SR3kezaJdoPKyIE9eEFOn HQWeIWV+yJMWTywY5fAhSfuWon0rD+1bLtrhSlfDPfPLaYe78rtE5TeXp1RaC1xlNArsUPK9NpCb r7wvaVcqPa/Mo+eVLj2vVDKvzCPzSpfMOxTfHXn47nDx3aH47sjDFzFN9Xofc8+m2gV3qhmfpeq0 /2rBq0/V325e28j+q13wxbRl0FVZ8s9Q9tmXwz4vhzRnuOxzhrLPvhz2yWmz7XOGss++HPbJabPt sw7qTkn7iCct18MjllkPsg4YzBo+XfIaeYbyrr4c3sW1Ju8PZg4fGkCfZgeUQx34jMknnvT0iX0u fJ7O0YA/Db6kegEv5ekFvKR6AZL2gGoPj+RpDw+42sOjqo45mqeOOerRHh5x1VsHVHt4JE97eMDV Hh5V7eHRPO3hUVd7eELl5USevJxw1ZeHVX1zJE97eNhV3xxW9c2RPO3hYVd9c1jVN0fytIeHXfXN CVXHn8hTx59wldFh5bFH8rSHh13t4Sml51N59HzKpedTSuZTeWQ+5ZK5ypJ8q6zcfBEzm3aJos3N FzFNvt9pmF2Mvv+kqz08oNpDHEfK1Q4c8GgPj7jawzeUfXZaudvDN1z2+Yayz04rd3v4hss+31D2 2Wnlbg8R01QHHjDUpVxv+6xsvT2ieOVuPw94tJ9HVJ1hyy/tHMezc8t/bcAs/1EXPMjmQcnel8Vr pHjrj09yRwUvP/P/H1fz/69qxNGos/P/z+T5/wNLSY2M/UPpVhIEHdLplvFRX0kQUlpwz1Vzau2j uZLAr3bOriQwedXZlQRnVxJ8FFYSFFaHfpRWEhRWf55dSXB2JcHZlQR+VxI4fcs0lhfOu5LAXkVA f3p7JjpXEkQMT0b2W+UPa15UuATSDd68KGed5kfeXPO4zsR5UaXITSnnRUWyOA80PvD86fOiBibP 4M+LKn3+SzEvqlgpZHofxryoM9ESnfOiSm+JpZ0Xlc3f8qWH07vWpHRlc7rWmjj7CKVqP0u31qQU spRqrUkpZBn4WpNipZDpna61JgPXVunWmgxGn+t0rTU581oNfa1JqVuNUq81KX3+S7HWxPkGw49c Oebi/kPpV2e7/eVMtELnOu3SW2Fp12kPhhUOfJ32wHvRp3+d9mD0VwZznXYp2sGBr9POHhkaeC9C X0lQmvRkLHslgfMwrEPpy9Sb7A//MKxL2m1pzIdhZZ1FVA4S2odgleLwK3m4ldfhV/KwrVyHXTEB 93OYVfYhWlxh+Q/L+uM4BOtU8/ejfw/lF7E+vEOwQkSbfQhWqtSHYP3xfExzzH7NcKZQNjzI3mVT RU3unPMu50MuyDMfcoFrPuRKRbsyD+1KF+0ORbsjDy1iuvMyz+qDHo4J/qRr3tRLat7US2relFlv L3no7YhLbyeU/CfyyH/ClfdTivZUHtpTLtoqS9JWWblpEdOkn07rPrXGiH94KnynZ7lXtPfKtxzP fY45VXoriG2zncoYx2xlFMLuS8dEG2dpkiXULtf/atWwe629TObb2YY6d7n2xys79Xsh9WODlvq/ Wk8Bh/w7dBeWOq+cw+yXtd+PvngI/gL5zwD7qdCLRPM2w33Ft6BexbEA6dPymUMyXE+9/UOQj5lW hJrPIHsYvsvZTyBn86fzRn8oSVpF39X0/STRfYu+Z8KdsXBFJ46om0H1tcWuCfQQ3j767qDvcmpc niOa/0WQcSzNfox6+zS9vQv2/i5mje3v7k+zTP8zmecyL2WezJyJODt9pRMCr0ccKyfO8Lw42H3K zesZH/I84yOdkz55leXAaQ01QL0D3cGOZR3DxgwblpkOf5aNpb+tITycvsFxb+mVq1dd60RoBUcY aiN0ZZz0EGsNDQPDbNUxslIhtMnQsRnP2PI0wM9JE3x5erqICkQb0DG2gyI9y9OtoS42Gi4gddLp RFkUs9gYNk1nBkK4+GkwSGDWLDuJSdAFG+dgKnFdxC7KRlaPnbJlw7l4o6cvGyX+LxvdGmoDfTc6 75KyNJQ0aLxJoSAfRxoQRZxOSCSdhaOnRIg/Fee+/DvYhP05lEa4JeHv+oMHCoSzjyDcorfjOhwf rwj/PR2OLTfNo303G3+EET/MRnnAIx7wmBEe8+Cr5E/rcH56CTzN7uzo6Av1QQNc64B35IDjlwme 7ug1pxPoC0HMnU6Anp/d6QR6jfgdyNWUDv+402G9RvyO3r5QrylfvYyZ4OneXiN+R8wjXzGPfMXM +QrE4kb8uz3SD9B/A76HfgK9cWO+7vbQQ0faQz9pD/2knfpJSHtTT7eHHHDAn1JZ2ZPuSbvhtbVm eKUHfJEHvNYj/UVefBd58PWAL/KAVyxiLjhER+l6SEr4Gmm3MYc+3XCVziU6XPl1jykd8utRfaFD qlySCr6okvt1LBu+yAyv9IDX1nrAPdKv9UrfI51KLzk1fJ7fRo96psqj3qjyqAconbshnbQBH+A9 HvBDpnQgfeaBb0xfw+f5rXTUb057qMIj6wx2VeXCTyp5TOXV6FFejR7l1eFRXh05ysurfPVyTNny L+T1THb6On7++sGrnqmodftprvrEWtTD/Po7whdqcC97tssxHO4hJz6UBa8IQzoGeFi4vAtftPEu /IU9dMeFvxCgBrjlIc9CD3ksD3kWeshjeciz0CBPJdo5HrCWBT/Ho704x6P+P8dVz5d51G82fJEH vPZqM7zSA75Iwe8PhFhFb7gffyt7Y/Rb1Ruh3+reIP3W9Ebpt7Y3RL/QK6Hfut54/wp6qv8sPON3 kWYj4kw3hHxhogMyHiHzFzsg3ffAU/AiuF60YhAYW7HWYv+HfQJPrjt5JZVf5GQDyhzjoyzcbnnA vHSzJL374G9LduOs5Bh/Q9LDWt+p4Fgx8OJYPYTfMVbxPptbPhrIL2KYYhhfRnXd2nklKoUPMeOg z3OZ45l/zhzOCIQ/LHlwk47w9czzgPKbTIiFx6CUC8bs+e7Nb63BDUT42bHYeXoMHop/CEj/k86o fZnOqZVnyOI3kQaW9T7w3ZtXPqiTvgBkbytS+xhkThpm4S6IPvzg00vDvd9ePXavPOw4QG9PniOi r9FRx8cgvAA5QXI8Cjloc154+5Q1bqH/GoR+Ap7lcwp98FPX7XKTvkAcc+QXOx27tj60dPm6D3r1 I59fBo7fA/KvZ/7RTXaOIEOBLXhg4WRY4JJMCu1BiOKaCaXITkJR6N/csmW1XujfA8RvgngiJ19d euKey7+46dN6Tp4HUZ4Dhf8AUn4xW6ARaMK33PL5H63/3DasljkZvtzgZ17/U+aEKCt54rXIxagl Kx88vhoFcuYCzxdH23gVeH7TrTfkdmppff/xBYkFOrfvEOHz4uxk/k5NGBa+P8TDn8OCzHl6sk0S 5MjDGQ7kTWXHVx9f8NlF2PGzT05+FbL/WOYVcdC5JXIkiPAs+IKJxgNaEURTCiPiWhtHB1f70ZvG a1wxquguTsDuwgXsZpOK0eCE4gScWJiAaHkTCrG8SYUakRRsSmGCcbLK/gafnqSRjS/GkLj2zrmp d5OeMyR7K/MTUWE5iBqV7jiR84h0SaClj2L5TT/OwtiStvdjZZIAG+8CXo39lf34kplXj/h5OZPg iB393H8SrKof0d7bsXi5jvpqBooVUcdmw1M8iWH93MITYH1dUNBeyQiOw/u5xhKs2pOjSLmzn1tA AlLPlbJZwGclxxH9XIcJVuPB8dlMkKPu2tp5ZbautJtVrptRXqJ+D76PsXBDFvrxBckFOBeBE2Dd /hi0kIgekOiTCkOf6BM9xD25adPlX16XWZLR/fgAmNbXHA01WSOitn8SUZ22KFFfcTRrlNVmanTG K2GQ3IuLkJ+TTCycZEqhJNgEFEwyuVCSbkdZ+OYywTdJgvcvpy8+97rje5Zkrshszmxe/8NdGJc9 zSB1drDz9DaEJ6gbxcspQOWEs21Css+HXZ7dfT+7Su8p8S7PL7T+bVB2Q7DynN5/ahvLzL97Zr9e ef4F9JEOZ/5KOIAlHEK5wWSfhprkXaupDnT04k0Z3vNzdrS+LfqzsgcoLT1uJzPFYV7FJFPBwjgd 7NVOlnn7wd8um3dbz8pRS/7lilsfnL54zo7l6x59YFNmwjUxUOEKSjAKlUEdO0HJYcA+P3YH34S+ 8G/g9wRp5+sZVPJrmUdFW4gKDjGL/Avr9SgL0EwtZJ+E72p6URuVRubHXsI2wSTfBEr1U0qh+qkO ByomGdEoTu+fupplbliP5uasiB7N/FvmO/Sk4DS2fnYpJLu/ks9TnFvN2FPwVPmTGsYuDTK2F54g fguPyePBIL8SYWzfUMZ+H2Xse1Ctj4eH1CtBXwcTjI1pZezLKX0ql3O2wOmbynU5uwP4XcgWssXs CrYANDAf/o8lb8LrAubnY4VY8MdsfyD4VdRVnD2UnBBbBf+i1hgLZRpDk0dmQ12UpqoyQ2/U8T8W YpptZBt98THyznN/P82pwa9WkINLMsay2ITYQ0n+zUDLq0Bqi5zE/kRZQkWtHqxHxlB+8BPSeASy 4nzvIGccbedclTo+YMpdofLJ/1H74GtD/kZhfMG0c+fPX3D9xtXd42deuPCycVMnz76gC0D2/YA3 ac6PZfg3F8KKItNzfnAyZZytYnwyZYB8JXsypSUmU94OdQI2ePsTQ6hav52q8TjE6ykuJ1vyqadY u8RoTRT+b+GiW0PSCLMIVi5hhBcwwIIGWMiQXtgAixhgUQMsZoDFDbCEAZY0wFIGWJkBVm6ADTHA KgywSgOsygCrNsBqDLBaA6zOAKs3wBoMsKEGWKMB1mSANRtgLQZYqwHWlgX7QMzdbaDvD8QI+FCy Px4LMD7XjMeCIGVQxUJwL6RiYYiFVSwCsYiKRYEuqmIxuBdTsTjkMi5iyPcyNkzFcGI24nyb5skH IGZtuaGnhb6hzg5EqFVoZkHwLIumb7/7wY92/tuI383i9yIAuSOAKUWZoCLMmAOTQ+KgrxXHX+t4 8/fvEi3meT5JgS1kG1nyB2LiehvZJo/hbggY4zQhuMfhYYHF4REFjwp8HotpacWhZpA0QcU/SPxT AitI/IeoGPIfomgk/yDxt+ERBY8KfB6LaWkhf0mD5Xo5wUP0rqpMYOEDXwf5HI8FobQqFU0I7nF4 GP5VKXhEwaOAX62oYwC3Y3F4EpExtKQFbLiK4dofskAoLeysdrKf/wdWv+/O4pAgdCx1SMiFEwbI H+5Y963t9/9aQCIA+TXU4RXX/EZAoq50Yi6qOBupqDB/aOdXkJwRzVYiVFY1KoZlZcdC2r2wFoto sahGF9PuYZnVCD1HlRxRzWaims1Elc3wWEi7F9ZiES0W1ehi2j2n7aBvLyR4TLOdGNlOrYqh7dSp GNpOp4pJ++GxiBZz2lBMs6GYZkNxsqERKua0oTjZ0EXP/gZqgXdmcQjakA4JOXCwHomTDbHH9/Uc pBQj9Boyyvg91AjeQx3ESSP4L6FKJaFZR4JKpV7FsFTsWEi7FxaxgxSTXPm9mLjHeUmuScU1qdlC UrOFpGYLSc0WksoWDlLMyTWpSp/zklxTquRTWsmnqOSHqhiWfIOKIddOFUOu1YJrSuOaIq4NgmuK uCK8jMp5pEihTJUzlkoZlTN7jZdKGeX325AGrnwbRfDR8JD4efxmfT0RxrGihFUF/9D78T6kPmVv T5zulyvdlmslWk66bRTylRMvDg/Bk2CjwgrDs4Ydi4gYp4kqmphIi8cwrxJriOI/RCvbIcS/SWFJ /kOIf5PCQv52LCJinCaqaJz+PUTz7wpVyhVaKVdQKTcrLMkf+6RjVAljb3SsIxYRMU4TVTQxR31Q QX4tY5VU3qNUTJb3QVxJBzKk6QpRCVZSbtnjn+uB7567oIQ5VpRwcJEX8q1SGq1SJYp4VY7U+F1M rUVwriLdtSpcPc1qlWa1KiXEq85Ks1orj2pVHhxXT7NGab5Gaf4gLXfT06yhNEeLNGsozdEK104T 72J9vAhnPYgYyiq1WZulzVpIF9K55C70l/s+I7RZmyVlncp5nabNuiwp60jKNsG5jqRsU7h6mvUq zXpNm/VZadZr2qzXtFmflWaD0maDps0GSHOYI80GslipzQay2NEKV9cm1nFXosWJmLMuGsrrovd2 Q+uBCxGDQvK0JlWjymmjVrs0kneniW8N9cNN1E2KukmrG5qIul1QN3lQNyuNNGue3UyePVpQNxuo EQv9YjEbI2haNEtqybKkFt6SZnb38O+IwNJLqFXlplWzpNasUm+lVqNDcG6lfkuHwtXTbFNptmmW 1JaVZhul2S7SbKM02xWunebrbC47DFXjhsA9bC/rpetr7G667mI76Noi4Feyq+iSv3PY+XRhHJ/P sHSdz2coL8JmkwxpkLdLWWka5D2PrpC4G2ZdykpxrLRLWSm2oIiZIXkjYuKoeannfurVh7KXfIIY 8eMgcAwqTz4AVCseG4eS2eAa0bTA5sNtYTHUGRfressYH+wwr5U9O8Ba3MfKc//sAOsf1+fsAGvu AVb8rAiMUwOsSNUTs+M49LLfEce6Zn/IjuNjrJMeHyCd9Liqf3/UjuPq/v3RIdoA7jD6xv9yALdc +LhzALfcrsgr5ABuedaAXFCnzcgB3GxY2ACLGGBRA9+YgW/cgJcw4CUNPFIGWJkBVm6ADTHwrSKY PohdbZClxkBba8CrM+DVG3g0GGBDDek1GtJrMuA1G/BaDHitBry2LFk+YHxg9jo2g2ETTkNpEJPX TCh9jhOF2IUKJ+bA6YFS+YDxQdUlbDpjYsDUYp8Q8AD8m0a05VRHfwKu5SptHDR10sXYMgGPwz+b LgGxZexa4neQhjUYu4YthTsfMD5gOhdaVHvAdC7rUrEQxM5TsTC0txnGuyw4aDoT0rkJ+PK7cWgz ZzI5pJqAGIcn4R+nwliK7SJJ5CDqNYSF7c8cJQUOol6IiztFLMguodqWx0IQ61axMLsU2m2eelDI FBX3YlqacXYrdOXkkGuC3SbgSfg3S6WQYp9S8oWUfCGST+oFB1kvUvJhd2yekggHWedR74nHwkA3 SaQe0uQLkXxddK+ChldvBUluc/APK/5h4i9LIkz8u1Us6OAYJv5TVQz5Txb8wxr/MPE/T/APG/hj DfZxwkX74mXPYwF2MWmdx9BmJqkY2sxkFUObmSL4R4j/xwV/HIiU9lRBQ6VO/geh3cHacqbxwk65 9B+sP6+iLvJB6KvhkOZV6prJPua4JEVc87i48jgcdLQ9BwccuedIj4trHocDipIurtFle1xC87iE 5nEJzeMSmsclNI9LiNJbKjwuoXlcQnlcQvO4hOZxSWVRSc3jkprHJTWPS5LHzVYx9LjZzB52tC0q qXlckkr0AiYHIaXHJcnj5qoUnB6XUvKlNI9LaR6XIoufo2IhLYYWP4fZA5S2fCnN41IGiy9T/Ms0 jysj/rNVzMm/TONfpvEv0/iXaR5XZuBfrjyuXPO4cvK42SqGNjNHxUJaDG1G8i/XPK5c87hyg8dh +z/LePXQVSYG1vA4adny4ZDc1eqaIXwFh9skDvYhYg6cFHlqNaXipLxaw+FDY4zdrDwOB9VWCHiA rVQeVwP6WAHXDYo7DqI56WKKLq7oUrSkiNOlSFvYW9nBrhd+ioNr05U11zI8bLRLxUIQO0/FwpCm 9NNakGEGpRMTd7H/LP20FiCrBTwJ8IyCp9iNanhuhxqem6wkwOG5buUDdSDPBOWjdSDPBNUi4MDd RNUq1gl5ouJeTEszztaoVrEOIGsFPMk2UavI4Sm2WQ3z7VDDfJOVPnCYb5KSrR5kG6+kqQfZxqv2 CQcAJ6sWsV6TrZ5k6xKlWg+yrWPr2Rb2SawNxIDgDjUgOFnpv4G4d6tY0MGvgbhPVTHkLtvDBo17 A3E/T3BvcHHHvuctathwmvJNHDacolrDoWQnk1QsRGMIMoZ2IlvDocT9FsEdX7lLGyqn3dM2sI1s K9smvAV7uTOMVz1cKTGIyNh20RJW0QDjdnVJz2jS/LIpyy/5YKLT55qVzzVrPtfs8rlmzeealc81 az7XnOVzLZrPtWg+16L5XIvmcy2az7Vk+VyL5nMtyudaNJ9rUT7XqiyrVfO5Vs3nWjWfayWfm61i 6HOyXWzVLKtV87lW8jnZLrYqn2sln5ur4NLn2pRsbZrPtWk+10ZWP0fFQloMrV62CW2abG2az7Vp Vv862NL50CTMDVwCkL1svxgmHQFp6/GL2HCQ/S72MLuDruEA4XE5bJr9JNfO3E9eHTqsQg6v8tyn NZ9PU+5nq5gz92kt92kt92kt92nN59Mun29XPt+u+Xw7+fxsFUM7naNiIS2Gdiq5t2s+3675fLvL 51Ef44zXELiwfKCnaeG+BKjzX7K/xdHYky+HaCSWNsjE/h5ukjmEBU8+Rb+hk/hiDp4RT/KREf0D z21Eh48++PSB+OuYveEmDtj2JHCMNnkS5fbecBMXlb5qrbuUsX6rAWpT07abWNBxetmHn+xtNwNi 282F5z2ghrV+CdrJlikoNgEtpUzMQ6agkOmxZqdMnyGZPuWQKSxkehpkwrL/NITeHJLVkWRNXQH2 QwsT5vLNCjLDhqXl7O8A+jDwvJp+3VKGhZQ9Lbk1FylpacZFaQ4xai4iZHo4j0zRkpZmXASzTFEh 092tuUszNoilOQTKs5JK81ig0liaMSHl8DanlO7NcOOiNAe6GW6NKMdGo87iQprePNIkSrQ1b40o QbM0CSHNznRuaZIl0k2z0E2HURq5bXGqPbc0p3fb4v0OaczbFuMrxZuhX9QC7VYQH8+jNBcswOIJ 2vg3RdsCJ2gz4BQNPCRomCFF2w0naHNjsdFxoRvz5tvod6AbCXNV5d+w2O+GyPwTZl4bMMsNmrM3 TvbakFlu2FyqDaLPpJe3+kbHEbKIwd/oOPddKFm/azLtUe6N0COMsRC9lYrDsxQk4ne9nBwM3y7I k5zcvwx8zHwHm+8YM99IiQVphAhM1u+K11BgLA2tX4LD2b6WmgYmUiIXSgK/C045YQgIIa+FLDvl hGGax2AVsvjUHv7fiHNmST2xQtUzj94SbMWx0YEucJQvGbaJZJNY2aMsA1vwKN9R3KzsIaTsIUT2 ENMznHPRMdgDlte8QuwB33ZcVEyxIlQQ+l8gzAnDPF+FLBO2X7dIewiRPRSgHvlWBp/Htjk0HlYa D0uN+10VjtkJk8aLUGDY1nxhCgxLzReynJkTKs37X21tv2iSmg9LzftVk3wfla15bDo3UZLor3ML qUgxO/h7aaEVCycMsosLtUBOGJKE/hXICcM8f4UsWrdfsW0SmsdXbAWpSb6Jc2o+95u42XAhViiw jzoHO3HS8UAWZPN9xE9a8hwTPBuE79CO/+Te6/gbsKjnQLuJ40fex73lnXD8yF3Gs/ePlx0FSZcb b63lD+9en3ivB1Cx2Sf1xpm9D729N7175/u1VjWTZ0VJrcU9tZZfmmqfeFf7xHvIJ95bPvGGW/61 JW3IaQf2bvPy7IGR4kzQ6gCe8ObF3WJV1khx+psfTWfz9V8Cj/i0m2M+8a4twL78aawOSp9rbKqy Azf3YQy7WVdn0U5jNYJ2GrvKkxb3IJwmdpHU7b0GemVLXPIcs6Q8xzxLkMtja03KI0+emKZOrfCS J/vUigUqLwvy5AUxddpR4BlS5oc8aXHdxCiHD0natxTtW3lo33LRDle6Gu6ZX0473JXfJSq/uTyl 0lrgKqNRYIeS77WB3HzlfftEFqnnlXn0vNKl55VK5pV5ZF7pknmH4rsjD98dLr47FN8defgipqle 76OHPh2+C+5Ug0dm23+14NWn6m83r21k/9Uu+GJ6cXFVlvwzlH325bDPyyHNGS77nKHssy+HfXLa bPucoeyzL4d9ctps+6yDulPSPuJJy/XwiOsUGa4H+/SZwavh0yWvkWco7+rL4V1ca/L+YObwoQH0 aXZAOdSBz5h84klPn9jnwufp8JOR8mvwJdULeClPL+Al1QuQtAdUe3gkT3t4wNUeHlV1zNE8dcxR j/bwiKveOqDawyN52sMDrvbwqGoPj+ZpD4+62sMTKi8n8uTlhKu+PKzqmyN52sPDrvrmsKpvjuRp Dw+76pvDqr45kqc9POyqb06oOv5Enjr+hKuMDiuPPZKnPTzsag9PKT2fyqPnUy49n1Iyn8oj8ymX zFWW5Ftl5eaLmNm0SxRtbr6IafL9Tsvs+0+62sMDqj3stHK3hwc82sMjrvbwDWWfnVbu9vANl32+ oeyz08rdHr7hss83lH12WrnbQ8Q01YEHDHUp19s+K1tvjyheudvPAx7t5xFVZ9jySzvvtHK3TIhp lv+oC44nvlW7TsQbqU7EG6lOxDPZ2EBPEvTq4/s5SdCr3+rnJEGvvudgnCRo1tvAThL0agv8nCTo Vb/5OUnQq44q7CTBhOov8bjXybd2z8bu7WB6pThJMM64ZJYmWZKZTxLUzzyUkvs9jS/uSl0/SbDU qesnCZZe9qdA9vypy3T1MvLqmUurkCce6vLJmOmzYPaCefzf+MR/GM4Plycoy7E9ee5yMAc/GyvX OeLV0JY67Q5/nafGf5nxU+PveWF3z75tuU6ND/iSyfske1smrHcOGE687iSZvlGys8QHLin21g57 ns39d77O5i6dLEdBlusCXrLcTrJMPE2yHLMO+Did/hXtdPpXtNPpi5VCpofnuh+FZ+HrArZ02VLI E97X06LQKROLOeF94NqaCnKO8iy5c09ryeGod514pnX7XhN7nJXG97JrtIHGB55zHC2rY6WRx6m5 BGmum4WoVdr7XdQBh80WsHt+acMWCtiXdtiw5QKWq0UohRVeDfmvYfl8tovskmkx6bPOtrF0LdTr 0Op+waOODbC6AG+h+t7f3XPf035aqDPR9h4Br5M98dLbHu9R6LbHYbrtcZhue/l7I6WwvWOQ//zt RZfWXnSVuL3A58Q68fRjbi94LTj0DOqB4AjvDPG8ZWrZ3rHQB6ZmPqyW7Vpo2bz6R+f66h/pNlGS cnY8a5UqPRnD50QcGZfSymeKwZi7EPE5d8ELL3vughde9twFLzzz3IWor3F+fe6C1FrUU2v5pcme u+CFlz13wQsve+6CF1723AUvPPPcBbO2pA0VPnfBzV2fu5Bf0/nf+3jlMHvughde9twFLzzz3IWB aMw0d8HN3f/cBZO2Bzp3wUseP3MXvOTxM3fBTOtv7oKb1v/cBS9aP3MXvGj9zF0w5dfv3AUvvn7m Lpj17G/ugllmf3MXzHz9zV0w8x2cuQtuXgOfu+BO0//cBS9aP3MXvGj9zF3w0kO+uQuDWcOb5y4M pEY2zV3w0pq8P5g5NM9d8NenOXPmLph7Af7mLpjbH39zF8x1zMDmLnjJ42fugpc8fuYumGn9zV0w tw/+5i540fqZu+BF62fugrmO9zd3wYuvn7kLZj37m7tgltnf3AUzX39zF8x8B2fugrkdGNjcBXMN 62/ughetn7kLXrSDMXfBS28DmbvgJf9gzF0w2dhA5y549fH9zF3w6rf6mbvg1fccjLkLZr0NbO6C V1vgZ+6CV/3mZ+6CVx1V2NyFmOov8bjXyJf3uN7A5y5EjXMX4sa5C6U6kFFuBrhTXTPZLY6LL1qa SuO2GzC9Qg/clHsHboZkLiP2m3FR9sAPAJWbD26G65O0+SCXMzoQOWNKznhp5UwIOec7NjvEBdMW rUDD5csXF7YKdxytcb24sJWs42i958WFLcYcR0sVC1wgJzditBeFJ4pZFJ5Qi8ITxSwKx80M7UXh SSaXpOK2jgUvCkenKWhReLK4ReHdtJfkhSie/3NSORkuCS+IzN6dUi5DTRazIDxpLwgf2LGrcg/M bSJZsSB8oMewyi007UWyKWULKVbEgnDc86CABeHdLEXLkqPod4UUKe7aWRRZmBeifzJ7H1BpCali loKnDAuSy5Suy1jBS8G7aSuOeYV7Q1lxGi8rTuNlxWm8TNN4WTFLwMsMGsddQvgScNwgtcAl4N3U Mbi0cI2XU4NUsOrKqUkqggwbpYI1Xq4t/S4vZul3uWHpN26ddZnxmk8X70XhpkTrQRSr0PPH5Q6y 69U1Q3R4cAfZIpPkG87aSdobzq7XGK3XcJApvum/qdheFt+fFntZfH/akvWy9A1uuZzRgcgZU3LG SyeneUPdNbS5J5ok31C3wL4g33e3wL4g3563wL4g38W3wL4g3+x3DW08yhPBjUcL7AvyPYE5eZKT +5XBvXXwGkqIbx1cYD+Q7zBcQD+Qb0JcxOZAfL/iIjZB4VsbF7E5UJ0oqKhQT6xQ9cyjzZKXlGpz INxr+RqRbJJ9ohSbA8mtmpeqrZq5LfCtmgvsB/IdnQuwBb7pcxFFyveHLmJfG76VdBEbA9VrtsB3 nS6oN8g3pz6fzaJt/u3Nqbm+G6S+C9kWiO9hXYT6Gmy9F6a+Bqn3QrcFarD1Xti2QA2a3huk3v33 Cfm23Lrecf+/tZQg35a7wE2B+O7dRWwKNFQ2TIVuCjRUNk6Fbgo0VDZQhW4KxHcaXyv0zncaL6id 4xuS97CPs+vYcuZvQ3LcEAj3alw30A2BSjcgyPdEX6cu2ZlqGkhPsymrp4kJNg+kF9msepHNpe1F Nrt6kc0D6UU2q15kc2l7kaYt4u1eZEsxvciWYnqRLcX0IluK6UW2ZPUiW4rpRbaoXmRLMb1IfTN8 3pK1FtOLbC20F9laXC+yW+zAX/DTPN+qv+DRxFat9WotpgfZavcgBz6a2Kp6kK2yBznQ0UR58MBS dfAAt4O2YnqQbYX1ILvFEQYFD5fwsw6KIAvzAixslKVNs4K2YvqObVofBg9ZeGAkHrLwGFtobbcq AlutW+Eawb5B8VRgg7UVrhHsMaicF1hbALLF2gnXcPYexWOBUhyywEs6XXjftZvxsxgK9sN0ceWd Lq6808WVd1or73Qxfda0q8/arvqs7YX3WbvF6RMF65sfU1Gw4vh5FkWQYUNYsL7btb5qezF91XZX X9XPQRo9QTxIYwv403/WgzS+VXWZmhtwphykkap2ynSmHqTxcHVuzX0YB2mMqckt04dxkMananKX 5plxkMbj9U4pP+yDNH7Rllua03uQxpR0bmkG/yCN/w+xBGCHAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAACeAAB4nO1dC5QU1Zm+93ZPT88DZpgZZoaBGZppUFAGe2aAGXykx1c2 GiTAGMwecMEHRnwBE0xiYpIBJAEbBeURjscTjcdNYUxWY8DHGhE20WXNxmjWnDYxJhJxN8e8zBZJ jAFm///eqttV96/qqR4Tj8lafW533//+3339//9V1a07Pc99f8wrX/5GyyFmHO9jMXZ8qIIlPDLu JHnUMiac/PGhoSFXPPTe8Td1HIM0xbHhBfBZBgltXg4pCakCUiWkKkjVkEZBGg2pRrkAGwOpDlI9 pAZIYyE1QmqC1AxpHKQWSOMhTYDUCqkN0kRIKUiTILVDSkOa7PQD04nwfSqkaZBOgnQypOmQOiDN gHQKpAykTkhdkLohzYQ0C9JsSD2QeiHNgXQqpNMgnQ7pDOnbjGUh9UE6E9JZkM6GdA6kcyG9H9I/ QPoApPMgnQ/pg5Dmevr393IsZCvhtQZscS67Dj4H2A0mFRQ9GsFj3LqQD1JJIeX7VfH7vbpbH/jX yw+d8TSPYSamZJx9iF3DlpfUpveoZIJ7xxMV18Dc9s+G8V/LVkE/LmVXldx+HbSPHBhnivuiYFB/ hfP9Imh9gF0NbaMdrh5R+6WOH/t6ap/6ftyxG36i3I1/zJvx//fk9+8d6uDqNO47dl3aHtn/OHhF rFL5vhn7yPUXrLhsYOXHVl6xJnXuJy9bfk1q/Za1i9fPW78I3j8qHe2sFVdc0StPKVJhRv+Vy5ev mdHLjsx5aHWE9o+Dx5dxMgQZY69suOt///ShK2vvvy3JTj7xmz/C88W9TJ3bsLyPqVhAnkdfX8LU uewaps51NzF1vtvK1PntTqYm696YOodhTNw+sO2ytX1f7N/0GyXDuq+8ZM3KgRWsH/O1dA5ku4Mf /cOhr85+muN39vn4V550ebHEo9j4xQ+/98M7Z4yv3fZFGP/0P/0Ljv9NpmIay+fj9yT0MFHGjk/4 XvkB6EwCCg7BKB+MH5Bj/bmcl1VoKjWs1DtznCX7cIkc2X7o0xk8AX0WcNq4E95Hs5+CxdBGKRjC ONnTOvleL98fkLhvyfczoKQDXl+dyltPd+bmI6JP6t0i39vl+2h45+wRifmxlHRC7T+Bz6HPbZWX vYMsyTuGuodSLDO0J/NI5tuZBzLvRp1PFnRi4fXEYf5QhxfVmTysDvpTeFtt8WY4p0D0tC9pT09P pzOnwZclHfJrW7wV/KrZU7Z44fLLL/YqtEFAjSsozMh48ZBri6fBEdr8GkYtUq0HriLhOnFpCuQn paR8aeo0J+soFgTtHe0y07c01RafAReh0xDqxflBBiILl6qn+huDTpD2fDKoIJstVDEbrng7PY26 ugRMkC1w7Q1X4Usmq+5NO23JVOf7kmlt8Ykw3y3eUjlZPpUUzPh4rYLteOqALOpMgUpSho6/Jqn4 inOd9XvwicKxP4Vy7sqPRJOLEuXs/6Gcy3sqv7wM4lPqv+mX45nqCF4vHjH1TwjUL4P7sWB5IkSe DJQnQ9rV/U/55epsBeflT7a3b4pvirN40iNvLyLHtyB5qn0wuB6xKQ45KsdaAuRON2n9bDBQv31w U3wwqJ+DjAXJU4ODgfrtyeB+ppKDgXKRrGCBcvk9QD5YEdif9lRI/1Mh/U/5+x9T8hvNeXblGMpB 8pQYDNQ350HXkwypJ2B+WnBcG6GelF9e58j7QuT74wH1gH1ZiH5g/WH6U0PqD/DPuhD/rCP+puOr LyTulhXk20Sc1Q6WDeHnmMGk/KwbTMjP+sGY/GwYLJefYwfj8hO8WH42DlYMLZNXURvgmmoDXjgD Q8jL+k6U7JrqkXShJDfNI+neDFcdC+B1gCchQbdWcHaUfTl5O1OrP4KV4QLTjE9NWYjDTMglHxgl eyTzWuZHme9kHIW3Ltp5nV/h65lHQcXOxFkZLiWxedPXPXX9z67kQGyohOFQwe6Fy5bnQem/Mv+T +UrmICQmG41DwncJFUsGdzx1/aU7/dDHAfZzDb0XvnmhZawMF67u3PnNxWWDTyzvuJnDJYkCV8Lr EQn6GsAeybwK6XEYCcJjQNSxQsvzP9N7Je30N6DT98PVVtFO77vxn26g0Mdli0XGi+a6YeCOxUuv OjbI4XpQQcvhdRBafBrgX888S2EnOTDsMIdTioIl4eXC3E6HALG7wUC3y16gY/THVq1a7jf606D4 GHTPGcldi1/ffMFt133OP5JHoSuPwIR/H2o+YHboBMhWfeITuReu/sLHkEgULAGv+6HuPZkfZF53 bCWkpfQopl506c7XlmOHvKN4GNpA3/gutPkYnTds7fjipqHX5lXO87f2pAQ+Ku2kgla4joUrqz0s w8ocWLOEcTkBBUhMKeMyayebw15b/tq8DQsw9FUbUMS+C8O/N/MMJCZvh4QX1A0tlAzqArURgHpL A6lZ68QORpo3X1udI5mK7pF1sLv0Dnaz2SOZwZkj6+Cs0jqInjezFM+bXaoTuR3rLa1jCjZmqDli JPlgXSNxJDV7J3108Dr/yBD2s8xPHcLygFr03ClQozN3MXi5AF/92K2o9VewMlx7mjSEZFIJPj4D 2moZGjPE4b5f0SMeBzOVSrF9SMVPJasbQrU3P96/1K/63QyYFVU7THm1qiI9pDy8ErxvBhg6rBqn xclDasYqWX1oi07NU4aUB1RC7cVqDu7gw26LJwypOaxkDSEtPpyJKdUbBqYsNOfKV1hHCodg2En2 UKVaPFwEbw/C5csboxg7Pwbn/RrG/gBXSeeMYexLCTgRwRXan8rV4rpahKv1LcKNklFQDe+Xsxr5 fYy81a2FNo7e97sfXHDp/OxSKT9Jyk+W7+ukZFDeZKljCl6asdF8LZQciLuP6NZL7Zvk+wXsszF8 8DWf9bMPsXngW3Phe4c8oeDrbBbl4HEW+wm7W8TuQh+sYHdUzUxeDt/K+XSOfZoul6zOBCdMScrN yIUq/D4HWkqxa+E10oMPU363XB/Ftzboh+rJdM7ZzOQdVeqdwSxfDr1G4vLWVs4qdZb3YWxNl+PB I+5rQxh5Lh+lePN4G3Kyrh2vUnDR3H2I/t5ROHB1QN2YdJWMPWfu3HmXXLu8u+uMc+d/sHNOz5ln zwBRoZwulUc7eMA3fGC8bIT1eY8vw2mmgmG0cKZ8jDkx/krW/eTsw/IC8jOSXeBuq7JGXv1hnoP8 bk8er+vvrmySeSZGS331SAfZJilqne+taii8JoUyLmWjXZnUEwGyWIAsHlBfWYAsESArD5AlA2QV AbLKAFlVgKw6QDYqQDY6QFYTIKsNkI0JkNUFyOoDZA0BsrEBssYAWVOArDlANi5A1hIgGx8gmxAg aw2QtQXIJhqyY9JqansIYyrHoXdc5wRTj3RULga9jOlcHMriOlcGuTKdS0AuoXPlgCvXuSSUJXWu AkZZ4eSw3V65AUXlOIwWdZ4A62E0nszY3F190+U7cLhIyLPEBPZZUSlZ/mS8qe9T8gTIn4CRwXmP KYQq7WDsxu19FRKNI5sj28LzYqv0V5UTkButczGYTcwpTBzKlLzM0VLyhJaXO/oql/TVVQFWcDEx 3X5Mtl/taMVk+zU6h+3XaIzbfky2X5AntLzc0Ve5pK8ubN/FyO0HUh6XC0+jHC28BU7JyFK5GJsk Y0phcKVMycvgW52WJ7S8HPTrNToJ8kKuAvjPzaG/dMrNRirHwfbK3rMhJ3B70Qvb+k6R7zPc98m3 4/vh2wtykGSkRFkV/a5L1pjwWTUhZ7VB53BWC7m4r6zMl0v4cuU+XNJXhrPb4MxIue5Huc+65T7r lmvrqlzcV1bmyyV8uXIfLukr81oZY61bypM+KyellcfqHFq5UefQylN0zrW0yiV8Oa+1kz5rJ33W rpDWPkHnCtZug5y0du1taFV4V9+BCXbf0lfG9kn9BOjhU0iM9go5XizFEVbI8eK3Sj3nlT7bV8o5 b9I5nPNCLu4rK3Ny+2TObVWVJZ0y1ZbbapVutcpn6Sqfpat8lq7yWbpKW3qfzHlbrdK2VW25rVZr u1b77Fot7TpO59CuzTqHrU7ROWy13mm12tdqtWy12Wm1WraK8lHSiic6NYzSVkSr4J0S2Ow5ZZVR crzIwaOg1SlSDu8P5tCubFNfgimtcqlVB9+SiIZyYITem51oHq3ndrTPoqPl3LY4/Rst21LyOPhY i9Yq8+USPky5xiQducrhWF2tGt1+jc+2NbL98VrLbb9Gtj9ea5X5cgkfplxjvNFb44veWm3lWp+V a6WVJ2gtt328AjxRWxiv/by5hBPVClOuMUlPtNfKqHVzY6S9p+qca+99MBN4H9wmX3FpwTFytGz3 F/ogNvs+DxZWWuVSZyJTFq3TM1qnLYp6dZ7aVCnW1uq0XCfnrk3r+uus13XWayuhXr1RZ73PHvXa HkrXX2eDnvkGPfOo12DUqR7UTnPqbJB1TtO6hTqxFNl2ptxGq3LYV3c2xxqzORbqBSt84PMYL1tv cmZzrNHLRj3yRt9sNhq9bJS9nOi03Ch7OVHr+uts0nU2+WazyaizyTebTb7ZbDLqbNaz2eybzWao c5Knzmbpse5sNkuPnaZ1/bOJHDdLbkhWOS8XjVNc9Obavn1ghXEyPgovt1cteqQtPnZpkdGdku02 yKveIPR4jR7v44bxEj3JQY8PQU/QMzLBF9kTZGRPc9ATAtCohXExW27EVjmvJ7UantQKcwpzkVnb p94TjpbfQm16NG0+T2ozrN4mzxrtTstt0urtWtdf50Rd50SfJ0006pwo65zk1DlR1jlJ6xbqzMOd fhdQ4zViM1vFBuVrEdsoX5ezj8uXK1/ILpQv9/Ms9j75wjzeDaF1zTukScx/R41jQL0e2a8Uwyd2 ruemYAzT5CvulOLGDNdzcV14qvbcFIwBNU+CMewDf8J2TiOv0+UIk+wOhqsuF7L3iTr2sPy7jz5W OO6G9urBo/GMEWtVPXWc9TUYZFLeFOFR5iw+VjgLFaOYWm4Y4yzpjHVu/MZJV2ROHYz9Vl7yzmLv hiXRL0vXGs3VgkxcYs0FGeYsyLgLLIWFITmBzJxAOXF+xXfzkNk7MeS/XE3upXFaXxpPZ3HRIy+N J+GNZolPcMUp8jp6Et4fRnuyqiAxqL5ESLz0VspKgbjX9u3wKncqSJZSgXsDkNY3AB1QzWnyBmAK zu0IHnSDadCrp2AvSntWqaAxaAqgpT0bjYsWeS8yCZ2IPMVSFTtTW9oTaPdGxp3iHnkjM6n0Hrp3 PWmopENy/lS8p4zyqCwu0vLGaBpWE74Pwr1jmua7Y2rXd0wzpPwUeUeEf2TlvWNq13dM02T5ycYd E4bcHHnHJEOu5L0WEuwEXanPot37sXanmji6dunVKHAZ3HyMGJwYGdi9OXQHkBzZPCgwetAI+1Cj ubNm5NxZ45ox2t4A92a23QE7xosGVhDHZKVAEqVA3Htnt4slMaiCOEaJTrq1mmpr3x7V1rpUW9ru C/cev10yJ97jd4UwZ4u85+8uUpoIKXXXBNw2ktDR8Foq4C4tuLRTrhlMxZNS1N0CyJhjhmdMd82h Xb4Kaw6dcs2h01hzQJ20Z81BcWLdSDnRXaJwG1eVefiplG0xCqz5qbTNMe4CiHeA9Zor6kfGFe5q SWF4p8jVkhJjub60WHbXXbxDadCx1jDyWHMXagrDaZELNZ0BTvtwRpUmQkrdhRy3k3hBoBZy4IIg yk4WdO+x0izDuvdYw71xEegUuQh0irEI5J2yRu3ejW/HvRsN924suHdp+7AUODEysLsi5R1gk3bv ppG7d5Ph3k2lu3dT6e7dZAylWbt389tzb1w5O8Hj3s0hvK/cuzmE95V7N/vce6KzshZjPHj3FTr0 uGhXuOPUFa5nHa7d80p71uGUA7eM/Jq1Ry7bea7Vou7Qc9f4gno2Xnve+JFehHXIBUHPRVjxTYbu mmFQbyZo55nwdq5DWuQiY9DpHd1BLTqazaNbqEVHxy3ovjt0i9ZoPNdq8BwuUU6Ti5PTjCVK7/Db tJu0vR2ea/MRQY9c0ZxUoKqobqOgiZFA3bVS7+Amak+bOHKOm+gbWodcWI3seQqQKMVV1fKsOwxc nn15Ci7PLhTfYU/wHH+S/4KdIl7mcfE028qX8Kv519h/gHwGv50dYt9l/8xudT5XsTvg++fYIHs5 cHm2sBSL7o9Lsb0j505cu50jX4o7ce22N5Q70Z7Bpe7aLtZ0qpyABHtMloWv3cacJ7+eVTQYV4Va ux1ubXa4td1380Imjui9tdu/xtrte8ff/iGc39+Zzwbg/WPOlu/oR7M8D6jfjcHtzFEwuBnnHGdL bhnrZ9fLzd+XyN8eOo9dx66Qv4mDkjVsBXy/rkhdU53fv0mU0D729wXmtn8OtHCZ7MNy+QtIpfWn F8bv/T2VKO3jFq2pf8E936W2b2JxPpA0uJN3t0j/+CLGdvWBj8xVW/pZjJ+AGynVuQEtXiHcb1xg 4/gtzkc5MiE3yuO3arFaLIxhO22ypRO5arWQQ60qWZuS++tU7fiRQRo4s41xbOuvrY9Ei7mjej85 ouFM7eDceTFnA7ejtSYmsTeY2yrO5p/F7xzLyV/SGISUWXfNuoHUupXr+9cvWn/p+nns0Xt/+4kD kFKZ333i6lFXzFDtcad3bj8LPVa/S4Wtd1XGoBXUv/XXO57B9d0aT8kqWXLzb7YMuiX1TsnD8iS0 8fXtz+y4ZNsWt9TUquKotfX1na/tuGRTn6nV6Gj9I8dzxpZDNy+49Qe3fnrry6aet8a9ssbNuZuv KtZupZDtPrp1aTGtpVJr24Hbf5Hr274kTGuP1sJWw7QqYq4Wtmpq+eNBWUTNcaMzx9uWbt3uRWDJ t9V21OmzZs2SmyGT8uWWNvNipf/mlM6c2RNQeo0ohj0gimEbY6q0u7PTUxo0QjU3U4EbcW5u3X/r k9s/dfv1wTM4FS5SUeu2Z9ct2nhwy6tqYz3VGs2jaD0aSetSEUXrkUha1bFiWuGzc6ozOzc/tflX 2w9/8SvBs3OqE289mbXbsH7XHqaWirfhtPZG0lLRMZzWnkhaKjrCtMJnZ64zO7e8vKlv21v+CCnU P9eZnc45297aeHDbK8G9mOvMTnemuJaana5ZxbXU7HT1FtfaE0lLzU6YVjh3LA3ljqWaO7pmzyEx vFRzR3DptUVLXWbpnN0ZUNrkcEdXJgjr8k5wzS7vBNfs8o6/5nDfGYjEOwOO79z2bGfGjVyvBVyt Kh5Fa1kkrb2RtCpFFK2lkbT2RNKqiBXTCp/pDZE4bEMkDtsQicM2ODM9nFYUptvgzPRwWlH4cEMk PtwwYj7cFYkPdzkz3dVZjHd2uXzYHaxV4Wh9Sl4rdtQkNS4KQ+5yZnU4rSg8uisSj+4aMY/eH8qj 92sezczpIpx0v+bR4NJrA0urndJ/l7/pOGfmnDl++dPCLw/3hn2RGG5fgeG6w6N/X4Hhimoti6S1 N5KWZqVArfBxPx+Jb56PxDfPR+Kb5yPxzfOR+Ob5YTgifNyHI0X/YTf6ZxaLlsNu9M8uFv2HSfQf dqO/aCwedsYYVnt4LP4xIBarnZKD6s8TZ83c7o2YP7IBHixXEdbbO9uQT5AR1pvJGHIVeVR/vFyd 6O2es324iKzkUSKykuuInBUeH5Vcx1pRrb2RtPTVRFGtPZG09HVCoFb47LTyKHHb6szOzKJR1OrM znBaeyNpqdkZTivKub2Vj/TcnuFRojvjzM7skLuYCkerELeu5PtEMlmYkmeJJB1zJeExezYPi9mz uYrBnlk9vpg6m6sY7OnsGjamFkWKqUWFOOgN8spGRyspKqXWuvnrLvLeqUe7W18RyYNXRPK6FcN4 XXgvbhzGUyocLdPiN3osHm7NLaHW3OJas7PbZ80tjjVnz+od1pr3RLLmPdqaXUXuWO7RrBasFd6L vZHsuDeSHfeO2I4HI9nxILHjwUh2fCnUji9xdSad1TNrWHv9JpK9fuM5o+28Z+eXoluCiyiW4KJw TsD6o89xg4gyxw3iOTb8jJ4owmb0RKEiY9Ys/zXFiUJFRkFeZCVQRJnpU0UhMoJm2tUqREZp9rgg kj0uEIXICLKHq1WIjNKstiyS1ZYJMzKWieKR4T4XMT/dpzXqIZmSCufpSx1Tj9vV0xcuhOi/4WNr ll/LGD5pwTPHJHazfGKHz8dOf6newccCnmYV2jSfjKn+qWdIi1m/3Ghq9tJ8ZoSN1io/c37cZN0y XIGucmYJz2nyT5sr58jtdHAvOmPm2vevm6/vRpVO2Kz4P8XbHpcF47q4pHENsLFqXJfgqlS1My7s uTqf3wSRiSNYtwCHddvN23aqn3Pxn8/fqfHZML77ShrfPrmPCfp/Kd4FV3nG1yzLnwO/lj/lMGO2 O0DDdu/0GLO8n/2+pDFWcseGl+HZwTtGZcMJ3LHhwneDDXMwvjMD6g8f3yLu2PByvPakNrySKxt2 v2tsmIcx3lLSGO9xx7gczygVxIZ7XBv2R7fh2x9HWvSzHxXt9x95k+z3tgM7nlk33+1HgfPefh9W Qh+miGJ9OFt4+rDA2wf/7oWR9wZr8O8++EvW5+bw/Lh//37d27j8fIO748AyVZP7zdzfgP7wlrMn AnW87TfoM3W9wJOwV7cwQ2WePRLy/xMxRmq5UNdyYSjqQoK6T6PuC0XdR1DHNep4KOo4QfVzF9XP w1BuSQG1W6N2h6J2E9QxjToWijpGUAuFi1oowlBuSQFlaZQVirII6qhGHQ1FHRVBV2iJwP0tBaxg C2KI9/trItBfzV4tiLm9WhAL69WC2Eh7hX/y5fXwwrVpuU8zyRar3VVaUgGSaiJpJpLJRJIhktOJ 5AOk9Q8TnWVEcg2RfJJIbiKSrURyp09SDpKvEp09RLKfSP6TSF4kksNE8oZPwkFy1CdJgGSIoJLc lDQQSYpIphNJL5Gc45MIkMz3ScpAciFBLSGSK4lkDZEMEslmItnlk8RAcq9PEgfJfQT1IJF8i0gO EskLRPIKkfyKtP4m6eFxgooLU1JLJBOIZCqRzCSSPmFaZ64wLdhPUB8hksuJZBWR3EgkG4lku0+C 3nu3T4IevpugvkYkjxLJd4jkOSL5CZH8wifB6D5CdFiMcB2RNBPJZCLJEMnpPgky2wcMiUWY1iJM axGmtQjTWoRpLcK0FmFaizCtRZjWIkxrEaa1CNNahGktwrQWYVqLMK1FmNYiTGsRprUI01qEaS3C tBZhWoswrUWY1iJMaxGmtQjTWoRpLcK0FmFaizCtRZjWIkxrEaa1CNNahGktwrQWYVqLMK1FmNYi TGsRprUI01qEaS3CtBZhWoswrUWY1iJMaxGmtQjTWoRpLR/T7pY+tUCYNjW51yLcaxHutQj3WoR7 LcK9FuFei3CvRbjXItxrEe61CPdahHstwr0W4V6LcK9FuNci3GsR7rUI91qEey3CvRbhXptwr024 1ybcaxPutQn32oR7bcK9NuFem3CvTbjXJtxrE+61CffahHttwr024V6bcK9NuNcm3GsT7rUJ99qE e23CvTbhXptwr0241ybcaxPutQn32oR7bcK9NuFem3CvTbjXJtxrE+61CffahHttwr024V6bcK9N uNcm3GsT7rUJ99qEe23CvTbhXptwr0241ybcaxPutQn32sZVLnqUyWw2YTabMJtNmM0mzGYTZrMJ s9mE2WzCbDZhNpswm02YzSbMZhNmswmzZbnJbFluMluWm8yW5SazZbnJbFluMluWm8yW5SazZbnJ bFluMluWm8yW5SazZbnJbFluMluWm8yW5SazZbnJbFluMluWm8yW5SazZbnJbFnuZbY+jrJjRLLQ YJssN9kmy022yXKTbbLcZJssN9kmy022yXKTbbLcZJssN9kmy022yXKTbbLcZJssN9kmy022yXKT bbLcZJssN9kmy022yXKTbbLcZJssN9kmy022yXKTbbLcyzbKgl8Rpt1N/slyk3+y3OSfLDf5J8tN /slyk3+y3OSfLD9CevhngjIZCTiBSExGAk4gEpORgBMI/5iMlCOMlCOMlCOMlCOMlCOMlCOMlCOM lCOMlCOMlCOMlCOMlCOMlCOMlDMYKQ4SM5pyJJpyJJpyJJpyJJpyJJpyJJpyJJpyJJpyJJpyJJpy JJpyJJpyJJpyJJpy3H/uTrI88Y088Y088Y088Y088Y088Y088Y088Y088Y088Y088Y088Y088Y08 OVvlydkqT85WeXK2ypOzVZ6crfLkbJUnZ6u872z1ouQNy/CfPPHePPHePPHePPHePPHePPHePPHe vM97VQ+PGv6cJ/6cJ/6cJ/6cJ/6cJ/6cJ/6cJ/6c9/nzfzO8m1hgeHhamB6eFqaHp4Xp4Wlhenha mB6eFqaHp4Xp4WlhenhamB6eFqaHp4Xp4WlhenhamB6eFqaHp4Xp4WlhenhamB6eFqaHp4Xp4Wlh enhamB6eFl4PnweyPD/m04mDjunhaWF6eFqYHp4WpoenhenhaWF6eFqYHp4WJj+nhenPaWH6c1qY /pwWpj+nhenPaWH6c1qY/pwWXn8eEOrXJAqSVQLntZ+Zkt3GPKeFl0mU5CiR+CNlQWylL1JUzfNj pT9LXS3c5/oDggU85cT9CquF+Rx/tbhQoy4MRZnP8VeL+zTqvlCU+Rx/tTiuUcdDUeZz/NXCfY4/ INyn9RRlPsdfLXZr1O5QlPkcf7U4plHHQlHmc/zVwn2OPyDcp/UUZT7HXy0sjbJCUeZz/NXiqEYd DUUdJSj3OfuAcJ+zU5Rb4tmf4KAY6w9BoY4fVa9R9aGoeoKaolFTQlFTCKpHo3pCUT0EdZ5GnReK Oo+glmjUklDUEoJaqVErQ1ErCWqdRq0LRa0jqB0atSMUtYOgdmvU7lDUboJ6XKMeD0U9TlDPatSz oahnCeqQRh0KRR0iqCMadSQUdYSgyrmLKudhKNTxo1o0qiUU1UJQHRrVEYrqIKg+jeoLRfURVL9G 9Yei+gnqCo26IhR1BUHdoFE3hKJuIKjNGrU5FLWZoO7SqLtCUXcR1EMa9VAo6iGCekqjngpFPUVQ L2rUi6GoFwnqlxr1y1DULwnquEYdD0UdJ6gxwkWNEWEo1PGjJmvU5FDUZILq0aieUFQPQZ2vUeeH os4nqIs16uJQ1MUEtUqjVoWiUCfol6cSeneium4rH2ZnqH8fp7q+oztMXVzQMe/MeeeFFL13/I0c uE/5I5Dwp64HIeEu9o1M7WveytRf+exi6m8r72bqV8N2M/U3Uc8z9e+0740x+Ru5+Du9a1fc+tza q7a9tfPTG1+9dc2m367t2/HS5gc2vvrFb296iYEUfenXo9Vueea0F/TZVqt+CQ49sv/K5cvXdBa+ dhW+drPqWvc/u6vOrd+ydvH6eesXwftHZQ1h3vvegcf/Aa3SNtMAAAACAAAAAABhbAAIAAAAAOQB AABwAQAABAAAACAAAAAQAAAAAAAAAAAAAACQAQAAAAAAgAMCATFIAEcAdVLxgtKJev+e/3z/b/94 /1UAQgAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAASABHAHVS8YLSiXr/ nv98/2//eP9VAEIAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA= ------=_NextPart_01C6446A.D3A536C0 Content-Location: file:///C:/19743011/060309_kaitei_1.files/filelist.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C6446A.D3A536C0--