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[null,"（別記様式第６号）"]
[null,"熊本栄養ケア・ステーション業務依頼書"]
[]
[null,"公益社団法人 熊本県栄養士会 会長 様"]
[null,"送信先 : FAX   096-368-4619"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"依頼者名"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住    所",null,null,null,null,"〒"]
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[null,"下記により管理栄養士・栄養士に業務を依頼いたします。"]
[]
[null,"依頼事業名"]
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[null,null,null,null,null,null,3,"訪問栄養指導（診療・介護報酬）"]
[null,null,null,null,null,null,4,"調理指導",null,null,null,null,null,null,"実習",null,null,null,null,"審査",null,null,"「テーマ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"」"]
[null,null,null,null,null,null,5,"講演・講座等の講師",null,null,null,null,null,null,null,null,null,"「テーマ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"」"]
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[null,null,null,null,null,null,8,"介護支援 ",null,null,null,null,null,"高齢者",null,null,null,null,null,"介護者",null,null,null,null,null,"その他（",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,null,null,null,null,null,9,"献立作成・メニュー開発"]
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[null,"予定人数",null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
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[null,"実施場所"]
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[null,"交通手段",null,null,null,null,"自家用車",null,null,null,null,null,null,"可",null,null,null,null,"不可（駐車場無）"]
[null,"上記事業の趣旨や講師の\n希望等（ある場合）"]
[]
[]
[null,"栄養士会\n\n記入欄",null,null,null,null,null,null,null,null,null,null,"受託日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当者指名"]
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[null,null,null,null,null,null,"実施担当代表者",null,null,null,null,null,null,null,null,null,"年",null,null,null,"月",null,null,null,"日"]
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