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["（別記様式第1号）"]
["　熊本栄養ケア･ステーション登録書"]
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["※該当する箇所に記入または○を付けてください。"]
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[null,null,null,null,null,null,5,"NST専門療法士",null,null,null,null,null,null,null,null,null,null,null,null,6,"病態栄養認定管理栄養士",null,null,null,null,null,null,null,null,null,null,null,7,"NR・ｻﾌﾟﾘﾒﾝﾄｱﾄﾞﾊﾞｲｻﾞｰ"]
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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,"実習",null,null,null,null,"審査"]
[null,null,null,null,null,null,5,"講演・講座等の講師"]
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[null,null,null,null,null,null,10,"栄養価計算"]
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[null,null,null,null,null,null,"管理栄養士登録証又は免許証番号",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"第",null,null,null,null,null,null,null,null,null,null,null,null,null,"号"]
["※修了証番号",null,null,null,null,null,"特定保健指導実践者育成研修修了証番号"]
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[null,null,null,null,null,null,"重症化予防のための栄養食事指導ｽｷﾙｱｯﾌﾟ研修修了証番号"]
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["※修了証明書番号",null,null,null,null,null,"生涯学習修了証明書番号"]
[null,null,null,null,null,null,"　ホワイト　",null,null,null,"・","ブロンズ",null,null,null,"・","シルバー",null,null,null,"・","ゴールド",null,null,null,null,null,"第",null,null,null,null,null,null,null,null,null,null,null,null,null,"号"]
["備考"]
[]
[]
["※確認のため各市町村から送付された個人番号\n（マイナンバー）通知カード及び各証書のコピー\n（A4サイズ）を添付して下さい。",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,"※　事務局記入欄"]
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