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[null,"保険適用希望書　【E１区分】　の入力が終わりましたら、下記のボタンを押下し、入力項目に不備がないかチェックをお願いします。"]
[null,"チェック結果がNGの場合は、対象の入力項目の値を再度ご確認ください。"]
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[null,null,null,null,"チェック結果"]
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[null,null,"No","シート名","セル名","項目名",null,"メッセージ"]

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["測定項目","F4","○",null,null,"形状、構造及び原理","-","○","定義","A8","○"]
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["薬事承認（認証）番号","F17","○","○"]
["承認（認証）年月日","F19","○"]
["保険区分","F20","○"]
["使用成績を踏まえた再評価希望の有無","G23","○"]
["担当者名","I25","○"]
["電話番号","P25","○"]
["E-mail","P26","○"]
["備考","F27"]
["提出年","C34","○"]
["提出月","E34","○"]
["提出日","G34","○"]
["住所（上段）","B36","○"]
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["別紙１",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"整理番号"]
["体外診断用医薬品保険適用希望書"]
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["測定項目"]
[]
[]
["販売名"]
[]
[]
["測定目的"]
[]
[]
["測定方法"]
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["薬事承認\n（認証）番号及び"]
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["承認（認証）年月日"]
["保険区分",null,null,null,null,"E1（既存項目）"]
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["使用成績を踏まえた\n再評価希望の有無"]
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["担当者連絡先",null,null,null,null,"担当者名：",null,null,null,null,null,null,"電話番号："]
[null,null,null,null,null,null,null,null,null,null,null,null,"E-mail："]
["備考"]
[]
[]
[]
[]
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["上記により、体外診断用医薬品の保険適用を希望します。"]
[null,"令和",null,"年",null,"月",null,"日"]
["住所（法人にあっては、主たる事務所の所在地）"," 住所（法人にあっては、主たる事務所の所在地）"]
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[]
["氏名（法人にあっては、名称及び代表者の氏名）"," 氏名（法人にあっては、名称及び代表者の氏名）"]
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[]
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["厚生労働大臣",null,null,null,null,null,null,null,"殿"]