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[null,"　公益財団法人 長野県健康づくり事業団",{"$nulls":18},"⇒　ＦＡＸ　０２６－２８６－６４１３"]
[null,"　　　　　　　　　　　　長野健康センター",{"$nulls":12},"宛"]
[]
["2024年度 長野健康センター健診申込書"]
[]
[{"$nulls":21},"申込日：2024年 　　月　 　日"]
["事業所（団体）名",{"$nulls":22},"加入健保"]
[]
["住         所",{"$nulls":5},"〒"]
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["ご 担 当 者",{"$nulls":5},"部署",{"$nulls":13},"氏名"]
[]
["ご 連 絡 先",{"$nulls":5},"TEL",{"$nulls":13},"FAX"]
[]
["Ｅ-ｍａｉｌ",{"$nulls":22},"事業所コード\n(記入不要)"]
[]
[]
[]
["健診コース",null,null,null,"日帰りドック",{"$nulls":5},"メンズドック",{"$nulls":5},"レディースドック",{"$nulls":5},"生活習慣病\n予防健診",{"$nulls":5},"定期健診"]
[]
[{"$nulls":4},"① 40歳以上",{"$nulls":17},"① 通常健診日"]
[{"$nulls":4},"② 39歳以下",{"$nulls":17},"② 女性健診日"]
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[]
["受診のお知らせ\nメール",{"$nulls":5},"※受診予定日の約1週間前に、ご本人の携帯番号にショートメールをお送りします。"]
[{"$nulls":6},"　□送信を希望する　　□送信を希望しない　　□申し出た方には送信しない"]
[]
[]
["【 連絡欄 】（ご要望等がありましたらご記入ください）　　例：土曜健診・早朝健診を希望"]
[]
[]
[]
[]
[]
[]
[null,"【 お願い 】"]
[null,"※1","１日当たりの受診者数は、「ドック」「生活習慣病予防健診」「定期健診（午前）」は各３名、"]
[null,null,"午後の定期健診は５名を原則上限としています。"]
[null,"※2","女性検診の項目については、必ず別紙「女性検診項目別申込書」に詳細の人数をご記入ください。"]
[null,"※3","受診希望月につきましては、調整をさせていただく場合がありますのでご了承ください。"]
[null,"※4","特殊健康診断につきましては、ご相談ください。"]
[]
[]
[{"$nulls":19},"担当：長野健康センター　健診・診療課　佐藤　由美"]
[{"$nulls":19},"TEL（026）286-6409　FAX（026）286-6413　"]
[{"$nulls":19},"E-mail：yumi.satoh@kenkou-nagano.or.jp"]

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[]
[null,"( 別　紙 )"]
[]
[]
["2024年度 女性検診項目別申込書"]
[]
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[]
["※1"," マンモグラフィ（乳房Ｘ線検査）は、４０歳以上の方が対象になります。"]
["※2"," マンモグラフィ・乳腺超音波検査は、どちらか一つのご予約になります。　両方は実施できません。"]
["※3"," 子宮検診（頸部）に併せてＨＰＶ検査をご希望の方は、備考欄にご記入下さい。"]
["※4","  子宮検診（頸部）のみを追加、または子宮検診（頸部）と乳腺超音波検診両方を追加される場合は、"]
[null,"女性の日の受診となります。"]
["※5"," 乳腺超音波検診のみを追加される場合は、女性の日以外の月曜日または水曜日での受診となります。"]
["※6"," マンモグラフィ検診のみ追加される場合は、女性の日以外の通常日での受診となります。"]