{"id":1225,"date":"2021-02-06T13:01:29","date_gmt":"2021-02-06T04:01:29","guid":{"rendered":"https:\/\/www.jalasite.org\/doc\/?page_id=1225"},"modified":"2021-02-22T17:23:12","modified_gmt":"2021-02-22T08:23:12","slug":"incident-form","status":"publish","type":"page","link":"https:\/\/www.jalasite.org\/doc\/incident-form","title":{"rendered":"\u6709\u5bb3\u4e8b\u8c61\u5831\u544a\u30d5\u30a9\u30fc\u30e0"},"content":{"rendered":"<div class=\"icf-container\">\n<div class=\"icf-row\">\n<div class=\"col-md-12\">\n<h3>\u6709\u5bb3\u4e8b\u8c61\u5831\u544a\u30d5\u30a9\u30fc\u30e0<\/h3>\n<p>\u4e0b\u8a18\u306e\u30d5\u30a9\u30fc\u30e0\u306b\u8a18\u5165\u3057\u3001\u753b\u9762\u6700\u4e0b\u90e8\u306e\u9001\u4fe1\u30dc\u30bf\u30f3\u3092\u62bc\u4e0b\u304f\u3060\u3055\u3044\u3002\u3000\u3000<span style=\"color: #ff0000;\">*<\/span>\u5370\u306f\u5fc5\u9808\u5165\u529b\u30d5\u30a9\u30fc\u30e0\u3067\u3059\u3002\u5fc5\u305a\u8a18\u5165\u3057\u3066\u4e0b\u3055\u3044\u3002<\/p>\n<\/div>\n<div class=\"col-md-12 icf-form-container\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1224-o1\" lang=\"ja\" dir=\"ltr\" data-wpcf7-id=\"1224\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/doc\/wp-json\/wp\/v2\/pages\/1225#wpcf7-f1224-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1224\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1224-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"incident-cf\">\n\t<div class=\"section-top col-md-12\">\n\t\t<div class=\"section-title icf-row\">\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<h5>\u5831\u544a\u8005\u306e\u9023\u7d61\u5148\n\t\t\t\t<\/h5>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-section icf-row\">\n\t\t\t<div class=\"col-md-12 form-group\">\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><label for=\"\">\u5831\u544a\u8005\u6c0f\u540d<span class=\"required-mark\">*<\/span><\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u5c71\u7530\u82b1\u5b50\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 form-group\">\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><label for=\"\">\u5831\u544a\u8005\u306e\u6240\u5c5e\u8a3a\u7642\u79d1<span class=\"required-mark\">*<\/span><\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"department\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u7523\u5a66\u4eba\u79d1\" value=\"\" type=\"text\" name=\"department\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 form-group\">\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><label for=\"\">\u5831\u544a\u8005\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<span class=\"required-mark\">*<\/span><\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09yamada@abc.co.jp\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"section-title icf-row\">\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<h5>\u65bd\u8a2d\u306e\u5c5e\u6027\n\t\t\t\t<\/h5>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-section icf-row\">\n\t\t\t<div class=\"col-md-12 form-group\">\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><label for=\"\">\u7121\u75db\u5206\u5a29\u65bd\u8a2d \u540d\u79f0<span class=\"required-mark\">*<\/span><\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"facility_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u5c71\u7530\u30af\u30ea\u30cb\u30c3\u30af\" value=\"\" type=\"text\" name=\"facility_name\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 form-group\">\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><label for=\"\">\u7121\u75db\u5206\u5a29\u65bd\u8a2d \u90f5\u4fbf\u756a\u53f7<span class=\"required-mark\">*<\/span><\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"facility_zip_code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09100-1234\" value=\"\" type=\"text\" name=\"facility_zip_code\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 form-group\">\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><label for=\"\">\u7121\u75db\u5206\u5a29\u65bd\u8a2d \u4f4f\u6240<span class=\"required-mark\">*<\/span><\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"facility_address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff09\u6771\u4eac\u90fd\u4e2d\u592e\u533a\u9280\u5ea7111-222\" value=\"\" type=\"text\" name=\"facility_address\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"section-title icf-row\">\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<h5>\u6bcd\u4f53\u306e\u5c5e\u6027\n\t\t\t\t<\/h5>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-section icf-row\">\n\t\t\t<div class=\"col-md-12 form-group\">\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><label for=\"\">\u4e8b\u4f8b\u767a\u751f\u5e74\u6708\uff08yyyymmdd\uff09<span class=\"required-mark\">*<\/span><\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"incident_date\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required incident_date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"incident_date\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 form-group\">\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><label for=\"\">\u598a\u7523\u5a66\u306e\u59d3\u540d\u30a4\u30cb\u30b7\u30e3\u30eb\u6587\u5b57\uff08\u534a\u89d2\u82f1\u5b57\uff09<span class=\"required-mark\">*<\/span><\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-8\">\n\t\t\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\n\t\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pregnant_woman_initial_fist_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u59d3\" value=\"\" type=\"text\" name=\"pregnant_woman_initial_fist_name\" \/><\/span>\n\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"col-md-6\">\n\t\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pregnant_woman_initial_last_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u540d\" value=\"\" type=\"text\" name=\"pregnant_woman_initial_last_name\" \/><\/span>\n\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 form-group\">\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><label for=\"\">\u598a\u7523\u5a66\u306e\u5e74\u9f62<span class=\"required-mark\">*<\/span><\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pregnant_age\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u6b73\" value=\"\" type=\"text\" name=\"pregnant_age\" \/><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"section-bottom col-md-12\">\n\t\t<div class=\"section-title icf-row\">\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<h5>\u7121\u75db\u5206\u5a29\u75c7\u4f8b\u3067\u306e\u767a\u751f\u4e8b\u8c61\uff08\u7121\u75db\u5206\u5a29\u3068\u306e\u56e0\u679c\u95a2\u4fc2\u306f\u554f\u308f\u306a\u3044\uff09\n\t\t\t\t<\/h5>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-section icf-row\">\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<p><label for=\"\">1. \u9ebb\u9154\u4e2d\u306e\u4e8b\u8c61\uff08\u8907\u6570\u9078\u629e\u53ef\uff09<\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 event_anesthesia_checkbox_container\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"event_anesthesia\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u5fc3\u505c\u6b62\" \/><span class=\"wpcf7-list-item-label\">\u5fc3\u505c\u6b62<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u5fc3\u5ba4\u7d30\u52d5\" \/><span class=\"wpcf7-list-item-label\">\u5fc3\u5ba4\u7d30\u52d5<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u91cd\u7be4\u306a\u4e0d\u6574\u8108\" \/><span class=\"wpcf7-list-item-label\">\u91cd\u7be4\u306a\u4e0d\u6574\u8108<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u5fc3\u96fb\u56f3ST\u4f4e\u4e0b\" \/><span class=\"wpcf7-list-item-label\">\u5fc3\u96fb\u56f3ST\u4f4e\u4e0b<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u5fc3\u96fb\u56f3ST\u4e0a\u6607\" \/><span class=\"wpcf7-list-item-label\">\u5fc3\u96fb\u56f3ST\u4e0a\u6607<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u9ad8\u5ea6\u5f90\u8108\uff08\uff1c40\/\u5206\uff09\" \/><span class=\"wpcf7-list-item-label\">\u9ad8\u5ea6\u5f90\u8108\uff08\uff1c40\/\u5206\uff09<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u9ad8\u5ea6\u983b\u8108\uff08\uff1e140\/\u5206\uff09\" \/><span class=\"wpcf7-list-item-label\">\u9ad8\u5ea6\u983b\u8108\uff08\uff1e140\/\u5206\uff09<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u9ad8\u5ea6\u4f4e\u8840\u5727\uff08\u53ce\u7e2e\u671f\u8840\u5727\uff1c60\uff4d\uff4dHg\uff09\" \/><span class=\"wpcf7-list-item-label\">\u9ad8\u5ea6\u4f4e\u8840\u5727\uff08\u53ce\u7e2e\u671f\u8840\u5727\uff1c60\uff4d\uff4dHg\uff09<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u547c\u5438\u505c\u6b62\" \/><span class=\"wpcf7-list-item-label\">\u547c\u5438\u505c\u6b62<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u547c\u5438\u6570\u4f4e\u4e0b\uff08\uff1c10\/\u5206\uff09\" \/><span class=\"wpcf7-list-item-label\">\u547c\u5438\u6570\u4f4e\u4e0b\uff08\uff1c10\/\u5206\uff09<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u547c\u5438\u6570\u5897\u52a0\uff08\uff1e25\/\u5206\uff09\" \/><span class=\"wpcf7-list-item-label\">\u547c\u5438\u6570\u5897\u52a0\uff08\uff1e25\/\u5206\uff09<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"SpO2\uff1c90%\" \/><span class=\"wpcf7-list-item-label\">SpO2\uff1c90%<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u610f\u8b58\u6d88\u5931\" \/><span class=\"wpcf7-list-item-label\">\u610f\u8b58\u6d88\u5931<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u75d9\u6523\" \/><span class=\"wpcf7-list-item-label\">\u75d9\u6523<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u8208\u596e\u30fb\u4e0d\u7a4f\" \/><span class=\"wpcf7-list-item-label\">\u8208\u596e\u30fb\u4e0d\u7a4f<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u610f\u8b58\u30ec\u30d9\u30eb\u4f4e\u4e0b\" \/><span class=\"wpcf7-list-item-label\">\u610f\u8b58\u30ec\u30d9\u30eb\u4f4e\u4e0b<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u8033\u9cf4\u308a\" \/><span class=\"wpcf7-list-item-label\">\u8033\u9cf4\u308a<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"event_anesthesia[]\" value=\"\u53e3\u5507\u306e\u3057\u3073\u308c\u611f\" \/><span class=\"wpcf7-list-item-label\">\u53e3\u5507\u306e\u3057\u3073\u308c\u611f<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-section icf-row\">\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<p><label for=\"\">2. \u6bcd\u4f53\u4e88\u5f8c\u306b\u95a2\u3059\u308b\u4e8b\u8c61<\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 event_related_checkbox\">\n\t\t\t\t<div class=\"icf_row\">\n\t\t\t\t\t<div class=\"col-md-12\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"event_related\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"event_related\" value=\"\u6bcd\u4f53\u6b7b\u4ea1\" \/><span class=\"wpcf7-list-item-label\">\u6bcd\u4f53\u6b7b\u4ea1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_related\" value=\"\u6bcd\u4f53\u4f4e\u9178\u7d20\u8133\u75c7\" \/><span class=\"wpcf7-list-item-label\">\u6bcd\u4f53\u4f4e\u9178\u7d20\u8133\u75c7<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"event_related\" value=\"\u6bcd\u4f53\u795e\u7d4c\u969c\u5bb3\u306e\u6b8b\u5b58\" \/><span class=\"wpcf7-list-item-label\">\u6bcd\u4f53\u795e\u7d4c\u969c\u5bb3\u306e\u6b8b\u5b58<\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-12 detail_event_anesthesia_checkbox\">\n\t\t\t\t\t\t<div class=\"col-md-12 detail_for_option_two\">\n\t\t\t\t\t\t\t<p><label for=\"\">[\u6bcd\u4f53\u4f4e\u9178\u7d20\u8133\u75c7]\u3092\u9078\u629e\u3057\u305f\u5834\u5408<\/label><br \/>\n<label for=\"\">\u30e9\u30f3\u30ad\u30f3\u30b9\u30b1\u30fc\u30eb <a href=\"#rankin-scale-modal\" rel=\"modal:open\">\uff08\u8868\u793a\uff09<\/a><\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<div class=\"scale_radio\">\n\t\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"scale\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"scale\" value=\"1\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"scale\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"scale\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"scale\" value=\"4\" \/><span class=\"wpcf7-list-item-label\">4<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"scale\" value=\"5\" \/><span class=\"wpcf7-list-item-label\">5<\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t\t\t\t<div class=\"col-md-2\">\n\t\t\t\t\t\t\t\t\t<p><label for=\"\">\u8a55\u4fa1\u65e5\uff08yyyymmdd\uff09<\/label>\n\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"evaluation_date_maternal_hipoxic\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text evaluation_date_maternal_hipoxic\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"evaluation_date_maternal_hipoxic\" \/><\/span>\n\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap event_related should-be-visible\"><\/span>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"col-md-12 detail_for_option_three\">\n\t\t\t\t\t\t\t<p><label for=\"\">[\u6bcd\u4f53\u795e\u7d4c\u969c\u5bb3\u306e\u6b8b\u5b58]\u3092\u9078\u629e\u3057\u305f\u5834\u5408<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t\t\t\t<div class=\"col-md-2\">\n\t\t\t\t\t\t\t\t\t<p><label for=\"\">\u969c\u5bb3\u306e\u5185\u5bb9<\/label>\n\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"detail_obstacle_residual_neuropathy\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"detail_obstacle_residual_neuropathy\" \/><\/span>\n\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t\t\t\t<div class=\"col-md-2\">\n\t\t\t\t\t\t\t\t\t<p><label for=\"\">\u8a55\u4fa1\u65e5\uff08yyyymmdd\uff09<\/label>\n\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"evaluation_date_residual_maternal\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text evaluation_date_residual_maternal\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"evaluation_date_residual_maternal\" \/><\/span>\n\t\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap event_related should-be-visible\"><\/span>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-section icf-row\">\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<p><label for=\"\">3. \u7523\u5f8c\u660e\u3089\u304b\u306b\u306a\u3063\u305f\u6bcd\u4f53\u4e8b\u8c61\uff08\u8907\u6570\u9078\u629e\u53ef\uff09<\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 event_after_childbirth_checkbox\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"event_after_childbirth\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"event_after_childbirth[]\" value=\"\u786c\u819c\u5916\u8840\u816b\" \/><span class=\"wpcf7-list-item-label\">\u786c\u819c\u5916\u8840\u816b<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_after_childbirth[]\" value=\"\u672b\u68a2\u795e\u7d4c\u969c\u5bb3\" \/><span class=\"wpcf7-list-item-label\">\u672b\u68a2\u795e\u7d4c\u969c\u5bb3<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_after_childbirth[]\" value=\"\u9ebb\u9154\u7d42\u4e86\u5f8c72\u6642\u9593\u306b\u6b8b\u5b58\u3059\u308b\u4e0b\u80a2\u9ebb\u75fa\" \/><span class=\"wpcf7-list-item-label\">\u9ebb\u9154\u7d42\u4e86\u5f8c72\u6642\u9593\u306b\u6b8b\u5b58\u3059\u308b\u4e0b\u80a2\u9ebb\u75fa<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_after_childbirth[]\" value=\"\u9ebb\u9154\u7d42\u4e86\u5f8c72\u6642\u9593\u306b\u6b8b\u5b58\u3059\u308b\u4e0b\u80a2\u30fb\u81c0\u90e8\u3057\u3073\u308c\u611f\" \/><span class=\"wpcf7-list-item-label\">\u9ebb\u9154\u7d42\u4e86\u5f8c72\u6642\u9593\u306b\u6b8b\u5b58\u3059\u308b\u4e0b\u80a2\u30fb\u81c0\u90e8\u3057\u3073\u308c\u611f<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"event_after_childbirth[]\" value=\"\u9ebb\u9154\u7d42\u4e86\u5f8c72\u6642\u9593\u306b\u6b8b\u5b58\u3059\u308b\u6392\u5c3f\uff0f\u4fbf\u969c\u5bb3\" \/><span class=\"wpcf7-list-item-label\">\u9ebb\u9154\u7d42\u4e86\u5f8c72\u6642\u9593\u306b\u6b8b\u5b58\u3059\u308b\u6392\u5c3f\uff0f\u4fbf\u969c\u5bb3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 detail_event_after_childbirth_checkbox\">\n\t\t\t\t<p><label for=\"\">\u672b\u68a2\u795e\u7d4c\u969c\u5bb3\u3092\u9078\u629e\u3057\u305f\u5834\u5408<\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-2\">\n\t\t\t\t\t\t<p><label for=\"\">\u969c\u5bb3\u306e\u5185\u5bb9<\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"detail_obstacle_peripheral_neuropathy\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"detail_obstacle_peripheral_neuropathy\"><\/textarea><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap event_after_childbirth should-be-visible\"><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-section icf-row\">\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<p><label for=\"\">4. \u5150\u306e\u4e8b\u8c61<\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 event_childs_checkbox\">\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"event_childs\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"event_childs[]\" value=\"\u6b7b\u7523\" \/><span class=\"wpcf7-list-item-label\">\u6b7b\u7523<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"event_childs[]\" value=\"\u5150\u6b7b\u4ea1\" \/><span class=\"wpcf7-list-item-label\">\u5150\u6b7b\u4ea1<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"event_childs[]\" value=\"\u5150\u306e\u5f8c\u907a\u969c\u5bb3\" \/><span class=\"wpcf7-list-item-label\">\u5150\u306e\u5f8c\u907a\u969c\u5bb3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<div class=\"icf-row detail_event_childs_checkbox\">\n\t\t\t\t\t<div class=\"col-md-12\">\n\t\t\t\t\t\t<p><label for=\"\">\u5150\u306e\u5f8c\u907a\u969c\u5bb3\u3092\u9078\u629e\u3057\u305f\u5834\u5408<\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t\t\t<div class=\"col-md-2\">\n\t\t\t\t\t\t\t\t<p><label for=\"\">\u969c\u5bb3\u306e\u5185\u5bb9<\/label>\n\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"detail_obstacle_child_disability\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"detail_obstacle_child_disability\"><\/textarea><\/span>\n\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-12\">\n\t\t\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t\t\t<div class=\"col-md-2\">\n\t\t\t\t\t\t\t\t<p><label for=\"\">\u8a55\u4fa1\u65e5\uff08yyyymmdd\uff09<\/label>\n\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"evaluation_date_child_disability\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text evaluation_date_child_disability\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"evaluation_date_child_disability\" \/><\/span>\n\t\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap event_childs should-be-visible\"><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"field-section icf-row\">\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<p><label for=\"\">5. \u305d\u306e\u4ed6\u306e\u4e8b\u8c61<\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12 detail_other_event\">\n\t\t\t\t<div class=\"icf-row\">\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><label for=\"\">\u5831\u544a\u3059\u3079\u304d\u3068\u5224\u65ad\u3055\u308c\u305f\u6709\u5bb3\u4e8b\u8c61\u3092\u304a\u66f8\u304d\u304f\u3060\u3055\u3044<\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"other_event\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"other_event\"><\/textarea><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div id=\"rankin-scale-modal\" class=\"modal\">\n\t\t<p><img decoding=\"async\" src=\"\/wp-content\/uploads\/2021\/02\/rankin-scale.png\" alt=\"\" \/><br \/>\n<a href=\"#\" rel=\"modal:close\">Close<\/a>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"section-bottom\">\n\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"\u9001\u4fe1\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"\u6709\u5bb3\u4e8b\u8c61\u5831\u544a\u30d5\u30a9\u30fc\u30e0 \u4e0b\u8a18\u306e\u30d5\u30a9\u30fc\u30e0\u306b\u8a18\u5165\u3057\u3001\u753b\u9762\u6700\u4e0b\u90e8\u306e\u9001 [&hellip;]","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-noside-notitle.php","meta":{"footnotes":""},"class_list":["post-1225","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.jalasite.org\/doc\/wp-json\/wp\/v2\/pages\/1225","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.jalasite.org\/doc\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.jalasite.org\/doc\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.jalasite.org\/doc\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.jalasite.org\/doc\/wp-json\/wp\/v2\/comments?post=1225"}],"version-history":[{"count":3,"href":"https:\/\/www.jalasite.org\/doc\/wp-json\/wp\/v2\/pages\/1225\/revisions"}],"predecessor-version":[{"id":1255,"href":"https:\/\/www.jalasite.org\/doc\/wp-json\/wp\/v2\/pages\/1225\/revisions\/1255"}],"wp:attachment":[{"href":"https:\/\/www.jalasite.org\/doc\/wp-json\/wp\/v2\/media?parent=1225"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}