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[]
[null,"北九州市長様",null,null,null,null,null,null,null,null,"令和7年3月31日"]
[null,"市区町村番号"]
[]
[null,4,0,1,0,0,5]
[null,null,null,null,null,null,null,null,"所在地"]
[null,null,null,null,null,null,null,null,"医療機関名"]
[null,null,null,null,null,null,null,null,"代表者氏名",null,null,"㊞"]
[null,null,null,null,null,null,null,null,"電話番号"]
[]
[null,"風しん対策　市区町村別請求書兼報告書（令和7年3月分）"]
[]
[null,"標記の件について、以下のとおり実施しました。\n風しんの追加的対策に係る費用の支払については、次の名義の預金口座に\n口座振替されるよう依頼します。"]
[null,"（金融コード）",null,null,null,null,null,null,"（支店名コード）"]
[null,"振込先",null,null,null,null,null,null,"支店名"]
[null,"預金種目",null,null,"１：普通　２：当座",null,null,null,"口座番号"]
[null,"（フリガナ）"]
[null,"口座名義人",null,null,null,null,null,null,null,null,null,null,null,null,"【計算スペース】※こちらに件数を記入すると請求書が埋まっていきます"]
[]
[null,null,null,null,null,null,null,null,"請求件数","請求金額\n（税抜）","請求金額\n（税込）",null,null,null,null,null,null,"請求件数","税抜き単価","税込み単価","請求総額（税抜き）\n※システムエラーのチェック用","請求総額（税込み）"]
[null,"抗体検査",null,null,"①健診・HI法",null,null,null,{"$f":"R21","v":0},{"$f":"U21","v":0},0,null,null,null,"抗体検査","①健診・HI法",null,0,1290,{"$f":"ROUNDDOWN(S21*(1+($K$34)/100),0)","v":1419},{"$f":"S21*R21","v":0},{"$f":"T21*R21","v":0}]
[null,null,null,null,"②健診・EIA法",null,null,null,0,0,0,null,null,null,null,"②健診・EIA法",null,0,2680,{"$f":"ROUNDDOWN(S22*(1+($K$34)/100),0)","v":2948},0,{"$f":"T22*R22","v":0}]
[null,null,null,null,"③HI法",null,null,null,0,0,0,null,null,null,null,"③HI法",null,0,4930,5423,0,0]
[null,null,null,null,"④EIA法",null,null,null,0,0,0,null,null,null,null,"④EIA法",null,0,6320,6952,0,0]
[null,null,null,null,"⑤夜間休日・HI法",null,null,null,0,0,0,null,null,null,null,"⑤夜間休日・HI法",null,0,5430,5973,0,0]
[null,null,null,null,"⑥夜間休日・EIA法",null,null,null,0,0,0,null,null,null,null,"⑥夜間休日・EIA法",null,0,6820,7502,0,0]
[null,null,null,null,"小計",null,null,null,0,0,0,null,null,null,null,"小計",null,{"$f":"SUM(R21:R26)","v":0},null,null,{"$f":"SUM(U21:U26)","v":0},{"$f":"SUM(V21:V26)","v":0}]
[null,"予防接種",null,null,"通常(MRワクチン)",null,null,null,0,0,0,null,null,null,"予防接種","通常(MRワクチン)",null,0,9485,10433,{"$f":"S28*R28","v":0},{"$f":"T28*R28","v":0}]
[null,null,null,null,"通常(単独ワクチン)",null,null,null,{"$f":"R29","v":0},{"$f":"U29","v":0},{"$f":"V29","v":0},null,null,null,null,"通常(単独ワクチン)",null,0,6205,6825,{"$f":"S29*R29","v":0},{"$f":"T29*R29","v":0}]
[null,null,null,null,"予診のみ",null,null,null,0,0,0,null,null,null,null,"予診のみ",null,0,2880,3168,{"$f":"S30*R30","v":0},{"$f":"T30*R30","v":0},"  ※税込単価は、１円未満の端数は切り捨て"]
[null,null,null,null,"小計",null,null,null,0,{"$f":"SUM(J28:J30)","v":0},{"$f":"SUM(K28:K30)","v":0},null,null,null,null,"小計",null,{"$f":"SUM(R28:R30)","v":0},null,null,{"$f":"SUM(U28:U30)","v":0},{"$f":"SUM(V28:V30)","v":0}]
[null,"合計",null,null,null,null,null,null,0,{"$f":"J31+J27","v":0},{"$f":"K31+K27","v":0},null,null,null,"合計",null,null,{"$f":"R31+R27","v":0},null,null,{"$f":"U31+U27","v":0},{"$f":"V31+V27","v":0}]
[]
[null,null,null,null,null,null,null,null,null,"消費税率",10,"％"]

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[]
[null,"北九州市長様",null,null,null,null,null,null,null,null,"令和7年3月31日"]
[null,"市区町村番号"]
[]
[null,4,0,1,0,0,5]
[null,null,null,null,null,null,null,null,"所在地","○○県○○市○○町○丁目○番○号"]
[null,null,null,null,null,null,null,null,"医療機関名","例）医療法人○○　　〇〇病院"]
[null,null,null,null,null,null,null,null,"代表者氏名","　　理事長〇〇　○○　　　　㊞"]
[null,null,null,null,null,null,null,null,"電話番号","○○○ー○○○ー○○○○"]
[]
[null,"風しん対策　市区町村別請求書兼報告書（令和7年3月分）"]
[]
[null,"標記の件について、以下のとおり実施しました。\n風しんの追加的対策に係る費用の支払については、次の名義の預金口座に\n口座振替されるよう依頼します。"]
[null,"（金融コード）",null,null,"1234",null,null,null,"（支店名コード）","123"]
[null,"振込先",null,null,"○○銀行",null,null,null,"支店名","○○支店"]
[null,"預金種目",null,null,"１：普通　２：当座",null,null,null,"口座番号","1234567"]
[null,"（フリガナ）",null,null,"イ）マルマル　マルマルビョウイン"]
[null,"口座名義人",null,null,"医療法人〇〇　〇〇病院",null,null,null,null,null,null,null,null,null,"【計算スペース】※こちらに件数を記入すると請求書が埋まっていきます"]
[]
[null,null,null,null,null,null,null,null,"請求件数","請求金額\n（税抜）","請求金額\n（税込）",null,null,null,null,null,null,"請求件数","税抜き単価","税込み単価","請求総額（税抜き）\n※システムエラーのチェック用","請求総額（税込み）"]
[null,"抗体検査",null,null,"①健診・HI法",null,null,null,{"$f":"R21","v":0},{"$f":"U21","v":0},0,null,null,null,"抗体検査","①健診・HI法",null,0,1290,{"$f":"ROUNDDOWN(S21*(1+($K$34)/100),0)","v":1419},{"$f":"S21*R21","v":0},{"$f":"T21*R21","v":0}]
[null,null,null,null,"②健診・EIA法",null,null,null,0,0,0,null,null,null,null,"②健診・EIA法",null,0,2680,{"$f":"ROUNDDOWN(S22*(1+($K$34)/100),0)","v":2948},0,{"$f":"T22*R22","v":0}]
[null,null,null,null,"③HI法",null,null,null,2,9860,10846,null,null,null,null,"③HI法",null,2,4930,5423,9860,10846]
[null,null,null,null,"④EIA法",null,null,null,1,6320,6952,null,null,null,null,"④EIA法",null,1,6320,6952,6320,6952]
[null,null,null,null,"⑤夜間休日・HI法",null,null,null,0,0,0,null,null,null,null,"⑤夜間休日・HI法",null,0,5430,5973,0,0]
[null,null,null,null,"⑥夜間休日・EIA法",null,null,null,0,0,0,null,null,null,null,"⑥夜間休日・EIA法",null,0,6820,7502,0,0]
[null,null,null,null,"小計",null,null,null,3,16180,17798,null,null,null,null,"小計",null,{"$f":"SUM(R21:R26)","v":3},null,null,{"$f":"SUM(U21:U26)","v":16180},{"$f":"SUM(V21:V26)","v":17798}]
[null,"予防接種",null,null,"通常(MRワクチン)",null,null,null,2,18970,20866,null,null,null,"予防接種","通常(MRワクチン)",null,2,9485,10433,{"$f":"S28*R28","v":18970},{"$f":"T28*R28","v":20866},"←予防接種関係の価格は市区町村で決定いたします。クーポンの下５桁に記載の金額を記載ください。"]
[null,null,null,null,"通常(単独ワクチン)",null,null,null,{"$f":"R29","v":0},{"$f":"U29","v":0},{"$f":"V29","v":0},null,null,null,null,"通常(単独ワクチン)",null,0,6205,6825,{"$f":"S29*R29","v":0},{"$f":"T29*R29","v":0}]
[null,null,null,null,"予診のみ",null,null,null,0,0,0,null,null,null,null,"予診のみ",null,0,2880,3168,{"$f":"S30*R30","v":0},{"$f":"T30*R30","v":0},"  ※税込単価は、１円未満の端数は切り捨て"]
[null,null,null,null,"小計",null,null,null,2,{"$f":"SUM(J28:J30)","v":18970},{"$f":"SUM(K28:K30)","v":20866},null,null,null,null,"小計",null,{"$f":"SUM(R28:R30)","v":2},null,null,{"$f":"SUM(U28:U30)","v":18970},{"$f":"SUM(V28:V30)","v":20866},"　※予診のみの費用を市町村が設定していない場合（０円の場合）は、本請求書に計上しないこと。その場合、予診票の原本を国民健康保険団体連合会に送付しないこと。"]
[null,"合計",null,null,null,null,null,null,5,{"$f":"J31+J27","v":35150},{"$f":"K31+K27","v":38664},null,null,null,"合計",null,null,{"$f":"R31+R27","v":5},null,null,{"$f":"U31+U27","v":35150},{"$f":"V31+V27","v":38664}]
[]
[null,null,null,null,null,null,null,null,null,"消費税率",10,"％"]