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["第30 回岩手県作業療法学会",null,null,"一般演題申し込み表"]
["テーマ：作業療法士と地域医療"]
[]
["FAX送信票"]
["送付先　：　第30回岩手県作業療法学会　事務局\n　　　　　　　 宮古第一病院リハビリテーション部　下河原　慎也/行",{"$nulls":4},"Tel:0193-62-3737\nFax:0193-62-3714"]
[]
[{"$nulls":5},"Tel :　"]
["施　設　名　：　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　",{"$nulls":4},"Fax："]
[]
["氏　名",null,"岩手県作業療法士会№　　　　　　　　　　　　　　（ナンバー）","事例報告読み替え登録　　",null,"連絡先電話番号"]
[]
["例）  作業　太郎","PT","№000","（　有　　・　　無　）",null,"0193-62-3714"]
{"$rows_empty":20}
["※　申し込み〆切　平成28年8月15日（月）　必着"]
["※　記入欄が不足する場合は、お手数ですがコピーの上ご利用ください。"]