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[null,"長岡中央綜合病院倫理委員会  第1号様式"]
[]
["倫 理 審 査 （審 議） 申 請 書"]
[]
[{"$nulls":17},"令和　　　",null,null,null,"年",null,null,"月",null,null,"日"]
[]
[null,"長岡中央綜合病院長　殿"]
[]
[{"$nulls":16},"申請者：",{"$nulls":10},"㊞"]
[]
[{"$nulls":16},"所　属："]
[]
[{"$nulls":16},"職　名："]
[]
[null,"審査･審議対象",{"$nulls":4},"  １： 実 施 計 画",{"$nulls":6}," ２： 事 例",{"$nulls":6}," ３： そ の 他"]
[null,"申  請  名"]
[]
[]
[]
[null,"代 表 者 名"]
[{"$nulls":6},"氏名",{"$nulls":7},"所属",{"$nulls":6},"職名"]
[]
[null,"共 同 申 請 者"]
[{"$nulls":6},"氏名",{"$nulls":7},"所属",{"$nulls":6},"職名"]
{"$rows_empty":10}
[null," 受 付　　　年　 　月　 　日",{"$nulls":15},"受 付 番 号　　　第　　　　　号"]
[]
[null,"申 請 の 目 的 と 概 要"]
{"$rows_empty":14}
[null,"医 療 行 為 ・ 研 究 の 対 象"]
{"$rows_empty":9}
[null,"医 学 ・ 倫 理 的 配 慮"]
{"$rows_empty":11}
[null,"学会等での発表を目的とした申請の場合は以下も記入"]
[null,"学会名",{"$nulls":16},"開催日","年　　　月　　　日"]