How to Fill Out a Medical Form in Japan

How to Fill Out a Medical Form in Japan

Filling out documents in a language you are not familiar with is stressful. Especially filling out a medical form when you’re in dire need of medical attention.

Whether you got sick or hurt yourself while traveling to Japan, or you have just started living in Japan and know little Japanese, this guide will help you in filling out a medical form in Japan.

In this article, you will come to know how to fill out a medical form and be able to understand Japanese medical terms.

When you arrive at the hospital or clinic, you will be handed a medical form consisting of questions regarding your condition.

問診票 (Monshin hyou) or “Medical Questionnaire” is a medical form that you need to fill out including your basic information, symptoms you‘re having, and medical history.

The following is an example of a typical Medical Form in Japan.

If you can’t read Japanese characters, don’t fret. The following is a handy list of vocabularies in Japanese with their corresponding English translation.

VOCABULARY

Basic Information Vocabulary

Japanese

English

問診票

Medical Form

氏名

Name

Male

Female

生年月日

Date of Birth

大正

Taisho (1912-1926)

昭和

Showa(1926-1989)

平成

Heisei (1989-2019)

Year

Month

Day

Age

体重

Weight

身長

Height

住所

Address

電話

Phone number

自宅

Telephone number

携帯

Cellphone number

If you’re not familiar with Taisho, Showa, and Heisei, these are eras in Japan. If you were born between July 30, 1912 and Dec 25, 1926, then you need to encircle the word Taisho.

Those who were born between December 25, 1926 and January 7, 1989, will have to encircle the word Showa.

And for those born between January 8, 1989 and April 30, 2019, the word Heisei should be encircled.

Symptoms Vocabulary

Japanese

English

体温

Body temperature

かぜ症状

Common colds symptoms

熱がある

Fever

のどが痛い

Throat pain

鼻水/鼻づまり

Runny nose / nasal congestion

咳/痰

Cough / phlegm

頭痛

Headache

関節が痛い

Joints (knee, elbow, etc.) hurting

頭•目

Head, eyes

めまい

Dizziness

目のかすみ

Bleary-eyed

Others (please specify)

胸•からだ

Chest, body

胸痛

Chest pain

息切れ

Shortness of breath

胸の圧迫感

Feeling of pressure in chest

むくみ

Swelling

お腹

Stomach

腹痛

Stomach ache

下痢

Diarrhea

吐き気

Nausea

食欲がない

Loss of appetite

便秘

Constipation

血便

Blood stool

痛み•しびれ

Pain, numbness

Neck

Hand

Shoulder

Arm

背中

Back (of body)

Hips

おしり

Buttocks

Knees

Feet

慢性的な疾患

Chronic Illness

高血圧

Hypertension

糖尿病

Diabetes

脂質代謝異常

Lipid metabolism disorder

呼吸器

Respiratory organs

かゆみ

Itch

湿疹/かぶれ

Eczema / rash

やけど

Burns

虫刺され

Insect bites

その他

Others

Encircle the corresponding symptoms and body parts that are aching.

Medical History Vocabulary

Japanese

English

ある

Have

ない

Don’t have

はい

Yes

いいえ

No

外来

Outpatient

入院

Inpatient

病院名

Name of hospital

Medicine

アレルギー

Allergy

病気

Illness

がん

Cancer

脳卒中

Stroke

高血圧

Hypertension

糖尿病

Diabetes

高脂血症

Hyperlipidemia

心臓病

Heart Disease

腎臓病

Kidney Disease

肝臓病

Liver Disease

胃腸の病気

Gastrointestinal Disorders

肺や気管支の病気

Lung and Bronchial Disease

眼の病気

Eye Disease

足腰の病気

Legs and Joints Disease

その他

Etc.

手術

Surgery

輸血

Blood Transfusion

Alcoholic Beverage

妊娠

Pregnant

授乳

Breast-feeding

診察

Medical Examination

治療

Medical Treatment

If you have a history or have experienced in the past any of the diseases mentioned, draw a circle around the corresponding word.

And that’s pretty much it. All you have to do next is to submit your medical form and get checked. Get well soon. Take care.

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  • Takes the ice sword.

“What are you gonna do with that?” “I have no idea.”

  • If you don’t want me to follow you into fire, then don’t run into fire.
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  • You feel what you feel and those feelings are real.
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  • Until then, I’m lost in the woods.
  • Water has memory.
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  • Go too far and you’ll be drowned.
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  • I’m sensing some rising anger in me.
  • Every inch of me is trembling but not from the cold.
  • have been a fortress full of secrets inside.
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  • This grief has a gravity; it pulls me down.
  • Hope is lost but you must go on and do the next right thing. Take a step. Step again.
  • The only star that guided me was you.
  • My love is not fragile.

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