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
男
Male
女
Female
生年月日
Date of Birth
大正
Taisho (1912-1926)
昭和
Showa(1926-1989)
平成
Heisei (1989-2019)
年
Year
月
Month
日
Day
歳
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
他
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
首
Neck
手
Hand
肩
Shoulder
腕
Arm
背中
Back (of body)
腰
Hips
おしり
Buttocks
膝
Knees
足
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
薬
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
酒
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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