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Bilingual General Medical Form

Step .1

名前 :: First Name 名字 :: Last Name 性別 :: Gender ビザの種類 :: Visa Status 母国語 :: First Language 宗教的制限 :: Religious Concerns 血液型 :: Blood Type 障害 :: Do you have a disability?

Step .2 : Reason

Taking Medicine 薬 :: Medicine Allergies

妊娠 :: Are you pregnant? ペースメーカー :: Do you have a pacemaker? MRI　可・不可 :: Are you able to have a MRI? 閉所恐怖症 :: Are you claustrophobic?

Immunized?

肝炎 :: Hepataitis B インフルエンザ :: Influenza

Childhood

感染症 :: Infectious Disease おたふくかぜ :: Mumps はしか :: Measles てんかん :: Epilepsy 水ぼうそう :: Chicken Pox リューマチ熱 :: Rheumatic Fever

Adult Section

心臓病 :: Heart Disease 心臓発作 :: Heart Attack 高血圧 :: High Blood Pressure 糖尿病 :: Diabetes 喘息 :: Asthma 性病 :: Veneral Disease 腎臓病 :: Kidney Problems 胃潰瘍 :: Ulcer 癌腫 :: Cancer 肝臓病 :: Liver Problems

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NEWSback to the top

New hospital added ::
If your employer requires you to have a health check then you can have one here
April 24th at 08.00 am

Kiku :: Social Worker
Available through health hokkaido. You can contact her through email . Once the social worker has assessed your needs she will contact you.
April 24th at 08.30 am

disAbility ::
health hokkaido is now accessible to blind and disAbled users. People using screen readers can now easily access our content. Also users with vision problems may use the enlarge text and low contrast functionality.
Feb 1st at 08.00 am

STAFF

SITE FEATURES

:: bilingual medical forms

:: ask medical questions

:: bilingual symptom sheet

:: bilingual dental services