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  • CERTIFICATE OF HEALTH (To Be Completed by The Examining Physician)

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    Ana Pino-Blanco
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    1. This document is a certificate of health completed by an examining physician. It contains information about the applicant's physical examination, medical history, and laboratory test results. 2. The physical examination includes measurements of height, weight, blood pressure, eyesight, hearing, and chest x-rays. Lungs and heart are noted to be normal or impaired. 3. The medical history section lists any past conditions like tuberculosis, malaria, or other diseases and their dates of recovery. It also asks if the applicant has any current illnesses under treatment. 4. At the end, the physician gives their overall impression of the applicant's health and whether their status is adequate to study in Japan based on the exam

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    Certificate Health

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    1. This document is a certificate of health completed by an examining physician. It contains information about the applicant's physical examination, medical history, and laboratory test results. 2. The physical examination includes measurements of height, weight, blood pressure, eyesight, hearing, and chest x-rays. Lungs and heart are noted to be normal or impaired. 3. The medical history section lists any past conditions like tuberculosis, malaria, or other diseases and their dates of recovery. It also asks if the applicant has any current illnesses under treatment. 4. At the end, the physician gives their overall impression of the applicant's health and whether their status is adequate to study in Japan based on the exam

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    14 views2 pages

    CERTIFICATE OF HEALTH (To Be Completed by The Examining Physician)

    Uploaded by

    Ana Pino-Blanco
    1. This document is a certificate of health completed by an examining physician. It contains information about the applicant's physical examination, medical history, and laboratory test results. 2. The physical examination includes measurements of height, weight, blood pressure, eyesight, hearing, and chest x-rays. Lungs and heart are noted to be normal or impaired. 3. The medical history section lists any past conditions like tuberculosis, malaria, or other diseases and their dates of recovery. It also asks if the applicant has any current illnesses under treatment. 4. At the end, the physician gives their overall impression of the applicant's health and whether their status is adequate to study in Japan based on the exam

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 2

    CERTIFICATE OF HEALTH (to be completed by the examining physician)

    Please ill o!t (PRI"T#T$PE) in %apanese o& English'



    (ale
    "ame) *
    Female +ate o ,i&th)
    Family name* Fi&st name (iddle name

    Physical Examination
    (-)
    Height cm .eight /g
    (0)
    Reg!la&
    ,lood p&ess!&e mm#Hg mm#Hg ,lood Type P!lse
    I&&eg!la&
    (1) ! "
    Eyesight) (R) (L) (R) (L)
    "o&mal
    #$ .itho!t glasses %& .ith glasses o& contact lenses Colo& blindness '( Impai&ed
    (2) ) " &( "o&mal * +&( "o&mal
    Hea&ing) ,- Impai&ed 3peech) '( Impai&ed
    !"#$%&'()*+,-./0123'456&+,-.78
    29:;<=>?-.@A)
    Please desc&ibe the &es!lts o physical and 45&ay examinations o the applicant6s chest 45&ays (45&ays ta/en mo&e than six months p&io&
    to the ce&tiication a&e "OT 7alid)'
    . &( "o&mal /0 &( "o&mal
    L!ngs) '( Impai&ed Ca&diomegaly) '( Impai&ed
    B
    C +ate DEFG
    Film "o' /12 Elect&oca&diog&aph )&( "o&mal
    '( Impai&ed
    +esc&ibe the condition o applicant6s l!ngs'
    HIJKLMNO $es (+isease )
    +isease c!&&ently being t&eated "o
    3456
    Past histo&y ) Please indicate 8ith 7 o& 8 and ill in the date o &eco7e&y
    (I the applicant has not cont&acted any o the disease* please chech 9"one:') 9&PQ8RS3T&FGUT3VWX
    YZ
    T!be&c!losis''''''( ' ' ) (ala&ia'''''''( ' ' ) Othe& comm!nicable disease''''''( ' ' )
    Epilepsy''''''( ' ' ) ;idney disease'''''( ' ' ) Hea&t disease''''''( ' ' )
    +iabetes''''''( ' ' ) +&!g alle&gy''''''( ' ' ) Psychosis'''''( ' ' )
    F!nctional diso&de& in ext&emities''''''( ' ' )
    "one'''''
    9 Labo&ato&y tests
    : <&inalysis) gl!cose ( )* p&otein ( )* occ!lt blood ( )
    ;< E3R) mm#H&* .,C co!nt) #cmm =
    anemia
    Hemoglobin) gm#dl* =PT)
    >?[\1]^'_6&9`aDT&FG8Ubcd2456&Z
    Please gi7e yo!& imp&ession o the applicant>s health' (I yo! do not ha7e a pa&tic!la& opinion* please 8&ite as s!ch')
    @ABCefg(*hi-./0jklm3'(IJnopqrstuv
    wx8yzQ{j|
    In 7ie8 o the applicant6s histo&y and the abo7e indings* is it yo!& obse&7ation that his#he& health stat!s is ade?!ate to p!&s!e st!dies in %apan@
    Yes No
    D E
    Date: Signature:
    ? F
    Physician's Name in Print :
    GH
    Oice#Instit!tion)
    IJK
    Add&ess)

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