Questionnaire for checkup

 This sheet is so useful when foreigners visit hospitals.

 

 Please download and use it. However, copyright has not abandoned. Copyright is in a Medical International Center Aichi.

 Please tell us by e-mail when you use it. And use of the use, reproduction, redistribution and secondary processing for the purpose of operating is forbidden.

 

 <The usage>

  (1) Please listen to foreigners showing this questionnaire and

           condition sheets.

  (2) After examination, please prescribe using "medicine sheets".

           If you have a question, please ask us by e-mail or telephone.

 

 <Download>

   Questionnaire for checkup ------here (English Only)

 

 

Pharmacy's questionnaire for checkup (condition and medicine sheets)

 This sheet is so useful when foreigners buy medicine at the pharmacy.

 

 Copyright has not abandoned, copyright is in MICA. Please tell us by e-mail

  when you use it.
 And use of the use, reproduction, redistribution and secondary processing

  for the purpose of operating is forbidden.

 

 <The usage>

  (1) When foreigners buy the medicine at the pharmacy, they write

           condition sheet.

  (2) The pharmacist writes medicine sheet referring pharmacy's

           questionnaire for checkup.

  (3) They sell medicine. If you have a question, please ask us by

           e-mail or telephone.

 

 <Sample Download>

      Condition sheet(customer) here → English, Portuguese, Spanish

      Medicine sheet(Pharmacy) here → English, Portuguese, Spanish