Health Check
2018-06-17
Most people in Japan with full time jobs have to do an annual health checkup, and my job is no exception. Reading the forms is problematic. In the worst case, the doctors usually know medical terminology in English, so I can ask them for help with the paperwork, but it would be better to be able to read the forms. Doctors here need to be able to read medical literature, which means even if they can't speak English well, their knowledge of medical terminology is generally sufficient ... although, for more obscure technical terms, perhaps you or I might not know the English.
This document was first written in 2013. My company's health check form changed slightly in 2018, and I've updated the Japanese to reflect the changes.
The above pages are directions and a blank form for me to complete. Here is my translation. I think it's of rather decent quality, but in medicine you don't want to screw things up, so please use your own judgment. Also, some of the Japanese words are vague, which makes for equally vague English translations. I think hospitals and dentists are some of the scariest places in foreign countries, because if you don't understand exactly what the question or explanation means, you won't really know how to answer or use it. Just guessing or being approximately on target isn't good enough. The good thing is, what I've found is that it's usually not so difficult for you to say what feels wrong with you. If the doctor is good, he or she can take that information and do something intelligent with it, which is half the reason you went to the doctor's office in the first place. The bad thing is that the doctor might or might not be good at explaining things in a comprehensible fashion, which can be stressful (for both you and them, but we aren't as worried about them). In some cases, I've had reasonable results with getting the explanation on paper and later asking school nurses and the internet for help.
This page is to be completed in pencil. To be precise, the form says either pencil or mechanical pencil is fine. These are seen as two different things in Japan, though I don't really understand why.
| 1 | 内服中 | Currently taking medicine |
| 2 | 定期検査中 | Regular testing |
| 3 | 食事療法中 | On a medical diet |
| 5 | 放置・中断 | Leaving as is |
| 6 | 治癒 | Recovered |
The above are answers for the below table. If you had or have any of the below conditions, circle the relevant number as described above. If you haven't had any of these conditions, put a circle in the □ 特になし box.
| 高血圧 | High blood pressure | 1 | 2 | 3 | 5 | 6 |
| 糖尿病 | Diabetes | 1 | 2 | 3 | 5 | 6 |
| 脂質異常症(高脂血症) | Lipid abnormality (hyperlipidaemia) | 1 | 2 | 3 | 5 | 6 |
| 心疾患(狭心症・心筋梗塞等) | Heart disease | 1 | 2 | 3 | 5 | 6 |
| 痛風(高尿酸血症) | Gout (hyperuricemia) | 1 | 2 | 3 | 5 | 6 |
| 胃十二指腸疾患 | Gastroduodenal ulcer | 1 | 2 | 3 | 5 | 6 |
| 血液疾患(貧血等) | Blood disease (anemia, etc.) | 1 | 2 | 3 | 5 | 6 |
| 胆石症 | Gallstones | 1 | 2 | 3 | 5 | 6 |
| 肝疾患 | Liver disease | 1 | 2 | 3 | 5 | 6 |
| 呼吸器疾患 | Respiratory illness | 1 | 2 | 3 | 5 | 6 |
| 肺結核 | Pulmonary tuberculosis | 1 | 2 | 3 | 5 | 6 |
| 慢性腎臓病・腎不全(人工透析等) | Renal failure (dialysis) | 1 | 2 | 3 | 5 | 6 |
| その他の腎疾患(結石等) | Other kidney disease (kidney stones, etc.) | 1 | 2 | 3 | 5 | 6 |
| 婦人科 | Gynecology (birth control) | 1 | 2 | 3 | 5 | 6 |
| 眼疾患(高眼圧等) | Eye disease (ocular tension, etc.) | 1 | 2 | 3 | 5 | 6 |
| 脳出血・脳梗塞 | Cerebral hemorrhage or stroke | 1 | 2 | 3 | 5 | 6 |
| その他 | Other | 1 | 2 | 3 | 5 | 6 |
There are several yes/no questions.
| 手術を受けたことがありますか。 | Have you ever had surgery? | □ いいえ No | □ はい Yes |
| 心臓ペースメーカーをお使いですか。 | Do you use a pacemaker? | □ いいえ No | □ はい Yes |
| 採血後に気分が悪くなったことがありますか。 | Have you ever felt bad after having blood drawn? | □ いいえ No | □ はい Yes |
| ピロリ菌の除菌をしたことはありますか。 | Have you ever been treated for gastric ulcers? | □ いいえ No | □ はい Yes |
| 今までに胃のバリウム検査によって体調不良や少しでも異変を感じたことはありますか。 | Have you ever felt bad or strange after taking a Barium stomach exam? | □ いいえ No | □ はい Yes |
Next, there is a section about subjective symptoms (自覚症状). For each symptom, if you're feeling it, put a circle in the box to the left of the symptom. If you aren't feeling any such subjective symptoms, put a circle in the □ 特になし box.
| □ | 胸痛 | Chest pain | □ | 肩こり | Stiff shoulders | □ | 便秘 | Constipation | ||
| □ | 動悸 | Palpitation (e.g., heart) | □ | 腰痛 | Lower back or hip pain | □ | 下痢 | Diarrhea | ||
| □ | 息切れ | Shortness of breath | □ | 咳 | Cough | □ | むくみ | Swelling, edema | ||
| □ | 疲れやすい | Easily tired | □ | 痰 | Phlegm | □ | 口が渇く | Dry mouth | ||
| □ | 頭痛 | Headache | □ | 食欲不振 | Loss of appetite | □ | 手足がしびれる | Numb hands or feet | ||
| □ | めまい | Dizziness | □ | 腹痛 | Stomach ache | □ | いらいらする | Getting irritated | ||
| □ | 耳鳴り | Ringing in the ear | □ | 胃の具合が悪い | Stomach trouble | □ | その他 | Other |
There is also a section for women on the right side of the subjective symptoms section.
| ※女性の方のみお答えください。 For women only. |
| 生理中ですか。 Are you currently menstruating? |
| □ はい Yes □ いいえ No |
| 妊娠、又は可能性がありますか。 Is there any chance you're pregnant? |
| □ はい Yes □ いいえ No |
Here are some questions regarding lifestyle and habits. Answer by writing a circle in the relevant box. For each question, choose only one answer.
| 1 | 血圧を下げる薬を服用していますか。 Are you taking medicine to lower your blood pressure? | □ はい Yes (薬品名 Medicine name) | □ いいえ No | |
| 2 | インスリン注射又は血糖を下げる薬を服用していますか。 Do you take shots or medicine to control your insulin or blood sugar? | □ はい Yes (薬品名 Medicine name) | □ いいえ No | |
| 3 | コレストロールを下げる薬を服用していますか。 Are you taking medicine to lower your cholesterol? | □ はい Yes (薬品名 Medicine name) | □ いいえ No | |
| 4 | 現在、たばこを習慣的に吸っていますか。 At present, do you have a smoking habit? | □ はい Yes | □ いいえ No | |
| 5 | 20歳の時の体重から10Kg以上増加していますか。 Have you gained more than 10 kg since you were 20 years old? | □ はい Yes | □ いいえ No | |
| 6 | 1回30分以上の軽く汗をかく運動を周２回以上、1年以上実施していますか。 In the past year, have you exercised for 30 minutes or more 2 or more times a week? | □ はい Yes | □ いいえ No | |
| 7 | 日常生活において歩行又は同等の身体活動を1日1時間以上実施していますか。 Do you walk or do some other physical activity for at least an hour daily? | □ はい Yes | □ いいえ No | |
| 8 | ほば同じ年齢の同性と比較して歩く速度が速いですか。（普通の場合は いいえ に記入して下さい。） Do you walk faster than people your age? (If the same, select "No".) | □ はい Yes | □ いいえ No | |
| 9 | 食事をかんで食べる時の状態はどれにあてはまりますか。①〜③の１つだけ選択してください。 When you eat food, which of the following best describes your chewing conditions? |
① □ 何でもかんで食べることができる I can chew and eat anything. | ||
| ② □ 歯や歯ぐき、かみあわせなど気になる部分があり、かみにくいことがある I have some concerns about my teeth or gums making some food difficult to eat. | ||||
| ③ □ ほとんどかめない I can't chew most food. | ||||
| 10 | 人と比較して食べる速度が速いですか。 Do you eat faster than others? | □ 速い Fast | □ 普通 Normal | □ 遅い Slow |
| 11 | 就寝前の2時間以内に夕食をとることが週に3回以上ありますか。 Do you have dinner less than 2 hours before bed 3 or more times a week? | □ はい Yes | □ いいえ No | |
| 12 | 朝昼夕の３食以外に間食や甘い飲み物を摂取していますか。 Do you have snacks or sweet drinks outside of your regular three meals? | □ 毎日 Daily | □ 時々 Sometimes | □ ほとんど摂取しない Rarely |
| 13 | 朝食を抜くことが週に3回以上ありますか。 Do you skip breakfast 3 or more times a week? | □ はい Yes | □ いいえ No | |
| 14 | お酒（清酒、焼酎、ビール、洋酒など）を飲む頻度 How often do you drink alcohol? | □ 毎日 Every day | □ 時々 Sometimes | □ ほとんど飲まない Rarely |
| 15 | 飲酒日の１日当たりの飲酒量 On a day when you're drink alcohol, how many drinks do you consume? | □ 1合未満 Less than 1 | □ 1~2合未満 1-2 drinks | |
| □ 2-3合未満 2-3 drinks | □ 合3以上 3 or more | |||
| 16 | 睡眠で休養が十分とれていますか。 Do you get enough sleep? | □ はい Yes | □ いいえ No | |
| 17 | 運動や食生活等の生活習慣を改善してみようと思いますか。①〜⑤の1つだけ選択して下さい。 Would you like to try to improve your exercise and eating habits? Choose only one of ①-⑤. | ① □ 改善するつもりはない I have no plans for changes. | ||
| ② □ 改善するつもりである(概ね6ヶ月以内) I plan to make changes in the next six months. | ||||
| ③ □ 近いうちに(概ね1ヶ月以内)改善するつもりであり、少しずつ始めている I plan to make changes little by little starting soon. | ||||
| ④ □ 既に改善に取り組んでいる(6ヶ月未満) I've made changes in the last six months. | ||||
| ⑤ □ 既に改善に取り組んでいる(6ヶ月以上) I've made changes more than six months ago. | ||||
| 18 | 生活習慣の改善について保健指導を受ける機会があれば、利用しますか。 Are you generally interested in a consultation regarding lifestyle changes? | □ はい Yes | □ いいえ No | |
