Health Check


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.

2013-06-13.90.Health.jpg 2013-06-13.91.Health.jpg

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

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 pressure12356
脂質異常症(高脂血症)Lipid abnormality (hyperlipidaemia)12356
心疾患(狭心症・心筋梗塞等)Heart disease12356
痛風(高尿酸血症)Gout (hyperuricemia)12356
胃十二指腸疾患Gastroduodenal ulcer12356
血液疾患(貧血等)Blood disease (anemia, etc.)12356
肝疾患Liver disease12356
呼吸器疾患Respiratory illness12356
肺結核Pulmonary tuberculosis12356
慢性腎臓病・腎不全(人工透析等)Renal failure (dialysis)12356
その他の腎疾患(結石等)Other kidney disease (kidney stones, etc.)12356
婦人科Gynecology (birth control)12356
眼疾患(高眼圧等)Eye disease (ocular tension, etc.)12356
脳出血・脳梗塞Cerebral hemorrhage or stroke12356


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 breathCoughむくみSwelling, edema
疲れやすいEasily tiredPhlegm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.

For women only.
Are you currently menstruating?
□ はい Yes       □ いいえ No
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.

Are you taking medicine to lower your blood pressure?
□ はい Yes (薬品名 Medicine name)□ いいえ No
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
Are you taking medicine to lower your cholesterol?
□ はい Yes (薬品名 Medicine name)□ いいえ No
At present, do you have a smoking habit?
□ はい Yes□ いいえ No
Have you gained more than 10 kg since you were 20 years old?
□ はい Yes□ いいえ No
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
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
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.
Do you eat faster than others?
□ 速い Fast□ 普通 Normal□ 遅い Slow
Do you have dinner less than 2 hours before bed 3 or more times a week?
□ はい Yes□ いいえ No
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
Do you skip breakfast 3 or more times a week?
□ はい Yes□ いいえ No
How often do you drink alcohol?
□ 毎日 Every day□ 時々 Sometimes□ ほとんど飲まない Rarely
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
Do you get enough sleep?
□ はい Yes□ いいえ No
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.
Are you generally interested in a consultation regarding lifestyle changes?
□ はい Yes□ いいえ No