When you visit a doctor’s office or hospital in Japan, you’ll be asked to be fill out a short medical questionnaire / examination form. In Japanese, this form is called a 問診票 (monshinhyou). Basically, this is the intake form where you provide basic information about yourself, your symptoms and a little about your medical history.
In this article, we provide English translations of the most commonly asked questions and words used in a typical medical questionnaire.
Some major hospitals in Tokyo, Osaka, and other big cities have English-speaking staff and English forms but most clinics and hospitals in smaller cities do not. In Tokyo, three well-known hospitals serving the English-speaking community are: Tokyo Takanawa Hospital Internatioal Clinic, St. Luke’s International Hospital, and Sanno Hospital.
There is no single standard Japanese medical questionnaire/exam form. Here is an example of a form you would fill out at an internal medicine clinic (where you would go, for example, if you have a cold or need a primary care physician).
Below we give the Japanese kanji, romaji, and English translation of the most commonly asked questions and commonly used words.
General Information
Japanese | Romaji | English |
氏名
|
Shimei | Name |
日付 | Hizuki | (Today’s) Date |
生年月日 | Seinengappi | Birthdate |
年 | Nen | Year |
月 | Tsuki | Month |
日 | Hi | Day |
性別 | Seibetsu | Sex |
男 | Otoko | Male |
女 | Onna | Female |
ご住所 | Gojūsho | Address |
連絡先 | Renraku saki | Contact Info |
自宅 | Jitaku | Home |
携帯 | Keitai | Mobile |
身長 | Shinchō | Height |
体重 | Taijū | Weight |
本日の温度 | Honnichi no ondo | Your body temperature (today) |
現在通院中の病院などはありますか? | Genzai tsūin-chū no byōin nado wa arimasu ka? | Are you currently going to any other hospitals/clinics? |
Symptoms
Not all questionnaire forms have a section asking you to check off your symptoms, but it’s still useful to know the main words to describe the most common ones.
Japanese | Romaji | English |
症状 | Shōjō | Symptoms |
どのような症状ですか? | Dono yōna shōjō desu ka? | What symptoms do you have? |
それはいつからですか? | Sore wa itsu kara desu ka? | When did the symptoms start? |
今日 | Kyou | Today |
昨日 | Kinou | Yesterday |
一週間前 | Isshūkanmae | One week ago |
一ヶ月前 | Ikkagetsumae | One month ago |
以上 | Ijyou | More than. As in “More than 1 month ago” |
喉が痛い | Nodo ga itai | Sore throat |
胸が痛い | Mune ga itai | Chest pain |
吐き気 | Hakike | Nausea |
下痢 | Geri | Diarrhea |
血便 | Ketsuben | Bloody stool |
高血圧 | Kōketsuatsu | High blood pressure |
疲れやすい | Tsukareyasui | Easily fatigued |
身体がふるえる | Karada ga furueru | Shaking / shivering |
めまい | Memai | Dizziness |
せき | Seki | Cough |
胸が苦しい | Mune ga kurushii | Chest discomfort |
嘔吐 | Ōto | Vomiting |
お腹が張る | Ohara ga haru | Abdominal swelling |
熱がある | Netsu ga aru | Fever |
眠れない | Nemurenai | Can not sleep |
体重が減っている | Taijū ga hette iru | Weight loss |
勝手に動く | Katte ni ugoku | Involuntary (body) movements |
口が渇く | Kuchi ga kawaku | Dry mouth |
動悸 | Dōki | Palpitations |
胃が痛い | I ga itai | Stomachache |
お腹が痛い | Onakagaitai | Abdominal pain |
息切れ | Ikegire | Shortness of breath |
発疹 | Hosshin | Rash |
だるい | Darui | Lack of energy |
食欲がない | Shokuyoku ga nai | Loss of appetite |
寒い | Samui | Coldness |
全身にむくみがある | Zenshin ni mukumi ga aru | Swelling of the whole body |
体にの部にむくみがある | Karada no ichibu ni mukumi ga aru | Swelling in part of the body |
痺れ | Shibire | Numbness / tingling |
その他 | Sonota | Other (Symptoms) |
Medical History
These questions cover your medical history, including whether you’ve ever had a major illness, whether you’re allergic to anything and your smoking and drinking habits.
Japanese | Romaji | English |
はい | Hai | Yes |
いえ | Ie | No |
現在治療している病気はありますか? | Genzai chiryō shite iru byōki wa arimasu ka? | Are you currently undergoing treatment for any illnesses? |
病名 | Byōmei | Name of disease |
薬や食べ物でアレルギーがでますか? | Kusuri ya tabemono arerugī ga demasu ka? | Are you allergic to any foods or medications? |
薬 | Kusuri | Medication |
食べ物 | Tabemono | Food |
その他 | Sonota | Other |
現在飲んでいる薬はありますか? | Genzai nonde iru kusuri wa arimasu ka? | Are you currently taking any medications? |
持っていれば見せてください | Motte ireba misete kuta ゙ sai | Please show us the medications if you have them with you. |
今までにかかった病気はありますか? | Ima made ni kakatta byōki wa arimasu ka? | Have you previously had any of the diseases listed below? |
胃腸の病気 | Ichō no byōki | Gastrointestinal disease |
腎臓の病気 | Jinzō no byōki | Kidney disease |
脳・神経系の病気 | Nō shinkei-kei no byōki | Brain and nervous system diseases |
甲状腺の病気 | Kōjōsen no byōki | Thyroid disease |
肝臓の病気 | Kanzō no byōki | Liver disease |
呼吸器の病気 | Kokyū-ki no byōki | Respiratory disease |
糖尿病 | Tōnyō-byō | Diabetes |
心臓の病気 | Shinzō no byōki | Heart disease |
血液の病気 | Ketsueki no byōki | Blood disease |
癌 | Gan | Cancer |
たばこを吸いますか? | Tabako o suimasu ka | Do you smoke? |
吸う | Suu | (Yes), I smoke. |
現在 | Genzai | Currently. As is, “Cuurently, how much do you smoke?” |
本/日 | Hon / Hi | # of Cigarettes Per Day |
喫煙歴 | Kitsuen-reki | Duration (How long you smoked) |
以前吸っていた | Izen sutte ita | No, but I used to smoke. |
過去 | Kako | Previous (amount you used to smoke). |
吸わない | Suwanai | No, I don’t smoke |
お酒を飲みますか? | Osake o nomimasuka? | Do you drink alcohol? |
手術を受けたことがありますか? | Shujutsu o uketa koto ga arimasu ka? | Have you ever had surgery |
いつごろですか? | Itsu goro desu ka? | When (did you have surgery)? |
手術名 | Shujutsu-mei | Type of surgery |
麻酔を受けたことがありますか? | Masui o uketa koto ga arimasu ka? | Have you ever had anesthesia? |
全身麻酔 | Zenshin masui | General anesthesia |
局所麻酔 | Kyokusho masui | Local anesthesia |
麻酔をして何かトラブルがありましたか? | Masui o shite nanika toraburu ga arimashita ka? | Did you have any problems related to the anesthesia? |
妊娠していますか、またその可能性はありますか? | Ninshin shite imasu ka, mata sono kanōsei wa arimasu ka? | Are you pregnant or is it possible? |
ヶ月 | Ka getsu | [Number] of months (pregnant) |
わからない | Wakaranai | I do not know. |
授乳中ですか? | Junyū-chūte desu ka? | Are you breastfeeding? |
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