生年月日
date of birth
married / you / are / ?
Are you married?
Do you _________?
smoke/drink alcohol
病気
illness
肺炎
pneumonia
紹介状
a. referral letter
b. occupation
c. nationality
referral letter
nationality / is / your / what / ?
What is your nationality?
Do you have any ___________?
allergies
錠剤
pill
膵臓
pancreas
緊急連絡先
a. marital status
b. single
c. emergency contact
emergency contact
living / you / do / for / do / a / what / ?
What do you do for a living?
Have you ever had a serious ___________?
生活習慣
a. habit
b. lifestyle habits
c. eating habits
lifestyle habits
小腸
a. small intestine
b. large intestine
small intestine
海外旅行保険
a. health insurance
b. overseas travel insurance
c. insurance
overseas travel insurance
religious / beliefs / do / you / any / have / ?
Do you have any religious beliefs?
Are you currently taking any ______________?
medication
治療
a. injury
b. surgery
c. treatment
treatment
白血病
a. hepatitis
b. asthma
c. leukemia
leukemia
婚姻状況
a. marital status
b. married
c. divorced
marital status
in / case / emergency / of / who / should / contact / we / an / ?
Who should we contact in case of an emergency?
Have you been ______________ with any illness?
diagnosed
輸血
a. hemoglobin
b. leukemia
c. blood transfusion
blood transfusion
虫垂炎
a. prescribe
b. appendicitis
c. blood type
appendicitis