Formulario · Español
Registro de Paciente
New patient registration and medical history form.
- Form type
- reg
- Language
- Spanish (Español)
- Archive source
- AMDA-IMIC Japan forms library, 2013–2024
About This Form
This page documents the Registro de Paciente as provided in Spanish through AMDA-IMIC's multilingual forms library. The form is used for: new patient registration and medical history form..
First-time patient registration is required at all Japanese medical facilities, regardless of prior care elsewhere. The registration card creates the patient's record and links it to their health insurance. For foreign residents, this process requires additional care: insurance card numbers are formatted differently from those held by Japanese nationals, and self-pay procedures differ from insured ones. The AMDA-IMIC registration form was designed to capture both standard Japanese patient data fields and the additional information specific to foreign patient circumstances.
For the original administrative forms in active use, contact the relevant Japanese institution directly — a hospital, employer, local health center, or labor bureau — depending on which form is needed. This reference documents the structure and purpose of the forms as they were used during the 2013–2024 period when AMDA-IMIC was operating.
Form Sections and Fields
The following sections and fields appear in the Spanish version of this form. Field labels are rendered here in English for reference; the original form presents them in Spanish (Español).
- Full name (romanized — family name, given name) and name in local script if applicable
- Date of birth and age
- Gender
- Nationality
- Current address in Japan and home country address
- Contact telephone (mobile and home)
- Emergency contact name and telephone
- Health insurance type (Kokumin Kenko Hoken / Shakai Hoken / Private / Uninsured)
- Health insurance card number and validity period
- Known allergies (medications, foods, environmental)
- Current medications (name, dose, frequency)
- Prior significant medical conditions or surgeries
- Primary language and language assistance required (yes/no)
How to Obtain This Form
The forms documented on this site were originally distributed by AMDA-IMIC through its consultation service and language-specific subdomains. Since the center closed in 2024, the forms are no longer distributed through that channel. Equivalent forms for current use are available from the relevant Japanese institution: municipal health centers issue administrative forms, hospitals provide their own registration and appointment materials, and the Labor Standards Inspection Office supplies labor insurance documentation.