서류 · 한국어
검사 신청서
Standard health examination request form used for scheduling diagnostic assessments.
- Form type
- exa
- Language
- Korean (한국어)
- Archive source
- AMDA-IMIC Japan forms library, 2013–2024
About This Form
This page documents the 검사 신청서 as provided in Korean through AMDA-IMIC's multilingual forms library. The form is used for: standard health examination request form used for scheduling diagnostic assessments..
Health examinations in Japan's public health system follow a defined request process. Employers, schools, and municipal health centers all issue standardized examination requests that identify the patient, specify the examination type, and indicate the responsible institution. Foreign residents use this form when referred for diagnostic work, including blood panels, imaging, or specialist assessments not initiated during a standard consultation visit.
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 Korean version of this form. Field labels are rendered here in English for reference; the original form presents them in Korean (한국어).
- Patient full name (romanized and local script)
- Date of birth and age
- Gender
- Health insurance card number
- Contact telephone number
- Referring institution or physician name
- Examination type requested (blood / imaging / ECG / specialist)
- Clinical indication or chief complaint
- Date of referral
- Physician or institution stamp
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.