Applying for Medical and Other Certificates

Where to Submit Your Application

Documentation Counter (on the second floor in front of the physiological function testing room)
Note: In some cases a visit must be made to the applicable ward.

Documentation Counter Hours

8:30 am to 4:30 pm Mondays to Fridays (weekdays only)

What You’ll Need

1. In-Person Applications
• A completed application form
• Proof of identity, such as a driver’s license or health insurance card

2. Applications by a Representative
• A completed application form
• A letter authorizing the representative to act on the applicant’s behalf
• Proof of the representative’s identity, such as a driver’s license or health insurance card
Note: If the certificate is for a deceased person, the applicant must provide proof of identity and a family register or other documentation demonstrating their relationship to the deceased.

Making an Application

Applications are made at the documentation counter.
Note: In principle, applications must be made in person, but application can be made by mail if you are unable to come to the hospital.

If you wish to apply by mail, you will in addition to the items listed above need to note the following (the name of the attending physician, patient’s name, patient registration number at the Center, and contact information) and include a self-addressed “Letter Pack Plus” envelope with the tracking sticker removed.

“Letter Pack Plus” postage: ¥520

Note: Because the forms contain personal information, a “Letter Pack Plus” envelope is requested to ensure secure delivery to the applicant.

Processing Time

Processing generally takes ten business days.
Note: This is an estimate only; processing may take longer as some doctors only attend hospital once a week.

Fees

The fees vary with the type of document requested.

General-purpose medical certificate, Japanese (in-house form)	5,500円
General-purpose medical certificate, English (in-house form)	11,000円
Certificate of birth, Japanese	5,500円
Certificate of birth, English	8,800円
Form requested by medical insurance provider, Japanese (record of admission, surgery, or hospitalization)	8,800円
Form requested by medical insurance provider, English (record of admission, surgery, or hospitalization)	11,000円
Pension fund physical or mental disability form	11,000円
Form pertaining to diagnosed chronic illness	5,500円

Note: All prices include tax.
Note: Inquire at the documentation counter for information on forms not listed above.

Additional Notes

• A separate application must be completed for each ward.
Note: If you were transferred between wards during your stay, each ward will issue a separate certificate.
• Medical and other certificates cannot be provided if the storage period for the relevant records has expired.
• The application procedure may differ depending on the document requested. For more information, be sure to inquire at the documentation counter.
　The documentation counter can be reached by phone via calls to reception.

Requesting Mail Delivery of Medical and Other Certificates

Requests for mail delivery of medical and other certificates should be sent to the Center’s documentation counter together with all the items listed below.
Mail delivery of medical and other certificates is a temporary service offered due to the COVID-19 pandemic and may be terminated at any time.

What You’ll Need

1. Applying on Your Own Behalf
• A completed application for medical or other certificates (pdf)
• Proof of identity, such as a driver’s license or health insurance card
• A “Letter Pack Plus” envelope

2. Applying on Behalf of a Third Party
• A completed application for medical or other certificates (pdf)
• Proof of the patient’s identity, such as a copy of their driver’s license or health insurance card
Note: If the certificate is for a deceased person, the applicant must instead provide a copy of a family register or other documentation demonstrating their relationship to the deceased.
• Proof of the applicant’s identity, such as a copy of their driver’s license or health insurance card
• A “Letter Pack Plus” envelope

Notices

• The completed certificate will be mailed using the “Letter Pack Plus” envelope included with the application.
• Write your address or the address of the person to whom the certificate is to be delivered in the “To” field. The Center will be listed in the “From” field.
• Remove the tracking sticker from the envelope and keep it in a safe place.
• The certificate will not be mailed if the “To” field is blank.
Note: Medical and other certificates containing personal information can be sent only via “Letter Pack Plus” envelopes, which ensure secure delivery to the applicant.