English forms brought by patients are basically unacceptable. Required information may be added to our own form.
Any document which requires doctor’s signature is charged.
How to apply
Application for the medical certificates is only acceptable on Weekdays 8:30am-5:15pm at Window #2, 1st floor, and we need to confirm details at this time. Please make your payment for the certificate at Window #5 on the day of applying, and show the receipt at Window #2 to begin your application.
◆ For submitting to Japanese Insurance companies, bring the Medical Certificate Form that the insurance company issued.
◆ For the cases that there are special forms written in Japanese language, bring the forms.
※Please submit your Hospital ID card or Identification Card such as Driver’s License.
If the applicant is not the patient to be treated, the letter of attorney is required to submit. (The form is available at Window #2)
If the patient is deceased, an original form of family register is required to confirm the relationship between the patient and the applicant.
For further questions, please ask at 0956-24-1515 Ext.6193, Window #2, 1st floor.*Available only in Japnese.
How to receive Certificates
Time length until your certificate issued
We give you the estimated date your certificates get issued when you apply. Usually it takes about 2 weeks except weekends and holidays. However, it may take more than 2 weeks during the season of renewing certificates for the Public Health Care Plans.
Receiving certificates by domestic mail service
We basically send the certificates by mail except a specific one.
Prepare the stamps in advance and submit them when you apply for the certificates.
(Stamps are available at the convenience store, 1st floor.)
￥244 stamp is required for a certificate. ￥254 for 2 certificates.
|Medical certificate||Special Certificate （Described in the form issued by insurance companies／Described in our form for overseas insurance companies）||Death Certificate||1||5,500 yen||11,000yen|
|Disability Certificate (Hospitalization Certificate)||1||5,500 yen||11,000yen|
|Residual disability Medical certificate for Automobile damages Liability insurance||1||5,500 yen||ー|
|Automobile damages liability insurance certificate||1||4,950 yen||ー|
|Other Special Certificate||Welfare pension or related certificate||1||4,400 yen||ー|
|National pension / Welfare annuity certificate||1||4,400 yen||ー|
|A-bomb victims certificate /
Certificate for its benefit application
|Physically handicapped certificate||1||5,500 yen||ー|
|Traffic disaster mutual aid certificate
(Described on the form issued by
local public organizations)
|Pension Certificate||3||5,500 yen||ー|
|Other Medical Certificate||Death Certificate||1||2,750 yen||ー|
|Death Certificate accompanying death notice(for city hall)||1||4,400 yen||ー|
|General Medical Certificate||1||2,750 yen||5,500yen|
|Death Inspection Certificate According to Police Request||1||22,000 yen||ー|
|Certificate||Pregnancy Certificate||1||2,750 yen||ー|
|Birth Plan Certificate||1||2,750 yen||ー|
|Birth Certificate(for city hall)||1||3,300 yen||ー|
|Stillbirth Certificate||1||2,750 yen||ー|
|Certificate of Hospitalization and Consultation Date with Diagnosis||1||2,750 yen||ー|
|Various Certificate except for Medical Treatment (including certificate of receipt)||1||550 yen||1,100yen|
|Specification||Itemized bill for Automobile damages liability insurance||1||1,650 yen||ー|
|Other||Certificate for Suspension of Attendance and Return Permission to school due to infectious disease||1||330 yen||ー|
※Any additional certificates issued on the same day with the same contents from first one will be a half price each except Pension Certificate.
※The fee price which is not described on the chart is determined by our supervisor in each occasion.
※The fee price in the chart including 10% of tax. *The fraction under ￥10 from total tax shall be discarded.