St. Luke’s International Hospital

St. Luke’s International Hospital

Documentation

Application process

Please fill out the Application for Documents, and submit to the Document Service Desk (1st floor, Counter #9.)

A medical certificate form for life insurance companies and various public fund institutions requires a designated form.

For hospitalized patients : the following documents must be applied at your ward

  • Documents urgently necessary for your company, etc. after discharge (Not a designated form)
  • "Lump-sum birth allowance" and Application form for "Lump-sum birth allowance"
  • Medical Report or Letter to other hospitals

Notes upon Application

  • You will need a physician' s consent beforehand depending on the document
  • We ask the patient to be applied for documents at the counter. The documents will be sent through postal mail

    If it is difficult to visit the hospital, application through e-mail or postal mail will be also accepted. Please send us the application for Documents with a copy of your ID.

  • In cases the claimant is not the patient, the documents below are additionally required:
    • An ID of the person applying (insurance card/driving license, etc.)
    • An authorization from the patient

      When the authorization cannot be given by the patient, an extra documentation will be required. Please ask us for more information.

  • Disclosure of Medical Information
  • Only patients have a right to ask for the disclosure of their medical charts. However, others may ask for the disclosure of our patient’s medical charts under these circumstances as below:

    1. The attorney, if the patient has him/her
    2. An arbitrarily-chosen conservator who has the authority of representation for medical treatment codes
    3. Relatives or those who received the authorization from the patient
    4. Relatives or those taking care of the patient, when it is suspicious that patient have an appropriate capacity for judgment even though he/she is above 20

Documentation Counter/Business Hours

Counter #9 on the 1st floor, Main Building

  • Email:

    gaimu@luke.ac.jp

  • Telephone:

    +81 (0)3-5550-7091

  • Business hours:

    Weekdays 8:30AM-5:00PM
    Saturday 8:30AM-4:00PM (except 1:30-2:30PM)

Type of Document

Items Fee (JPY)
Medical Certificate (Japanese) 3,650
Medical Certificate (English) 5,850
Medical Certificate for insurance (Japanese) 6,900
Medical Certificate for insurance (English) 3,650
Payment certificate 1,500
Birth Certificate (English) 5,850
Death Certificate (Japanese) 3,650
Death Certificate (English) 5,850
Examination Results 60
X-ray Film (CD-R) 1,300
Medical Record Disclosure Fee 5,400
Copy of Medical Record (per page) 27
Discharge of Summary 3,240