St. Luke’s International Hospital

St. Luke’s International Hospital


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)
  • 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/my number card, etc.)
    • An authorization from the patient (within 3 months)

      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

  • Telephone:

    +81 (0)3-5550-7091

  • Business hours:

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

Type of Document

Items Fee (JPY)
Medical Certificate for insurance (Japanese)  7,027
 Medical Certificate in free format(Japanese)  3,718
 Medical Certificate in free format(English)  5,958
 Medical Certificate in Hospital Format (English)  3,718
 Death Certificate(Japanese)  3,718
 Death Certificate(English)  5,958
 Birth Certificate(English)  5,958
 Examination Results(Per examination)  61
 X-ray Film(CD-R)  1,324
 Medical Record Disclosure Fee  5,500
 Copy of Medical Record(per page)  27
 Discharge of Summary  3,300

Document Translations

Documents, such as itemized bill for the insurance claim or test reports will be issued only in Japanese. However, most major insurance companies have their own translation departments and accept documents in Japanese. Please inquire with your insurance company if they can accept documents in Japanese. If the insurance company still demands documents in English, please contact a professional translation company/agency at your own volition. One such company we can introduce is as follows:

Emergency Assistance Japan

Please contact the above company directly in regards to timelines and fees.