Patients who wishes the medical treatment information to be disclosed

Because of a medical treatment information is a crutial private information, so based on parivacy information protection point of view, we will disclose Medical Treatment information after when we deliberate it inside the hospital in accordance with laws and regulations and our stipulation.

The scope of disclosure

• Medical Treatment Log, Nursing Record, Prescription Record, Checkup Record and Checkup Result Report, X-ray photograph, etc, the record which we at hospital created or obtained for the purpose of the medical treatment.

Person who is able to claim a disclosure

• In principle, Patient itself is able to claim the disclosure.
  • Please consult with us when Patient is unable to judge by itself, unable to submit the application due to phisical requirement reason, or nonage or patient is deceased. Also depend on the case consideration, we may disclose the information to representative person.

Items needed for disclosure procedure

• Application Form for Medical Treatment Information disclosure (Form designated by the hospital) ….......Please ask for a form at 1F General Reception Desk.
• Ientification Card (Driver License, Passport, Residence Certificate, etc)
  • For the deseased person's disclosure application, please prepare any kind of document which is able to prove the relation with the deseased patient.
    (Family Register, etc)
  • The expense accrued from the preparation of requested documents is a applicant responsibility.
  • when any descrepancy found in the ietms for the application, we regret to say we are unable to accept the disclosure application.
  • Please understand that entire documents for the disclosure application is unable to return to an applicant. Please bear in a mind in prior.
  • In principle, Representative's application is unable to accept other than deseased person's disclosure. But when Personal Identifiction sheet, items which is able to prove a relationship with a patient (Family Register, etc), and Authorization letter for which patient itself signed or letter of consent, are presented, we at Hospital will deliberate the authorization of the procedure.

Disclosure Method

Please ask for the "Medical Treatment Information Control Section" about the cost, such as commission charge.

• Duplication(Copying) of the Medical Treatment information (Black and white copy only)
• X-ray Photograph CD-ROM
• Pathological Prepared Slide
  • Copying charge for the original of medical treatment information is other than A4 size, charges as the same as A4 document.
  • Please understand that the document may be created and issued in a different form or style from its original document due to writing style of the paper medical treatment record or screen layout of the electronic chart.

※Please ask Medical Treatment information Management Unit for further detail.

Contact
Telephone Number	０４８－５６２－３０００ (Medical Treatment Information Management Unit)