Medical Examination Flowchart 1-A. Chest X-ray Examination(X-ray analysis by medical institutions in Japan)
Ver. Feb 2018

Application process

Has the applicant consented to a chest X-ray scan and submitted X-rays with
their application form?
Yes

Screening process

No

Request a medical institution in Japan to analyze
the X-rays

Screen out theapplicant

Send the X-ray analysis results to the domestic
training manager

Fill in Appendix 2 based on the results

Submit the completed Appendix 2 to the ICP Director toobtain approval

Local training
manager

Domestic training
manager(Course Leader)

Medical institutionin Japan

Trainingadministrator

Medical Examination Flowchart 1-B. Chest X-ray Examination (X-ray analysis by NCGM radiologists)
Ver. May 2023

Has the applicant consented to a chest X-ray scan?

Application processYes* X-rays taken within a year before the start of
the training session are valid

Does the applicant have access to X-ray scanning services in their country?

Yes

NoNo

The applicant is not allowed toparticipate in training in Japan(not allowed to enter Japan)

Send an X-ray digital data (DICOM-PDI format) or film
to the domestic training manager in NCGMRequest the training administrator to create a patient ID card for X-ray analysis

An arrangement should be made to consult a doctor on
behalf of the applicant to help them undergo X-ray
examinations in Japan after they arrive

Request an outpatient receptionist to issue a patient ID card and capture theX-ray images / Request a radiologist (diagnostic radiology doctor) to analyze
the X-ray images

Request the ICP team to issue a patient ID cardand make an appointment

The radiologist analyzes the X-ray images, completes the analysis report, andinforms the training administrator of completion

Consult a doctor on behalf of the applicant
Allowed to enter Japan

Confirm the X-ray analysis results received through the training administrator

NormalPlace an order for X-rayexaminations

Abnormal

Not allowed to enter Japan

Fill in Appendix 3 andsubmit it to the domestic
training manager

Inform the ICP Director
Fill in Appendix 2Submit the completed
Appendix 2 to the ICP
Director to obtain approval

Request the applicant to submit additional
materials and undergo additional examinations

The doctor in charge in the applicant’s country fills in theMedical Certification for TB Control (Appendix 4) basedon the additional materials and examination results

The ICP Director makes a final decision within twodays from the receipt of the additional materials

Screening process

Local training
managerTake the applicant to the medicalinstitution on the appointed day

Fill in Appendix 3 based on theexamination results and submit it to
the domestic training manager

Inform the applicant of the consequences and screening results

Domestic training
manager

ICP Director

Training
administrator

Medical Examination Flowchart 2-A. Measles, Mumps, Rubella, and Varicella (MMRV)Ver. Feb 2018
The domestic training manager should directly communicate with participants via email (and send CCs to the local training managers).
If the domestic training manager has difficulty communicating with some participants, institutional support should be provided tofacilitate the communication through the local training managers in their countries.

Application process

Has the applicant consented to MMRV tests and vaccinations?
YesNo

No later than 6 weeks before the training session starts
Confirm whether the participant has received two doses of MMRV vaccines (Vaccination cards without lotnumbers are acceptable though it is desirable to include such information)
Yes
NoNo later than 6 weeks before theNo later than 6 weeks before thetraining session starts
training session starts

Screen out the applicant

Confirm whether the participant can access antibody tests
Help the participant scan and email vaccination cards orForm A2 to the domestic training manager, the training
administrator, and the local training manager

No later than 6 weeks before thetraining session starts

Not availableAvailable

Help the participant undergo antibody tests and scan or
photograph and email the test results to the domestic
training manager, the local training manager, and thetraining administrator as soon as possible

Fill in Appendix 2 based on the results
Submit the completed Appendix 2 to the ICP Director toobtain approval

Instruct the participant to receive
two doses at a minimum intervalof 28 days and at least a week
before the training session

No later than 6 weeks before
the training session starts
Confirm the testing methods and results based on the following
requirements (have them double-checked by medical professionals)

Inform the participant of the consequences

Go to the double
vaccination course inFlowchart 2-B

No later than 6 weeks before
the training session starts
Confirm whether the participant has followed the specified methods(Measles: EIA / NT / PA; Mumps: EIA; Rubella: EIA / HI; Varicella: EIA / IAHA

Yes

No later than 6 weeks before
the training session starts

No later than 6 weeks before
the training session starts

Confirm the test results

Confirm the test results
Positive and above thethreshold

Positive but below the threshold = weak
positive

Fill in Appendix 2 (Test Report)
based on the test results andsubmit it to the ICP Director toobtain approval

Inform the participant of theconsequences

NoPositive or ±Negative or ZeroNegative

The participant requires
one dose of vaccines

The participant requires
two doses of vaccines

The participant requires one
dose of vaccines(because it cannot be
determined whether theantibody levels exceed thethresholds)

The participant requires
two doses of vaccines

Go to the single
vaccination course in
Flowchart 2-B

Go to the double
vaccination course in
Flowchart 2-B

Go to the single
vaccination course in
Flowchart 2-B

Go to the double
vaccination course in
Flowchart 2-B

Thresholds for antibody positivity**Measles EIA method: 0.72 IU/mL or higher (16 or higher in Japan); NT method: 1:8 or higher; PA method: 1:256 or higher
Mumps EIA method: Positive (4 or higher in Japan)
Rubella EIA method: 18.4 IU/mL or higher (8 or higher in Japan); HI method: 1:32 or higher
Varicella EIA method: Positive (4 or higher in Japan); IAHA method: 1:4 or higher

Local trainingmanagerDomestic training manager(Course Leader)

DCC doctor incharge

Trainingadministrator

Medical Examination Flowchart 2-B. Measles, Mumps, Rubella, and Varicella (MMRV)Ver. Feb/2018

If the participant needs to get vaccinated…
No later than 6 weeks before the training session starts
Send an email to inform the participant of the need to get vaccinated (and send a CC to the local training manager and the training
administrator) and confirm whether the participant can receive the required number of doses in theircountry

If the participant requires one dose of vaccines…
(i)
If the participant can get
vaccinated in their country
at least a week before thetraining session

Inform the local training
manager that theparticipant needs toreceive one dose at a
medical institution in theircountry

If the participant requires two doses of vaccines…

(ii)
If the participant cannot
get vaccinated in theircountry by a week before
the training session

Request the travel clinic toissue a patient ID card andmake an appointment(iii)
If the participant cancomplete two doses intheir country at least a
week before the training
session(iv)
If the participant can only
receive one dose in theircountry by a week before
the training session

No later than 6 weeks before thetraining session starts

No later than 6 weeks before thetraining session starts

Instruct the participant tocomplete two doses at a
medical institution in theircountry at a minimum
interval of 28 days and at
least a week before thetraining session

Instruct the participant toreceive one dose at a
medical institution in theircountry at least 4 weeks
before the training session

Consult a doctor on behalfof the participant

Help the participant receive
two doses at a minimum
interval of 28 days and fill in
Form A2 or get vaccination
certificates at least a week
before the training session

Immediately after vaccination

Help the participant scan or
photograph and email Form
A2 or vaccination certificatesto the domestic training
manager, the local training
manager, and the training
administrator

Confirm the submitted
documents, fill in Appendix
2 based on the documents,and obtain approval fromthe ICP Director

Inform the participant thatthey may not be allowed toattend clinical training
during the training session

Request the travel clinic toissue a patient ID card andmake an appointment

Help the participant
receive one dose and fill inForm A2 or get vaccination
certificates
Place an order for
vaccination(v)
If the participant cannot
receive any doses in theircountry by a week before
the training session

Take the participant to therelevant department on theappointed day

Fill in Appendix 3 based on
the vaccination history andhand it over to the domestic
training manager

Help the participant receive
one dose and fill in Form
A2 or get vaccination
certificates and email it to
the domestic training
manager, the local training
manager, and the training
administrator

Request the travel clinic toissue a patient ID card andmake an appointment

Consult a doctor on behalfof the participant

Place an order for
vaccination

Consult a doctor on behalfof the participant

Place an order for antibody
testing
Place an order for varicellavaccination

Take the participant to therelevant department on theappointed day

Fill in Appendix 3 based on
the test results anddetermine the participant’s
eligibility to attend clinicaltraining
Hand over Appendix 3 to thedomestic training manager

Inform the participant of the consequences
Local training
manager

Domestic training manager(Course Leader)

DCC doctor incharge

Training
administrator