【様式１】To the guardians

Board of Education, Kashiwa City
Medical Certificate of School Infectious disease
When your child is diagnosed of any School Infectious Disease in accordance with the Schools Health and Safety Act (check the list in theseparate form), child will be suspended from school attendance. When a child is diagnosed any of the School Infectious Disease inaccordance with the Schools Health and Safety Act, please make sure to check with the doctor "When the symptoms appeared" and "Whenthe child can resume the school attendance" and engage in the recovery following the doctor's advise and resume the school attendance
when the child is fully recovered. The guardians must submit the medical certificate to the school, when the child resumes the school
attendance.

To: The principle of Municipal ofelementary school

Medical certificate
Grade:, Class:

I declare that the child has engaged in recovery since date:, Student number:, month:, Name:, (when the symptoms appeared), and symptoms are inremission and is duly recovered. The child resumes the school attendance from date:, month:.

Details
Tick theBenchmark to resume the school attendance

Name of Diseasedisease✔

5days (counting the next day as the first day) after the day the symptom appeared have

Influenza (A, B, Others)↑passed.

Tick one with circle ○Check 2 checkboxes are ticked

2 days (counting the next day as the first day) after the fever subsided have passed.

with ✔→
COVId-19 (Coronavirus Disease

5days (counting the next day of the day the symptoms appeared or the next day of the day2019）

taking the sample in case of no symptoms shown as the first day) after the day the symptoms
1day (counting the next day as the first day) after the day the symptom are in remission has

Check 2 checkboxes are ticked

passed.

with ✔→＊ Fever is subsiding without taking any Antipyretic medication and any symptoms in
respiratory are improving to heal.
The distinctive cough disappeared and the treatment with the proper antimicrobial substance

Pertussis, Whooping coughformulation for 5 days is completed.
3 days (counting the next day as the first day) after the day when the fever subsided have passed.

Measles

5 days (counting the next day as the first day) after the swelling of parotid glands, submandibular

Mumpsglands, sublingual glands appeared have passed and general condition is good overall.

RubellaThe rashes are totally healed.

Chickenpox
Pharyngal conjunctival Fever

The rashes are scabby and healed.
2 days (counting the next day as the first day) after major symptoms such as fever and hyperemia(PCF)

disappeared have passed.
3 consecutive negative results of sputum tests on different days and the physician gave theTuberculosis
Meningococcal Meningitis
Enterohemorrhagic Escherichia
Coli Infection（O157, O26, O111

clearance of any symptoms.
The physician gave the clearance of any symptoms.
The physician gave the clearance of any symptoms.

and others)

Epidemic Keratoconjunctivitis(EKC)
Acute Hemorrhagic

The physician gave the clearance of any symptoms.
The physician gave the clearance of any symptoms.

conjunctivitis (AHC), Apollo
DiseaseHemolytic Streptococcal

24hours after taking antibiotics has passed and general condition is good overall.

Infection

Type A and E liver function become normal. For Type B and C, there is not any restriction on school

Viral Hepatitis

attendance.

Infectious gastroenteritis(Norovirus , Rotavirus,Symptoms such as vomiting and diarrhea are under control and general condition is good overall.

Adenovirus and others)
Mycoplasma Pneumonia
Respiratory Syncytial Virus

Symptoms such as fever and coughing are improved and general condition is good overall.

Infection
When with the rashes (Erythema Infection) only and general condition is good overall, school

Erythema Infection

attendance is permitted.

Herpangina
Hand, Foot and Mouth Disease(HFMD)

While in acute stage with fever, blister and ulcer in the mouth and throat, school attendance issuspended. When general condition becomes good overall, school attendance is permitted.
The rashes are scabby and healed. When the infected area is covered appropriately, school

Shinglesattendance is permitted.

Other Infectious disease（）

The physician gave the clearance of any symptoms.

Name of the medical institute （）As above, there is not any discrepancy.
Year: Reiwa, Month:, Date:Name of the guardian:【様式１】To the guardians

Board of Education, Kashiwa City
Medical Certificate of School Infectious disease
When your child is diagnosed of any School Infectious Disease in accordance with the Schools Health and Safety Act (check the list in theseparate form), child will be suspended from school attendance. When a child is diagnosed any of the School Infectious Disease inaccordance with the Schools Health and Safety Act, please make sure to check with the doctor "When the symptoms appeared" and "Whenthe child can resume the school attendance" and engage in the recovery following the doctor's advise and resume the school attendance when
the child is fully recovered. The guardians must submit the medical certificate to the school, when the child resumes the school attendance.

To: The principle of Municipal

Kashiwa

elementary school

Medical certificate

SampleGrade: 1, Class: 1, Student number: 1, Name: Kashiwa TaroI declare that the child has engaged in recovery since date: 5th, month: September, (when the symptoms appeared),and symptoms are in remission and is duly recovered. The child resumes the school attendance from date: 11 ,month:
Details
Tick theBenchmark to resume the school attendance

Name of Diseasedisease✔

Influenza (A, B, others)✔

↑✔

Tick one with circle ○Check 2 checkboxes are ticked✔

with ✔→COVId-19 (Coronavirus Disease

5days (counting the next day as the first day) after the day the symptom appeared havepassed.
2 days (counting the next day as the first day) after the fever subsided have passed.
5days (counting the next day of the day the symptoms appeared or the next day of the day
taking the sample in case of no symptoms shown as the first day) after the day the symptoms
1day (counting the next day as the first day) after the day the symptom are in remission has2019）
Check 2 checkboxes are ticked

passed.

with ✔→＊ Fever is subsiding without taking any Antipyretic medication and any symptoms inrespiratory are improving to heal.
The distinctive cough disappeared and the treatment with the proper antimicrobial substance

Pertussis, Whooping coughformulation for 5 days is completed.
3 days (counting the next day as the first day) after the day when the fever subsided have passed.

Measles

5 days (counting the next day as the first day) after the swelling of parotid glands, submandibular

Mumps

glands, sublingual glands appeared have passed and general condition is good overall.

RubellaThe rashes are totally healed.

ChickenpoxPharyngal conjunctival Fever

The rashes are scabby and healed.
2 days (counting the next day as the first day) after major symptoms such as fever and hyperemia(PCF)

disappeared have passed.
3 consecutive negative results of sputum tests on different days and the physician gave theTuberculosis
Meningococcal Meningitis
Enterohemorrhagic Escherichia

clearance of any symptoms.
The physician gave the clearance of any symptoms.

Coli Infection（O157, O26, O111 The physician gave the clearance of any symptoms.
and others)
Epidemic Keratoconjunctivitis(EKC)
Acute Hemorrhagic

The physician gave the clearance of any symptoms.

The physician gave the clearance of any symptoms.

conjunctivitis (AHC), Apollo
DiseaseHemolytic Streptococcal

24hours after taking antibiotics has passed and general condition is good overall.

Infection

Type A and E liver function become normal. For Type B and C, there is not any restriction on school

Viral Hepatitis

attendance.

Infectious gastroenteritis(Norovirus , Rotavirus,Symptoms such as vomiting and diarrhea are under control and general condition is good overall.

Adenovirus and others)
Mycoplasma Pneumonia
Respiratory Syncytial Virus

Symptoms such as fever and coughing are improved and general condition is good overall.

Infection
When with the rashes (Erythema Infection) only and general condition is good overall, school

Erythema Infection

attendance is permitted.

Herpangina
Hand, Foot and Mouth Disease(HFMD)

suspended. When general condition becomes good overall, school attendance is permitted.
The rashes are scabby and healed. When the infected area is covered appropriately, school

Shinglesattendance is permitted.

Other Infectious disease（While in acute stage with fever, blister and ulcer in the mouth and throat, school attendance is）

The physician gave the clearance of any symptoms.

Name of the medical institute （Kashiwa city clinic）
As above, there is not any discrepancy.
Year: Reiwa 5, Month: September, Date: 11th
Name of the guardians

Kashiwa Shiro