《Health Guidance and Consultations》（Hongo, Komaba, Kashiwa）■Ⅰ 措置不要 （Normal）
No action necessary. Please continue to maintain your health.
■Ⅱ 要保健指導 （Health consultation by nurse recommended）
Health Guidance by appointment only. Please call-in advance. (Reception time: 9：00～17：00)*If you would like to undergo a re-examination by visiting the Internal Medicine Dept. of the Health Service
Center, please refer to the information below.
Hongo
Tel: 03-5841-2579・2580
ext. 22579・22580
Health Service Center
E-mail: hoken-kanri-hongo.adm[at sign]gs.mail.u-tokyo.ac.jp
KomabaTel: 03-5454-6166ext. 46166
Health Service Center
E-mail: hoken-kanri-komaba.adm[at sign]gs.mail.u-tokyo.ac.jp
Kashiwa
Tel: 04-7136-3040
ext. 63040
Health Service Center
E-mail: hoken-kanri-kashiwa.adm[at sign]gs.mail.u-tokyo.ac.jp■Ⅲ 要医療 （Further examination / Treatment necessary）
Make sure to print out your Health Check-up Results and take them with you when consulting a doctor.
Following the consultation, please report the results using the online response form.
* If you have been advised to visit the Internal Medicine Dept. of the Health Service Center due to anabnormality found during the chest X-ray examination, please check “Re-examination schedules for X-ray”
on website and see the physician on the appropriate date and time.
*If you would like various referral letters (for chest X-ray examination, electrocardiogram examination)issued, please contact in advance the Health Service Center of the campus you wish to visit. If you do notcontact us in advance, we may not be able to accommodate your request.
Fee: referral letter (JPY 300 per copy), chest X-ray digital data (JPY 500)
If you wish to be examined at the Health Service Center *A report is required from the online response form.
【Internal Medicine Dept.】 （Opening times: weekdays from 10:00 to 12:20, and from 14:00 to 15:45）
https://www.hc.u-tokyo.ac.jp/en/guide/internal-medicine/〇As consultations are not by appointment, you may be required to wait before your consultation. Also, there
are no set dates for consultations. Please check the Health Service Center website for dates when there
are no consultations.
〇If an abnormal value in "urine protein", "urine occult bleeding" or "urine sugar" has been reported:Please obtain a container for urinalysis from the health center beforehand and collect a urine sample firstthing on the morning of the day of your visit.
〇If an abnormal value in " HbA1c", "glucose", "urinal sugar", "triglycerides", "HDL cholesterol", or "LDLcholesterol" has been reported:
A blood sample may be required. Please do not have anything to eat for at least ten hours before coming
for your examination. (Please make sure to keep hydrated by taking drinks without calories, such as water or straighttea.)〇Please make sure to bring your student or staff ID card.
〇Those who have previously used the Internal Medicine Dept. please make sure to bring your patient IDcard.
〇There is a consultation fee of JPY 100 depending on your status. (Separate charge will be made if moreexamination is required)■Ⅳ 要継続医療 (Under management of other medical facilities)
Please make sure to show your doctor the health check-up results and report the results using the online
response form.
■Ⅴ 他医療機関受診 (Checkup by other medical facilities)
Regarding abnormal values, please follow the instructions of the medical institution where you received
the examination and report the results using the online response form.

Go to online response form➚*Please fill out this "Response Form" and submit it to the Health Service Center ONLY if it is difficult to answer online.

Response Form

Status：Date：

Student・

Faculty & Staff

Common ID：

Name：

Department：

Contact (phone, Ext. number)① Health check-up item（Please place a ✓ in boxes below.）②

身体計測 (BMI, Abdominal girth)

脂質代謝 (Test for lipid metabolism)

血圧 (Blood pressure)

糖代謝 (Tests for diabetes mellitus)

尿検査 (Uric protein・Uric blood)

腎機能 (Kidney functions)

胸部 X 線 (Chest X-ray)

診察 (Physician examination)

心電図 (Electrocardiogram)

尿酸 (Uric acid)

血液一般 (Cell ingredients of the blood)

便潜血 (Fecal occult blood test)

肝・胆道系 (Liver functions)

CRP (Test for incidences of inflammation)

他検査 (Other exams)

LDH (Lactate Dehydrogenase)On consulting a medical clinic (Name:) following the health check-up,（Please place a ✓ in one of boxes below.）□1. No treatment or further follow-up is required.
□2. Follow-up check (no treatment, only for check-up or examination). Follow-up visit is on/□3. Starting out-patient treatment (e.g., internal medication, etc.)□4. Hospital care
□5. Others ()□6. I am discussing the results of this examination with my regular doctor from prior to the check-up.

.