| Document Date: 2015-02-17 02:25:48
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Country Japan / / MedicalCondition Malaria / Epilepsy / recovery Tuberculosis / Drug Allergy / Other communicable disease / Heart Diseases / Functional Disorder / anemia / Disease / Diabetes / blindness / Kidney Disease / Cardiomegaly / / Position Physician / examining physician / / Technology X-ray / /
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健康診断書 CERTIFICATE OF HEALTH (to be completed by the examining physician) 日本語又は英語により明瞭に記載すること。 Please fill out (PRINT/TYPE)in Japanese or English. 氏名