「Refferal Letter」作成時の質問内容(問診票)
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- Tuberculosis (TB), treatment for tuberculosis? (結核の治療を受けていますか?)
- Close household contact with Tuberculosis (TB)? (家族に結核の人がいますか?)
- Have you ever been admitted to hospital and/or received medical treatment for an extended period for any reason (including for a major operation or treatment of a psychiatric illness)? (あなたは、長期にわたる入院や治療を受けていますか?(大手術や精神疾患の治療を含む))
- Do you suffer, or have you ever suffered, from mental health problems? (いままでに精神疾患を患いましたか?)
- Have you ever been told you are HIV positive? (HIV感染していると言われたことはありますか?)
- Do you have, or have you ever had, hepatitis, problems with your liver or yellowingof the skin? (肝炎などになったり、黄疸がありますか?)
- Do you have or have you had cancer in the last 5 years? (過去5年にガンになったことはありますか?)
- Do you have high blood sugar / diabetes? (あなたは高血糖や糖尿病をもっていますか?)
- Do you have heart problems, including high blood pressure or a heart condition that you were born with? (心臓病、高血圧、生まれつきの心臓の病気をもっていますか?)
- Do you have a blood condition? (血液疾患ですか?)
- Do you have bladder or kidney problems? (膀胱や腎臓に問題がありますか?)
- Do you have a physical or intellectual disability that make it difficult for you to function independently (for example, to move around or learn) or work full-time? (肉体的、精神的に、自力で活動できない障害を抱えていますか?)
- Do you need to take drugs or drink alcohol regularly? (あなたは、定期的に薬や、アルコールを服用する必要がありますか?
- Are you taking any prescribed pills or medication (excluding oral contraceptives, over-the counter medication and natural supplements)? (あなたは、病院から処方された錠剤または薬を服用していますか?(店頭薬、天然サプリメント、経口避妊薬は除く。))
- Are you pregnant? (妊娠していますか?)