特定健康診査に関する質問 ... - amda-imic.com

1 Questionnaire on specific health examination English No1 31 Yes No2 Yes No3 Yes No4 Yes No5 Yes No6 Yes No7 Yes No8 Yes No9 Yes No10 Yes No11 Yes No Questionnaire on specific health examination 0ptions answers Are you taking the following medicines at present? Have you ever been told by the doctor you have a heartdisease ( angina pectoris, myocardial infarction, etc ) andreceived treatment? Have you ever been diagnosed as having chronic kidneydisease or kidney failure and received treatment (dialysistherapy)?

2 Have you ever been diagnosed as anemic? 100 6 1 A heavy smoker refers to those who have smoked a total ofover 100 cigarettes or have smoked over a period of 6 monthsand has been smoking over the past Medication to reduce blood pressureb. Medication to reduce blood sugar or insulin injectionc. Medication to reduce your level of cholesterol or ofneutral fat Have you ever been told by the doctor you have a stroke( cerebral hemorrhage, brain infarction, etc.) and receivedtreatment?20 10K Have you gained over 10 kg from your weight at age 20?1 30 2 1 Are you in a habit of doing exercise to sweat lightly forover 30 minutes a time, 2 times weekly, for over a year?

3 1 1 In your daily life do you walk or do any equivalentamount of physical activity more than one hour a day?12 Yes No13 I can chew on anything. Sometimes I havedifficulty chewing due toproblems of tooth, gum, orocclusion. I can hardly quicker normal late15 Yes No16 Yes No17 Yes No18 everyday sometimes rarely drink cannnot drink 19 1 1 2 2 3 3 less than 180ml 180-360ml 360-540ml more than 540ml20 Yes No Which of these best describes your condition while eatingand chewing on food? Is your eating speed quicker than others ?

4 2 3 Do you eat supper two hours before bedtime more than 3times a week? 3 Do you eat snacks or drink sweet beverage betweenmeals ? Is your walking speed faster than the speed of those ofyour age and sex? 3 Do you skip breakfast more than 3 times a week ? How often do you drink ? (sake, shochu, beer, wine,whisky, or brandy, etc.) 1 1 180ml) 500ml 25 110ml 1 60ml) 2 (240ml)How much do you drink per day? Sake (180ml), beer(500ml), Shochu 25% (110ml), double whisky (60ml), twoglasses of wine (240ml) Do you sleep well and enough?21 1 (6 (6 Don't want Do want want to improve in nearfuture(within a month) andbegan to start already trying to improve(less than 6 months) already trying to improve(over 6 months)22 Yes No AMDA AMDA International Medical Information Center 2008 2017 2018 Do you want to improve your life habits of eating andexcercising?

5 Do you want to use the opportunity of health instructionsfor improvement of your life habits?