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My Medical Summary 医療サマリー（1枚）

By Dr. Masa · physician licensed in Japan

Allergies, medicines, conditions, surgeries, family history — the things every new doctor asks, on one page in Japanese and English. Fill it in once, keep it on your phone, and show or print it at any clinic. Japanese doctors read this format in ten seconds; a twenty-page history, they can't.

Stored only on this device. データはこの端末にのみ保存されます。 Nothing is sent to us or anyone else — there is no account and no server, and no script on this page can read what you type (the only external script is Cloudflare's page-view counter, which sees the page URL, not the form). That also means: clearing this browser's data erases it, and no other device can see it — use Backup now and then. Don't fill this in on a shared or public computer. You can add a passcode (below) that encrypts it on the device.

1Basics 基本情報

Name (optional) 氏名（任意） Date of birth 生年月日 Sex 性別 Blood type 血液型 Height (cm) 身長 Weight (kg) 体重 Home country 出身国 Languages you speak 使用言語

2Allergies アレルギー

No known allergies アレルギーなし

Pick from the list for a Japanese label, or type your own. Say what happens (rash, swelling, anaphylaxis) — that is what the doctor needs.

3Current medicines 現在の内服薬・使用薬

Type the generic or brand name — 355 common medicines get their Japanese name added automatically. Include supplements and the pill.

4Conditions 既往歴・治療中の病気

5Surgeries & hospital stays 手術歴・入院歴

6Family history 家族歴

Parents, siblings, children, grandparents — diabetes, heart disease, stroke, cancers, anything hereditary.

7Lifestyle & other 生活歴・その他

Smoking 喫煙 If smoking: per day / years 本数・年数 Alcohol 飲酒 If drinking: how much 量 Pregnancy 妊娠 If pregnant: weeks 週数

Implants, devices, other things a doctor must know 体内デバイス・特記事項 Anything else, in one line その他

8Contacts 連絡先

Emergency contact 緊急連絡先（氏名・続柄） Their phone 電話番号 Doctor at home (optional) 母国の主治医（任意）

9Save 保存

Restore backup

Passcode (optional) パスコードで暗号化（任意）

Adds a passcode that encrypts the summary on this device, so someone holding your unlocked phone can't read it. Trade-off: in an emergency, nobody else can open it either, and there is no recovery if you forget it.

New passcode 新しいパスコード Repeat 確認

What this is: a patient-written summary, in a layout Japanese clinics can read at a glance. Japanese labels are fixed translations of listed items — free text stays in English. What it is not: a medical record, a prescription, or proof of anything; the doctor will still confirm what matters. Keep it short on purpose: one page is read, twenty are not. Nothing here is sent anywhere.