MS. IIJIMA was seen at your clinic regarding the above-mentioned diagnosis from 25 April 2016~26 April 2016.
According to the medical report, you stated “She had sought treatment at several specialist clinics in Singapore and Japan but with little improvement.
1) If you know, please advise us when she had treatment in Japan?
Date(approx. year and month is fine) :_________________________
2) Or it was just information from the patient?
□ Yes
(from patient information, that is why , does not know when patient had
Treatment in Japan)
□ No