Application form for a visit

• Emergency contact information may be a work address where the family can be reached.

• It is recommended that you purchase travel insurance (minimum coverage US$30,000) covering COVID19 treatment. Please check the box on the application form if you wish to purchase the University of Tokyo's travel insurance policy. After your return to Japan, the University will send you an invoice for the insurance fee.

  If you are not from Japan, you may purchase insurance for travel from and to Japan under the following conditions.

  1. Reside in Japan

  2. Able to understand Japanese

  3. have a resident card and pay taxes.

Copy of passport

To be used to request a visit to the TAO base facility and to provide information to El Loa Hospital in Calama.

Waiver agreement

• The term is for one year. Please submit all those who may have expired.

• Contractors with a contractual relationship with TAO are not required to submit this.

The Institute of Medical Science, The University of Tokyo
（Access）

＜Available Dates and Times＞ Every Thursday, 14:00-16:00
・If you visit the clinic by 15:00, you can receive the result on the same day in case of no retest.
・If you visit after 15:00, you will need to come back to the clinic later to receive the result. Also, the accounting counter closes at 17:00, so it may be better to avoid coming in after 15:00.

＜Time required＞　1.5 to 2 hours

＜Consultation fee＞ Approx. 30,000 yen /Payable by credit card
※If you wish to receive vaccinations or a prescription for anti-altitude sickness medication (Diamox), additional fees will be charged.

＜Reservation method＞ TEL: 03-5449-5560
Please tell them that you would like to receive the TAO Annual Altitude Health Evaluation.

＜Belongings＞
・Non-woven cloth mask
・Health Insurance Card
・Medical Examination Card /For a second visit
・Medication Notebook
・Past medical checkup results
*If you have had any previous health problems, bring it with you for reference information.
・Maternity Notebook and Immunization Records, if you wish to receive vaccinations.
・Optional：Results of annual health checkups at your company or institution

【Flow of examination】
Fill out an application form, Issue a medical card
Urine sampling
Blood sampling ＊Breakfast should be light and eaten as early as possible, and lunch is not allowed!
Interview

～Move to the 2nd floor～
Chest X-ray
Basic respiratory function test
Cardiac Electrocardiogram

～Move to the 1st floor～
Report of the results
Receive medical certificate

Payment, etc.