1.
medical questionnaire; pre-examination form
A form a patient fills in before seeing a doctor or receiving a vaccination, giving symptoms, medical history, and current condition.
Formed from 予 (beforehand) + 診 (examination) + 票 (slip, form). Routinely used at clinics and vaccination sites.
Common collocations
- 予診票に記入する: to fill in the questionnaire
- 予診票を提出する: to submit the form
- ワクチンの予診票: vaccination questionnaire
Similar words
- 問診票: medical interview sheet — near-synonym; both collect a patient's self-reported information before examination.