55record
sain
sign
shimei
full name
jibyou
chronic illness
shujutsu reki
history of operation
shusshinchi
hometown
shusseichi
birthplace
juusho
address
shokugyou
occupation
shoshin
first visit
sundeiru
to live
seinengappi
date of birth
seibetsu
gender
seimei
last name, first name
seireki
the western calendar
taishitsu
one's constitution
taibyou
severe illness
tabako o suu
to smoke
denwa bangou
phone number
toshi
age
dokushin
single/unmarried person