Tokyo Securities Industry Health Insurance Society

______, 2008

Joint use of health examination data in health examination services jointly undertaken by the Tokyo Securities Industry Health Insurance Society and ______

Tokyo Securities Industry Health Insurance Society

The Tokyo Securities Industry Health Insurance Society and the insured worksite hereby disclose the following information pursuant to the Personal Information Protection Law for the purpose of jointly providing health examination services for insured persons (employees) and jointly using data from such health examinations.

1. Health examination services jointly undertaken with ______

The Tokyo Securities Industry Health Insurance Society and ______jointly provide health examination services, judging such joint provision of services to be efficient and effective in managing the health of those insured (employees).

2. Health examination data used jointly

See the Appendix.

3. Scope of those permitted access to health examination data

(1) The ______Department in the ______Division of ______, and industrial physicians at worksites

(2) The Health Management Department in the Tokyo Securities Industry Health Insurance Society’s Health Management Division, and Tokyo Securities Industry Health Insurance Society clinics

4. Purposes of use of health examination data by those using the data

The employer retains health examination data in its relevant sections, using this data to provide the health consultation and health guidance as deemed appropriate and as instructed by industrial physicians.

In addition, in accordance with the objectives of the Industrial Safety and Health Law, the employer promotes the establishment of a comfortable work environment and ensures the health and safety of workers at worksites. Together with the Tokyo Securities Industry Health Insurance Society, the employer also seeks to maintain and promote the health of workers to permit all to improve and maintain their health in all aspects of their life, not just at worksites.

The Tokyo Securities Industry Health Insurance Society retains health examination data in its computer systems (and stores paper documents in its archives), using this data to provide health consultation and health guidance services conducted by the worksite’s industrial physicians and the Society’s public health nurses and physicians, as well as in health-related education. In addition, the Society uses data from special medical examinations to group those afflicted by or at risk of developing metabolic syndrome and to provide special health guidance.

In accordance with Article 150 of the Health Insurance Law, the Tokyo Securities Industry Health Insurance Society works with relevant personnel at worksites to maintain and promote the health of those insured.

5. Names (or titles) of those responsible for managing health examination data

Those responsible for managing health examination data are the Manager of the ______Department in the ______Division of ______and the Manager of the Health Management Department in the Tokyo Securities Industry Health Insurance Society’s Health Management Division.

6. How health examination data is obtained

(1) By ______

______obtains health examination data from facilities (medical institutions) contracted to handle health examinations and from medical institutions selected by the employer, in written form.

(2) By the Tokyo Securities Industry Health Insurance Society

The Tokyo Securities Industry Health Insurance Society obtains health examination data from facilities (medical institutions) contracted to handle health examinations and from the employer, in written or electronic form.

7. Such disclosure of personal information is subject to change based on the establishment, amendment, or abolition of relevant laws and regulations or changes in related circumstances.

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Examination items / Examination items subject to joint use
Main examination items and additional examination items recommended and performed by the Tokyo Securities Industry Health Insurance Society / Examination items identified in special medical examinations / Examination items that the worksite is required to conduct under the Industrial Safety and Health Law
Internal medicine examination
Stethoscope/plexor examination
Interview, check of medical history (including medicines taken and smoking history) and occupational history / ○ / ○ / ○
Inspections for any subjective or objective symptoms / ○ / ○ / ○
Body measurements
Height, weight, BMI / ○ / ○ / ○
Girth / ○ / ○
Obesity index
Eyesight examination / ○ / ○
Hearing examination
Conversational method or using audiometer / ○ / ○
Chest X-ray / ○ / ○
Examination of lung functions
Lung capacity, estimated lung capacity, lung capacity ratio, capacity per second, rate per second
Sputum examination
Screening for tubercule bacillus and lung cancer
Blood-pressure measurement
Systolic, diastolic / ○ / ○ / ○
Electrocardiogram (ECG)
After resting and under duress / ○ / ■ / ○
Urinary examination
Urinary protein, sugar / ○ / ○ / ○
Occult blood / ○
Examination items / Examination items subject to joint use
Main examination items and additional examination items recommended and performed by the Tokyo Securities Industry Health Insurance Society / Examination items identified in special medical examinations / Examination items that the worksite is required to conduct under the Industrial Safety and Health Law
Examination of functioning of kidneys
Urea nitrogen, creatinine / ○
Examination of functioning of the liver
GOT, GPT, r-GTP / ○ / ○ / ○
Total protein, albumin, total bilirubin
LDH / ○
Cholinesterase, ALP, LAP, A/G
Pancreatic examination
Amylase
Blood lipid examination
Serum triglycerides (neutral fat), HDL cholesterol, LDL cholesterol / ○ / ○ / ○
Total serum cholesterol / ○
Uric-acid examination
Uric acid / ○
Blood glucose (sugar metabolism) examination
Fasting blood glucose / ○ / ○ / ○
HbA1c / ○ / △
Glucose tolerance test
General blood (anemia) examination
White blood cell count, thrombocyte count / ○
Red blood cell count, hemoglobin count, Ht / ○ / ■ / ○
(Not including Ht)
MCH, MCV, MCHC, neutrophils,
eosinophils, basophils, monocytes, lymphocytes

In addition to notifications of the above examinations, etc., results of each item, general diagnosis, and guidance items

※ Examination items required of the worksite are stipulated in Articles 66 and 44 of the Industrial Safety and Health Law. The nature of such items may differ with examinee age.

※ The nature of the main examination items and additional examination items recommended and performed by the Tokyo Securities Industry Health Insurance Society may vary with examinee age and by examination course selected. In addition, special medical examination items denoted by a black square (■) must be performed as deemed necessary by a physician. The items denoted by a white triangle (△) are performed, as required, according to conditions of contract under which the examination is conducted.

※ The Tokyo Securities Industry Health Insurance Society will not notify worksites of the results of screenings for hepatitis, examinations of the upper digestive tract (stomach), screenings for colorectal cancer, screenings for uterine cancer, or screenings for breast cancer.

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