Taichung Tzu Chi Hospital International Medical Center

20. Past Medical History

1. No

2. Unknown

3. Hypertension

4. Diabetes

5. Heart

6. Apoplexy

7. Cancer

8. Others

21. Familial Medical History

1. No

2. Unknown

3. Hypertension

4. Diabetes

5. Heart

6. Apoplexy

7. Cancer

8. Others

22. Travel History

1. No

2. 2 weeks

3. 1 month

4. 6 months

5. 1 year

23. Ever been to other Tzu Chi Hospitals for Treatment?

1. Hualien

2. Taipei

3. Taichung

4. Douliou

5. Dalin

6. Yuli

7. Kuanshan

8. Chiayi

9. Sanyi

10. No

24. Do you have the following identities?

1. Tzu Chi Honorary Director

2. Tzu Chi Committee Member

3. Direct Blood Relative of Tzu Chi Hospital Employees

4. No

※Collection, processing and use of personal data: I agree that the hospital may collect, process or use my medical records and related information for medical treatment, care or specific purposes.

Contact Us - International Medical Service Center, Taichung Tzu-Chi Hospital