Designated incurable disease Supporter Certification Business (Registrant Certificate)

It is a proof issued by Yokohama City to those who have applied for the designated incurable disease patients so that they can smoothly use measures for independent daily support in the community by proving the facts of the designated incurable disease.
In principle, you can check the contents on the minor portal in cooperation with your My Number Card, but you can also issue it on paper to those who wish.
In addition, since the expiration date of the validity period is not set, those who have been issued a registrant card can continue to use it after the validity period start date. (There is no renewal application.)

・Those who have resident certificate in Yokohama City

・Those who meet the diagnostic criteria of the designated incurable disease

※If you wish to receive a registrant's card, you need to apply for a new registrant ID. Please note that this will not be issued automatically to those who do not apply for a new registration card or who have only applied for a new medical expenses (designated incurable disease) subsidy program.

●Name

●Date of Birth

●Date of validity period

※The name of the disease will not be displayed on the registration card.
Please note that if you need to show the disease name when using the service, you will not be able to use your registrant's card as proof.

Please submit the following documents.

・Registrant ID (designated incurable disease) application form (first style) ... You can download from the following. (Please be sure to read the attached sheet.)
　Registration card (designated incurable disease) application form (first style) (Excel: 50KB)
　Registration card (designated incurable disease) Application Form (No. 1 style) (PDF: 142KB)
　・・・ Please check "New Application" in the check box at the top of the application form.
　Attachment (PDF: 285KB)

・Clinical survey personal form (medical certificate)
　・・・ You can download it from the following website.
　http://www.nanbyou.or.jp/ (external site) (external site) (link: incurable disease Information Center)
　 http://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000084783.html (external site) (external site) (link: Ministry of Health, Labour and Welfare website)

・Personal number report (No. 4 style) pertaining to the registrant's card ... You can download it from the following.
　※Confirmation documents vary depending on the person who is applying. Be sure to submit a personal number report (Form No. 4)
　　Please check the second page, “About required documents” (PDF: 225KB) on page 2 and submit a copy of the mail application.
　　Please enclose it and mail it. In the case of window entrance application, please bring your required documents as the original will be checked at the window entrance.

　Personal number report (No. 4 style) pertaining to the registrant's card (Excel: 30KB)
　Personal number report (No. 4 style) pertaining to the registrant ID (PDF: 231KB)
　Power of Attorney (Excel: 10KB)
　Power of Attorney (PDF: 37KB)

●Only incurable disease designated physicians can create a clinical research personalrequired documents.
Please confirm about designated doctor, designated medical institution list of incurable disease designated doctors that Yokohama-shi appointed.

When the name listed on the registrant's card issued by Yokohama City is changed, it is necessary to have you submit an application for change.
(For a name change on the registrant's card issued by another city, please contact the local government of the issuer.)

・Registrant ID (designated incurable disease) application form (first style) ... You can download from the following. (It is the same as the new application form.)
　Registration card (designated incurable disease) application form (first style) (Excel: 50KB)
　Registration card (designated incurable disease) Application Form (No. 1 style) (PDF: 142KB)
　・・・ Please check "Application for Change" in the check box at the top of the application form.
　・・・ Please enter the name after the change in the part where "If you are applying for a change, please also fill in this form."

・(If you have already been transferred out of the city) Public certificate that allows you to confirm the name before and after the change
　※If you have resident certificate in Yokohama City, you do not need a certificate.

If the registrant's card of paper issued by Yokohama City has been lost or damaged, you can apply for a re-grant.
(For re-grant of the registrant's ID issued by another city, please contact the local government of the grant.)

　Registrant ID (designated incurable disease) application form (first style) ... You can download from the following. (It is the same as the new application form.)
　Registration card (designated incurable disease) application form (first style) (Excel: 50KB)
　Registration card (designated incurable disease) Application Form (No. 1 style) (PDF: 142KB)
　・・・ Please check "Reissue" in the check box at the top of the application form.

When returning the registrant's card due to healing or death, the registrant's card can be returned.

・Registrant ID (designated incurable disease) application form (first style) ... You can download from the following. (It is the same as the new application form.)
　Registration card (designated incurable disease) application form (first style) (Excel: 50KB)
　Registration card (designated incurable disease) Application Form (No. 1 style) (PDF: 142KB)
　・・・ Check "Return Application" in the check box at the top of the application form.

・Registrant ID

〒231-0062
56 Minatomirai 21 Clean Center, 1-1, Sakuragicho, Naka-ku, Yokohama
City of Yokohama, Health and Social Welfare Bureau Medical Aid Division, incurable disease
※It is also possible for family members to fill out the form on your behalf.
※Please be aware that if there are any missing or missing documents even if you apply at the ward office Elderly and Disabled Support Division window, you will be contacted by the Health and Social Welfare Bureau Medical Aid Division, incurable disease Countermeasure Section.
　

Elderly and Disabled Support Division Health and Welfare Centers in each ward
※It is also possible for family members to apply on your behalf.
※Please be aware that if there are any missing or missing documents even if you apply at the ward office Elderly and Disabled Support Division window, you will be contacted by the Health and Social Welfare Bureau Medical Aid Division, incurable disease Countermeasure Section.