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Supplementary Provisions, Article 69-3, paragraph (3)

第三項

The document referred to in item (iii) of the preceding paragraph must state the following matters concerning the face-to-face guidance received by the specified physician concerned:

前項第三号の書面は、当該特定医師の受けた面接指導について、次に掲げる事項を記載したものでなければならない。

the date on which it was provided

実施年月日

the name of the specified physician who received the face-to-face guidance

当該面接指導を受けた特定医師の氏名

the name of the physician who provided the face-to-face guidance

当該面接指導を行つた医師の氏名

the sleep status of the specified physician who received the face-to-face guidance

当該面接指導を受けた特定医師の睡眠の状況

the status of accumulated fatigue of the specified physician who received the face-to-face guidance

当該面接指導を受けた特定医師の疲労の蓄積の状況

beyond what is set forth in the preceding two items, the physical and mental condition of the specified physician who received the face-to-face guidance

前二号に掲げるもののほか、当該面接指導を受けた特定医師の心身の状況

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