Reissuance of Certificates Related to Late-Stage Elderly Medical Care for Those Who Have Lost Them

If you lose any certificates related to Late-Stage Elderly Medical Care, you can fill out the Application Form (Application Form for Reissuance of Late-Stage Elderly Medical Care) and submit it by mail or in person at the office for reissuance.

If the insured person (the individual) comes to City Hall, please bring the necessary items listed below and visit the Insurance and Pension Division, Late-Stage Elderly Medical Care Section at window 3 on the first floor of City Hall.

Items that can be reissued

Qualification Confirmation Document, Specific Disease Treatment Certificate

Application by Mail

If you wish to apply or receive by mail, please download and print the form below, fill in the necessary information, and send it by mail. (If you would like the application form to be sent by mail, please contact us.) As soon as the application form arrives at City Hall, it will be processed and sent by mail.

Application at City Hall

Regarding the Reissuance of Qualification Confirmation Documents

If you wish to apply or receive at City Hall, please wait for the identity verification document of the insured person (the individual). (Documents that can verify identity include driver's license, My Number Card, passport, Long-Term Care Insurance card, Late-Stage Elderly Medical Care insurance premium determination notice, cash card, etc. Note: If the document has a photo, one verification is required; if it does not have a photo, two verifications are required.)

Note: If a representative comes to the office, please bring something that can verify the representative's identity.
Also, if the representative living with the insured person (the principal) is handling the procedure and can verify their identity, a qualification confirmation document can be issued at the counter.
If a representative living separately from the insured person (the principal) is handling the procedure, they can fill out and submit the Application Form, but regarding the issuance of the qualification confirmation document, it will be sent by registered mail.

Regarding the Reissuance of Specific Disease Treatment Certificates

If you wish to reissue the specific disease treatment certificate at City Hall, please wait for the identity verification of the insured person (the individual). (Documents that can verify identity include driver's license, My Number Card, passport, Late-Stage Elderly Medical Care Health Insurance Card, Late-Stage Elderly Medical Care Qualification Confirmation Document, Long-Term Care Insurance Health Insurance Card, Late-Stage Elderly Medical Care Insurance Premium Determination Notification, cash card, etc. Note: If the document has a photo, one verification is required; if it does not have a photo, two verifications are required.)
Note: If a representative living with the insured person (the individual) is processing the request, the representative can receive the reissued document at the counter if their identity can be verified.
Additionally, if a representative living separately from the insured person (the individual) is processing the request, please bring the insured person's health insurance card or qualification confirmation document along with a document that can verify the representative's identity. If you bring these two items, the reissued document can be provided at the counter.

About Applications at the Branch Office

You can also fill out and submit the Application Form for reissuance of certificates related to Late-Stage Elderly Medical Care at the Hirao and Wakabadai Branch Office. Once the Application Form arrives at City Hall, it will be prepared and mailed to you.

Download Form

• Late-Stage Elderly Medical Care Reissue Application Form (PDF 67.7KB)