If you need to see a specialist or visit a large hospital in Japan, you will likely need a referral letter \u2014 known in Japanese as a \u7d39\u4ecb\u72b6 (sh\u014dkaij\u014d). This document is a fundamental part of how Japan’s healthcare system works, yet it is one of the most confusing aspects for foreigners. This guide explains what a referral letter is, when you need one, how to get one, and what happens if you do not have one.<\/p>\n\n\n\n
A referral letter (\u7d39\u4ecb\u72b6 \/ sh\u014dkaij\u014d, formally called \u8a3a\u7642\u60c5\u5831\u63d0\u4f9b\u66f8 \/ shinry\u014d j\u014dh\u014d teiky\u014dsho) is an official document written by one doctor to another. It contains:<\/p>\n\n\n\n
Think of it as a professional handoff letter that ensures the receiving doctor has all the context needed to provide appropriate care without starting from scratch.<\/p>\n\n\n\n
Since 2016, hospitals with 200 or more beds (which includes most major hospitals and all university hospitals) are required to charge a special fee to patients who arrive without a referral letter. This fee typically ranges from \u00a55,000 to \u00a57,000 and is not covered by insurance. The fee is meant to discourage patients from bypassing clinics and going directly to hospitals for routine issues. For more on this system, see our guide on choosing between a clinic and a hospital<\/a>.<\/p>\n\n\n\n While you can technically visit any specialist clinic without a referral in Japan (free access system), having a referral letter provides several advantages:<\/p>\n\n\n\n If you want to switch from one clinic to another \u2014 for example, because you are moving to a new area or want a different doctor \u2014 requesting a referral letter from your current doctor ensures continuity of care. This is especially important for mental health treatment, where medication management and treatment history are critical. Your current doctor will include your treatment history, current medications, and any notes relevant to ongoing care.<\/p>\n\n\n\n The process is straightforward:<\/p>\n\n\n\n Referral letters in Japan are almost always written in Japanese, as they are professional medical documents intended for Japanese doctors. Even if your consultation is in English, the referral letter will likely be in Japanese \u2014 and that is fine, because the receiving doctor will be Japanese.<\/p>\n\n\n\nSituation 2: Seeing a Specialist<\/h3>\n\n\n\n
\n
Situation 3: Changing Doctors or Clinics<\/h3>\n\n\n\n
How to Get a Referral Letter<\/h2>\n\n\n\n
\n
Can You Request a Referral in English?<\/h2>\n\n\n\n