初診英文：填表、報到、基本資料常用句

第一次到國外診所，最讓人手忙腳亂的不是看診本身，而是櫃台遞給你的那疊紙：個人資料、緊急聯絡人、保險資訊、病史問卷、家族史、HIPAA 同意書（在美國）、有時還有 financial responsibility 同意書。每一頁都有英文專有名詞，填錯或漏掉都可能讓報到流程卡住。

本文僅整理初診表格的英文用語與填寫方式，不提供醫療診斷或法律建議；對於醫療同意書、保險條款的具體內容，建議由你信任的醫師、保險業務或律師判讀。緊急狀況請立即聯絡當地急救單位。

這篇把初診常見的 8 種表單 拆開逐項講，再附上「櫃檯怎麼問你」的聽力提示與完整對話。

你會拿到的 8 種表

  1. Patient Information Form（個人資料）
  2. Insurance Information（保險資料）
  3. Emergency Contact（緊急聯絡人）
  4. Medical History Questionnaire（病史問卷）
  5. Medication & Allergy List（用藥／過敏）
  6. HIPAA / Privacy Notice Acknowledgment（隱私同意書，美國）
  7. Consent to Treat（治療同意書）
  8. Financial Responsibility / No-Show Policy（費用責任、爽約政策）

核心單字表

English 中文 例句
full legal name 法定全名 Please enter your full legal name.
date of birth (DOB) 出生年月日 Date of birth: 01/05/1995
Social Security Number (SSN) 社安號（美） Leave blank if you don't have one.
ZIP / postal code 郵遞區號 What's your ZIP code?
guardian 監護人 Parent or guardian signature.
marital status 婚姻狀況 Marital status: single / married / divorced / widowed.
occupation 職業 Occupation: software engineer.
primary insurance 主保險 List your primary insurance first.
policy number 保單號 Your policy number is on the front of the card.
group number 團體號 Group number: 12345.
signature 簽名 Sign here, please.
initial 簡寫簽（首字母） Please initial each page.
acknowledgment 確認／簽收 This is just an acknowledgment, not a contract.
consent 同意書 Consent to treat.

常見欄位的英文與填寫提醒

Patient Information

欄位 中文 提示
Last name / Surname / Family name 姓 護照上的羅馬拼音。
First name / Given name 名 不要寫中間英文名字到 first name。
Middle name / initial 中間名 沒有就空白或寫 "N/A"。
Preferred name 偏好稱呼 想被怎麼叫就寫這。
Date of birth 生日 美國格式 MM/DD/YYYY，不是 DD/MM。
Sex / Gender 性別 通常分 M / F / Other / Prefer not to say。
Marital status 婚姻 Single / Married / Divorced / Widowed。
Occupation 職業 學生寫 "Student"，自由業寫 "Self-employed"。
Address (street, city, state, ZIP) 地址 寫你目前在當地的地址，不是台灣地址。
Phone (cell / home / work) 電話 標清楚是手機 (cell)。
Email 電郵 留你會看的。

Insurance Information

欄位 中文 提示
Insurance company 保險公司 旅遊保險就寫保險公司英文名。
Policy / member number 保單號 通常是長一串英數混合。
Group number 團體號 如果保單上沒有就寫 "N/A"。
Subscriber 投保人 自己投保就寫 "Self"。
Effective date 生效日 保單開始日期。
Self-pay / out-of-pocket 自費 沒保險的話勾這欄。

Medical History Questionnaire

問卷通常是一長串 yes/no，例如：

Have you ever had: high blood pressure / diabetes / heart disease / asthma / cancer / stroke / depression …

照實打勾。診所問這些是為了用藥安全，不是為了標籤你。

Allergies

通常會分三類：

  • Drug allergies（藥物過敏）
  • Food allergies（食物過敏）
  • Environmental allergies（環境過敏：花粉、塵蟎、寵物）

每個過敏旁邊通常會留欄位寫 reaction（反應），可以填 rash / hives / swelling / trouble breathing / nausea。

必背句型（櫃檯會問你的）

  1. "Have you been to our clinic before?" — 是否來過。
  2. "Do you have your photo ID and insurance card?" — 證件 + 保險卡。
  3. "Could you fill out these forms and bring them back when you're done?" — 把表填完拿回來。
  4. "Please initial here and sign at the bottom." — initial 是「簡寫」，sign 是「正式簽名」。
  5. "Make sure to list all the medications you're currently taking." — 列所有目前用藥。
  6. "Is the address on file still correct?" — 地址有沒有變。
  7. "Have you been here in the last three years?" — 三年內有沒有來過（影響是否算 new patient）。

你需要會講的回答

  1. "This is my first visit." — 我是初診。
  2. "Here's my passport and travel insurance card." — 給證件保險卡。
  3. "I don't have a Social Security Number — I'm visiting from Taiwan." — 沒有社安號的解釋。
  4. "How do I fill in this part?" — 不會填的時候直接問。
  5. "Do I need to fill in the SSN field?" — 有些欄位可以跳過。
  6. "Could you explain what this form is for?" — 不懂某張同意書的時候。

錯誤說法 vs 自然說法

不自然 自然說法 為什麼
I am no SSN. I don't have a Social Security Number. 用 don't have，不要直翻「沒有」。
First time come here. This is my first visit. 完整句子。
I write wrong, can change? I made a mistake. Could I get a new form? 直接講重填。
What this paper means? Could you explain what this form is for? 用 form，不是 paper。
My address Taiwan. My permanent address is in Taiwan, but my current address here is __________. 區分「永久地址」與「現居地址」。
I sign here? Should I sign here? 加 should 軟化問句。

情境對話：到診所報到

Receptionist: Hi, do you have an appointment? You: Yes, my appointment is at 10:30 with Dr. Patel. My name is Lin. Receptionist: Great. Could I see a photo ID and your insurance card, please? You: Sure. Here's my passport and my travel insurance card. Receptionist: Thanks. Since this is your first visit, please fill out these forms. Make sure to list any medications you're currently taking and any allergies. Sign and date the last page, and initial each page where you see a small line. You: Got it. Quick question — I don't have a Social Security Number. Should I leave that field blank? Receptionist: Yes, just leave it blank or write "N/A." You: Okay. And for the address, should I write my hotel address or my permanent address back home? Receptionist: Your current address while you're here is fine. We just need a way to send any follow-up paperwork. You: Got it. I'll fill these out and bring them back.

可替換句型模板

  1. "I don't have [BLANK] — I'm visiting from [BLANK]."
    • I don't have a local phone number — I'm visiting from Taiwan.
  2. "Should I write [BLANK] or [BLANK] for [欄位]?"
    • Should I write my hotel or my home address for the address field?
  3. "Could you explain what [BLANK] means in this section?"
    • Could you explain what "guarantor" means in this section?
  4. "I'd like to leave [BLANK] blank. Is that okay?"
    • I'd like to leave the SSN blank. Is that okay?

小練習

翻成自然英文：

  1. 我沒有美國社安號，可以空著嗎？
  2. 我這個欄位寫錯了，可以換一張表嗎？
  3. 這份是什麼同意書？可以解釋一下嗎？
  4. 我帶了護照跟保險卡。
  5. 我目前在這裡的地址是 [BLANK]，台灣的地址是 [BLANK]，我該填哪一個？
參考答案
  1. I don't have a Social Security Number. Can I leave it blank?
  2. I made a mistake on this part. Could I get a new form?
  3. What is this consent form for? Could you explain it?
  4. I brought my passport and insurance card.
  5. My current address here is [BLANK], and my permanent address in Taiwan is [BLANK]. Which one should I write?

看診前可複製的英文整理表

報到時遞給櫃台，可以省一半填表時間。

First-visit information sheet
- Full legal name: __________
- Preferred name: __________
- Date of birth (MM/DD/YYYY): __________
- Sex: __________
- Marital status: __________
- Occupation: __________
- Current address (while traveling): __________
- Permanent address (home country): __________
- Cell phone: __________
- Email: __________

Insurance:
- Company: __________
- Policy / member number: __________
- Effective dates: __________

Emergency contact:
- Name + relationship: __________
- Phone: __________

Allergies: __________
Current medications: __________
Reason for today's visit: __________

延伸閱讀

再次提醒：本文僅整理初診表單的英文用語；對任何醫療同意書、保險條款的具體內容，請與專業醫護或保險人員確認。緊急狀況請立即聯絡當地急救單位。