填寫欄位
患者資訊
診斷內容
中藥處方
醫師與診所資訊
即時預覽 Live Preview
醫療證明書
Medical Certificate / Doctor's Statement
發票章
待補
待補
| 患者姓名 Patient Name | 陳韻琪 |
| 出生日期 Date of Birth | 1992-12-13 |
| 證明日期 Date | 2026年03月31日 (March 31, 2026) |
致相關單位 To whom it may concern：
診斷 Diagnosis
本人 陳敬智（中醫師）謹此聲明，以上患者已接受本院中醫診療，目前診斷為
痛經。
This is to certify that the above-mentioned patient has been under my medical care and has been diagnosed with
Dysmenorrhea.
持續治療 Ongoing Treatment
本院為患者開立以下中藥處方：
The patient has been prescribed the following traditional Chinese herbal formulas:
| 中藥名稱 Herbal Medicine | 服用期間 Duration |
|---|
聲明事項 Statement
上述中藥處方屬於傳統中醫治療方案，僅供個人醫療使用，不含任何管制物質或麻醉藥品。如需進一步說明，請聯繫本院辦理。
These herbal medications are used as part of a traditional Chinese medicine (TCM) treatment plan and are intended solely for personal medical use. They contain no controlled substances or narcotics.
These herbal medications are used as part of a traditional Chinese medicine (TCM) treatment plan and are intended solely for personal medical use. They contain no controlled substances or narcotics.
聯繫方式 Contact Information
| 醫師姓名 Physician | 陳敬智 (Dr. Chen Ching Chih) |
| 診所名稱 Clinic | 日知堂中醫診所 Rechain Chinese Medicine Clinic |
| 地址 Address | 台北市大安區信義路四段138號2樓 2F, No. 138, Xinyi Rd., Da'an Dist., Taipei City |
| 電話 Phone | (02) 2701-9898 |
| 執照號碼 License No. | 台中字011470 |
陳敬智
中醫師 Physician of TCM
此致 Sincerely,
醫師
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