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When inviting foreign nationals from overseas, it may be necessary to attach a “Certificate of No Active Tuberculosis” to the Application for Certificate of Eligibility (COE). This is the pre-entry tuberculosis screening. There are two common misunderstandings here. One is that while there are 6 target countries, submission is currently mandatory for only 3 countries (Indonesia is scheduled to become mandatory from January 4, 2027). The other is that a significant number of individuals with the nationality of a target country are excluded from the scope. This article clarifies the scope, exclusions, and deadlines for both foreign nationals and corporate HR professionals.
For how to respond if a Certificate of Eligibility is not issued, please refer to “If Your Certificate of Eligibility is Not Issued,” and for the application process itself, please see “Online Residence Application System.” Please refer to both.
Pre-entry tuberculosis screening is a system that requires individuals coming to Japan for mid- to long-term residence from designated countries to undergo a chest X-ray examination, etc., at a designated medical institution before entry, and to submit a “Certificate of No Active Tuberculosis” proving that they do not have active tuberculosis. It is operated based on a Guideline jointly issued by the Immigration Services Agency, the Ministry of Foreign Affairs, and the Ministry of Health, Labour and Welfare (established on December 26, Reiwa 6, revised on March 31, Reiwa 7).
The first point to understand is that “being designated as a target country” and “being mandated to submit the certificate” are separate matters.
| Target Country | Start of Health Check Acceptance | Mandatory Submission of Certificate of No Active Tuberculosis |
|---|---|---|
| Philippines | March 24, 2025 | Mandatory from June 23, 2025 |
| Nepal | March 24, 2025 | Mandatory from June 23, 2025 |
| Vietnam | May 26, 2025 | Mandatory from September 1, 2025 |
| Indonesia | November 2, 2026 (scheduled) | Mandatory from January 4, 2027 (scheduled) |
| Myanmar | Under adjustment for start | Start date undecided |
| China | Under adjustment for start | Start date undecided |
The heading of the announcement page of the Immigration Services Agency was changed in the September 2026 update to “For Nationals of the Philippines, Nepal, Vietnam, and Indonesia.” Please understand this as a two-tiered system: 6 countries are designated under the system, and 3 countries are currently mandated. For Indonesia, health checks at designated medical institutions will be accepted from November 2, 2026, and submission of the Certificate of No Active Tuberculosis will be mandatory for applications filed on or after January 4, 2027 (scheduled) (see “Indonesia Pre-Entry Tuberculosis Screening Mandatory from Jan 4, 2027” for details). The start dates for Myanmar and China have not been decided.
According to the Guideline, while the number of tuberculosis patients in Japan has been decreasing year by year, approximately 10,000 people still develop the disease annually. On the other hand, the number of foreign-born patients is on the rise; out of 10,096 newly registered tuberculosis patients in Reiwa 5, 1,619 were foreign-born.
The target countries are selected from among the birth countries of foreign-born patients diagnosed with tuberculosis while residing in Japan, specifically those with a large proportion (based on the decision at the 9th Tuberculosis Subcommittee of the Health Sciences Council on February 26, Heisei 30).
| Country of Birth | Number of Patients in Japan (2023) | Percentage of Foreign-Born Patients |
|---|---|---|
| Philippines | 317 people | 19.6% |
| Vietnam | 272 people | 16.8% |
| Indonesia | 231 people | 14.3% |
| Nepal | 229 people | 14.1% |
| Myanmar | 155 people | 9.6% |
| China | 148 people | 9.1% |
The purpose of the system is not to exclude individuals of specific nationalities, but to confirm the presence or absence of the disease before entry and to ensure that those who need it can access early treatment.
Those subject to this system are individuals who possess the nationality of a target country and intend to enter and reside in Japan under any of the following categories:
The term “Mid- to long-term residents” here refers to individuals defined in Article 19-3 of the Immigration Control and Refugee Recognition Act (hereinafter, Immigration Control Act). Specifically, these are foreign nationals residing in Japan with a Status of Residence who do not fall under any of the following ① to ④:
In other words, individuals visiting Japan for Temporary Visitor purposes (such as tourism or business) or those whose Period of Stay is determined to be 3 months or less are fundamentally excluded. The understanding that “everyone from that country requires an examination” is not accurate.
Even if an individual holds the nationality of a target country, they will not be subject to the requirement if any of the following conditions apply. This is the point where HR professionals at companies are most likely to make mistakes.
If it is confirmed by a permit of stay in the country of residence, etc., that the current place of residence is a country or region other than the target country, the individual is excluded. According to the Ministry of Health, Labour and Welfare, the period of residence in the current place of residence is not questioned. A typical example is a Vietnamese national residing in a third country and holding a permit of stay for that country.
In this case, a copy of the permit of stay, etc. (including scanned data), along with the explanatory document (Japanese and English versions) published by the Immigration Services Agency must be submitted.
Individuals coming to Japan under systems that already require a health examination, including a chest X-ray for tuberculosis screening, prior to entry are excluded for the time being. The following individuals are applicable:
In particular, the fact that Specified Skilled Workers are excluded for the time being is a significant point for accepting companies. The entire Specified Skilled Worker system is explained in “Differences between Specified Skilled Worker (i) and (ii)“.
Individuals holding a Re-entry Permit (including a Special Re-entry Permit) are excluded from the scope. This applies to cases where individuals who already have their base of life in Japan return from a temporary visit home.
Individuals who are unable to submit a Certificate of No Active Tuberculosis due to unavoidable special circumstances are required to submit a statement of reasons (Japanese and English versions) published by the Immigration Services Agency. However, this does not mean that the submission obligation is automatically waived; rather, it is a procedure to submit a document explaining the circumstances.
The Certificate of No Active Tuberculosis is limited to those issued by medical institutions designated by the Government of Japan (designated health examination medical institutions) located within the target country. X-ray results from a local hospital or general health certificates cannot be substituted.
The process is as follows:
As practical points to note, the Ministry of Health, Labour and Welfare lists the following:
As of August 28, 2026, the designated health examination medical institutions listed on the Ministry of Health, Labour and Welfare’s special website are: 6 locations in the Philippines (Manila, Baguio, Davao, Cebu), 9 locations in Nepal (Kathmandu, Pokhara, Damak), and 17 locations in Vietnam (Hanoi, Ho Chi Minh City, Da Nang), for a total of 32 locations. More are expected to be added sequentially as preparations are completed.
It is explicitly stated that only certificates issued by designated health check medical institutions are recognized as official certificates, and fraudulent acts such as forging certificates may have a significant impact on applications for COE or Visa.
The validity period of the Certificate of No Active Tuberculosis is, as a general rule, 180 days from the date of the tuberculosis health check (date of chest X-ray). While the Immigration Services Agency’s page only indicates this general rule, the Ministry of Health, Labour and Welfare’s special website notes that the validity period may be 90 days depending on conditions, and advises to inquire with the designated health check medical institution for details.
This is a critical point in the recruitment schedule. Since the number of days from “obtaining the certificate to using it” is limited, please calculate backward in the following order:
If taken too early, the validity period may expire before the COE is issued or before the Visa application. Conversely, if too late, there will be no time to accommodate the treatment period if the onset of the disease is discovered. It is stated that individuals diagnosed with active tuberculosis must undergo another examination after completing treatment, which would significantly delay their start date of employment.
What is often overlooked is that there is a route where the COE may state “Certificate of No Active Tuberculosis Not Submitted.” The Guideline categorizes the situations for Immigration review into the following three:
| Situation | Examining Authority |
|---|---|
| ① At the time of Application for Certificate of Eligibility | Regional Immigration Services Bureau |
| ② At the time of Visa application for those whose COE states “Certificate of No Active Tuberculosis Not Submitted“ | Overseas diplomatic mission |
| ③ At the time of Visa application for those who apply for a Visa without obtaining a COE, or for the purpose of Mid- to long-term residents with a Status of Residence not subject to COE issuance (e.g., some Designated Activities) | Overseas diplomatic mission |
Situation ② refers to a procedure where, although the COE has been issued, it states that the certificate has not been submitted, and submission is requested again at the Visa application stage at the overseas diplomatic mission. As an accepting company, it is advisable not to relax once the COE arrives, but to implement a system to check for such a statement to prevent issues.
Please note that the Certificate of No Active Tuberculosis submitted at the time of Application for Certificate of Eligibility may be a copy (including scanned data). There is no need to mail the original to Japan.
We will organize the items that should be confirmed internally when recruiting from overseas.
For those already residing in Japan, this system concerns family members who will be coming to Japan. For example, if you invite your Spouse or Child residing in a target country under “Dependent,” that person will enter as a Mid- to long-term resident, and thus may be subject to this system.
On the other hand, the Immigration review situations stipulated by the Guideline are at the time of Application for Certificate of Eligibility and Visa application, and applications for Change of Status of Residence or Extension of Period of Stay for those already in Japan are not included in the Immigration review situations envisioned by this system.
Furthermore, the Ministry of Health, Labour and Welfare calls upon Mid- to long-term residents in Japan as follows: If you are from a high-burden country for tuberculosis, have a history of staying in such a country, or have been identified as having a risk of developing the disease during Pre-entry tuberculosis screening, please consult a medical institution if you experience symptoms such as a cough, phlegm, low-grade fever, or general malaise lasting for two weeks or more. If you develop tuberculosis in Japan, you can receive procedures for partial public medical expense coverage and medication support at the public health center in your place of residence.
Tuberculosis is categorized as a Class II infectious disease under Article 6, Paragraph 3, Item 2 of the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases. Article 5, Paragraph 1, Item 1 of the Immigration Control Act stipulates that being a patient with a Class II infectious disease is a reason for denial of Landing, meaning that foreign nationals with active tuberculosis will not meet the conditions for Landing.
Furthermore, the proviso to Article 6-2, Paragraph 5 of the Ordinance for Enforcement of the Immigration Control Act stipulates that a Certificate of Eligibility may not be issued if it is clear that the applicant does not meet the conditions for Landing. The Certificate of No Active Tuberculosis is requested as “other reference materials” referred to in Article 6-2, Paragraph 2 of the same Ordinance.
The Immigration Services Agency explains that for individuals who have developed tuberculosis, doubts may arise as to whether they can stably and continuously engage in activities corresponding to their Status of Residence. Please note that this is not merely a health check, but a document directly relevant to the Immigration review of the Status of Residence.
Q1. I am a national of a target country but am already working in Japan. Do I need the certificate for my next Extension of Period of Stay?
A. The review stages specified in the Guideline are at the time of Application for Certificate of Eligibility and Visa application, and procedures for Extension of Period of Stay within Japan are not included. If you are concerned, please confirm with your nearest regional Immigration Services Agency office or a specialist before applying.
Q2. Can I have an X-ray taken at a hospital in Japan and submit it?
A. No, you cannot. The Certificate of No Active Tuberculosis must be issued by medical institutions designated by the Japanese government located in the target country.
Q3. We plan to hire an Indonesian national. Is preparation necessary now?
A. Depending on the timing of the hire, preparation may be necessary. For Indonesia, health checks at designated medical institutions will be accepted from November 2, 2026, and submission of the Certificate of No Active Tuberculosis will be mandatory for applications filed on or after January 4, 2027 (scheduled). See “Indonesia Pre-Entry Tuberculosis Screening Mandatory from Jan 4, 2027” for details.
Q4. My X-ray was taken more than six months ago. Can I use it?
A. The validity period is generally 180 days from the date of the X-ray, so it cannot be used if it has exceeded this period. Please note that it may be 90 days depending on the conditions, so please confirm with the designated medical institution where you were examined.
Q5. If diagnosed with tuberculosis, does that mean I can no longer go to Japan?
A. That is not the case. You are required to undergo another examination at a designated medical institution after completing treatment. It will take time, but the path is not closed.
Q6. Must the original certificate be submitted?
A. For the Application for Certificate of Eligibility, a copy (including scanned data) is acceptable. However, for Visa applications, please follow the instructions provided by the overseas diplomatic mission.
Q7. I am a national of a target country, but I have lived in another country for a long time.
A. You are exempt if your current place of residence is confirmed to be outside the target country by your residence permit or similar document from your country of residence. The Ministry of Health, Labour and Welfare states that the duration of residence is not questioned. Please submit a copy of your residence permit or similar document and an explanatory letter.
Regarding Pre-entry tuberculosis screening, among the six target countries, only the Philippines, Nepal, and Vietnam are currently mandated (Indonesia is scheduled to become mandatory from January 4, 2027). Furthermore, even if you are a national of a target country, you are not subject to the screening if your current place of residence is outside the target country, if a health check is already required under other systems such as Specified Skilled Worker or EPA nurses/care workers, or if you possess a Re-entry Permit.
What is effective in practice are two points: calculating backward from the validity period (generally 180 days, but 90 days under certain conditions), and the existence of a route where “Certificate of No Active Tuberculosis not submitted” is noted on the Certificate of Eligibility. Incorporating these two into your hiring schedule can largely prevent last-minute rushes before travel.
The determination of eligibility varies depending on the combination of nationality, type of Status of Residence, current place of residence, and the system being utilized. If you are unsure, please consult us before applying for the Certificate of Eligibility.
Our office provides consultations to both foreign nationals and accepting Corporations, based on the latest institutional trends.
Please feel free to use our free consultation service first.
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For those who will apply for a status of residence at the Immigration Services Bureau by themselves. Before you submit, we check your application form and supporting documents and tell you about any missing documents and points to watch. We accept checks online (Google Meet, about 20 minutes) or via LINE.
・Eligible: applications for a Certificate of Eligibility, change of status of residence and extension of period of stay (applications for permanent residence are accepted only from residents of Miyazaki Prefecture). Naturalization is not covered.
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・Our guideline for replies via LINE is, in principle, within 2 business days (we are closed on Saturdays, Sundays and public holidays; replies may take longer when we are busy).
・Please send copies of your documents by LINE or email. For your residence card, send the front side only; please do not send the side showing your My Number.
・What we tell you is our office’s opinion. It does not guarantee approval; the outcome depends on the decision of the Immigration Services Bureau.
・We only point out missing documents and points to watch. We do not prepare or rewrite your application documents for you or draft text for them, and we do not tell you whether your application is likely to be approved (if you would like to engage us, we will introduce the Self-Prep Course, the Light Plan and the Standard Plan).
・If we find that a document contains information that is not true, or that the application is not your own (or a family member’s), we will decline the check.
This article is written based on publicly available information as of August 2026. Details of the system and implementation dates may change in the future. For actual applications, please confirm with the official information from the Immigration Services Agency or our office.
Author of this article: Administrative Scrivener Authorized to File Applications, Satoshi Nakayama
Representative, Administrative Scrivener Corporation Miyazaki International Legal Office
Location: Miyazaki City, Miyazaki Prefecture
