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Medical Certificate of Good Health

This certificate verifies that Mr./Ms. [Name] is free of drug addiction, mental illness, and contagious diseases. It certifies that the individual does not have any condition that could seriously endanger public health, such as smallpox, polio, SARS, cholera, plague, Ebola, or nationally important illnesses like dengue fever. The certificate also states that Mr./Ms. [Name] is in good overall health, with no pre-existing medical conditions, and is capable of international travel. The document is signed and stamped by the examining physician.

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geologistlakhan
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423 views1 page

Medical Certificate of Good Health

This certificate verifies that Mr./Ms. [Name] is free of drug addiction, mental illness, and contagious diseases. It certifies that the individual does not have any condition that could seriously endanger public health, such as smallpox, polio, SARS, cholera, plague, Ebola, or nationally important illnesses like dengue fever. The certificate also states that Mr./Ms. [Name] is in good overall health, with no pre-existing medical conditions, and is capable of international travel. The document is signed and stamped by the examining physician.

Uploaded by

geologistlakhan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Medical Certificate of Good Health

This certificate verifies that Mr./Ms. .................................................................................


is free of drug addiction, mental illness, and does not suffer from any disease that could cause
serious repercussions to public health according to the specifications of the International Health
Regulations of 2005. These contagious diseases include, but are not limited to smallpox,
poliomielitis by wild polio virus, the human influenza caused by a new subtype of virus and the
severe acute respiratory syndrome (SARS), cholera, pneumonic plague, Bellow fever, viral
hemorrhagic fevers (e.g.: Ebola, Lassa, Marbug), West Nile Virus and other illnesses of special
importance nationally or regionally (e.g.: Dengue Fever, Rift Valley Fever, and meningococcal
disease).

Mr./Ms. ........................................................................................ is a very healthy individual in all


senses, he/she has no pre-existing medical conditions, and she/he is capable of travelling
abroad.

Original Physician Signature: ...........................................................

Place and date: ...........................................................

Official Physician Stamp: ...........................................................

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