MEDICATION LETTER / 携药医生说明 — CLINICIAN REVIEW / 医生审核
Supporting evidence only; not a permit or medical clearance.
仅作辅助证明，不是许可或适航证明。
Recipient / 收件方：[ ]
Patient name and DOB / 患者证件姓名及出生日期：[ ]
Relevant authorised clinical reason / 相关且获授权的临床原因：[ ]
Travel dates and supply purpose / 旅行日期及携药目的：[ ]
For EACH medicine / 每种药品分别填写：
Generic + brand; all ingredients / 通用名、商品名、全部成分：[ ]
Strength + formulation / 规格及剂型：[ ]
Dose + route + frequency / 剂量、途径及频次：[ ]
Total quantity / 总量：[ ]
Needles, cooling, device and handling / 针具、温控、设备及处理要求：[ ]
Clinician + role / 医生及专业身份：[ ]
Institution + contact / 机构及联系方式：[ ]
Signature + date / 签名及日期：[ ]
Entry, controlled-drug, security and airline permission remain separate.
入境、管制药品、安检与航司许可须分别确认。