DOCTOR MEDICATION LETTER — DRAFT FOR CLINICIAN REVIEW
Supporting document only. NOT a Customs permit, import licence, airline approval, medical clearance or proof of controlled-drug entry permission.
To / intended recipient: [ ]
Patient name as in travel document: [ ]
Date of birth: [ ]
Clinical reason relevant to this letter, with patient authorisation: [ ]
Travel dates and purpose of carrying the supply: [ ]
Repeat for each medicine:
- Generic name and brand: [ ]
- All active ingredients (including combination products): [ ]
- Strength and formulation: [ ]
- Prescribed dose, administration route and frequency: [ ]
- Total quantity travelling: [ ]
Required needles / syringes / cooling / associated device: [ ]
Relevant clinician-confirmed handling instructions: [ ]
Treating clinician name and professional role: [ ]
Institution and contact details: [ ]
Clinician signature and issue date: [ ]
This letter explains the clinical need only. Applicable entry, controlled-drug, security and airline requirements must be confirmed separately.