COMMUNICABLE  DISEASES

Parents/Guardians seeking medical care assistance for their child must download this form and have the child's doctor retype it on the doctor's letterhead. A copy of this document must be submitted to ICMF and the original must be handcarried with patient on the airline(s).

Click Here For A Downloadable PDF Copy Of The Doctor Stating This Child Does Not Have Any Communicable Diseases.

Questions: ICMFHope@Aol.Com

Questions? Email: ICMFHOPE@Aol.Com

(DOCUMENT MUST BE FILLED OUT IN ENGLISH AND MUST BE TYPED, EXACTLY AS SHOWN HERE,

ON DOCTOR'S BUSINESS LETTERHEAD)

TO WHOM IT MAY CONCERN:

Date: __________________

Patient's Name:_____________________________________

DOB: __________________________

Patient's Address: ___________________________________

I certify that I am the attending Physician for the above

referenced since _____________________________________.

I certify that __________________________________ does not

carry any communicable diseases and his/her immunizations

are up to date. Copy of these records are provided.

(Doctor's Printed/Signature)