Fit To Fly Certificate [PDF]

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FIT TO FLY CERTIFICATE From : Abdi Waluyo Hospital



Date : 6th July 2018



TO WHOMESOEVER IT MAY CONCERN



This is to state that patient Name : Mr. Sukhani Khemcand Tejoomal Birth of date : 15th October 1935 Age : 82 years old was admitted on Kirana Ward of Abdi Waluyo hospital in Jakarta, under dr. Paulus Simadibrata, Internist supervision due to his illness. His relatives wish to take the patient to travel to India for further diagnostic and management of the treatment. The patient’s relatives have been informed about the condition of the patient in their language. I hereby state that the patient is FIT TO FLY without the required of medical support.



Best Regards,



Dr. Paulus Simadibrata, Internist