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  • Republic of Indonesia Ministry of Health

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    setyo hermawan
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    This document is a notification from an Indonesian doctor certifying that certain medicines carried by Yayuk Sami Rahayu binti Harjo are for her personal medical use. The notification lists 5 medicines - Hufabion, Caviplek, Lerzin, Alpara, and Dextam Plus - and states they are strictly for Yayuk's daily personal use based on medical reasons. The doctor provides the notification to be shown to Saudi Arabian authorities for clearance upon Yayuk's arrival.

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    This document is a notification from an Indonesian doctor certifying that certain medicines carried by Yayuk Sami Rahayu binti Harjo are for her personal medical use. The notification lists 5 medicines - Hufabion, Caviplek, Lerzin, Alpara, and Dextam Plus - and states they are strictly for Yayuk's daily personal use based on medical reasons. The doctor provides the notification to be shown to Saudi Arabian authorities for clearance upon Yayuk's arrival.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    19 views1 page

    Republic of Indonesia Ministry of Health

    Uploaded by

    setyo hermawan
    This document is a notification from an Indonesian doctor certifying that certain medicines carried by Yayuk Sami Rahayu binti Harjo are for her personal medical use. The notification lists 5 medicines - Hufabion, Caviplek, Lerzin, Alpara, and Dextam Plus - and states they are strictly for Yayuk's daily personal use based on medical reasons. The doctor provides the notification to be shown to Saudi Arabian authorities for clearance upon Yayuk's arrival.

    Copyright:

    © All Rights Reserved
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    of 1

    Tanggal Cetak : 04 Jul 2019 09:20:16

    REPUBLIC OF INDONESIA

    MINISTRY OF HEALTH

    Regency/Municipal Health Service 1100423658


    of .............................................

    TO WHOM IT MAY
    CONCERN

    Herewith the undersigned :

    Name : dr. Wahyuning Hendarsari

    Address : Indonesia

    NOTIFIES THAT

    Name : YAYUK SAMI RAHAYU BINTI HARJO


    PAWIRO

    Passport : 0
    Number

    Flight :

    for his/her own needs has to bring the following medicines

    No. Items/kind of medicines Unit Amount

    1 HUFABION

    2 CAVIPLEK

    3 LERZIN

    4 ALPARA

    5 DEXTAM PLUS

    Based on medical reasons, the above medicines are stricly prepared for daily
    personal use by the bearer, and this notification is provided to be shown/produced
    to the Saudi Arabian Authority when necessary uppon arrival for clearance

    dr. Wahyuning Hendarsari

    NIP/NRP

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