ANNEX 17b

Edisi 28 Oktober 2021

MINISTRY OF HEALTH MALAYSIA

Reference No.:

To:

Name: ……………………………………………………………….
Identification Card / Passport No: ……………….………………….
Address: ……………………………………………
…………………………………………………………………………
………….……………………………………………………………..

Release Order from Isolation or Surveillance for Person Infected with Coronavirus
Disease (COVID-19) Infection or Person Suspected of Being Infected by Coronavirus
Disease (COVID-19) Under Subregulation 12A Prevention and Control of Infectious
Diseases (Measures Within Infected Local Areas) (National Recovery Plan)
Regulations 2021 [P.U.(A) 293/2021]

In refence to the above matter.

2. You have been identified as a person infected with Coronavirus 2019 (COVID-19)
or a person suspected of being infected with COVID-19; and have been ordered to undergo
an isolation or surveillance under subregulation 12A.(1) Prevention and Control of Infectious
Diseases (Measures Within Infected Local Areas) Regulations (National Recovery Plan)
Regulations 2021 [P.U. (A) 293/2021] starting from ……………………….…. (date) to
…………………………... (date).

3. On the last day of Isolation or Surveillance Order, an assessment carried out found
that your health status is satisfactory. Hence, you are granted relief from isolation or
surveillance under subregulation 12A. (1) P.U. (A) 293/2021, commencing from the date
below. Your attention and cooperation during the period of isolation or surveillance is greatly
appreciated.

Thank you.

The Authorized Officer

Name :

Designation :

Place of work & Phone No. :

Date & Time :