MEDICAL CERTIFICATE
of suitability and fitness for the purpose of Stipendium Hungaricum Scholarship Programme
I the undersigned Doctor in Medicine, (Full name) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Certify that I examined the blood test results and tests of the below patient:
Full Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nationality:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date of Birth:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Place of Birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Country of Residence: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I have found him in good general health, and free of:
HIV
Hepatitis A
Hepatitis B
Hepatitis C
Any Serious physical / mental illness
Any other epidemic disease
Comment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Date: . . . . . . . . . . . . . . . . . . . . .
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Doctor’s signature and stamp