Dear Sir or Madam:
A person with hemophilia can control bleeding only with transfusion of plasma or recombinant concentrate.
________________ (patient’s name), who suffers from ________________ (hemophilia or von Willebrand disease), is travelling to ___________________. It would not be possible for him/her to travel without a supply of concentrates. S/he carries with him/her sufficient units for self-infusion as maintenance therapy and additional amounts in the event of an emergency. S/he also carries the syringes, needles etc ., necessary for infusion. ________ prescribed drugs are also being carried for management of _______________.
A customs official who inadvertently withholds bottles of human plasma or recombinant concentrate may place _______________’s (patient’s name) life in jeopardy. For purposes of comparison, it is as if insulin vials were withheld from a person with diabetes.
In anticipation of your cooperation, I am,
Yours very truly,
(Doctor’s signature,
name, position)
Last Updated December 2006
|
