Physician’s Letter for Travel – Suggested Template

Letter should be printed on Physician’s Letterhead

Date:

To Whom It May Concern:

Patient Name, DOB (DATE), is under my care for a Primary Immunodeficiency disorder, for which he requires (weekly, daily, every three days) infusions. They must be allowed to travel with their medication and supplies, which include, but are not limited to vials of liquid medication, syringes, and tubing with needles, in his carry on luggage for temperature control and prevention of loss.

(For international travel) Patient name anticipated international travels <flight> are (Date) through (Date), with flights in between.

Thank you for your understanding and cooperation.

Sincerely,

(Dr. Sign’s here)

Physician’s Name

Office Contact Information

Office Address