This document certifies that:

_________________________________________________________________________________

(name, surname, date of birth)

is suffering from diabetes mellitus and has to receive insulin injections.

It is necessary for this individual to keep the medicine, needles and syringes in the hand luggage to be able to take proper care of the illness and to make sure that the medicine is kept at an appropriate temperature to avoid it from being destroyed.

In case of any severe medical problems please send this patient to the nearest hospital.

For further information call: IC-amb. (out patient clinic), Endocrine Section, Dept. of Internal Medicine I, Bispebjerg Hospital, Denmark: +45 3863 6175.

Yours sincerly:__________________________________________________________________

                                                            (doctors signature)