Projet (anglais)

Annex 8 WHA58.3

ATTACHMENT TO MODEL OF MARITIME DECLARATION OF HEALTH

Drugs

Reported medicines Class Port, date Nature Date of to a port Disposal or other Name or Age Sex Nationality joined of onset of Comments medical of case* treatment rating ship/vessel illness symptoms officer? given to

patient

* State: (1) whether the person recovered, is still ill or died; and (2) whether the person is still on board, was

evacuated (including the name of the port or airport), or was buried at sea.