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Medical Certificate 2023 2024

This medical certificate is required for applicants to the Stipendium Hungaricum scholarship program. It contains medical test results and vaccination records for Nafis Ahtasum, a Bangladeshi national applying for the program. Key tests show negative results for tuberculosis, HIV, hepatitis B, and hepatitis C. The applicant has also been vaccinated against diphtheria, tetanus, pertussis, MMR, polio, COVID-19, hepatitis B, and typhoid. The examining physician declares the information is correct.

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494 views1 page

Medical Certificate 2023 2024

This medical certificate is required for applicants to the Stipendium Hungaricum scholarship program. It contains medical test results and vaccination records for Nafis Ahtasum, a Bangladeshi national applying for the program. Key tests show negative results for tuberculosis, HIV, hepatitis B, and hepatitis C. The applicant has also been vaccinated against diphtheria, tetanus, pertussis, MMR, polio, COVID-19, hepatitis B, and typhoid. The examining physician declares the information is correct.

Uploaded by

aranna aranna
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MEDICAL CERTIFICATE STIPENDIUM HUNGARICUM SCHOLARSHIP PROGRAM

The present certificate is a compulsory document to be submitted during application to the Stipendium Hungaricum
scholarship. Tempus Public Foundation manages applicants’ data based on the Privacy Statement for data management
in connection with the Stipendium Hungaricum Programme in force.

Full name of the applicant (as it appears on passport): Nafis Ahtasum

Date of birth: 02 July 2000

Nationality: Bangladeshi

TYPE OF MEDICAL TEST OR VACCINATION EXAMINATION / RESULT


VACCINATION DATE (circle the relevant option)
Tuberculosis (TB) screening (chest X-ray within 3 months) negative / positive
or
Quantiferon test
Please attach the result (not the film) in English/Hungarian.
SEROLOGICAL TESTS
(within 3 months, please attach results in English)
HIV negative / positive
Hepatitis B surface antigen (HBsAg) negative / positive
Hepatitis C antibody (anti-HCV/ HCV Ab) negative / positive
VACCINATIONS
If available please attach Childhood Vaccination/Immunisation Records in English.
If the patient is not vaccinated, please consider vaccination before arriving in Hungary.
Has the patient been vaccinated against diphtheria, tetanus and Yes / No
pertussis? (dTap/Tdap booster should be given every 10 years)
Has the patient been vaccinated against MMR (measles, mumps, Yes / No
rubella)?
Has the patient been vaccinated against poliomyelitis? Yes / No
Has the patient been vaccinated against Coronavirus (COVID- Yes / No
19)?
Has the patient been vaccinated against Hepatitis B? Yes / No
Has the patient been vaccinated against typhoid? Please note, Yes / No
that in case of patients from endemic countries if the patient had
not been vaccinated against typhoid, vaccination is compulsory
after entering Hungary, as part of the healthcare protocol*
*to be filled out only in case of endemic countries

With my signature I hereby declare that the information provided in this form is correct.

Date of issue: 5 April, 2023

signature and stamp of examining physician

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