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Referral letter
Client personal details Client identity details
Family name: ARDONIA Identity document presented: Original Passport
Given names: Grace Identity document number: P9677657A
Gender: FEMALE Issuing country: PHILIPPINES
Date of birth: 26 Apr 1997 Date of issue: 23 Nov 2018
Country of birth: PHILIPPINES Date of expiry: 22 Nov 2028
Source: Australia
If an examination is listed as Completed this means that there is an existing examination that can be re-used for this
visa application. You will not be asked to complete this examination again unless a repeat examination is required
because your medical circumstances have changed or the examination has since expired. More information about when
the department allows re-use is available at www.homeaffairs.gov.au/Trav/Visa/Heal/meeting-the-healthrequirement/
arranging-a-health-examination. If you believe that you have additional examinations for re-use contact your case officer
before you attend your appointment.
When making your appointment, please provide the clinic with your health identifying number (HAP ID) indicated at the
top of this letter. Please also make sure that you bring with you to your appointment:
• existing specialist and/or other relevant medical reports for known medical conditions
Note: a copy of any health information that you have already provided to Home Affairs online is
included below for your information. This information will also assist staff at the panel clinic that you
select to visit.
Consent provided
On 17 JUL 2019 you consented online to using eMedical to process your health examinations where available.
Client declaration
The client has provided true and correct medical history information.
Doctor declaration
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