Confirmation of Safe Arrival at Final Destination - Health Partners International Canada

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Humanitarian Medical Kit Confirmation of Safe Arrival at Final Destination

Name of the Kit Carrier and/or Organization*
Date of Arrival*
MM slash DD slash YYYY
Shipment Number
If known
Condition Of Boxes And Their Contents*
Condition Of Boxes And Their Contents*
Did the contents match the packing list?*
- Yes
- No
If no, please specifiy
Name and title of the healthcare provider receiving medicines at the final destination.*
Confirmation*
By checking this box I hereby confirm the safe arrival of the medications outlined in the packing list at the final destination.
Address of final destination where medications were delivered*
E-mail address of physician named above*
Telephone number of physician named above

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