An address of the clinic Date To whom it may concern: I understand that John Smith have initiated the process of adopting a child/ren in Ukraine and a complete medical review is reguired for this purpose. They each underwent extensive testing and the following results indicate that they are both healthy. The medical testing included the following: I, Dr. A. Nickson, M.D., have examined John Smith and find him to be in good health. 1. Tuberculosis Negative X 2. HIV Negative X 3. STD (including syphilis) Negative X 4. Mental Disorder Negative X 5. Substance Abuse Negative X (Test results are included with this letter). List any other medical condition that would impair her ability to adopt or subsequently raise and care for the child/ren: No All of results from these medical tests certify and confirm that there are no medical reasons to prevent John Smith from becoming an adoptive parent. Dr. A. Nickson, M.D Sign Stamp