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These contagious diseases include, but are not limited to smallpox, poliomyelitis by wild polio virus, the human influenza caused by a new subtype of virus and the severe acute respiratory syndrome (SARS), cholera, pneumonic plague, Bellow fever, viral hemorrhagic fevers (e.g.: Ebola, Lassa, Marbug), West Nile Virus and other illnesses of special importance nationally or regionally (e.g.: Dengue Fever, Rift Valley Fever, and meningococcal disease) .  \nCertificado Médico de Buena Salud  \nPor el presente se certifica que el Sr./Sra. .............................................................................................. No padece ninguna drogodependencia, enfermedad mental o alguna de las enfermedades que suponen riesgo para la salud pública de conformidad con lodispuesto en el Reglamento Sanitario Internacional de 2005. Estas enfermedadesincluyen, entre otras, la viruela, poliomielitis por poliovirus, gripe humana causada por nuevos subtipos de virus, síndrome respiratorio agudo severo (SARS), cólera, neumonía, fiebre amarilla, las fiebres hemorrágicas virales (como el Ébola, Lassa, Marburgo, etc.), la fiebre del Nilo Occidental y otras enfermedades de ámbito nacional o regional (como el Dengue, fiebre del Valle del Rift, síndrome meningocócico, etc.)  \nOriginal Physician Signature: ...........................................................  \nFirma original del médico  \nPlace and date:    \nLugary fecha  \nOfficial Physician Stamp: ...........................................................  \nSello oficial del médico  \nInstructions:  \nSee a doctor (MD or DO) and they will determine if you are of good health according to the International Health Regulation (2005) . This PDF file can be sent electronically in order to be printed out on letterhead paper. The doctor may also use this sample as a guide to write their own certificate. Remember that it must specifically mention the International Health Regulations (2005) . The doctor should then print out, sign, date and stamp the Medical Certificate. Make sure your name is filled out in both the Spanish and English portions. Bring the original Medical Certificate and a photocopy to your visa application appointment. We will seal and return your original document so that you can later present it in Spain. We will keep the photocopy to process your visa.  \nVisa Department General Consulate of Spain 5055 Wilshire Blvd. Suite 860  \nLos Angeles, CA 90036 cog.losangeles.vis@maec.es","cbCaijv6poV0oGEA","https://ap.wps.com/l/cbCaijv6poV0oGEA","pdf",499936,"English","# Medical Certificate of Good Health\n## Declaration content (public health and specified diseases)\n## Physician signature, stamp, place and date\n## Instructions for completion and visa submission","[{\"question\":\"What does the Medical Certificate of Good Health confirm?\",\"answer\":\"It confirms that the applicant is free of drug addiction, mental illness, and diseases that could cause serious repercussions to public health according to the International Health Regulations (2005).\"},{\"question\":\"Which organizations and regulations are referenced in the certificate?\",\"answer\":\"The certificate specifically references the International Health Regulations (2005) and is associated with visa processing by the Visa Department General Consulate of Spain in Los Angeles.\"},{\"question\":\"What information is required from the physician and applicant for submission?\",\"answer\":\"The physician must print, sign, date, and stamp the certificate, and the applicant’s name must be filled in both the Spanish and English portions. The original certificate and a photocopy should be brought to the visa appointment.\"}]","Medical Certificate of Good Health - Place and Date | PDF",1789613869]