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TUE No.

/Numro de AUT
T-258574792
ADO No./Numro d'ADO
FIBA TUE 14-017

CERTIFICATE OF APPROVAL FOR THERAPEUTIC USE


CERTIFICAT DAUTORISATION DUSAGE DES FINS THRAPEUTIQUES
Athlete Details/Renseignements sur lathlte
Surname/Nom de famille
DELLE DONNE
Date of Birth/Date de naissance
05-Sep-1989
Competition Name
/Nom de la comptition
2014 FIBA World Championship
for Women

Given Name/Prnom
Elena
Sport/Sport
Basketball
Registered Testing Pool
/Groupe cible

Gender/Sexe
female
Discipline/Discipline
Basketball

Medical Information/Renseignements mdicaux

The Athlete has received approval for the use of the prohibited substances(s) listed below under the
conditions stipulated in this document. / Lathlte a reu lautorisation dutiliser la (les) substance(s)
interdite(s) cite(s) ci-dessous selon la (les) condition(s) stipule(s) dans ce document.

Diagnosis/Diagnostic: ****** CONFIDENTIAL / CONFIDENTIEL ******


REFER TO THE SPORTING ORGANIZATION / DEMANDEZ L'ORGANISATION SPORTIVE
Effective date/Date dentre en vigueur:

03-Aug-2014

Prohibited Substance/Substance interdite: hydrocortisone


Dosage/Dosage

Frequency/Frquence

Route/Voie

Expiration/Expiration

20 mg
3 times/day
Oral
03-Aug-2018
Comment(s)/Commentaire(s): Regular assessment by the treating physician(s) is
strongly recommended.
Attention athlete: the dose, method and frequency of administration as prescribed by your physician have
to be followed meticulously. Please carry a copy of this form with you at all times. This form should be
presented to the doping control officer at the time of testing.
Athlte: les posologies, voies et frquences dadministration doivent tre mticuleusement respectes
conformment aux prescriptions de votre mdecin. Gardez une copie de ce formulaire en tout temps. Ce
formulaire devrait tre prsent lagent(e) de contrle antidopage au moment du contrle.

Authorized by/Autorise par:


Committee, TUE
FIBA - International Basketball Federation
tue@fiba.com

Date

: 13-Aug-2014

Phone : +41 22 545 00


00

ADAMS TUE 2.3 01/2011