Elysium, Medical Release Form

original movie prop

Please, sign this to receive medication.


After being accidentally subjected to a fatal radiation dose at the Armadyne plant where he works, Max Da Costa is given a quick exam by an Armadyne company medical droid, judged to be terminal, made to sign a release form, and given some pills to keep him going for the few days he has left.


Paper forms, in Spanish, one of which has a scrawl in pen which appears identical to the small section of Da Costa's 'signature' glimpsed in the scene.


From VIP Fan Auctions & MRC.

prop: collector:
category: original / screen-used
type: movie props
movie: Elysium (2013)
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