looking at the text... 07:49 May 6, 2010
it appears to be a "guarantee" (as in "Solicitantante del AVAL") or assurance or promise that the citizen will not remain in the foreign country any longer than the period of his/her training. In that case it would be intended to satisfy the U.S. (?) immigration authorities. (Is it addressed to them, or to the hospital?)
That is different from an "endorsement", which would be basically a reference (academic, character reference) for the future trainee to help him/her be accepted at the hospital. What do you yourself understand, Yvonne? | 
peer agreement (net): +4