2022

GUIDE FOR AVIATION MEDICAL EXAMINERS

(Updated 04/27/2022)

Welcome to the Guide for Aviation Medical Examiners. The format of this version of the
Guide provides instant access to information regarding regulations, medical history,
examination procedures, dispositions, and protocols necessary for completion of the
FAA Form 8500-8, Application for Airman Medical Certificate.

To navigate through the Guide PDF by Item number or subject matter, simply click on
the “BOOKMARK” tab in the left column to search specific certification decision-making
criteria. To expand any “BOOKMARK” files, click on the corresponding + button located
in the front of the text. To collapse any of the expanded files, click on the + button
again.

The most current version of this guide may be found and downloaded at the following
FAA site:
http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/

AME ALERT
 NEW GUIDANCE: COVID-19 Medication, Eye Medication, Glaucoma and Ocular Hypertension
Medication, Premature Atrial Contraction, and Barrett’s Esophagus.
 CURRENT, DETAILED CLINICAL PROGRESS NOTE is replacing the term “current status report” or “status
report” to help you and your pilots more easily obtain the required information from physicians. All current
references to “current status report” or “status report” must meet the criteria for a current, detailed
Clinical Progress Note.
 CHANGES TO INSULIN TREATED DIABETES MELLITUS - CGM OPTION – Data needs to be sent in 30-
day increments. Changed and expanded ranges to report.

NOTE: Updates to the 2022 AME Guide are scheduled for the last Wednesday of each month,
as indicated below. Please refer to the Archives section for a description of changes that are
made.
2022
JANUARY – No updates JULY 27
FEBRUARY 23 AUGUST 31
MARCH 30 SEPTEMBER 28
APRIL 27 OCTOBER 26
MAY 25 NOVEMBER 30
JUNE 29 DECEMBER – No updates
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TABLE OF CONTENTS
TABLE OF CONTENTS ....................................................................................... 2
GENERAL INFORMATION .................................................................................. 7
1. Legal Responsibilities of Designated Aviation Medical Examiners ............... 8
2. Authority of Aviation Medical Examiners ....................................................... 9
3. Equipment Requirements............................................................................ 10
4. Medical Certification Decision Making ........................................................ 13
5. Authorization for Special Issuance and AME Assisted Special Issuance
(AASI) ............................................................................................................. 14
6. Privacy of Medical Information .................................................................... 17
7. Release of Information ................................................................................ 18
8. No "Alternate" Examiners Designated......................................................... 18
9. Who May Be Certified ................................................................................. 18
10. Classes of Medical Certificates ................................................................. 19
11. Operations Not Requiring a Medical Certificate ........................................ 19
12. Medical Certificates – AME Completion .................................................... 20
13. Validity of Medical Certificates .................................................................. 21
14. Title 14 CFR § 61.53, Prohibition on Operations During Medical Deficiency
........................................................................................................................ 22
15. Reexamination of an Airman ..................................................................... 22
16. Examination Fees ..................................................................................... 22
17. Replacement of Medical Certificates ......................................................... 23
18. Disposition of Applications and Medical Examinations ............................. 23
19. Protection and Destruction of Forms ......................................................... 24
20. Questions, Requests for Assistance, and Technical Support.................... 24
21. Airman Appeals ......................................................................................... 25
22. Medical Certificates Requested for any Situation or Job Other than a Pilot
or Air Traffic Controller. ................................................................................... 28
23. Pilot Information – Current Detailed Clinical Progress Note ...................... 29
APPLICATION FOR MEDICAL CERTIFICATION ............................................. 32
I. AME Guidance for Positive Identification of Airmen and Application
Procedures...................................................................................................... 33
II. Prior to the Examination .............................................................................. 33
ITEMS 3-10. Identification .............................................................................. 35
ITEMS 11-12. Occupation; Employer ............................................................. 36
ITEM 13. Has Your FAA Airman Medical Certificate Ever Been Denied,
Suspended, or Revoked?................................................................................ 36
ITEMS 14-15. Total Pilot Time ....................................................................... 37
ITEM 16. Date of Last FAA Medical Application ............................................ 37
ITEM 17.a. Do You Currently Use Any Medication (Prescription or NON
prescription)? .................................................................................................. 37
ITEM 17.b. Do You Ever Use Near Vision Contact Lens(es) While Flying? ... 38
ITEM 18. Medical History ............................................................................... 38
ITEM 19. Visits to Health Professional Within Last 3 Years ............................ 43
ITEM 20. Applicant's National Driver Register and Certifying Declaration ...... 44
ITEMS 21-22. Height and Weight .................................................................. 46

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ITEMS 23-24. Statement of Demonstrated Ability (SODA); SODA Serial
Number ........................................................................................................... 48
AME PHYSICAL EXAMINATION INFORMATION AND DISPOSITION TABLES
........................................................................................................................... 49
ITEMS 25-30. Ear, Nose and Throat (ENT) ................................................... 50
ITEMS 31-34. Eye .......................................................................................... 60
ITEM 35. Lungs and Chest ............................................................................. 72
ITEM 36. Heart................................................................................................ 79
ITEM 37. Vascular System............................................................................ 104
ITEM 38. Abdomen and Viscera ................................................................... 107
ITEM 39. Anus .............................................................................................. 119
ITEM 40. Skin ............................................................................................... 120
ITEM 41. G-U System ................................................................................... 124
ITEMS 42-43. Musculoskeletal ..................................................................... 142
ITEM 44. Identifying Body Marks, Scars, Tattoos ......................................... 152
ITEM 45. Lymphatics .................................................................................... 153
ITEM 46. Neurologic ..................................................................................... 155
ITEM 47. Psychiatric ..................................................................................... 173
ITEM 48. General Systemic .......................................................................... 201
AME OFFICE-REQUIRED ANCILLARY TESTING ......................................... 222
ITEM 49. Hearing ......................................................................................... 223
ITEMS 50-54. Vision Testing (Updated 05/29/2019) ..................................... 227
ITEM 50. Distant Vision ................................................................................ 227
ITEM 51.a. Near Vision ................................................................................ 230
ITEM 51.b. Intermediate Vision .................................................................... 230
ITEM 52. Color Vision ................................................................................... 233
ITEM 53. Field of Vision ................................................................................ 240
ITEM 54. Heterophoria ................................................................................. 241
ITEM 55. Blood Pressure .............................................................................. 243
ITEM 56. Pulse ............................................................................................. 245
ITEM 57. Urine Test/Urinalysis ..................................................................... 245
ITEM 58. ECG............................................................................................... 246
APPLICATION REVIEW .................................................................................. 251
ITEM 59. Other Tests Given ........................................................................ 252
ITEM 60. Comments on History and Findings.............................................. 253
ITEM 61. Applicant's Name .......................................................................... 254
ITEM 62. Has Been Issued .......................................................................... 254
ITEM 63. Disqualifying Defects .................................................................... 255
ITEM 64. Medical Examiner's Declaration ................................................... 255
CACI CONDITIONS ......................................................................................... 256
DISEASE PROTOCOLS .................................................................................. 257
Protocol for Allergies, Severe........................................................................ 259
Specifications for Neuropsychological Evaluations for ADHD/ADD .............. 260
Protocol for Binocular Multifocal and Accommodating Devices .................... 266
Protocol for Bundle Branch Block (BBB) ....................................................... 267
Protocol for Cardiac Transplant .................................................................... 268
Protocol for Cardiac Valve Replacement ...................................................... 269

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Protocol for Cardiovascular Evaluation (CVE) .............................................. 271
Protocol for Conductive Keratoplasty ............................................................ 272
Protocol for Evaluation of .............................................................................. 273
Coronary Heart Disease (CHD Protocol) ...................................................... 273
Specifications for Neuropsychological Evaluations for Treatment with SSRI
Medications ................................................................................................... 275
Protocol for Diabetes Mellitus - Diet Controlled............................................. 277
Protocol for History of Diabetes Mellitus Type II Medication-Controlled (Non
Insulin) .......................................................................................................... 278
Protocol for Diabetes Mellitus Type I or Type II ............................................ 281
Insulin Treated - CGM Option ....................................................................... 281
Protocol for Insulin-Treated Diabetes Mellitus - Type I & Type II ................. 303
Non CGM - Third-Class Option ..................................................................... 303
Protocol for Maximal Graded Exercise .......................................................... 308
Stress Test Requirements............................................................................. 308
Protocol for History of Human ....................................................................... 309
Immunodeficiency Virus (HIV) Related Conditions ....................................... 309
Protocol for Initial Evaluation of..................................................................... 313
Implanted Pacemaker ................................................................................... 313
Protocol for Liver Transplant (Recipient) ....................................................... 315
Protocol for Medication Controlled ................................................................ 316
Metabolic Syndrome ..................................................................................... 316
Protocol for Musculoskeletal Evaluation ....................................................... 318
Specifications for........................................................................................... 319
Neuropsychological Evaluations for Potential ............................................... 319
Neurocognitive Impairment ........................................................................... 319
FAA Specifications for Neurologic Evaluation ............................................... 321
Protocol for Obstructive Sleep Apnea ........................................................... 325
Protocol for Peptic Ulcer ............................................................................... 335
Specifications for Psychiatric Evaluations ..................................................... 336
Specifications for Psychiatric and ................................................................. 338
Psychological Evaluations............................................................................. 338
Protocol for Renal Transplant ....................................................................... 342
Protocol for Substances of ............................................................................ 344
Dependence/abuse (Drugs - Alcohol) ........................................................... 344
Protocol for Thromboembolic Disease .......................................................... 345
PHARMACEUTICALS ..................................................................................... 369
Do Not Issue - Do Not Fly ............................................................................. 370
ACNE MEDICATIONS .................................................................................. 374
ALLERGY – ANTIHISTAMINE & IMMUNOTHERAPY MEDICATION .......... 375
ANTACIDS .................................................................................................... 377
ANTICOAGULANTS ..................................................................................... 378
EMBOLI MITIGATION IN NON-VALVULAR ................................................. 379
ATRIAL FIBRILLATION (AFIB) ..................................................................... 379
ANTIDEPRESSANTS ................................................................................... 380
ANTIHYPERTENSIVE .................................................................................. 381
CHOLESTEROL MEDICATION .................................................................... 382

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CONTRACEPTIVES AND............................................................................. 383
HORMONE REPLACEMENT THERAPY...................................................... 383
COVID-19 MEDICATIONS............................................................................ 384
DIABETES MELLITUS - INSULIN TREATED ............................................... 385
DIABETES MELLITUS TYPE II - MEDICATION CONTROLLED (NOT
INSULIN)....................................................................................................... 386
ACCEPTABLE COMBINATIONS OF DIABETES MEDICATIONS ............... 387
ERECTILE DYSFUNCTION AND ................................................................. 389
BENIGN PROSTATIC HYPERPLASIA MEDICATIONS ............................... 389
EYE MEDICATION ....................................................................................... 390
GLAUCOMA AND OCULAR HYPERTENSION MEDICATIONS .................. 391
HYDROXYCHLOROQUINE (HCQ)/ CHLOROQUINE (CQ) STATUS REPORT
...................................................................................................................... 392
MALARIA MEDICATIONS ............................................................................ 393
SEDATIVES .................................................................................................. 394
SLEEP AIDS ................................................................................................. 395
VACCINES.................................................................................................... 397
AME ASSISTED SPECIAL ISSUANCES (AASI) ............................................ 398
AASI for Arthritis and/or Psoriasis ................................................................. 401
AASI for Asthma ........................................................................................... 402
AASI for Atrial Fibrillation .............................................................................. 403
AASI for Bladder Cancer ............................................................................... 404
AASI for Breast Cancer ................................................................................. 405
AASI for Cardiac - Single Valve Replacement or Repair .............................. 406
AASI for Chronic Kidney Disease (CKD) ...................................................... 407
AASI for Chronic Lymphocytic Leukemia (CLL) ............................................ 408
AASI for Chronic Obstructive Pulmonary Disease (COPD) .......................... 409
AASI for Colitis (Ulcerative or Crohn’s Disease) ........................................... 410
or Irritable Bowel Syndrome (IBS) ................................................................. 410
AASI for Colon Cancer/Colorectal Cancer .................................................... 411
AASI for Coronary Heart Disease (CHD) ...................................................... 412
AASI for Venous Thromboembolism (VTE) - Deep Venous Thrombosis (DVT),
Pulmonary Embolism (PE), and/or Hypercoagulopathies ............................. 413
AASI for Diabetes Mellitus - Type II Medication Controlled (Not Insulin) ...... 414
AASI for Glaucoma ....................................................................................... 416
AASI for Hepatitis C ...................................................................................... 417
AASI for Hypertension (HTN) ........................................................................ 418
AASI for Hyperthyroidism .............................................................................. 419
AASI for Hypothyroidism ............................................................................... 420
AASI for Lymphoma and Hodgkin’s Disease ................................................ 421
AASI for Melanoma ....................................................................................... 422
AASI for Migraines ........................................................................................ 423
AASI for Mitral or Aortic Insufficiency ............................................................ 424
AASI for Paroxysmal Atrial Tachycardia (PAT) ............................................. 425
AASI for Prostate Cancer .............................................................................. 426
AASI for Renal Calculi .................................................................................. 427
AASI for Renal Cancer .................................................................................. 428

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AASI for Sleep Apnea/Obstructive Sleep Apnea (OSA) ................................ 429
AASI for Testicular Cancer............................................................................ 430
AASI for Thrombocytopenia .......................................................................... 431
Certificate Issuance ...................................................................................... 432
SUBSTANCES OF DEPENDENCE/ABUSE.................................................... 434
General Information for ALL AMES............................................................... 435
DUI/DWI ........................................................................................................ 437
Drug Use ....................................................................................................... 440
Drug/Alcohol Monitoring Programs and HIMS .............................................. 447
SYNOPSIS OF MEDICAL STANDARDS ........................................................ 466
STUDENT PILOT RULE CHANGE .................................................................. 468
GLOSSARY ..................................................................................................... 470
ARCHIVES AND UPDATES ............................................................................ 474

Forms: http://www.faa.gov/library/forms

Federal Aviation Administration Regional and Center Medical Office Addresses:

http://www.faa.gov/licenses_certificates/medical_certification/rfs

Federal Aviation Administration FAA Flight Standards District Offices (FSDOs):

http://www.faa.gov/about/office_org/field_offices/fsdo

Title 14 Code of Federal Regulations Part 67 — Medical Standards and

Certification:
https://www.gpo.gov/fdsys/granule/CFR-2012-title14-vol2/CFR-2012-title14-vol2-part67

Convention on International Civil Aviation International Standards on Personnel

Licensing:

The international Standards on Personnel Licensing are contained in Annex 1 –

Personnel Licensing to the Convention on International Civil Aviation. The FAA
maintains an updated, hard copy of all the ICAO Annexes and also an on-line
subscription. The FAA makes copies of Annex 1 available at seminars and can provide
AMEs access upon request.

http://www.icao.int/safety/AirNavigation/Pages/peltrgFAQ.aspx

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GENERAL INFORMATION

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This section provides input to assist an Aviation Medical Examiner (AME), otherwise
known as an Examiner, in performing his or her duties in an efficient and effective
manner. It also describes AME responsibilities as the Federal Aviation Administration's
(FAA) representative in medical certification matters and as the link between airmen
and the FAA.

1. Legal Responsibilities of Designated Aviation Medical Examiners

Title 49, United States Code (U.S.C.) (Transportation), sections 109(9), 40113(a),
44701-44703, and 44709 (1994) formerly codified in the Federal Aviation Act of 1958,
as amended, authorizes the FAA Administrator to delegate to qualified private persons;
i.e. designated AMEs, matters related to the examination, testing, and inspection
necessary to issue a certificate under the U.S.C. and to issue the certificate.
Designated Examiners are delegated the Administrator's authority to examine
applicants for airman medical certificates and to issue or deny issuance of certificates.

Approximately 450,000 applications for airman medical certification are received and
processed each year. The vast majority of medical examinations conducted in
connection with these applications are performed by physicians in private practice who
have been designated to represent the FAA for this purpose. An AME is a designated
representative of the FAA Administrator with important duties and responsibilities. It is
essential that AMEs recognize the responsibility associated with their appointment.

At times, an applicant may not have an established treating physician and the AME may
elect to fulfill this role. You must consider your responsibilities in your capacity as an
AME as well as the potential conflicts that may arise when performing in this dual
capacity.

The consequences of a negligent or wrongful certification, which would permit an

unqualified person to take the controls of an aircraft, can be serious for the public, for
the Government, and for the AME. If the examination is cursory and the AME fails to
find a disqualifying defect that should have been discovered in the course of a thorough
and careful examination, a safety hazard may be created and the AME may bear the
responsibility for the results of such action.

Of equal concern is the situation in which an AME deliberately fails to report a

disqualifying condition either observed in the course of the examination or otherwise
known to exist. In this situation, both the applicant and the AME in completing the
application and medical report form may be found to have committed a violation of
Federal criminal law which provides that:

"Whoever in any matter within the jurisdiction of any department or agency of the
United States knowingly and willfully falsifies, conceals, or covers up by any trick,
scheme, or device a material fact, or who makes any false, fictitious or fraudulent
statements or representations, or entry, may be fined up to $250,000 or imprisoned not
more than 5 years, or both" (Title 18 U.S. Code. Secs. 1001; 3571).

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Cases of falsification may be subject to criminal prosecution by the Department of

Justice. This is true whether the false statement is made by the applicant, the AME, or
both. In view of the pressures sometimes placed on AMEs by their regular patients to
ignore a disqualifying physical defect that the physician knows to exist, it is important
that all AMEs be aware of possible consequences of such conduct.

In addition, when an airman has been issued a medical certificate that should not have
been issued, it is frequently necessary for the FAA to begin a legal revocation or
suspension action to recover the certificate. This procedure is time consuming and
costly. Furthermore, until the legal process is completed, the airman may continue to
exercise the privileges of the certificate, thereby compromising aviation safety.

2. Authority of Aviation Medical Examiners

The AME is delegated authority to:

 Examine applicants for, and holders of, airman medical certificates to determine
whether or not they meet the medical standards for the issuance of an airman
medical certificate.

 Issue, defer, or deny airman medical certificates to applicants or holders of such

certificates based upon whether or not they meet the applicable medical
standards. The medical standards are found in Title 14 of the Code of Federal
Regulations, part 67.

The AME may NOT:

 Perform self-examinations for issuance of a medical certificate to themselves*;

 Issue a medical certificate to themselves or to an immediate family member*; or
 Generate or author their own medical status reports. Reports regarding the
medical status of an airman should be written by their treating provider. A
report completed by an airman will NOT be accepted, even if that airman is a
physician.

*For more information, see FAA Order 8000.95A Designee Management Policy.

A medical certificate issued by an AME is considered to be affirmed as issued unless,

within 60 days after date of issuance (date of examination), it is reversed by the Federal
Air Surgeon, a RFS, or the Manager, AMCD. However, if the FAA requests additional
information from the applicant within 60 days after the issuance, the above-named
officials have 60 days after receipt of the additional information to reverse the issuance.

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3. Equipment Requirements

AME EQUIPMENT AND MEDICAL CONFIDENTIALITY

(Updated 03/31/2021)

AMEs must have adequate facilities and equipment for performing the required physical
examinations. AMEs shall certify, at the time of designation, prior to conducting any FAA
examinations, re-designation, or upon request, that they possess and maintain as necessary
the equipment specified below.
The form is 3 pages. Indicate the items available in your office with a checkmark:

1. VISUAL ACUITY AND PHORIA TESTING - Must have ALL in either 1.A. OR Exception 1.B.
VISUAL ACUITY TESTING: Must have all of the following:
☐ 1. A.
MANUAL TESTING ☐ Standard Snellen test for distance visual acuity, with appropriate eye lane
and lighting.
☐ FAA Form 8500-1, Near Vision Acuity Card for near and intermediate
vision testing
☐ Opaque eye occluder

PHORIA TESTING: Must have at least one option from EACH category: Prisms,
Red Maddox Rod, and Eye Muscle Test Light:
Prisms - Must have at least one of the following:
To measure heterophoria, must begin with 1 prism diopter and increase to
at least 8 prism diopters for BOTH horizontal and vertical.
☐ Risley rotary prism device
☐ Prism bars: BOTH horizontal and vertical
☐ Individual hand prisms
Red Maddox Rod - Must have at least one of the following:
☐ Maddox Rod included in Risley rotary prism device
☐ Maddox Rod hand held
Eye Muscle Test Light - Must have at least one of the following:
☐ Muscle light
☐ Ophthalmoscope light
☐ Penlight 0.5cm in diameter

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☐ 1. B. Optional substitute: Any commercially available visual acuity and heterophoria-

COMMERCIAL testing device that gives distance and near acuity in Snellen equivalents is
TESTING EXCEPTION acceptable for the equipment listed in 1.A. It is strongly recommended that if using
a commercial device, that both a Snellen wall chart and near vision acuity card
are available to recheck testing, if needed.

If applicable, check the box below and write the name of the device.
☐ I use the following commercially available visual acuity and heterophoria testing
device(s) in my office:
Device name: Click or tap here to enter text.

2. COLOR VISION TESTING - Must have AT LEAST ONE of the following:

Pseudoisochromatic Plates (PIP)

☐ American Optical Company (AOC), 1965 Edition
☐ AOC-HRR, 2nd edition
☐ Dvorine, 2nd edition
☐ Ishihara (select one below)
☐Concise 14-plate ☐ 24-plate ☐ 38-plate edition
☐ Richmond, 1983 edition, 15-plate
☐ Richmond-HRR
Commercial Vision Testers
☐ Farnsworth Lantern
☐ Keystone Orthoscope
☐ Keystone Telebinocular
☐ OPTEC 900 Color Vision Tester
☐ OPTEC 2000
Model 2000PM, 2000 PAME, 2000P
Must include the 2000-010 Far color perception PIP plate to be approved
☐ OPTEC 2500
☐ Titmus Vision Tester
☐ Titmus i400

3. FIELD OF VISION TESTING – must have at least ONE of the following:

☐ Direct confrontation field-testing (must test all 4 quadrants). No equipment required

☐ Wall Target (50-inch square surface made of black felt or dull/matte finish paper; and a 2-mm white test object,
which may be a pin with a handle the same color as the wall target.
☐ Visual Field Perimeter (must test all 4 quadrants).

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4. OTHER OFFICE EQUIPMENT – must have ALL of the following:

☐ Computer with internet access and printer

☐ Diagnostic instruments necessary to complete FAA exam
☐ Equipment to measure height and weight
☐ Urinalysis Test Strips to test for albumin and sugar

Urine dipstick expiration date on package: Click or tap here to enter text.

5. SENIOR AME - SPECIAL EQUIPMENT REQUIRED – must have the following:


☐ Access to electrocardiograph (EKG/ECG) equipment (preferably at your office location)
Brand of ECG equipment Click or tap here to enter text.

6. EMPLOYEE AME - SPECIAL EQUIPMENT REQUIRED - must have the following:

☐ Audiometric Equipment. Brand: Click or tap here to enter text.
☐ Calibration date: Click or tap here to enter text.

I hereby certify that I possess and maintain as necessary the equipment specified above in
my office or available at the designated location below:

Address: Click or tap here to enter text.

City: Click or tap here to enter text. State: Click or tap here to enter text. Zip Code: Click or tap here to enter text.
Country (if outside the US): Click or tap here to enter text.

Telephone Number (Include Area Code): Click or tap here to enter text.

Signature: ___________________________ Date: Click or tap here to enter text.

AND

I hereby certify that I maintain confidentiality of medical records at all times.

Signature: ___________________________ Date: Click or tap here to enter text.

Printed Name: Click or tap here to enter text. AME number: Click or tap here to enter text.

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4. Medical Certification Decision Making

The format of the Guide establishes aerospace medical dispositions, protocols, and
AME Assisted Special Issuances (AASI) identified in Items 21–58 of the FAA Form
8500. This guidance references specific medical tests or procedure(s) the results of
which are needed by the FAA to determine the eligibility of the applicant to be medically
certificated. The request for this medical information must not be misconstrued as the
FAA ordering or mandating that the applicant undergo testing, where clinically
inappropriate or contraindicated. The risk of the study based upon the disease state and
test conditions must be balanced by the applicant’s desire for certification and
determined by the applicant and their healthcare provider(s).

After reviewing the medical history and completing the examination, AMEs must:

• Issue a medical certificate,

• Deny the application, or

• Defer the action to the Manager, AMCD, AAM-300, or the appropriate RFS

AMEs may issue a medical certificate only if the applicant meets all medical standards,
including those pertaining to medical history unless otherwise authorized by the FAA.

AMEs may not issue a medical certificate if the applicant fails to meet specified
minimum standards or demonstrates any of the findings or diagnoses described in this
Guide as "disqualifying" unless the condition is unchanged or improved and the
applicant presents written documentation that the FAA has evaluated the condition,
found the applicant eligible for certification, and authorized AMEs to issue certificates.

The following medical conditions are specifically disqualifying under 14 CFR part 67.
However, the FAA may exercise discretionary authority under the provisions of
Authorization of Special Issuance, to issue an airman medical certificate. See
Special Issuances section for additional guidance where applicable.

• Angina pectoris;

• Bipolar disorder;

• Cardiac valve replacement;

• Coronary heart disease that has required treatment or, if untreated, that has
been symptomatic or clinically significant;

• Diabetes mellitus requiring insulin or other hypoglycemic medication;

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• Disturbance of consciousness without satisfactory medical explanation of the
cause;

• Epilepsy;

• Heart replacement;
• Myocardial infarction;

• Permanent cardiac pacemaker;

• Personality disorder that is severe enough to have repeatedly manifested itself

by overt acts;

• Psychosis;

• Substance abuse and dependence; and/or

• Transient loss of control of nervous system function(s) without satisfactory

medical explanation of cause.

An airman who is medically disqualified for any reason may be considered by the FAA
for an Authorization for Special Issuance of a Medical Certificate (Authorization). For
medical defects, which are static or non-progressive in nature, a Statement of
Demonstrated Ability (SODA) may be granted in lieu of an Authorization.

The AME may always defer the application to the FAA for action. In the interests of
the applicant and of a responsive certification system, however, deferral is appropriate
only if: the standards are not met; if there is an unresolved question about the history,
the findings, the standards, or agency policy; if the examination is incomplete; if further
evaluation is necessary; or if directed by the FAA.

The AME may deny certification only when the applicant clearly does not meet the
standards. For information on Denial – see Item 62.

5. Authorization for Special Issuance and AME Assisted Special Issuance (AASI)

A. Authorization for Special Issuance of a Medical Certificate (Authorization).

At the discretion of the Federal Air Surgeon, an Authorization for Special Issuance of a
Medical Certificate (Authorization), valid for a specified period, may be granted to a
person who does not meet the established medical standards if the person shows to the
satisfaction of the Federal Air Surgeon that the duties authorized by the class of medical
certificate applied for can be performed without endangering public safety during the
period in which the Authorization would be in force. The Federal Air Surgeon may
authorize a special medical flight test, practical test, or medical evaluation for this
purpose. A medical certificate of the appropriate class may be issued to a person who

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fails to meet one or more of the established medical standards if that person possesses
a valid agency issued Authorization and is otherwise eligible. An airman medical
certificate issued in accordance with the special issuance section of part 67 (14 CFR §
67.401), shall expire no later than the end of the validity period or upon the withdrawal
of the Authorization upon which it is based. An airman must again show to the
satisfaction of the Federal Air Surgeon that the duties authorized by the class of medical
certificate applied for can be performed without endangering public safety in order to
obtain a new medical certificate and/or a Re-Authorization.

In granting an Authorization, the Federal Air Surgeon may consider the person's
operational experience and any medical facts that may affect the ability of the person to
perform airman duties including:

 The factors leading to and surrounding the episode;

 The combined effect on the person of failing to meet one or more than one
requirement of part 67; and

 The prognosis derived from professional consideration of all available information

regarding the person.

In granting an Authorization, the Federal Air Surgeon specifies the class of medical
certificate authorized to be issued and may do any or all of the following:

 Limit the duration of an Authorization;

 Condition the granting of a new Authorization on the results of subsequent

medical tests, examinations, or evaluations;

 State on the Authorization, and any medical certificate based upon it, any
operational limitation needed for safety; or

 Condition the continued effect of an Authorization, and any second- or third-class

medical certificate based upon it, on compliance with a statement of functional
limitations issued to the person in coordination with the Director of Flight
Standards or the Director's designee.

 In determining whether an Authorization should be granted to an applicant for a

third-class medical certificate, the Federal Air Surgeon considers the freedom of
an airman, exercising the privileges of a private pilot certificate, to accept
reasonable risks to his or her person and property that are not acceptable in the
exercise of commercial or airline transport pilot privileges, and, at the same time,
considers the need to protect the safety of persons and property in other aircraft
and on the ground

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An Authorization granted to a person who does not meet the applicable medical
standards of part 67 may be withdrawn, at the discretion of the Federal Air Surgeon, at
any time if:

 There is an adverse change in the holder's medical condition;

 The holder fails to comply with a statement of functional limitations or operational

limitations issued as a condition of certification under the special issuance
section of part 67 (14 CFR 67.401);

 Public safety would be endangered by the holder's exercise of airman privileges;

 The holder fails to provide medical information reasonably needed by the Federal
Air Surgeon for certification under the special issuance section of part 67
(14 CFR 67.401); or

 The holder makes or causes to be made a statement or entry that is the basis for
withdrawal of an Authorization under the falsification section of part 67
(14 CFR 67.403).

A person who has been granted an Authorization under the special issuance section of
part 67 (14 CFR 67.401), based on a special medical flight or practical test, need not
take the test again during later medical examinations unless the Federal Air Surgeon
determines or has reason to believe that the physical deficiency has or may have
degraded to a degree to require another special medical flight test or practical test.

The authority of the Federal Air Surgeon under the special issuance section of part 67
(14 CFR 67.401) is also exercised by the Manager, AMCD, and each RFS.

If an Authorization is withdrawn at any time, the following procedures apply:

 The holder of the Authorization will be served a letter of withdrawal, stating the
reason for the action;

 By not later than 60 days after the service of the letter of withdrawal, the holder of
the Authorization may request, in writing, that the Federal Air Surgeon provide for
review of the decision to withdraw. The request for review may be accompanied
by supporting medical evidence;

 Within 60 days of receipt of a request for review, a written final decision either
affirming or reversing the decision to withdraw will be issued; and

 A medical certificate rendered invalid pursuant to a withdrawal, in accordance

with the special issuance section of part 67 (14 CFR 67.401) shall be
surrendered to the Administrator upon request.

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B. AME Assisted Special Issuance (AASI).

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization to an
applicant who has a medical condition that is disqualifying under 14 CFR part 67.
An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. AMEs may re-issue an airman medical certificate under the
provisions of an Authorization, if the applicant provides the requisite medical information
required for determination. AMEs may not issue initial Authorizations. An AME’s
decision or determination is subject to review by the FAA.

6. Privacy of Medical Information

A. Within the FAA, access to an individual's medical information is strictly on a

"need-to-know" basis. The safeguards of the Privacy Act apply to the application for
airman medical certification and to other medical files in the FAA's possession. The
FAA does not release medical information without an order from a court of competent
jurisdiction, written permission from the individual to whom it applies, or, with the
individual's knowledge, during litigation of matters related to certification. The FAA
does, however, on request, disclose the fact that an individual holds an airman medical
certificate and its class, and it may provide medical information regarding a pilot
involved in an accident to the National Transportation Safety Board (NTSB) (or to a
physician of the appropriate medical discipline who is retained by the NTSB for use in
aircraft accident investigation).

The AME, as a representative of the FAA, should treat the applicant's medical
certification information in accordance with the requirements of the Privacy Act.
Therefore, information should not be released without the written consent of the
applicant or an order from a court of competent jurisdiction. Whenever a court order or
subpoena is received by the AME, the appropriate RFS or the AMCD should be
contacted In order to ensure proper release of information. Similarly, unless the
applicant's written consent for release routine in nature (e.g., accompanying a standard
insurance company request), the FAA must be contacted before releasing any
information. In all cases, copies of all released information should be retained.

B. Health Insurance Portability and Accountability Act of 1996 (HIPAA) and AME’s
activities for the FAA.

This Act provides specific patient protections and depending upon an AME’s activation
and practice patterns, you may have to comply with additional requirements.

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C. AMEs shall certify at the time of designation, re-designation, or upon request that
they shall protect the privacy of medical information.

7. Release of Information
(Updated 08/29/2018)
Except in compliance with an order of a court of competent jurisdiction, or upon an
applicant's written request, AMEs will not divulge or release copies of any reports
prepared in connection with the examination to anyone other than the applicant or the
FAA. A copy of the examination may be released to the applicant upon request. (See:
Request for Airman Medical Records Form 8065-2). Upon receipt of a court subpoena
or order, the AME shall notify the appropriate RFS. Other requests for information will
be referred to:

MANAGER
Federal Aviation Administration
Civil Aerospace Medical Institute, Bldg. 13
Aerospace Medical Certification Division, AAM-300
PO Box 25082
Oklahoma City, OK 73125-9867

8. No "Alternate" Examiners Designated

The AME is to conduct all medical examinations at their designated address only. An
AME is not permitted to conduct examinations at a temporary address and is not
permitted to name an alternate examiner. During an AME's absence from the
permanent office, applicants for airman medical certification shall be referred to another
AME in the area.

9. Who May Be Certified

a. Age Requirements

There is no age restriction or aviation experience requirement for medical certification.

Any applicant who qualifies medically may be issued a Medical Certificate regardless of
age.

There are, however, minimum age requirements for the various airman certificates (i.e.,
pilot license certificates) are defined in 14 CFR part 61, Certification: Pilots and Flight
Instructors, and Ground Inspectors as follows:

(1) Airline transport pilot (ATP) certificate: 23 years

(2) Commercial pilot certificate: 18 years
(3) Private pilot certificate: powered aircraft - 17 years; gliders and balloons -16
years.

Note: As of April 1, 2016 (per Final Rule [81 FR 1292]), AMEs will no longer be able to issue the
combined FAA Medical Certificate and Student Pilot Certificate. See Student Pilot Rule Change.

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b. Language Requirements

There is no language requirement for medical certification.

10. Classes of Medical Certificates

An applicant may apply and be granted any class of airman medical certificate as long
as the applicant meets the required medical standards for that class of medical
certificate. However, an applicant must have the appropriate class of medical certificate
for the flying duties the airman intends to exercise. For example, an applicant who
exercises the privileges of an airline transport pilot (ATP) certificate must hold a first-
class medical certificate. That same pilot when holding only a third-class medical
certificate may only exercise privileges of a private pilot certificate. Finally, an applicant
need not hold an ATP airman certificate to be eligible for a first-class medical certificate.

Listed below are the three classes of airman medical certificates, identifying the
categories of airmen (i.e., pilot) certificates applicable to each class.

First-Class - Airline Transport Pilot

Second-Class - Commercial Pilot; Flight Engineer; Flight Navigator; or

Air Traffic Control Tower Operator. (Note: This category of air traffic controller
does not include FAA employee air traffic control specialists)

Third-Class - Private Pilot or Recreational Pilot

An airman medical certificate is valid only with the original signature of the AME who
performed the examination or with the digital signature of an authorized FAA physician
(e.g., Regional Flight Surgeon, manager of the Aerospace Medical Certification Division,
Federal Air Surgeon). Note:
 Copies are NOT valid.
 An AME may only issue ONE originally signed certificate to an airman. A
replacement for a lost or destroyed certificate must be issued by the FAA.

11. Operations Not Requiring a Medical Certificate

Glider and Free Balloon Pilots are not required to hold a medical certificate of any class.
To be issued Glider or Free Balloon Airman Certificates, applicants must certify that
they do not know, or have reason to know, of any medical condition that would make
them unable to operate a glider or free balloon in a safe manner. This certification is
made at the local FAA FSDO.

“Sport” pilots are required to hold either a valid airman medical certificate or a current
and valid U.S. driver’s license. When using a current and valid U.S. driver’s license to
qualify, sport pilots must comply with each restriction and limitation on their U.S. driver’s

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license and any judicial or administrative order applying to the operation of a motor
vehicle.

To exercise sport pilot privileges using a current and valid U.S. driver’s license as
evidence of qualification, sport pilots must:

 Not have been denied the issuance of at least a third-class airman medical
certificate (if they have applied for an airman medical certificate)
 Not have had their most recent airman medical certificate revoked or suspended
(if they have held an airman medical certificate); and
 Not have had an Authorization withdrawn (if they have ever been granted an
Authorization).

Sport pilots may not use a current and valid U.S. driver’s license in lieu of a valid airman
medical certificate if they know or have reason to know of any medical condition that
would make them unable to operate a light-sport aircraft in a safe manner.

Sport pilot medical provisions are found under 14 CFR §§ 61.3, 61.23, 61.53, and
61.303).

For more information about the sport pilot final rule, see the Certification of Aircraft and
Airmen for the Operation of Light-Sport Aircraft; Final Rule.

12. Medical Certificates – AME Completion

(Updated 07-26-2017)

 Date the medical certificate to reflect the date the medical examination
was performed, NOT the date of import, issuance, or transmission.
 Limitations must be selected from the list in the Aerospace Medical Certification
System (AMCS). Additional limitations may NOT be typed/written in.
 Signatures: Each medical certificate must be fully completed prior to being
signed.
o Both the AME and applicant must sign the medical certificate in ink.
o The applicant must sign before leaving the AME’s office.

 Give only ONE certificate to the airman

 Use AMCS generated certificates only.
 Transmit the exam electronically to the FAA using AMCS within 14 days.
 The following are NOT valid:
o Copies of medical Certificates;
o Typewriter or handwritten certificates;
o Obviously corrected certificates;
o Paper 8500-8 certificates (any remaining paper forms should be destroyed
by the AME).
 Replacement medical certificates must be issued by the FAA.

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13. Validity of Medical Certificates

An airman medical certificate is valid only with the original signature of the AME who
performed the examination or with the digital signature of an authorized FAA physician
(e.g., Regional Flight Surgeon, manager of the Aerospace Medical Certification Division,
Federal Air Surgeon).
 Copies are NOT valid.
 An AME may only issue ONE originally signed certificate to an airman. A
replacement for a lost or destroyed certificate must be issued by the FAA.

A. First-Class Medical Certificate: A first-class medical certificate is valid for the

remainder of the month of issue; plus

6-calendar months for operations requiring a first-class medical certificate if the

airman is age 40 or over on or before the date of the examination, or plus

12-calendar months for operations requiring a first-class medical certificate if the

airman has not reached age 40 on or before the date of examination

12-calendar months for operations requiring a second-class medical certificate, or

plus

24-calendar months for operations requiring a third-class medical certificate, or plus

60-calendar months for operations requiring a third-class medical certificate if the

airman has not reached age 40 on or before the date of examination.

B. Second-Class Medical Certificate: A second-class medical certificate is valid for the

remainder of the month of issue; plus

12-calendar months for operations requiring a second-class medical certificate, or

plus

24-calendar months for operations requiring a third-class medical certificate, or plus

60-calendar months for operations requiring a third-class medical certificate if the

airman has not reached age 40 on or before the date of examination.

C. Third-Class Medical Certificate: A third-class medical certificate is valid for the

remainder of the month of issue; plus

24-calendar months for operations requiring a third-class medical certificate, or plus

60-calendar months for operations requiring a third-class medical certificate if the

airman has not reached age 40 on or before the date of examination.

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14. Title 14 CFR § 61.53, Prohibition on Operations During Medical Deficiency

NOTE: 14 CFR § 61.53 was revised on July 27, 2004 by adding subparagraph (c)

(a) Operations that require a medical certificate. Except as provided in paragraph

(b) of this section, a person who holds a current medical certificate issued under
part 67 of this chapter shall not act as pilot in command, or in any other capacity
as a required pilot flight crewmember, while that person:

(1) Knows or has reason to know of any medical condition that would make the
person unable to meet the requirements for the medical certificate necessary
for the pilot operation; and/or

(2) Is taking medication or receiving other treatment for a medical condition that
results in the person being unable to meet the requirements for the medical
certificate necessary for the pilot operation.

(b) Operations that do not require a medical certificate. For operations provided for
in § 61.23(b) of this part, a person shall not act as pilot in command, or in any
other capacity as a required pilot flight crewmember, while that person knows or
has reason to know of any medical condition that would make the person unable
to operate the aircraft in a safe manner.

(c) Operations requiring a medical certificate or a U.S. driver's license. For

operations provided for in Sec. 61.23(c), a person must meet the provisions of—

(1) Paragraph (a) of this section if that person holds a valid medical certificate
issued under part 67 of this chapter and does not hold a current and valid
U.S. driver's license

(2) Paragraph (b) of this section if that person holds a current and valid U.S.
driver's license

15. Reexamination of an Airman

A medical certificate holder may be required to undergo a reexamination at any time if,
in the opinion of the Federal Air Surgeon or authorized representative within the FAA,
there is a reasonable basis to question the airman's ability to meet the medical
standards. An AME may NOT order such reexamination.

16. Examination Fees

The FAA does not establish fees to be charged by AMEs for the medical examination of
persons applying for airman medical certification. It is recommended that the fee be the

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usual and customary fee established by other physicians in the same general locality for
similar services.

17. Replacement of Medical Certificates

(Updated 08/30/2017)

Medical certificates that are lost or accidentally destroyed may be replaced upon proper
application provided such certificates have not expired. The request should be sent to:

FOIA DESK
Federal Aviation Administration
Civil Aerospace Medical Institute, Bldg. 13
Aerospace Medical Certification Division, AAM-331
PO Box 25082
Oklahoma City, OK 73125-9867

The airman's request for replacement must be accompanied by a remittance of two

dollars ($2) (check or money order) made payable to the FAA. This request must
include:

 Airman’s full name and date of birth;

 Class of certificate;

 Place and date of examination;

 Name of the AME; and

 Circumstances of the loss or destruction of the original certificate.

The replacement certificate will be prepared in the same manner as the missing
certificate and will bear the same date of examination regardless of when it is issued.

In an emergency, contact your RFS or the Manager, AMCD, AAM-300, at the above
address or by facsimile at 405-954-4300 for certification verification only.

18. Disposition of Applications and Medical Examinations

All completed applications and medical examinations, unless otherwise directed by the
FAA, must be transmitted electronically via AMCS within 14 days after completion to the
AMCD. These requirements also apply to submissions by International AMEs.

A record of the examination is stored in AMCS, however, AMEs are encouraged to print
a copy for their own files. While not required, the AME may also print a summary sheet
for the applicant.

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19. Protection and Destruction of Forms

Forms are available electronically in AMCS. AMEs are accountable for all blank FAA
forms they may have printed and are cautioned to provide adequate security for such
forms or certificates to ensure that they do not become available for illegal use. AMEs
are responsible for destroying any existing paper forms they may still have.

NOTE: Forms should not be shared with other AMEs.

20. Questions, Requests for Assistance, and Technical Support

(Updated 09/29/2021)

AMCS Technical Support: For any questions regarding technical issues related to
transmitting exams, please contact the AMCS Support Team. Typical technical issues
include AMCS password resets, data entry questions, corrections to transmitted exams,
etc.

AMCS Support is available Monday-Friday, 8 a.m. to 4:15 p.m. (CT) and can be
reached by:

 Phone (405) 954-3238 or

 Email at [email protected].

For access to AMCS, please complete and submit the AMCS Access Form.

Other Issues: When an AME has a question or needs assistance in carrying out
responsibilities, the AME should contact one of the following individuals:

A. Regional Flight Surgeon (RFS)

 Questions pertaining to problem medical certification cases in which the RFS

has initiated action;

 Telephone interpretation of medical standards or policies involving an

individual airman whom the AME is examining;

 Matters regarding designation and re-designation of AMEs and the Aviation

Medical Examiner Program; or

 Attendance at Aviation Medical Examiner Seminars.

B. Manager, AMCD, AAM-300

 Inquiries concerning guidance on problem medical certification cases;

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 Information concerning the overall airman medical certification program;

 Matters involving FAA medical certification of military personnel; or

 Information concerning medical certification of applicants in foreign countries

These inquiries should be made to:

MANAGER
Federal Aviation Administration
Civil Aerospace Medical Institute, Building 13
Aerospace Medical Certification Division, AAM-300
PO Box 25082
Oklahoma City, OK 73125-9867

C. Manager, Aeromedical Education Division, AAM-400

 Matters regarding designation and re-designation of AMEs;

 Requests for medical forms and stationery; or

 Requests for airman medical educational material

These inquiries should be made to:

MANAGER
Federal Aviation Administration
Civil Aerospace Medical Institute, Building 13
Aerospace Medical Certification Division, AAM-400
PO Box 25082
Oklahoma City, OK 73125-9867

21. Airman Appeals

(Updated 08/30/2017)

A. Request for Reconsideration

An AME’s denial of a medical certificate is not a final FAA denial. An applicant may ask
for reconsideration of an AME's denial by submitting a request in writing to:

MANAGER
Federal Aviation Administration
Civil Aerospace Medical Institute, Building 13, Room 308
Aerospace Medical Certification Division, AAM-300
PO Box 25082
Oklahoma City, OK 73125-9867

The AMCD will provide initial reconsideration. Some cases may be referred to the
appropriate RFS for action. If the AMCD or a RFS finds that the applicant is not
qualified, the applicant is denied and advised of further reconsideration and appeal

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procedures. These may include reconsideration by the Federal Air Surgeon and/or
petition for NTSB review.

B. Statement of Demonstrated Ability (SODA)

At the discretion of the Federal Air Surgeon, a Statement of Demonstrated Ability

(SODA) may be granted, instead of an Authorization, to a person whose disqualifying
condition is static or non-progressive and who has been found capable of performing
airman duties without endangering public safety. A SODA does not expire and
authorizes a designated AME to issue a medical certificate of a specified class if the
AME finds that the condition described on the SODA has not adversely changed.

In granting a SODA, the Federal Air Surgeon may consider the person's operational
experience and any medical facts that may affect the ability of the person to perform
airman duties including:

 The combined effect on the person of failure to meet more than one requirement
of part 67; and

 The prognosis derived from professional consideration of all available information

regarding the person.

In granting a SODA under the special issuance section of part 67 (14 CFR 67.401), the
Federal Air Surgeon specifies the class of medical certificate authorized to be issued
and may do any of the following:

 State on the SODA, and on any medical certificate based upon it, any operational
limitation needed for safety; or

 Condition the continued effect of a SODA, and any second- or third-class medical
certificate based upon it, on compliance with a statement of functional limitations
issued to the person in coordination with the Director of Flight Standards or the
Director's designee.

 In determining whether a SODA should be granted to an applicant for a

third-class medical certificate, the Federal Air Surgeon considers the freedom of
an airman, exercising the privileges of a private pilot certificate, to accept
reasonable risks to his or her person and property that are not acceptable in the
exercise of commercial or airline transport pilot privileges, and, at the same time,
considers the need to protect the safety of persons and property in other aircraft
and on the ground.

A SODA granted to a person who does not meet the applicable standards of part 67
may be withdrawn, at the discretion of the Federal Air Surgeon, at any time if:

 There is adverse change in the holder's medical condition;

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 The holder fails to comply with a statement of functional limitations or operational
limitations issued under the special issuance section of part 67 (14 CFR 67.401);

 Public safety would be endangered by the holder's exercise of airman privileges;

 The holder fails to provide medical information reasonably needed by the Federal
Air Surgeon for certification under the special issuance section of part 67
(14 CFR 67.401);

 The holder makes or causes to be made a statement or entry that is the basis for
withdrawal of a SODA under the falsification section of part 67 (14 CFR 67.403);
or

 A person who has been granted a SODA under the special issuance section of
part 67 (14 CFR 67.401), based on a special medical flight or practical test need
not take the test again during later medical examinations unless the Federal Air
Surgeon determines or has reason to believe that the physical deficiency has or
may have degraded to a degree to require another special medical flight test or
practical test.

The authority of the Federal Air Surgeon under the special issuance section of part 67
(14 CFR 67.401) is also exercised by the Manager, AMCD, and each RFS.

If a SODA is withdrawn at any time, the following procedures apply:

 The holder of the SODA will be served a letter of withdrawal stating the reason
for the action;

 By not later than 60 days after the service of the letter of withdrawal, the holder of
the SODA may request, in writing, that the Federal Air Surgeon provide for
review of the decision to withdraw. The request for review may be accompanied
by supporting medical evidence;

 Within 60 days of receipt of a request for review, a written final decision either
affirming or reversing the decision to withdraw will be issued; and

 A medical certificate rendered invalid pursuant to a withdrawal, in accordance

with the special issuance section of part 67 (14 CFR 67.401 (a)) shall be
surrendered to the Administrator upon request.

C. National Transportation Safety Board (NTSB)

Within 60 days after a final FAA denial of an unrestricted airman medical certificate, an
airman may petition the NTSB for a review of that denial. The NTSB does not have
jurisdiction to review the denial of a SODA or special issuance airman medical
certificate.

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A petition for NTSB review must be submitted in writing to:

NATIONAL TRANSPORTATION SAFETY BOARD

490 L'ENFANT PLAZA, EAST SW
WASHINGTON, DC 20594-0001

The NTSB is an independent agency of the Federal Government that has the authority
to review on appeal the suspension, amendment, modification, revocation, or denial of
any certificate or license issued by the FAA Administrator.

An Administrative Law Judge for the NTSB may hold a formal hearing at which the FAA
will present documentary evidence and testimony by medical specialists supporting the
denial decision. The petitioner will also be given an opportunity to present evidence and
testimony at the hearing. The Administrative Law Judge’s decision is subject to review
by the full NTSB.

22. Medical Certificates Requested for any Situation or Job Other than a Pilot or
Air Traffic Controller.
(Updated 07/29/2020)

The FAA’s authority to issue airman medical certificates is limited to civil aviation safety
considerations by statute (Title 49, United States Code, Chapter 447) and regulation
(Title 14, Code of Federal Regulations (CFR), Parts 61 and 67). The Federal Air
Surgeon’s authority is therefore limited to considering whether an individual
applying for medical certification is physically and mentally qualified to safely
perform pilot or air traffic control duties requiring any class of airman medical
certificate. This includes contract air traffic control tower operators who are required by
regulation to have a class II airman medical certificate.

The Federal Air Surgeon may not give consideration to non-pilot occupational,
employment, recreational, or other reasons an individual may have for seeking an
airman medical certificate. This would be an abrogation of the Federal Air Surgeon’s
safety responsibilities.

Historically, several industries have required certain employees to obtain medical

certification by completing an FAA airman medical examination, usually related to
accident or health insurance liability issues, e.g. parachute jump instructors, speedboat
drivers, and Armed Security Officers (per TSA/DHS requirements).

Those requirements are set by the employer, not by the FAA. The FAA may not put
limitations on an airman’s medical certificate, such as “valid for speedboat racing only.”
Similarly, the FAA may not issue airman medical certificates with a limitation of “not
valid for flying.”

The medical application may not be tailored to specific industries or non-aviation uses.
The applicant either meets all of the medical requirements for a specific class, with or

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without a Special Issuance or SODA, or they do not. The FAA may not issue a medical
certificate, for example, if the applicant passed everything except the vision requirement
or the hearing requirement for that class because they are not a pilot or ATC. The fact
that an employer requires an airman medical certificate for employment is an issue that
the individual should address with their employer. It is outside the purview of the FAA.

Once issued an FAA airman medical certificate, the individual may legally use that
certificate to become a pilot or perform pilot (or air traffic control) duties, even if the
individual specifically denied intent to do so at the time of the application. Therefore, if
the FAA issues an airman medical certificate with the intent that the person not use it to
fly, yet they decided to do so, that would be an abrogation of the FAA’s safety duties.

23. Pilot Information – Current Detailed Clinical Progress Note

(Updated 03/30/2022)

In the course of the certification process, the pilot may be asked to provide a current
detailed Clinical Progress Note performed within 90 days of the exam from the treating
physician. In some instances, the specialty of the physician will be specified (ex.
cardiologist or neurologist, etc.). A current detailed Clinical Progress Note must include
a summary of the history of the condition; current medications, dosages, and side
effects (if any); clinical exam findings; results of any testing performed; diagnosis;
assessment; plan (prognosis); and follow-up. Based on the condition, we may require
additional, specific criteria.

If the pilot submits patient information from the patient portal or an “After Visit Summary
(AVS)” instead of an actual detailed clinical progress note, it may NOT address all of the
information the FAA needs to review the application for medical certification. The review
process will be significantly delayed if incorrect or incomplete information is submitted.
To avoid this, refer the pilot to the Pilot Information – Current Detailed Clinical
Progress Note sheets below.

NOTE: Any reference to a “current status report” or “status report’ is a request for a
current detailed Clinical Progress Note as described above.

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PILOT INFORMATION – CURRENT DETAILED CLINICAL PROGRESS NOTE

(Updated 03/30/2022)

The FAA requires a current detailed Clinical Progress Note performed within 90 days of your
AME exam* to make a determination on your FAA Medical Certificate. If you ask your physician's
office for a copy of your progress note, they may direct you to your patient portal to print out “notes”
or an “After Visit Summary (AVS).” Patient Portal notes or an AVS that do not meet the criteria listed
below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. Submitting incorrect
or incomplete information will delay your medical certification review. To help avoid this, please
review the information provided below.

Here is how to tell the difference between patient portal notes or AVS vs a current detailed Clinical
Progress Note:
Patient Portal or After Visit Summary (AVS) Current Detailed Clinical Progress Note
Ready immediately after the visit. May take some time (days) for the physician
to review and sign.
Accessible on your patient portal. May be accessible in your patient portal,
however, this depends on your physicians
Electronic Medical Record (EMR) system.
Title = “After Visit Summary” Title = "Progress Notes" or "View notes"

Page Contents: Page Contents:

 Blood pressure, weight, pulse;  Blood pressure, weight, pulse;
 Instructions (“pick up medications, return in 6  Instructions (“pick up medications, return
months,” etc.); in 6 months,” etc.);
 Reason for visit, list of medications given, or tests  Reason for visit, list of medications given,
ordered; and or tests ordered;
 Medication allergies, immunization history, etc.  Medication allergies, immunization
history, etc.;

PLUS:
 Review of body systems;
 Physical exam findings
(Ex. constitutional, cardiovascular, skin,
etc.);
 List of all current medication(s) and
dosages;
 Assessment;
 Plan (prognosis); and
 ICD-10 codes
You do not need to sign a release to obtain. You may have to sign a release with your
physician's office to get a copy (printed or
released to you in your EMR).

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Review the following FAA terms. You may wish to share this with your treating physician.

WHEN YOU SEE THIS: IT MEANS:

CURRENT Performed within 90 days of your AME exam*

Example: You see your AME on June 1.

To be “current,” the detailed Clinical Progress Note should be from an
evaluation in which you saw your treating physician in clinic between
March 1 and June 1 (90 days).

(*FAA ATCS clearance exams correlate with birth month, so the treating
physician evaluation should be within 90 days of birth month.)

DETAILED Must include the following items:**

 A summary of the history of the condition,

 Current medications, dosages, and side effects (if any);
 Clinical exam findings;
 Results of any testing performed;
 Diagnosis;
 Assessment;
 Plan (prognosis); and
 Follow-up

Example: A letter stating “Mr. Smith is ok to fly” (or any other simple note) is
NOT a current detailed Clinical Progress Note and is NOT acceptable.

(**This information is standard in most clinical progress notes. [E.g.

Medicare standards])

CLINICAL Describes findings from an actual clinical encounter (usually in office).

PROGRESS NOTE This is part of the actual medical record that details events of your office or
hospital visit.
You may also see this called a
“current status report” or Physicians and other providers understand this term. It may be called a
“status report” in current FAA SOAP note or patient note. It has specific components (see “Detailed”
Guidance. Any reference to a above).
“status report” equals the
criteria listed on this sheet. A patient “after visit summary” or “patient summary” are NOT sufficient for
FAA purposes. To see if your note meets FAA requirements, see the
previous page for a comparison between “patient portal or after visit
summary” vs. current detailed Clinical Progress Note.

“IT MUST SPECIFICALLY If this language is in your letter, it is to highlight SPECIFIC items (that may
INCLUDE” or may not be part of a standard current detailed Clinical Progress Note).
Make sure your physician addresses these specific items.
 Guide for Aviation Medical Examiners
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APPLICATION FOR MEDICAL

CERTIFICATION
Items 1-20 of FAA Form 8500-8

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ITEMS 1- 20 of FAA Form 8500-8

This section contains guidance for items on the Medical History and General
Information page of FAA Form 8500-8, Application for Airman Medical Certificate.

I. AME Guidance for Positive Identification of Airmen and Application Procedures

All applicants must show proof of age and identity under 14 CFR §67.4. On
occasion, individuals have attempted to be examined under a false name. If the
applicant is unknown to the AME, the AME should request evidence of positive
identification. A Government-issued photo identification (e.g., driver’s license,
identification card issued by a driver’s license authority, military identification, or
passport) provides age and identity and is preferred. Applicants may use other
government-issued identification for age (e.g., certified copy of a birth certificate);
however, the AME must request separate photo identification for identity (such as
a work badge). Verify that the address provided is the same as that given under
Item 5. Record the type of identification(s) provided and identifying number(s)
under Item 60. Make a copy of the identification and keep it on file for 3 years
with the AME work copy.

An applicant who does not have government-issued photo identification may use non-
photo government-issued identification (e.g. pilot certificate, birth certificate, voter
registration card) in conjunction with a photo identification (e.g. work identification card,
student identification card).

If an airman fails to provide identification, the AME must report this immediately to the
AMCD, or the appropriate RFS for guidance.

II. Prior to the Examination

(Updated 02/28/2018)

 Once the applicant successfully completes Items 1-20 of FAA Form 8500-8
through the FAA MedXPress system, he/she will receive a confirmation number
and instructions to print a summary sheet. This data entered through the
MedXPress system will remain valid for 60 days.
 Applicants must bring their MedXPress confirmation number and valid photo
identification to the Exam. If the applicant does not bring their confirmation
number to the exam, the applicant can retrieve it from MedXPress or their email
account. AMEs should call AMCS Support if the confirmation number cannot be
retrieved.
 AMEs must not begin the exam until they have imported the MedXPress
application into AMCS and have verified the identity of the applicant.

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III. After the Applicant Completes the Medical History of the FAA Form 8500-8

The AME must review all Items 1 through 20 for accuracy. The applicant must answer
all questions. The date for Item 16 may be estimated if the applicant does not recall the
actual date of the last examination. However, for the sake of electronic transmission, it
must be placed in the mm/dd/yyyy format.

Verify that the name on the applicant's identification media matches the name on the
FAA Form 8500-8. If it does not, question the applicant for an explanation. If the
explanation is not reasonable (legal name change, subsequent marriage, etc.), do not
continue the medical examination or issue a medical certificate. Contact your RFS for
guidance.

The applicant's Social Security Number (SSN) is not mandatory. Failure to provide is
not grounds for refusal to issue a medical certificate. (See Item 4). All other items on
the form must be completed.

Applicants must provide their home address on the FAA Form 8500-8. Applicants may
use a private mailing address (e.g., a P.O. Box number or a mail drop) if that is their
preferred mailing address; however, under Item 18 (in the "Explanations" box) of the
FAA Form 8500-8, they must provide their home address.

An applicant cannot make updates to their application once they have certified and
submitted it. If the AME discovers the need for corrections to the application during the
review, the AME is required to discuss these changes with the applicant and obtain their
approval. The AME must make any changes to the application in AMCS.

Strict compliance with this procedure is essential in case it becomes necessary for the
FAA to take legal action for falsification of the application.

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ITEMS 1-2. Application for; Class of Medical Certificate Applied For

The applicant indicates the class of medical certificate desired. The class of medical
certificate sought by the applicant is needed so that the appropriate medical standards
may be applied. The class of certificate issued must correspond with that for which the
applicant has applied.

The applicant may ask for a medical certificate of a higher class than needed for the
type of flying or duties currently performed. For example, an aviation student may ask
for a first-class medical certificate to see if he or she qualifies medically before entry into
an aviation career. A recreational pilot may ask for a first- or second-class medical
certificate if they desire.

The AME applies the standards appropriate to the class sought, not to the airman's
duties - either performed or anticipated. The AME should never issue more than one
certificate based on the same examination.

ITEMS 3-10. Identification

Items 3-10 on the FAA Form 8500-8 must be entered as identification. While most of the
items are self-explanatory (as indicated in the MedXPress drop-down menu next to
individual items) specific instructions include:

 Item 3. Last Name; First Name; Middle Name

The applicant’s legal last, first, and middle name* (or initial if appropriate) must
be provided.

*If an applicant has no middle name, leave the middle name box blank. Do not
use nomenclature which indicates no middle name (i.e. NMN, NMI, etc.). If the
applicant has used such a nomenclature on their MedXPress application, delete
it and leave the middle name box blank.

Note: If the applicant's name changed for any reason, the current name is listed
on the application and any former name(s) in the EXPLANATIONS box of Item
18 on the application.

 Item 4. Social Security Number (SSN)

The applicant must provide their SSN. If they decline to provide one or are an
international applicant, they must check the appropriate box and a number will be
generated for them. The FAA requests a SSN for identification purposes, record
control, and to prevent mistakes in identification.

 Item 6. Date of Birth

The applicant must enter the numbers for the month, day, and year of birth in
order. Name, date of birth, and SSN are the basic identifiers of airmen. When
an AME communicates with the FAA concerning an applicant, the AME must

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give the applicant's full name, date of birth, and SSN if at all possible. The
applicant should indicate citizenship; e.g., U.S.A.

Although nonmedical regulations allow an airman to solo a glider or balloon at

age 14, a medical certificate is not required for glider or balloon operations.
These airmen are required to certify to the FAA that they have no known physical
defects that make them unable to pilot a glider or balloon. This certification is
made at the FAA FSDO’s.

There is a maximum age requirement for certain air carrier pilots. Because this
is not a medical requirement but an operational one, the AME may issue medical
certificates without regard to age to any applicant who meets the medical
standards.

ITEMS 11-12. Occupation; Employer

Occupational data are principally used for statistical purposes. This information, along
with information obtained from Items 10, 14 and 15 may be important in determining
whether a SODA may be issued, if applicable.

11. Occupation

This should reflect the applicant's major employment. "Pilot" should only be reported
when the applicant earns a livelihood from flying.

12. Employer

The employer's name should be entered by the applicant.

ITEM 13. Has Your FAA Airman Medical Certificate Ever Been Denied,
Suspended, or Revoked?

The applicant shall check "yes" or "no." If "yes" is checked, the applicant should enter
the date of action and should report details in the EXPLANATIONS box of Item 18.

The AME may not issue a medical certificate to an applicant who has checked "yes."
The only exceptions to this prohibition are:

 The applicant presents written evidence from the FAA that he or she was
subsequently medically certificated and that an AME is authorized to issue a
renewal medical certificate to the person if medically qualified; or

 The AME obtains oral or written authorization to issue a medical certificate from
an FAA medical office

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ITEMS 14-15. Total Pilot Time

14. Total Pilot Time to Date

The applicant should indicate the total number of civilian flight hours and whether those
hours are logged (LOG) or estimated (EST).

15. Total Pilot Time Past 6 Months

The applicant should provide the number of civilian flight hours in the 6-month period
immediately preceding the date of this application. The applicant should indicate
whether those hours are logged (LOG) or estimated (EST).

ITEM 16. Date of Last FAA Medical Application

If a prior application was made, the applicant should indicate the date of the last
application, even if it is only an estimate of the year. This item should be completed
even if the application was made many years ago or the previous application did not
result in the issuance of a medical certificate. If no prior application was made, the
applicant should check the appropriate block in Item 16.

ITEM 17.a. Do You Currently Use Any Medication (Prescription or NON

prescription)?

If the applicant checks yes, give name of medication(s) and indicate if the medication
was listed in a previous FAA medical examination.

This includes both prescription and nonprescription medication. (Additional guidelines

for the certification of airmen who use medication may be found throughout the Guide).

For example, any airman who is undergoing continuous treatment with anticoagulants,
antiviral agents, anxiolytics, barbiturates, chemotherapeutic agents, experimental
hypoglycemic, investigational, mood-ameliorating, motion sickness, narcotic, sedating
antihistaminic, sedative, steroid drugs, or tranquilizers must be deferred certification
unless the treatment has previously been cleared by FAA medical authority. In such an
instance, the applicant should provide the AME with a copy of any FAA correspondence
that supports the clearance.

During periods in which the foregoing medications are being used for treatment of acute
illnesses, the airman is under obligation to refrain from exercising the privileges of
his/her airman medical certificate unless cleared by the FAA.

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Further information concerning an applicant's use of medication may be found under the
items pertaining to specific medical condition(s) for which the medication is used, or you
may contact your RFS.

ITEM 17.b. Do You Ever Use Near Vision Contact Lens(es) While Flying?

The applicant should indicate whether near vision contact lens(es) is/are used while
flying. If the applicant answers "yes," the AME must counsel the applicant that use of
contact lens(es) for monovision correction is not allowed. The AME must note in
Item 60 that this counseling has been given. Examples of unacceptable use include:

 The use of a contact lens in one eye for near vision and in the other eye for
distant vision (for example: pilots with myopia plus presbyopia).

 The use of a contact lens in one eye for near vision and the use of no contact
lens in the other eye (for example: pilots with presbyopia but no myopia).

If the applicant checks "yes" and no further comment is noted on FAA Form 8500-8 by
either the applicant or the AME, a letter will automatically be sent to the applicant
informing him or her that such use is inappropriate for flying.

Please note: the use of binocular contact lenses for distance-correction-only is

acceptable. In this instance, no special evaluation or SODA is routinely required for a
distance-vision-only contact lens wearer who meets the standard and has no
complications. Binocular bifocal or binocular multifocal contact lenses are also
acceptable under the Protocol for Binocular Multifocal and Accommodating Devices. If
the applicant checks “yes” in Item 17.b but actually is using binocular bifocal or
binocular multifocal contact lenses then the AME should note this in Item 60.

ITEM 18. Medical History

Each item under this heading must be checked either "yes" or "no." For all items
checked "yes," a description and approximate date of every condition the applicant has
ever been diagnosed with, had, or presently has, must be given in the EXPLANATIONS
box. If information has been reported on a previous application for airman medical
certification and there has been no change in the condition, the applicant may note
"PREVIOUSLY REPORTED, NO CHANGE" in the EXPLANATIONS box, but the
applicant must still check "yes" to the condition.

Of particular importance are conditions that have developed since the last FAA medical
examination. The AME must take the time to review the applicant's responses on FAA
Form 8500-8 before starting the applicant's medical examination.

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The AME should ensure that the applicant has checked all of the boxes in Item 18 as
either "yes" or "no." The AME should use information obtained from this review in
asking the applicant pertinent questions during the course of the examination.

Certain aspects of the individual’s history may need to be elaborated upon. The AME
should provide in Item 60 an explanation of the nature of items checked “yes” in items
18.a. through 18.y. Please be aware there is a character count limit in Item 60. If all
comments cannot fit in Item 60, the AME may submit additional information on a plain
sheet of paper and include the applicant’s full name, date of birth, signature, any
appropriate identifying numbers (PI, MID or SSN), and the date of the exam.

Supplementary reports from the applicant's physician(s) should be obtained and

forwarded to the AMCD, when necessary, to clarify the significance of an item of history.
The responsibility for providing such supplementary reports rests with the applicant. A
discussion with the AME's RFS may clarify and expedite the certification process at that
time.

Affirmative answers alone in Item 18 do not constitute a basis for denial of a medical
certificate. A decision concerning issuance or denial should be made by applying the
medical standards pertinent to the conditions uncovered by the history.

Experience has shown that, when asked direct questions by a physician, applicants are
likely to be candid and willing to discuss medical problems.

The AME should attempt to establish rapport with the applicant and to develop a
complete medical history. Further, the AME should be familiar with the FAA certification
policies and procedures in order to provide the applicant with sound advice.

18.a. Frequent or severe headaches. The applicant should report frequency,

duration, characteristics, severity of symptoms, neurologic manifestations, whether they
have been incapacitating, treatment, and side effects, if any. (See Item 46)

18.b. Dizziness or fainting spells. The applicant should describe characteristics of

the episode; e.g., spinning or lightheadedness, frequency, factors leading up to and
surrounding the episode, associated neurologic symptoms; e.g., headache, nausea,
LOC, or paresthesias. Include diagnostic workup and treatment if any.
(See Items 25-30 and Item 46)

18.c. Unconsciousness for any reason. The applicant should describe the event(s)
to determine the primary organ system responsible for the episode, witness statements,
initial treatment, and evidence of recurrence or prior episode. Although the regulation
states, “an unexplained disturbance of consciousness is disqualifying,” it does not mean
to imply that the applicant can be certificated if the etiology is identified, because the
etiology may also be disqualifying in and of itself. (See Item 46).

18.d. Eye or vision trouble except glasses. The AME should personally explore the
applicant's history by asking questions, concerning any changes in vision, unusual

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visual experiences (halos, scintillations, etc.), sensitivity to light, injuries, surgery, or
current use of medication. Does the applicant report inordinate difficulties with eye
fatigue or strain? Is there a history of serious eye disease such as glaucoma or other
disease commonly associated with secondary eye changes, such as diabetes?
For glaucoma or ocular hypertension, obtain a FAA Form 8500-14, Report of Eye
Evaluation for Glaucoma. For any other medical condition, obtain a FAA Form 8500-7,
Report of Eye Evaluation. Under all circumstances, please advise the examining eye
specialist to explain why the airman is unable to correct to Snellen visual acuity of
20/20. (See Items 31-34, Item 53, and Item 54)

18.e. Hay fever or allergy. The applicant should report frequency and duration of
symptoms, any incapacitation by the condition, treatment, and side effects. The AME
should inquire whether the applicant has ever experienced any barotitis (“ear block”),
barosinusitis, alternobaric vertigo, or any other symptoms that could interfere with
aviation safety. (See Item 26)

18.f. Asthma or lung disease. The applicant should provide frequency and severity of
asthma attacks, medications, and number of visits to the hospital and/or emergency
room. For other lung conditions, a detailed description of symptoms/diagnosis, surgical
intervention, and medications should be provided. (See Item 35)

18.g. Heart or vascular trouble. The applicant should describe the condition to
include, dates, symptoms, and treatment, and provide medical reports to assist in the
certification decision-making process. These reports should include: operative reports
of coronary intervention to include the original cardiac catheterization report, stress
tests, worksheets, and original tracings (or a legible copy). When stress tests are
provided, forward the reports, worksheets and original tracings (or a legible copy) to the
FAA. Part 67 provides that, for all classes of medical certificates, an established
medical history or clinical diagnosis of myocardial infarction, angina pectoris, cardiac
valve replacement, permanent cardiac pacemaker implantation, heart replacement, or
coronary heart disease that has required treatment or, if untreated, that has been
symptomatic or clinically significant, is cause for denial. (See Item 36)

18.h. High or low blood pressure. The applicant should provide history and
treatment. Issuance of a medical certificate to an applicant with high blood pressure
may depend on the current blood pressure levels and whether the applicant is taking
anti-hypertensive medication. The AME should also determine if the applicant has a
history of complications, adverse reactions to therapy, hospitalization, etc.
(Details are given in Item 36 and Item 55)

18.i. Stomach, liver, or intestinal trouble. The applicant should provide history and
treatment, pertinent medical records, current status report, and medication. If a surgical
procedure was done, the applicant must provide operative and pathology reports.
(See Item 38)

18.j. Kidney stone or blood in urine. The applicant should provide history and
treatment, pertinent medical records, current status report and medication. If a

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procedure was done, the applicant must provide the report and pathology reports.
(See Item 41)

18.k. Diabetes. The applicant should describe the condition to include symptoms and
treatment. Comment on the presence or absence of hyperglycemic and/or
hypoglycemic episodes. A medical history or clinical diagnosis of diabetes mellitus
requiring insulin or other hypoglycemic drugs for control are disqualifying. The AME can
help expedite the FAA review by assisting the applicant in gathering medical records
and submitting a current specialty report. (See Item 48)

18.l. Neurological disorders; epilepsy, seizures, stroke, paralysis, etc. The

applicant should provide history and treatment, pertinent medical records, current status
report and medication. The AME should obtain details about such a history and report
the results. An established diagnosis of epilepsy, a transient loss of control of nervous
system function(s), or a disturbance of consciousness is a basis for denial no matter
how remote the history. Like all other conditions of aeromedical concern, the history
surrounding the event is crucial. Certification is possible if a satisfactory explanation
can be established. (See Item 46)

18.m. Mental disorders of any sort; depression, anxiety, etc. An affirmative answer
to Item 18.m. requires investigation through supplemental history taking. Dispositions
will vary according to the details obtained. An applicant with an established history of a
personality disorder that is severe enough to have repeatedly manifested itself by overt
acts, a psychosis disorder, or a bipolar disorder must be denied or deferred by the AME.
(See Item 47)

18.n. Substance dependence; or failed a drug test ever; or substance abuse or

use of illegal substance in the last 2 years. "Substance" includes alcohol and other
drugs (e.g., PCP, sedatives and hypnotics, anxiolytics, marijuana, cocaine, opioids,
amphetamines, hallucinogens, and other psychoactive drugs or chemicals). For a "yes"
answer to Item 18.n., the AME should obtain a detailed description of the history. See
disposition tables. A history of substance dependence or abuse is disqualifying. The
AME must defer issuance of a certificate if there is doubt concerning an applicant's
substance use.
See: Pharmaceuticals and Substances of Dependence/Abuse.

18.o. Alcohol dependence or abuse. See DUI/ DWI /Alcohol Incidents Disposition
Table.

18.p. Suicide attempt. A history of suicidal attempts or suicidal gestures requires

further evaluation. The ultimate decision of whether an applicant with such a history is
eligible for medical certification rests with the FAA. The AME should take a
supplemental history as indicated, assist in the gathering of medical records related to
the incident(s), and, if the applicant agrees, assist in obtaining psychiatric and/or
psychological examinations. (See Item 47)

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18.q. Motion sickness requiring medication. A careful history concerning the nature
of the sickness, frequency and need for medication is indicated when the applicant
responds affirmatively to this item. Because motion sickness varies with the nature of
the stimulus, it is most helpful to know if the problem has occurred in flight or under
similar circumstances. (See Item 29)

18.r. Military medical discharge. If the person has received a military medical
discharge, the AME should take additional history and record it in Item 60. It is helpful
to know the circumstances surrounding the discharge, including dates, and whether the
individual is receiving disability compensation. If the applicant is receiving veteran's
disability benefits, the claim number and service number are helpful in obtaining copies
of pertinent medical records. The fact that the applicant is receiving disability benefits
does not necessarily mean that the application should be denied.

18.s. Medical rejection by military service. The AME should inquire about the place,
cause, and date of rejection and enter the information in Item 60. It is helpful if the AME
can assist the applicant with obtaining relevant military documents. If a delay of more
than 14-calendar days is expected, the AME should transmit FAA Form 8500-8 to the
FAA with a note specifying what documents will be forwarded later.

Disposition will depend upon whether the medical condition still exists or whether a
history of such a condition requires denial or deferral under the FAA medical standards.

18.t. Rejection for life or health insurance. The AME should inquire regarding the
circumstances of rejection. The supplemental history should be recorded in Item 60.
Disposition will depend upon whether the medical condition still exists or whether a
history of such a condition requires denial or deferral under the FAA medical standards.

18.u. Admission to hospital. For each admission, the applicant should list the dates,
diagnoses, duration, treatment, name of the attending physician, and complete address
of the hospital or clinic. If previously reported, the applicant may enter "PREVIOUSLY
REPORTED, NO CHANGE." A history of hospitalization does not disqualify an
applicant, although the medical condition that resulted in hospitalization may.

18.v. History of Arrest(s), Conviction(s), and/or Administrative Action(s).

(Updated 06/24/2020)
Arrest(s), conviction(s), and/or administrative action(s) affecting driving privileges may
raise questions about the applicant's qualifications for airman medical certification. All
incidents must be reported (even if reported on a previous application), to include even
a single driving while intoxicated (DWI) arrest, conviction and/or administrative
action. Incidents reported under 18.v. are just part of many factors considered in the
overall process of medical certification. See Substances of Dependence/Abuse.

NOTE: Remind your airman that once he/she has checked yes to any item in #18,
especially items 18 n., 18 o. or 18 v., they must ALWAYS mark yes to these
numbers, even if the condition has been reviewed and granted an eligibility letter from
the FAA.

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18.w. History of nontraffic convictions. The applicant must report any other
(nontraffic) convictions (e.g., assault, battery, public intoxication, robbery, etc.). The
applicant must name the charge for which convicted and the date of the conviction(s),
and copies of court documents (if available). (See Item 47)

18.x. Other illness, disability, or surgery. The applicant should describe the nature
of these illnesses in the EXPLANATIONS box. If additional records, tests, or specialty
reports are necessary in order to make a certification decision, the applicant should so
be advised. If the applicant does not wish to provide the information requested by the
AME, the AME should defer issuance.

If the applicant wishes to have the FAA review the application and decide what ancillary
documentation is needed, the AME should defer issuance of the medical certificate and
forward the completed FAA Form 8500-8 to the AMCD. If the AME proceeds to obtain
documentation, but all data will not be received with the 2 weeks, FAA Form 8500-8
should be transmitted immediately to the AMCD with a note that additional documents
will be forwarded later under separate cover.

18. y. Medical Disability Benefits. The applicant must report any disability benefits
received, regardless of source or amount. If the applicant checks “yes” on this item, the
FAA may verify with other Federal Agencies (i.e. Social Security Administration,
Veteran’s Affairs) whether the applicant is receiving a disability benefit that may present
a conflict in issuing an FAA medical certificate. The AME must document the specifics
and nature of the disability in findings in Item 60.

ITEM 19. Visits to Health Professional Within Last 3 Years

The applicant should list all visits in the last 3 years to a physician, physician assistant,
nurse practitioner, psychologist, clinical social worker, or substance abuse specialist for
treatment, examination, or medical/mental evaluation. The applicant should list visits for
counseling only if related to a personal substance abuse or psychiatric condition. The
applicant should give the name, date, address, and type of health professional
consulted and briefly state the reason for the consultation. Multiple visits to one health
professional for the same condition may be aggregated on one line.

Routine dental, eye, and FAA periodic medical examinations and consultations with an
employer-sponsored employee assistance program (EAP) may be excluded unless the
consultations were for the applicant's substance abuse or unless the consultations
resulted in referral for psychiatric evaluation or treatment.

When an applicant does provide history in Item 19, the AME should review the matter
with the applicant. The AME will record in Item 60 only that information needed to
document the review and provide the basis for a certification decision. If the AME finds
the information to be of a personal or sensitive nature with no relevancy to flying safety,
it should be recorded in Item 60 as follows:

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"Item 19. Reviewed with applicant. History not significant or relevant to application."

If the applicant is otherwise qualified, a medical certificate may be issued by the AME.

FAA medical authorities, upon review of the application, will ask for further information
regarding visits to health care providers only where the physical findings, report of
examination, applicant disclosure, or other evidence suggests the possible presence of
a disqualifying medical history or condition.

If an explanation has been given on a previous report(s) and there has been no change
in the condition, the applicant may enter "PREVIOUSLY REPORTED, NO CHANGE."

Of particular importance is the reporting of conditions that have developed since the
applicant's last FAA medical examination. The AME is asked to comment on all entries,
including those "PREVIOUSLY REPORTED, NO CHANGE." These comments may be
entered under Item 60.

ITEM 20. Applicant's National Driver Register and Certifying Declaration

In addition to making a declaration of the completeness and truthfulness of the

applicant's responses on the medical application, the applicant's declaration authorizes
the National Driver Register to release the applicant's adverse driving history
information, if any, to the FAA. The FAA uses such information to verify information
provided in the application. Applicant must certify the declaration outlined in Item 20. If
the applicant does not certify the declaration for any reason, AME shall not issue a
medical certificate but forward the incomplete application to the AMCD.

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EXAMINATION TECHNIQUES
Items 21-58 of FAA Form 8500-8

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ITEMS 21- 58 of FAA Form 8500-8

The AME must personally conduct the physical examination. This section provides
guidance for completion of Items 21-58 of the Application for Airman Medical Certificate,
FAA Form 8500-8.

The AME must carefully read the applicant's history page of FAA Form 8500-8
(Items 1-20) before conducting the physical examination and completing the Report of
Medical Examination. This alerts the AME to possible pathological findings.

The AME must note in Item 60 of the FAA Form 8500-8 any condition found in the
course of the examination. The AME must list the facts, such as dates, frequency, and
severity of occurrence.

When a question arises, the Federal Air Surgeon encourages AMEs first to check this
Guide for Aviation Medical Examiners and other FAA informational documents. If the
question remains unresolved, the AME should seek advice from a RFS or AMCD.

ITEMS 21-22. Height and Weight

21. Height (inches) 22. Weight (pounds)

ITEM 21. Height

Measure and record the applicant's height in inches. Although there are no medical
standards for height, exceptionally short individuals may not be able to effectively reach
all flight controls and must fly specially modified aircraft. If required, the FAA will place
operational limitations on the pilot certificate.

ITEM 22. Weight

Measure and record the applicant's weight in pounds.

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BMI CHART AND FORMULA TABLE

Measurement Units BMI Formula and Calculation

Pounds and inches Formula: weight (lb) / [height (in)]2 x 703
Calculate BMI by dividing weight in pounds (lbs) by height in
inches (in) squared and multiplying by a conversion factor of
703.
Example: Weight = 150 lbs, Height = 5'5" (65")
Calculation: [150 ÷ (65)2] x 703 = 24.96

Kilograms and meters (or centimeters) Formula: weight (kg) / [height (m)]2
With the metric system, the formula for BMI is weight in
kilograms divided by height in meters squared. Since height is
commonly measured in centimeters, divide height in centimeters
by 100 to obtain height in meters.

Example: Weight = 68 kg, Height = 165 cm (1.65 m)

Calculation: 68 ÷ (1.65)2 = 24.98

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ITEMS 23-24. Statement of Demonstrated Ability (SODA); SODA Serial Number

23. Statement of Demonstrated Ability (SODA)

Defect Noted:
Yes No

ITEM 23. Has a SODA ever been issued?

Ask the applicant if a SODA has ever been issued. If the answer is "yes," ask the
applicant to show you the document. Then check the "yes" block and record the nature
and degree of the defect.

SODA's are valid for an indefinite period or until an adverse change occurs that results
in a level of defect worse than that stated on the face of the document.

The FAA issues SODA's for certain static defects, but not for disqualifying conditions or
conditions that may be progressive. The extent of the functional loss that has been
cleared by the FAA is stated on the face of the SODA. If the AME finds the condition
has become worse, a medical certificate should not be issued even if the applicant is
otherwise qualified. The AME should also defer issuance if it is unclear whether the
applicant's present status represents an adverse change.

The AME must take special care not to issue a medical certificate of a higher class than
that specified on the face of the SODA even if the applicant appears to be otherwise
medically qualified. The AME may note in Item 60 the applicant's desire for a higher
class.

ITEM 24. SODA Serial Number

24. SODA Serial Number

Enter the assigned serial number in the space provided.

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AME PHYSICAL EXAMINATION

INFORMATION AND DISPOSITION TABLES
Items 25-48 of FAA Form 8500-8

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ITEMS 25-30. Ear, Nose and Throat (ENT)
(Updated 03/30/2022)
CHECK EACH ITEM IN APPROPRIATE COLUMN Normal Abnormal

25. Head, face, neck, and scalp

26. Nose

27. Sinuses

28. Mouth and Throat

29. Ears, general (internal and external canals:
Hearing under Item 49)
30. Ear Drums (Perforation)

I. Code of Federal Regulations

All Classes: 14 CFR 67.105(b)(c), 67.205(b)(c), and 67.305(b)(c)

(b) No disease or condition of the middle or internal ear, nose, oral cavity, pharynx,
or larynx that -

(1) Interferes with, or is aggravated by, flying or may reasonably be expected to

do so; or

(2) Interferes with, or may reasonably be expected to interfere with, clear and
effective speech communication.

(c) No disease or condition manifested by, or that may reasonably be expected to be

manifested by, vertigo or a disturbance of equilibrium.

II. Examination Techniques

1. The head and neck should be examined to determine the presence of any
significant defects such as:

a. Bony defects of the skull

b. Gross deformities
c. Fistulas
d. Evidence of recent blows or trauma to the head
e. Limited motion of the head and neck
f. Surgical scars

2. The external ear is seldom a major problem in the medical certification of applicants.
Otitis externa or a furuncle may call for temporary disqualification. Obstruction of the
canal by impacted cerumen or cellular debris may indicate a need for referral to an ENT
specialist for examination.

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The tympanic membranes should be examined for scars or perforations. Discharge or
granulation tissue may be the only observable indication of perforation. Middle ear
disease may be revealed by retraction, fluid levels, or discoloration. The normal
tympanic membrane is movable and pearly gray in color. Mobility should be
demonstrated by watching the drum through the otoscope during a valsalva maneuver.

3. Pathology of the middle ear may be demonstrated by changes in the appearance

and mobility of the tympanic membrane. The applicant may only complain of stuffiness
of the ears and/or loss of hearing. An upper respiratory infection greatly increases the
risk of aerotitis media with pain, deafness, tinnitus, and vertigo due to lessened aeration
of the middle ear from eustachian tube dysfunction. When the applicant is taking
medication for an ENT condition, it is important that the AME become fully aware of the
underlying pathology, present status, and the length of time the medication has been
used. If the condition is not a threat to aviation safety, the treatment consists solely of
antibiotics, and the antibiotics have been taken over a sufficient period to rule out the
likelihood of adverse side effects, the AME may make the certification decision.

The same approach should be taken when considering the significance of prior surgery
such as myringotomy, mastoidectomy, or tympanoplasty. Simple perforation without
associated symptoms or pathology is not disqualifying. When in doubt, the AME should
not hesitate to defer issuance and refer the matter to the AMCD. The services of
consultant ENT specialists are available to the FAA to help in determining the safety
implications of complicated conditions.

4. Unilateral Deafness. An applicant with unilateral congenital or acquired deafness

should not be denied medical certification if able to pass any of the tests of hearing
acuity.

5. Bilateral Deafness. It is possible for a totally deaf person to qualify for a private
pilot certificate. When the applicant initially applies for medical certification, the AME
should defer the exam with notes in Block 60 explaining this and include which FSDO
the airman wants to use to take a Medical Flight Test.

The student may practice with an instructor before undergoing a pilot check ride for the
private pilot’s license. When the applicant is ready to take the check ride, he/she must
have an authorization to take a medical flight test (MFT) from either RFS/AMCD. Upon
successful completion of the MFT, the applicant will be issued a SODA and an
operational restriction will be placed on his/her pilot’s license that restricts the pilot
from flying into airspace requiring radio communication.

6. Hearing Aids. Under some circumstances, the use of hearing aids may be
acceptable. If the applicant is unable to pass any of the above tests without the use of
hearing aids, he or she may be tested using hearing aids.

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7. The nose should be examined for the presence of polyps, blood, or signs of
infection, allergy, or substance abuse. The AME should determine if there is a
history of epistaxis or anosmia. Polyps may cause airway obstruction or sinus
blockage. Infection or allergy may be cause for obtaining additional history. (Updated
03/30/2022)

8. Evidence of sinus disease must be carefully evaluated by a specialist because of

the risk of sudden and severe incapacitation from barotrauma.

9. The mouth and throat should be examined to determine the presence of active
disease that is progressive or may interfere with voice communications. Gross
abnormalities that could interfere with the use of personal equipment such as oxygen
equipment should be identified. Also see Protocol for Obstructive Sleep Apnea.

10. The larynx should be visualized if the applicant's voice is rough or husky. Acute
laryngitis is temporarily disqualifying. Chronic laryngitis requires further diagnostic
workup. Any applicant seeking certification for the first time with a functioning
tracheostomy, following laryngectomy, or who uses an artificial voice-producing device
should be denied or deferred and carefully assessed.

III. Aerospace Medical Disposition

The Aerospace Medical Disposition Tables list the most common conditions of
aeromedical significance and course of action that should be taken by the AME as
defined by the protocol and disposition in the table.

Conditions AMEs Can Issue (CACI) Certification Worksheets are also found within the
Dispositions tables. These are a series of conditions which allow AMEs to regular issue
if the applicant meets the parameters of the CACI Condition Worksheets. The
worksheets provide detailed instructions to the AME and outline condition-specific
requirements for the applicant. If the requirements are met, and the applicant is
otherwise qualified, the AME may issue without contacting AMCD first. If the
requirements are not met, the AME must defer the exam and send the supporting
documents to the FAA.

Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or
subtle incapacitation without consulting the AMCD or the RFS. Medical documentation
must be submitted for any condition in order to support an issuance of an airman
medical certificate.

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ITEM 25. Head, Face, Neck, and Scalp

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Head, Face, Neck, and Scalp

Active fistula of neck, All Submit all pertinent Requires FAA Decision
either congenital or medical information
acquired, including and current status
tracheostomy report
Loss of bony All Submit all pertinent Requires FAA Decision
substance involving medical information
the two tables of the and current status
cranial vault report
Deformities of the face 1st & 2nd Submit all pertinent Requires FAA Decision
or head that would medical information
interfere with the and current status
proper fitting and report
wearing of an oxygen 3rd Submit all pertinent If deformity does not
mask medical information interfere with
administration of
supplemental O²
- Issue

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ITEM 26. Nose

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Nose
(Updated 02/24/2015)

Evidence of severe All Submit all pertinent Requires FAA Decision

allergic rhinitis medical information
and current status
report
Hay fever controlled All Submit all pertinent If responds to
solely by medical information treatment and without
desensitization and current status side effects - Issue
without report, include duration
antihistamines or of symptoms, name Otherwise - Requires
other medications and dosage of drugs FAA Decision
and side effects
Obstruction of sinus All Submit all pertinent Requires FAA Decision
ostia, including polyps, medical information and
that would be likely to current status report
result in complete
obstruction

For hay fever requiring antihistamines, see the Pharmaceuticals Section, Allergy -
Antihistamine & Immunotherapy Medication.

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Anosmia*
All Classes
Updated 02/23/2022
DISEASE/CONDITION EVALUATION DATA DISPOSITION
A. KNOWN etiology No evaluations or follow-up needed if
the AME can determine the condition is ISSUE
Including COVID-19 benign and the pilot has no other Annotate this
infection condition(s) that would interfere with information in Block
flight duties: 60. For any
If due to trauma identified underling
associated with condition(s), see
traumatic brain injury, ******************************************** that section.
tumor removal, etc., Discuss with the pilot:
review that section for  This condition may cause an inability to
receive early warning of fuel leaks,
additional information
exhaust fumes, or a fire (prior to visible
or required recovery smoke).
periods.  Importance of using of a carbon
monoxide (CO) detector (not a spot
detector) in all aircraft flown that have an
internal combustion engine.
 CO is odorless and tasteless; however, it
is frequently accompanied by exhaust
fumes that can be detected by smell.
Encourage the pilot to ask someone else
to verify the absence of fuel fumes in the
cabin prior to flight.
B. UNKNOWN (or Submit the following to the FAA for
uncertain) review: DEFER
etiology Submit the
 The most recent detailed Clinical information to the
For ANY duration. Progress Note (actual clinical FAA for a possible
record) from an otolaryngologist Special Issuance.
(ENT).
 It should include a summary of the
history of the condition or
diagnosis, current medications, Follow up
clinical exam findings, results of Issuance will be
any testing performed, diagnosis, per the airman’s
assessment, plan (prognosis), and authorization letter.
follow-up.
 It must specifically include etiology.

*Anosmia-partial or complete loss of smell.

ENT evaluation required as some cases may be due to nasal polyps or nasal growth
(tumor) which could be aeromedically significant.

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ITEM 27. Sinuses

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Sinuses - Acute or Chronic

Sinusitis, intermittent All Document medication, Responds to treatment
use of topical or non- dose and absence of without any side effects -
sedating medication side effects Issue

Severe - requiring All Submit all pertinent Requires FAA Decision

continuous use of medical information and
medication or affected current status report
by barometric changes

Sinus Tumor

Benign - Cysts/Polyps All If no physiologic effects, Asymptomatic, no

submit documentation observable growth over a
12-month period, no
potential for sinus block -
Issue
Malignant All Submit all pertinent Requires FAA Decision
medical information and
current status report

ITEM 28. Mouth and Throat

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Mouth and Throat

Any malformation or All Submit all pertinent Requires FAA Decision

condition, including medical information and
stuttering, that would current status report
impair voice
communication
Palate: Extensive All Submit all pertinent Requires FAA Decision
adhesion of the soft medical information and
palate to the pharynx current status report

See Protocol for

Obstructive Sleep Apnea

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ITEM 29. Ears, General

Acoustic Neuroma
All Classes Updated 5/30/2018

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Treated The AME should review a current
5 or more years ago status report from the treating ISSUE
With physician. If no symptoms or current Summarize history in
 Surgery OR problems, no ongoing treatment or Block 60.
 Stereotactic surveillance needed:
radiation Submit documents to
the FAA for retention in
the file.
B. Treated Submit the following to the FAA for
5 or more years ago review: DEFER
With  Current status report from the Submit the information
 Observation treating physician with treatment to the FAA for a possible
ONLY plan and prognosis; Special Issuance.
o It should identify all
treatment used, size of the Follow up Issuance
tumor at diagnosis, and Will be per the airman’s
current size; authorization letter.
 List of medications and side
effects, if any;
 Operative notes and discharge
summary, if applicable; and
 Copies of most recent imaging
report(s) (MRI).
C. Treated less than 5 Submit the following to the FAA for
years ago review: DEFER
With ANY of the  Current status report from the Submit the information
following: treating physician (ENT or to the FAA for a
 Observation, neurosurgeon) with possible Special
 Surgery, OR o Treatment plan, Issuance.
 Stereotactic prognosis, and adherence to
radiation treatment; Follow up Issuance
o It should indicate the Will be per the airman’s
presence or absence of any authorization letter.
residual tumor and any
complications;
 List of medications and side
effects, if any;
 Operative notes and discharge
summary
(if applicable); SEE NEXT PAGE

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 Copies of initial and most recent
imaging reports (MRI) and lab;
 Current audiogram (pure tone and
speech discrimination); and
 If any neurologic deficit is noted,
current documentation of the deficit
and severity, as well as the status
of the rest of the neurologic exam
by treating neurosurgeon or
neurotologist, must be submitted.

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Inner Ear
Acute or chronic All Submit all pertinent If no physiologic effects -
disease without medical information Issue
disturbance of
equilibrium and
successful
miringotomy, if
applicable
Acute or chronic All Submit all pertinent Requires FAA Decision
disease that may medical information and
disturb equilibrium current status report
Motion Sickness All Submit all pertinent If occurred during flight
medical information and training and resolved
current status report - Issue

If condition requires
medication - Requires
FAA Decision

Mastoids
Mastoid fistula All Submit all pertinent Requires FAA Decision
medical information and
current status report
Mastoiditis, acute or All Submit all pertinent Requires FAA Decision
chronic medical information and
current status report

Middle Ear
Impaired Aeration All Submit all pertinent Requires FAA Decision
medical information and
current status report

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Otitis Media All Submit all pertinent If acute and resolved –
medical information and Issue
current status report If active or chronic
- Requires FAA Decision

Outer Ear
Impacted Cerumen All Submit all pertinent If asymptomatic and
medical information and hearing is unaffected
current status report - Issue
Otherwise - Requires
FAA Decision
Otitis Externa that may All Submit all pertinent Requires FAA Decision
progress to impaired medical information and
hearing or become current status report
incapacitating

ITEM 30. Ear Drums

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Ear Drums

Perforation that has All Establish etiology, Requires FAA Decision

associated pathology treatment, and submit all
pertinent medical
information
Perforation which has All Submit all pertinent If no physiologic effects -
resolved without any medical information Issue
other clinical symptoms

Otologic Surgery: A history of otologic surgery is not necessarily disqualifying for

medical certification. The FAA evaluates each case on an individual basis following
review of the otologist's report of surgery. The type of prosthesis used, the person's
adaptability and progress following surgery, and the extent of hearing acuity attained
are all major factors to be considered. AME should defer issuance to an applicant
presenting a history of otologic surgery for the first time, sending the completed report of
medical examination, with all available supplementary information, to the AMCD.
Some conditions may have several possible causes or exhibit multiple symptomatology.
Episodic disorders of dizziness or disequilibrium require careful evaluation and
consideration by the FAA. Transient processes, such as those associated with acute
labyrinthitis or benign positional vertigo may not disqualify an applicant when fully
recovered. (Also see Item 46., Neurologic for a discussion of syncope and vertigo).

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ITEMS 31-34. Eye

CHECK EACH ITEM IN APPROPRIATE COLUMN Normal Abnormal

31. Eyes, general (vision under Items 50 to 54)
32. Ophthalmoscopic
33. Pupils (Equity and reaction)
34. Ocular motility (Associated parallel movement nystagmus)

I. Code of Federal Regulations

All Classes: 14 CFR 67.103(e), 67.203(e), and 67.303(d)

(e) No acute or chronic pathological condition of either the eye or adnexa that
interferes with the proper function of the eye, that may reasonably be
expected to progress to that degree, or that may reasonably be expected to
be aggravated by flying.

II. Examination Techniques

For guidance regarding the conduction of visual acuity, field of vision, heterophoria, and
color vision tests, please see Items 50-54.

The examination of the eyes should be directed toward the discovery of diseases or
defects that may cause a failure in visual function while flying or discomfort sufficient to
interfere with safely performing airman duties.

The AME should personally explore the applicant's history by asking questions
concerning any changes in vision, unusual visual experiences (halos, scintillations,
etc.), sensitivity to light, injuries, surgery, or current use of medication. Does the
applicant report inordinate difficulties with eye fatigue or strain? Is there a history of
serious eye disease such as glaucoma or other disease commonly associated with
secondary eye changes, such as diabetes? (See Item 53., Field of Vision and Item
54., Heterophoria)

1. It is recommended that the AME consider the following signs during the course of
the eye examination:

1. Color — redness or suffusion of allergy, drug use, glaucoma, infection,

trauma, jaundice, ciliary flush of Iritis, and the green or brown Kayser-
Fleischer Ring of Wilson's disease.

2. Swelling — abscess, allergy, cyst, exophthalmos, myxedema, or tumor.

3. Other — clarity, discharge, dryness, ptosis, protosis, spasm (tic), tropion, or

ulcer.

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2. Ophthalmoscopic examination. It is suggested that a routine be established for

ophthalmoscopic examinations to aid in the conduct of a comprehensive eye
assessment.

a. Cornea — observe for abrasions, calcium deposits, contact lenses,

dystrophy, keratoconus, pterygium, scars, or ulceration. Contact lenses
should be removed several hours before examination of the eye. (See
Item 50, Distant Vision)

b. Pupils and Iris — check for the presence of synechiae and uveitis. Size,
shape, and reaction to light should be evaluated during the
ophthalmoscopic examination. Observe for coloboma, reaction to light, or
disparity in size.

c. Aqueous — hyphema or iridocyclitis.

d. Lens — observe for aphakia, discoloration, dislocation, cataract, or an

implanted lens.

e. Vitreous — note discoloration, hyaloid artery, floaters, or strands.

f. Optic nerve — observe for atrophy, hemorrhage, cupping, or papilledema.

g. Retina and choroid — examine for evidence of coloboma, choroiditis,

detachment of the retina, diabetic retinopathy, retinitis, retinitis
pigmentosa, retinal tumor, macular or other degeneration, toxoplasmosis,
etc.

3. Ocular Motility. Motility may be assessed by having the applicant follow a point
light source with both eyes, the AME moving the light into right and left upper and
lower quadrants while observing the individual and the conjugate motions of each
eye. The AME then brings the light to center front and advances it toward the
nose observing for convergence. End point nystagmus is a physiologic
nystagmus and is not considered to be significant. It need not be reported. (For
further consideration of nystagmus, see Item 50., Distant Vision.)

4. Monocular Vision. An applicant will be considered monocular when there is only

one eye or when the best corrected distant visual acuity in the poorer eye is no
better than 20/200. An individual with one eye, or effective visual acuity
equivalent to monocular, may be considered for medical certification, any class,
through the special issuance section of part 67 (14 CFR 67.401).

In amblyopia ex anopsia, the visual acuity loss is simply recorded in Item 50 of

FAA Form 8500-8, and visual standards are applied as usual. If the standards
are not met, a Report of Eye Evaluation, FAA Form 8500-7, should be submitted
for consideration.

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Although it has been repeatedly demonstrated that binocular vision is not a

prerequisite for flying, some aspects of depth perception, either by stereopsis or
by monocular cues, are necessary. It takes time for the monocular airman to
develop the techniques to interpret the monocular cues that substitute for
stereopsis; such as, the interposition of objects, convergence, geometrical
perspective, distribution of light and shade, size of known objects, aerial
perspective, and motion parallax.

In addition, it takes time for the monocular airman to compensate for his or her
decrease in effective visual field. A monocular airman’s effective visual field is
reduced by as much as 30% by monocularity. This is especially important
because of speed smear; i.e., the effect of speed diminishes the effective visual
field such that normal visual field is decreased from 180 degrees to as narrow as
42 degrees or less as speed increases. A monocular airman’s reduced effective
visual field would be reduced even further than 42 degrees by speed smear.

For the above reasons, a waiting period of 6 months is recommended to permit

an adequate adjustment period for learning techniques to interpret monocular
cues and accommodation to the reduction in the effective visual field.

Applicants who have had monovision secondary to refractive surgery may be

certificated, providing they have corrective vision available that would provide
binocular vision in accordance with the vision standards, while exercising the
privileges of the certificate. The certificate issued must have the appropriate
vision limitations statement.

5. Contact Lenses. The use of contact lens(es) for monovision correction is not
allowed:

 The use of a contact lens in one eye for near vision and in the other
eye for distant vision is not acceptable (for example: pilots with myopia
plus presbyopia).

 The use of a contact lens in one eye for near vision and the use of no
contact lens in the other eye is not acceptable (for example: pilots with
presbyopia but no myopia).

Additionally, designer contact lenses that introduce color (tinted lenses), restrict
the field of vision, or significantly diminish transmitted light are not allowed.

Please note: the use of binocular contact lenses for distance-correction-only is

acceptable. In this instance, no special evaluation or SODA is routinely required
for a distance-vision-only contact lens wearer who meets the standard and has
no complications. Binocular bifocal or binocular multifocal contact lenses are
acceptable under the Protocol for Binocular Multifocal and Accommodating
Devices.

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6. Intraocular Devices. Binocular airman using multifocal or accommodating

ophthalmic devices may be issued an airman medical certificate in accordance
with the Protocol for Binocular Multifocal and Accommodating Devices.

7. Orthokeratology (Ortho-K) is the use of rigid gas-permeable contact lenses,

normally worn only during sleep, to improve vision through reshaping of the
cornea. It is used as an alternative to eyeglasses, refractive surgery, or for those
who prefer not to wear contact lenses while awake. The correction is not
permanent and visual acuity can regress while not wearing the Ortho-K lenses.
There is no reasonable or reliable way to determine standards for the entire
period the lenses are removed. Therefore, to be found qualified, applicants who
use Ortho-K lenses must meet the applicable vision standard while wearing
the Ortho-K lenses AND must wear the Ortho-K lenses while piloting
aircraft. The limitation “must use Ortho-K lenses while performing pilot duties”
must be placed on the medical certificate.

8. Glaucoma. The AME should deny or defer issuance of a medical certificate to an

applicant if there is a loss of visual fields or a significant change in visual acuity.

The FAA may grant an Authorization under the special issuance section of Part
67 (14 CFR 67.401) on an individual basis. The AME must obtain a report of
Ophthalmological Evaluation for Glaucoma (FAA Form 8500-14) from an
ophthalmologist. See Glaucoma Worksheet. Because secondary glaucoma is
caused by known pathology such as; uveitis or trauma, eligibility must largely
depend upon that pathology. Secondary glaucoma is often unilateral, and if the
cause or disease process is no longer active and the other eye remains normal,
certification is likely.

Applicants with primary or secondary narrow angle glaucoma are usually denied
because of the risk of an attack of angle closure, because of incapacitating
symptoms of severe pain, nausea, transitory loss of accommodative power,
blurred vision, halos, epiphora, or iridoparesis. Central venous occlusion can
occur with catastrophic loss of vision. However, when surgery such as
iridectomy or iridoclesis has been performed satisfactorily more than 3 months
before the application, the likelihood of difficulties is considerably more remote,
and applicants in that situation may be favorably considered.

An applicant with unilateral or bilateral open angle glaucoma may be certified by

the FAA (with follow-up required) when a current ophthalmological report
substantiates that pressures are under adequate control, there is little or no
visual field loss or other complications, and the person tolerates small to
moderate doses of allowable medications. Individuals who have had filter
surgery for their glaucoma, or combined glaucoma/cataract surgery, can be
considered when stable and without complications. Applicants using miotic or
mydriatic eye drops or taking an oral medication for glaucoma may be
considered for Special Issuance certification following their demonstration of

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adequate control. These medications DO NOT qualify for the CACI
program. Miotics such as pilocarpine cause pupillary constriction and could
conceivably interfere with night vision. Although the FAA no longer routinely
prohibits pilots who use such medications from flying at night, it may be
worthwhile for the AME to discuss this aspect of the use of miotics with
applicants. If considerable disturbance in night vision is documented, the FAA
may limit the medical certificate: NOT VALID FOR NIGHT FLYING.

9. Sunglasses. Sunglasses are not acceptable as the only means of correction to

meet visual standards, but may be used for backup purposes if they provide the
necessary correction. Airmen should be encouraged to use sunglasses in bright
daylight but must be cautioned that, under conditions of low illumination, they
may compromise vision. Mention should be made that sunglasses do not protect
the eyes from the effects of ultra violet radiation without special glass or coatings
and that photosensitive lenses are unsuitable for aviation purposes because they
respond to changes in light intensity too slowly. The so-called "blue blockers"
may not be suitable since they block the blue light used in many current panel
displays. Polarized sunglasses are unacceptable if the windscreen is also
polarized.

10. Refractive Procedures. The FAA accepts the following Food and Drug
Administration approved refractive procedures for visual acuity correction:

 Radial Keratotomy (RK)

 Epikeratophakia
 Laser-Assisted In Situ Keratomileusis (LASIK), including Wavefront-
guided LASIK
 Photorefractive Keratectomy (PRK)
 Conductive Keratoplasty (CK)

Please be advised that these procedures have potential adverse effects that
could be incompatible with flying duties, including: corneal scarring or opacities;
worsening or variability of vision; and night-glare.

The FAA expects that airmen will not resume airman duties until their treating
health care professional determines that their post-operative vision has
stabilized, there are no significant adverse effects or complications (such as
halos, rings, haze, impaired night vision and glare), the appropriate vision
standards are met, and they have been reviewed by an AME or AMCD. When
this determination is made, the airman should have the treating health care
professional document this in the health care record, a copy of which should be
forwarded to the AMCD before resumption of airman duties. If the health care
professional's determination is favorable and after consultation and review by an
AME, the applicant may resume airman duties, unless informed otherwise by the
FAA.

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An applicant treated with a refractive procedure may be issued a medical
certificate by the AME if the applicant meets the visual acuity standards and the
Report of Eye Evaluation (FAA Form 8500-7) indicates that healing is complete;
visual acuity remains stable; and the applicant does not suffer sequela such as;
glare intolerance, halos, rings, impaired night vision, or any other complications.
There should be no other pathology of the affected eye(s).

If the procedure was done 2 years ago or longer, the FAA may accept the AME's
eye evaluation and an airman statement regarding the absence of adverse
sequela.

If the procedure was performed within the last 2 years, the airman must provide a
report to the AMCD from the treating health care professional to document the
date of procedure, any adverse effects or complications, and when the airman
returned to flying duties. If the report is favorable and the airman meets the
appropriate vision standards, the applicant may resume airman duties, unless
informed otherwise by the FAA.

A. Conductive Keratoplasty (CK): CK is used for correction of farsightedness. As this

procedure is not considered permanent and there is expected regression of visual
acuity in time, the FAA may grant an Authorization for special issuance of a medical
certificate under 14 CFR 67.401 to an applicant who has had CK.

The FAA evaluates CK procedures on an individual basis following a waiting period of 6

months. The waiting period is required to permit adequate adjustment period for
fluctuating visual acuity. The AME can facilitate FAA review by obtaining all pre- and
post-operative medical records, a Report of Eye Evaluation (FAA Form 8500-7) from a
treating or evaluating eye specialist with comment regarding any adverse effects or
complications related to the procedure.

III. Aerospace Medical Disposition

Applicants with many visual conditions may be found qualified for FAA certification
following the receipt and review of specialty evaluations and pertinent medical records.

Examples include retinal detachment with surgical correction, open angle glaucoma
under adequate control with medication, and narrow angle glaucoma following surgical
correction.

The AME may not issue a certificate under such circumstances for the initial application,
except in the case of applicants following cataract surgery. The AME may issue a
certificate after cataract surgery for applicants who have undergone cataract surgery
with or without lens(es) implant. If pertinent medical records and a current
ophthalmologic evaluation (using FAA Form 8500-7 or FAA Form 8500-14)

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indicate that the applicant meets the standards, the FAA may delegate authority to the
AME to issue subsequent certificates.

The following is a table that lists the most common conditions of aeromedical
significance, and course of action that should be taken by the AME as defined by the
protocol and disposition in the table. Medical certificates must not be issued to an
applicant with medical conditions that require deferral, or for any condition not listed in
the table that may result in sudden or subtle incapacitation without consulting the AMCD
or the RFS. Medical documentation must be submitted for any condition in order to
support an issuance of an airman medical certificate.

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ITEM 31. Eyes, General

Eyes, General

DISEASE/CONDITION CLASS EVALUTION DATA DISPOSITION

Amblyopia* All Provide completed FAA Form If applicant does not correct to
Initial certification 8500-7 standards, DEFER.

Note: applicant should be at Note in Block 60 along with which

best corrected visual acuity FSDO the airman wants to use to
before evaluation take a MFT
Congenital or acquired All Provide completed FAA Form Requires FAA Decision
conditions (whether acute or 8500-7
chronic) of either eye or
adnexa, that may interfere Submit all pertinent medical
with visual functions, may information and current status
progress to that degree, or report
may be aggravated by flying
(tumors and ptosis obscuring For keratoconus, include if
the pupil, acute inflammatory available results of imaging
disease of the eyes and lids, studies such as kertatometry,
cataracts, or keratoconus.) videokeratography, etc., with
clinical correlation

Note: applicant should be at

best corrected visual acuity
before evaluation
Any ophthalmic All Submit all pertinent medical Requires FAA Decision
pathology reflecting a information and current status
serious systemic report.
disease (e.g., diabetic (If applicable, see Diabetes and
and hypertensive Hypertensive Protocols)
retinopathy)
Diplopia All If applicant provides written Contact RFS for approval to Issue
evidence that the FAA has Otherwise - Requires FAA
previously considered and Decision
determined that this condition is
not adverse to flight safety. A
MFT may be requested.
Pterygium All Document findings in Item 60 If less than 50% of the cornea and
not affecting central vision
- Issue

Otherwise - Requires FAA

Decision

*In amblyopia ex anopsia, the visual acuity of one eye is decreased without presence of organic eye disease, usually
because of strabismus or anisometropia in childhood.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Eyes - Procedures

Aphakia/Lens Implants All Submit all pertinent medical If visual acuity meets
information and current standards - Issue
status report (See additional
disease dependent Otherwise - Requires FAA
requirements) Decision
Conductive All See Protocol for Conductive See Protocol for Conductive
Keratoplasty - Keratoplasty Keratoplasty
Farsightedness
Intraocular Devices All See Protocol for Binocular See Protocol for Binocular
Multifocal and Multifocal and
Accommodating Devices Accommodating Devices
Refractive Procedures All Provide completed FAA If visual acuity meets
other than CK Form 8500-7, type and date standards, is stable, and no
of procedure, statement as complications exist - Issue
to any adverse effects or
complications (halo, glare, Otherwise - Requires FAA
haze, rings, etc.) Decision

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ITEM 32. Ophthalmoscopic

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Ophthalmoscopic

Chorioretinitis; All Submit all pertinent Requires FAA Decision

Coloboma; medical information and
Corneal Ulcer or current status report
Dystrophy;
Optic Atrophy or
Neuritis;
Retinal Degeneration or
Detachment;
Retinitis Pigmentosa;
Papilledema; or Uveitis
Glaucoma (treated or All Review all pertinent Follow CACI -
untreated) medical information and Glaucoma Worksheet.
current status report, If airman meets all
including Form 8500-14 certification criteria –
Issue.

All others require FAA

decision. Submit all
evaluation data.

Initial Special
Issuance - Requires
FAA Decision

Follow-up Special
Issuances - See AASI
Protocol
Macular Degeneration; All Submit all pertinent Requires FAA Decision
Macular Detachment medical information and
current status report
Tumors All Submit all pertinent Requires FAA Decision
medical information and
current status report
Vascular Occlusion; All Submit all pertinent Requires FAA Decision
Retinopathy medical information and
current status report

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CACI - Glaucoma Worksheet (Updated 04/13/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress
Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME
exam.If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants
for first- or second- class must provide this information annually; applicants for third-class must provide the
information with each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA

Treating ophthalmologist finds the [ ] Yes
condition stable on current regimen
and no changes recommended.
Age at diagnosis [ ] 40 or older
FAA Form 8500-14 or equivalent [ ] Yes
treating physician report that
documents the considerations below:
Acceptable types of glaucoma [ ] Open Angle being monitored and stable, Ocular Hypertension or
Glaucoma Suspect being monitored and stable, or previous history of
Narrow Angle/Angle Closure Glaucoma which has been treated with
iridectomy/iridotomy (surgical or laser) and is currently stable.

NOT acceptable: Normal Tension Glaucoma, secondary glaucoma due

to inflammation, trauma, or the presence of any other significant eye
pathology (e.g. neovascular glaucoma due to proliferative diabetic
retinopathy or an ischemic central vein occlusion or uveitic glaucoma)
Documented nerve damage or [ ] No
trabeculectomy (filtration surgery)
Medications [ ] None or Prostaglandin analogs (Xalatan, Lumigan, Travatan or
Travatan Z), Carbonic anhydrase inhibitor (Trusopt and Azopt), Beta
blockers (Timoptic, etc), or Alpha agonist (Alphagan). Combination eye
drops are acceptable

NOT acceptable for CACI: Pilocarpine or other miotics, cycloplegics

(Atropine), or oral medications.
Medication side effects [ ] None
Intraocular pressure [ ] 23 mm Hg or less in both eyes
ANY evidence of defect or reported [ ] No
Unreliable Visual Fields

Acceptable visual field tests: Humphrey

24-2 or 30-2 (either SITA or full threshold),
Octopus (either TOP or full threshold).
Other formal visual field testing may be
acceptable but you must call for approval.
Confrontation or screening visual field
testing is not acceptable.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified glaucoma. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified glaucoma.

[ ] NOT CACI qualified glaucoma. I have deferred. (Submit supporting documents.)

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ITEM 33. Pupils

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Pupils

Disparity in size or All Submit all pertinent Requires FAA Decision

reaction to light medical information and
(afferent pupillary current status report
defect) requires
clarification and/or
further evaluation
Nonreaction to light in All Submit all pertinent Requires FAA Decision
either eye acute or medical information and
chronic current status report
Nystagmus1 All Submit all pertinent Requires FAA Decision
medical information and
current status report
Synechiae, anterior or All Submit all pertinent Requires FAA Decision
posterior medical information and
current status report

ITEM 34. Ocular Motility

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Ocular Motility

Absence of conjugate All Submit all pertinent Requires FAA Decision

alignment in any medical information and
quadrant current status report
Inability to converge on All Submit all pertinent Requires FAA Decision
a near object medical information and
current status report
Paralysis with loss of All Submit all pertinent Requires FAA Decision
ocular motion in any medical information and
direction current status report

1
Nystagmus of recent onset is cause to deny or defer certificate issuance. Any recent neurological or other
evaluations available to the Examiner should be submitted to the AMCD. If nystagmus has been present for a
number of years and has not recently worsened, it is usually necessary to consider only the impact that the
nystagmus has upon visual acuity. The Examiner should be aware of how nystagmus may be aggravated by the
forces of acceleration commonly encountered in aviation and by poor illumination.

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ITEM 35. Lungs and Chest

CHECK EACH ITEM IN APPROPRIATE COLUMN Normal Abnormal

35. Lungs and chest (Not including breast examination)

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified
medical judgment relating to the condition involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges;

(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the
medication or other treatment involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.

II. Examination Techniques

Breast examination: The breast examination is performed only at the applicant's option or if
indicated by specific history or physical findings. If a breast examination is performed, the
results are to be recorded in Item 60 of FAA Form 8500-8. The applicant should be advised of
any abnormality that is detected, then deferred for further evaluation.

III. Aerospace Medical Dispositions

The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the AME as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle

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incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Allergies (Updated 02/24/2021)

Allergies, severe All Submit all pertinent medical Requires FAA

information and current status Decision
report, include duration of
symptoms, name and dosage
of drugs and side effects
Hay fever controlled All Submit all pertinent medical If responds to
solely by information and current status treatment and
desensitization* report, include duration of without side
without symptoms, name and dosage effects - Issue
antihistamines or of drugs and side effects
other medications Otherwise -
Requires FAA
Decision

For hay fever requiring antihistamines, see the Pharmaceuticals Section, Allergy -
Antihistamine & Immunotherapy Medication.
.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Asthma

Mild or seasonal All Review all pertinent Follow the CACI -

asthmatic symptoms medical information Asthma Worksheet. If
and current status airman meets all
report, include PFT’s, certification criteria –
duration of symptoms, Issue.
name and dosage of
drugs and side effects All others require FAA
for special issuance Decision. Submit all
consideration evaluation data.

Initial Special
Issuance - Requires
FAA Decision

Follow-up
Special Issuances -
See AASI Protocol

Frequent severe All Submit all pertinent Initial Special

asthmatic symptoms medical information Issuance - Requires
and current status FAA Decision
report, include PFT’s,
duration of symptoms, Follow-up
name and dosage of Special Issuances -
drugs and side effects See AASI Protocol
for special issuance
consideration.

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CACI - Asthma Worksheet (Updated 04/13/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more
than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification
criteria listed below, the AME can issue. Applicants for first- or second- class must provide this
information annually; applicants for third-class must provide the information with each required
exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA

Treating physician finds the [ ] Yes
condition stable on current
regimen and no changes
recommended.
Symptoms: Stable and well- [ ] Yes for all of the following:
controlled (either on or off - Frequency of symptoms - no more than 2 days per week
medication) - Use of inhaled short-acting beta agonist (rescue inhaler) -
no more than 2 times per week
- Use of oral corticosteroids for exacerbations - no more than
2 times per year
- In the last year:
o No in-patient hospitalizations
o No more than 2 outpatient clinic/urgent care visits for
exacerbations (with symptoms fully resolved).
Acceptable Medications [ ] One or more of the following
- Inhaled long-acting beta agonist
- Inhaled short-acting beta agonist (e.g., albuterol)
- Inhaled corticosteroid
- leukotriene receptor antagonist, (e.g. montelukast [Singulair])

NOT acceptable Note: A short course of oral or IM steroids during an exacerbation is

for CACI: acceptable. The AME must caution airman not to fly until course of
Monoclonal antibodies oral steroids is completed and airman is symptom free.

Pulmonary Function Tests * [ ] Current within last 90 days

*PFT is not required if the only [ ] FEV1, FVC, and FEV1/FVC are all equal to or greater than
treatment is PRN use on one or two
80% predicted before bronchodilators.
days a week of a short-acting beta
agonist (e.g. albuterol).

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified asthma. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified asthma.

[ ] NOT CACI qualified asthma. I have deferred. (Submit supporting documents.)

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION
2
Chronic Obstructive Pulmonary Disease (COPD)
(Updated 02/23/2022)

Chronic bronchitis, All Submit all pertinent Initial Special Issuance

emphysema, or medical information - Requires FAA Decision
COPD5 and current status
report. Include an Follow-up
FEV1, FVC, and Special Issuances -
FEV1/FVC. See AASI Protocol

6MWT (in some

cases)

Disease of the Lungs, Pleura, or Mediastinum

Abscesses All Submit all pertinent Requires FAA Decision

Active Mycotic disease medical information
Active Tuberculosis and current status
report
Fistula, All Submit all pertinent Requires FAA Decision
Bronchopleural, medical information
to include and current status
Thoracostomy report
Lobectomy All Submit all pertinent Requires FAA Decision
medical information
and current status
report
Pulmonary Embolism All See Thromboembolic See Thromboembolic
Disease Protocol Disease Protocol
Pulmonary Fibrosis All Submit all pertinent If >75% predicted and
medical information, no impairment - Issue
current status report,
PFT’s with diffusion
capacity
Otherwise - Requires
FAA Decision

5
Certification may be granted by the FAA when the condition is mild without significant impairment of pulmonary
functions. If the applicant has frequent exacerbations or any degree of exertional dyspnea, certification should be
deferred.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Pleura and Pleural Cavity

Acute fibrinous All Submit all pertinent Requires FAA Decision

pleurisy; medical information
Empyema; and current status
Pleurisy with effusion; report, and PFT’s
or Pneumonectomy
Malignant tumors or All Submit all pertinent Requires FAA Decision
cysts of the lung, medical information
pleura or and current status
mediastinum report
Other diseases or All Submit all pertinent Requires FAA Decision
defects of the lungs medical information
or chest wall that and current status
require use of report
medication or that
could adversely
affect flying or
endanger the
applicant's well-being
if permitted to fly
Pneumothorax - All Submit all pertinent If 3 months after
Traumatic medical information resolution - Issue
and current status
report
Sarcoid, if more than All Submit all pertinent Requires FAA Decision
minimal involvement medical information
or if symptomatic and current status
report
Spontaneous All Submit all pertinent Requires FAA Decision
pneumothorax 6 medical information
and current status
report

6
A history of a single episode of spontaneous pneumothorax is considered disqualifying for airman medical
certification until there is x-ray evidence of resolution and until it can be determined that no condition that would be
likely to cause recurrence is present (i.e., residual blebs). On the other hand, an individual who has sustained a
repeat pneumothorax normally is not eligible for certification until surgical interventions are carried out to correct the
underlying problem. A person who has such a history is usually able to resume airmen duties 3 months after the
surgery. No special limitations on flying at altitude are applied.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Pulmonary

Bronchiectasis All Submit all pertinent If moderate to severe -

medical information Requires FAA Decision
and current status
report

Sleep Apnea

Obstructive Sleep All Requires risk If meets OSA Criteria –

Apnea evaluation, per OSA Issue, if otherwise
Protocol. Document qualified
history and Findings.
Initial Special Issuance
- Requires FAA Decision

Follow-up
Special Issuance
See AASI
Periodic Limb All Submit all pertinent Requires FAA Decision
Movement, etc. medical information
and current status
report. Include sleep
study with a
polysomnogram, use
of medications and
titration study results,
along with a
statement regarding
Restless Leg
Syndrome

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ITEM 36. Heart

CHECK EACH ITEM IN APPROPRIATE COLUMN Normal Abnormal

36. Heart (Precordial activity, rhythm, sounds, and murmurs)

I. Code of Federal Regulations:

First-Class: 14 CFR 67.111(a)(b)(c)

Cardiovascular standards for first-class airman medical certificate are:

(a) No established medical history or clinical diagnosis of any of the following:

(1) Myocardial infarction

(2) Angina pectoris

(3) Coronary heart disease that has required treatment or, if untreated, that has
been symptomatic or clinically significant

(4) Cardiac valve replacement

(5) Permanent cardiac pacemaker implantation; or

(6) Heart replacement

(b) A person applying for first-class airman medical certification must demonstrate an
absence of myocardial infarction and other clinically significant abnormality on
electrocardiographic examination:

(1) At the first application after reaching the 35th birthday; and

(2) On an annual basis after reaching the 40th birthday

(c) An electrocardiogram will satisfy a requirement of paragraph (b) of this

section if it is dated no earlier than 60 days before the date of the application it is to
accompany and was performed and transmitted according to acceptable standards
and techniques.

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Second- and Third-Class: 14 CFR 67.211(a)(b)(c)(d)(e)(f) and 67.311(a)(b)(c)(d)(e)(f)

Cardiovascular standards for a second- and third-class airman medical certificate are no
established medical history or clinical diagnosis of any of the following:

(a) Myocardial infarction

(b) Angina pectoris

(c) Coronary heart disease that has required treatment or, if untreated, that has been
symptomatic or clinically significant

(d) Cardiac valve replacement

(e) Permanent cardiac pacemaker implantation; or

(f) Heart replacement

II. Examination Techniques

A. General Physical Examination.

1. A brief description of any comment-worthy personal characteristics as well as height,

weight, representative blood pressure readings in both arms, funduscopic examination,
condition of peripheral arteries, carotid artery auscultation, heart size, heart rate, heart
rhythm, description of murmurs (location, intensity, timing, and opinion as to significance),
and other findings of consequence must be provided.

2. The AME should keep in mind some of the special cardiopulmonary demands of flight,
such as changes in heart rates at takeoff and landing. High
G-forces of aerobatics or agricultural flying may stress both systems considerably.
Degenerative changes are often insidious and may produce subtle performance
decrements that may require special investigative techniques.

a. Inspection. Observe and report any thoracic deformity (e.g., pectus excavatum),
signs of surgery or other trauma, and clues to ventricular hypertrophy. Check the
hematopoietic and vascular system by observing for pallor, edema, varicosities,
stasis ulcers, and venous distention. Check the nail beds for capillary pulsation
and color.

b. Palpation. Check for thrills and the vascular system for arteriosclerotic changes,
shunts, or AV anastomoses. The pulses should be examined to determine their
character, to note if they are diminished or absent, and to observe for
synchronicity. The medical standards do not specify pulse rates that, per se, are
disqualifying for medical certification. These tests are used, however, to determine

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the status and responsiveness of the cardiovascular system. Abnormal pulse rates
may be reason to conduct additional cardiovascular system evaluations.

i. Bradycardia of less than 50 beats per minute, any episode of tachycardia

during the course of the examination, and any other irregularities of pulse
other than an occasional ectopic beat or sinus arrhythmia must be noted
and reported. If there is bradycardia, tachycardia, or arrhythmia further
evaluation may be warranted and deferral may be indicated.

ii. A cardiac evaluation may be needed to determine the applicant's

qualifications. Temporary stresses or fever may, at times, result in
abnormal results from these tests. If the AME believes this to be the case,
the applicant should be given a few days to recover and then be retested. If
this is not possible, the AME should defer issuance, pending further
evaluation.

c. Percussion. Determine heart size, diaphragmatic elevation/excursion, abnormal

densities in the pulmonary fields, and mediastinal shift.

d. Auscultation. Check for resonance, asthmatic wheezing, ronchi, rales, cavernous

breathing of emphysema, pulmonary or pericardial friction rubs, quality of the heart
sounds, murmurs, heart rate, and rhythm. If a murmur is discovered during the
course of conducting a routine FAA examination, report its character, loudness,
timing, transmission, and change with respiration. It should be noted whether it is
functional or organic and if a special examination is needed. If the latter is
indicated, the AME should defer issuance of the medical certificate and transmit
the completed FAA Form 8500-8 to the FAA for further consideration. AME must
defer to the AMCD or Region if the treating physician or AME reports the murmur
is moderate to severe (Grade III or IV). Listen to the neck for bruits.

It is recommended that the AME conduct the auscultation of the heart with the
applicant both in a sitting and in a recumbent position.

Aside from murmur, irregular rhythm, and enlargement, the AME should be careful
to observe for specific signs that are pathognomonic for specific disease entities or
for serious generalized heart disease. Examples of such evidence are: (1) the
opening snap at the apex or fourth left intercostal space signifying mitral stenosis;
(2) gallop rhythm indicating serious impairment of cardiac function; and (3) the
middiastolic rumble of mitral stenosis.

B. When General Examinations Reveal Heart Problems.

These specifications have been developed by the FAA to determine an applicant’s eligibility for
airman medical certification. Standardization of examination methods and reporting is essential
to provide sufficient basis for making determinations and the prompt processing of applications.

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1. This cardiovascular evaluation (CVE), therefore, must be reported in sufficient detail to permit
a clear and objective evaluation of the cardiovascular disorder(s) with emphasis on the degree of
functional recovery and prognosis. It should be forwarded to the FAA immediately upon
completion. Inadequate evaluation, reporting, or failure to promptly submit the report to the FAA
may delay the certification decision.

a. Medical History. Particular reference should be given to cardiovascular abnormalities

cerebral, visceral, and/or peripheral. A statement must be included as to whether
medications are currently or have been recently used, and if so, the type, purpose,
dosage, duration of use, and other pertinent details must be provided. A specific history
of any anticoagulant drug therapy is required. In addition, any history of hypertension
must be fully developed to also include all medications used, dosages, and comments on
side effects.

b. Family, Personal, and Social History. A statement of the ages and health status of
parents and siblings is required; if deceased, cause and age at death should be included.
Also, any indication of whether any near blood relative has had a “heart attack,”
hypertension, diabetes, or known disorder of lipid metabolism must be provided.
Smoking, drinking, and recreational habits of the applicant are pertinent as well as
whether a program of physical fitness is being maintained. Comments on the level of
physical activities, functional limitations, occupational, and avocational pursuits are
essential.

c. Records of Previous Medical Care. If not previously furnished to the FAA, a copy of
pertinent hospital records as well as out-patient treatment records with clinical data, x-ray,
laboratory observations, and originals or copies of all electrocardiographic (ECG) tracings
should be provided. Detailed reports of surgical procedures as well as cerebral and
coronary arteriography and other major diagnostic studies are of prime importance.

d. Surgery. The presence of an aneurysm or obstruction of a major vessel of the body is

disqualifying for medical certification of any class. Following successful surgical
intervention and correction, the applicant may ask for FAA consideration. The FAA
recommends that the applicant recover for at least 3 months for ATCS’s and 6 months for
airmen.

A history of coronary artery bypass surgery is disqualifying for certification. Such surgery does
not negate a past history of coronary heart disease. The presence of permanent cardiac
pacemakers and artificial heart valves is also disqualifying for certification.

The FAA will consider an Authorization for a Special Issuance of a Medical Certificate
(Authorization) for most cardiac conditions. Applicants seeking further FAA consideration should
be prepared to submit all past records and a report of a complete current cardiovascular
evaluation (CVE) in accordance with FAA specifications.

C. Medication.

 Medications acceptable to the FAA for treatment of hypertension in airmen include all
Food and Drug Administration (FDA) approved diuretics, alpha-adrenergic blocking

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agents, beta-adrenergic blocking agents, calcium channel blocking agents, angiotension
converting enzyme (ACE inhibitors) agents, and direct vasodilators.

 The following are NOT ACCEPTABLE to the FAA:

o Centrally acting agents (such as reserpine, guanethidine, guanadrel, guanabenz,
and methyldopa).
o The use of flecainide when there is evidence of left ventricular dysfunction or
recent myocardial infarction.
o The use of nitrates for the treatment of coronary artery disease or to modify
hemodynamics.
 The AME must defer issuance of a medical certificate to any applicant whose
hypertension has not been evaluated, who uses unacceptable medications, whose
medical status is unclear, whose hypertension is uncontrolled, who manifests significant
adverse effects of medication, or whose certification has previously been specifically
reserved to the FAA.

III. Aerospace Medical Disposition

The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the AME as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Arrhythmias
(Updated 04/27/2022)

Bradycardia All Document history and If no evidence of

(<50 bpm) findings, CVE structural, functional or
Protocol, and submit coronary heart disease -
any tests deemed Issue
appropriate
Otherwise - Requires
FAA Decision
Bundle Branch Block All See Protocol for If no evidence of
(Left and Right) Bundle Branch Block structural, functional or
(BBB) coronary heart disease -
*IRBBB or ICVD Issue

Otherwise - Requires
FAA Decision
History of Implanted All See Implanted Requires FAA Decision
Pacemakers Pacemaker
Disposition Table
PAC All Requires evaluation, If no evidence of
(2 or more on ECG) e.g., check for MVP, structural, functional or
See next page caffeine, pulmonary coronary heart disease –
disease, thyroid, etc. Issue
Otherwise - Requires
FAA Decision
PVC’s All Max GXT – to include If no evidence of
(2 or more on a baseline ECG structural, functional or
standard ECG) coronary heart disease
and PVC’s resolve with
exercise - Issue

Otherwise - Requires
FAA Decision

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Premature Atrial Contraction (PAC)

All Classes
(Updated 04/27/2022)

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Asymptomatic, If the AME can determine the pilot has no
symptoms, required no treatment, and does not ISSUE
not requiring treatment require medication: Summarize this
history in Block 60.
Current or history of PACs This includes PACs found incidentally on ECG.

Asymptomatic PACs are considered a Normal

Variant. No evaluation is required unless
symptomatic or AME has concerns.

B. Symptomatic The pilot should submit the following for FAA

review: DEFER
OR Submit the information
Requiring treatment  A current, detailed Clinical Progress to the FAA for a
Note generated from a clinic visit with possible Special
your treating physician Issuance
or cardiologist no more than 90
days before your AME exam. It should Annotate (elements or
include a detailed summary of the findings such as test
history of the condition or abnormalities or
diagnosis; treatments and symptoms) in Block 60.
outcomes; current
medications, dosages, and side effects
(if any); physical exam findings;
applicable test results;
assessment; plan (prognosis); and
follow-up.
 ECG performed within the past 90 days
or most recent (already performed).
 24-hour cardiac ambulatory
monitor (CAM) such as holter.
 Echocardiogram (echo).
 Any other testing deemed
necessary by the treating physician.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Arrhythmias (continued)

1st Degree All Document history and If no evidence of

AV Block findings, CVE structural, functional or
Protocol, and submit coronary heart disease
any tests deemed - Issue
appropriate
Otherwise - Requires
FAA Decision
2nd Degree All Document history and If no evidence of
AV Block findings, CVE structural, functional or
Protocol, and submit coronary heart disease
Mobitz I any tests deemed - Issue
appropriate
Otherwise - Requires
FAA Decision
2nd Degree All CVE Protocol in Requires FAA Decision
AV Block accordance w/
Hypertensive
Mobitz II Evaluation
Specifications and
24-hour Holter
3rd Degree All CVE Protocol in Requires FAA Decision
AV Block accordance w/
Hypertensive
Evaluation
Specifications and
24-hour Holter
Pre-excitation All CVE Protocol, GXT, Requires FAA Decision
and 24-hour Holter
Radio Frequency All 3-month wait, then If Holter negative for
Ablation 24-hour Holter arrhythmia and no
recurrence – Issue
*If performed for atrial
fibrillation, see that Otherwise -
section first. Requires FAA Decision

Supraventricular All CHD Protocol Initial Special

Tachycardia with ECHO and Issuance - Requires
24-hour Holter FAA Decision

Follow-up
Special Issuances -
See AASI Protocol

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Atrial Fibrillation (AFib)/A-Flutter

All Classes
Updated 06/30/2021

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Previously reported The airman should bring his/her letter(s)
to FAA and the from the FAA (for this condition) for the AME ISSUE
airman has a letter to review. Summarize this
from the FAA that history in Block 60.
monitoring is not If the AME’s history and exam do not reveal
required. any evidence or concern of recurrence:

B. Previously warned; Submit the following to the FAA for review:

Now with New event or  Non-Valvular Atrial Fibrillation (AFib)/ DEFER
Findings: A-Flutter INITIAL Status Report
OR Submit the
 A current clinical summary from the treating information to the
cardiologist describing all items on the FAA for a possible
AFib/A-Flutter Status Report sheet. Special Issuance.

PLUS: Follow-up Special

 ≥ 24-hour cardiac monitor. Issuance –
Will be per the
Airman’s
authorization letter
C. Non-Valvular Submit the following to the FAA for review:
AFib/A-Flutter DEFER
 Non-Valvular Atrial Fibrillation (AFib)/
History of at any time A-Flutter INITIAL Status Report Submit the
OR current: OR information to the
 A current clinical summary from the treating FAA for a possible
Single or multiple episodes cardiologist describing all items on the Special Issuance.
Paroxysmal AFib/A-Flutter Status Report sheet.
Persistent  Initial etiology work-up as follows: Follow-up Special
Permanent/chronic o TSH; Issuance –
Untreated or treated o Sleep Study that meets current AASM Will be per the
or CMS Guidelines for a Type I or Type Airman’s
AFib treated with ablation II sleep study (Type III or Type IV NOT authorization letter
(3-month recovery period) allowed);
or cardioversion (1-month o ≥ 24 hour cardiac monitor; See Non-Valvular
recovery period) Atrial Fibrillation
o Cardiac echocardiogram; and
o Exercise stress test (AFib)/A-Flutter
 If taking Warfarin, submit info listed on RECERTIFICATION
Pharmaceutical Anticoagulants – Emboli Status Report
Mitigation.
D. Treated with After a 6-month recovery period, submit the
following to the FAA for review: DEFER

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left atrial appendage
(LAA) closure device  Cardiologist evaluation that describes why Submit the
the procedure/device was indicated, information to the
ex: Watchman treatment regimen throughout the process, FAA for a possible
any procedure complications, whether Special Issuance.
device is working properly, and the current
status of AFib;
 Current CHA2DS2-VASc score; Follow-up Special
 Initial AFib etiology work up (TSH, sleep Issuance –
study that meets current AASM or CMS Will be per the
Guidelines for a Type I or Type II sleep Airman’s
study [Type III or Type IV not allowed], ≥ 24 authorization letter
hour cardiac monitor, cardiac
echocardiogram, exercise stress test), if not
previously submitted;
 Procedure report;
 TEE report from time of implantation, if
performed (images not required in most
cases); and
 TEE report from ≥ 45 days post procedure to
evaluate for peri-device leaks
(Recommended images at 0, 45, 90, and 135
degrees with 2-4 heartbeats to show
appendage and occlusion device or in
accordance with industry standards).

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NON-VALVULAR ATRIAL FIBRILLATION (AFIB)/A-FLUTTER
INITIAL STATUS REPORT (Page 1 of 2)
(Updated 08/26/2020)

Name: _______________________________ Birthdate: _____________________

Applicant ID: __________________________ PI: ___________________________

Please have the cardiologist who treats your AFib or A-Flutter complete this report (or submit a current
clinic summary that addresses all items below) AND a cardiac monitor report. Return this status report (or
a clinic summary) AND the cardiac monitor report to your AME or mail to the FAA at:
Using regular mail (US Postal Service) Using special mail (FedEx, UPS, etc.)

Federal Aviation Administration Federal Aviation Administration

Civil Aerospace Medical Institute, Building 13 Medical Appeals Section, AAM-313
Aerospace Medical Certification Division, AAM-313 Aerospace Medical Certification Division
PO Box 25082 6700 S. MacArthur Boulevard, Room B-13
Oklahoma City, OK 73125-9914 Oklahoma City, OK 73169

1. Describe history in detail: when and how diagnosed; historical characteristics/type displayed; all
intervention, management, and treatment history:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

2. Were notable findings present on a cardiac echo, EST, TSH, and sleep study etiology work-up?
☐ No ☐ Yes ☐ N/A (Explain if Yes or N/A):
__________________________________________________________________________________
__________________________________________________________________________________

3. Is there a definitive or suspicious history for stroke, TIA, or other thromboembolic event?
☐ No ☐ Yes/Explain:
__________________________________________________________________________________
__________________________________________________________________________________

4. Does a current ≥ 24hr cardiac monitor show good rate control and is your patient functionally
asymptomatic? (Address any concerns if average heart rate is > 100, maximum (non-exercise) is > 120, or a single pause is > 3
seconds. You must submit the 1-page computerized summary and the representative full-scale multi-lead ECG tracings, even if findings are
normal.)
☐ Yes ☐ No/Explain:
__________________________________________________________________________________
__________________________________________________________________________________

5. Is treatment for AFib/A-Flutter currently indicated?

☐ No ☐ Yes (If yes, see 5a.)
5a. If treatment is indicated, is patient currently on such treatment?☐ No/Explain ☐ Yes/Explain:
(If indicated but not treated, explain. If treated, describe exact methodology, including medication and dosage, and reasons for
treatment, e.g. symptom, rate and/or rhythm control.)
_____________________________________________________________________________
_____________________________________________________________________________

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NON-VALVULAR ATRIAL FIBRILLATION (AFIB)/A-FLUTTER INITIAL STATUS REPORT (Page 2 of 2)

6. Were any treatment changes made or recommended in the last year?

☐ No ☐ Yes/Explain:
___________________________________________________________________________________
___________________________________________________________________________________

7. What is your patient’s current CHA2DS2-VASc score? _____________________________________

8. Is emboli mitigation strategy indicated/applicable?

(Include medication, dosages, and copy of the last 6 monthly INR values if warfarin/Coumadin is used. CHAD2DS2-VASc score of 2 or more
should be emboli mitigated with warfarin/Coumadin, NOAC/DOAC, or LAA closure. Warfarin/Coumadin requires 6 weeks of stabilization with
80% of INRs between 2.0 and 3.0. If otherwise, explain.)
☐ No ☐ Yes/Explain
___________________________________________________________________________________
___________________________________________________________________________________

9. Are other stroke risk factors (e.g. hypertension and hyperlipidemia) well controlled?
☐ Yes ☐ No/Explain:
___________________________________________________________________________________
___________________________________________________________________________________

10. Is your patient tolerating AFib/A-Flutter treatment and/or emboli mitigation medication, if indicated,
without complication or side effect?
☐ N/A ☐ Yes ☐ No/Explain:
___________________________________________________________________________________
___________________________________________________________________________________

Cardiologist Printed Name and Credentials: _______________________ Phone #: _____________

Cardiologist Signature _________________________________________ Date _________________

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NON-VALVULAR ATRIAL FIBRILLATION (AFIB)/A-FLUTTER
RECERTIFICATION STATUS REPORT (Page 1 of 2)
(Updated 08/26/2020)

Name: _______________________________ Birthdate: _____________________

Applicant ID: __________________________ PI: ___________________________

Please have the cardiologist who treats your AFib or A-Flutter complete this report (or submit a
clinic summary that addresses all items below) AND a cardiac monitor report. Return the
completed form (or a clinic summary) AND cardiac monitor report to your AME or mail to the
FAA at:
Using regular mail (US Postal Service) Using special mail (FedEx, UPS, etc.)

Federal Aviation Administration Federal Aviation Administration

Civil Aerospace Medical Institute, Building 13 Medical Appeals Section, AAM-313
Aerospace Medical Certification Division, AAM-313 Aerospace Medical Certification Division
PO Box 25082 6700 S MacArthur Boulevard, Room B-13
Oklahoma City, OK 73125-9914 Oklahoma City, OK 73169

1. Describe the clinical history since the last evaluation:

_________________________________________________________________________________
_________________________________________________________________________________

2. Is there a definitive or suspicious history for stroke, TIA, or other thromboembolic event?
☐ No ☐ Yes/Explain:
_________________________________________________________________________________
_________________________________________________________________________________

3. Have there been any AFib/A-Flutter procedures performed which were not previously reported?
☐ No ☐ Yes/Explain: (Include procedure dates):
_________________________________________________________________________________
_________________________________________________________________________________

4. Does a current ≥ 24hr cardiac monitor show good rate control and is your patient functionally
asymptomatic? (Address any concerns if average heart rate is > 100, maximum (non-exercise) is > 120, or a single pause is > 3
seconds. You must submit the 1-page computerized summary and the representative full-scale multi-lead ECG tracings, even if findings
are normal.)
☐ Yes ☐ No/Explain:
_________________________________________________________________________________
_________________________________________________________________________________

5. Is treatment for AFib/A-Flutter currently indicated?

☐ No ☐ Yes (If yes, see 5a.)
5a. If treatment indicated, is patient currently on such treatment? ☐ No/Explain ☐ Yes/Explain
(If indicated but not treated, explain. If treated, describe exact methodology, including medication and dosage, and reasons for
treatment - e.g. symptom, rate, and/or rhythm control.)
___________________________________________________________________________
___________________________________________________________________________

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NON-VALVULAR ATRIAL FIBRILLATION (AFIB)/A-FLUTTER RECERTIFICATION STATUS REPORT (Page 2 of 2)

6. Were any treatment changes made or recommended in the last year?

☐ No ☐ Yes/Explain:
_________________________________________________________________________________
_________________________________________________________________________________

7. What is your patient’s current CHA2DS2-VASc score? ___________________________________

8. Is emboli mitigation strategy indicated/applicable?

(Include medication, dosages, and copy of the last 6 monthly INR values if warfarin/Coumadin is used. CHAD2DS2-VASc score of 2 or
more should be emboli mitigated with warfarin/Coumadin, NOAC/DOAC, or LAA closure. Warfarin/Coumadin requires 6 weeks of
stabilization with 80% of INRs between 2.0 and 3.0. If otherwise, explain.)
☐ No ☐ Yes/Explain
_________________________________________________________________________________
_________________________________________________________________________________

9. Are other stroke risk factors (e.g. hypertension and hyperlipidemia) well controlled?
☐ Yes ☐ No/Explain:
_________________________________________________________________________________
_________________________________________________________________________________

10. Is your patient tolerating AFib/A-Flutter treatment and/or emboli mitigation medication, if indicated,
without complication or side effect?
☐ N/A ☐ Yes ☐ No/Explain:
_________________________________________________________________________________
_________________________________________________________________________________

Cardiologist Printed Name and Credentials: _______________________ Phone #: ___________

Cardiologist Signature _________________________________________ Date _______________

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Pacemaker
All Classes
(Updated 08/25/2021)

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. After a 2-month recovery period,
Pacemaker Only* DEFER
Submit the following to the FAA for review. Submit the information
Initial FAA review to the FAA for a
possible Special
 Items on Pacemaker Protocol
Issuance.
 Pacemaker Status Summary
1st and 2nd class
NOTE: All testing must be performed AFTER airmen are reviewed
The 2-month recovery period. by the FAS Cardiology
Panel or Consultant

Follow up Issuance
Will be per the
airman’s authorization
letter.

B.  Cardiac narrative, (current within the past 90 days)

Pacemaker with from the treating physician which describes the DEFER
Implantable reason the pacemaker and ICD were implanted, a Submit the information
Cardiac statement if the ICD is needed or not, an to the FAA for a
Defibrillator (ICD)* assessment regarding the general physical and possible Special
cardiac examination to include symptoms or Issuance.
An active ICD is treatment referable to the cardiovascular system;
disqualifying for all classes.
Pacemaker with ICD will be interim and current cardiac condition; functional
Follow up Issuance
considered only with capacity; and medical history;
Will be per the
documentation from the
treating cardiologist that the
 Medication list airman’s
ICD circuit has been turned  Hospital records to include authorization letter.
OFF (i.e. deactivated).
o Admission (history & physical),
o Coronary catheterization/ angiography report
(if performed),
o Operative report that includes the make of
the generator and leads, model and serial
number,
o All ECG tracings, and
o Discharge summary;
 A report of current fasting blood sugar and a
current blood lipid profile to include cholesterol,
HDL, LDL, and triglycerides.
 Interrogation report from the ICD for the past 60
days.

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C. Pacemaker After a 2-month recovery period (to ensure lead
Lead replacement stability), submit the following to the FAA for review: DEFER
Submit the information
1. Procedure note detailing the replacement to the FAA for a
2. Pacemaker Status Summary possible Special
3. Status report from the surgeon indicating the Issuance.
procedure was successful; device is functioning properly
with no residual complications.
Follow up Issuance
Will be per the
Note: In accordance with CFR61.53, airmen who currently hold
airman’s
a medical certificate and have a lead replaced should NOT
fly. Once the above information is submitted and if the FAA authorization letter.
authorizes the Special Issuance, the airman may resume flight
duties.
D. Pacemaker After a 14-day recovery period, if the cardiologist OR
Battery/Generator AME verifies: ISSUE
Replacement  The pocket is healing well; Annotate Block 60
 Off pain medications; and
 No complications: Submit the information
to the FAA for
Submit the following to the FAA for retention in the file: retention in your file.
1. Procedure note detailing the replacement
2. Pacemaker Status Summary

Note: In accordance with CFR61.53, pilots who currently hold a

medical certificate and have not yet met the above criteria,
should NOT fly.

Notes:
 Medtronic EnRhythm® Pacemaker is not acceptable for medical certification.
 Medtronic REVO pacemaker requires specific battery information from the manufacturer. Estimated battery
longevity is required for recertification and we cannot issue without this specific piece of information. Please note
that battery voltage and/or RRT, ERI, or EOL flags are not acceptable substitutes. With the Medtronic REVO
pacemaker, the pacer clinic will need to call Medtronic at 1-800-505-4636 with a current scan in order to determine
battery longevity.

*Permanent cardiac pacemaker implantation is a specifically disqualifying condition per Code of Federal Regulations 14 CFR
67.111(a) (5), 67.211(e), and 67.311(e).

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Coronary Heart Disease

(Updated 01/27/2021)

Coronary Heart Disease: All See CHD Protocol Initial Special Issuance -
Angina Pectoris Requires FAA Decision
Atherectomy;
Brachytherapy; Follow-up
Coronary Bypass Special Issuances - See AASI
Grafting (CABG); Protocol
Myocardial Infarction
(MI);
PTCA;
Rotoblation; and
Stent Insertion

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Hypertension (HTN)
All Classes
Updated 10/28/2015
Disease/Condition Evaluation Data Disposition
A. No medication If airman meets standards:
ISSUE
(If treating physician Summarize this history
discontinued medications 30 in Block 60.
days ago or longer.)

B. Treated with 3 or fewer* See CACI – Hypertension Follow the CACI –

acceptable medications. Worksheet Hypertension
Worksheet.
For additional information, see Annotate Block 60.
Hypertension FAQs
C. Any of the following: Submit the following to the FAA
for review: DEFER
 Treated with 4 or  Current status report from
more* acceptable treating physician with Submit the information
medications; treatment plan, prognosis to the FAA for a
and how long the condition possible Special
 HTN is clinically has been stable; Issuance.
uncontrolled;  Specific mention if there is
a secondary cause for
 Unacceptable HTN or any evidence of a
medications are used; co-morbid condition (ex. Follow up Issuance
diabetes or OSA), or end Will be per the
 Side effects are organ damage (ex. renal airman’s authorization
present; insufficiency, kidney letter
disease, eye disease, MI,
 Medical status of the CVA heart failure, etc);
airman is unclear; or and
 List of medications, dates
 Certification has been started and stopped, and
specifically reserved any side effects.
to the FAA
Notes: *Number of medications counts each component. (Example: lisinopril/HCTZ is 2
medications.)

If this airman is new to you or you are not certain of their HTN control, you may request a
current status report from the treating physician for your review.

If the airman did not meet standards on exam, See Item 55. Blood Pressure.

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CACI - Hypertension Worksheet (Updated 04/13/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical
Progress Note generated from a clinic visit with the treating physician or specialist no more than 90
days prior to the AME exam. HOWEVER, the AME is not required to review a Clinical Progress Note
from the treating physician IF the AME can otherwise determine that the applicant has had stable clinical
blood pressure control on the current antihypertensive medication for at least 7 days, without symptoms
from the hypertension or adverse medication side-effects, and no treatment changes are recommended.
If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue.
Applicants for first- or second- class must provide this information annually; applicants for third-class
must provide the information with each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA

Treating physician or the AME [ ] Yes
finds the condition stable on
current regimen for at least 7 days
and no changes recommended.

Symptoms [ ] None
Blood pressure in office [ ] Less than or equal to 155 systolic and 95 diastolic

(Although 155/95 is acceptable for certification, the airman should be

referred to their primary provider for further management, if the blood
pressure is above clinical practice standards)

Acceptable medication(s) [ ] Combinations of up to 3 of the following: Alpha blockers, Beta-

See Pharmaceuticals - blockers, calcium channel blockers, diuretics, ACE inhibitors, ARBs,
Antihypertensive direct renin inhibitors, and/or direct vasodilators are allowed.

NOT acceptable: Centrally acting antihypertensive (ex: clonidine)

Side effects from medications [ ] No

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified hypertension. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified hypertension.

[ ] NOT CACI qualified hypertension. I have deferred. (Submit supporting documents.)

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HYPERTENSION (HTN) - FREQUENTLY ASKED QUESTIONS (FAQs)

(Updated: 10/28/2015)

We continue to see deferrals when an airman has HTN and is on medications. Please review the
following FAQs before making a determination.

GENERAL:

1. What is the FAA specified limit for blood pressure during an exam?
The maximum systolic during exam is 155mmHg and the maximum diastolic is
95mmHg during the exam. (See Item 55. Blood Pressure.)

2. If during the exam the airman’s blood pressure is higher than 155/95, do I have to
defer?
Not necessarily. If the airman’s blood pressure is elevated in clinic, you have any the
following options:

 Recheck the blood pressure. If the airman meets FAA specified limits on
the second attempt, note this in Block 60 along with both readings. If the
airman is still elevated, follow B:

 Have the airman return to clinic 3 separate days over a 7-day period. If
the airman meets FAA specified limits during these re-checks, note this
and the readings in Block 60. Also note if there was a reason for the
blood pressure elevation. If the airman does not demonstrate good
control on re-checks, follow C:

 Send the airman back to his/her treating physician for re-evaluation. If

medication adjustment is needed, a 7-day no-fly period applies to verify no
problems with the medication. If this can be done within the 14 day exam
transmission period, you could then follow the Hypertension Disposition
Table.

3. Can I hold an exam longer than 14 days to allow the airman time provide the
necessary information?
No.

MEDICATION(S):

4. Can an airman fly while on HTN medication?

Yes, the majority of common blood pressure medications can be approved for flight. If the
airman’s blood pressure is controlled with 3 or fewer medications and there are no
adverse medication side effects, the AME can often issue an unrestricted medical
certificate (if otherwise qualified). See Hypertension Disposition Table.

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5. What HTN medications are acceptable/not acceptable by the FAA?

See Pharmaceuticals – Antihypertensive.

6. The airman had medication(s) adjusted and now meets the standards, but it took
longer than 14 days and the exam was deferred. What can the airman do now?

 If the airman is now well controlled and is on 3 or fewer medications, direct

them to the CACI - Hypertension Worksheet. They should obtain the
required information from their treating physician and submit it to the FAA.

 If the airman is on 4 or more medications (combination medications count

as the sum of their parts), direct them to the Hypertension Disposition
Table. They should obtain the required information from their treating
physician and submit it to the FAA.

7. What if the treating physician stopped the medications less than 30 days ago?
See Section B of the Hypertensive Disposition Table and follow the CACI - Hypertension
Worksheet.

8. What if the airman stopped the medication on his/her own so they could fly?
Educate your airman (and their treating physician, if needed) that most HTN medications
are acceptable and almost no one is denied for HTN.

9. What if the airman has multiple conditions, e.g. HTN, Obstructive Sleep Apnea,
and/or prior heart attack?
The airman must provide the required information for each condition.

10. What if the airman is on a HTN medication that is not allowed by the FAA?
The treating physician can evaluate if the airman can safely be changed to an acceptable
HTN medication.

 If the medication(s) can be changed and the airman meets the required
criteria, they should submit the items as detailed in Section C of the
Hypertensive Disposition Table for FAA review. The treating physician
note should describe the clinical rationale as to why the unacceptable
medication was previously chosen and why it is ok for the airmen to be on
a different medication now.

 If the airman cannot safely be changed to an acceptable HTN medication,

defer the exam and send in the documents listed in Section C of the
Hypertensive Disposition Table for FAA review.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Syncope
Syncope All CHD Protocol Requires FAA Decision
with ECHO and 24- Syncope, recurrent or not satisfactorily
hour Holter; explained, requires deferral (even though the
bilateral carotid syncope episode may be medically explained,
an aeromedical certification decision may still
Ultrasound be precluded). Syncope may involve
cardiovascular, neurological, and psychiatric
factors.

Valvular Disease (Updated 01-27-2021)

Aortic and Mitral All CHD Protocol Initial Special Issuance -
Insufficiency with ECHO Requires FAA Decision

Follow-up
Special Issuances - See
AASI
Mitral Valve Repair All See CACI – Mitral Follow the CACI – Mitral Valve
Valve Repair Repair Worksheet
Worksheet
Annotate Block 60
Single Valve All See Cardiac Valve Initial Special Issuance -
Replacement (Tissue, Replacement Requires FAA Decision
Mechanical, or
Valvuloplasty) Follow-up
Special Issuances - See
AASI Protocol
Multiple Valve All Document history Requires FAA Decision
Replacement and findings, CVE
Protocol, and submit
appropriate tests.
All Other Valvular All CHD Protocol Requires FAA Decision
Disease with ECHO

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Mitral Valve Repair
All Classes
Updated 02/23/2022

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A.
5 or more years ago See CACI – Mitral Valve Repair Worksheet. Follow the
and no co-morbid conditions* CACI – Mitral Valve
Note to pilot: Take the CACI worksheet to Repair Worksheet
your cardiologist so they can fully address
the FAA requirements. Annotate Block 60.

B.
Less than 5 years ago After a 3 month recovery period submit DEFER
the following to the FAA for review: Submit the information
OR to the FAA for review.
 Hospital admission history and physical;
Any of the co-morbid  Operative report/surgical report; Follow up Issuance
conditions below*  Hospital discharge summary; Will be per the
 Current status report from the treating airman’s authorization
cardiologist which should describe the type letter
of repair, any complications, current
treatment needed, and follow up plan;
 List of medications and side effects, if any;
 Cardiac testing performed AFTER the 3
month recovery period and within the last
90 days:
o 24-hour Holter;
o Electrocardiogram (ECG);
o Echo;
o Exercise Stress Test (EST); and
 Other imaging reports (if any) for studies
performed by the treating cardiologist (e.g.
Cath, CTA, or MRA).

Notes:
*Co-morbid conditions for FAA purposes include:
 Cardiac disease (disease of other valves, ischemia, CHF, Left Ventricular Systolic Dysfunction (LVSD), Secondary or
Functional mitral valve disease, arrhythmia, etc.);
 Connective tissue disorder (such as Marfan’s or Ehlers-Danlos, etc.);
 Coumadin or other anticoagulation (other than ASA) due to a cardiac condition;
 Lung disease such as COPD (considered moderate to severe; any FEV1 or FVC less than 70%) or Pulmonary
Hypertension; or
 Residual Mitral valve regurgitation listed as moderate or higher on cardiac echo.

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CACI – Mitral Valve Repair Worksheet (Updated 04/27/2022)
To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical
Progress Note generated from a clinic visit with the treating physician or specialist no more than 90
days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed
below, the AME can issue. Applicants for first- or second-class must provide this information annually;
applicants for third-class must provide the information with each required exam.

AME MUST REVIEW ACCEPTABLE

CERTIFICATION
CRITERIA
The airman had Mitral Valve Repair surgery 5 or more years ago [ ] Yes
for primary mitral valve disease (not secondary MR or functional MR
due to coronary heart disease, MI, ischemic disease, or cardiomyopathy).
The treating cardiologist’s current, detailed Clinical Progress Note verifies: [ ] Yes
 Is asymptomatic and stable;
 Has no other current cardiac conditions;
 Has not developed any new conditions, arrhythmias, or complications
that would affect cardiac function;
 Requires no more than a routine annual follow-up; and
 No additional surgery is anticipated or recommended.

The airman has NO history of: [ ] Yes

 Connective tissue disorder (Marfan’s or Ehlers-Danlos, etc.);
 Lung disease: COPD (moderate or higher), or pulmonary HTN; or
 Other cardiac disease (e.g. Congestive Heart Failure, ischemia, other
valve disease, etc.)
The most recent echo was performed within the last 24 months [ ] Yes
shows:
 Mitral valve regurgitation (if present) is classified as mild;
 No other abnormalities on echo such as:
o Dilated aorta greater than 4 cm;
o Hypertrophic cardiomyopathy or other cardiomyopathy;
o Left Atrial Enlargement;
o Aortic regurgitation/insufficiency (any severity);
o Regurgitation of any valve moderate or higher; or
o Structural abnormalities (dilated ventricle, atria, etc.)
Notes:
 If any valve other than mitral was involved, the information must be submitted to the FAA for review.
 An annual echo is not required for each FAA exam for this CACI.
 Anticoagulation is not routinely required for mitral valve repair. If Coumadin or other anticoagulation (other than ASA) is
required for a cardiac condition, the AME should defer.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Mitral Valve Repair.

[ ] Has current OR previous SI/AASI but now CACI qualified Mitral Valve Repair.

[ ] NOT CACI qualified Mitral Valve Repair. I have deferred. (Submit supporting
documents.)
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Other Cardiac Conditions

(Updated 10/25/2017)

The following conditions must be deferred:

1. Cardiac Transplant – see Disease Protocols.

2. Cardiac decompensation
3. Congenital heart disease
4. Hypertrophy or dilatation of the heart as evidenced by clinical examination and supported
by diagnostic studies. (Concentric LVH with no dilatation can be issued by the AME if no
symptoms.)
5. Pericarditis, endocarditis, or myocarditis
6. Cardiac enlargement or other evidence of cardiovascular abnormality, If the applicant
wishes further consideration, a consultation is required, preferably from the applicant’s
treating physician. It must include a narrative report of evaluation and be accompanied
by an ECG with report and appropriate laboratory test results which may include, as
appropriate, 24-hour Holter monitoring, thyroid function studies, ECHO, and an
assessment of coronary artery status.
7. Anti-tachycardia devices
8. Implantable defibrillators (ICDs)
9. Anticoagulants may be allowed, if the condition is allowed.
10. Cardioversion (electrical or pharmacologic), may be allowed. A current, complete
cardiovascular evaluation (CVE) and follow up Holter monitoring test is required. A 1-
month observation period must elapse after the procedure before consideration for
certification.
11. Any other cardiac disorder not otherwise covered in this section.
12. Hypotension. A history of low blood pressure requires elaboration. If the AME is in
doubt, it is usually better to defer issuance rather than to deny certification for such a
history.

For all classes, certification decisions will be based on the applicant's medical history and
current clinical findings. Evidence of extensive multi-vessel disease, impaired cardiac
functioning, precarious coronary circulation, etc., will preclude certification. Before an
applicant undergoes coronary angiography, it is recommended that all records and the report
of a current cardiovascular evaluation (CVE), including a maximal electrocardiographic
exercise stress test, be submitted to the FAA for preliminary review. Based upon this
information, it may be possible to advise an applicant of the likelihood of favorable
consideration.

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ITEM 37. Vascular System

CHECK EACH ITEM IN APPROPRIATE COLUMN Normal Abnormal

37. Vascular System

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified
medical judgment relating to the condition involved, finds –

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges;

(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the
medication or other treatment involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.

II. Examination Techniques

1. Inspection. Observe and report any thoracic deformity (e.g., pectus excavatum), signs of
surgery or other trauma, and clues to ventricular hypertrophy. Check the hematopoietic
and vascular system by observing for pallor, edema, varicosities, stasis ulcers, venous
distention, nail beds for capillary pulsation, and color.

2. Palpation. Check for thrills and the vascular system for arteriosclerotic changes, shunts or
AV anastomoses. The pulses should be examined to determine their character, to note if
they are diminished or absent, and to observe for synchronicity.

3. Percussion. N/A.

4. Auscultation. Check for bruits and thrills.

III. Aerospace Medical Disposition

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The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the AME as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Vascular Conditions

Aneurysm All Submit all available Requires FAA Decision

(Abdominal or Thoracic) medical
documentation
Aneurysm All Submit all Requires FAA Decision
(Status Post Repair) documentation in
accordance with CVE
Protocol, and include
a GXT
Arteriosclerotic Vascular All Submit all Requires FAA Decision
disease with evidence documentation in
of circulatory accordance with CVE
obstruction Protocol, and include
a GXT, and CAD
ultra sound if
applicable
Buerger's Disease All Document history If no impairment and
and findings no symptoms in flight
- Issue

Otherwise - Requires
FAA Decision

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Vascular Conditions

Peripheral Edema All The underlying If findings can be

medical condition explained by normal
must not be physiologic response
disqualifying or secondary to
medication(s)
- Issue

Otherwise -
Requires FAA Decision
Raynaud's Disease All Document history and If no impairment
findings - Issue

Otherwise - Requires
FAA Decision
Phlebothrombosis or 1st & See Thrombophlebitis Requires FAA Decision
Thrombophlebitis 2nd Protocol

3rd Document history and A single episode

findings resolved, not currently
treated with
anticoagulants, and a
negative evaluation
- Issue

See Thrombophlebitis If history of multiple

Protocol episodes - Requires
FAA Decision

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ITEM 38. Abdomen and Viscera

CHECK EACH ITEM IN APPROPRIATE COLUMN Normal Abnormal

38. Abdomen and viscera (including hernia)

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified
medical judgment relating to the medication or other treatment involved, finds-

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.

c No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the
medication or other treatment involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.

II. Examination Techniques

1. Observation: The AME should note any unusual shape or contour, skin color, moisture,
temperature, and presence of scars. Hernias, hemorrhoids, and fissure should be noted and
recorded.

A history of acute gastrointestinal disorders is usually not disqualifying once recovery is achieved,
e.g., acute appendicitis.

Many chronic gastrointestinal diseases may preclude issuance of a medical certificate (e.g.,
cirrhosis, chronic hepatitis, malignancy, ulcerative colitis). Colostomy following surgery for cancer
may be allowed by the FAA with special follow-up reports.

The AME should not issue a medical certificate if the applicant has a recent history of bleeding
ulcers or hemorrhagic colitis. Otherwise, ulcers must not have been active within the past
3 months.

In the case of a history of bowel obstruction, a report on the cause and present status of the
condition must be obtained from the treating physician.

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2. Palpation: The AME should check for and note enlargement of organs, unexplained masses,
tenderness, guarding, and rigidity.

III. Aerospace Medical Disposition

The following tables list the most common conditions of aeromedical significance and the course of action
that should be taken by the AME as defined by the protocol and disposition in the table.
Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for
any condition not listed in the table that may result in sudden or subtle incapacitation without consulting
the AMCD or the RFS. Medical documentation must be submitted for any condition in order to support
an issuance of an airman medical certificate.

Abdomen and Viscera and Anus Conditions

BARRETT'S ESOPHAGUS
All Classes
(Updated 4/27/2022)

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Endoscopy (EGD) If the AME can determine the medications are
biopsy finding acceptable, the pilot has no symptoms that ISSUE
would interfere with flight duties, and there is no Summarize this
evidence of a GI bleed, esophageal cancer, or information
other pathology: including
approximate date
The AME should comment on the approximate of procedure in
date of the procedure and any complications or Block 60.
additional findings (see corresponding section).

B. Abnormal findings or Submit the following to the FAA for review:

complications DEFER
1. A current, detailed Clinical Progress Submit the
(High-grade dysplasia, Note generated from a clinic visit with the information to the
progression) treating physician no more than 90 days FAA for a possible
prior to the AME exam. It must include a Special Issuance.
detailed summary of the history of the
condition; current medications, dosage, Follow up
and side effects (if any); physical exam Issuance will be
findings; results of any testing performed; per the airman’s
diagnosis; assessment; plan (prognosis); authorization letter.
and follow-up.

2. It must specifically include if there is any

history of GI bleed, GI cancer, or
complications.

If history of GI cancer - see that section.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Abdomen and Viscera and Anus Conditions

Cholelithiasis All Document history and If asymptomatic – Issue
findings
Otherwise - Requires FAA
Decision
Cirrhosis (Alcoholic) All See Substance Requires FAA Decision
Abuse/Dependence
Disposition in Item 47.
Cirrhosis All Submit all pertinent Requires FAA Decision
(Non-Alcoholic) medical records,
current status report, to
include history of
encephalopathy;
PT/PTT; albumin; liver
enzymes; bilirubin;
CBC; and other testing
deemed necessary
Colitis All Submit all pertinent Follow the CACI – Colitis
medical information Worksheet. If Airman meets
(Ulcerative, and current status all certification criteria –
Regional Enteritis report, include duration Issue
or Crohn's of symptoms, name
disease) or Irritable Bowel and dosage of drugs Initial Special Issuance -
Syndrome and side effects Requires FAA Decision

Follow-up Special
Issuance - See AASI
Protocol

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CACI - Colitis Worksheet (Updated 04/27/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical
Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days
prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the
AME can issue. Applicants for first- or second-class must provide this information annually; applicants for
third-class must provide the information with each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA

The general health status of the [ ] Favorable
applicant due to this condition, as
documented by the treating
physician’s current, detailed Clinical
Progress Note.

Symptoms [ ] None or mild diarrhea with or without mild abdominal pain/cramping

Fatigue which limits activity or severe abdominal symptoms are not

acceptable for certification.

Cause of Colitis [ ] Crohn’s Disease, Ulcerative colitis, or Irritable Bowel Syndrome

Any other causes require FAA decision.

Surgery for condition in last 6 weeks [ ] No

Medications for condition [ ] One or more of the following:
 Oral steroid which does not exceed equivalent of prednisone 20
mg/day (see steroid conversion calculator)
 Imuran or Sulfasalazine
 Mesalamine (5-aminosalicylic acid such as Asacol, Pentasa, Lialda,
etc.)
 Steroid foams or enemas/ budesonide enema
 Loperamide less than or equal to 16 mg a day and no side effects
 Hyoscyamine - use 1-2 times a week with no side effects and no-fly
48 hours after use
 Mercaptopurine (6-MP)
 Tofacitinib (Xeljanz)
 Vedolizumab (Entyvio): 4-hour no-fly after each dose

NOT acceptable: Use of infliximab, use of hyoscyamine greater than 2

times per week, Prednisone greater than 20 mg/day, or Loperamide greater
than 16 mg per day.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified colitis. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified colitis.

[ ] NOT CACI qualified. I have deferred. (Submit supporting documents.)

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Abdomen and Viscera and Anus Conditions

Hepatitis All Submit all pertinent If disease is resolved
medical records, without sequela
current status report to - Issue
include any other
testing deemed Otherwise - Requires
necessary FAA Decision
Hepatitis C All Review all pertinent If disease is resolved
medical information without sequela and
and current status need for medications-
report, include duration Issue
of symptoms, name
and dosage of drugs If applicant has chronic
and side effects Hepatitis C, follow the
CACI - Hepatitis C -
Chronic Worksheet
(PDF). If Airman meets
all certification criteria -
Issue.

All others require FAA

decision. Submit all
evaluation data.

Initial Special Issuance

- Requires FAA Decision

Follow-up Special
Issuances - See AASI
Protocol

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CACI - Hepatitis C - Chronic Worksheet (Updated 04/13/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no
more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable
certification criteria listed below, the AME can issue. Applicants for first- or second- class
must provide this information annually; applicants for third-class must provide the information
with each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA

Treating physician finds the [ ] Yes
condition stable on current
regimen and no changes
recommended

Complications or symptoms from [ ] None

Chronic Hepatitis C
Medications for condition [ ] None

Current Labs [ ] Within last 90 days

[ ] AST (SGOT), ALT (SGPT), Albumin, and PT all within 10% of

normal lab scale.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Hepatitis C - Chronic. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified Hepatitis C - Chronic.

[ ] NOT CACI qualified Hepatitis C - Chronic. I have deferred. (Submit supporting documents.)

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Abdomen and Viscera and Anus Conditions

Hernia - Inguinal, Ventral All Document history and If symptomatic; likely to
or Hiatal findings cause any degree of
obstruction - Requires
FAA Decision

Otherwise - Issue
Liver Transplant - All Submit items listed on Initial Special Issuance -
Recipient the Protocol for Liver Requires FAA decision
Transplant (Recipient)
Follow up Special
Issuance – per
Authorization Letter
requirements
Liver Transplant - All Review a current status Initial certification - If
Donor report from the the current status report
transplant surgeon or shows there were no
transplant team complications, the
physician airman is off all pain
medications, functional
status has returned to
normal, and the treating
physician has granted a
full release - ISSUE

Note in block 60 and

send a copy of the
current status report to
the FAA for retention in
the file

*If there were

complications, see the
appropriate, related
section(s) within the AME
Guide. Submit additional
reports as necessary.

Follow up Certification
–No follow up is required
unless there are changes
in condition
Liver + kidney All Submit the required Defer - Requires FAA
Liver + heart items on the transplant Decision
Liver + other protocol for each
individual organ
Combined Transplants transplanted

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Abdomen and Viscera and Anus Conditions

Peptic Ulcer All See Peptic Ulcer Requires FAA Decision
Protocol

Splenomegaly All Provide hematologic Requires FAA Decision

workup

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Pancreatitis
All Classes
Updated 06/24/2020
DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Gallstone pancreatitis 1 month recovery period after release from

Single episode resolved treating physician. ISSUE
Summarize this
Must have specific documentation from history in Block 60.
General Surgery (GS) or Gastroenterology
(GI) verifying definitive treatment:
 Alcohol must be ruled out as a
contributing factor (via hospital records
or treating physician determination. If
not available, AME should screen).
 Common Bile Duct (CBD) was cleared of
stones/debris;
 Cholecystectomy; and
 Off all pain medications
B. Any others such as: 3 month recovery period then
DEFER
 Alcohol induced or Submit the following for FAA review: Submit the
contributing factor Current status report from treating information to the
Gastroenterologist (GI) describing: FAA for review.
 CBD stricture/stenosis  Cause of the condition, how long the
condition has been stable, and Follow up
 Chronic pancreatitis prognosis; Issuance
 If CBD stricture/stenosis or obstruction Will be per the
 Recurrent pancreatitis verify it has resolved; airman’s
 If there is any evidence of alcohol authorization
 Retained stones involvement; and letter
 Verify off all pain medication
 Secondary to elevated Current Medication list
triglycerides  Lab (minimum amylase and lipase, from
hospital admission, discharge, and current
 Etiology unknown evaluation;
Operative notes, admission H&P and
 Other causes discharge summary, if applicable; and
Results of MRI/CT or other imaging, if
performed.
Notes:
1. This applies to CLINICAL PANCREATITIS ONLY, not isolated elevations in amylase/lipase due to a concurrent illness.
2. Gallstone pancreatitis with retained stones should NOT be certified by AME as the risk of recurrent pancreatitis with
incapacitation remains. (Applicant may have had an endoscopic retrograde cholangio-pancreatography (ERCP) with
ampulotomy and opened the CBD but etiology of pancreatitis (residual stone/microlith/sludge) likely not resolved without
cholecystectomy).

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Malignancies

Colon Cancer/ Colorectal Cancer

All Classes
Updated 10/27/2021

DISEASE/CONDITION EVALUATION DATA DISPOSITION

N
A. If no recurrence or ongoing treatment:
Non metastatic - ISSUE
treatment completed Summarize this
5 or more years ago history in Block 60.
B. Review a status report. If it shows:
Pedunculated  Local lesion only (TNM stage 0 or I); ISSUE
cancerous polyp  Complete resection with no Summarize this
(Adenocarcinoma) additional treatment needed; history in Block 60.
removed by  Follow up is annual or less frequent
colonoscopy colonoscopy;
Less than 5 years ago  No clinical concerns.

C. Follow CACI worksheet. Follow the CACI-

Non metastatic and no Colon Cancer/
High Risk features* Colorectal Cancer
Worksheet
Treatment completed
Less than 5 years ago Note in Block 60

*Notes: High Risk features for FAA purposes include the following.

These DO NOT CACI qualify:

 CEA increase or CEA did not decrease with colectomy;

 Chemotherapy ever (including neoadjuvant);
 Familial Adenomatous Polyposis (FAP);
 High risk pathology per the treating oncologist;
 Incomplete resection or positive margins;
 Lynch syndrome;
 Metastatic disease (Refers to distant metastatic disease such as: lung, liver, lymph nodes,
peritoneum, brain)
 Pathology of any type other than adenoma (ex: lymphoma, GIST, carcinoid)
 Radiation therapy;
 Recurrence; and or
 Sessile polyp with invasive cancer surgically treated only, no additional chemo/radiation.

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D. Submit the following to the FAA for review:
HIGH RISK features*  Status report or treatment records from DEFER
treating oncologist that provide the
Or following information: Submit the
o Initial staging, information to the
Metastatic disease o Disease course including FAA for a possible
(Refers to distant recurrence(s), Special Issuance.
metastatic disease such o Location(s) of metastatic
as: lung, liver, lymph disease (if any),
nodes, peritoneum, o Treatments used, Follow-up Special
brain.) o How long the condition has been Issuance –
stable, Will be per the
o If any upcoming treatment airman’s
change is planned or expected authorization letter
and prognosis;
 Medication list. Dates started and
stopped. Description of side effects.
 Treatment records including clinic notes;
 Operative notes and discharge summary,
if applicable;
 Colonoscopy reports;
 Pathology reports;
 Results of MRI/CT or PET scan reports
that have already been performed (In some
cases, the actual CDs will be required in DICOM
format for FAA review.); and
 Lab reports.
o CBC and CEA performed within
the last 90 days;
o Previous tumor marker lab
results (such as CEA).

Other Malignancies Submit all pertinent medical records, operative/ Requires FAA
pathology reports, current oncological status Decision
report, including tumor markers, and any other
testing deemed necessary

An applicant with an ileostomy or colostomy may also receive FAA consideration. A report is
necessary to confirm that the applicant has fully recovered from the surgery and is completely
asymptomatic.

In the case of a history of bowel obstruction, a report on the cause and present status of the
condition must be obtained from the treating physician.

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CACI - Colon Cancer/ Colorectal Cancer Worksheet (Updated 04/27/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical
Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days
prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the
AME can issue. Applicants for first- or second- class must provide this information annually; applicants for
third-class must provide the information with each required exam.

ACCEPTABLE CERTIFICATION
AME MUST REVIEW
CRITERIA
The treating physician’s current, detailed Clinical Progress
Note verifies the condition is stable with no concerns and [ ] Yes
the airman is back to full daily activities with no treatment
needed.
High Risk – any evidence of the following features ever: [ ] None
 CEA increase or CEA did not decrease with colectomy;
 Chemotherapy ever (including neoadjuvant);
 Familial Adenomatous Polyposis (FAP);
 High-risk pathology per the treating oncologist;
 Incomplete resection or positive margins;
 Lynch syndrome;
 Metastatic disease - refers to distant metastatic disease such as lung,
liver, lymph nodes, peritoneum, brain, etc.;
 Pathology of any type other than adenoma (ex: lymphoma, GIST,
carcinoid);
 Radiation therapy;
 Recurrence; and/or
 Sessile polyp with invasive cancer surgically treated only, no
additional chemo/radiation.
Recurrence - any evidence or concern based on [ ] No
colonoscopy or imaging studies per acceptable current
practice guidelines.
Metastatic disease ever (distant to liver, lung, lymph [ ] None
nodes, peritoneum, brain, etc.) or symptoms such as:
 Headache or vision changes;
 Focal neurologic dysfunction;
 Gait disturbance ; and/or
 Cognitive dysfunction, including memory problems and mood or
personality changes.
TNM stage at diagnosis was 0, I, II or III. [ ] Yes
CEA at diagnosis was less than 5 ng/ml. [ ] Yes
CEA within the last 90 days is normal and has no increase [ ] Yes
from previous levels.
CBC within the last 90 days shows a hemoglobin [ ] Yes
greater than 11 and no other significant abnormalities.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified colon cancer/colorectal cancer.

[ ] Has current OR previous SI/AASI but now CACI qualified colon cancer/colorectal cancer.
[ ] NOT CACI qualified colon cancer/colorectal cancer. I have deferred. (Submit supporting
documents.)

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ITEM 39. Anus

CHECK EACH ITEM IN APPROPRIATE COLUMN Normal Abnormal

39 Anus (Not including digital examination)

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(a), 67.213(b)(c), and 67.313(b)(c)

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified
medical judgment relating to the medication or other treatment involved, finds

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.

c No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the
medication or other treatment involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.

II. Examination Techniques

1. Digital Rectal Examination: This examination is performed only at the applicant's option
unless indicated by specific history or physical findings. When performed, the following
should be noted and recorded in Item 59 of FAA Form 8500-8.

2. If the digital rectal examination is not performed, the response to Item 39 may be based
on direct observation or history.

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ITEM 40. Skin

CHECK EACH ITEM IN APPROPRIATE COLUMN NORMAL ABNORMAL

40. Skin

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical
judgment relating to the condition involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.

(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or
other treatment involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.

II. Examination Techniques

A careful examination of the skin may reveal underlying systemic disorders of clinical
importance. For example, thyroid disease may produce changes in the skin and fingernails.
Cushing's disease may produce abdominal striae, and abnormal pigmentation of the skin occurs
with Addison's disease.
Needle marks that suggest drug abuse should be noted and body marks and scars should be
described and correlated with known history. Further history should be obtained as needed to
explain findings.
The use of isotretinoin (Accutane) can be associated with vision and psychiatric side effects of
aeromedical concern – specifically decreased night vision/night blindness and depression.
These side-effects can occur even after the cessation of isotretinoin. See Aeromedical Decision
Considerations.

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III. Aerospace Medical Disposition

The following is a table that lists the most common conditions of aeromedical significance, and course of
action that should be taken by the AME as defined by the protocol and disposition in the table. Medical
certificates must not be issued to an applicant with medical conditions that require deferral, or for any
condition not listed in the table that may result in sudden or subtle incapacitation without consulting the
AMCD or the RFS. Medical documentation must be submitted for any condition in order to support an
issuance of an airman medical certificate.

Cutaneous
All classes
DISEASE/CONDITION EVALUATION DATA DISPOSITION
Dermatomyositis; Submit all pertinent medical Requires FAA Decision
Deep Mycotic information and current status report
Infections;
Eruptive Xanthomas;
Hansen's Disease;
Lupus Erythematosus;
Raynaud's
Phenomenon;
Sarcoid; or Scleroderma
Kaposi's Sarcoma Submit all pertinent medical Requires FAA Decision
information and current status
report.
See HIV Protocol
Use of isotretinoin For applicants using isotretinoin, Any history of psychiatric
(Accutane) there is a mandatory 2-week waiting side-effect requires FAA
period after starting isotretinoin prior Decision.
to consideration. This medication If there is no vision,
can be associated with vision and psychiatric, or other
psychiatric side effects of aeromedically unacceptable
aeromedical concern - specifically side-effects – Issue with
decreased night vision/night restriction: “NOT VALID
blindness and depression. These FOR NIGHT FLYING.”
side-effects can occur even after
cessation of isotretinoin. A report To remove restriction:
must be provided with detailed, *See note
specific comment on presence or
absence of psychiatric and vision
side-effects. The AME must
document these findings in Item 60.,
Comments on History and Findings.

*Note:
 Use of isotretinoin must be permanently discontinued for at least 2 weeks prior to consideration
date (confirmed by the prescribing physician);
 An eye evaluation in accordance with specifications in 8500-7; and
 Airman must provide a statement of discontinuation
o Confirming the absence of any visual disturbances and psychiatric symptoms, and
o Acknowledging requirement to notify the FAA and obtain clearance prior to performing any
aviation safety-related duties if use of isotretinoin is resumed.

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Skin Cancer
All Classes
Updated 08/26/2015
DISEASE/CONDITION EVALUATION DATA DISPOSITION
Unknown pathology If unable to verify pathology, have airman More info needed
collect: Once reports are received, refer to
 Medical records describing the the appropriate skin cancer
diagnosis and treatment; and diagnosis in this section.
 Pathology report(s)
ISSUE
Basal cell cancer AME interview and exam findings consistent Note BCC or SCC treated in block
(BCC) with uncomplicated local BCC or SCC 60.
completely treated (excised, destroyed, or
Squamous cell cancer Mohs procedure) and resolved. If complicated lesion, see below.
(SCC)

Uncomplicated skin only

No organ involvement
SCC or BCC Submit the following for FAA review: DEFER
 Medical records describing the Submit reports to FAA for review.
Complicated lesion diagnosis and treatment;
Metastatic  Pathology report(s);
lymph node or deep tissue  Operative notes;
involvement, aggressive  Current status summary report that
pathology or other abnormalities includes current or planned future
treatment & prognosis; and Follow-up certification - based on
Also see ENT section  Copies of any imaging performed Special Issuance Authorization.
(CT/MRI)
Melanoma Review: ISSUE
 Medical records describing the If complete resection with clear
Less than diagnosis and treatment; and margins, no recurrence, no
0.75 mm in depth  Pathology report(s) metastatic disease, and favorable
reports.
OR
Document in block 60 AND submit
Melanoma in Situ reports to FAA for retention in the
file.
Melanoma Review and submit the following: DEFER
 Medical records describing the Submit reports to FAA for review.
Equal to 0.75 mm or greater in diagnosis and treatment;
depth  Pathology report(s);
 Operative notes;
 Current status report that includes if
any additional lesions, any Follow-up certification - based on
metastatic disease, any current or Special Issuance Authorization.
future treatment planned; and
 Current MRI brain
Metastatic Melanoma Submit the following for FAA review: DEFER
 Info from Melanoma greater than Submit supporting documents for
OR 0.75 mm above; FAA review.
 PET scan; and
Melanoma of Unknown Primary  Copies of any additional testing
Origin performed by your treating
physician not listed above

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DISEASE/CONDITION EVALUATION DATA DISPOSITION

Urticarial Eruptions
All Classes

Angioneurotic Edema Submit all pertinent medical Requires FAA Decision

records and a current status
report to include treatment

Chronic Urticaria Submit all records and a current Requires FAA Decision
status report to include treatment

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ITEM 41. G-U System

CHECK EACH ITEM IN APPROPRIATE COLUMN NORMAL ABNORMAL

41. G-U system (Not including pelvic examination)

NOTE: The pelvic examination is performed only at the applicant's option or if indicated by specific
history or physical findings. If a pelvic examination is performed, the results are to be recorded in Item 60
of FAA Form 8500-8.

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical
judgment relating to the condition involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.

(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or
other treatment involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.

II. Examination Techniques

The AME should observe for discharge, inflammation, skin lesions, scars, strictures, tumors, and
secondary sexual characteristics. Palpation for masses and areas of tenderness should be
performed. The pelvic examination is performed only at the applicant's option or if indicated by
specific history or physical findings. If a pelvic examination is performed, the results are to be
recorded in Item 60 of FAA Form 8500-8. Disorders such as sterility and menstrual irregularity
are not usually of importance in qualification for medical certification.

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Specialty evaluations may be indicated by history or by physical findings on the routine
examination. A personal history of urinary symptoms is important; such as:

1. Pain or burning upon urination

2. Dribbling or Incontinence
3. Polyuria, frequency, or nocturia
4. Hematuria, pyuria, or glycosuria

Special procedures for evaluation of the G-U system should best be left to the discretion of an
urologist, nephrologist, or gynecologist.

III. Aerospace Medical Disposition

(See Item 48.,General Systemic, for details concerning diabetes and Item 57., Urine Test, for
other information related to the examination of urine).

The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the AME as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.

General Disorders
All Classes

DISEASE/CONDITION EVALUATION DATA DISPOSITION

Congenital lesions of Submit all pertinent If the applicant has an ectopic, horseshoe
the kidney medical information kidney, unilateral agenesis, hypoplastic, or
and status report dysplastic and is asymptomatic
– Issue

Otherwise – Requires FAA Decision

Cystostomy and Requires evaluation, Requires FAA Decision
Neurogenic bladder report must include
etiology, clinical
manifestation and
treatment plan
Renal Dialysis Submit a current status Requires FAA Decision
report, all pertinent
medical reports to
include etiology, clinical
manifestation, BUN,
Ca, PO4,
Creatinine, electrolytes,
and treatment plan
Renal Transplant See Renal Transplant Requires FAA Decision
Protocol

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Chronic Kidney Disease(CKD)

All Classes
Updated 03/27/2019

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. eGFR 45 to 59 No symptoms or complications and the
underlying cause is not disqualifying. ISSUE
Summarize this
history in block 60.

B. eGFR 35 to 44 See CACI worksheet. Follow the CACI –

Chronic Kidney
Single kidney – DO NOT CACI Disease Worksheet
annotate block 60.

C. eGFR 34 or less Submit the following to the FAA for review:

 Current status report from the treating DEFER
OR physician. It should note if the condition is
stable or if additional treatment or dialysis is Submit the
Symptoms or recommended; information to the
complications with any  List of medications and side effects, if any; FAA for a possible
eGFR  Recent lab (within last 90 days) Special Issuance.
o Renal function studies(creatinine,
Proteinuria 2+ or higher BUN and eGFR); Follow-up Special
or ACR is 300 or higher o Albumin as dipstick or ACR; and Issuance –
o Hemoglobin and hematocrit Will be per the
OR  Imaging reports (if performed by treating airman’s
physician); and Authorization Letter
Single kidney with  Assessment by treating physician if a
eGFR 44 or less cardiac evaluation is warranted
ESRD requiring See table on previous page for more information.
dialysis or kidney DEFER
transplant
Notes: eGFR is a calculated/estimated value. If additional testing shows the actual renal function is higher than the
eGFR, this should be stated in the note from the treating physician.

ACR= albumin creatinine ratio

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CACI – Chronic Kidney Disease (CKD) Worksheet (Updated 04/27/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no
more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable
certification criteria listed below, the AME can issue. Applicants for first- or second-class must
provide this information annually; applicants for third-class must provide the information with
each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION

CRITERIA
The treating physician’s current, detailed Clinical [ ] Yes
Progress Note verifies:

 Is asymptomatic and stable;

 Has not developed any new conditions or
complications that would affect renal function;
 Has 2 functioning kidneys;
 Any underlying conditions (such as diabetes,
HTN, glomerulonephritis, PKD, or chronic
obstruction) are well controlled; and
 Dialysis or transplant is not recommended or
anticipated at this time.

eGFR is 35 or higher [ ] Yes

(most recent value, must be within the last 6 months).
Albumin on urine dipstick is trace or negative [ ] Yes
OR albumin creatinine ratio (ACR) is 29 or less
Hemoglobin is at least 10 gm/dL AND hematocrit is [ ] Yes
at least 30%
Current treatment [ ] allowed HTN medication

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Chronic Kidney Disease.

[ ] Has current OR previous SI/AASI but now CACI qualified Chronic Kidney Disease.

[ ] NOT CACI qualified Chronic Kidney Disease. I have deferred. (Submit supporting
documents.)

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Inflammatory Conditions
All Classes

DISEASE/CONDITION EVALUATION DATA DISPOSITION

Acute (Nephritis) Submit all pertinent If > 3 mos. ago, resolved, no sequela, or
medical information indication of reoccurrence - Issue
and status report
Otherwise - Requires FAA Decision
Chronic (Nephritis) Submit all pertinent Requires FAA Decision
medical information
and status report
Nephrosis Submit all pertinent Requires FAA Decision
medical information
and status report

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Kidney Stone(s)
(Nephrolithiasis, Renal Calculi)
or Renal Colic
All Classes
Updated 06/28/2017

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Most recent No symptoms or current problems. Renal
event/diagnosis function has returned to normal. No ongoing ISSUE
5 or more years ago. treatment or surveillance needed. Summarize this
history in Block 60.
B. Single stone If a single stone passed or is in the bladder
that passed with no further problems ISSUE
Less than 5 years ago and imaging (such as a KUB) verifies Summarize this
with no complications* no retained stones: history in Block 60.

C. Multiple or Retained See CACI worksheet Follow the CACI –

asymptomatic stone(s) Retained Kidney
Less than 5 years ago Stone(s) Worksheet.
with no complications* Annotate Block 60.

Note: Use this for

incidental findings.
D. All others Submit the following to the FAA for review:
Complications*  Current status report from the treating DEFER
Symptomatic urologist with treatment plan and prognosis; Submit the
Underlying cause for  If underlying cause is identified, the status information to the
recurrent stones report should include diagnosis, treatment FAA for a possible
plan, prognosis and adherence to treatment Special Issuance.
for this condition;
 List of medications and side effects if any; Follow up Issuance
 Operative notes and discharge summary Will be per the
(if applicable);and airman’s
 Copies of imaging reports and lab (if authorization letter
already performed by treating physician)
*Complications include the following:
 Hydronephrosis (chronic).
 Metabolic/underlying condition requiring treatment/surveillance/monitoring
 Procedures (3 or more for kidney stones within the last 5 years)
 Renal failure or obstruction (acute or chronic).
 Sepsis or recurrent urinary tract infections due to stones

Metabolic evaluations and imaging should be performed as clinically indicated by the treating physician.
Acceptable imaging includes KUB, ultrasound, IVP, or CT/MRI as clinically appropriate per the treating physician.

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CACI – Retained Kidney Stone(s) Worksheet (Updated 04/27/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no
more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable
certification criteria listed below, the AME can issue. Applicants for first- or second-class must
provide this information annually; applicants for third-class must provide the information with
each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION

CRITERIA
The treating physician’s current, detailed Clinical [ ] Yes
Progress Note verifies that the condition is:

 Asymptomatic;
 Stable (no increase in number or size of
stones);
 Unlikely to cause a sudden incapacitating event;
 If surgery has been performed, the airman:
o Is off pain medication(s);
o Has made a full recovery; and
o Has a full release from the surgeon;
 No history of complications (including chronic
hydronephrosis; metabolic/underlying condition;
procedures (3 or more in the last 5 years); renal
failure or obstruction; sepsis; or recurrent UTIs
due to stones.)
Is there an underlying cause for stone recurrence? [ ] No
Current or recommended treatment [ ] None

After a single stone event - if follow up imaging verifies Supportive treatments such as hydration
no further stone(s) present, annotate this in Block 60. or medications (such as thiazides,
No further follow up is required unless there is a allopurinol, or potassium citrate) to
change in condition. decrease recurrence (with no side
effects) are allowed.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Retained Kidney Stone(s). (Documents do not need to be submitted to the
FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified Retained Kidney Stone(s).

[ ] NOT CACI qualified Retained Kidney Stone(s). I have deferred. (Submit supporting
documents.)

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Neoplastic Disorders/Cancer

Bladder Cancer
All Classes
Updated 08/26/2015

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Non metastatic No recurrence or ongoing treatment: ISSUE

and treatment Summarize this
completed 5 or more history in Block 60.
years ago
Follow the CACI -
B. Non metastatic See CACI worksheet. Bladder Cancer
and treatment completed Worksheet.
less than 5 years ago Local recurrence within the bladder only: Note in Block 60.
Follow CACI – Bladder Cancer Worksheet.

C. Metastatic disease, Information that needs to be submitted to the DEFER

FAA for review:
muscle invasion, Initial Issuance -
 Current status report from oncologist Submit the information
or describing treatment plan and prognosis; to the FAA
 List of medications with attention to any
Recurrent disease chemotherapy agents and dates used; Follow up Issuance -
that has spread  Treatment records including clinic notes Will be per the
outside the bladder or summary letter describing initial airman’s authorization
staging and treatment course; letter
 Operative notes and discharge summary
(if applicable);
 Pathology report(s) (if applicable); and
 MRI/CT or PET scan reports (In some
cases, the actual CDs will be required in
DICOM format for FAA review.)

Notes: If the airman is currently on radiation or chemotherapy, the treatment course must be completed before
medical certification can be considered.

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CACI – Bladder Cancer Worksheet (Updated 04/27/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no
more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable
certification criteria listed below, the AME can issue. Applicants for first- or second-class must
provide this information annually; applicants for third-class must provide the information with
each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION

CRITERIA
The treating physician’s current, detailed Clinical [ ] Yes
Progress Note verifies:

 Condition is stable;
 If recurrence, there has been NO spread outside
the bladder;
 There is no current or historic evidence of any
metastatic disease or muscle invasion;
 Active treatment is completed
(chemotherapy/radiation, etc.) and no new
treatment is recommended at this time; and/or
 If surgery has been performed, the airman is off
pain medication(s), has made a full recovery,
and has been released by the surgeon.
Symptoms [ ] None
Current treatment [ ] None or maintenance intravesical
BCG or mitomycin.
Notes: If it has been 5 or more years since the airman (If these medications are used, the
has had any treatment for this condition, with no airman should not fly until 24 hours
history of metastatic disease and no reoccurrence, post treatment and asymptomatic.)
CACI is not required. Note this in Block 60. (See
disposition table.)

If the airman is currently on chemotherapy or radiation

treatment, defer the exam. (See disposition table.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified bladder cancer. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified bladder cancer.

[ ] NOT CACI qualified bladder cancer. I have deferred. (Submit supporting documents.)

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Prostate Conditions
All Classes
Updated 08/26/2015

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Benign Prostatic If the airman has findings consistent with

Hypertrophy (BPH) or uncomplicated BPH with no evidence of ISSUE
elevated PSA prostate cancer: Summarize this history
in Block 60
Notes: See Pharmaceuticals section for list of medications usually allowed.

Prostate Cancer
All Classes
A. Prostate Cancer If NO recurrence or ongoing
Updated treatment:
8/26/2015
Non metastatic ISSUE
With treatment Summarize this history
completed in Block 60.
5 or more years ago

B. Prostate Cancer See CACI worksheet. Follow the CACI -

Non metastatic with Prostate Cancer
treatment Worksheet
completed less than 5 Note in Block 60.
years ago
C. Prostate Cancer Submit the following for FAA review:
With  Current status report from oncologist DEFER
Metastatic disease describing treatment plan, how long the
Current OR any time condition has been stable, and prognosis; Initial Special
in the past  List of medications and presence or absence Issuance – Requires
of side effects with specific attention to any FAA Decision
OR chemotherapy, steroids, or hormone agents
and dates used;
Recurrence of  Treatment records including clinic notes or a Follow up Special
disease summary letter describing initial staging, Issuance will be per
Including a biochemical disease course, locations of metastatic the airman’s
recurrence (BCR) after disease, and stability; authorization letter
prostatectomy  Operative notes and discharge summary, if
applicable;
 Pathology report(s), if applicable; and
 Results of MRI/CT or PET scan reports. (In
some cases, the actual CDs will be required
in DICOM format for FAA review).
Notes: If the airman is currently on radiation or chemotherapy, the treatment course should be
completed before medical certification can be considered.

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CACI – Prostate Cancer Worksheet (Updated 04/27/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no
more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable
certification criteria listed below, the AME can issue. Applicants for first- or second- class must
provide this information annually; applicants for third-class must provide the information with
each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION

CRITERIA
The treating physician’s current, detailed Clinical [ ] Yes
Progress Note verifies:
 Condition is stable with no spread or
recurrence;
 There is no current or historical evidence
of any metastatic disease;
 Active treatment is completed
(Chemotherapy/radiation, etc.) and no
further treatment is recommended at this
time; and
 If surgery has been performed, the airman
o Is off pain medications;
o Has made a full recovery; and
o Has been released by the surgeon

Current PSA (within the last 6 months) [ ] 20 or less if no prostatectomy

[ ] 0.2 or less after prostatectomy
Symptoms [ ] None
Current treatment [ ] None or
active surveillance/watchful waiting
Notes: If it has been 5 or more years since the or Brachytherapy
airman has had any treatment for this condition,
with no history of metastatic disease and no
reoccurrence, CACI is not required. Note this in
Block 60. (See disposition table.)

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified prostate cancer. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified prostate cancer.

[ ] NOT CACI qualified prostate cancer. I have deferred. (Submit supporting documents.)
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Renal Cancer
All Classes
Updated 09/30/2015

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. If no recurrence or ongoing treatment:
Non metastatic with ISSUE
treatment completed Summarize this
5 or more years ago history in Block 60.
B. See CACI worksheet. Follow the CACI-
Non metastatic with Renal Cancer
treatment completed Worksheet
less than 5 years ago Note in Block 60

C. Submit the following to the FAA for review:

 Current status report from your treating DEFER
Metastatic disease oncologist. It should describe the treatment
Current OR any time in plan, how long the condition has been Submit the
the past stable, prognosis, and if any upcoming information to the
treatment change is planned or expected; FAA for a possible
OR  List of medications and presence or Special Issuance.
absence of side effects with specific
Recurrence of disease mention of chemotherapy and dates used;
 Treatment records including clinic notes or Follow-up Special
a summary letter describing initial staging, Issuance –
disease course, locations of metastatic Will be per the
disease, and stability; airman’s
 Operative notes and discharge, if authorization letter
applicable;
 Pathology report(s), if applicable;
 Results of MRI/CT or PET scan reports (In
some cases, the actual CDs will be required in
DICOM format for FAA review.); and
 Copies of most recent lab results performed
by your treating physician.

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CACI – Renal Cancer Worksheet (Updated 04/13/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no
more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable
certification criteria listed below, the AME can issue. Applicants for first- or second-class must
provide this information annually; applicants for third-class must provide the information with
each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION

CRITERIA
Treating physician finds the condition stable on [ ] Yes
current regimen and no changes recommended.
Any current or historic evidence of: [ ] No
 Chemotherapy
 Disease recurrence;
 Extra capsular extension;
 Metastatic disease;
 Stage 4 disease; or
 Paraneoplastic syndrome
If surgery was performed - the airman is off pain [ ] Yes
medication(s), has made a full recovery, and has been
released by the surgeon.

Symptoms [ ] No
Treatment completed and back to full, unrestricted [ ] Yes
activities (ECOG performance status or equivalent
is 0).
Current treatment: [ ] None

Notes: If it has been 5 or more years since the airman

has had any treatment for this condition, with no
history of metastatic disease and no reoccurrence,
CACI is not required. Note this in Block 60. (See
disposition table.)

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified renal cancer. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified renal cancer.

[ ] NOT CACI qualified renal cancer. I have deferred. (Submit supporting documents.)
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Testicular Cancer
All Classes
Updated 08/26/2015
DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Non metastatic No recurrence or ongoing treatment: ISSUE

and treatment completed Summarize this
5 or more years ago history in Block 60.

Follow the CACI -

B. Non metastatic See CACI worksheet. Testicular Cancer
and treatment completed Worksheet
less than 5 years ago
Note in Block 60.

C. Metastatic disease Submit the following to the FAA for review: DEFER
Current OR any time in
the past  Current status report from oncologist Submit the
describing treatment plan and prognosis; information to the
 List of medications with attention to any FAA for a possible
Recurrence of disease chemotherapy agents and dates used; Special Issuance.
 Treatment records including clinic notes
or summary letter describing disease
course and initial staging;
 Operative notes and discharge summary
(if applicable);
 Pathology report(s) (if applicable);
 MRI/CT or PET scan reports (in some cases,
the actual CDs will be required in DICOM format for
FAA review); and
 Serum tumor markers results (if applicable).

Notes: If the airman is currently on radiation or chemotherapy, the treatment course must be
completed before medical certification can be considered.

Watchful waiting is allowed. See CACI – Testicular Cancer Worksheet.

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CACI – Testicular Cancer Worksheet (Updated 04/27/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no
more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable
certification criteria listed below, the AME can issue. Applicants for first- or second-class must
provide this information annually; applicants for third-class must provide the information with
each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION

CRITERIA
The treating physician’s current, detailed Clinical [ ] Yes
Progress Note verifies:

 Condition is stable with no spread or recurrence;

 There is no current or historic evidence of any
metastatic disease;
 Active treatment is completed
(chemotherapy/radiation, etc.) and no new
treatment is recommended at this time; and
 If surgery has been performed, the airman is off
pain medication(s), has made a full recovery,
and has been released by the surgeon.

Symptoms [ ] None
Current treatment [ ] None, surveillance or watchful
waiting

Notes: If it has been 5 or more years since the airman

has had any treatment for this condition, with no
history of metastatic disease and no reoccurrence,
CACI is not required. Note this in Block 60. (See
disposition table.)

If the airman is currently on chemo or radiation

treatment, defer the exam. (See disposition table.)

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified testicular cancer. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified testicular cancer.

[ ] NOT CACI qualified testicular cancer. I have deferred. (Submit supporting documents.)

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Other G-U Cancers/Neoplastic Disorders

All Classes
Updated 09/30/2015

DISEASE/CONDITION EVALUATION DATA DISPOSITION

Other G-U Cancers Interview airman Currently cancer-free and released from
when treatment was oncology care – Issue and warn for
completed more than recurrence
5 years ago and there is Summarize in Block 60
no history of metastatic
All others – see below
disease. (If less than 5
years, see below.)

Other G-U cancers Submit a current Requires FAA decision

when treatment was status report, all
completed less than 5 pertinent medical
years ago or for which reports to include
there is a history of staging, metastatic
metastatic disease work up, and
operative report if
applicable.

Nephritis
All Classes

DISEASE/CONDITION EVALUATION DATA DISPOSITION

Pyelitis or Submit all pertinent If asymptomatic
Pyelonephritis medical information - Issue
and status report Otherwise - Requires FAA Decision
Pyonephrosis Submit all pertinent Requires FAA Decision
medical information
and status report

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Polycystic Kidney Disease

All Classes
Updated 07/29/2020

DISEASE/CONDI EVALUATION DATA DISPOSITION

TION
A. Autosomal Submit the following to the FAA for review:
Dominant  Nephrologist current evaluation detailing: DEFER
(AD-PKD) o History, diagnosis, physical exam; Submit the information to
o Current status; the FAA for a possible
o Treatment plan and prognosis; and Special Issuance.
o If airman has hypertension, the
physician should comment if it is Follow up Issuance
controlled. Will be per the airman’s
 Medication list and side effects, if any; authorization letter.
 Lab (recent) to include at a minimum:
Serum creatinine;
o eGFR; and
o Spot urine protein/creatinine ratio
 Imaging to include:
o Brain MRA (preferred) or CTA (if
MRI contraindications) for aneurysm;
and
o Current transthoracic
echocardiogram.
B. Autosomal Submit the following to the FAA for review:
recessive  Nephrologist current evaluation detailing DEFER
(AR-PKD) o History, diagnosis, physical exam; Submit the information to
o Current status; the FAA for a possible
o Treatment plan and prognosis; and Special Issuance.
o If airman has hypertension, the
physician should comment if it is Follow up Issuance Will
controlled. be per the airman’s
 Medication list and side effects if any; authorization letter.
 Lab (recent) to include at a minimum:
o Serum creatinine;
o eGFR; and
o spot urine protein/creatinine ratio
 Gastroenterologist current evaluation
detailing:
o History, diagnosis, physical exam;
o Current status;
o Treatment plan and prognosis;
o Abdominal ultrasound; and
o Liver function testing plus any
additional testing deemed clinically
indicated.

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Urinary Systems
All Classes
Updated 09/30/2015

DISEASE/CONDITION EVALUATION DATA DISPOSITION

Hydronephrosis with Submit all pertinent medical Requires FAA Decision
impaired renal function information and status report

Nephrectomy Submit all pertinent medical If the remaining kidney function and
(non-neoplastic) information and status report anatomy is normal, without other
system disease, hypertension,
uremia, or infection of the remaining
kidney – Issue
Otherwise – Requires FAA Decision

Hematuria Submit all pertinent medical If no underlying condition found after

information and status report. urology evaluation – Issue and
submit evaluation to the FAA

If underlying cause found, see that

section.

Proteinuria and Submit all pertinent medical Trace or 1+ protein

Glycosuria records; current status to and glucose intolerance ruled out
include names and dosage of - Issue
medication(s) and side effects
Otherwise – Requires FAA Decision

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ITEMS 42-43. Musculoskeletal

CHECK EACH ITEM IN APPROPRIATE COLUMN NORMAL ABNORMAL

42. Upper and lower extremities (Strength and range of motion)

43. Spine, other musculoskeletal

I. Code of Federal Regulations

All Classes: 14 CFR 67.113 (b)(c), 67.213 (b)(c), and 67.313 (b)(c)

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical
judgment relating to the condition involved finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.

(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or
other treatment involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.

II. Examination Techniques

Standard examination procedures should be used to make a gross evaluation of the integrity of
the applicant's musculoskeletal system. The AME should note:

1. Pain - neuralgia, myalgia, paresthesia, and related circulatory and neurological findings

2. Weakness - local or generalized; degree and amount of functional loss

3. Paralysis - atrophy, contractures, and related dysfunctions

4. Motion coordination, tremors, loss or restriction of joint motions, and performance

degradation
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5. Deformity - extent and cause

6. Amputation - level, stump healing, and phantom pain

7. Prostheses - comfort and ability to use effectively

III. Aerospace Medical Disposition

The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the AME as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.

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ITEM 42. Upper and Lower Extremities

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Upper and Lower Extremities

Amputations All Submit a current If applicant has a

status report to SODA issued on the
include functional basis of the amputation
status (degree of - Issue
impairment as
measured by
strength, range of Otherwise - Requires
motion, pain), FAA Decision
medications with side After review of all
effects and all medical data, the
pertinent medical FAA may authorize a
reports special medical
flight test
Atrophy of any muscles All Submit a current Requires FAA Decision
that is progressive, status report to
Deformities, either include functional
congenital or acquired, status (degree of
or impairment as
Limitation of motion of a measured by
major joint, that are strength, range of
sufficient to interfere motion, pain),
with the performance medication with side
of airman duties effects, and all
pertinent medical
reports

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Upper and Lower Extremities

Neuralgia or Neuropathy, All Submit a current status Requires FAA Decision

chronic or acute, report to include functional
particularly sciatica, if status (degree of
sufficient to interfere impairment as measured
with function or is likely by strength, range of
to become motion, pain), medications
incapacitating with side effects and all
pertinent medical reports
Osteomyelitis, acute or All Submit a current status Requires FAA Decision
chronic, with or without report to include functional
draining fistula(e) status (degree of
impairment as measured
by strength, range of
motion, pain), medications
with side effects and all
pertinent medical reports
Tremors, if sufficient to All Submit a current status Requires FAA Decision
interfere with the report to include functional
performance of airman status (degree of
duties1 impairment as measured
by strength, range of
motion, pain), medications
with side effects and all
pertinent medical reports

For all the above conditions: If the applicant is otherwise qualified, the FAA may issue a limited
certificate. This certificate will permit the applicant to proceed with flight training until ready for a MFT. At
that time, at the applicant's request, the FAA (usually the AMCD) will authorize the student pilot to take a
MFT in conjunction with the regular flight test. The MFT and regular private pilot flight test are conducted
by an FAA inspector. This affords the student an opportunity to demonstrate the ability to control the
aircraft despite the handicap. The FAA inspector prepares a written report and indicates whether there is
a safety problem. If the airman successfully completes the MFT, a medical certificate and SODA will be
sent to the airman from AMCD.

When prostheses are used or additional control devices are installed in an aircraft to assist the amputee,
those found qualified by special certification procedures will have their certificates limited to require that
the devices (and, if necessary, even the specific aircraft) must always be used when exercising the
privileges of the airman certificate.

1
Essential tremor is not disqualifying unless it is disabling.
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Item 43. Spine, Other Musculoskeletal

Arthritis
All Classes
(Updated 07/28/2021)

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Osteoarthritis  Well controlled, no persistent daily
symptoms; ISSUE
 No functional limitations; and Summarize this
 Treatment is PRN NSAIDS or anti- History, annotate
inflammatory medication only. Block 60.

B. Osteoarthritis on Follow the CACI -

additional medication See CACI worksheet Arthritis Worksheet

Or Annotate Block 60.

Autoimmune arthritis

C. All others Submit the following to the FAA for review:

 Complications*; DEFER
 Symptomatic; or  Current status report from the treating Submit the
 Underlying cause physician with diagnosis, treatment plan information to the
with complications and prognosis, and adherence to treatment FAA for a possible
or systemic disease, for this condition. It should note if there are Special Issuance.
etc. any functional limitations.
 List of medications and side effects if any; Follow up Issuance
 Operative notes (if applicable); and Will be per the
 Copies of imaging reports and lab (if airman’s
already performed by treating physician). authorization letter.
*Complications include:
 Joint deformity or decreased range of motion or strength that would impair flight duties
 Systemic disease

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CACI - Arthritis Worksheet (Updated 04/13/2022)
To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more
than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification
criteria listed below, the AME can issue. Applicants for first- or second- class must provide this
information annually; applicants for third-class must provide the information with each required
exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA

Treating physician finds the [ ] Yes
condition stable on current
regimen and no changes
recommended
Symptoms [ ] None or mild to moderate symptoms with no significant
limitations to range of motion, lifestyle, or activities
Cause of Arthritis Acceptable causes are limited to:
[ ] Osteoarthritis*
and/or
*OA - see Arthritis Disposition Table [ ] Autoimmune to include only the following: Rheumatoid (limited
CACI may not be required. to joint), Psoriatic, or Ankylosing Spondylitis
Lab [ ] NSAIDS or steroid only - no lab required
Or
[ ] Normal CBC, Liver Function Test, and Creatinine within the
past 90 days
Acceptable Medications [ ] One or more of the following:
 Oral steroid which does not exceed equivalent of prednisone
20 mg/day (see steroid conversion calculator)
 NSAIDS
 Methotrexate
 Hydroxychloroquine/ Chloroquine (Plaquenil/Aralen) see mandatory
status report requirement below**
 Only ONE of the following - with required no-fly time after each use:
o Adalimumab (Humira): 4-hour no-fly
o Apremilast (Otezla): n/a
o Etanercept (Enbrel): 4-hour no-fly
o Infliximab (Remicade): 24-hour no-fly
o rituximab (Rituxan): 72-hour no-fly
o secukinumab (Cosentyx): 4-hour no-fly
** STATUS REPORT is required if [ ] Hydroxychloroquine (HCQ)/ Chloroquine (CQ) Status Report
Hydroxychloroquine (HCQ)/ (Plaquenil/Aralen) is favorable and no concerns
Chloroquine (CQ) (Plaquenil/Aralen) is OR
used. [ ] N/A (NOT taking hydroxychloroquine/chloroquine
[Plaquenil/Aralen]

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified arthritis. (Documents do not need to be submitted to the FAA.)
[ ] Has current OR previous SI/AASI but now CACI qualified arthritis.
[ ] NOT CACI qualified arthritis. I have deferred. (Submit supporting documents.)

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Gout and Pseudogout

All Classes
Updated 04/29/2015

DISEASE/CONDITION EVALUATION DATA DISPOSITION

Gout Interview and examination reveal: ISSUE
Pseudogout Note findings in
 No persistent symptoms or functional Block 60.
Well controlled impairment.

 Med combinations of NSAIDS, uric

acid reducers (allopurinol, etc.), or uric
acid excreters (probenecid) with no
aeromedically significant side effects.

Gout Submit a current status report that DEFER

Pseudogout addresses: Submit records to
the FAA for
Functional impairment  Clinical course with severity and decision
Joint deformity frequency of exacerbations to include
Kidney stones, recurrent interval between and date of most
Meds other than above recent flare; extent of renal Follow up—per
Not controlled involvement; current treatment, side SI/AASI
Persistent symptoms effects, and prognosis; and

 Describe extent of joint deformity or

functional impairment and if it would
impair operation of aircraft controls.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Collagen Disease

Acute Polymyositis; ALL Submit a current Requires FAA Decision

Dermatomyositis; status report to
Lupus Erythematosus; or include functional
Periarteritis Nodosa status, frequency and
severity of episodes,
organ systems
effected, medications
with side effects and
all pertinent medical
reports

Spine, other musculoskeletal

Active disease of bones Submit a current Requires FAA Decision

and joints status report to
include functional
status (degree of
impairment as
measured by
strength, range of
motion, pain),
medications with side
effects and all
pertinent medical
reports
Ankylosis, curvature, or Submit a current Requires FAA Decision
other marked status report to
deformity of the spinal include functional
column sufficient to status (degree of
interfere with the impairment as
performance of airman measured by
duties strength, range of
motion, pain),
medications with side
effects and all
pertinent medical
reports

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Spine, other musculoskeletal

Intervertebral Disc All See Footnote See Footnote

Surgery
Musculoskeletal effects All Submit a current Requires FAA Decision
of: status report to
Cerebral Palsy, include functional
Muscular Dystrophy status (degree of
Myasthenia Gravis, or impairment as
Myopathies measured by
strength, range of
motion, pain),
medications with side
effects and all
pertinent medical
reports
Other disturbances of All Submit a current Requires FAA Decision
musculoskeletal status report to
function, acquired or include functional
congenital, sufficient to status (degree of
interfere with the impairment as
performance of airman measured by
duties or likely to strength, range of
progress to that motion, pain),
degree medications with side
effects and all
pertinent medical
reports

A history of intervertebral disc surgery is not disqualifying. If the applicant is asymptomatic, has
completely recovered from surgery, is taking no medication, and has suffered no neurological
deficit, the AME should confirm these facts in a brief statement in Item 60. The AME may then
issue any class of medical certificate, providing that the individual meets all the medical
standards for that class.

The paraplegic whose paralysis is not the result of a progressive disease process is considered
in much the same manner as an amputee. The AME should defer issuance and may advise the
applicant to request a Medical Flight Test.

Other neuromuscular conditions are covered in more detail in Item 46.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Spine, other musculoskeletal

Symptomatic herniation All Submit a current Requires FAA Decision

of intervertebral disc status report to
include functional
status (degree of
impairment as
measured by
strength, range of
motion, pain),
medications with side
effects and all
pertinent medical
reports

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ITEM 44. Identifying Body Marks, Scars, Tattoos

CHECK EACH ITEM IN APPROPRIATE COLUMN NORMAL ABNORMAL

44. Identifying body marks, scars, tattoos (Size and location)

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b), 67.213(b), and 67.313(b)

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical
judgment relating to the condition finds-

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges

II. Examination Techniques

A careful examination for surgical and other scars should be made, and those that are significant
(the result of surgery or that could be useful as identifying marks) should be described. Tattoos
should be recorded because they may be useful for identification.

III. Aerospace Medical Disposition

The AME should question the applicant about any surgical scars that have not been previously
addressed, and document the findings in Item 60 of FAA Form 8500-8. Medical certificates must
not be issued to applicants with medical conditions that require deferral without consulting the
AMCD or RFS. Medical documentation must be submitted for any condition in order to support
an issuance of a medical certificate.

Disqualifying Condition: Scar tissue that involves the loss of function, which may interfere with
the safe performance of airman duties.

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ITEM 45. Lymphatics

CHECK EACH ITEM IN APPROPRIATE COLUMN NORMAL ABNORMAL

45. Lymphatics

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical
judgment relating to the condition involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.

(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or
other treatment involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.

II. Examination Techniques

A careful examination of the Iymphatic system may reveal underlying systemic disorders of
clinical importance. Further history should be obtained as needed to explain findings.

III. Aerospace Medical Disposition

The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the AME as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Lymphoma and Hodgkin's Disease

Lymphoma and All Submit a current Initial Special

Hodgkin's Disease status report and all Issuance - Requires
pertinent medical FAA Decision
reports. Include past
and present Follow-up
treatment(s). Special Issuances -
See AASI Protocol

Leukemia, Acute and Chronic

Leukemia, Acute and All Submit a current Requires FAA Decision

Chronic – All Types status report and all
pertinent medical
reports
Chronic Lymphocytic All Submit a current Initial Special
Leukemia status report and all Issuance - Requires
pertinent medical FAA Decision
reports
Follow-up
Special Issuances -
See AASI Protocol

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Lymphatics

Adenopathy secondary All Submit a current Requires FAA Decision

to Systemic Disease status report and all
or Metastasis pertinent medical
reports
Lymphedema All Submit a current Requires FAA Decision
status report and all
pertinent medical
reports. Note if there
are any motion
restrictions of the
involved extremity
Lymphosarcoma All Submit a current Requires FAA Decision
status report and all
pertinent medical
reports. Include past
and present
treatment(s).

ITEM 46. Neurologic

CHECK EACH ITEM IN APPROPRIATE COLUMN NORMAL ABNORMAL

46. NEUROLOGIC

I. Code of Federal Regulations

All Classes: 14 CFR 67.109 (a)(b), 67.209 (a)(b), and 67.309 (a)(b)

(a) No established medical history or clinical diagnosis of any of the following:

(1) Epilepsy

(2) A disturbance of consciousness without satisfactory medical explanation

of the cause; or

(3) A transient loss of control of nervous system function(s) without

satisfactory medical explanation of the cause;

(b) No other seizure disorder, disturbance of consciousness, or neurologic condition

that the Federal Air Surgeon, based on the case history and appropriate, qualified
medical judgment relating to the condition involved, finds-

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
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(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.

II. Examination Techniques

A neurologic evaluation should consist of a thorough review of the applicant's history prior to the
neurological examination. The AME should specifically inquire concerning a history of weakness
or paralysis, disturbance of sensation, loss of coordination, or loss of bowel or bladder control.
Certain laboratory studies, such as scans and imaging procedures of the head or spine,
electroencephalograms, or spinal paracentesis may suggest significant medical history. The
AME should note conditions identified in Item 60 on the application with facts, such as dates,
frequency, and severity of occurrence.

A history of simple headaches without sequela is not disqualifying. Some require only temporary
disqualification during periods when the headaches are likely to occur or require treatment.
Other types of headaches may preclude certification by the AME and require special evaluation
and consideration (e.g., migraine and cluster headaches).

One or two episodes of dizziness or even fainting may not be disqualifying. For example,
dizziness upon suddenly arising when ill is not a true dysfunction. Likewise, the orthostatic faint
associated with moderate anemia is no threat to aviation safety as long as the individual is
temporarily disqualified until the anemia is corrected.

An unexplained disturbance of consciousness is disqualifying under the medical standards.

Because a disturbance of consciousness may be expected to be totally incapacitating,
individuals with such histories pose a high risk to safety and must be denied or deferred by the
AME. If the cause of the disturbance is explained and a loss of consciousness is not likely to
recur, then medical certification may be possible.

The basic neurological examination consists of an examination of the 12 cranial nerves, motor
strength, superficial reflexes, deep tendon reflexes, sensation, coordination, mental status, and
includes the Babinski reflex and Romberg sign. The AME should be aware of any asymmetry in
responses because this may be evidence of mild or early abnormalities. The AME should
evaluate the visual field by direct confrontation or, preferably, by one of the perimetry
procedures, especially if there is a suggestion of neurological deficiency.

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III. Aerospace Medical Disposition

A history or the presence of any neurological condition or disease that potentially may
incapacitate an individual should be regarded as initially disqualifying. Issuance of a medical
certificate to an applicant in such cases should be denied or defer, pending further evaluation. A
convalescence period following illness or injury may be advisable to permit adequate
stabilization of an individual's condition and to reduce the risk of an adverse event. Applications
from individuals with potentially disqualifying conditions should be forwarded to the AMCD.
Processing such applications can be expedited by including hospital records, consultation
reports, and appropriate laboratory and imaging studies, if available. Symptoms or disturbances
that are secondary to the underlying condition and that may be acutely incapacitating include
pain, weakness, vertigo or in coordination, seizures or a disturbance of consciousness, visual
disturbance, or mental confusion. Chronic conditions may be incompatible with safety in aircraft
operation because of long-term unpredictability, severe neurologic deficit, or psychological
impairment. See FAA Neurologic Specification Sheet.

The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the AME as defined by the protocol and disposition in
the table. Medical certificates must not be issued to an applicant with medical conditions that
require deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Cerebrovascular Disease (including the brain stem) 1

Transient Ischemic Attack All  All pertinent inpatient and Requires FAA Decision
(TIA): outpatient medical
records, including work up
for any correctable
underlying cause(s)
 Current neurologic
evaluation by a
neurologist with a detailed
written report addressing
motor, sensory, language,
and intellectual/cognitive
function; all medications
(dosage and side effects)
 MRA or CTA of the head
and neck
 Current FBS and lipids
 Carotid artery ultrasound
studies
 Cardiovascular Evaluation
(CVE) with EST, a 24-
hour Holter monitor and
M-mode / 2-D
echocardiogram (usually
TTE but TEE optional if
clinically indicated)
 Neurocognitive testing:
may be required as
clinically indicated

1
Complete neurological evaluations supplemented with appropriate laboratory and imaging studies are required of
applicants with these conditions.
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Completed Stroke (ischemic All  All pertinent inpatient and Requires FAA decision
or hemorrhagic); outpatient medical
records, including work up
for any correctable
underlying cause(s)
 Current neurologic
evaluation by a
neurologist with a detailed
written report addressing
motor, sensory, language,
and intellectual/ cognitive
function; all medications
(dosage and side effects)
 MRA or CTA of the head
and neck
 Current FBS and lipids
 Carotid artery ultrasound
studies: required for
ischemic strokes;
otherwise only if clinically
indicated
 Cardiovascular Evaluation
(CVE) with EST, a 24-
hour Holter monitor and
M-mode / 2-D
echocardiogram (usually
TTE but TEE optional if
clinically indicated)
NOTE: required for
ischemic stroke; for
hemorrhagic stroke is
required if clinically
indicated (for
example in a
hemorrhagic stroke
due to hypertension,
even if felt to be
transient
hypertension)

 Neurocognitive testing to
"SPECIFICATIONS FOR
NEUROPSYCHO-
LOGICAL EVALUATIONS
FOR POTENTIAL
NEUROCOGNITIVE
IMPAIRMENT" required
for all strokes
**** For hemorrhagic
strokes, the bleeding must
be resolved as

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documented by CT or
MRI
Subdural, Epidural or All  All pertinent inpatient and Requires FAA Decison
Subarachnoid Hemorrhage outpatient medical
records, including work up
for any correctable
underlying cause(s)
 Current neurologic
evaluation by a
neurologist with a detailed
written report addressing
motor, sensory, language,
and intellectual/ cognitive
function; all medications
(dosage and side effects)
 CT or MRI of the head
 Additional testing such
as EEG,
neurocognitive testing,
etc., may be required
as clinically indicated

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Cerebrovascular Disease (Updated 02/23/2022)

Intracranial Aneurysm All Submit all pertinent Requires FAA Decision

or Arteriovenous medical records, current
Malformation neurologic report, name
and dosage of
medication(s) and side
effects
Intracranial Tumor2 All Submit all pertinent Requires FAA Decision
medical records, current
neurologic report, name
and dosage of
medication(s) and side
effects
Pseudotumor Cerebri All Submit all pertinent Requires FAA Decision
(benign intracranial medical records, current
hypertension) neurologic report, name
and dosage of
medication(s) and side
effects

2
A variety of intracranial tumors, both malignant and benign, are capable of causing incapacitation directly by
neurologic deficit or indirectly through recurrent symptomatology. Potential neurologic deficits include weakness,
loss of sensation, ataxia, visual deficit, or mental impairment. Recurrent symptomatology may interfere with flight
performance through mechanisms such as seizure, headaches, vertigo, visual disturbances, or confusion. A history
or diagnosis of an intracranial tumor necessitates a complete neurological evaluation with appropriate laboratory
and imaging studies before a determination of eligibility for medical certification can be established.
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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Demyelinating Disease3

Acute Optic Neuritis; All Submit all pertinent Requires FAA Decision
medical records,
Allergic current neurologic
Encephalomyelitis; report, to comment
Landry-Guillain-Barre on involvement and
Syndrome; persisting deficit,
Myasthenia Gravis; or period of stability
Multiple Sclerosis without symptoms,
name and dosage of
medication(s) and
side effects

3
Factors used in determining eligibility will include the medical history, neurological involvement and persisting
deficit, period of stability without symptoms, type and dosage of medications used, and general health. A
neurological and/or general medical consultation will be necessary in most instances.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Extrapyramidal, Hereditary, and Degenerative Diseases of the

Nervous System4

Dystonia – primary or All Obtain medical Requires FAA Decision

secondary; records and current
Huntington's Disease; neurological status,
Parkinson's Disease; complete
Wilson's Disease; or neurological
Gilles de la Tourette evaluation with
Syndrome; appropriate
Alzheimer's Disease; laboratory and
Dementia (unspecified); imaging studies, as
indicated
or
Slow viral diseases May consider Neuro-
i.e., Creutzfeldt psychological testing
-Jakob's Disease

4
Extrapyramidal, Hereditary, and Degenerative Diseases of the Nervous System: Considerable variability exists in
the severity of involvement, rate of progression, and treatment of the above conditions. A complete neurological
evaluation with appropriate laboratory and imaging studies, including information regarding the specific neurological
condition, will be necessary for determination of eligibility for medical certification.
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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Headaches5
Atypical Facial Pain All Submit all pertinent Requires FAA Decision
medical records,
current neurologic
report, to include name
and dosage of
medication(s) and side
effects
Ocular or complicated All Submit all pertinent Requires FAA Decision
migraine medical records,
current neurologic
report, to include
characteristics,
frequency, severity,
associated with
neurologic phenomena,
name and dosage of
medication(s) and side
effects
Migraines, Chronic Tension All Review all pertinent Follow CACI - Migraine
or Cluster Headaches medical records, and Chronic Headache
current neurologic Worksheet. If airman
report, to include meets all certification
characteristics, criteria – Issue.
frequency, severity,
associated with All others require FAA
neurologic phenomena, decision. Submit all
and name and dosage evaluation data.
of medication(s) and
side effects Initial Special Issuance
- Requires FAA Decision

Follow-up Special
Issuances - See AASI
Protocol
Post-traumatic Headache All Submit all pertinent Requires FAA Decision
medical records,
current neurologic
report, name and
dosage of
medication(s) and side
effects

5
Pain, in some conditions, may be acutely incapacitating. Chronic recurring headaches or pain syndromes often
require medication for relief or prophylaxis, and, in most instances, the use of such medications are disqualifying
because they may interfere with a pilot's alertness and functioning. The Examiner may issue a medical certificate to
an applicant with a long-standing history of headaches if mild, seldom requiring more than simple analgesics, occur
infrequently, are not incapacitating, and are not associated with neurological stigmata.

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CACI - Migraine and Chronic Headache Worksheet (Updated 04/13/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no
more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable
certification criteria listed below, the AME can issue. Applicants for first- or second- class must
provide this information annually; applicants for third-class must provide the information with
each required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA

Treating physician finds the [ ] Yes
condition stable on current
regimen and no changes
recommended
Acceptable Types of Migraine or [ ] Classic/Common Migraine, Chronic Tension headache, Cluster
Headache headache

NOT acceptable: Ocular migraine, complicated migraine

Frequency [ ] No more than one episode per month
Symptoms [ ] Only mild symptoms controlled with medication(s) listed below.

[ ] In the last year:

o no in-patient hospitalizations
o no more than 2 outpatient clinic/urgent care visits for
exacerbations (with symptoms fully resolved)

NOT acceptable: neurological or TIA-type symptoms; vertigo;

syncope; and/or mental status change
Medications - Preventive [ ] None; or daily calcium channel blockers or beta blockers only
for prophylaxis without side effects
Medications - Abortive [ ] OTC headache medications; warn airman:
24 hour no-fly - Triptans
36 hour no-fly - Metoclopramide (Reglan);
96 hour no-fly - promethazine (Phenergan)

NOT acceptable: Injectable medications and narcotics

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified migraine and chronic headaches. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified migraine and chronic headaches.

[ ] NOT CACI qualified migraine and chronic headaches. I have deferred. (Submit supporting documents.)

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Hydrocephalus and Shunts

Hydrocephalus, All Submit all pertinent Requires FAA Decision

secondary to a known medical records,
injury or disease current neurologic
process; or normal report, to include
pressure name and dosage of
medication(s) and
side effects

Infections of the Nervous System

Brain Abscess; All Complete Requires FAA Decision

Encephalitis; neurological
evaluation with
Meningitis; and appropriate
Neurosyphilis laboratory and
imaging studies

Neurologic Conditions

A disturbance of All Submit all pertinent Requires FAA Decision

consciousness without medical records,
satisfactory medical current neurologic
explanation of the cause report, to include
name and dosage of
medication(s) and
side effects
Epilepsy6 All Submit all pertinent Requires FAA Decision
medical records,
current status report,
Rolandic Seizure to include name and
*See below dosage of
medication(s) and
side effects

6
Unexplained syncope, single seizure. An applicant who has a history of epilepsy, a disturbance of consciousness
without satisfactory medical explanation of the cause, or a transient loss of control of nervous system function(s)
without satisfactory medical explanation of the cause must be denied or deferred by the AME. Rolandic seizures
may be eligible for certification if the applicant is seizure free for 4 years and has a normal EEG. Consultation with
the FAA required.

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Febrile Seizure7 All Submit all pertinent If occurred prior to age
(Single episode) medical records and 5, without recurrence
a current status and off medications for
report 3 years - Issue

Otherwise – Requires
FAA Decision
Transient loss of nervous All Submit all pertinent Requires FAA Decision
system function(s) medical records,
without satisfactory current status report,
medical explanation of to include name and
the cause; e.g., transient dosage of
global amnesia medication(s) and
side effects

7
Infrequently, the FAA has granted an Authorization under the special issuance section of part 67 (14 CFR 67.401)
when a seizure disorder was present in childhood but the individual has been seizure-free for a number of years.
Factors that would be considered in determining eligibility in such cases would be age at onset, nature and
frequency of seizures, precipitating causes, and duration of stability without medication. Follow-up evaluations are
usually necessary to confirm continued stability of an individual's condition if an Authorization is granted under the
special issuance section of part 67 (14 CFR 67.401).

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FAA Airman Seizure Questionnaire (Updated 06/29/2016)
The following questions should be answered by the AIRMAN who should read through the entire
questionnaire and complete all sections as appropriate. If the seizures occurred when the
airman was a child, a parent or guardian familiar with the episodes should complete this form.

Section 1 - Big Seizures

Have you ever had a grand mal seizure or a big seizure where you lost consciousness or Yes No
your whole body shook and stiffened? Go to A Go to Section
2
(next page)
A. How many have you had? Enter a number
B. When was the first one? Enter approximate date, how long ago, or your age at the time
C. When was the last one/most recent Enter the approximate date
D. Do you ever have a warning before your big seizure(s)? Yes No Don’t know
Go to E
D1. Did you ever have this warning and not have a seizure? Yes No Don’t know
D2. When was the last warning? Enter actual date OR how long ago (in months) Date:
Or months ago:
D3. Did this warning consist of Unusual feeling in stomach or chest Yes No Don’t know
any of the following? Unusual smells or tastes? Yes No Don’t know
Hearing unusual sounds or hearing difficulty? Yes No Don’t know
See anything unusual, or have any change in your Yes No Don’t know
vision?
Behave in unusual ways such as smacking your lips, Yes No Don’t know
touching your clothes, or doing any other unusual things
without intending to?
Have difficulty speaking or understand speech? Yes No Don’t know
E. Of the grand mal or big seizures that you had while awake, did they usually occur shortly after Yes No Don’t know
waking up? (Either in the morning or after a nap.) Go to F
E1. How many minutes after waking up would you say the grand mal [ ]15 min or less
or big seizure(s) usually occurred? Check one [ ]16-30 min
[ ]31-45 min
[ ]46-60 min
[ ]More than 60 min

F. Before the seizure started did you have jerking, shaking, or uncontrolled body Yes No Don’t
movements or did your whole body jump suddenly, as if someone had startled you Go to know
from behind? Section
2
(next
page)
F1. Which side was affected? Check one [ ] Left side only
[ ] Right side only
[ ] Both sides
[ ] One side; unsure of which
[ ] Don’t know

Airman Name ___________________________________________ MID#, PI#, or App D#______________________

(Printed)

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Section 2 - Small Seizures
Yes No
Have you ever had any small spells (other than grand mal or big seizures)? Go to A Go to Section 3
(next page)

A. When was the last time you had one of these spells? Write in the approximate date OR age Date: Or age:
at which it occurred.

B. How long would you say the spell lasted? Check one
[ ] 15 seconds or less [ ] 1-2 min
[ ] 16-30 seconds [ ] More than
[ ] 31 -59 seconds 2 minutes
C. During this most recent spell, which of the following best describes your awareness [ ] Fully aware [ ] Fully unaware
[ ] Somewhat aware,
of the surroundings? Check one
but less aware than usual
D. During this spell, were you able to FUNCTION as you normally do? Yes No Don’t know

E. During this spell, were you able to COMMUNICATE as you normally do? Yes No Don’t know

F. After the spell was over, did you remember what happened during the spell or did [ ] Yes, I [ ] No, someone else had
remembered to tell me
you learn about it from someone else?

G. During this spell, did any parts of your body move uncontrollably? Yes No Don’t know
Go to H
G1. Which parts of the body were involved? [ ] Arm [ ] Face [ ] Don’t
know
[ ] Leg [ ] Other
G2. Was this only on one side? Yes No Don’t know

H. During this spell, did any parts of your body JERK suddenly and unexpectedly? Yes No Don’t know
Go to I
H1. Which parts of the body were involved? [ ] Arm [ ] Face [ ] Total body
[ ] Leg [ ] Other [ ] Don’t know
H2. Was this on only ONE SIDE? Yes No Don’t know

H3. Which side? [ ] Left [ ] One side; unsure which

[ ] Right [ ] Unsure
H4. Have you ever had a similar spell with jerking on the opposite side? Yes No Don’t know

H5. Would you say the jerking felt like an electric shock going through your body? Yes No Don’t know

H6. Has this type of spell usually occurred shortly after waking up (either in the Yes No Don’t know
morning or after a nap)?
H7. Does this type of spell occur only when you are going to sleep? Yes No Don’t know

H8. Did this type of spell ever occur as a result of lights shining in your eyes (for Yes No Don’t know
example strobe lights, video games, reflections or sun glare?)

I. During this spell, did you behave in unusual ways such as smacking your lips, Yes No Don’t know
touching your clothes, or doing any other unusual things without intending to?
J. Did your eyelids flutter during this spell? Yes No Don’t know

K. Do you tend to be clumsy in the morning such as dropping things or spilling coffee or Yes No Don’t know
other drinks?
L. During your spells, did you ever have any other symptoms? Yes (explain No Don’t know
in Section 5)

Airman Name ____________________________________________ MID#, PI#, or App ID#

(Printed)

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Section 3 - Other

Do you ever have unexplained episodes of:

A. Unusual feelings in your stomach or chest? Yes No Don’t know

B. Unusual smells or tastes? Yes No Don’t know

C. Hearing unusual sounds or hearing difficulty? Yes No Don’t know

D. Seeing anything unusual or have any changes in your vision Yes No Don’t know

E. Behaving in unusual ways such as smacking your lips, touching your clothes, or Yes No Don’t know
doing any other unusual things without intending to?
F. Having periods of lost time due to “spacing out” or daydreaming? Yes No Don’t know

G. Awaking in the morning with a bitten tongue or a bloody pillow? Yes No Don’t know

H. Awaking in the morning with unexplained bed wetting? Yes No Don’t know

I. Other (or comments) Yes No Don’t know

(explain in
Section 5)
Section 4 - Medication History
A. I am currently taking medication to prevent or control my seizures Yes No Don’t know
Go to B
A1. I am currently taking medication to prevent or control my seizures Name of med:
Dosage:
Date started: Or age:
B. I took medication in the past. Yes No Don’t know
Go to
Section 5
B1. Previous medication information: Name of med:
If you do not know the date or calendar year, enter your age when medication was stopped. Dosage:
Date started: Or age:
Section 5 - Comments
Please enter additional explanation or comments for ANY part of this questionnaire:

If anyone other than the airman completed this form, list name and relationship to the airman:

Signature __________________________________ Date completed ______________________________

Airman Name MID#, PI#, or App ID#_________________________

(Printed)

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Other Conditions

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Neurofibromatosis with All Submit all pertinent Requires FAA Decision

Central Nervous medical information
System Involvement and current status
medical report
Trigeminal Neuralgia All Submit all pertinent Requires FAA Decision
medical records,
current neurologic
report, name and
dosage of
medication(s) and
side effects

Presence of any neurological condition or disease

that potentially may incapacitate an individual

Head Trauma associated All Submit all pertinent Requires FAA Decision
with: medical records,
current status report,
Epidural or Subdural to include pre-
Hematoma; hospital and
emergency
Focal Neurologic Deficit; department records,
operative reports,
Depressed Skull neurosurgical
Fracture; evaluation, name and
dosage of
or medication(s) and
side effects
Any loss of
consciousness, alteration
of consciousness, or
amnesia, regardless of
duration

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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Spasticity, Weakness, or Paralysis of the Extremities

Conditions that are All Submit all pertinent Requires FAA Decision
stable and non- medical records,
progressive may current neurologic
be considered for report, to include
medical certification etiology, degree of
involvement, period
of stability,
appropriate
laboratory and
imaging studies

Vertigo or Disequilibrium8

Alternobaric Vertigo; All Submit all pertinent Requires FAA Decision

medical records,
Hyperventilation current neurologic
Syndrome; report, name and
dosage of
Meniere's Disease and medication(s) and
Acute Peripheral side effects
Vestibulopathy;

Nonfunctioning
Labyrinths; or

Orthostatic
Hypotension

8
Numerous conditions may affect equilibrium, resulting in acute incapacitation or varying degrees of chronic
recurring spatial disorientation. Prophylactic use of medications also may cause recurring spatial disorientation and
affect pilot performance. In most instances, further neurological evaluation will be required to determine eligibility
for medical certification.

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ITEM 47. Psychiatric
(Updated 10/14/2021)

CHECK EACH ITEM IN APPROPRIATE COLUMN NORMAL ABNORMAL

47. Psychiatric (Appearance, behavior, mood, communication, and memory)

I. Code of Federal Regulations

All Classes: 14 CFR 67.107(a)(b)(c), 67.207(a)(b)(c), and 67.307(a)(b)(c)

(a) No established medical history or clinical diagnosis of any of the following:

(1) A personality disorder that is severe enough to have repeatedly manifested

itself by overt acts.

(2) A psychosis. As used in this section, "psychosis" refers to a mental disorder

in which:

(i) The individual has manifested delusions, hallucinations, grossly bizarre or

disorganized behavior, or other commonly accepted symptoms of this condition; or

(ii) The individual may reasonably be expected to manifest delusions,

hallucinations, grossly bizarre or disorganized behavior, or other commonly
accepted symptoms of this condition.

(3) A bipolar disorder.

(4) Substance dependence, except where there is established clinical evidence,

satisfactory to the Federal Air Surgeon, of recovery, including sustained total
abstinence from the substance(s) for not less than the preceding 2 years. As used in
this section -

(i) "Substance" includes: alcohol; other sedatives and hypnotics; anxiolytics;

opioids; central nervous system stimulants such as cocaine, amphetamines, and
similarly acting sympathomimetics; hallucinogens; phencyclidine or similarly acting
arylcyclohexylamines; cannabis; inhalants; and other psychoactive drugs and
chemicals; and

(ii) "Substance dependence" means a condition in which a person is

dependent on a substance, other than tobacco or ordinary xanthine-containing
(e.g., caffeine) beverages, as evidenced by-

(A) Increased tolerance

(B) Manifestation of withdrawal symptoms;
(C) Impaired control of use; or
(D) Continued use despite damage to physical health or impairment of
social, personal, or occupational functioning.

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(b) No substance abuse within the preceding 2 years defined as:

(1) Use of a substance in a situation in which that use was physically hazardous,
if there has been at any other time an instance of the use of a substance also in a
situation in which that use was physically hazardous;

(2) A verified positive drug test result, an alcohol test result of 0.04 or greater
alcohol concentration, or a refusal to submit to a drug or alcohol test required by the
U.S. Department of Transportation or an agency of the U.S. Department of
Transportation; or

(3) Misuse of a substance that the Federal Air Surgeon, based on case history
and appropriate, qualified medical judgment relating to the substance involved, finds-

(i) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(ii) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.

(c) No other personality disorder, neurosis, or other mental condition that the Federal
Air Surgeon, based on the case history and appropriate, qualified medical judgment
relating to the condition involved, finds-

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
Medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.

(Also see Items 18.m.,18.n., and 18.p.)

II. Examination Techniques

The FAA does not expect the AME to perform a formal psychiatric examination. However, the
AME should form a general impression of the emotional stability and mental state of the
applicant. There is a need for discretion in the AME/applicant relationship consonant with the
FAA's aviation safety mission and the concerns of all applicants regarding disclosure to a public
agency of sensitive information that may not be pertinent to aviation safety. AMEs must be
sensitive to this need while, at the same time, collect what is necessary for a certification
decision. When a question arises, the Federal Air Surgeon encourages AMES first to check this
Guide for Aviation Medical Examiners and other FAA informational documents. If the question
remains unresolved, the AMEs should seek advice from a RFS or the Manager of the AMCD.

Review of the applicant's history as provided on the application form may alert the AME to
gather further important factual information. Information about the applicant may be found in

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items related to age, pilot time, and class of certificate for which applied. Information about the
present occupation and employer also may be helpful. If any psychotropic drugs are or have
been used, follow-up questions are appropriate. Previous medical denials or aircraft accidents
may be related to psychiatric problems.

Psychiatric information can be derived from the individual items in medical history (Item 18).
Any affirmative answers to Item 18.m., “Mental disorders of any sort; depression, anxiety, etc.,"
or Item 18.p., "Suicide attempt," are significant. Any disclosure of current or previous drug or
alcohol problems requires further clarification. A record of traffic violations may reflect certain
personality problems or indicate an alcohol problem. Affirmative answers related to rejection by
military service or a military medical discharge require elaboration. Reporting symptoms such as
headaches or dizziness, or even heart or stomach trouble, may reflect a history of anxiety rather
than a primary medical problem in these areas. Sometimes, the information applicants give
about their previous diagnoses is incorrect, either because the applicant is unsure of the correct
information or because the applicant chooses to minimize past difficulties. If there was a
hospital admission for any emotionally related problem, it will be necessary to obtain the entire
record.

Valuable information can be derived from the casual conversation that occurs during the
physical examination. Some of this conversation will reveal information about the family, the job,
and special interests. Even some personal troubles may be revealed at this time. The AME’s
questions should not be stilted or follow a regular pattern; instead, they should be a natural
extension of the AME's curiosity about the person being examined. Information about the
motivation for medical certification and interest in flying may be revealing. A formal Mental
Status Examination is unnecessary. For example, it is not necessary to ask about time, place,
or person to discover whether the applicant is oriented. Information about the flow of
associations, mood, and memory, is generally available from the usual interactions during the
examination. Indication of cognitive problems may become apparent during the examination.
Such problems with concentration, attention, or confusion during the examination or slower,
vague responses should be noted and may be cause for deferral.

The AME should make observations about the following specific elements and should note on
the form any gross or notable deviations from normal:

1. Appearance (abnormal if dirty, disheveled, odoriferous, or unkempt);

2. Behavior (abnormal if uncooperative, bizarre, or inexplicable);
3. Mood (abnormal if excessively angry, sad, euphoric, or labile);
4. Communication (abnormal if incomprehensible, does not answer questions directly);
5. Memory (abnormal if unable to recall recent events); and
6. Cognition (abnormal if unable to engage in abstract thought, or if delusional or
hallucinating).

Significant observations during this part of the medical examination should be recorded in Item
60, of the application form. The AME, upon identifying any significant problems, should defer
issuance of the medical certificate and report findings to the FAA. This could be accomplished
by contacting a RFS or the Manager of the AMCD.

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III. Aerospace Medical Disposition

Drug and alcohol conditions are found in Substances of Dependence/Abuse.

A. General Considerations. It must be pointed out that considerations for safety, which in the
"mental" area are related to a compromise of judgment and emotional control or to diminished
mental capacity with loss of behavioral control, are not the same as concerns for emotional
health in everyday life. Some problems may have only a slight impact on an individual's overall
capacities and the quality of life but may nevertheless have a great impact on safety.
Conversely, many emotional problems that are of therapeutic and clinical concern have no
impact on safety.

B. Denials. The FAA has concluded that certain psychiatric conditions are such that their
presence or a past history of their presence is sufficient to suggest a significant potential threat
to aviation safety. It is, therefore, incumbent upon the AME to be aware of any indications of
these conditions currently or in the past, and to deny or defer issuance of the medical certificate
to an applicant who has a history of these conditions. An applicant who has a current diagnosis
or history of these conditions may request the FAA to grant an Authorization under the special
issuance section of part 67 (14 CFR 67.401) and, based upon individual considerations, the FAA
may grant such an issuance.

All applicants with any of the following conditions must be denied or deferred:
Attention deficit/hyperactivity, bipolar disorder, personality disorder, psychosis, substance
abuse, substance dependence, suicide attempt.

In some instances, the following conditions may also warrant denial or deferral:
Adjustment disorder; bereavement; dysthymic; or minor depression; use of psychotropic
medications for smoking cessation

NOTE: The use of a psychotropic drug is disqualifying for aeromedical certification purposes. This
includes all sedatives, tranquilizers, antipsychotic drugs, antidepressant drugs (including SSRI’s -
see exceptions below), analeptics, anxiolytics, and hallucinogens. The AME should defer issuance
and forward the medical records to the AMCD.

C. Use of Antidepressant Medications. The FAA has determined that airmen requesting
first, second, or third class medical certificates while being treated with one of four specific
selective serotonin reuptake inhibitors (SSRIs) may be considered. The Authorization
decision is made on a case-by-case basis. The AME may not issue.

If the applicant opts to discontinue use of the SSRI, the AME must notate in Block 60,
Comments on History and Findings, on FAA Form 8500-8 and defer issuance. To reapply
for regular issuance, the applicant must be off the SSRI for a minimum of 60 days with a
favorable report from the treating physician indicating stable mood and no aeromedically
significant side effects. See SSRI Decision Path I

176
 Guide for Aviation Medical Examiners
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USE OF ANTIDEPRESSANT MEDICATIONS

(Updated 02/28/2018)

If you are an AIRMAN taking an SSRI – see Airman Information - SSRI INITIAL Certification

If you are an ATCS taking an SSRI – see FAA ATCS How to Guide

The FAA has determined that airmen or FAA Air Traffic Control Specialists (FAA ATCS)
requesting medical certificates while being treated with one of four specific selective
serotonin reuptake inhibitors (SSRIs) may be considered. The Authorization decision is
made on a case-by-case basis. The AME may not issue.

If the airman/FAA ATCS opts to discontinue use of the SSRI, the AME must notate in
Block 60, Comments on History and Findings, on FAA Form 8500-8 and defer issuance.
To reapply for regular issuance, the applicant must be off the SSRI for a minimum of 60
days with a favorable report from the treating physician indicating stable mood and no
aeromedically significant side effects. See SSRI Decision Path I

An individual may be considered for an FAA Authorization of a Special Issuance (SI) or

Special Consideration (SC) of a Medical Certificate (Authorization) if:

1.) The applicant has one of the following diagnoses:

 Major depressive disorder (mild to moderate) either single episode or recurrent
episode;
 Dysthymic disorder;
 Adjustment disorder with depressed mood; or
 Any non-depression related condition for which the SSRI is used
2.) For a minimum of 6 continuous months prior, the applicant has been clinically
stable as well as on a stable dose of medication without any aeromedically
significant side effects and/or an increase in symptoms. If the applicant has been
on the medication under 6 months, the AME must advise that 6 months of continuous
use is required before SI/SC consideration.
3.) The SSRI used is one the following (single use only):
 Fluoxetine (Prozac)
 Sertraline (Zoloft)
 Citalopram (Celexa)
 Escitalopram (Lexapro)

If the applicant is on a SSRI that is not listed above, the AME must advise that the
medication is not acceptable for SI/SC consideration.
4.) The applicant DOES NOT have symptoms or history of:
 Psychosis
 Suicidal ideation
 Electro convulsive therapy
 Guide for Aviation Medical Examiners
____________________________________________________________________
 Treatment with multiple SSRIs concurrently
 Multi-agent drug protocol use (prior use of other psychiatric drugs in conjunction
with SSRIs.)
If applicant meets the all of the above criteria and wishes to continue use of the SSRI,
advise the applicant that he/she must be further evaluated by a Human Intervention
Motivation Study (HIMS) AME.

Off Medication for 60 Days:

SSRI Decision Path I

Initial Certification/Clearance:

 SSRI Decision Path II (HIMS AME - Initial Certification/Clearance)

 Airman Information - SSRI INITIAL Certification

 FAA ATCS HOW TO GUIDE - SSRI

 HIMS AME Checklist - SSRI Certification/Clearance

 FAA Certification Aid - SSRI Initial Certification/Clearance

 Specifications for Neuropsychological Evaluations for Treatment with SSRI

Medications

Recertification/ Follow Up Clearance:

 Airman SSRI Follow Up Path for the HIMS AME

 FAA ATCS SSRI Follow Up Path for the HIMS AME

 HIMS AME Checklist - SSRI Recertification/ Follow Up Clearance

 FAA Certification Aid - SSRI Recertification/ Follow Up Clearance

 HIMS AME Change Request

 Specifications for Neuropsychological Evaluations for Treatment with SSRI

Medications
 Guide for Aviation Medical Examiners
____________________________________________________________________

See:

Airman Information - SSRI INITIAL Certification

FAA ATCS How to Guide – SSRI

FAA Certification Aid - SSRI Initial Certification/Clearance

 Guide for Aviation Medical Examiners
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 Guide for Aviation Medical Examiners
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Airman Information - SSRI INITIAL Certification (Updated 08/25/2021)

If you are an FAA ATCS: See the FAA ATCS HOW TO GUIDE – SSRI below and contact your RFS

If you are an AIRMAN:

1. See your treating physician/therapist and/or psychiatrist and get healthy.

2. Do not fly in accordance with 14 CFR 61.53 until you have an Authorization from the FAA.

3. Select and contact a Human Intervention Motivation Study Aviation Medical Examiner (HIMS AME) to
work with you through the FAA process.
a. Provide the HIMS AME with a copy of ALL of your treatment records (no matter how many
years have passed) from the time you:
1. Sought treatment for any condition that required an SSRI or psychiatric
medication or
2. Had symptoms but were NOT on an SSRI
b. Have a copy of your complete FAA file sent to the HIMS AME AND to a board certified
psychiatrist if your treating physician is not a board certified psychiatrist. See Release of
Information on how to request a copy of your file.
c. At this time, make sure you also tell your HIMS AME about any other medical conditions you
may have. They should be able to help you identify and collect the information that will be
needed for a CACI/Special Issuance for these other conditions.

4. Print a copy of the FAA CERTIFICATION AID – SSRI INITIAL Certification/Clearance

a. Review what reports, providers, or testing will be required.
b. Take the correct CERTIFICATION AID page to each of the required physicians or providers so
they understand what their report must include for FAA purposes. (This should save time and
decrease the letters asking for more information.)
c. Make sure the providers specifically address in their report the “FAA SSRI “Rule-Outs.”

5. When you have been stable with no symptoms or side effects and on the same dose of medication for
6 months (this must be documented), you should meet with your HIMS AME to determine if it is
appropriate to submit an INITIAL SSRI Special Issuance packet for FAA review.
***Remember to bring all documents to this evaluation, including information on any
other condition you may have that requires a CACI or Special Issuance. ***

6. When your HIMS AME determines you are ready to submit a Special Issuance package they will:
a. Review and complete the HIMS AME checklist;
b. Complete a new 8500-8 exam;
c. Place notes in Block 60 stating that the SSRI evaluation is complete;
d. Place notes in Block 60 regarding any other conditions the airman may have (Special
Issuance/CACI);
e. Submit the SSRI information and information on any other condition that may require a Special
Issuance to the FAA.

7. When submitting information:

 The AME must submit your exam as DEFERRED.
 Coordinate with your AME to make sure that ALL ITEMS LISTED on the AME Checklist and a
COMPLETE package is sent to the FAA at the address below WITHIN 14 DAYS.
 Partial or incomplete packages WILL NOT BE REVIEWED and will cause a DELAY IN
CERTIFICATION.
AIRMAN - Initial Certification
FAA, Civil Aerospace Medical Institute, Building 13
Aerospace Medical Certification Division, Room 308 - AAM-300
PO Box 25082
Oklahoma City, OK 73125-9867
For RECERTIFICATION, see the HIMS AME Checklist – SSRI Recertification/ Follow up Clearance.
 Guide for Aviation Medical Examiners
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FAA ATCS HOW-TO GUIDE – SSRI

(Updated 03/29/2017)

1. Notify Regional Flight Surgeon (RFS) of your diagnosis and treatment with a
Selective Serotonin Reuptake Inhibitor (SSRI).
 In conjunction with the Regional Flight Surgeon’s office (RFS), select a Human
Intervention Motivation Study Aviation Medical Examiner (HIMS AME).
 Sign a release to send a copy of your FAA ATCS medical file the HIMS AME.
 You will be placed in an Incapacitated Status.
 Any fees involved in obtaining medical tests and/or documentation to support a
Special Consideration are the responsibility of the employee/applicant.

2. Contact the HIMS AME who will assist you in locating an acceptable psychiatrist and
neuropsychologist for the required evaluations.
 You must be on a stable dose with of one of the approved SSRIs for six
months with no symptoms or side effects.
 Your condition must be well controlled before review for a Special
Consideration.
 Provide your HIMS AME with all the items listed on the FAA Certification Aid –
SSRI INITIAL Certification/Clearance.

3. When the above criteria have been met, you should meet with your HIMS AME for a
face-to-face, in-office evaluation. The HIMS AME will prepare a report,
recommendation, and submit an INITIAL SSRI Special Consideration packet to the
RFS for determination.

4. RFS will process packet within the Office of Aerospace Medicine.

5. If Special Consideration is granted, the RFS will issue a time-limited clearance with
Special Consideration for six (6) months.

For follow up Clearance, you must provide all items listed on the FAA Certification Aid –
SSRI Recertification/ Follow Up Clearance.
 Guide for Aviation Medical Examiners
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HIMS AME Checklist - SSRI INITIAL Certification/Clearance (Updated 08/25/2021)
Name: ____________________________________________ Airman MID or PI#: __________________________

Submit this checklist ALL supporting information for INITIAL SSRI consideration within 14 days of deferred exam
to:

AIRMAN FAA ATCS

FAA, Civil Aerospace Medical Institute, Building 13 Regional Flight Surgeon (RFS) office
Aerospace Medical Certification Division, Room 308
PO BOX 25082
Oklahoma City, OK 73125-9867

All numbered (#) items below refer to the corresponding section of the FAA CERTIFICATION AID - SSRI INITIAL
Certification/Clearance.

1. Airman/FAA ATCS statement and records Yes No

 Addresses/describes ALL items in FAA Certification Aid ………………………………………………
 Is signed and dated …………………………………………………………………………………………
 Provides all medical/treatment records related to mental health history.…………………...

2. HIMS AME FACE-TO-FACE, IN-OFFICE EVALUATION: Yes No

 Describes ALL items in #1-7 of “HIMS AME” checklist…….……..……………………..………………
 Verifies the airman/ FAA ATCS has been on the same medication at the same dose for a
minimum of 6 months………….…………………………………………………......................................
 Is signed and dated ………………………………………………………………………………………….
 Copies of all reports have been submitted to the FAA or are enclosed with this checklist ………….
 Any other condition(s) that would require Special Issuance (SI)/Special Consideration (SC). Do
not include CACI qualified condition(s)………....................................................................................
o List conditions:

3. TREATING PHYSICIAN (non-psychiatrist) REPORT (If the treating physician is a

Board Certified Psychiatrist, check N/A and skip to #4.):
N/A Yes No
 Verifies the airman/FAA ATCS has been on the same medication at the same dose for a
minimum of 6 months …………………………………………………...........................................
 Is signed and dated …………………………………………..……………………………………….

4. Board Certified PSYCHIATRIST REPORT: Yes No

 Describes ALL items in #1-8 of PSYCHIATRIST requirements (including FAA SSRI “Rule-Outs.”)..
 Verifies the airman/FAA ATCS has been on the same medication at the same dose for a
minimum of 6 months.........................................................................................................................
 Is signed and dated…………………………………………………………………………………………..

5. NEUROPSYCHOLOGIST REPORT: Yes No

 Describes ALL items in #1-8 of the NEUROPSYCHOLOGIST requirements ………………………..
 CogScreen-AE computerized report is attached …..…………………………………………………….
 Additional neuropsychological testing (if performed or required) score summary sheet is attached.
 Is signed and dated ………………………………………………..………………………………………..

6. ADDITIONAL REPORTS
 Chief Pilot Report (for Commercial pilots requesting 1 st or 2nd-class certificates; 3rd class N/A Yes No
N/A) or Air Traffic Manager (ATM) for FAA ATCS................................................……………
 SSRI related (drug testing, therapy reports, etc.) …...…………………………………………..
 Reports from other providers or for non-SSRI conditions that may require SI or SC.........….

HIMS AME Signature___________________________ Date of Evaluation_______________

IF ANY ITEMS ARE MISSING OR ARE INCOMPLETE, CERTIFICATION WILL BE DELAYED.

 Guide for Aviation Medical Examiners
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FAA CERTIFICATION AID – SSRI INITIAL Certification (Page 1 of 5)
(Updated 03/29/2017)
The following information is to assist your treating physician/ provider who may be unfamiliar with FAA medical certification/clearance
requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a determination on a medical certificate for airmen or
clearance for FAA ATCS. You should strongly consider taking a copy to each evaluator so they understand what specific information is needed
in their report to the FAA. If each item is not addressed by the corresponding provider, there may be a delay in the processing of your medical
certification or clearance until that information is submitted. Additional information such as clinic notes or explanations should also be submitted as
needed. All reports must be CURRENT (within the last 90 days) for FAA purposes.

REPORT FROM MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING (SSRI INITIAL Certification/Clearance Evaluation)

AIRMAN or 1. A typed statement, in your own words, describing your mental health history, antidepressant use, and any other treatment.
FAA ATCS At a minimum, you must include the following information:
a. Symptoms: when started, what type, and when/how you first sought treatment.
b. List all providers you have seen for any mental health condition(s) and dates.
c. List all medications you have taken, dates they were started and stopped, whether they helped or not.
d. List any other treatment(s) you have utilized, dates they were started and stopped, if they helped or not.
e. List dates and locations of any hospitalizations due to any mental health condition. If you have not had any, that
must be stated.
f. Describe your current status: current medication dose, how long you have been on it, and how you function
both on and off the medication.
2. Sign and date your statement.
3. Provide copies of all of your medical/treatment records related to your mental health history (to include any treatment
records for past related symptoms where you were NOT on SSRI as well as from the date you began treatment to the present)
and sign two release forms* for the FAA to release a complete copy of your FAA medical file to your HIMS AME and to a
board certified psychiatrist (if your treating physician is not a psychiatrist).
*For ATCS release form information, contact your RFS office.

HIMS AME 1. Evaluation MUST be a face-to-face, in person, and this must be noted in your report.
2. Record review verification: Verify that you have reviewed (a) complete copy of the airman/FAA ATCS’s Agency medical
file, (b) the treating physician and/or/psychiatrist reports (as required), and (c) neuropsychologist report (see below). If you
reviewed additional clinical and/or mental health records provided by the airman/FAA ATCS, the reports should be noted
as reviewed and submitted to the FAA.
Must be in 3. Medication verification
letter/report format. a. Verify the current medication name, dose, and how long has the airman/ FAA ATCS been on this medication at
Due to length and this dosage.
detail required, we b. When was the most recent change in medication (discontinuation, dose, or change in medication type)?
cannot accept Block c. Are additional changes in dose or medication recommended or anticipated?
60 notes for this 4. Summarize your aeromedical impression and evaluation as a HIMS AME based on the face-to-face evaluation AND
section. review of the supporting documents.
a. If you do not agree with the supporting documents, or if you have additional concerns not noted in the
documentation, please discuss your observations or concerns.
b. Review and specifically comment on whether or not the airman/FAA ATCS has any of the FAA SSRI “Rule-Outs”
(e.g., suicide attempt, etc. See the table on page 3 of this document).
5. Special Issuance/ Consideration Recommendation
a. Do you recommend Special Issuance (SI)/Special Consideration (SC) for this airman/FAA ATCS?
b. Do you have any clinical concerns or recommend a change in the treatment plan?
c. Will you agree to continue to follow the airman/FAA ATCS as his/her HIMS AME per FAA policy? If so, at what
interval?
6. Agreement to immediately notify the FAA (for Airmen: 405-954-4821; for FAA ATCS contact the RFS office)
if there is:
a. Change in condition;
b. Deterioration in psychiatric status or stability;
c. Change in the medication dosage; or
d. Plan to reduce or discontinue any medication.
7. Additional conditions
a. Does this airman/FAA ATCS have ANY other medical conditions that are potentially disqualifying or required a
special issuance/consideration?
b. Is all documentation present for those other conditions?
 Guide for Aviation Medical Examiners
____________________________________________________________________
FAA CERTIFICATION AID – SSRI INITIAL Certification (Page 2 of 5)
(Updated 03/29/2017)
The following information is to assist your treating physician/ provider who may be unfamiliar with FAA medical certification/clearance requirements. It
lists the ABSOLUTE MINIMUM information required by the FAA to make a determination on a medical certificate for airmen or clearance for FAA
ATCS. You should strongly consider taking a copy to each evaluator so they understand what specific information is needed in their report to
the FAA. If each item is not addressed by the corresponding provider, there may be a delay in the processing of your medical certification or
clearance until that information is submitted. Additional information such as clinic notes or explanations should also be submitted as needed. All
reports must be CURRENT (within the last 90 days) for FAA purposes.

REPORT FROM MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING

(SSRI INITIAL Certification/Clearance Evaluation)
TREATING A Current detailed evaluation report that summarizes clinical findings and status of how the airman/FAA ATCS is
PHYSICIAN doing. At a minimum, it must include the following:

Use this 1. Qualifications: State your board certifications and specialty.

section if the
person 2. History:
prescribing your a. Review the overall symptom and treatment history, with a timeline of evaluations and treatments
medication is (including start and stop dates).
NOT a board b. Discuss the severity of the condition and any relapse/recurrence.
certified
psychiatrist. 3. Medication
a. Current name and dose of medication.
(You will also b. How long has the airman/FAA ATCS been on this medication at this dosage?
have to submit c. Any side effects from the current medications? (If none, that should be stated.)
an evaluation d. When was the most recent change in medication? (Dose, medication type, or discontinuation of
from a board medication)
certified e. Previous medications that have been tried. List name, dosage, dates of use, and presence or
psychiatrist - see absence of any side effects and outcomes.
next section.) f. Are additional changes in dose or medication recommended or anticipated?
4. Diagnosis:
IF the physician a. Specify the current diagnosis (es).
prescribing your b. Discuss the severity of the condition
medication IS a
BOARD 5. Summary, Treatment and follow-up recommendations:
CERTIFIED a. Discuss the airman/FAA ATCS’s overall psychiatric and behavioral status and risk of recurrence.
PSYCHIATRIST, b. How will this airman/FAA ATCS be followed? At what interval?
you do not need c. Do you have any clinical concerns or recommend a change in treatment plan?
to submit this
“Treating 6. Agreement to immediately notify the FAA (for airmen: 405-954-4821; for FAA ATCS, contact the RFS office) if there are
Physician” any: changes in the airman/FAA ATCS’s condition, dosage, change in medication or if the medication is stopped.
section. Go to
“Psychiatrist”
section below.
 Guide for Aviation Medical Examiners
____________________________________________________________________
FAA CERTIFICATION AID – SSRI INITIAL Certification (Page 3 of 5)
(Updated 03/29/2017)
The following information is to assist your treating physician/ provider who may be unfamiliar with FAA medical certification/medical clearance
requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a determination on a medical certificate for airmen or
medical clearance for FAA ATCS. You should strongly consider taking a copy to each evaluator so they understand what specific information is
needed in their report to the FAA. If each item is not addressed by the corresponding provider, there may be a delay in the processing of your medical
certification or clearance until that information is submitted. Additional information such as clinic notes or explanations should also be submitted as
needed. All reports must be CURRENT (within the last 90 days) for FAA purposes.

REPORT MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING

FROM (SSRI INITIAL Certification/Clearance Evaluation)
PSYCHIATRIST A Current detailed evaluation report that summarizes clinical findings and status of how the airman/FAA ATCS is doing.
At a minimum, it must include the following:
Must be a 1. Qualifications: State your board certifications, specialty, and any other pertinent qualifications.
board certified 2. Records review: What documents were reviewed?
psychiatrist a. Specify if using your own clinic notes and/or notes from other providers or hospitals.
b. Verify if you were provided with and reviewed a complete copy of the airman/FAA ATCS’s FAA medical
(If your file.
treating 3. History:
physician IS a a. Review the overall symptom and treatment history, with a timeline of evaluations and treatments
board certified (including start and stop dates).
psychiatrist, b. Discuss the severity of the condition and any relapse/recurrence.
you should c. Each of the FAA SSRI “Rule-Outs” below MUST be individually addressed. The report must
submit this specifically detail if there have been any symptoms or any history of the following:
section.)
FAA SSRI “RULE-OUTS” Any prior Any prior
CONDITION SYMPTOMS? HISTORY?
I Affective instability
Ii Bipolar spectrum disorders
Iii Electroconvulsive therapy (ECT)
Iv Psychiatric hospitalization
V Psychosis
Vi Suicidal ideation or attempts
Vii Treatment with multiple antidepressants concurrently
viii Treatment with multi-agent drug protocol use (prior use of other psychiatric drugs in
conjunction with antidepressant medications)
ix Any additional symptoms not listed above
4. Medication
a. Current name and dose of medication.
b. How long has the airman/FAA ATCS been on this medication at this dosage?
c. Any side effects from the current medications? (If none, that should be stated.)
d. When was the most recent change in medication? (Dose, medication type, or discontinuation of
medication.)
e. Previous medications that have been tried. List name, dosage, dates of use, and presence or absence
of any side effects and outcomes.
f. Are additional changes in dose or medication recommended or anticipated?
5. Diagnosis:
a. Specify the current diagnosis (es).
b. Discuss any prior diagnostic questions or issues and explain why/how these are no longer under
consideration or have been ruled-out.
c. Discuss the severity of the condition, both current and historically.
6. Summary, Treatment and follow-up recommendations:
d. Discuss the airman/FAA ATCS’s overall psychiatric and behavioral status and risk of recurrence.
e. How will this airman/FAA ATCS be followed? At what interval?
f. Do you have any clinical concerns or recommend a change in treatment plan?
7. Agreement to immediately notify the FAA if there is any changes in the airman/FAA ATCS’s condition, dosage,
change in medication or if the medication is stopped. (For airmen: 405-954-4821; for FAA ATCS: contact the RFS office)
8. Submit copies of all treatment records such as clinic or hospital notes for any period of time which the airman/FAA
ATCS has sought treatment or taken medication. (You do not need to submit any records received from the FAA.)
 Guide for Aviation Medical Examiners
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FAA CERTIFICATION AID – SSRI INITIAL Certification (Page 4 of 5)
(Updated 03/29/2017)

The following information is to assist your treating physician/ provider who may be unfamiliar with FAA medical certification/medical clearance
requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a determination on a medical certificate for airmen or
medical clearance for FAA ATCS. You should strongly consider taking a copy to each evaluator so they understand what specific information is
needed in their report to the FAA. If each item is not addressed by the corresponding provider, there may be a delay in the processing of your medical
certification or clearance until that information is submitted. Additional information such as clinic notes or explanations should also be submitted as
needed. All reports must be CURRENT (within the last 90 days) for FAA purposes.

REPORT FROM MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING

(SSRI INITIAL Certification/Clearance Evaluation)
NEUROPSYCHOLOGIST Th The neuropsychologist report MUST address:
1. Qualifications: State your certifications and pertinent qualifications.
CogScreen Results 2. Records review: What documents were reviewed, if any?
a. Specify clinic notes and/or notes from other providers or hospitals.
AND b. Verify if you were provided with and reviewed a complete copy of the airman/FAA
Neurocognitive evaluation
ATCS’s FAA medical file.
3. History: Items from the clinical, educational, training, social, family, legal, medical, or other history
pertinent to the context of the neuropsychological testing and interpretation.
4. Testing results:
a. CogScreen-AE information:
i. Date(s) of evaluation
ii. CogScreen-AE Session number. (Note: Session 1 should be for initial test only;
retests should be Session 2 or incrementally higher.)
iii. Normative group used for comparison:
 Major Carrier (age-corrected); or
 Regional Carrier (NOT age-corrected) [also acceptable for GA pilots]; or
 General Aviation Pilot Norms (age-corrected)
b. CogScreen-AE results with specific review of and discussion when any threshold
values exceeded:
i. LRPV (threshold: if score > 0.80)
ii. Base Rate for scores at-or-below the 5th percentile (threshold: if any T-scores <
40) [age corrected acceptable]
iii. Base Rate for scores at-or-below the 15th percentile (threshold: if any T-scores <
40) [age corrected acceptable]
iv. Taylor Aviation Factors (threshold: if any T-scores < 40)
c. Results of any additional focused testing or a comprehensive test battery
5. Interpretation:
a. The overall neurocognitive status of the airman/FAA ATCS
b. Clinical diagnosis (es) suggested or established base on testing (if any).
c. Discuss any weaknesses or concerning deficiencies that may potentially affect safe
performance of pilot or aviation safety-related duties (if any).
d. Discuss rationale and interpretation of any additional focused testing or comprehensive
test battery that was performed.
e. Any other concerns.
6. Recommendations: additional testing, follow-up testing, referral for medical evaluation (e.g.,
neurology evaluation and/or imaging), rehabilitation, etc.
7. Agreement to immediately notify the FAA (for airmen: 405-954-4821; for FAA ATCS contact the RFS office)
if there are any changes or deterioration in the airman/FAA ATCS’s psychological status or stability.
8. Submit the CogScreen computerized summary report (approximately 13 pages) and summary
score sheet for any additional testing (if performed).
 Guide for Aviation Medical Examiners
____________________________________________________________________
FAA CERTIFICATION AID – SSRI INITIAL Certification (Page 5 of 5)
(Updated 03/29/2017)

The following information is to assist your treating physician/ provider who may be unfamiliar with FAA medical certification/medical clearance
requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a determination on a medical certificate for airmen or
medical clearance for FAA ATCS. You should strongly consider taking a copy to each evaluator so they understand what specific information is
needed in their report to the FAA. If each item is not addressed by the corresponding provider, there may be a delay in the processing of your medical
certification or clearance until that information is submitted. Additional information such as clinic notes or explanations should also be submitted as
needed. All reports must be CURRENT (within the last 90 days) for FAA purposes.

REPORT FROM MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING

(SSRI INITIAL Certification/Clearance Evaluation)

CHIEF PILOT Report should address:

AIRLINE For Airman:

MANAGEMENT 1. The airman’s performance and competence.
DESIGNEE 2. Crew interaction.
3. Mood and behavioral changes.
OR 4. Any other concerns.
AIR TRAFFIC For FAA ATCS:
MANAGER (ATM) 1. Issues related to safety and safe operations.
2. Interaction with other FAA ATCSs.
1st and 2nd class pilots 3. Mood and behavioral changes.
who have been 4. Any other concerns.
employed by an air
carrier within the last 2
years or FAA ATCS
employees

3rd class pilots or

FAA ATCS Applicant for
Hire – Not applicable

REPORTS FROM Supplemental reports (if any) that may be related to the condition for which the SSRI is
ADDITIONAL prescribed:
PROVIDERS  Any drug testing results
 Psychotherapist records and reports
 Social worker reports
OR

Special Issuance/ Special Consideration conditions: The airman/FAA ATCS should bring reports
REPORTS and documentation for any other conditions that may require Special Issuance/Special
REGARDING OTHER Consideration to the HIMS AME for review.
CONDITIONS
CACI conditions (airman only): The airman should bring reports or other documentation listed
on the CACI worksheet to the HIMS AME for review.
 Guide for Aviation Medical Examiners
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________________________________________________________________________
 Guide for Aviation Medical Examiners
____________________________________________________________________
HIMS AME Checklist - SSRI Recertification /Follow Up Clearance (Updated 08/28/2019)
Name ____________________________ Airman PI#____________________________

Instructions to the HIMS AME:

 Address the following items based on your in-office exam and documentation review;
 Submit this Checklist (signed and dated by the HIMS AME); AND include supporting documentation reviewed to
complete this Checklist (including your HIMS AME report) within 14 days to:

AIRMAN FAA ATCS: Regional Flight Surgeon (RFS) office

FAA, Civil Aerospace Medical Institute, Bldg. 13
Aerospace Medical Certification Division, Room 308 - AAM-300
PO Box 25082
Oklahoma City, OK 73125-9867

I reviewed the airman’s SSRI Authorization or the FAA ATCS’s Special Consideration Letter dated: ________________
(Date of Letter)

1. HIMS AME FACE-TO-FACE, IN OFFICE EVALUATION: Required EVERY 6 months for ALL CLASSES
No Yes
 Interval visit summaries (if any) are unfavorable or reflect concerns………………………………………….
 Any concerns about the airman/FAA ATCS’s current psychiatric status based on your clinical interview,
evaluation, and review of reports? …………………………………………………...........................................
 Any new psychiatric conditions identified or change in medication or dose during this period? ..................
 Any abnormal physical exam or mental exam findings? …………………………………………………….…
 Any NEW condition(s) that would require Special Issuance/Consideration? (Do not include any new
CACI qualified condition.) ……………………………………………………………………..……………………

2. TREATING PSYCHIATRIST REPORT: Required EVERY 6 months for ALL CLASSES

OR
HIMS PSYCHIATRIST REPORT plus PRESCRIBING PHYSICIAN REPORT
Yes No
 Report(s) is/are favorable with no anticipated or interim treatment changes ………………………….
 The airman/FAA ATCS is on the same medication at the same dose stated in the Authorization
letter or Special Consideration Letter.……….......................................................................................

3. NEUROPSYCHOLOGIST REPORT: Required EVERY 12 months for 1st and 2nd class and FAA ATCS
and every 24 months for 3rd class (unless otherwise specified on the Authorization Letter /Special Not Yes No
Consideration Letter). due
 Concludes NO aeromedically significant cognitive deficits or adverse changes? ................
 CogScreen is attached? …………………………………………………………………………...
 Additional neuropsych testing (if performed or required) is attached? .................................

4. CHIEF PILOT or AIR TRAFFIC MANAGER (ATM) REPORT(S): Required EVERY 3 months
Chief Pilot Reports required only for Commercial pilots holding 1st or 2nd class certificates.
ATM reports required for FAA ATCS. N/A Yes No
Reports are favorable? .........................………………………………………………………………
If any report is unfavorable immediately contact the FAA: For Airmen: call 405-954-4821;
for FAA ATCS contact the RFS office.

5. ADDITIONAL REPORTS required by Authorization letter N/A Yes No

o SSRI-related (drug testing, therapy reports, etc.) reports are favorable…………….....................
o Reports required for other non-SSRI conditions meet Authorization requirements………………

6. I have no other concerns about this airman/FAA ATCS and I recommend re-certification for Special Yes No
Issuance/Consideration……………………………………………………………………………………….....................

_______________________________________ __________________________________
HIMS AME Signature Date of Evaluation

For Airman: If ALL items fall into the clear column, the AME may issue with the time limitation specified in the Authorization Letter or Special
Consideration Letter. If Any Single Item falls into the shaded column, the AME MUST DEFER or contact the FAA and Explain in the HIMS report.
For FAA ATCS: When Checklist is complete, immediately contact RFS with results and submit all documents within 14 days.
 Guide for Aviation Medical Examiners
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FAA CERTIFICATION AID – SSRI Recertification (Page 1 of 2)
(Updated 03/29/2017)
The following information is to assist your treating physician/ provider who may be unfamiliar with FAA medical certification requirements. It lists the ABSOLUTE
MINIMUM information required by the FAA to make a determination on a medical certificate for airmen or medical clearance for FAA ATCS. You should strongly
consider taking a copy to each evaluator so they understand what specific information is needed in their report to the FAA. If each item is not addressed by
the corresponding provider there may be a delay in the processing of your medical certification until that information is submitted. Additional information such as
clinic notes or explanations should also be submitted as needed. All reports must be CURRENT (within the last 90 days) for FAA purposes.
REPORT FROM REQUIRED MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING
INTERVAL (SSRI Recertification/ Follow Up Clearance)
1. Must be a face-to-face, in person evaluation every 6 months.
HIMS AME Every 6 months or 2. Summarize findings from additional interim evaluations that were performed by any other venue
as stated in the (phone/ video/ email), either at the AME’s discretion or as required by the Authorization or Special
All classes airman Consideration Letter (every 1-3 months).
Authorization letter 3. Summarize your aeromedical impression and evaluation as a HIMS AME based on the face-to-face
and FAA ATCS evaluation AND review of the supporting documents.
Or FAA ATCS 4. If you do not agree with the supporting documents, or if you have additional concerns not noted in the
Special documentation, please discuss your observations or concerns.
Consideration 5. State if the airman/FAA ATCS meets all the requirements of the Authorization Letter/Special
Letter Consideration Letter or describe why they do not.
6. Review and comment if there has been any change in the dose, type, or discontinuation of
medication stated in the Authorization Letter/ Special Consideration Letter.
7. Do you recommendation continued Special Issuance/Special Consideration in this airman/FAA
ATCS?
8. Agreement to continue to serve as the airman/FAA ATCS’s HIMS AME and follow this airman/FAA
ATCS per FAA policy.
9. Agreement to immediately notify the FAA (for airmen: 405-954-4821; for FAA ATCS contact the RFS
office) if there is any change in condition, deterioration in psychiatric status or stability, if the
medication dosage has changed, or there is a plan to reduce or discontinue any medication.
10. Using the HIMS AME Checklist –SSRI Recertification/ Follow Up Clearance, comment on any items
that fall into the shaded category.
11. Submit the SSRI check list, your HIMS AME written report, and all required supporting
documentation that you reviewed with your package.

PSYCHIATRIST Every 6 months or 1. Summarize clinical findings and status of how the airman/FAA ATCS is doing.
INTERIM HISTORY per Authorization 2. Have there been any new symptoms or hospitalizations?
REPORT Letter 3. Did a change in dose or medication occur or is one recommended or anticipated?
4. Have there been any clinical concerns or changes in treatment plan?
(or treating physician as
Or FAA ATCS 5. Has the clinical diagnosis changed?
noted in the Authorization
Special 6. Agreement to immediately notify the FAA (for Airmen: 405-954-4821; for FAA ATCS: contact the
letter)
Consideration RFS office) if there is any change in the airman/FAA ATCS’s condition, dosage, change in
Letter medication or if the medication is stopped.
If the prescribing
7. Interval treatment records such as clinic or hospital notes should also be submitted.
physician is not a
psychiatrist, items #2-7
must be submitted from
the prescribing physician
IN ADDITION TO the
psychiatrist report.
 Guide for Aviation Medical Examiners
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FAA CERTIFICATION AID – SSRI Recertification (Page 2 of 2)
(Updated 03/29/2017)
The following information is to assist your treating physician/ provider who may be unfamiliar with FAA medical certification requirements. It lists the ABSOLUTE
MINIMUM information required by the FAA to make a determination on a medical certificate for airmen or medical clearance for FAA ATCS. You should strongly
consider taking a copy to each evaluator so they understand what specific information is needed in their report to the FAA. If each item is not addressed by
the corresponding provider there may be a delay in the processing of your medical certification until that information is submitted. Additional information such as
clinic notes or explanations should also be submitted as needed. All reports must be CURRENT (within the last 90 days) for FAA purposes.

REPORT FROM REQUIRED MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING

INTERVAL (SSRI Recertification/ Follow Up Clearance)
CLINICAL 1st and 2nd class: CogScreen information results that must be addressed in the narrative:
PSYCHOLOGIST OR Every 12 months 1. Specify the norm used:
NEUROPSYCHOLOGIST or per  Major Carrier (age-corrected); or
Authorization  Regional Carrier (NOT age-corrected) [also acceptable for GA pilots]; or
CogScreen Results Letter  General Aviation Pilot Norms (age-corrected)
(or neurocognitive testing as 2. Specify Session Number administered (listed on Page 1 and Page 2 of printout).
required per the FAA ATCS: Every Session 1 for initial test only; retests should be Session 2 or incrementally higher.
Authorization Letter or 12 months or per Clinical report MUST specifically comment on the following CogScreen items. If they have changed or are
Special Consideration the Special not normal, the narrative must discuss these findings and if they are of any clinical or aeromedical concern:
Letter) Consideration 1. Any increase in LRPV (page 4)
Letter 2. Taylor Factor scores (page 5)
AND Neurocognitive 3. Base Rate for Speed, Accuracy, or Process (page 4)
evaluation 3rd class: Every 24
6) The psychologist or neuropsychologist report should also specifically mention:
months or per 1. The overall neurocognitive status of the airman/FAA ATCS.
Authorization 2. Any adverse neurocognitive findings or a decline in condition.
Letter 3. If additional focused neuropsych testing is/was required or recommended. If any additional testing
was performed, the report must explain why the testing was performed, the results, and how that fits
into the airman/FAA ATCS’s overall neurocognitive status.
6) 4. Any other concerns or absence of concerns.
5. Agreement to immediately notify the FAA (for Airmen: 405-954-4821; for FAA ATCS: contact the
RFS office) if there is any change or deterioration in the psychological status or stability in the airman/FAA
ATCS’s condition.
6. Submit the entire CogScreen report (approximately 13 pages) and any additional testing (if performed).
CHIEF PILOT Report must address:
1st., 2nd class, and
AIRLINE MANAGEMENT FAA ATCS: Every For Airman:
DESIGNEE 3 months (bring 1. The airman’s performance and competence.
cumulative reports 2. Crew interaction.
OR to AME evaluation
3. Mood and behavioral changes.
every 6 months.)
4. Any other concerns.
AIR TRAFFIC
MANAGER (ATM)
For FAA ATCS:
1st and 2nd class pilots 1. Issues related to safety and safe operations.
who have been employed 2. Interaction with other FAA ATCSs.
by an air carrier within the 3. Mood and behavioral changes.
last 2 years or FAA ATCS 4. Any other concerns.
employee

3rd class pilots or ATCS

Applicant for hire – Not
applicable
ADDITIONAL Every 6 months or Varies. See the Authorization Letter or Special Consideration Letter. Include any drug testing results,
PROVIDERS per Authorization therapist follow up reports, social worker reports, etc.
or FAA ATCS
Additional reports for SSRI Special If the prescribing physician is NOT a psychiatrist, reports from the prescribing physician and their clinic
or any other condition noted Consideration office notes must be submitted in addition to the required psychiatric evaluations (see above).
in Authorization or FAA Letter
ATCS Special Consideration If the airman/FAA ATCS has other non-SSRI conditions that require a special issuance/consideration,
Letter those reports should also be submitted according to the Authorization or FAA ATCS Special Consideration
Letter.
 Guide for Aviation Medical Examiners
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HIMS AME Change Request

(Updated 07/25/2018)

The Authorization for Special Issuance requires that airmen DO NOT change his/her HIMS AME
without prior FAA approval.

In rare cases in which the HIMS AME listed on the Authorization Letter is no longer available to the
airman (ex: HIMS AME retires, is no longer a HIMS AME, is deceased, or the airman or HIMS AME
relocates to a new state, etc.), a change request is required.

The FAA requires the following to consider any request:

1. CURRENT HIMS AME - must write a closeout, current status report describing why the
change is requested and agree to release monitoring/sponsorship to the new HIMS AME (list
the name of new HIMS AME). The closeout report must note if there are any concerns
regarding the airman’s compliance.

If the HIMS AME is deceased, his/her office staff should contact AAM-200 Manager, Medical
Specialties in Washington, DC at 202-267-8035.

2. NEW HIMS AME - must review the airman’s records and, in writing, agree to sponsor/monitor
the airman in accordance with the terms of the FAA SI Authorization Letter

3. The AIRMAN must send a written request that describes why the change to a new HIMS AME
is needed.

The FAA will review the submitted information, and IF the change is approved*, will send an updated
Authorization Letter with the new HIMS AME information to the airman.

Submit requests to:

Federal Aviation Administration

Civil Aerospace Medical Institute, Bldg. 13
Aerospace Medical Certification Division, AAM-313
PO Box 25082, Oklahoma City, OK 73125-9867

*NOTE: Submission of a HIMS AME Change Request does not automatically guarantee approval of the request.
 Guide for Aviation Medical Examiners
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Post-Traumatic Stress Disorder (PTSD)

All Classes
Updated 10/14/2021

DISEASE/ EVALUATION DATA DISPOSITION

CONDITION
A.
NO treatment The AME should gather information regarding the diagnosis, severity, If all items on the
treatment, symptoms, and address ALL of the questions on the Post- decision tool are in
Traumatic Stress Disorder (PTSD) Decision Tool for the AME. the clear “No
AND column”, the AME
may:
NO symptoms in
past 2 years ISSUE
Summarize this
history, and annotate
Block 60 with
“discussed the
history of PTSD, no
positives to
screening questions,
and no concerns.”

If any “YES” answers,

any AME concerns,
or unable to verify
history - go to Row B.
B. Submit the following to the FAA for review:
All others DEFER
including: 1. Airman personal statement (typed) that describes in their own words: Submit the information
a. The incident(s) leading up to PTSD-related symptoms and the to the FAA for a
 Continued eventual diagnosis of PTSD. possible Special
symptoms; b. Triggers for PTSD symptoms - characterize the frequency and Issuance.
severity of the symptoms (flashbacks, nightmares, anxiety,
 Treatment with avoidance, and cognitive changes). Follow up Issuance
SSRI or other c. Impact - include any recent or ongoing performance change, loss Will be per the
psychiatric of job/school, or relationship problems due to PTSD. airman’s authorization
medication in d. Modifications - include any recent or current changes to work, letter.
the previous academic, or living situation to accommodate or lessen the PTSD
two years; symptoms.
and/or e. Medication - list names and dates (if used);
f. Counseling - include any form of individual or group counseling or
 Psychotherapy psychotherapy. List dates and provider(s) name(s).
in the previous 2
years 2. Current evaluation by your treating psychiatrist or psychologist
with clinical summary to include severity, frequency of episodes, and
response to treatment (medications or psychotherapy). The report should
identify if there is any history of suicidal ideation(s), homicidal ideation(s),
substance use disorder(s) or other co-morbid psychiatric or psychological
conditions, and identify diagnosis (DSM-V), treatment plan, and prognosis.

3. Medication list. List all current medications (including non-PTSD related

medications), reason for use, start dates, and side effects, if any. If recently
 Guide for Aviation Medical Examiners
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discontinued, list date and reason. Note: if currently on an SSRI, must
also submit items in the Initial SSRI Protocol.

4. Copies of any PTSD screening tools or other assessment instruments

(already performed).

5. Copies of psychological testing (already performed) including raw data.

6. Veterans Administration (VA) records (if applicable)

a. VA Compensation and Pension disability evaluations (C&P exam);
b. VA Disability Compensation Award letters; and
c. VA clinic and/or hospital records

7. Previous medical/hospital records including previous clinical progress

notes for any psychiatric evaluations and clinical progress notes for any
psychiatric condition or PTSD that describe the dates, severity, and any
treatment used.

See the next page for the Post-Traumatic Stress Disorder (PTSD) Decision Tool for the AME.
 Guide for Aviation Medical Examiners
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Post-Traumatic Stress Disorder (PTSD) Decision Tool for the AME

(Updated 10/14/2021)

AME Instructions:

Address each the following items in your in-office exam and history review:
No Yes*
1. Is there any additional mental health diagnosis other than PTSD? (Including but not limited to
depression, anxiety, ADHD, substance disorder.)......................................................................

2. Is there any history of suicidal (or homicidal) ideation or attempt(s) ever in their No Yes*
life?.............................................................................................................................................

3. Have there been any symptoms of PTSD (such as: re-living, avoidance, or increased No Yes*
arousal) within the past two (2) years? a ..................................................................................

4. Has the individual taken medication or undergone psychotherapy for the PTSD in the past No Yes*
two (2) years?............................................................................................................................
No Yes*
5. Is there any history of the individual being limited by the PTSD in performing the functions of
any job (aviation related or not)? b .............................................................................................

6. Are there any elements of the history (such as: nature of the triggers, social dysfunction) No Yes*
which cause you to question whether the PTSD is in full remission or is of aeromedical
concern? c …..............................................................................................................................
No Yes*
7. Do you have ANY concerns regarding this airman or are unable to obtain a complete
history? ....................................................................................................................................

If ALL items fall into the clear/No column, the AME may issue with notes in Block 60 which show you discussed the
history of PTSD, found no positives to the screening questions, AND had no concerns.

*If ANY SINGLE ITEM falls into the SHADED/YES COLUMN, the AME MUST DEFER. The AME report should note
what aspect caused the deferral and explain any Yes answers (shaded column).

Notes:

The AME should elicit what triggers the PTSD episode(s). If the airman has recently been exposed to their triggers (such
as smells or loud noises), do they continue to react to these triggers? The AME should also take into consideration the
likelihood of the triggers being encountered when flying or in everyday life. If the AME is unsure of any of the above
criteria, the diagnosis, or severity - DEFER and note in Block 60

aFor additional information on PTSD see: https://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-

ptsd
b AMEs should pay specific attention to cockpit or flight-specific PTSD triggers. Has the airman changed jobs or
occupations to avoid triggers or due to symptoms? Do they have any current accommodations for school or work due to
PTSD?
c In the past 24 months, has the airman been given an increase in VA PTSD benefits or is there evidence of social

impact such as divorce or severe isolation?

This decision tool is for AME use; it does not have to be submitted to the FAA.
 Guide for Aviation Medical Examiners
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The following table lists the most common conditions of aeromedical significance and course of action that
should be taken by the AME as defined by the protocol and disposition in the table. Medical certificates must
not be issued to an applicant with medical conditions that require deferral, or for any condition not listed in the
table that may result in sudden or subtle incapacitation without consulting the AMCD or the RFS. Medical
documentation must be submitted for any condition in order to support an issuance of an airman medical
certificate.
NOTE – See Disease Protocols for specifications for Neurocognitive, Psychiatric, and/or Psychiatric
and Psychological Evaluations.

DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Psychiatric Conditions
Adjustment Disorders All Submit all pertinent If stable, resolved, no
medical information and associated disturbance of
clinical status report. thought, no recurrent
episodes, and
psychotropic
medication(s) used for
less than 6 months and
discontinued for at least 3
months - Issue

Otherwise - Requires FAA

Decision
Attention Deficit All Submit all pertinent Requires FAA Decision
Disorder medical information and
clinical status report to
include documenting the
period of use, name and
dosage of any
medication(s), and side-
effects. If submitting
neurocognitive test data,
the applicant must have
a drug screen for
ADHD/ADD medications
done within 24 hours of
the neurocognitive
testing and submit the
results.
See Disease Protocols,
ADHD/ADD.
 Guide for Aviation Medical Examiners
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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Psychiatric Conditions
(Updated 09/27/2017)

Bipolar Disorder All Submit all pertinent Requires FAA Decision

medical information
and clinical status
report.
Also see 3. below.
Bereavement; All Submit all pertinent If stable, resolved, no
medical information associated disturbance
Dysthymic; or and clinical status of thought, no recurrent
report. episodes, and;
Minor Depression
a). psychotropic
medication(s) used for
less than 6 months and
discontinued for at least
3 months – Issue

b). No use of
psychotropic
medication(s) - Issue

Otherwise - Requires
FAA Decision
Depression requiring All Submit all pertinent Requires FAA Decision
the use of medical information
antidepressant and clinical status
medications report.
See Use of
Antidepressant
Medication Policy and
Disease Protocols,
Specifications for
Neuropsychological
Evaluations for
Treatment with SSRI
Medications.
Personality Disorders All Submit all pertinent Requires FAA Decision
medical information
and clinical status
report. Also see 1.
below.
 Guide for Aviation Medical Examiners
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Psychosis All Submit all pertinent Requires FAA Decision
medical information
and clinical status
report. Also see 2.
below.

Psychotropic All Document period of If medication(s)

medications for use, name and discontinued for at least
Smoking Cessation dosage of 30 days and w/o side-
medication(s) and effects - Issue
side-effects.
Otherwise – Requires
FAA Decision
Substance Abuse All See Substances of Requires FAA Decision
Dependence/Abuse
Substance All See Substances of Requires FAA Decision
Dependence Dependence/Abuse
Suicide Attempt All Submit all pertinent Requires FAA Decision
medical information
required.

1. The category of personality disorders severe enough to have repeatedly manifested itself by
overt acts refers to diagnosed personality disorders that involve what is called "acting out"
behavior. These personality problems relate to poor social judgment, impulsivity, and
disregard or antagonism toward authority, especially rules and regulations. A history of long-
standing behavioral problems, whether major (criminal) or relatively minor (truancy, military
misbehavior, petty criminal and civil indiscretions, and social instability), usually occurs with
these disorders. Driving infractions and previous failures to follow aviation regulations are
critical examples of these acts.

Certain personality disorders and other mental disorders that include conditions of limited
duration and/or widely varying severity may be disqualifying. Under this category, the FAA is
especially concerned with significant depressive episodes requiring treatment, even outpatient
therapy. If these episodes have been severe enough to cause some disruption of vocational
or educational activity, or if they have required medication or involved suicidal ideation, the
application should be deferred or denied issuance.

Some personality disorders and situational dysphorias may be considered disqualifying for a
limited time. These include such conditions as gross immaturity and some personality
disorders not involving or manifested by overt acts.

2. Psychotic Disorders are characterized by a loss of reality testing in the form of delusions,
hallucinations, or disorganized thoughts. They may be chronic, intermittent, or occur in a
single episode. They may also occur as accompanying symptoms in other psychiatric
conditions including but not limited to bipolar disorder (e.g. bipolar disorder with psychotic
 Guide for Aviation Medical Examiners
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features), major depression (e.g. major depression with psychotic features), borderline
personality disorder, etc. All applicants with such a diagnosis must be denied or
deferred.

3. Bipolar Disorders are considered on a continuum as part of a spectrum of disorders where

there are significant alternations in mood. Generally, only one episode of manic or hypomanic
behavior is necessary to make the diagnosis. Please note that cyclothymic disorder is part of
this spectrum. Even if the bipolar disorder does not have accompanying symptoms that reach
the level of psychosis, the disorder can be so disruptive of judgment and functioning
(especially mania) as to pose a significant risk to aviation safety. Impaired judgment does
occur even in the milder form of the disease. All applicants with a diagnosis of Bipolar
Disorder must be denied or deferred.

4. Although they may be rare in occurrence, severe anxiety problems, especially anxiety and
phobias associated with some aspect of flying, are considered significant. Organic mental
disorders that cause a cognitive defect, even if the applicant is not psychotic, are considered
disqualifying whether they are due to trauma, toxic exposure, or arteriosclerotic or other
degenerative changes.
(See Item 18.m.).
 Guide for Aviation Medical Examiners
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ITEM 48. General Systemic

CHECK EACH ITEM IN APPROPRIATE COLUMN NORMAL ABNORMAL

48. General Systemic

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(a)(b)(c), 67.213(a)(b)(c), and 67.313(a)(b)(c)

(a) No established medical history or clinical diagnosis of diabetes mellitus that

requires insulin or any other hypoglycemic drug for control.

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment
relating to the condition involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.

(c) No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or other
treatment involved, finds -

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.

II. Examination Techniques

A protocol for examinations applicable to Item 48 is not provided because the necessary history-
taking, observation, and other examination techniques used in examining other systems have
already revealed much of what can be known about the status of the applicant's endocrine and other
systems. For example, the examination of the skin alone can reveal important signs of thyroid
dysfunction, Addison's disease, Cushing's disease, and several other endocrine disorders. The eye
may reflect a thyroid disorder (exophthalmos) or diabetes (retinopathy).

When the AME reaches Item 48 in the course of the examination of an applicant, it is recommended
that the AME take a moment to review and determine if key procedures have been performed in
conjunction with examinations made under other items, and to determine the relevance of any
positive or abnormal findings.
 Guide for Aviation Medical Examiners
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III. Aerospace Medical Disposition

The following is a table that lists the most common conditions of aeromedical significance, and
course of action that should be taken by the AME as defined by the protocol and disposition in the
table. Medical certificates must not be issued to an applicant with medical conditions that require
deferral, or for any condition not listed in the table that may result in sudden or subtle incapacitation
without consulting the AMCD or the RFS. Medical documentation must be submitted for any
condition in order to support an issuance of an airman medical certificate.

Blood Donation
All Classes
Updated 01/25/2017

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. One unit After a 24 hour recovery period ISSUE

(less than or equal to and the airman has no Summarize this
500 ml) symptoms: history in Block 60.

B. Two or more units After a 72 hour recovery period ISSUE

(more than 500 ml) and the airman has no Summarize this
This includes Power Red symptoms: history in Block 60.
(double red cell
donation)

C. Platelet After a 4-hour recovery period ISSUE

OR Plasma and the airman has no Summarize this
donation symptoms: history in Block 60.
 Guide for Aviation Medical Examiners
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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Blood and Blood-Forming Tissue Disease

(Updated 11/28/2018)

Anemia All Submit a current Requires FAA Decision

status report and all
pertinent medical
reports. Include a
CBC, and any other
tests deemed
necessary
Hemophilia All Submit a current Requires FAA Decision
status report and all
pertinent medical
reports. Include
frequency, severity
and location of
bleeding sites
Leukemia, Acute and All Submit a current Requires FAA Decision
Chronic – All Types status report and all
pertinent medical
reports.
Chronic Lymphocytic All Submit a current Initial Special Issuance
Leukemia status report and all – requires FAA
pertinent medical Decision
reports.
Follow-up Special
Issuance's - See AASI
Protocol

Other disease of the All Submit a current Requires FAA Decision

blood or blood- status report and all
forming tissues that pertinent medical
could adversely affect reports
performance of
airman duties
Polycythemia All Submit a current Requires FAA Decision
status report and all
pertinent medical
reports; include CBC
 Guide for Aviation Medical Examiners
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Thrombocytopenia
(Platelet count < 150,000)
All Classes
Updated 09/25/2019

EVALUATION DATA DISPOSITION

A. 5 or more years ago No symptoms or current problems. No ongoing
Most recent treatment OR surveillance needed. ISSUE
event/diagnosis Summarize this
history in Block 60.
B. Less than 5 years ago  Treating physician report verifies condition
Due to: has resolved or, if due to a medication, it ISSUE
Drugs (including HIT*), has been stopped with no plan to re-start. Summarize this
Infection (now resolved),  No symptoms or current problems. history in Block 60
Pregnancy, etc.  No ongoing treatment OR surveillance
needed.
*Heparin induced
thrombocytopenia
Note: If an underlying condition is identified,
see that section. Example: Thrombocytopenia
due to chemotherapy, malignancy, autoimmune
disorders, or alcohol use.
C. Less than 5 years ago See CACI worksheet Follow the CACI –
Immune thrombocytopenia Chronic Immune
(ITP) Note: CACI is for Chronic ITP only. Thrombocytopenia
All other causes of thrombocytopenia, See item (cITP) Worksheet
“D. All Others” below.
Annotate Block 60.

D. All others Submit the following to the FAA for review:

 Current status report from the treating DEFER
Hematologist with diagnosis, treatment Submit the information
plan and prognosis; to the FAA for a
 If an underlying cause is identified, the possible Special
status report should include diagnosis, Issuance.
treatment plan, prognosis, and adherence
to treatment for this condition; Follow up Issuance will
 List of medications and side effects, if any; be per the airman’s
 Operative notes and discharge summary (if authorization letter.
applicable);
 Copies of imaging reports or other lab (if
already performed by treating
hematologist); and
 CBC within the past 90 days.
 Guide for Aviation Medical Examiners
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CACI – Chronic Immune Thrombocytopenia (cITP) Worksheet

(Also known as idiopathic thrombocytopenic purpura, immune thrombocytopenic purpura,
or autoimmune thrombocytopenic purpura (AITP).
(Updated 04/27/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no
more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable
certification criteria listed below, the AME can issue. Applicants for first- or second-class must
provide this information annually; applicants for third-class must provide the information with each
required exam.

AME MUST REVIEW ACCEPTABLE

CERTIFICATION CRITERIA
The treating physician’s current, detailed Clinical Progress [ ] Yes
Note verifies:
 The condition is CHRONIC ITP* and platelet counts are
stable above 50,000/microL;
 It has been more than 12 months from diagnosis;
 No history of bleeding episodes that required medical
attention ever (medication, IVIG, etc.);
 No splenectomy required for treatment;
 No current use of antiplatelet agents (NSAIDS, ASA,
gingko biloba) or anticoagulants;
 No increased risk of bleeding (ulcer, high fall risk); and
 No treatment changes recommended.
Back to full, unrestricted activities. [ ] Yes
Current treatment: [ ] None

CBC within the last 90 days shows a platelet count of [ ] Yes

50,000/microL or higher AND no anemia or leukopenia
Notes: * Chronic ITP defined as more than 12 months from diagnosis.

Any recurrence, bleeding that requires treatment, or platelet count drops below 50,000/microL
OR
If any surgery or invasive procedures are performed, the airman should not fly in accordance with 61.53.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified cITP.

[ ] Has current OR previous SI/AASI but now CACI qualified cITP.
[ ] NOT CACI qualified cITP. I have deferred. (Submit supporting documents.)
 Guide for Aviation Medical Examiners
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COVID-19 INFECTIONS
All Classes
Updated 04/27/2022

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. Asymptomatic or Fully recovered. No residual
mild infection symptoms or clinical findings.* ISSUE if otherwise
qualified with notation:
See COVID-19 Medication “Asymptomatic or mild
outpatient COVID-19
See Anosmia Disposition infection with full
Table - Item 26. Nose. recovery.”

B. Prolonged Fully recovered. No

outpatient symptoms or current ISSUE if otherwise
course problems. qualified with notation:
“Prolonged outpatient
COVID-19 infection with
full recovery.”

List symptoms and

See COVID-19 Medication duration in Block 60.

C. Hospitalization,
NOT requiring Fully recovered. No ISSUE with notation:
intensive (ICU) care symptoms or current “Inpatient treatment for
problems. COVID-19 infection with
full recovery.”

Provide detail about the

hospital course and
treatments given in Block
60.
D. Hospitalization, Submit the following to the
requiring ICU care FAA for review: DEFER*
with or without  Current, detailed Clinical Note in Block 60:
ventilator Progress Note from the “Intensive care COVID-
treating physician with 19 infection with full
treatment plan and recovery.”
prognosis;
 Specialty consultations Submit the information to
already performed (ex: the FAA for review.
neurology, cardiology,
pulmonology,
neuropsychology, etc.);
 Guide for Aviation Medical Examiners
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 List of current medications
and side effects, if any;
 Hospital discharge
summary; and
 Copies of imaging reports
and lab (if already
performed).

E. All others Submit the following to the

FAA for review: DEFER**
Ongoing residual  Current clinical status Note in Block 60:
Signs and/or report from the treating “Currently experiencing
Symptoms* of physician describing the sequelae from COVID-19
confirmed COVID-19 sequelae, treatment plan, infection to include…
such as: and prognosis; [List the pathology or
 Cardiovascular dysfunction;  Specialty consultations symptoms].”
 Cognitive symptoms or performed (ex: neurology,
concerns; cardiology, pulmonology, Submit the information to
 Kidney injury; neuropsychology, etc.); the FAA for review.
 Neurological dysfunction;  List of medications and
 Psychiatric conditions side effects, if any;
(depression, anxiety,  Hospital discharge
moodiness); summary;
 Respiratory abnormalities; (if applicable); and
and/or  Copies of imaging reports
 Symptoms such as fatigue, and lab (if already
shortness of breath, cough, performed by treating
arthralgia, or chest pain. physician).
 6MWT (in some cases)

* See Anosmia Disposition Table for evaluation criteria

**DEFER - If the AME defers the exam, the FAA will request additional information, including hospitalization
and treating physician records. After review, the FAA will determine eligibility for airman medical certificate or if
special issuance or denial is indicated.
 Guide for Aviation Medical Examiners
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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Diabetes, Pre-Diabetes, Metabolic Syndrome, and/or

Insulin Resistance

Diabetes Insipidus All Submit all pertinent Requires FAA Decision

medical records;
current status to
include names and
dosage of
medication(s) and
side effects

Pre-Diabetes (Metabolic All Review all pertinent Follow the CACI - Pre-
Syndrome, Impaired Fasting medical records; Diabetes Worksheet
Glucose, Insulin Resistance, current status to If airman meets all
Glucose Elevation/Intolerance,
Polycystic Ovary Syndrome)
include names and certification criteria –
dosage of Issue.
medication(s) and
side effects All others require FAA
decision. Submit all
evaluation data.

Diabetes Mellitus – Diet All See Diabetes If no glycosuria and

Controlled Mellitus -Diet normal HbA1c – Issue.
Controlled Protocol
All others require FAA
decision. Submit all
evaluation data.

Diabetes Mellitus II - All See Diabetes Initial Special

Medication Controlled Mellitus II - Issuance - Requires
(Non Insulin) Medication FAA Decision
Controlled (non
insulin) Protocol Follow-up Special
Issuances - See AASI
See chart of Protocol
Acceptable
Combinations of
Diabetes Medications
Diabetes Mellitus I & II - All See Diabetes Requires FAA Decision
Insulin Treated Mellitus I & II - Insulin
Treated Protocol
 Guide for Aviation Medical Examiners
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CACI - Pre-Diabetes Worksheet (Updated 04/13/2022)
(Metabolic Syndrome, Impaired Fasting Glucose, Insulin Resistance,
Glucose Elevation/Intolerance, Polycystic Ovary Syndrome)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no
more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable
certification criteria listed below, the AME can issue. Applicants for first- or second- class must
provide this information annually; applicants for third-class must provide the information with each
required exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA

Treating physician finds the [ ] Yes
condition stable on current
regimen and no changes
recommended
Symptoms associated with [ ] None
diabetes

Hypoglycemic events (symptoms [ ] None

or glucose less than or equal to
70 mg/dL) within the past 12
months.
Fasting blood sugar [ ] Less than 126 mg/dL

Current A1C [ ] Within last 90 days

[ ]Less than or equal to 6.5 mg/dL

Oral glucose tolerance test, if [ ] Less than 200 mg/dL at 2 hours

performed [ ] N/A

Medications for condition [ ] None

[ ] Metformin only (after a 14-day trial period with no side effects)

AME MUST NOTE in Block 60 either of the following:

[ ] CACI qualified Pre-Diabetes (Metabolic Syndrome, Impaired Fasting Glucose, Insulin Resistance, Glucose
Elevation/Intolerance, Polycystic Ovary Syndrome). (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified Pre-Diabetes (Metabolic Syndrome, Impaired
Fasting Glucose, Insulin Resistance, Glucose Elevation/Intolerance, Polycystic Ovary Syndrome).

[ ] NOT CACI qualified Pre-Diabetes (Metabolic Syndrome, Impaired Fasting Glucose, Insulin Resistance, Glucose
Elevation/Intolerance, Polycystic Ovary Syndrome). I have deferred. (Submit supporting documents.)
 Guide for Aviation Medical Examiners
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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Endocrine Disorders
Acromegaly All Submit all pertinent Requires FAA Decision
medical records;
current status to
include names and
dosage of
medication(s) and side
effects
Addison's Disease All Submit all pertinent Requires FAA Decision
medical records;
current status to
include names and
dosage of
medication(s) and side
effects
Cushing's Disease or All Submit all pertinent Requires FAA Decision
Syndrome medical records;
current status to
include names and
dosage of
medication(s) and side
effects
Hypoglycemia, whether All Submit all pertinent Requires FAA Decision
functional or a result of medical records;
pancreatic tumor current status to
include names and
dosage of
medication(s) and side
effects
Hyperparathyroidism All Submit all pertinent If status post-surgery,
medical records; disease controlled, stable
current status; include and no sequela
names and dosage of - Issue
medication(s) and side
effects, and current Otherwise - Requires
serum calcium and FAA Decision
phosphorus levels
Hypoparathyroidism All Submit all pertinent Requires FAA Decision
medical records;
current status; include
names and dosage of
medication(s) and side
effects and current
serum calcium and
phosphorus levels
 Guide for Aviation Medical Examiners
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DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Endocrine Disorders
Hyperthyroidism All Submit all pertinent Initial Special
medical records; Issuance – Requires
current status to FAA Decision
include names and
dosage of Follow-up Special
medication(s) and Issuances – See AASI
side effects and Protocol
current TFTs
Hypothyroidism All Review all pertinent Follow the CACI -
medical records; Hypothyroidism
current status to Worksheet. If
include names and airman meets all
dosage of certification criteria –
medication(s) and Issue.
side effects and
current TFTs All others require FAA
decision. Submit all
evaluation data.

Initial Special
Issuance – Requires
FAA Decision

Follow-up Special
Issuances – See AASI
Protocol
Proteinuria & Glycosuria All Submit all pertinent Trace or 1+ protein
medical records; and glucose
current status to intolerance ruled out
include names and - Issue
dosage of Otherwise - Requires
medication(s) and FAA Decision
side effects
 Guide for Aviation Medical Examiners
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CACI - Hypothyroidism Worksheet (Updated 04/13/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more
than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification
criteria listed below, the AME can issue. Applicants for first- or second- class must provide this
information annually; applicants for third-class must provide the information with each required
exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA

Treating physician finds the [ ] Yes
condition stable on current
regimen and no changes
recommended

Symptoms and signs [ ] None of the following: fatigue, mental status impairment, or
symptoms related to pulmonary, cardiac, or visual systems

Acceptable medications [ ] Levothyroxine sodium (Synthroid, Levothyroid), porcine thyroid

(Armour), liothyronine sodium (Cytomel), or liotrix (Thyrolar)

Normal TSH within the last one [ ] Yes

year

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified hypothyroidism. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified hypothyroidism.

[ ] NOT CACI qualified hypothyroidism. I have deferred. (Submit supporting documents.)

 Guide for Aviation Medical Examiners
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Gender Dysphoria
All Classes
Updated 01/27/2016

CONDITION EVALUATION DATA DISPOSITION

A.
Completed gender reassignment If there is no evidence of a mental health ISSUE
surgery 5 or more years ago diagnosis and the airman is doing well on Annotate Block 60
current treatment:
OR

Treated with hormone therapy

for 5 or more years

B. Submit the following to the FAA for review:

Treated with Hormone therapy* DEFER
for less than 5 years  A completed FAA Gender Dysphoria Submit the
Mental Health Status Report or an information to the
OR evaluation from the treating physician, FAA for review.
using World Professional Association for
Gender reassignment
Transgender Health guidelines (WPATH), Follow up
surgery less than 5 years ago
which addresses items listed in the Mental Issuance
Health Status Report. Will be per the
OR
airman’s
History of a coexisting  Updated evaluations AFTER: authorization
mental health concern letter
 Hormone therapy:
OR If on hormones, a current status report
describing the length of time on the
History of mental health medication and side effects, if any.
treatment such as psychotherapy
or medications for any condition  Surgery:
other than Gender Dysphoria If surgery has been performed within the
last one year, a status report from the
(Information is required if the airman has ever
had a mental health diagnosis [including surgeon or current treating physician
substance use disorder] or has received showing full release, off any sedation or
treatment for a mental health condition at any
time. If treatment was short-term counseling pain medication, and any surgical
for Gender Dysphoria only, note in Block 60.) complications (e.g. DVT/PE/cardiac,
etc.).
Notes:

The AME may ISSUE (no further information is needed), if the airman:
 Was evaluated for or diagnosed with Gender Dysphoria and has never undergone treatment (counseling or support group for GD does
not require information);
 Has no history of other mental health diagnoses or treatment; and
 Is otherwise qualified

*Side effects from hormone therapy can be aeromedically significant. The airman should be warned not to fly per Title 14 CFR 61.53 if they
experience medication side effects.
 Guide for Aviation Medical Examiners
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FAA Gender Dysphoria Mental Health Status Report

(Updated 06/24/2020)

Name _____________________________________ Birthdate ____________________________

Applicant ID# _______________________________ PI# _________________________________

The following information must be addressed in the treating provider’s evaluation. Evaluation should be performed in accordance with
a comprehensive mental health assessment following the World Professional Association for Transgender Health (WPATH)
guidelines (Note: Link must be opened in Google Chrome.)
Submit either this status report sheet* or supporting documentation addressing each item to your AME or to the FAA at:

Federal Aviation Administration

Civil Aerospace Medical Institute, Bldg. 13
Aerospace Medical Certification Division, AAM-300
PO Box 25082
Oklahoma City, OK 73125-9867

1. I am a board certified psychiatrist or licensed psychologist AND I meet the criteria

[ ] Yes [ ] No-explain
for a qualified mental health professional” per WPATH
(current version) guidelines.

2. This airman meets the DSM-5 diagnostic criteria for Gender Dysphoria [ ] Yes [ ] No-explain
and the condition is not secondary to, or better accounted for, by other diagnoses.

3. PSYCHIATRIC HISTORY:
Current mental health diagnosis or coexisting mental health concerns….............. [ ] None [ ] Yes-explain
Previous mental health diagnosis or coexisting mental health concerns................ [ ] None [ ] Yes-explain
ER visit or hospitalization for any psychiatric illness or condition ever………......... [ ] None [ ] Yes-explain
Any suicide attempt(s) ever.....………..………………………………………….......... [ ] None [ ] Yes-explain
Substance Use disorder per DSM-5…………………………………………………… [ ] None [ ] Yes-explain
(e.g. alcohol, cannabis, stimulants, hallucinogens, opioids)

4. PSYCHIATRIC TREATMENT: (List start and end dates on each. For medications,
also note name, dose, and side effects, if any.)
Current use………………………………………………………………………………. [ ] None [ ] Yes-explain
Previous use…………………………………………………………………………….. [ ] None [ ] Yes-explain
Psychotherapy for any condition other than GD (e.g. depression, anxiety)……….. [ ] None [ ] Yes-explain
Other treatments (e.g. cognitive therapy, talk therapy, electroconvulsive therapy) [ ] None [ ] Yes-explain

5. CURRENT STATUS: Airman is doing well. There are no mental health [ ] Yes [ ] No-explain
concerns. Psychotherapy (if any) is for gender dysphoria only. No other
treatment is needed (do not include support group or support
group counseling).

6. Any evidence of cognitive dysfunction or is a formal neuropsychological [ ] None [ ] Yes-explain

evaluation indicated?

7. Do you have ANY concerns regarding this airman? [ ] None [ ] Yes-explain

___________________________________________ ___________________________________
Treating Provider Signature Date of Evaluation

________________________________________ ____________________________________
Name or Office Stamp Phone Number

*For any response which requires further explanation, submit supporting documentation. In some cases,
actual records will be required.
 Guide for Aviation Medical Examiners
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Human Immunodeficiency Virus (HIV)

All Classes
Updated 10/30/2019

DISEASE/CONDITION EVALUATION DATA DISPOSITIONS

HIV medication taken for Review a current status
long-term prevention or Pre- report from the prescribing ISSUE
Exposure Prophylaxis (PrEP) physician that verifies:
in an HIV negative airman* Note this in Block 60 and submit
 HIV status is the initial current status and lab
Note: This does NOT include use negative; report to FAA for retention in the
for short-term Post-Exposure
 Appropriate lab airman’s file.
Prophylaxis (PEP) - (ex: healthcare
exposure.) studies are being
monitored; Inform the airman that if they
 Medication is develop any problems with the
Truvada medication, change in
(tenofovir-emtricitabine) or prophylactic medications, or
Descovy (emtricitabine seroconvert to HIV+ status they
and tenofovir alafenamide); must report this to the FAA.
and
 No side effects For continued certification:
from the If no change in medication and
medication. HIV status remains negative, the
AME may issue and note this in
Block 60.
Human Immunodeficiency See HIV Protocol
Virus (HIV) DEFER

Use this disposition if the airman Requires FAA Decision

has a history of HIV only.
Acquired See HIV Protocol
Immunodeficiency DEFER
Syndrome (AIDS) Requires FAA Decision

Use this disposition if the airman

has EVER had a history of AIDS.
 Guide for Aviation Medical Examiners
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Breast Cancer
All Classes
Updated 09/27/2017

DISEASE/CONDITION EVALUATION DATA DISPOSITION

A. If no recurrence, current problems, or ongoing
Non metastatic – treatment: ISSUE
treatment completed Summarize this
5 or more years ago Continued hormone treatment is allowed history in Block 60.
(tamoxifen, aromatase inhibitor)
B. See CACI worksheet Follow the CACI –
Non metastatic – Breast Cancer
treatment completed Worksheet.
Less than 5 years ago Annotate Block 60.

C. Submit the following to the FAA for review:

All others  Status report or treatment records from DEFER
Chemotherapy used treating oncologist that provides the Submit the
Lymph node spread following information: information to the
Metastatic disease o Initial staging, FAA for a possible
Stage IA or higher o Disease course including recurrence(s), Special Issuance.
o Location(s) of metastatic disease (if
any), Follow up Issuance
o Treatments used, Will be per the
o How long the condition has been stable, airman’s
o If any upcoming treatment change is authorization letter.
planned or expected and prognosis;

 Medication list. Dates started and stopped.

Description of side effects, if any;
 Operative notes and discharge summary
(if applicable);
 Copies of lab including pathology reports,
tumor markers (if already performed by
treating physician);
 Copies of imaging such as mammogram,
MRI/CT or PET scan reports that have
already been performed (In some cases, the
actual CDs will be required in DICOM format for
FAA review).
 Guide for Aviation Medical Examiners
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CACI – Breast Cancer Worksheet (Updated 04/27/2022)

To determine the applicant’s eligibility for certification, the AME must review a current, detailed
Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more
than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification
criteria listed below, the AME can issue. Applicants for first- or second-class must provide this
information annually; applicants for third-class must provide the information with each required
exam.

AME MUST REVIEW ACCEPTABLE CERTIFICATION

CRITERIA
The pathology showed: [ ] Yes
Carcinoma in Situ (Tis), Stage 0;
Ductal Carcinoma in Situ (DCIS);
Lobular Carcinoma in Situ (LCIS);
Paget disease of the breast (Tis)
The treating physician’s current, detailed Clinical Progress [ ] Yes
Note verifies:
 Condition is stable with no spread or reoccurrence
and no evidence of disease (NED).
 Radiation therapy (if any) is completed
 If surgery has been performed, the airman is off all
pain medication(s), has made a full recovery, and has
been released by the surgeon.
 The airman is back to full, unrestricted activities and
no new treatment is recommended at this time.
Any evidence of: [ ] No
 Stage IA or higher
 Invasive or metastatic disease
 Use of chemotherapy for this condition at any time
Current medication(s): [ ] None; or
Approved medications include:
tamoxifen (Nolvadex); [ ] An approved medication that is being
Aromatase inhibitors: anastrozole (Arimidex), letrozole well tolerated with no side effects
(Femara), or exemestane (Aromasin)

Notes: If it has been 5 or more years since the airman has had any treatment (surgery or radiation) for this condition,
has no history of metastatic disease, and no reoccurrence, CACI is not required. Note this in Block 60.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified breast cancer (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified breast cancer.
[ ] NOT CACI qualified breast cancer. I have deferred. (Submit supporting documents.)
 Guide for Aviation Medical Examiners
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Neoplasms
All Classes
(Updated 09/27/2017)

DISEASE/CONDITION EVALUATION DATA DISPOSTITIONS

Also see:

Acoustic Neuroma
Colon/ Rectal Cancer and other
Abdominal Malignancies
G-U System Cancers
Kaposi’s Sarcoma
Leukemias and Lymphomas
Malignant Melanomas
Eye Tumors
 Guide for Aviation Medical Examiners
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Pregnancy

Pregnancy under normal circumstances is not disqualifying. It is recommended that the

applicant's obstetrician be made aware of all aviation activities so that the obstetrician can
properly advise the applicant. The AME may wish to counsel applicants concerning
piloting aircraft during the third trimester. The proper use of lap belt and shoulder harness
warrants discussion.
 Guide for Aviation Medical Examiners
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Primary Hemochromatosis
All Classes
Updated 10/27/2021
DISEASE/CONDITION EVALUATION DATA DISPOSITION
A. Tested and found not to No evaluations or follow up needed.
have the disease. ISSUE
Carrier status in the Summarize this
absence of disease is not history in Block 60.
disqualifying.
B. Asymptomatic See CACI worksheet Follow the CACI-Primary
Hemochromatosis
Worksheet.
Annotate Block 60.
C. Symptomatic Submit the following to the FAA for review:
DEFER
OR
 Current evaluation from a board-certified Submit the information to
Evidence of End Organ gastroenterologist, hepatologist, or the FAA for a possible
Damage hematologist which documents course of Special Issuance.
disease from diagnosis to present; severity
OR of the condition; presence or absence of Follow up Issuance will
Co-morbid conditions* joint, liver, CNS, endocrine, renal or be per the airman’s
hematologic disease; pertinent historical lab authorization letter.
 Unacceptable summary; and evidence of any cognitive
medications are used; changes. Evaluation should document
stability, treatment plan, and prognosis.
 Side effects are present;  List of medications and side effects, if any
 Current Lab (within the past 90 days)
 Phlebotomy performed  CBC, serum iron, ferritin level, and
more than monthly; transferrin saturation
and/or  Comprehensive metabolic panel
 Hemoglobin A1c
 Iron overload caused by  TSH
other mechanisms or  Resting EKG
diseases (e.g. secondary  Echocardiogram
hemochromatosis  Liver/cardiac imaging and biopsies (only if
clinically indicated)
 Any other testing clinically indicated
Note: *Co-morbid conditions for FAA purposes include:
 Arthropathy;
 Cardiomyopathy or other cardiac disease;
 Cirrhosis or other documented hepatic disease;
 CNS disease (including cognitive deficits);
 Endocrine disease including diabetes, hypopituitarism, hypogonadism, or hypothyroidism;
 Kidney disease;
 Polycythemia;
 Myeloproliferative disorders; and/or
 Other condition requiring multiple transfusions
 Guide for Aviation Medical Examiners
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CACI – Primary Hemochromatosis Worksheet

(Updated 04/13/2022)

To determine the applicant’s eligibility for certification, the AME must review a current,
detailed Clinical Progress Note generated from a clinic visit with the treating physician or
specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the
acceptable certification criteria listed below, the AME can issue. Applicants for first- or
second-class must provide this information annually; applicants for third-class must provide
the information with each required exam.

AME MUST REVIEW ACCEPTABLE

CERTIFICATION CRITERIA
Treating physician finds the condition is: [ ] Yes
 Stable and asymptomatic;
 NOT due to a secondary hemochromatosis;
and
 No treatment changes recommended
Treating physician documents NO evidence of: [ ] Yes
 Arthropathy;
 Cardiomyopathy or other cardiac disease;
 Cirrhosis or other hepatic disease;
 CNS disease (including cognitive deficits);
 Endocrine disease including diabetes;
hypopituitarism, hypogonadism, or
hypothyroidism;
 Kidney disease;
 Polycythemia;
 Myeloproliferative disorders; and/or
 Other condition requiring multiple transfusions
Labs (within past 90 days): [ ] Yes
 Hemoglobin 11 mg/dL or higher
 Ferritin level less than or equal to 150 ng/mL
Current treatment: [ ] None or dietary changes
OR
Note: Maintain hydration following phlebotomy and no fly for 24 [ ] Phlebotomy no more
hours. If more than one unit of blood is removed (greater than frequently than monthly
500mL), no fly time is 72 hours.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Primary Hemochromatosis

[ ] Has current OR previous SI/AASI but now CACI qualified Primary Hemochromatosis.

[ ] NOT CACI qualified Primary Hemochromatosis. I have deferred. (Submit supporting documents.)
 Guide for Aviation Medical Examiners
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AME OFFICE-REQUIRED ANCILLARY TESTING

Items 49-580 of FAA Form 8500-8
 Guide for Aviation Medical Examiners
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ITEM 49. Hearing

49. Hearing Record Audiometric Speech

Discrimination Score Below
Conversational
Voice Test at 6 Feet
Pass Fail

I. Code of Federal Regulations

All Classes: 14 CFR 67.105(a)(b)(c), 67.205(a)(b)(c), and 67.305(a)(b)(c)

(a) The person shall demonstrate acceptable hearing by at least one of the following
tests:

(1) Demonstrate an ability to hear an average conversational voice in a quiet

room, using both ears, at a distance of 6 feet from the AME, with the
back turned to the AME.

(2) Demonstrate an acceptable understanding of speech as determined by

audiometric speech discrimination testing to a score of at least 70 percent
obtained in one ear or in a sound field environment.

(3) Provide acceptable results of pure tone audiometric testing of unaided

hearing acuity according to the following table of worst acceptable
thresholds, using the calibration standards of the American National
Standards Institute, 1969 (11 West 42nd Street, New York, NY 10036):

Frequency (Hz) 500 Hz 1000 Hz 2000 Hz 3000 Hz

Better ear (Db) 35 30 30 40

Poorer ear (Db) 35 50 50 60

(b) No disease or condition of the middle or internal ear, nose, oral cavity, pharynx,
or larynx that-

(1) Interferes with, or is aggravated by, flying or may reasonably be expected to

do so; or

(2) Interferes with, or may reasonably be expected to interfere with, clear and
effective speech communication.

(c) No disease or condition manifested by, or that may reasonably be expected to be

manifested by, vertigo or a disturbance of equilibrium.
 Guide for Aviation Medical Examiners
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II. Examination Equipment and Techniques

A. Order of Examinations

1. The applicant must demonstrate an ability to hear an average conversational voice in

a quiet room, using both ears, at a distance of 6 feet from the AME, with the back
turned to the AME.

2. If an applicant fails the conversational voice test, the AME may administer pure tone
audiometric testing of unaided hearing acuity according to the following table of worst
acceptable thresholds, using the calibration standards of the American National
Standards Institute, 1969:

1 2 3
5
0 0 0
0
0 0 0
Frequency (Hz) 0
0 0 0
H
H H H
z
z z z
3 3 3 4
Better ear (Db)
5 0 0 0
3 5 5 6
Poorer ear (Db)
5 0 0 0

If the applicant fails an audiometric test and the conversational voice test had not been
administered, the conversational voice test should be performed to determine if the
standard applicable to that test can be met.

3. If an applicant is unable to pass either the conversational voice test or the pure tone
audiometric test, then an audiometric speech discrimination test should be
administered. A passing score is at least 70 percent obtained in one ear at an
intensity of no greater than 65 Db.

B. Discussion

1. Conversational voice test. For all classes of certification, the applicant must
demonstrate hearing of an average conversational voice in a quiet room, using both
ears, at 6 feet, with the back turned to the AME. The AME should not use only
sibilants (S-sounding test materials). If the applicant is able to repeat correctly the test
numbers or words, "pass" should be noted and recorded on FAA Form 8500-8,
Item 49. If the applicant is unable to hear a normal conversational voice then "fail"
should be marked and one of the following tests may be administered.

2. Standard. For all classes of certification, the applicant may be examined by pure tone
audiometry as an alternative to conversational voice testing or upon failing the
conversational voice test. If the applicant fails the pure tone audiometric test and has
not been tested by conversational voice, that test may be administered. The
requirements expressed as audiometric standards according to a table of acceptable
thresholds (American National Standards Institute [ANSI], 1969, calibration) are as
follows:
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EAR(All classes of medical certification)
Frequency (Hz) 500 Hz 1000 Hz 2000 Hz 3000 Hz
Better ear (Db) 35 30 30 40
Poorer ear (Db) 35 50 50 60

3. Audiometric Speech Discrimination. Upon failing both conversational voice and pure
tone audiometric test, an audiometric speech discrimination test should be
administered (usually by an otologist or audiologist). The applicant must score at least
70 percent at intensity no greater than 65 Db in either ear.

C. Equipment

1. Approval. The FAA does not approve or designate specific audiometric equipment for
use in medical certification. Equipment used for FAA testing must accurately and
reliably cover the required frequencies and have adequate threshold step features.
Because every audiometer manufactured in the United States for
screening and diagnostic purposes is built to meet appropriate standards, most
audiometers should be acceptable if they are maintained in proper calibration and are
used in an adequately quiet place.

2. Calibration. It is critical that any audiometer be periodically calibrated to ensure its

continued accuracy. Annual calibration is recommended. Also recommended is the
further safeguard of obtaining an occasional audiogram on a "known" subject or staff
member between calibrations, especially at any time that a test result unexpectedly
varies significantly from the hearing levels clinically expected. This testing provides an
approximate "at threshold" calibration. The AME should ensure that the audiometer is
calibrated to ANSI standards or if calibrated to the older ASA/USASI standards, the
appropriate correction is applied (see paragraph 3 below).

3. ASA/ANSI. Older audiometers were often calibrated to meet the standards specified
by the USA Standards Institute (USASI), formerly the American Standards Association
(ASA). These standards were based upon a U.S. Public Health Service survey.
Newer audiometers are calibrated so that the zero hearing threshold level is now
based on laboratory measurements rather than on the survey. In 1969, the American
National Standards Institute (ANSI) incorporated these new measurements.
Audiometers built to this standard have instruments or dials that read in ANSI values.
For these reasons, it is very important that every audiogram submitted (for values
reported in Item 49 on FAA Form 8500-8) include a note indicating whether it is ASA
or ANSI. Only then can the FAA standards be appropriately applied. ASA or USASI
values can be converted to ANSI by adding corrections as follows:

Frequency (Hz) 500 Hz 1,000 Hz 2,000 Hz 3,000 Hz

Decibels Added* 14 10 8.5 8.5

* The decibels added figure is the amount added to ASA or USASI at each
specific frequency to convert to ANSI or older equivalent ISO values.
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III. Aerospace Medical Disposition

1. Special Issuance of Medical Certificates. Applicants who do not meet the auditory
standards may be found eligible for a SODA. An applicant seeking a SODA must
make the request in writing to the Aerospace Medicine Certification Division, AAM-
300. A determination of qualifications will be made on the basis of a special medical
examination by an ENT consultant, a MFT, or operational experience.

2. Bilateral Deafness. See Items 25-30. If otherwise qualified, when the student pilot's
instructor confirms the student's eligibility for a private pilot checkride, the applicant
should submit a written request to the AMCD for an authorization for a MFT. This test
will be given by an FAA inspector in conjunction with the checkride. If the applicant
successfully completes the test, the FAA will issue a third-class medical certificate and
SODA. Pilot activities will be restricted to areas in which radio communication is not
required.

3. Hearing Aids. If the applicant requires the use of hearing aids to meet the standard,
issue the certificate with the following restriction:

VALID ONLY WITH USE OF HEARING AMPLIFICATION

Some pilots who normally wear hearing aids to assist in communicating while on the
ground report that they elect not to wear them while flying. They prefer to use the
volume amplification of the radio headphone. Some use the headphone on one ear
for radio communication and the hearing aid in the other for cockpit communications.
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ITEMS 50-54. Vision Testing (Updated 05/29/2019)

Visual Acuity Standards:

 As listed below or better;

 Each eye separately;
 Snellen equivalent; and
 With or without correction. If correction is used, it should be noted and the correct limitation applied.

First or Second Class Third Class

Distant Vision 20/20 20/40

Near Vision 20/40 20/40

Measured at 16 inches

Intermediate Vision 20/40 No requirement

Measured at 32 inches;
Age 50 and over only

ITEM 50. Distant Vision

(Updated 06/28/2017)

I. Code of Federal Regulations

First- and Second-Classes: 14 CFR 67.103(a) and 67.203(a)

(a) Distant visual acuity of 20/20 or better in each eye separately, with or without
corrective lenses. If corrective lenses (spectacles or contact lenses) are necessary for
20/20 vision, the person may be eligible only on the condition that corrective lenses
are worn while exercising the privileges of an airman certificate

Third-Class: 14 CFR 67.303(a)

(a) Distant visual acuity of 20/40 or better in each eye separately, with or without
corrective lenses. If corrective lenses (spectacles or contact lenses) are necessary for
20/40 vision, the person may be eligible only on the condition that corrective lenses
are worn while exercising the privileges of an airman certificate.

II. Examination Equipment and Techniques

Note: If correction is required to meet standards, only corrected visual acuity needs to be
tested and recorded.
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Equipment:

1. Snellen 20-foot eye chart may be used as follows:

a. The Snellen chart should be illuminated by a 100-watt incandescent lamp placed 4 feet
in front of and slightly above the chart.

b. The chart or screen should be placed 20 feet from the applicant's eyes and the 20/20
line should be placed 5 feet 4 inches above the floor.

c. A metal, opaque plastic, or cardboard occluder should be used to cover the eye not
being examined.

d. The examining room should be darkened with the exception of the illuminated chart or
screen.

e. If the applicant wears corrective lenses, only the corrected acuity needs to be
checked and recorded. If the applicant wears contact lenses, see the
recommendations in Chapter 3. Items 31-34, Section II, #5,

f. Common errors:

1. Failure to shield the applicant's eyes from extraneous light.

2. Permitting the applicant to view the chart with both eyes.

3. Failure to observe the applicant's face to detect squinting.

4. Incorrect sizing of projected chart letters for a 20-foot distance.

5. Failure to focus the projector sharply.

6. Failure to obtain the corrected acuity when the applicant wears glasses.

2. Acceptable Substitutes for Distant Vision Testing: any commercially available visual
acuities and heterphoria testing devices.

There are specific approved substitute testers for color vision, which may not
include some commercially available vision testing machines. For an approved
list, see Item 52. Color Vision.

3. Directions furnished by the manufacturer or distributor should be followed when using

the acceptable substitute devices for the above testing.

Examination Techniques:

1. Each eye will be tested separately, and both eyes together.

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III. Aerospace Medical Disposition

A. When corrective lenses are required to meet the standards, an appropriate limitation
will be placed on the medical certificate. For example, when lenses are needed for
distant vision only:

HOLDER SHALL WEAR CORRECTIVE LENSES

For multiple vision defects involving distant and/or intermediate and/or near vision
when one set of monofocal lenses corrects for all, the limitation is:

HOLDER SHALL WEAR CORRECTIVE LENSES

For combined defective distant and near visual acuity where multifocal lenses are
required, the appropriate limitation is:

HOLDER SHALL WEAR LENSES THAT CORRECT FOR DISTANT VISION AND
POSSESS GLASSES THAT CORRECT FOR NEAR VISION

For multiple vision defects involving distant, near, and intermediate visual acuity
when more than one set of lenses is required to correct for all vision defects, the
appropriate limitation is:

HOLDER SHALL WEAR LENSES THAT CORRECT FOR DISTANT VISION AND
POSSESS GLASSES THAT CORRECT FOR NEAR AND INTERMEDIATE VISION

B. An applicant who fails to meet vision standards and has no SODA that covers the
extent of the visual acuity defect found on examination may obtain further FAA
consideration for grant of an Authorization under the special issuance section of
part 67 (14 CFR 67.401) for medical certification by submitting a report of an eye
evaluation. The AME can help to expedite the review procedure by forwarding a
copy of FAA Form 8500-7, Report of Eye Evaluation that has been completed by an
eye specialist (optometrist or ophthmologist) 1.

C. Applicants who do not meet the visual standards should be referred to a specialist for
evaluation. Applicants with visual acuity or ocular muscle balance problems may be
referred to an eye specialist of the applicant's choice. The FAA Form 8500-7, Report
of Eye Evaluation, should be provided to the specialist by the AME.

1
In obtaining special eye evaluations in respect to the airman medical certification program, reports from an
eye specialist are acceptable when the condition being evaluated relates to a determination of visual acuity,
refractive error, or mechanical function of the eye. The FAA Form 8500-7, Report of Eye Evaluation, is a form
that is designed for use by either optometrists or ophthalmologists.
 Guide for Aviation Medical Examiners
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D. Any applicant eligible for a medical certificate through special issuance under
these guidelines shall pass a MFT, which may be arranged through the
appropriate agency medical authority.

E. Amblyopia. In amblyopia ex anopsia, the visual acuity of one eye is decreased

without presence of organic eye disease, usually because of strabismus or
anisometropia in childhood. In amblyopia ex anopsia, the visual acuity loss is simply
recorded in Item 50 of FAA form 8500-8, and visual standards are applied as usual.
If the standards are not met, a report of eye evaluation, FAA Form 8500-7, should be
submitted for consideration.

ITEM 51.a. Near Vision

ITEM 51.b. Intermediate Vision

Visual Acuity Standards:

 As listed below or better;

 Each eye separately;
 Snellen equivalent; and
 With or without correction. If correction is used, it should be noted and the correct limitation applied.

First or Second Class Third Class

Near Vision 20/40 20/40

Measured at 16 inches

Intermediate Vision 20/40 No requirement

Measured at 32 inches;
Age 50 and over only

I. Code of Federal Regulations

First- and Second-Classes: 14 CFR 67.103(b) and 67.203(b)

(b) Near vision of 20/40 or better, Snellen equivalent, at 16 inches in each eye
separately, with or without corrective lenses. If age 50 or older, near vision of 20/40 or
better, Snellen equivalent, at both 16 inches and 32 inches in each eye separately,
with or without corrective lenses.

Third-Class: 14 CFR 67.303(b)

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(b) Near vision of 20/40 or better, Snellen equivalent, at 16 inches in each eye
separately, with or without corrective lenses.

II. Equipment and Examination Techniques

Note: If correction is required to meet standards, only corrected visual acuity needs to be
tested and recorded.

Equipment:

1. FAA Form 8500-1, Near Vision Acuity Test Chart, dated April 1993.

2. For testing near at 16 inches and intermediate at 32 inches, acceptable substitutes:

any commercially available visual acuities and heterophoria testing devices. For
testing of intermediate vision, some equipment may require additional apparatus.

There are specific approved substitute testers for color vision, which may not
include some commercially available vision testing machines. For an approved
list, see Item, 52. Color Vision.

Examination Techniques:

1. Near visual acuity and intermediate visual acuity, if the latter is required, are
determined for each eye separately and for both eyes together. If the applicant needs
glasses to meet visual acuity standards, the findings are recorded, and the certificate
appropriately limited. If an applicant has no lenses that bring intermediate and/or near
visual acuity to the required standards, or better, in each eye, no certificate may be
issued, and the applicant is referred to an eye specialist for appropriate visual
evaluation and correction.

2. FAA Form 8500-1, Near Vision Acuity Test Chart, dated April 1993, should be used as
follows:

f. The examination is conducted in a well-lighted room with the source of light

behind the applicant.

g. The applicant holds the chart 16 inches (near) and 32 inches (intermediate)
from the eyes in a position that will provide uniform illumination. To ensure that
the chart is held at exactly 16 inches or 32 inches from the eyes, a string of that
length may be attached to the chart.

h. Each eye is tested separately, with the other eye covered. Both eyes are then
tested together.

i. The smallest type correctly read with each eye separately and both eyes
together is recorded in linear value. In performing the test using FAA
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Form 8500-1, the level of visual acuity will be recorded as the line of smallest
type the applicant reads accurately. The applicant should be allowed no more
than two misread letters on any line.

j. Common errors:

1. Inadequate illumination of the test chart.

2. Failure to hold the chart the specified distance from the eye.
3. Failure to ensure that the untested eye is covered.

k. Practical Test. At the bottom of FAA Form 8500-1 is a section for Aeronautical
Chart Reading. Letter types and charts are reproduced from aeronautical
charts in their actual size.

This may be used when a borderline condition exists at the certifiable limits of
an applicant's vision. If successfully completed, a favorable certification action
may be taken.

3. Acceptable substitute equipment may be used. Directions furnished by the

manufacturer or distributor should be followed when using the acceptable substitute
devices for the above testing.

III. Aerospace Medical Disposition

When correcting glasses are required to meet the near and intermediate vision standards, an
appropriate limitation will be placed on the medical certificate. Contact lenses that correct
only for near or intermediate visual acuity are not considered acceptable for aviation duties.

If the applicant meets the uncorrected near or intermediate vision standard of 20/40, but
already uses spectacles that correct the vision better than 20/40, it is recommended that the
AME enter the limitation for near or intermediate vision corrective glasses on the certificate.

For all classes, the appropriate wording for the near vision limitation is:

HOLDER SHALL POSSESS GLASSES THAT CORRECT FOR NEAR VISION

Possession only is required, because it may be hazardous to have distant vision obscured by
the continuous wearing of reading glasses.

For first- and second-class, the appropriate wording for combined near and intermediate
vision limitation is:

HOLDER SHALL POSSESS GLASSES THAT CORRECT FOR NEAR AND

INTERMEDIATE VISION
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For multiple defective distant, near, and intermediate visual acuity when unifocal glasses or
contact lenses are used and correct all, the appropriate limitation is:

HOLDER SHALL WEAR CORRECTIVE LENSES

For multiple vision defects involving distance and/or near and/or intermediate visual acuity
when more than one set of lenses is required to correct for all vision defects, the appropriate
limitation is:

HOLDER SHALL WEAR LENSES THAT CORRECT FOR DISTANT VISION AND
POSSESS GLASSES THAT CORRECT FOR NEAR AND INTERMEDIATE VISION

ITEM 52. Color Vision

(Updated 03/30/2022)
52. Color Vision

Pass

Fail

I. Code of Federal Regulations

First- and Second-Classes: 14 CFR 67.103(c) and 67.203(c)

(c) Color vision: Ability to perceive those colors necessary for the safe performance
of airman duties.

Third-Class: 14 CFR 67.303(c)

(c) Color vision: Ability to perceive those colors necessary for the safe performance
of airman duties.

II. Examination Equipment and Techniques

TESTS APPROVED FOR AIRMEN ARE NOT ALL ACCEPTABLE FOR AIR TRAFFIC CONTROLLERS
(ATCS - FAA employee 2152 series and contract tower air traffic controllers). For ATCS color vision
criteria, see Acceptable Test Instruments for Color Vision Screening of ATCS chart at the end of
this section or contact a Regional Flight Surgeon.

Note: If the airman fails acceptable color vision tests, then obtains an LOE or SODA - check fail
and add airman has LOE. If they pass any acceptable color vision test - mark pass.
 Guide for Aviation Medical Examiners
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The following equipment and techniques apply TO AIRMEN ONLY:

EQUIPMENT TEST EDITION PLATES

Pseudoisochromatic plates Test book should be held 30’’ from
applicant
Plates should be illuminated by at
least 20’ candles, preferably by a
Macbeth Easel Lamp or a Verilux
True Color Light (F15T8VLX)
Only three seconds are allowed for
the applicant to interpret and respond
to a given plate
American Optical Company 1965 1-15
[AOC]
AOC-HRR 2nd 1-11
Richmond-HRR 4th 5-24
Dvorine 2nd 1-15
Ishihara 14 Plate 1-11
24 Plate 1-15
38 Plate 1-21
Richmond, 15-plates 1983 1-15

Acceptable Substitutes: (May be used following the directions accompanying the

instruments) Farnsworth Lantern; OPTEC 900 Color Vision Test; Keystone Orthoscope;
Keystone Telebinocular; OPTEC 2000 Vision Tester (Model Nos. 2000 PM, 2000 PAME,
and 2000 PI) - Tester MUST contain 2000-010 FAR color perception PIP plate to be
approved; OPTEC 2500; Titmus Vision Tester; Titmus i400.

III. Aerospace Medical Disposition

TESTS APPROVED FOR AIRMEN ARE NOT ALL ACCEPTABLE FOR AIR TRAFFIC CONTROLLERS
(ATCS - FAA employee 2152 series and contract tower air traffic controllers). For ATCS color vision
criteria, see Acceptable Test Instruments for Color Vision Screening of ATCS chart at the end of
this section or contact a Regional Flight Surgeon.

The following criteria apply TO AIRMEN ONLY:

An applicant meets the color vision standard if he/she passes any of the color vision tests
listed in Examination Techniques, Item 52. Color Vision. If an applicant fails any of these
tests, inform the applicant of the option of taking any of the other acceptable color vision tests
listed in Item 52. Color Vision Examination Equipment and Techniques before requesting the
Specialized Operational Medical Tests in Section D below.

Inform the applicant that if he/she takes and fails any component of the Specialized
Operational Medical Tests in Section D, then he/she will not be permitted to take any
of the remaining listed office-based color vision tests in Examination Techniques, Item
52. Color Vision as an attempt to remove any color vision limits or restrictions on their
airman medical certificate. That pathway is no longer an option to the airman, and no new
result will be considered.
 Guide for Aviation Medical Examiners
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An applicant does not meet the color vision standard if testing reveals:

A. All Classes

1. AOC (1965 edition) pseudoisochromatic plates: seven or more errors on plates 1-15.
2. AOC-HRR (second edition): Any error in test plates 7-11. Because the first 4 plates in
the test book are for demonstration only, test plate 7 is actually the eleventh plate in
the book. (See instruction booklet.)
3. Dvorine pseudoisochromatic plates (second edition, 15 plates): seven or more errors
on plates 1-15.

4. Ishihara pseudoisochromatic plates: Concise 14-plate edition: six or more errors on

plates 1-11; the 24-plate edition: seven or more errors on plates 1-15; the 38-plate
edition: nine or more errors on plates 1-21.
5. Richmond (1983 edition) pseudoisochromatic plates: seven or more errors on plates
1-15.
6. OPTEC 900 Vision Tester and Farnsworth Lantern test: an average of more than one
error per series of nine color pairs in series 2 and 3. (See instruction booklet.)
7. Titmus Vision Tester, Titmus i400, OPTEC 2000 Vision Tester, Keystone Orthoscope,
or Keystone View Telebinocular: any errors in the six plates.
8. Richmond-HRR, 4th edition: two or more errors on plates 5-24. Plates 1-4 are for
demonstration only; plates 5-10 are screening plates; and plates 11-24 are diagnostic
plates.

B. Certificate Limitation. If an applicant fails to meet the color vision standard as interpreted
above, but is otherwise qualified, the AME must issue a medical certificate bearing the
limitation:

NOT VALID FOR NIGHT FLYING OR BY COLOR SIGNAL CONTROL

C. The color vision screening tests above (Section A) are not to be used for the purpose of
removing color vision limits/restrictions from medical certificates of airmen who have failed
the Specialized Operational Medical Tests below (Section D). See bold paragraph in the
introduction of this section (above).

D. Specialized Operational Medical Tests for Applicants Who Do Not Meet the Standard.
Applicants who fail the color vision screening test as listed, but desire an airman medical
certificate without the color vision limitation, may be given, upon request, an opportunity to
take and pass additional operational color perception tests. If the airman passes the
operational color vision perception test(s), then he/she will be issued a Letter of Evidence
(LOE).

 The operational tests are determined by the class of medical certificate requested.
The request should be in writing and directed to AMCD or RFS. See NOTE for
description of the operational color perception tests.
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 Applicants for a third-class medical certificate need only take the Operational Color
Vision Test (OCVT).

 The applicant is permitted to take the OCVT only once during the day. If the applicant
fails, he/she may request to take the OCVT at night. If the applicant elects to take the
OCVT at night, he/she may take it only once.

 For an upgrade to first- or second-class medical certificate, the applicant must first
pass the OCVT during daylight and then pass the color vision Medical Flight Test

(MFT). If the applicant fails the OCVT during the day, he/she will not be allowed to
apply for an upgrade to First- or Second-Class certificate. If the applicant fails the
color vision MFT, he/she is not permitted to upgrade to a first- or second-class
certificate.

E. An LOE may restrict an applicant to a third-class medical certificate. Airmen shall not be
issued a medical certificate of higher class than indicated on the LOE. Exercise care in
reviewing an LOE before issuing a medical certificate to an airman.

F. Color Vision Correcting Lens (e.g. X-Chrom). Such lenses are unacceptable to the FAA as
a means for correcting a pilot's color vision deficiencies.

G. Any tests not specifically listed above are unacceptable methods of testing for FAA
medical certificate. Examples of unacceptable tests include, but are not limited to:

UNACCEPTABLE TESTING FOR COLOR VISION (Updated 03/30/2022):

o The OPTEC 5000 Vision Tester (color vision portion)
o Farnsworth Lantern Flashlight aka Farnsworth Flashlight
o Farnsworth D-15
o “Yarn tests”
o AME-administered aviation Signal Light Gun Test (AME office use is
prohibited.)
o Web-based color vision applications, downloads, or printed versions of
color vision tests are also prohibited.

The AME must use actual color vision plates and testing machinery for applicant
evaluations.

NOTE: An applicant for a third-class airman medical certificate who has defective color vision and
desires an airman medical certificate without the color vision limitation must demonstrate the ability to
pass an Operational Color Vision Test (OCVT) during the day. The OCVT consists of the following:
1. A Signal Light Test (SLT): Identify in a timely manner aviation red, green, and white
2. Aeronautical chart reading: Read and correctly interpret in a timely manner aeronautical
charts including print in various sizes, colors, and typefaces; conventional markings in several
colors; and terrain colors.
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An applicant for a first- or second- class airman medical certificate who has defective color
vision and desires an airman medical certificate without the color vision limitation must first
demonstrate the ability to pass the OCVT during the day (as above) and then must pass a
color vision Medical Flight Test (MFT). The color vision MFT is performed in the aircraft,
including in-flight testing. It consists of the following:

1. Read and correctly interpret in a timely manner aviation instruments or displays

2. Recognize terrain and obstructions in a timely manner
3. Visually identify in a timely manner the location, color, and significance of aeronautical lights
such as, but not limited to, lights of other aircraft in the vicinity, runway lighting systems, etc.

Applicants who take and pass both the OCVT during the day and the color vision MFT will be given a
letter of evidence (LOE) valid for all classes of medical certificates and will have no limitation or
comment made on the certificate regarding color vision as they meet the standard for all classes.
Applicants who take and pass only the OCVT during the day will be given an LOE valid only for third-
class medical certificate.

An applicant who fails the SLT portion of the OCVT during daylight hours may repeat the test at night.
Should the airman pass the SLT at night, the restriction:

NOT VALID FOR FLIGHT DURING DAYLIGHT HOURS BY COLOR SIGNAL CONTROL

will be placed on the replacement medical certificate. The airman must have taken the daylight hours
test first and failed prior to taking the night test.
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Color Vision Testing Flowchart
Failed
Color Vision
Screening Test
Test

Limitation
Medical certificate limitation: “Not valid for
night flying or by color signal controls.”

Airman opts to take Letter of Evidence (LOE); Class 3 only.

Operational Color Vision (Must pass Color Vision Medical Flight
Test (OCVT) DAY Test for upgrade.)

YES
Pass ?
Airman opts to take
Color Vision Medical Flight Test
NO
LOE;
Upgrade
YES to Class 1
Medical certificate limitation remains: “Not valid Pass ? or Class 2
for night flying or by color signal controls.”
NO

No upgrade. LOE and

certificate remain Class 3
Airman opts to take
OCVT NIGHT

YES
Pass ? Medical certificate limitation: “Not valid for flight
during daylight hours by color signal controls.”

NO

Medical certificate limitation remains: “Not valid

for night flying or by color signal controls.”
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ACCEPTABLE TEST INSTRUMENTS FOR COLOR VISION SCREENING OF ATCS
(FAA EMPLOYEE 2152 SERIES and CONTRACT TOWER ATCSs)
Color Vision Test Does not meet the standard (fails) if: Supplier
Richmond
Richmond-HRR, 4th edition Any error on plates 5-10 Products
All Ishihara test plates approved for Ishihara
airmen:
14-Plate (plates 1-11) More than 6 errors on plates 1-11
24-Plate (plates 1-15) More than 2 errors on plates 1-15
38-Plate (plates 1-21) More than 4 errors on plates 1-21

No errors on the 6 total trials on plates 4 Keystone

Keystone View Telebinocular and 5 View
Titmus testers approved for airmen: Any errors on any of the 6 plates Titmus
Titmus

OPTEC 2000 Any errors on any of the 6 Stereo Optical Stereo

Co., Inc., plates Optical
Co., Inc.
AOC-HRR, 2nd, 1-11 Any errors on plates 5-10 Richmond
Products
Richmond
Dvorine 2nd Edition More than 2 errors on plates 1-15 Products
Special Instructions
Test Administration The AME must document the color vision test instrument
used, version, answer sheet with the actual subject
responses and the score. If MEDExpress is used the
AME should fax or mail the results to the Flight Surgeon
or may document the findings in Block 60.
AME Office Inspection AME office inspections: The inspector must visually
inspect the condition of the color vision test instrument,
for fading, finger prints, pen or pencil smudges; and lights
used. Only a Macbeth Easel or a Verilux True Daylight
Illuminator (F15T8VLX) are acceptable. Room lights
must be off.
False Negatives Any test device with a restricted test set, like the Titmus
testers, generally have a high false alarm test. If a
disproportionally high number of subjects are failing, it
may be necessary to review the acceptability of that test
instrument. Regional Medical Offices are expected to
monitor this situation.
UNACCEPTABLE TEST INSTRUMENTS FOR COLOR VISION SCREENING OF ATCS
(FAA EMPLOYEE 2152 SERIES and CONTRACT TOWER ATCSs)
AOC-PIP Mast Stereo-
Optic
OPTEC 900, 2500*, 5000* Titmus
Bausch & Lomb Vision Tester i400*
D-15 Prism Vision
Chart -
color
letters
FALANT Richmond-HRR Versions 2 and 3
H-O Chart Schilling
Any computer applications, downloaded, or printed versions of color vision tests are prohibited.
 Guide for Aviation Medical Examiners
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ITEM 53. Field of Vision

53. Field of Vision

Normal Abnormal

I. Code of Federal Regulations

First- and Second-Classes: 14 CFR 67.103(d) and 67.203(d)

(d) Field of Vision: Normal

Third-Class: 14 CFR 67.303(d)

(d) Field of Vision: No acute or chronic pathological condition of either eye or adnexa
that interferes with the proper function of an eye, that may reasonably be expected to
progress to that degree, or that may reasonably be expected to be aggravated by
flying.

II. Examination Equipment and Techniques

1. Fifty-inch square black matte surface wall target with center white fixation point;
2 millimeter white test object on black-handled holder:

1. The applicant should be seated 40 inches from the target.

2. An occluder should be placed over the applicant's right eye.

3. The applicant should be instructed to keep the left eye focused on the fixation
point.

4. The white test object should be moved from the outside border of the wall
target toward the point of fixation on each of the eight 4-degree radials.

5. The result should be recorded on a worksheet as the number of inches from

the fixation point at which the applicant first identifies the white target on each
radial.

6. The test should be repeated with the applicant's left eye occluded and the right
eye focusing on the fixation point.

2. Alternative Techniques:

a. A standard perimeter may be used in place of the above procedure. With this
method, any significant deviation from normal field configuration will require
evaluation by an eye specialist.
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b. Direct confrontation. This is the least acceptable alternative since this tests for
peripheral vision and only grossly for field size and visual defects. The AME,
standing in front of the applicant, has the applicant look at the AME's nose
while advancing two moving fingers from slightly behind and to the side of the
applicant in each of the four quadrants. Any significant deviation from normal
requires ophthalmological evaluation.

III. Aerospace Medical Disposition

A. Ophthalmological Consultations.

If an applicant fails to identify the target in any presentation at a distance of less than
23 inches from the fixation point, an eye specialist's evaluation must be requested. This is a
requirement for all classes of certification. The AME should provide FAA Form 8500-14,
Ophthalmological Evaluation for Glaucoma, for use by the ophthalmologist if glaucoma is
suspected.

B. Glaucoma.

The FAA may grant an Authorization under the special issuance section of part 67
(14 CFR 67.401) on an individual basis. The AME can facilitate FAA review by obtaining a
report of Ophthalmological Evaluation for Glaucoma
(FAA Form 8500-14) from a treating or evaluating ophthalmologist.

NOTE: See AASI for History of Glaucoma

If considerable disturbance in night vision is documented, the FAA may limit the medical
certificate: NOT VALID FOR NIGHT FLYING

C. Other Pathological Conditions.

See Items 31-34.

ITEM 54. Heterophoria

Esophoria Exophoria Right Hyperphoria Left Hyperphoria

54. Heterophoria 20’ (in prism diopters)

I. Code of Federal Regulations

First- and Second-Classes: 14 CFR 67.103(f) and 67.203(f)

(f) Bifoveal fixation and vergence-phoria relationship sufficient to prevent a break in

fusion under conditions that may reasonably be expected to occur in performing
airman duties. Tests for the factors named in this paragraph are not required except
for persons found to have more than 1 prism diopter of hyperphoria, 6 prism diopters
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of esophoria, or 6 prism diopters of exophoria. If any of these values are exceeded,
the Federal Air Surgeon may require the person to be examined by a qualified eye
specialist to determine if there is bifoveal fixation and an adequate vergence-phoria
relationship. However, if otherwise eligible, the person is issued a medical certificate
pending the results of the examination.

Third-Class: No Standards

II. Examination Equipment and Techniques

Equipment:

1. Red Maddox rod with handle.

2. Horizontal prism bar with graduated prisms beginning with one prism diopter and
increasing in power to at least eight prism diopters.
3. Acceptable substitutes: any commercially available visual acuities and heterophoria
testing devices.

There are specific approved substitute testers for color vision, which may not
include some commercially available vision testing machines. For an approved
list, See Item, 52. Color Vision.

Examination Techniques:

Test procedures to be used accompany the instruments. If the AME needs specific
instructions for use of the horizontal prism bar and red Maddox rod, these may be obtained
from a RFS.

III. Aerospace Medical Disposition

1. First- and second-class: If an applicant exceeds the heterophoria standards (1 prism

diopter of hyperphoria, 6 prism diopters of esophoria, or 6 prism diopters of
exophoria), but shows no evidence of diplopia or serious eye pathology and all other
aspects of the examination are favorable, the AME should not withhold or deny the
medical certificate. The applicant should be advised that the FAA may require further
examination by a qualified eye specialist.

2. Third-class: Applicants for a third-class certificate are not required to undergo

heterophoria testing. However, if an applicant has strabismus or a history of diplopia,
the AME should defer issuance of a certificate and forward the application to the
AMCD. If the applicant wishes further consideration, the AME can help expedite FAA
review by providing the applicant with a copy of FAA Form 8500-7, Report of Eye
Evaluation.
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ITEM 55. Blood Pressure

(Updated 10/28/2015)

55. Blood Pressure

Systolic Diastolic
(Sitting mm of Mercury)

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(b)(c), 67.213(b)(c), and 67.313(b)(c)

(b). No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical
judgment relating to the condition involved, finds -

(1). Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2). May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.

(c). No medication or other treatment that the Federal Air Surgeon, based on the
case history and appropriate, qualified medical judgment relating to the medication or
other treatment involved finds -

(1). Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2). May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform
those duties or exercise those privileges.

Measurement of blood pressure is an essential part of the FAA medical certification

examination. The average blood pressure while sitting should not exceed 155 mm mercury
systolic and 95 mm mercury diastolic maximum pressure for all classes. A medical
assessment is specified for all applicants who need or use antihypertensive medication to
control blood pressure. (See Section III. B. below.)

II. Examination Techniques

In accordance with accepted clinical procedures, routine blood pressure should be taken with the
applicant in the seated position. An applicant should not be denied or deferred first-, second-, or
third-class certification unless subsequent recumbent blood pressure readings exceed those
contained in this Guide. Any conditions that may adversely affect the validity of the blood pressure
reading should be noted.
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III. Aerospace Medical Disposition

A. Examining Options

1. An applicant whose pressure does not exceed 155 mm mercury systolic and 95 mm
mercury diastolic maximum pressure, who has not used antihypertensive medication
for 30 days, and who is otherwise qualified should be issued a medical certificate by
the AME.

2. If the airman’s blood pressure is elevated in clinic, you have any of the following options:

 Recheck the blood pressure. If the airman meets FAA specified limits on the
second attempt, note this in Block 60 along with both readings.

 Have the airman return to clinic 3 separate days over a 7-day period. If the
airman meets FAA specified limits during these re-checks, note this and the
readings in Block 60. Also note if there was a reason for the blood pressure
elevation.

 Send the airman back to his/her treating physician for re-evaluation. If

medication adjustment is needed, a 7-day no-fly period applies to verify no
problems with the medication. If this can be done within the 14 day exam
transmission period, you could then follow the Hypertension Disposition Table.

The AME must defer issuance of a medical certificate to any applicant whose
hypertension has not been evaluated, who uses unacceptable medications, whose
medical status is unclear, whose hypertension is uncontrolled, who manifests

significant adverse effects of medication, or whose certification has previously been

specifically reserved to the FAA. See Hypertension FAQs, Hypertension Disposition
Table, and CACI – Hypertension Worksheet.

B. Initial and Follow-up Evaluation for Hypertensives Under Treatment -

See CACI - Hypertension Worksheet (in the dispositions table, Item 36. Heart)
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ITEM 56. Pulse

56. Pulse (Resting)

The medical standards do not specify pulse rates that, per se, are disqualifying for medical
certification. These tests are used, however, to determine the status and responsiveness of
the cardiovascular system. Abnormal pulse rates may be reason to conduct additional
cardiovascular system evaluations.

II. Examination Techniques

The pulse rate is determined with the individual relaxed in a sitting position.

III. Aerospace Medical Disposition

If there is bradycardia, tachycardia, or arrhythmia, further evaluation is warranted and

deferral may be indicated (see Item 36., Heart). A cardiac evaluation may be needed to
determine the applicant’s qualifications. Temporary stresses or fever may, at times, result in
abnormal pulse readings. If the AME believes this to be the case, the applicant should be
given a few days to recover and then be retested. If this is not possible, the AME should
defer issuance, pending further evaluation.

ITEM 57. Urine Test/Urinalysis

57. Urine Test (if abnormal, give results)

Albumin Sugar

Normal Abnormal

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(a)(b), 67.213(a)(b), and 67.313(a)(b)

(a) No established medical history or clinical diagnosis of diabetes mellitus that

requires insulin or any other hypoglycemic drug for control.

(b) No other organic, functional, or structural disease, defect, or limitation that the
Federal Air Surgeon, based on the case history and appropriate, qualified medical
judgment relating to the condition involved, finds:

(1) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to perform those
duties or exercise those privileges.
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II. Examination Techniques

Any standard laboratory procedures are acceptable for these tests.

III. Aerospace Medical Disposition

Glycosuria or proteinuria is cause for deferral of medical certificate issuance until additional
studies determine the status of the endocrine and/or urinary systems. If the glycosuria has
been determined not to be due to carbohydrate intolerance, the AME may issue the
certificate. Trace or 1+ proteinuria in the absence of a history of renal disease is not cause
for denial.

The AME may request additional urinary tests when they are indicated by history or
examination. These should be reported on FAA Form 8500-8 or attached to the form as an
addendum.

See Item 48., General Systemic.

ITEM 58. ECG

(Updated 11/30/2016)

58. ECG (Date)

MM DD YYYY

I. Code of Federal Regulations

First-Class: 14 CFR 67.111(b)(c)

(a) A person applying for first-class medical certification must demonstrate an

absence of myocardial infarction and other clinically significant abnormality on
electrocardiographic examination:

(1) At the first application after reaching the 35th birthday; and

(2) On an annual basis after reaching the 40th birthday.

(b) An electrocardiogram will satisfy a requirement of paragraph (b) of this section if it is

dated no earlier than 60 days before the date of the application it is to accompany and
was performed and transmitted according to acceptable standards and techniques.

Note: Any applicant for certification may be required to provide ECGs when indicated by
history or physical examination.
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II. Examination Techniques

A. When an ECG/EKG is required:

Class Applicant age EGG is required
on day of exam at the following intervals
34 or younger not required
1st
35 to 39 A single baseline ECG is required at the first exam
performed after reaching the 35th birthday.

40 or older Annually

2nd or Any Not required*

3rd
*If the AME performed an EKG, it should be
submitted along with notes in Block 60
describing why it was performed.

Other times an ECG/EKG can be requested by an AME (for All classes):

Any time the airman has a history or physical examination finding that suggests a
clinically significant abnormality.

Substitution for an ECG/EKG:

If a first-class airman does not have a current resting ECG on file, but the FAA has the
tracings of any type of stress test (pharmaceutical stress, Bruce stress, nuclear stress,
or stress echocardiogram) which was done within the last 60 days, the information
may be accepted on a case by case basis. The image must be of good quality.
Stress test or ECG images that have been faxed do not have enough clarity/definition
for adequate review. In most cases, they will not be acceptable. A cardiac
catheterization and/or a Holter monitor test are NOT acceptable in place of a resting
12-lead ECG.

Additional Work-Up/Evaluation (All classes):

If additional work up was performed based on history or ECG findings, copies of the
work up (cardiovascular evaluation, clinic notes, stress testing, etc.) should also be
submitted to the FAA with notes in Block 60 describing the findings. If any pathology
was identified, refer to the appropriate, individual section.
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AMCS notification regarding ECG will appear as:

1. ECG is Required:
A Red X will precede the words ECG Date. No date will be in the box.

2. ECG is Not Required:

The AMCS screen will show the word “Ok” along with a date in the box.

Can I submit an ECG performed on a day other than the date of exam?

Yes, but it must be considered current.

B. Currency of ECG/What is considered a current ECG:

 Only an ECG performed up to 60 days prior to the exam is considered current.

 There is no provision for issuance of a first-class medical certificate based upon

a promise that an ECG will be obtained at a future date.

 As of the August 2014 changes in AMCS, an AME cannot transmit the exam
until the required ECG is attached.

C. ECG equipment/technical requirements:

The FAA does not require a specific type of machine, however the ECG machine used
must give a clear picture AND meet the following technical requirements:

 Must generate an image that can be converted to a PDF;

 Must be recorded at 25mm/sec. (This is standard in the US).

 Recordings at 50mm/sec will NOT be accepted. Many international programs

are set at 50mm/sec as a baseline; the AME must change this to 25mm/sec for
the FAA to accept the tracing; and

 300 dpi color resolution (or better)

D. AME Review and Interpretation of the ECG:

The AME must review the ECG for the following PRIOR to transmitting:
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 Quality - It is not uncommon for the FAA to receive an ECG that has leads
missing or even an asystole picture. If the quality is poor and the ECG cannot
be interpreted, the airman will receive a letter requiring a new ECG.

 Correct airman/Correct exam - Verify you attach the correct ECG to the
correct airman file. Also verify NO OTHER documents are attached.

 Abnormalities/pathology - Review the ECG for any abnormalities which may

cause you to defer or inform the airmen that a work up is required. See
Item 36. Heart – Arrhythmias.

 Normal Variants - The following common ECG findings are considered normal
variants and are not cause for deferment unless the airman is symptomatic or
there are other concerns. Airmen who have these findings may be certified, if
otherwise qualified:

 Early repolarization
 Ectopic atrial rhythm
 First-degree AV (atrioventricular) block with PR interval less than 0.21 in age < 51
 Incomplete Right Bundle Branch Block (IRBBB)
 Indeterminate axis
 Intraventricular conduction delay (IVCD)
 Left atrial abnormality
 Left axis deviation, less than or equal to -30 degrees
 Left ventricular hypertrophy by voltage criteria only
 Low atrial rhythm
 Low voltage in limb leads (May be a sign of obesity or hypothyroidism.)
 Premature Atrial Contraction (PAC) – multiple, asymptomatic
 Premature Ventricular Contraction (PVC) - single only; 2 or more on ECG require
evaluation.
 Short QT – if no history of arrhythmia
 Sinus arrhythmia
 Sinus bradycardia. Up to age 49 if heart rate is >44; Age 50 and older if heart rate is >48
 Sinus tachycardia – heart rate < 110
 Wandering atrial pacemaker

E. Transmitting/uploading the ECG:

Complete instructions can be found on the AMCS User Guide. As of October 2014, all
Senior AMEs in the United States and International AMEs are required to upload a PDF
version of an ECG into the correct section on the 8500-8. Clicking on the icon will launch
an ECG Import window, where the applicant’s current ECG can be uploaded as a PDF
attachment and eventually transmitted to the FAA with the exam.
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 Date - The AME no longer fills in the date. The date entered in the ECG import
window will populate this field (Item 58).

 One ECG - You may attach only one ECG to the exam:

o Only the last ECG attached will be saved and transmitted with the exam.
Ex: If you attach ECG #1 and then attach ECG #2, ECG #1 will be replaced
and not sent to the FAA.

o If an incorrect ECG is uploaded, a new one may be attached. You will

receive a warning at the top of the window if an ECG has already been
attached.

 AME Comments - The AME can comment on findings when uploading the ECG.

 Non-AME transmissions:

o ECGs must be electronically attached to an 8500-8 by the AME.

o It is not possible for a medical department or any other physician to transmit

a current ECG directly to the FAA 8500-8 exam.

o If an ECG was done outside the AME’s office, the AME must verify that the
ECG belongs to the airman, it is less than 60 days old, and is of suitable
quality before it is attached to the 8500-8.

o The image must be of good quality. Stress test or ECG images that have
been faxed do not have enough clarity/definition for adequate review. In
most cases, they will not be acceptable.

 Applicant refuses ECG - If an ECG is due and the airman refuses, the AME will
be unable to transmit the exam. The AME should call the AMCS Support Desk at
(405) 954-3238 AND note in Block 60 that the airman refused the required ECG.

 No ECG submitted - When an ECG is due but is not submitted, the FAA will not
affirm the applicant's eligibility for medical certification until the requested ECG has
been received and interpreted as being within normal limits. Failure to respond to
FAA requests for a required current ECG will result in denial of certification.

F. After the ECG is transmitted to the FAA:

All first class ECGs are reviewed by AMCD’s ECG department, staff physicians, or
consultant cardiologists. If abnormalities are identified, additional work up or information
may be requested. For additional help transmitting the exam or attaching the ECG
contact:

AMCS SUPPORT DESK

(405) 954-3238
APPLICATION REVIEW
Items 59-64 of FAA Form 8500-8
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ITEMS 59-64 of FAA Form 8500-8

This section provides guidance for the completion of Items 59-64 of the
FAA Form 8500-8. The AME is responsible for conducting the examination. However,
he or she may delegate to a qualified physician's assistant, nurse, aide, or laboratory
assistant the testing required for Items 49-58. Regardless of who performs the tests,
the AME is responsible for the accuracy of the findings, and this responsibility may not
be delegated.

The medical history page of FAA Form 8500-8 must be completed and certified by the
applicant or it will not appear in AMCS. After all routine evaluations and tests are
completed, the AME should review FAA Form 8500-8. If the form is complete and
accurate, the AME should add final comments, make qualification decision statements,
and certify the examination.

ITEM 59. Other Tests Given

59. Other Tests Given

I. Code of Federal Regulations

All Classes: 14 CFR 67.413(a)(b)

(a) Whenever the Administrator finds that additional medical information or history is
necessary to determine whether an applicant for or the holder of a medical certificate
meets the medical standards for it, the Administrator requests that person to furnish
that information or to authorize any clinic, hospital, physician, or other person to
release to the Administrator all available information or records concerning that
history. If the applicant or holder fails to provide the requested medical information
or history or to authorize the release so requested, the Administrator may suspend,
modify, or revoke all medical certificates the airman holds or may, in the case of an
applicant, deny the application for an airman medical certificate.

(b) If an airman medical certificate is suspended or modified under paragraph (a) of this
section, that suspension or modification remains in effect until the requested
information, history, or authorization is provided to the FAA and until the Federal Air
Surgeon determines whether the person meets the medical standards under this
part.

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II. Examination Techniques

Additional medical information may be furnished through additional history taking,

further clinical examination procedures, and supplemental laboratory procedures.

On rare occasions, even surgical procedures such as biopsies may be indicated. As a

designee of the FAA Administrator, the AME has limited authority to apply
14 CFR 67.413 in processing applications for medical certification. When an AME
determines that there is a need for additional medical information, based upon history
and findings, the AME is authorized to request prior hospital and outpatient records and
to request supplementary examinations including laboratory testing and examinations
by appropriate medical specialists. The AME should discuss the need with the
applicant. The applicant should be advised of the types of additional examinations
required and the type of medical specialist to be consulted. Responsibility for ensuring
that these examinations are forwarded and that any charges or fees are paid will rest
with the applicant. All reports should be forwarded to the AMCD, unless otherwise
directed (such as by a RFS).

Whenever, in the AME's opinion, medical records are necessary to evaluate an

applicant's medical fitness, the AME should request that the applicant sign an
authorization for the Release of Medical Information. The AME should forward this
authorization to the custodian of the applicant's records so that the information
contained in the record may be obtained for attachment to the report of medical
examination.

ITEM 60. Comments on History and Findings

Comments on all positive history or medical examination findings must be reported by

Item Number. Item 60 provides the AME an opportunity to report observations and/or
findings that are not asked for on the application form. Concern about the applicant's
behavior, abnormal situations arising during the examination, unusual findings,
unreported history, and other information thought germane to aviation safety should be
reported in Item 60. The AME should record name, dosage, frequency, and purpose for
all currently used medications.

If possible, all ancillary reports such as consultations, ECGs, x-ray release forms, and
hospital or other treatment records should be attached. If the delay for those items
would exceed 14 days, the AME should forward all available data to the AMCD, with a
note specifying what additional information is being prepared for submission at a later
date.

If there are no significant medical history items or abnormal physical findings, the AME
should indicate this by checking the appropriate block.

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ITEM 61. Applicant's Name

Item 61. Applicant’s Name

The legal name applicant's name should be entered.

ITEM 62. Has Been Issued

(Updated 04/27/2022)

The AME must check the proper box to indicate the status of the application for Medical
Certificate. Note: The “x” will appear until the AME selects an option:

62. X Has been Issued:

o Medical Certificate
o Medical and Student Pilot Certificate
o No Certificate Issued – Deferred for Further Evaluation
o Has Been Denied – Letter of Denial Issued (copy attached)

A. Applicant's Refusal or Exam Not Complete: If applicant leaves before the exam
is completed or elects not to continue if more information or evaluation is required:
Note in Block 60, do not issue any certificate, and contact AMCS Support for
instructions.

B. AME Issuance: When the AME receives all required information AND the applicant
meets all FAA medical standards for the class sought, the AME may issue a medical
certificate. If the applicant has an Authorization for Special Issuance, refer to the
Authorization Letter to determine if you must also add a time limitation. If the AME
or the applicant will send in supporting records or reports WITHIN 14 DAYS,
note what items are coming in Block 60.

C. AME Deferral: AME should defer if:

 The disposition table or Authorization Letter instructs the AME to defer;
 More information or further evaluation is needed;
 There is uncertainty about the significance of the findings; or
 The applicant did not provide the required documents within 14 days of the
AME exam. All exams must be transmitted WITHIN 14 DAYS.
Do not delay transmitting an exam (beyond 14 days) while waiting for the
applicant to provide requested records or reports.

Note in Block 60 any concerns, findings, or if more information was requested; do

not issue any certificate, and transmit as deferred.

D. AME Denial: If the AME determines the applicant is clearly ineligible for certification
(see Medical Certificate Decision Making), give the applicant a signed and dated

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AME Letter of Denial. The letter provides the applicant with reasons for the denial
and how to request reconsideration. The AME must send a copy of the AME
Letter of Denial to the FAA.

ITEM 63. Disqualifying Defects

The AME must check the “Disq” box on the Comments Page beside any disqualifying
defect. Comments or discussion of specific observations or findings may be reported in
Item 60. If all comments cannot fit in Item 60, the AME may submit additional
information on a plain sheet of paper and include the applicant’s full name, date of birth,
signature, any appropriate identifying numbers (PI, MID or SSN), and the date of the
exam.

If the AME denies the applicant, the AME must issue a Letter of Denial, to the applicant,
and report the issuance of the denial in Item 60.

ITEM 64. Medical Examiner's Declaration

 The FAA designates specific individuals as AMEs and this status may not be
delegated to staff or to a physician who may be covering the designee's practice.

 Before transmitting to AMCD, the AME must certify the exam and enter all
appropriate information including his or her AME serial number.

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CACI CONDITIONS
(Updated 08/25/2021)
Conditions AMEs Can Issue (CACI) is a series of conditions which allow AMEs to
regular issue if the applicant meets the parameters of the CACI Condition Worksheet.
The worksheets provide detailed instructions to the AME and outline condition-specific
requirements for the applicant.

1. Review the disposition table BEFORE the CACI worksheet to verify a CACI is
required.
2. If ALL the CACI criteria are met and the applicant is otherwise qualified, the
AME may issue on the first exam or the first time the condition is reported to the
AME without contacting AMCD/RFS. Keep the supporting documents in your
files; they do not need to be submitted to the FAA at this time.
3. If the requirements are not met, the AME must defer the exam and send the
supporting documents to the FAA.
4. Annotate Block 60 with one of the three allowable options found on the
bottom of the CACI worksheets.

CACIs with Certification Worksheets:

ARTHRITIS
HYPERTENSION
ASTHMA
HYPOTHYROIDISM
BLADDER CANCER
RETAINED KIDNEY STONE(S)

BREAST CANCER MIGRAINE AND CHRONIC HEADACHE

CHRONIC IMMUNE MITRAL VALVE REPAIR

THROMBOCYTOPENIA (cITP)
PRE-DIABETES
CHRONIC KIDNEY DISEASE
PRIMARY HEMOCHROMATOSIS
COLITIS
PROSTATE CANCER
COLON CANCER/ COLORECTAL
CANCER RENAL CANCER

GLAUCOMA TESTICULAR CANCER

HEPATITIS C – CHRONIC

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DISEASE PROTOCOLS

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PROTOCOLS (Updated 08/25/2021)

The following lists the Guide for Aviation Medical Examiners Disease Protocols, and course of
action that should be taken by the AME as defined by aeromedical decision considerations.
(Also see condition-specific CACI Certification Worksheets, which can be found in the
Dispositions Section.)

 ALLERGIES, SEVERE
 ATTENTION DEFICIT/HYPERACTIVITY DISORDER
 BINOCULAR MULTIFOCAL AND ACCOMMODATING DEVICES
 BUNDLE BRANCH BLOCK (BBB)
 CARDIAC TRANSPLANT
 CARDIAC VALVE REPLACEMENT
 CARDIOVASCULAR EVALUATION (CVE)
 CONDUCTIVE KERATOPLASTY
 CORONARY HEART DISEASE (CHD PROTOCOL)
 DEPRESSION TREATED WITH SSRI MEDICATIONS
 DIABETES MELLITUS - DIET CONTROLLED
 DIABETES MELLITUS Type II - MEDICATION CONTROLLED (Non Insulin)
 DIABETES MELLITUS Type I or Type II – INSULIN TREATED - CGM OPTION
 DIABETES MELLITUS Type I or Type II - INSULIN TREATED - THIRD CLASS OPTION
 GRADED EXERCISE STRESS TEST REQUIREMENTS (Maximal)
 HUMAN IMMUNODEFICIENCY VIRUS (HIV)
 INITIAL EVALUATION OF IMPLANTED PACEMAKER
 LIVER TRANSPLANT (RECIPIENT)
 METABOLIC SYNDROME – MEDICATION CONTROLLED
 MUSCULOSKELETAL EVALUATION
 NEUROCOGNITIVE IMPAIRMENT
 NEUROLOGIC EVALUATION

 OBSTRUCTIVE SLEEP APNEA (OSA)*

 PEPTIC ULCER
 PSYCHIATRIC EVALUATION
 PSYCHIATRIC AND PSYCHOLOGICAL EVALUATIONS
 RENAL TRANSPLANT
 6-MINUTE WALK TEST (6MWT)
 SUBSTANCES of DEPENDENCE/ABUSE (Drugs and Alcohol)
 THROMBOEMBOLIC DISEASE
* OSA Reference Materials are located at the end of the Protocols below

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Protocol for Allergies, Severe

In the case of severe allergies, the AME should deny or defer certification and provide a
report to the Aerospace Medical Certification Division, AAM-300, that details the period
and duration of symptoms and the nature and dosage of drugs used for treatment
and/or prevention.

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Specifications for Neuropsychological Evaluations for ADHD/ADD

(Updated 01/27/2021)

Why is a neuropsychological evaluation required?

Attention-Deficit/Hyperactivity Disorder (ADHD), formerly called Attention Deficit Disorder
(ADD), and medications used for treatment may result in cognitive deficits that would make an
airman unsafe to perform pilot duties.

What testing is required?

There are two test batteries:
a. INITIAL BATTERY - performed on everyone; and
b. SUPPLEMENTAL BATTERY - performed when the Initial Battery indicates a
potential problem.

Who may perform a neuropsychological evaluation? Neuropsychological evaluations should

be conducted by a qualified neuropsychologist with additional training in aviation-specific topics.
The following link contains a list of neuropsychologists who meet all FAA quality criteria: FAA
Neuropsychologist List.

Information for the AIRMAN – ADHD/ADD Evaluation

(Updated 12/13/2018)

1. Work with your AME to obtain any necessary evaluations and documentation.
If you have stopped taking ADHD/ADD medication(s), you must be off the
medication(s) for 90 days before testing and evaluation.

2. Arrange for required testing and evaluation by a neuropsychologist.

The neuropsychologist must have experience with aeromedical neuropsychology (not all
neuropsychologists have this training). See the FAA HIMS Neuropsychologist List to
find one in your area.

3. PRIOR to your appointment: Before going for testing, please ensure the following:

 Verify with the neuropsychologist’s office that they have the ability to
obtain a urinalysis for ADHD medication the day of the exam or within 24
hours after the exam.

a. If they do not, then you will need to have your AME or primary
care physician write an order for the lab or arrange urinalysis
testing.

b. The urine drug screening must test for ADHD medications,

including psychostimulant medications. It should include testing
for amphetamine and methylphenidate. *The sample must be
collected at the conclusion of the neurocognitive testing or
within 24 hours afterward.

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c. The results must be documented in the neuropsychologist’s

report.

d. If this testing is not performed, the FAA may not accept the
neuropsychologist’s findings and you will have to repeat
neurocognitive testing.

 Have a copy of your medical records sent to the neuropsychologist for

review.

o The neuropsychologist will need to obtain a complete history.

To do so, you should provide the information in the checklist below. If
the information is not available/applicable, a statement must be
provided as to why is not available/applicable.

Submit this information to the neuropsychologist PRIOR to your appointment 

All medical records documenting prior diagnosis or treatment for ADHD/ADD, including dates
of treatment or evaluation AND name, dosage, and dates the medications were started and
stopped.
If diagnosed as a child: Academic records (including transcripts), Section 504 plans, IEPs, any
academic accommodations, etc., from times both on and off medication.
Adults with a history of ADHD and no recent school information: Submit a copy of your drivers’
record from each state in which you have had a license in the past 10 years.
ALL previous psychological or neuropsychological evaluation reports.
Copies of all records regarding prior psychiatric or substance-related hospitalizations,
observations, or treatment.
A complete copy of your FAA medical records.

To have a copy of your FAA records sent directly to the neuropsychologist, submit a Request
for Airman Medical Records (FAA Form 8065-2).

4. Day of testing: Urine drug screen is required after neurocognitive testing.*

5. Submit an 8500-8 exam via MedXPress:

 The AME will submit your exam as DEFERRED.

 Coordinate with your AME to make sure that ALL ITEMS LISTED are sent to the
FAA WITHIN 14 DAYS of the AME exam.

 Partial or incomplete packages WILL CAUSE A DELAY IN CERTIFICATION.

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Information for the NEUROPSYCHOLOGIST:

TESTING REQUIREMENTS – ADHD/ADD

(Updated 01/29/2020)

The following evaluation is the minimum recommended evaluation for the presence of
aeromedically significant ADHD/ADD by a neuropsychologist. Results of each of these
sections must be included in the final report. If the neuropsychologist believes there are
any concerns* with the evaluation results, a Supplemental Battery must also be
conducted.

If the airman stopped taking ADHD/ADD medication(s), they must be off the medication(s)
for 90 days before testing and evaluation.

INITIAL BATTERY:

1. Comprehensive background review.

2. Possible interview of collateral sources of information such as parent, school

counselor/teacher, employer, flight instructor, etc.

3. Administration of the Administration of the tests as described in the FAA

Neuropsychology Testing Specifications site. To promote test security, itemized
lists of tests comprising psychological/neuropsychological test batteries have
been moved to this secure site. Authorized professionals should use the secure
portal. For access, email a request to [email protected].

4. Urine drug screening test for ADHD medications, including psychostimulant

medications. It should include testing for amphetamine and methylphenidate.
The sample must be collected at the conclusion of the neurocognitive
testing or within 24 hours after testing.

If the results of the above testing indicate:

NO CONCERNS: If the neuropsychologist interprets the clinical interview and/or

screening battery results as exhibiting functioning that is completely within normal
limits and lacking any suspicion of aeromedically significant neurocognitive deficit,
then the initial evaluation can be considered complete and a report generated. See
Report Requirements for items that must be covered as well as additional items that
must be submitted.

ANY CONCERNS: If after interpreting the INITIAL BATTERY evaluation results, the
neuropsychologist has any concerns regarding impairment, deficiencies, or
comorbid disorders that could pose a threat to aviation safety, the neuropsychologist
must perform a full battery of testing as described in the SUPPLEMENTAL
BATTERY section below. The purpose of this additional testing is to explore and

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clarify the findings or rule out ADHD/ADD as well as any neurocognitive deficits
previously misidentified as ADHD/ADD and/or any comorbid disorders.

SUPPLEMENTAL BATTERY:
(Updated 01/29/2020)

 Complete the INITIAL BATTERY testing;

 At minimum, complete and add the Supplemental Testing as described in the
FAA Neuropsychology Testing Specifications site. To promote test security,
itemized lists of tests comprising psychological/neuropsychological test batteries
have been moved to this secure site. Authorized professionals should use the
secure portal. For access, email a request to [email protected].
 See Report Requirements below for items that must be covered in the
neuropsychologist report as well as additional items that must be submitted.

Information for the NEUROPSYCHOLOGIST:

REPORT REQUIREMENTS – ADHD/ADD

(Updated 01/29/2020)

Report based on INITIAL BATTERY ONLY:

At minimum, the report must include:

1. Listing of all documents reviewed. Verify that you were provided with and
reviewed a complete copy of the airman’s FAA medical file sent to you by the
FAA.
2. Summary of all available record findings. This includes diagnosis and treatment.
If records were not clear or did not provide sufficient detail to permit a clear
evaluation of the nature and extent of any previous mental disorders, that should
be stated.
3. Results of a thorough clinical interview that includes detailed history regarding
psychosocial or developmental problems:
a. Educational history and academic performance (special education and/or
Section 504, IEPs, school-based psychoeducational evaluations, tutoring,
discipline, high school transcript, discipline, repeating of grade, special
accommodations, etc.);
b. Current substance use and substance use/abuse history including
treatment and quality of recovery, if applicable;
c. Driving record, accidents, etc.;
d. Legal issues and arrest history;
e. Career difficulties/challenges or employment performance;
f. Aviation background and experience;
g. Medical conditions;
h. All medication use history;

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i. Behavioral observations during the interview and testing; and

j. Results from interview of collateral sources of information such as parent,
school counselor/teacher, employer, flight instructor, etc.

4. A mental status examination/behavioral observations;

5. Interpretation of the battery of neuropsychological and psychological tests
administered;
6. An integrated summary of findings;
7. An explicit diagnostic statement (consistent with the FAA Regulations):
a. Your final clinical diagnosis or findings:
i. Do not simply list if ADHD/ADD is present or not. You should
report if there are other conditions or a learning disorder present;
and
ii. If there is no DSM diagnosis, are there any noted areas of
neurocognitive impairment or deficiencies? If so, describe their
nature and severity;
b. Any evidence of a comorbid disorder that could pose a hazard to aviation
safety? If none, then that should be noted;
c. Does your diagnosis or findings agree with the diagnosis noted on other
supporting or historical documents you reviewed? If it does not, then you
should explain your rationale as to your diagnosis or findings; and
8. Documentation of urine drug screen results (what testing was performed and the
results or a copy of the final results should be attached).

SUBMIT to the FAA all of the following:

 Report containing a MINIMUM of all the above elements;

 Copies of all computer score reports; and
 An appended score summary sheet that includes all scores for all tests
administered. When available, pilot norms must be used. If pilot norms are
not available for a particular test or inappropriate for a specific applicant, then
the normative data/comparison group relied upon for interpretation (e.g.,
general population, age/education-corrected) must be specified. A summary
of test scores including raw scores, percentile scores, and/or standard scores
must be included.

Report based on INITIAL BATTERY plus SUPPLEMENTAL BATTERY:

The report must include ALL items in the INITIAL BATTERY evaluation, the
SUPPLEMENTAL BATTERY, AND the applicable item below:

1. NO CONCERNS/ABNORMALITIES:
If the neuropsychologist interprets the clinical interview and INITIAL BATTERY PLUS
SUPPLEMENTAL BATTERY results as exhibiting functioning that is completely within
normal limits and lacking any suspicion of neurocognitive deficit, then the final report
should also document abnormalities found in the SCREENING and what additional
testing dismissed the abnormalities as a diagnostic concern.

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2. CONCERNS OR ABNORMALITIES FOUND:

If the neuropsychologist interprets the clinical interview and INITIAL BATTERY
PLUS SUPPLEMENTAL BATTERY results as raising concerns or showing
neuropsychological impairment, then include the following in the report:
 Describe the nature and severity of any noted neurocognitive deficit(s);
 Describe the potential impact to flight performance/flight safety of the
noted deficit(s); and
 Describe any applicable diagnosis, as well as any applicable comorbid
condition(s)

Additional information for the neuropsychologist:

 The FAA will not proceed with a review of the test findings without all of the
required data.
 Safeguard of data and clinical findings will be in accordance with the APA Ethical
Principles of Psychologists and Code of Conduct (2002) as well as applicable
federal law.
 Raw neurocognitive testing data may be required at a future date for expert
review by one of the FAA’s consulting clinical neuropsychologists. In that event,
authorization for release of the data (by the airman to the expert reviewer) is
required.
 Recommendations should be strictly limited to the neuropsychologist’s area of
expertise.
 Periodic re-evaluations may be required in certain cases. The airman’s FAA
Special Issuance letter will outline required follow up testing. This may be limited
to specific tests or expanded to include a comprehensive battery. For questions
about testing or requirements, email [email protected].

Information for the NEUROPSYCHOLOGIST

Reference Information for the Neuropsychologist:

(Updated 04/25/2018)

The responsibility of the neuropsychologist is to identify any neurocognitive

deficit/impairment that has aeromedical significance. Attention-Deficit/Hyperactivity
Disorder (ADHD), formerly called Attention Deficit Disorder (ADD), is a condition that
may be aeromedically disqualifying. For reference information and comments on
specific tests, authorized professionals should use the portal at FAA Neuropsychology
Testing Specifications. For access to the portal, email a request to 9-amc-aam-
[email protected].

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Protocol for Binocular Multifocal and Accommodating Devices

(Updated 05/29/2019)

This Protocol establishes the authority for the AME to issue an airman medical certificate to
binocular applicants using multifocal or accommodating ophthalmic devices.

Devices acceptable for aviation-related duties must be FDA approved and include:

Intraocular Lenses (multifocal or accommodating intraocular lens implants)

Bifocal/Multifocal contact lenses

AMEs may issue as outlined below:

 Adaptation period before certification:

o Surgical lens implantation – minimum 3 months post-operative
o Contact lenses (bifocal or multifocal) – minimum one month of use

 Must provide a report to include the FAA Form 8500-7, Report of Eye Evaluation, from
the operating surgeon or the treating eye specialist. This report must attest to stable
visual acuity and refractive error, absence of significant side effects/complications, need
of medications, and freedom from any glare, flares or other visual phenomena that could
affect visual performance and impact aviation safety

 Visual Acuity Standards:

o As listed below or better;

o Each eye separately;
o Snellen equivalent; and
o With or without correction. If correction is used, it should be noted and the correct
limitation applied.

First or Second Class Third Class

Distant Vision 20/20 20/40

Near Vision 20/40 20/40

Measured at 16 inches

Intermediate Vision 20/40 No requirement

Measured at 32 inches;
Age 50 and over only

Note: The above does not change the current certification policy on the use of monofocal non-
accommodating intraocular lenses.

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Protocol for Bundle Branch Block (BBB)

(Updated 04/28/2021)

A. PREVIOUSLY DOCUMENTED AND EVALUATED: No further evaluation required

unless there is a change in condition.

B. RIGHT (RBBB): If a complete RBBB is identified at:

 Age 35* or younger - If otherwise healthy, will usually not require a CVE (unless
there is some other indication). Annotate Block 60.

 Age 36 or older (or other indication) - Will require a cardiac evaluation to

include:
 Cardiovascular Evaluation (CVE) = Narrative + lab (FBS + Lipid Panel)
 Stress echo

C. LEFT (LBBB): A LBBB in a person of any age will require a cardiac evaluation to
include:
 CVE
 Pharmaceutical radionuclide perfusion study

Note: The exercise radionuclide stress test can often show a false-positive reversible
septal defect due to the wall motion abnormality associated with the LBBB.
Specifically, according to the current literature, approximately 40% of individuals with
LBBB will demonstrate a false positive radionuclide reperfusion defect in the septal
area.

AME ACTIONS:

 Individuals with a negative work-up may be issued the appropriate class of

medical certificate with notes in Item 60 and submission of evaluation
documents for retention in the file. No follow-up is required. If any future
changes occur, a new current CVE may be required.

 If areas of ischemia are noted, a coronary angiogram will usually be indicated for
definitive diagnosis. If significant CAD is diagnosed, refer to Special Issuance
guidelines.

*Age updated to 35 (4/2021)

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Protocol for Cardiac Transplant (Updated 08/30/2017)

The AME must defer issuance. Issuance is considered for Third-class applicants only. FAA
Cardiology Panel will review. Applicants found qualified will be required to provide annual
follow-up evaluations. All studies must be performed within 30 days of application.

Requirements for consideration:

 A current report from the treating transplant cardiologist regarding the status of the
cardiac transplant, including all pre- and post-operative reports. A statement regarding
functional capacity, modifiable cardiovascular risk factors, and prognosis for
incapacitation

 Current blood chemistries (fasting blood sugar, hemoglobin A1C concentration, and
blood lipid profile to include total cholesterol, HDL, LDL, and triglycerides), within 30
days

 Any tests performed or deemed necessary by all treating physicians (e.g., myocardial
biopsy)

 Coronary Angiogram

 Graded Exercise Stress Test (see disease protocol) and stress echocardiogram

 A current 24-hour Holter monitor evaluation to include selective representative tracings

 Complete documentation of all rejection history, whether treated or not; include hospital
records and reports of any tests done

 A complete history regarding any infectious process

 All complete history regarding any malignancy

 List of all present medications and dosages, including side effects.

It is the responsibility of each applicant to provide the medical information required to determine
his/her eligibility for airman medical certification. A medical release form may help in obtaining
the necessary information. Please ensure full name appears on any reports or correspondence.

All information shall be forwarded in one mailing to either:

Using regular mail (US postal service) Using special mail (FedEx, UPS, etc.)

Federal Aviation Administration Federal Aviation Administration

Civil Aerospace Medical Institute, Bldg. 13 Medical Appeals Section, AAM-313
Aerospace Medical Certification Division, AAM- Aerospace Medical Certification Division
313 6700 S MacArthur Blvd., Room B-13
PO Box 25082 Oklahoma City, OK 73169
Oklahoma City, OK 73125-9914

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Protocol for Cardiac Valve Replacement

(Updated 02/24/2021)

For applicants with tissue or mechanical valve replacement(s):

INITIAL CONSIDERATION:

 First- or Second-Class Applicants: Applicants are reviewed by the Federal Air

Surgeon's (FAS) Cardiology Panel or FAS Cardiology Consultant and must have
a 6-month recovery period after procedure to ensure stabilization.
 Multiple heart valve replacement(s): Applicants who have received multiple
heart valve replacements may be considered.
 Ross Procedure: The FAA may consider certification of all classes of applicants
who have undergone a Ross Procedure (pulmonic valve transplanted to the
aortic position and pulmonic valve replaced by a bioprosthesis).
 Transcatheter Aortic Valve Replacement (TAVR) Procedure: TAVR may also
be considered for any class. In addition to the requirements listed below, a note
from the cardiologist specifically explaining why the TAVR procedure was chosen
(risk factors, conditions making open procedure not acceptable, etc.) must be
provided.

 The following information must be submitted for all classes:

1. Copies of all hospital/medical records pertaining to the valve
replacement:
 Admission History & Physical (H&P);
 Discharge summary;
 Operative report with valve information (make, model, serial number
and size); and
 Pathology report
2. A current report from the treating cardiologist regarding the status of
the cardiac valve replacement. It should address your general
cardiovascular condition, any symptoms of valve or heart failure, any
related abnormal physical findings, and must substantiate satisfactory
recovery and cardiac function without evidence of embolic phenomena,
significant arrhythmia, structural abnormality, or ischemic disease.
3. If on warfarin (Coumadin), the attending physician must confirm stability
without complications. Report must include warfarin (Coumadin) dose
history, schedule, and International Normalized Ratio (INR) values
(monthly for the past 6-month period of observation; must be within
acceptable range).
4. Current 24-hour Holter monitor evaluation to include select
representative tracings.

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5. Current M-mode, 2-dimensional, and M-Mode Doppler echocardiogram,

specifically including chamber dimensions and valvular gradients. Submit
the video resulting from this study on CD-ROM in DICOM compatible
format.
6. Current maximal GXT (stress test) – See GXT Protocol.
7. If cardiac catheterization and coronary angiography have been performed,
all reports AND films must be submitted, including a copy of the
cineangiogram on CD-ROM in DICOM compatible format.

FOLLOW-UP CERTIFICATION:

After initial certification, all classes are usually followed at 12-month intervals with the
following requirements:
 Current clinical status report from your treating cardiologist;
 Standard resting ECG; (actual LEGIBLE tracing);
 Doppler echocardiogram report; and
 If used, a warfarin (Coumadin) status report: Include dose; monthly INRs;
any complications from treatment and subsequent actions taken.
Note:
 Holter and GXT may be required periodically, if clinically indicated.
 All classes may be eligible for an AASI Cardiac Valve Replacement.
o This includes TAVR or other SINGLE valve replacement.
 If any new valve replacement since their Special Issuance, the AME must
defer.

SUBMITTING INFORMATION TO THE FAA:

 The applicant is responsible for providing all medical information required by the
FAA to determine eligibility for medical certification. A medical release form may
help in obtaining the necessary information. Authorization cannot be considered
until all the required data has been received.
 Use full name and applicant ID on any reports or correspondence. This will assist
in locating the file.
 Keep a copy of all documents and media submitted as a safeguard against loss.
 Send all information in one mailing to either:

Using regular mail (US postal service) Using special mail (FedEx, UPS, etc.)

Federal Aviation Administration Federal Aviation Administration

Civil Aerospace Medical Institute, Bldg. 13 Medical Appeals Section, AAM-313
Aerospace Medical Certification Division, AAM-313 Aerospace Medical Certification Division
PO Box 25082 6700 S MacArthur Blvd., Room B-13
Oklahoma City, OK 73125-9914 Oklahoma City, OK 73169

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Protocol for Cardiovascular Evaluation (CVE)

A current cardiovascular evaluation (CVE) must include:

 A personal and family medical history assessment

 Clinical cardiac and general physical examination

 An assessment and statement regarding the applicant’s medications, functional

capacity, and modifiable cardiovascular risk factors

 Prognosis for incapacitation

 Blood chemistries (fasting blood sugar, current blood lipid profile to include total
cholesterol, HDL, LDL, and triglycerides) performed within the last 90 days

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Protocol for Conductive Keratoplasty

Conductive Keratoplasty (CK) is a refractive surgery procedure. It is acceptable for

aeromedical certification, with Special Issuance, after review by the FAA.

The following criteria are necessary for initial certification:

 The airman is not qualified for six months post procedure

 The airman must provide all medical records related to the procedure

 A current status report by the surgical eye specialist with special note regarding
complications of the procedure or the acquired monocularity, or vision complaints
by the airman

 A current FAA Form 8500-7, Report of Eye Evaluation

 A medical flight test may be necessary (consult with the FAA)

 Annual follow-ups by the surgical eye specialist

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Protocol for Evaluation of

Coronary Heart Disease (CHD Protocol)
(Updated 12/30/2020)

For the purpose of airman certification coronary heart disease (CHD) is divided into 4
broad categories, with or without myocardial infarction (MI):
 Open revascularization of any coronary artery(s) and left main coronary
artery stenting (with or without MI). Open revascularization includes coronary
artery bypass grafting (CABG; on- or off-pump), minimally invasive procedures
by incision, and robot operations. Left main coronary artery stenting carries the
same risk of future cardiac events as CABG, thus it is treated the same for
certification or qualification purposes
 Percutaneous intervention (with or without MI). This includes angioplasty
(PTCA) and bare metal or drug-eluting stents
 MI without any open or percutaneous intervention
 MI from non-coronary artery disease causes. Examples include epinephrine
injection, cardiac trauma, complications of catheterization, blood clotting
disorders (e.g. PT/PTT, Protein S and C, Factor V Leiden), etc.

Recovery time before consideration and required tests will vary by the airman medical
certificate applied for and the categories above.

A. Required recovery times for first and second-class:

a. 6 months: Open revascularization of any coronary artery(s) or left main
coronary artery stenting
b. 3 months:
 Percutaneous intervention excluding left main coronary artery
interventions
 Myocardial infarction (MI), uncomplicated, without any open or
percutaneous intervention procedures
 MI from non-coronary artery disease
B. Required documentation for all pilots with MI due to non-coronary artery disease:
a. Current status report from the treating physician
b. Copies of all medical records (inpatient and outpatient) pertaining to the
event, including all labs, tests, or study results and reports.
C. Required documentation for all pilots with any of the remaining conditions above:
a. The required documentation, including GXT and cardiac catheterization,
must be accomplished no sooner than either 6 months or 3 months post-
event, depending on the underlying condition as listed in Paragraph A.
above
b. Copies of all medical records (inpatient and outpatient) pertaining to the
event, including all labs, tests, or study results and reports.
c. Current status report from the treating cardiologist (cardiovascular
evaluation (CVE)) including:
 Personal and family medical history assessment; clinical cardiac
and general physical examination; assessment and statement

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regarding the applicant's functional capacity and prognosis for

incapacitation
 Documentation of counselling on modifiable cardiovascular risk
factors
 All medications and side-effects, if any
 Labs (lipids, blood glucose)
d. Current Bruce Protocol Stress Test (GXT):
 Third-class airmen - maximal plain GXT
 First and unlimited second-class airmen require maximal
radionuclide GXT.
 For specific GXT requirements see Guidelines for GXT
D. Additional required documentation for first and unlimited* second - class airmen
a. For conditions requiring 6-month recovery:
 6-month post event cardiac catheterization
 6-month post event maximal radionuclide GXT (see above)
b. For conditions requiring 3-month recovery:
 3-month post event cardiac catheterization
 3-month post event maximal radionuclide GXT (see above)
c. The applicant should indicate if a lower class medical certificate is
acceptable (if they are found ineligible for the class sought)
E. Additional required documentation for percutaneous coronary intervention:
The applicant must provide the operative or post procedure report. If a STENT
was placed, the report must include make of STENT, implant location(s), and the
length and diameter of each STENT.

A SPECT myocardial perfusion exercise stress test using technetium agents and/or
thallium may be required for consideration for any class if clinically indicated or if the
exercise stress test is abnormal by any of the usual parameters. The interpretive report
and all SPECT images, preferably in black and white, must be submitted.

Note: If cardiac catheterization and/or coronary angiography have been performed, all
reports and actual films (if films are requested) must be submitted for review. Copies
should be made of all films to safeguard against loss. Films should be labeled with the
applicant’s name and return address.

* Limited second-class medical certificate refers to a second-class certificate with a

functional limitation such as “Not Valid for Carrying Passengers for Compensation
or Hire,” "Not Valid for Pilot in Command, Valid Only When Serving as a Pilot
Member of a Fully Qualified Two-Pilot Crew," etc.

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Specifications for Neuropsychological Evaluations for Treatment with

SSRI Medications
(Updated 01/29/2020)

Depressive disorders and medications used to treat depression are medically disqualifying
for pilots and FAA Air Traffic Control Specialists. However, the Federal Air Surgeon has
established a policy for Authorizations for Special Issuance (SI) of medical certificates for
pilots and Special Consideration (SC) clearance for FAA ATCS treated with selective
serotonin reuptake inhibitor (SSRI) medications who meet specific criteria.

 Where can I find the policy? The policy is published in the Guide for Aviation
Medical Examiners at Item 47. Psychiatric Conditions - Use of Antidepressant
Medications.

 What will be required if special issuance/ special Consideration is authorized?

Airmen found eligible for SI and FAA ATCS found eligible for SC will be required to
undergo periodic re-evaluations. Requirements for re-evaluation testing will be
specified in the letter authorizing SI/SC, and may be limited to the CogScreen-AE or
expanded to include additional tests.

Why is a neuropsychological evaluation required? Depression and other conditions

treated with selective serotonin reuptake inhibitor (SSRI) medications, as well as the SSRIs
themselves, may produce cognitive deficits that would make an airman unsafe to perform
pilot duties. This guideline outlines the requirements for a neuropsychological evaluation.

Who may perform a neuropsychological evaluation? Neuropsychological evaluations

should be conducted by a qualified neuropsychologist with additional training in aviation-
specific topics. The following link contains a list of neuropsychologists who meet all FAA
quality criteria: FAA Neuropsychologist List.

Will I need to provide any of my medical records? You should make records available to
the neuropsychologist prior to the evaluation, to include:
 Copies of all records regarding prior psychiatric/substance-related hospitalizations,
observations or treatment not previously submitted to the FAA.
 Have a copy of your complete FAA file sent to the HIMS AME AND to a board certified
psychiatrist if your treating physician is not a board certified psychiatrist.
o For airmen, see Release of Information on how to request a copy of your file
by submitting a Request for Airman Medical Records (Form 8065-2).
o For FAA ATCS information on this process, contact your Regional Flight
Surgeon’s office.

What must the neuropsychological evaluation report include? At a minimum:

 A review of all available records, including academic records, records of prior
psychiatric hospitalizations, and records of periods of observation or treatment (e.g.,
psychiatrist, psychologist, or pediatric neuropsychiatrist treatment notes). Records

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must be in sufficient detail to permit a clear evaluation of the nature and extent of any
previous mental disorders.
 A thorough clinical interview to include a detailed history regarding: psychosocial or
developmental problems; academic and employment performance; legal issues;
substance use/abuse (including treatment and quality of recovery); aviation
background and experience; medical conditions, and all medication use; and
behavioral observations during the interview and testing.
 A mental status examination.
 Interpretation of testing including, but not limited to, the tests as specified below.
 An integrated summary of findings with an explicit diagnostic statement, and the
neuropsychologist’s opinion(s) and recommendation(s) regarding clinically or
aeromedically significant findings and the potential impact on aviation safety
consistent with the Federal Aviation Regulations.

What is required for testing?

To promote test security, itemized lists of tests comprising psychological/neuropsychological
test batteries have been moved to a secure site. Authorized professionals should use the
portal at FAA Neuropsychology Testing Specifications. For access, email a request to 9-amc-
[email protected].

What must be submitted? The neuropsychologist’s report as specified in the portal, plus:
 Copies of all computer score reports; and
 An appended score summary sheet that includes all scores for all tests administered.
When available, pilot norms must be used. If pilot norms are not available for a
particular test, then the normative comparison group (e.g., general population,
age/education-corrected) must be specified. Also, when available, percentile scores
must be included.

Recommendations should be strictly limited to the psychologist’s area of expertise. For

questions about testing or requirements, email [email protected] .

What else does the neuropsychologist need to know?

 The FAA will not proceed with a review of the test findings without the above data.
 The data and clinical findings will be carefully safeguarded in accordance with the
APA Ethical Principles of Psychologists and Code of Conduct (2002) as well as
applicable federal law.
 Raw psychological testing data may be required at a future date for expert review by
one of the FAA’s consulting clinical psychologists. In that event, the airman/FAA
ATCS will need to provide an authorization for release of the data to the expert
reviewer. Contact your RFS office for more information.

Useful references for the neuropsychologist:

 MOST COMPREHENSIVE SINGLE REFERENCE: Aeromedical Psychology (2013). C.H. Kennedy & G.G. Kay
(Editors). Ashgate.
 Pilot norms on neurocognitive tests: Kay, G.G. (2002). Guidelines for the Psychological Evaluation of Aircrew
Personnel. Occupational Medicine, 17 (2), 227-245.
 Aviation-related psychological evaluations: Jones, D. R. (2008). Aerospace Psychiatry. In J. R. Davis, R.
Johnson, J. Stepanek & J. A. Fogarty (Eds.), Fundamentals of Aerospace Medicine (4th Ed.), (pp. 406-424).
Philadelphia: Lippencott Williams & Wilkins.

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Protocol for Diabetes Mellitus - Diet Controlled

A medical history or clinical diagnosis of diabetes mellitus may be considered previously

established when the diagnosis has been or clearly could be made because of supporting
laboratory findings and/or clinical signs and symptoms. When an applicant with a history of
diabetes is examined for the first time, the AME should explain the procedures involved and
assist in obtaining prior records and current special testing.

Applicants with a diagnosis of diabetes mellitus controlled by diet alone are considered
eligible for all classes of medical certificates under the medical standards, provided they have
no evidence of associated disqualifying cardiovascular, neurological, renal, or
ophthalmological disease. Specialized examinations need not be performed unless indicated
by history or clinical findings. The AME must document these determinations on FAA Form
8500-8.

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Protocol for History of Diabetes Mellitus Type II Medication-Controlled (Non Insulin)

This protocol is used for all diabetic applicants treated with oral agents or incretin mimetic
medications (such as exenatide), herein referred to as medication(s).

An applicant with a diagnosis of diabetes mellitus controlled by medication may be

considered by the FAA for an Authorization of a Special Issuance of a Medical Certificate
(Authorization). For medications currently allowed, see chart of Acceptable Combinations of
Diabetes Medications.

When medication is started the following time periods must elapse prior to certification to
assure stabilization, adequate control, and the absence of side effects or complications from
the medication.
 Metformin only. A 14 day period must elapse.
 Any other single diabetes medication requires a 60-day period.

The initial Authorization decision is made by the AMCD and may not be made by the AME.
An AME may re-issue a subsequent airman medical certificate under the provisions of the
Authorization.

The initial Authorization determination will be made on the basis of a DIABETES or

HYPERGLYCEMIA ON ORAL MEDICATIONS STATUS REPORT signed and completed by
the airman’s treating provider or a report from the treating physician. The report must contain
a statement regarding the medication used, dosage, the absence or presence of side effects
and clinically significant hypoglycemic episodes, and an indication of satisfactory control of
the diabetes. The results of an A1C hemoglobin determination within the past 30 days must
be included. Note must also be made of the presence of cardiovascular, neurological, renal,
and/or ophthalmological disease. The presence of one or more of these associated diseases
will not be, per se, disqualifying but the disease(s) must be carefully evaluated to determine
any added risk to aviation safety.

Re-issuance of a medical certificate under the provisions of an Authorization will also be

made on the basis of reports from the treating physician. The contents of the report must
contain the same information required for initial issuance and specifically reference the
presence or absence of satisfactory control, any change in the dosage or type of medication,
and the presence or absence of complications or side effects from the medication. In the
event of an adverse change in the applicant's diabetic status (poor control or complications
or side effects from the medication), or the appearance of an associated systemic disease,
an AME must defer the case with all documentation to the AMCD for consideration.

If, upon further review of the deferred case, AMCD decides that re-issuance is appropriate,
the AME may again be given the authority to re-issue the medical certificate under the
provisions of the Authorization based on data provided by the treating physician, including
such information as may be required to assess the status of associated medical condition(s).
At a minimum, follow up evaluation by the treating physician of the applicant's diabetes
status is required annually for all classes of medical certificates.

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An applicant with diabetes mellitus - Type II should be counseled by his or her AME
regarding the significance of the disease and its possible complications.

The applicant should be informed of the potential for hypoglycemic reactions and cautioned
to remain under close medical surveillance by his or her treating physician.

The applicant should also be advised that should their medication be changed or the dosage
modified, the applicant should not perform airman duties until the applicant and treating
physician has concluded that the condition is:

 Under control;
 Stable;
 Presents no risk to aviation safety; and
 Treating physician has consulted with the AME who issued the certificate,
AMCD, or RFS.

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DIABETES or HYPERGLYCEMIA ON ORAL MEDICATIONS

STATUS REPORT (Updated 08/30/2017)

Name ________________________________ Birthdate ______________________

Applicant ID# __________________________ PI#___________________________

Please have the provider who treats your diabetes enter the information in the space below.
Return the completed form to your AME or to the FAA at:
Using US Postal Service: or Using special mail (UPS, FedEx, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division AAM-313 Aerospace Medical Certification Division-AAM-313
Mike Monroney Aeronautical Center Civil Aerospace Medical Institute, Bldg. 13
PO Box 25082 6700 S. MacArthur Blvd, Room 308
Oklahoma City, OK 73125 Oklahoma City, OK 73169

1. Provider printed name _______________________ and phone # ____________

2. Date of last clinical encounter for diabetes ____________
3. Date of most recent DIABETES MEDICATION change ____________
4. Hemoglobin A1C lab value ___________________ and date ____________
(A1C lab value must be taken more than 30 days after medication change and within 90 days of re/certification)
5. List ALL current medications (for any condition) *
__________________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___________________________________________________
If YES is circled on any of the questions below, please attach narrative, tests, etc.
6. Any side effects from medications Yes No
7. ANY episode of hypoglycemia in the past year Yes No
8. Any evidence of progressive diabetes induced end organ disease

Cardiac……………………………………………. Yes No
Neurological………………………………………. Yes No
Ophthalmological……………………….……… Yes No
Peripheral neuropathy…………………………… Yes No
Renal disease…………………………………….. Yes No

9. Does this patient take ANY form of insulin Yes No

10. Any clinical concerns? Yes No

__________________________________ ________________
Treating Provider Signature Date
Note: Acceptable Combinations of Diabetes Medications and copies of this form for future follow-ups can be found at
www.faa.gov/go/diabetic.

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Protocol for Diabetes Mellitus Type I or Type II

Insulin Treated - CGM Option
(Updated 03/30/2022)

Consideration will be given to those individuals who have been clinically stable on their current
treatment regimen for a period of 6-months or more. The FAA has an established policy that permits
the special issuance medical certification to some insulin treated applicants. Individuals certificated
under this policy will be required to provide medical documentation regarding their history of
treatment, accidents, and current medical status. If certificated, they will be required to adhere to
monitoring requirements. There are no restrictions regarding flight outside of the United States air
space. Airmen with a current 3rd class certificate will have the limitation removed with their next
certificate. If they need the limitation removed sooner, they should contact AMCD for an updated
certificate without the limitation.

CONTINUOUS GLUCOSE MONITORING (CGM PROTOCOL) - ALL CLASSES:

For consideration for first- or second-class airman certification, the airman must submit
Continuous Glucose Monitoring (CGM) data and ALL the certification requirements as
outlined below:

For details of what specific information must be included for each requirement/report, see
the links below (or the following pages in this document) for:

A. AIRMAN INFORMATION

B. INITIAL CERTIFICATE CONSIDERATION REQUIREMENTS

C. RENEWAL CERTIFICATE REQUIREMENTS

D. INSULIN TREATED DIABETES INFORMATION SUBMISSION REQUIREMENTS

E. OVERLAY REPORT AND ALERT SAMPLE

F. FREQUENTLY ASKED QUESTIONS (FAQs)

NON-CGM PROTOCOL - THIRD CLASS OPTION:

Third class airmen may elect to use either the CGM protocol or the non-CGM protocol. See
the links below (or the following pages in this document) for details of what specific
information must be included for each requirement/report for third-class certification.

A. INITIAL CERTIFICATION

B. MONITORING AND ACTIONS REQUIRED DURING FLIGHT OPERATIONS

C. RE-CERTIFICATION

D. DIABETES ON INSULIN RE-CERTIFICATION STATUS REPORT

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CGM PROTOCOL
INITIAL CERTIFICATION - AIRMAN INFORMATION (Updated 03/30/2022)
If you are an AIRMAN:
1. See your treating physician and get healthy.
2. Do not fly, in accordance with 14 CFR 61.53, until you have an Authorization from the FAA.
3. Find an Aviation Medical Examiner (AME) to work with you through the FAA process:

 Establish care with a board-certified endocrinologist.

 Select, in conjunction with your board-certified endocrinologist, an appropriate Continuous
Glucose Monitor (CGM) device that meets all FAA monitoring criteria. (See “Item # 4 -
Continuous Glucose Monitor Data” of the ITDM Initial Certificate Consideration Requirements ).

 Collect a minimum of 6 months of CGM data - in 30-day increments.

 Verify your CGM report identifies the percentage of time spent with glucose less than 54
mg/dL, less than 70 mg/dL, between 80 and 180 mg/dL, above 180 mg/dL, and above 250
mg/dL.

 Obtain initial lab battery and submit copies of A1C from at least past 12 months.
 Obtain an eye evaluation from a board-certified ophthalmologist (M.D. or D.O.). Exam by
an optometrist (OD) is NOT acceptable.

 Obtain a cardiac evaluation from a board-certified cardiologist.

 Obtain an ECG.
 Undergo a Stress Test Bruce Protocol (if age 40 or older).
4. When you have accomplished all of the above:

 See your AME and complete a new 8500-8 exam;

 Submit the above information and information on any other condition that may require a
Special Issuance.
5. When submitting information:

 The AME must submit your exam as DEFERRED.

 Coordinate with your AME to make sure that A COMPLETE package is sent to the FAA at
the address below WITHIN 14 DAYS. Partial or incomplete packages will NOT be
reviewed and will cause a DELAY in certification. Submit all the information to:

Regular 1st Class Mail (US Postal) OR Special/Overnight Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
AMCD – Medical Appeals Section AMCD – Medical Appeals Section
CAMI Building 13, Room 308, AAM-300, P.O. BOX 25082 6500 S. MacArthur Boulevard
P.O. BOX 25082 CAMI Building 13, Rm 308
Oklahoma City, OK 73125 Oklahoma City, OK 73169

IMPORTANT NOTE
While your exam is under review:
Continue to submit your endocrinologist report and 30-day CGM printouts EVERY 3 MONTHS. This will
ensure the FAA has the most current information and will decrease wait time. If we do not have current
information when we review your case, we will have to request it, which will slow down your certification review.

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DIABETES MELLITUS TYPE I OR TYPE II INSULIN TREATED –

CGM OPTION
(Updated 03/30/2022)

A. INITIAL CERTIFICATE CONSIDERATION REQUIREMENTS:

For consideration for first or second class airman certification, the airman must submit
Continuous Glucose Monitoring (CGM) data. Below is a list of requirements. For details of
what specific information must be included for each requirement/report (ITEMS #1-5), see
the following pages.

The airman must demonstrate stability and adequate control, verified by CGM data, for a
minimum of 6 months. Airman with a new diagnosis of Insulin-treated Diabetes Mellitus
(ITDM) or any concerns regarding their control may require a longer stability period.
Submit the following performed within the past 90 days:

ITEM # 1 Initial Comprehensive clinical consultation from your treating board-certified

endocrinologist. This may be labeled progress note, consultation note or
history and physical. Note: for initial evaluations, the former DIABETES ON
INSULIN Re-Certification STATUS REPORT (Now called “Diabetes on Insulin
Re-Certification Status Report NON CGM – Third Class Option”) will NOT be
accepted. The Initial Comprehensive report contains significant additional
information.
ITEM # 2 Lab – Initial/Annual comprehensive panel;
ITEM # 3 Monthly CGM data with a device that meets FAA requirements for the
preceding 12 months (when available) in overlay view.
It should show trends per day of actual readings, not only averages.
If recently started on CGM, a minimum of 6 months of CGM data is required for
consideration. CGM data should demonstrate consistent, effective ongoing use;
time-in-range (80–180 mg/dL); and excursions below 54, below 70 and above
180, and above 250 mg/dL. (See chart below.)

Parameter Target Range for Certification

Consideration
Auto Mode Greater than 90%
Coefficient of Variance Less than or equal to 33% (May consider up
to 36%.)
Glucose Management Indicator (GMI) Less than 6.5%
Glucose readings - less than 54 mg/dl less than 1%
Glucose readings - less than 70 mg/dl less than 4%
Glucose readings - greater than 250 mg/dl less than 5%
Overall glucose readings - 70-250 mg/dl 90% or greater
Sensor wear 90% of the time or greater
Time in Range (TIR) of 80-180 mg/dl 70% or greater

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ITEM # 4 Eye evaluation from a board-certified ophthalmologist (M.D. or D.O). Exam by

an optometrist (O.D.) is NOT acceptable; AND
ITEM # 5 Cardiac Risk Evaluation from a board-certified cardiologist

Additional information may be required on a case-by-case basis.

When your AME performs your exam (8500-8), they must DEFER. Work with your Aviation
Medical Examiner (AME) to coordinate submission of all of the above documents to the FAA
for consideration:

Using Regular Mail (US Postal) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
CAMI Building 13, Room 308, AAM-300 6500 S. MacArthur Boulevard
P.O. Box 25082 CAMI Building 13, Room 308, AAM-300
Oklahoma City, OK 73125 Oklahoma City, OK 73169

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B. RENEWAL CERTIFICATE REQUIREMENTS:

Once an airman has obtained an Authorization for Special Issuance, they should submit the
requirements specified in their Authorization Letter. The item numbers below correspond to the
numbers on Initial Certificate Consideration Requirements sheet. In general, the renewal information
required is as follows:

MONTHLY:

ITEM #3 - Monthly CGM data printouts:

 Collect data every 30 days;
 Sent to the FAA in ONE package every 6 months; and
 Continue ongoing use with a CGM device that meets FAA requirements.

EVERY 3 MONTHS:

ITEM #1 - Comprehensive, in-person clinical evaluation:

 After the evaluation, obtain a current detailed Clinical Progress Note from your
treating board-certified endocrinologist;
 It should include all parts of the clinical evaluation: Summary of the history of the
condition; current medications, dosages and side effects (if any); clinical exam findings;
results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.
 NOTE: A letter from your endocrinologist is NOT sufficient and cannot substitute for a
current detailed Clinical Progress Note.
 If additional visits occur, submit those actual clinic record(s) to the FAA also.
 Evaluation information must be obtained every 3 months, however, send them to the
FAA as ONE package every 6 months.

EVERY 6 MONTHS:

 Submit all monthly CGM data printouts AND each 3-month current detailed Clinical
Progress Notes from your endocrinologist as ONE package.
 Work with your AME to aggregate the above information and send to the FAA.

EVERY 12 MONTHS:

 All items listed in the EVERY 6 MONTHS section above, PLUS:

 ITEM #2 - Lab - Annual comprehensive panel;
 ITEM #4 - Eye evaluation from a board-certified ophthalmologist (M.D. or D.O). Exam
by an optometrist is NOT acceptable; AND
 ITEM #5 - Cardiac Risk Evaluation from a board-certified cardiologist.

Additional information may be required on a case-by-case basis. Send all to:

Using Regular Mail (US Postal) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
CAMI Building 13, Room 308, AAM-300 6500 S. MacArthur Boulevard
P.O. Box 25082 CAMI Building 13, Room 308, AAM-300
Oklahoma City, OK 73125 Oklahoma City, OK 73169

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The following are the specifics of the ITEM numbers listed in the Initial and Renewal
requirements:

ITEM #1: INITIAL COMPREHENSIVE REPORT (Updated 03/30/2022)

INITIAL COMPREHENSIVE in-person evaluation performed within the past 90 days from the treating
board-certified endocrinologist. The airman must submit a copy of the actual comprehensive current
detailed Clinical Progress Note. (We will NOT accept the patient encounter summary or a letter from the
endocrinologist.) It must detail and comment on ALL of the following*1:

A. DIABETES HISTORY:
1. Characteristics at onset (age, symptoms, etc.):
a) Review previous treatment and response
b) Frequency/cause/severity of past hospitalizations
c) Complications and common comorbidities:
 Any end organ damage (macrovascular or microvascular);
 Presence of hemoglobinopathies or anemias;
 High blood pressure or abnormal lipids and treatment; and
 Visits to specialist - type and why
d) Lifestyle and behavior patterns:
 Eating patterns and weight history;
 Sleep behavior and physical activity;
 Familiarity with carbohydrate counting, if applicable;
 Tobacco, alcohol, and substance use; and
 Any motor vehicle accidents or incidents pertinent to their history of diabetes
2. Medication and Reporting:
a) Medication compliance;
b) Medication intolerance or side effects;
c) Complementary or alternative medicine use;
d) Glucose monitoring (meter/CGM): results and data use; and
e) Review insulin pump settings

3. Screening for Psychosocial conditions:

a) Screen for depression, anxiety, disordered eating (ex: Patient Health Questionnaire 9 or 2
[PHQ-9 or PHQ-2] or similar);
b) Cognitive impairment assessment (and formal testing, if clinically indicated); and
c) Diabetes self-management education and support:
 History of dietician/diabetes educator visits; and
 Screen for barriers to diabetes self-management
4. Glucose control:
a) Hypoglycemia:
 Any symptomatic episodes in the past 12 months requiring treatment or
assistance by another individual, with comment on timing, awareness, frequency,
causes, and treatment.
 Sustained episodes, e.g. CGM/FSBG values below 70 mg/dL for over 30 minutes
or below 54 mg/dL for over 15 minutes, with comment on symptoms and treatment.
b) Hyperglycemia:
 Any symptomatic episodes in the past 12 months with comment on timing,
awareness, frequency, causes, and treatment.
 Sustained episodes, e.g. CGM/FSBG values above 250 mg/dL for over 60 minutes
or above 300 mg/dL for over 30 minutes, with comment on symptoms and
treatment.

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B. PHYSICAL EXAM (Must narrate what is examined and any findings):
1. Height, Weight, Body Mass Index (BMI);
2. Pulse and blood pressure including orthostatic blood pressure, when indicated;
3. Thyroid palpation and skin exam (acanthosis nigricans, insulin injection or insertion sites,
lipodystrophy); and
4. Comprehensive foot exam:
a) Visual inspection; screen for PAD (check pedal pulses; refer for ABI if diminished); and
b) Determination of temperature, vibration or pinprick sensation, and 10-g monofilament
exam

C. ASSESSMENT AND PLAN:

1. Current status of diabetes including an assessment of the airman’s compliance, glucose control,
and stability as well as their ability to monitor and respond accordingly to HYPO and HYPER
glycemic events and administer insulin doses;
2. Prognosis for progression over the next 12 months; and
3. Recommendations for treatment changes

D. DATE OF NEXT CLINICAL FOLLOW-UP (Required every 3 months for FAA.)

*1 Modified from American Diabetes Association (ADA) Standards of Medical Care 2020

ITEM #2: LAB

LAB - Initial/Annual comprehensive panel performed within the past 90 days:

A. A1C (Within last 90 days AND all prior values from the preceding 12 months)
B. CBC (Complete Blood Count)
C. Lipids (Total, LDL [low density lipoprotein], HDL [high density lipoprotein], cholesterol, and
triglycerides)
D. LFT’s (Liver function tests)
E. Micro albumin (or spot urinary albumin-to-creatinine ratio)
F. Renal function (Serum creatinine, BUN (blood urea nitrogen), eGFR (estimated glomerular filtration)
G. TSH (Thyroid-stimulating hormone)
H. Vitamin B12 (When clinically indicated)
I. Potassium (Serum level when clinically indicated or when taking ACE-I [angiotensin converting
enzyme inhibitors], ARBs [angiotensin II receptor blockers], or diuretics)

ITEM #3: CONTINUOUS GLUCOSE MONITOR (CGM) DATA (Updated 03/30/2022)

A. CONTINUOUS GLUCOSE MONITOR (CGM) DATA on a device that meets the FAA’s minimum CGM
device feature requirements.
1. Readings from (at a minimum) the preceding 6 months for initial certification and thereafter 3
months.
2. Analyze to identify percentage time in the following ranges:
a) Less than 54 mg/dL
b) Less than 70mg/dL
c) Between 80 and 180 mg/dL
d) Above 180 mg/dL
e) Above 250 mg/dL

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B. CGM DEVICE FEATURES: The FAA does not endorse any particular manufacturer, however, the CGM
device must have the following features:

1. Must be FDA-approved and appropriate for airman’s age;

2. Must be a real-time CGM (automatically transmits glucose data to the user) without need to
manually scan the sensor (e.g. intermittently scanned CGM);
3. Have “predictive arrow trends” that provide warnings of potentially dangerous glucose levels
(high or low) before they occur;
4. Able to customize low and high glucose levels;
5. Must be a real-time CGM (automatically transmits glucose data to the user) without need to
manually scan the sensor (e.g. intermittently scanned CGM);
6. Have a high-accuracy rating with an overall Mean Absolute Relative Difference (MARD) of 10%
or less. (e.g. If the MARD is 10% and the glucose reading is 70mg/dL, the actual blood glucose
could be as low as 63 mg/dL or as high as 77mg/dL);
7. Printout reports must include monthly summary showing: Time-In-Range (TIR) Values for 80-
180 mg/dL; Average Glucose Levels; Standard Deviation (SD); and (when provided by the
reporting software) Coefficient of Variability [CoV] values. Reports must include weekly
glucose value data graphics. All data must be legible. Failure to provide these values could
result in a delay in processing your application;
8. Calibrated to at least at the minimum frequency required by the manufacturer or endocrinologist;
9. Ability to self-insert sensor at home; and
10. Must be airman’s own, unblinded CGM that cannot be shared with anyone else. Airman cannot
use anyone else’s CGM (e.g. blinded CGM device, which is professional use only).
a) Time-In-Range (TIR) Values for 80-180 mg/dL;
b) Average Glucose Levels;
c) Standard Deviation (SD); and (when provided by the reporting software)
d) Coefficient of Variability [CoV] values;
e) Alarm Settings, indicating both high and low alarms are active;
f) Device manufacturer and current model; and
g) Reports must include weekly glucose value data graphics. All data must be legible.
Failure to provide these values could result in a delay in processing your application.

CGM devices that currently meet the above CGM Device Features (as of 03/30/2022) include:

Dexcom G6
Dexcom G5
Dexcom G4 PLATINUM
Medtronic MiniMed 670G system CGM with insulin pump
Medtronic MiniMed 630G system CGM with insulin pump
Medtronic Guardian Connect CGM system
Senseonics’ Eversense CGM (90-day monitor)
Senseonics’ Eversense E3 CGM (180-day monitor)

This list may not be all-inclusive. Refer to the CGM Device Features above.

C. INSULIN PUMP REQUIREMENTS:

1. If using an insulin pump, it must have the ability to suspend insulin for a predictive low glucose or
predicted pressure changes;
2. Insulin used in the pumps must be FDA approved for that use; and
3. Insulin pumps must also be FDA approved as compatible with the airman’s CGM device. (Not all
CGM devices are compatible with all insulin pumps.)

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ITEM #4: EYE EVALUATION

EYE EVALUATION performed within the past 90 days from a board-certified ophthalmologist (M.D. or D.O.).
Exam by optometrist (O.D.) is NOT acceptable. Evaluation must include:

B. VISUAL ACUITY (with and without correction) each eye separately and together for:
1. Near;
2. Intermediate; and
3. Distance vision

C. EVALUATION FOR OTHER RETINAL OR CLINICALLY SIGNIFICANT EYE DISEASE:

1. Cataracts, any evidence;
2. Color vision deficiency: test used, method used;
3. Contrast sensitivity: test used, method used;
4. Depth perception abnormality;
5. Intra Ocular P Pressure (IOP) reading (and treatment if required): test used, method used; and
6. Visual field defects: type of test, method used (confrontation fields are acceptable).

D. DILATED FUNDUS EXAM with documentation of absence of retinopathy or degree of retinopathy, if

present, and any treatment indicated or recommended.

E. DIAGNOSIS, PROGNOSIS, AND RECOMMENDATIONS FOR TREATMENT OR FOLLOW UP.

ITEM #5: CARDIAC RISK EVALUATION (Updated 03/30/2022)

CARDIAC RISK EVALUATION performed within the past 90 days from a board-certified cardiologist. The
document submitted MUST be the actual in person office evaluation and resultant detailed clinical progress
note:

A. INITIAL EVALUATION AND ANNUALLY:

1. Evaluation from a board-certified cardiologist assessing cardiac risk factors;
2. Baseline ECG (regardless of age);
3. The evaluation must be COMPREHENSIVE, in-person, and performed within the past 90 days
from the treating board-certified cardiologist. The airman must submit a copy of the actual
comprehensive current detailed Clinical Progress Note. (We will NOT accept the patient
encounter summary or a letter.)

B. EVERY 5 YEARS AND AS CLINICALLY INDICATED:

1. Maximal exercise treadmill stress testing (Bruce): beginning at age 40 and every 5 years thereafter
and at any age when clinically indicated. See Graded Exercise Stress Test Protocol.

C. IF THERE ARE ANY ABNORMALITIES on the ECG, stress test, or identification of any cardiac
conditions, the cardiologist must provide a report that details:
1. Any confirmed or suspected diagnosis
2. Clinical status including any symptoms
3. Control of cardiac risk factors (HTN, smoking, hyperlipidemia, exercise, weight)
4. Treatment or monitoring required or recommended and any side effects
5. Were other investigations conducted or recommended (attach reports)
6. Risk of any acutely disabling cardiovascular event (annualized percentage risk)

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DIABETES MELLITUS TYPE I OR TYPE II INSULIN TREATED - CGM OPTION

INFORMATION SUBMISSION REQUIREMENTS

(Updated 03/30/2022)

AIRMAN’S NAME___________________________ PI# or MID#____________________________

Frequency Initial At 3 At 6 At 9 Every 12 Every 5

SUBMIT ALL NEW ITEMS (left of this line) to the FAA every 6 months as ONE package.
Submit all INITIAL Info to the FAA for consideration.

SUBMIT ALL NEW ITEMS (left of this line) to the FAA every 6 months as ONE package.
Months months months months years

Month/Year Due
Endocrinologist Report
30 day CGM printout

A1C
L
A CBC
B Lipids
O Liver Function Tests
R (LFTs)
A Microalbumin
T Renal
O (creatinine/BUN/eGFR)
R TSH
Y B12 (if indicated)
Potassium (if
indicated)

Eye evaluation

Must be done by board-

certified ophthalmologist
(M.D. or D.O.). Exam by
optometrist (O.D.) is NOT
acceptable.

Cardiac Risk Evaluation

done by a cardiologist

Stress Test

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DIABETES MELLITUS TYPE I OR TYPE II INSULIN TREATED - CGM OPTION

OVERLAY REPORT AND ALERT SAMPLE

(Updated 03/30/2022)

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DEXCOM AGP
EXAMPLE - DATA SETTINGS

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DEXCOM G6
EXAMPLE – DATA SETTINGS

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DEXCOM G6
EXAMPLE

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MEDTRONIC 670G
EXAMPLE - ASSESSMENT AND PROGRESS

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MEDTRONIC 670G
EXAMPLE - WEEKLY REVIEW REPORT

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MEDTRONIC 630G
EXAMPLE - SENSOR AND METER OVERVIEW REPORT

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EVERSENSE REPORT
EXAMPLE

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DIABETES MELLITUS TYPE I OR TYPE II

INSULIN TREATED - CGM OPTION PROTOCOL

FREQUENTLY ASKED QUESTIONS (FAQs)

(Updated 03/30/2022)

POLICY FAQs

1. Why has it taken the FAA so long to develop an insulin-use policy for Class I/II airmen
especially when other countries have allowed it for years?
Various flight safety considerations for this serious health condition could not be safely mitigated
for commercial operations until recently. Advances in technology and diabetes management now
provide the FAA better parameters to consider Class I and II medical certification for some insulin-
dependent airmen.

Currently, only Canada and the United Kingdom allow the use of insulin in their pilots with an
equivalent Class I or II medical. Unlike the FAA, those aviation authorities can impose specific
operational limitations on the medical certificate (e.g. “valid only for two pilot operations” or
requiring the other pilot to be both aware of the diabetic condition and able to provide emergency
treatment.)
2. Why is the FAA so restrictive and why is there so much testing?

Testing ensures both good control and demonstrates the absence of end-organ damage. If the
latter is present, the potential risk of cognitive impairment is increased, which could be magnified
in a hypoxic or high-stress environment, affecting safety.

3. My doctor says my diabetes is well controlled and that I have no limitations. Why doesn’t
FAA accept that?
While your physician understands how to keep your blood sugar stable while on the ground,
he/she may not understand the additional challenges of the demanding aviation environment and
may not consider them when determining clinical limitations. FAA guidance addresses these
aviation-specific concerns.

4. Are there additional risks when flying with diabetes?

Yes. As already noted, both hypoglycemia and hypoxia can lead to cognitive impairment.
Unfortunately, many other conditions can as well. These include some medications, substance
abuse, depression, sleep disorders, + HIV status, hypothyroidism, Parkinson ’s disease, head
injuries, hypothyroidism, infections, etc. Many physicians are not aware of the demands of
aviation. Be sure to discuss with your physician the fact that you operate in an environment that
can be both hypoxic and place high demands on your ability to think clearly and rapidly. It is in
your best interest to inform them to ensure that you receive the appropriate evaluations and care.
.
BLOOD SUGAR FAQs

5. Why is the blood sugar range so narrow?

The recommended blood glucose range is not intended to be “narrow,” but to provide realistic
guidance reflecting generally accepted treatment guidelines, accuracy of testing, the potential
effect of workload demands, and the needs of safety. The FAA considered these values carefully

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and consulted with nationally recognized experts in diabetes care. Low blood sugar symptoms
can occur when blood sugar falls below 70 mg/dL and high blood sugar can cause cognitive
impairment and other symptoms at levels above 250 mg/dL. The American Diabetes
Association 2020 guidelines recommends target fasting blood sugar levels of 80 – 130
mg/dL and after-meal levels of less than 180 mg/dL. For flight safety, our experts concur with
these recommendations for all airmen with diabetes. Airmen using Continuous Glucose Monitors
(CGM) should use 80-180 mg/dL as the values for calculating time-in-range. The
recommendations also take into account that testing methods are only an estimate of actual blood
sugar. Current generation CGMs are accurate within 10% of the actual level, while finger sticks,
considered a back-up if the CGM fails, are less accurate at within 20%. Additionally, the
“acceptable” range for blood sugars provides a safety cushion should workload demands render
blood sugar testing, insulin injection, or intake of glucose difficult or even impossible. In addition,
the more time spent in a low blood sugar or hypoglycemic condition, the more likely that the
individual is unaware of it, and it can take up to several hours for full functional recovery from
hypoglycemia. The best way to ensure good blood sugar control in flight is for airmen with
diabetes to maintain their blood sugars in the acceptable range whether in the cockpit or on the
ground.

6. I fly a fixed schedule and am home every night. I am well controlled with finger sticks and
injections. Why do I need to follow these new rules?
The FAA is not able to issue a medical certificate restricted to specific types of flying such as short
segments and regular schedule, but must assume that the pilot will engage in any flight activity for
which he or she is certified.

7. I am currently on a Special Issuance (SI) for another condition. How will ITDM affect that?

Your existing SI will be invalid due to the additional diagnosis. You will need a new authorization
letter.

8. What do I do if my blood sugar is out of limits while I am on a trip?

 You must disqualify yourself from flight activities as required by both the SI and 14
CFR61.53;
 Contact your treating endocrinologist to determine if there is a need to change your insulin
treatment; and
 Contact your AME with details surrounding the event.
o Your AME should contact the FAA to discuss your case.

CONTINUOUS GLUCOSE MONITOR (CGM) AND INSULIN PUMP FAQs

9. Which CGMs does the FAA allow?

The FAA lists the required functions* of CGMs in the Guide for Aviation Medical Examiners (AME
Guide). The FAA updates this information periodically, as medical technology improves. While we
do not recommend specific brands, however, at the request of pilots and AMEs, we have added a
section of devices we know meet these requirements. This list may not be up to date. For the
most up to date information of which brands meet FAA requirements, consult your
endocrinologist. (*See “Item # 4 - Continuous Glucose Monitor Data” of the ITDM Initial Certificate
Consideration Requirements).

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10. Why is a CGM required instead of finger stick blood sugar?

The CGM is more accurate, measuring within 10% of the actual blood sugar. It is also
independent of the pilot’s action. Turbulence can make it impossible for pilots to perform finger
sticks, even with an autopilot and/or second pilot. The CGMs can enable notifications and alerts
for specific blood glucose values and show predictive trends, both of which are required. The
CGM can also communicate with an insulin pump.

11. How do I know if my CGM and/or insulin pump is legal for flight as an “authorized personal
electronic device?”
Most current medical devices should be approved; however, the pilot needs to verify this with the
aircraft operator for the aircraft that they fly. It is not feasible for the FAA to maintain a list of
approved devices due to the rapidly changing technology and to the large number of airframe and
avionics combinations seen in the Part 91, 91k, 121, and 135 fleets. See AC 20-164A for
guidance.

12. I know I have to submit CGM data to the FAA. How do I get this information?
Most devices have the ability to print out customized data reports to your computer, via the USB
port. Check your device’s user guide for instructions as well as computer and software
requirements as these may differ between manufacturers. (Note: Some devices will not allow the
export of data onto your phone or tablet.)

13. What do I do if my device fails?

You should have a backup correction pen and basal insulin available if using an insulin pump.
You should also carry an infusion kit. For the CGM device, you should have a backup sensor and
glucose meter available. In most cases, if the CGM stops working, you will have no readings and
therefore no warnings/alerts during the 2-hour warm-up period after inserting a new sensor. In
this case, go to a back-up plan for the remainder of the flight and measure your finger stick blood
sugar every 30 minutes. If you are unable to correct your blood sugar, treat this as any in flight
emergency and land as soon as practicable.

14. Do I have to get an insulin pump?

No. However, if you choose to get an insulin pump, both the pump and CGM need to be FDA
approved, both separately and in combination. Self-built systems are NOT acceptable for
flying.

15. Are there any concerns with the insulin pumps?

Yes, they can sometimes fail, delivering too much or too little insulin. This risk is present each
time there is a change in pressure altitude, however, airmen can mitigate the risk by limiting the
amount of insulin available for injection and by clearing bubbles at the top of ascent. (Note: This
does not prevent the risk of an insulin bolus associated with a rapid decompression.) Some
pumps have a reservoir that is not directly inline between the pump and injection site. These
pumps are relatively resistant to the effects of pressure changes and provide obvious advantages
to pilots who operate aircraft in the flight levels.

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16. Are there any features that make some insulin pumps better for flying?
The ability to suspend insulin delivery for a low reading is a good safety feature. In addition, as
previously noted, a pump in which the insulin reservoir is not in direct line for delivery is preferred.

17. I do not use an insulin pump. Do I need to make any changes from my normal routine on
the days that I fly?
The goal is to avoid hypoglycemia while flying. Talk with your board-certified endocrinologist
about whether or not adjustments should be made on days when you are flying.

18. What do I do if my machine breaks while traveling or I run out of supplies?

Replace the machine as soon as possible. If you cannot do this, finish the scheduled trip with your
back-up system (finger sticks and injections) and remain compliant with the SI. Once the trip
concludes, do not start a new trip until the system authorized in the SI is back in place and
functional. While you may complete at trip once on the road, you are NOT authorized to add
additional legs to the trip.

If neither the primary nor the backup system is functional, you must terminate flight activity. This
is an absolute flight safety requirement.

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Protocol for Insulin-Treated

Diabetes Mellitus - Type I & Type II
Non CGM - Third-Class Option
(Updated 04/28/2021)

Consideration will be given only to those individuals who have been clinically stable on their current
treatment regimen for a period of 6 months or more. The FAA has an established policy that permits
the special issuance medical certification to some insulin treated applicants. Individuals certificated
under this policy will be required to provide medical documentation regarding their history of
treatment, accidents, and current medical status. If certificated, they will be required to adhere to
monitoring requirements. There are no restrictions regarding flight outside of the United States air
space. Airmen with a current 3rd class certificate will have the limitation removed with their next
certificate. If they need the limitation removed sooner, they should contact AMCD for an updated
certificate without the limitation.

The following is a summary of the evaluation protocol and an outline of the conditions that the FAA
will apply for third class applicants. First and second class applicants will be evaluated on a case-by-
case basis by the Federal Air Surgeon’s Office.

A. Initial Certification

1. The applicant must have had no recurrent (two or more) episodes of hypoglycemia in the
past 5 years and none in the preceding 1 year which resulted in loss of consciousness,
seizure, impaired cognitive function or requiring intervention by another party, or occurring
without warning (hypoglycemia unawareness).

2. The applicant should provide copies of medical records as well as accident and incident
records pertinent to their history of diabetes.

3. A report of a complete medical examination, preferably by a physician who specializes in

the treatment of diabetes, will be required. The exam must be performed within the past
90 days. The Initial Comprehensive Report, which outlines our requirements, is preferred,
however, ANY report submitted MUST include, as a minimum:

a. Two measurements of glycosylated hemoglobin (total A1 or A1C concentration and

the laboratory reference range), separated by at least 90 days. The most recent
measurement must be no more than 90 days old.

b. Specific reference to the applicant’s insulin dosages and diet.

c. Specific reference to the presence or absence of cerebrovascular, cardiovascular,

or peripheral vascular disease or neuropathy.

d. Confirmation by an eye specialist of the absence of clinically significant eye

disease.

e. Verification that the applicant has been educated in diabetes and its control and
understands the actions that should be taken if complications, especially
hypoglycemia, should arise. The examining physician must also verify that the
applicant has the ability and willingness to properly monitor and manage his or her

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diabetes.

f. If the applicant is age 40 or older, a report, with ECG tracings, of a maximal graded
exercise stress test.

g. The applicant shall submit a statement from his/her treating physician, AME, or
other knowledgeable person attesting to the applicant's dexterity and ability to
determine blood glucose levels using a recording glucometer.

NOTE: Student pilots may wish to ensure they are eligible for medical certification prior to beginning
or resuming flight instruction or training. In order to serve as a pilot in command, you must have a
valid medical certificate for the type of operation performed.

B. Subsequent Medical Certification

1. For documentation of diabetes management, the applicant will be required to carry and
use a whole blood glucose measuring device with memory and must report to the FAA
immediately any hypoglycemic incidents, any involvement in accidents that result in
serious injury (whether or not related to hypoglycemia); and any evidence of loss of control
of diabetes, change in treatment regimen, or significant diabetic complications. With any
of these occurrences, the individual must cease flying until cleared by the FAA.

2. At 3-month intervals, the airman must be evaluated by the treating physician. This
evaluation must include a general physical examination, review of the interval medical
history, and the results of a test for glycosylated hemoglobin concentration. The physician
must review the record of the airman's daily blood glucose measurements and comment
on the results. The results of these quarterly evaluations must be accumulated and
submitted annually unless there has been a change. (See No. 1 above - If there has been
a change the individual must report the change(s) to the FAA and wait for an eligibility
letter before resuming flight duties).

3. On an annual basis, the reports from the examining physician must include confirmation
by an eye specialist of the absence of significant eye disease.

4. At the first examination after age 40 and at 5-year intervals, the report, with ECG tracings,
of a maximal graded exercise stress test must be included in consideration of continued
medical certification.

C. Monitoring and Actions Required During Flight Operations

To ensure safe flight, the insulin using diabetic airman must carry during flight a recording
glucometer; adequate supplies to obtain blood samples; and an amount of rapidly absorbable
glucose, in 10 gm portions, appropriate to the planned duration of the flight. The following actions
shall be taken in connection with flight operations:

1. One-half hour prior to flight, the airman must measure the blood glucose concentration. If it
is less than 100 mg/dl the individual must ingest an appropriate (not less than 10 gm)
glucose snack and measure the glucose concentration one-half hour later. If the
concentration is within 100 -- 300 mg/dl, flight operations may be undertaken. If less than
100, the process must be repeated; if over 300, the flight must be canceled.

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2. One hour into the flight, at each successive hour of flight, and within one half hour prior to
landing, the airman must measure their blood glucose concentration. If the concentration
is less than 100 mg/dl, a 20 gm glucose snack shall be ingested. If the concentration is
100 -- 300 mg/dl, no action is required. If the concentration is greater than 300 mg/dl, the
airman must land at the nearest suitable airport and may not resume flight until the
glucose concentration can be maintained in the 100 -- 300 mg/dl range. In respect to
determining blood glucose concentrations during flight, the airman must use judgment in
deciding whether measuring concentrations or operational demands of the environment
(e.g., adverse weather, etc.) should take priority. In cases where it is decided that
operational demands take priority, the airman must ingest a10 gm glucose snack and
measure his or her blood glucose level 1 hour later. If measurement is not practical at that
time, the airman must ingest a 20 gm glucose snack and land at the nearest suitable
airport so that a determination of the blood glucose concentration may be made.

(Note: Insulin pumps are acceptable)

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DIABETES ON INSULIN Re-Certification STATUS REPORT

NON CGM – THIRD CLASS OPTION
(Updated 11/07/2019)

Name __________________________________ Birthdate ________________________

Applicant ID# _____________________________ PI# ____________________________

Class Applied __________________________ Circle one: INITIAL / Re-Certification

Please have the provider who treats your diabetes enter the information in the space below.
Return the completed form to your AME or to the FAA at:

Using regular mail (US postal service) Using special mail (FedEx, UPS, etc.)

Federal Aviation Administration Federal Aviation Administration

Civil Aerospace Medical Institute, Bldg. 13 Medical Appeals Section, AAM-313
Aerospace Medical Certification Division, AAM-313 Aerospace Medical Certification Division
PO Box 25082 6700 S MacArthur Blvd., Room B-13
Oklahoma City, OK 73125-9914 Oklahoma City, OK 73169

1. Provider printed name________________________________ phone ________________

2. Date of last clinical encounter for Diabetes ___________________________

3. Date of most recent DIABETES MEDICATION CHANGE ________________

And describe what was changed:

4. Quarterly hemoglobin A1c

(A1c’s must be done > 30 days after meds change and < 90 days of recertification.)

Quarterly Value Date

A1Cs
#1
#2
#3
#4

5. Review the blood glucose self-monitoring log book, recording device download, or continuous
glucose monitoring (CGM) data, if used. Comment on stability, variance (highs and lows), and any
other concerns you have. If control is good and there are no concerns, state that also.

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DIABETES ON INSULIN Re-Certification STATUS REPORT

NON-CGM – THIRD CLASS OPTION
(Updated 11/07/2019)

Name __________________________________ Birthdate ________________________

Applicant ID# _____________________________ PI# ____________________________

In lieu of #6 and #7, the physician’s office may attach a current medication list. The list should
note for what condition the medications are used.

6. List Insulin treatment schedule:

7. List ALL other current medications* (for any condition) and why they are used/diagnosis treated.
Dosage is not required.

IF YES on any of the questions below, please attach narrative, tests, etc.

8. Any side effects from medications..........................................................................Yes No

9. ANY episode of hypoglycemia in the past year

REQUIRING ASSISTANCE from another person...................................................Yes No

10. Any evidence of progressive diabetes induced end organ disease:

Cardiac........................................................................................................Yes No
Neurological.................................................................................................Yes No
Ophthalmological ........................................................................................Yes No
Neuropathy .................................................................................................Yes No
Renal disease .............................................................................................Yes No

11. Any clinical concerns or other comments? ..........................................................Yes No

____________________________ ___________________
Treating Provider Signature Date

For more information, see:

 Acceptable Combinations of Diabetes Medications

 Pharmaceuticals (Therapeutic Medications) - Diabetes Mellitus - Insulin Treated

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Protocol for Maximal Graded Exercise

Stress Test Requirements
(Updated 08/25/2021)

 If a plain GXT is required and is uninterpretable for any reason, a radionuclide GXT will then be required
before further consideration.
o In patients with bundle branch blocks (BBB), LVH, or diffuse ST/T wave changes at rest, a stress echo
or nuclear stress test will be required.
 GXT requirements:
o 100% of predicted maximal heart rate (PMHR), unless medically contraindicated or prevented either
by symptoms or medications;
o Complete Stage 3 (equivalent to at least 9 minutes);
o Studies of less than 85% of maximum predicted heart rate and less than 9 minutes of exercise
(6 minutes for age 70 or greater) may serve a basis for denial; and
o Beta blockers and calcium channel blockers (specifically diltiazem and verapamil) or digitalis
preparations should be discontinued for 24-48 hours prior to testing (if not contraindicated and only
with the consent of the treating physician) in order to obtain maximum heart rate.
 If the GXT is done on beta blockers, calcium blockers, or digitalis medications, the applicant must
provide explanation from the treating cardiologist as to why the medication(s) cannot be held.
 The worksheet with blood pressure/pulse recordings at various stages, interpretive report, and actual ECG
tracings* must be submitted.
o Tracings must include a rhythm strip;
o A full 12-lead ECG recorded at rest (supine and standing); and
o One or more times during each stage of exercise, at the end of each stage, at peak exercise, and
every minute during recovery for at least 5 minutes or until the tracings return to baseline level.
*Computer generated, sample-cycle ECG tracings are unacceptable in lieu of the standard
tracings. If submitted alone, this may result in deferment until this requirement is met.
Remember, a phone call to either AMCD or RFS may avoid unnecessary deferral.
Reasons for not renewing an AASI [based on GXT]: The applicant reports any other disqualifying medical
condition or undergoes therapy not previously reported OR:

TEST IF ANY OF THE FOLLOWING ARE NOTED, THE AME MAY NOT ISSUE.
PMHR less than 85%; (predicted maximal heart rate)
Exercise stress test
(EST) Time less than 9 minutes--under age 70;
Time less than 6 minutes --age 70 or greater

1 mm ST depression or greater at any time during stress testing - UNLESS the

applicant has additional medical evidence such as a nuclear imaging study or a
stress echocardiogram showing the absence of reversible ischemia or wall
motion abnormalities reviewed and reported by a qualified cardiologist.
Evidence of reversible ischemia OR
Nuclear Negative change from the prior study of the same type OR
stress test Ejection Fraction (EF) reported as 40% or less OR
EF decrease by 10% or more from a prior study
Exercised induced wall motion abnormalities (WMA) OR
Stress echo Negative change from the prior study of the same type OR
EF 40% or less OR
EF decreased by 10% or more from a prior study

NOTE: AASI CHD or Single Valve Replacement or Repair for all classes: If ANY of the items from the regular Bruce EST are not
acceptable, the AME MUST DEFER. An AME is NOT authorized to recertify a CHD or Single Valve Replacement or Repair for any
class AASI if a nuclear stress test or stress echo is required.

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Protocol for History of Human

Immunodeficiency Virus (HIV) Related Conditions

Persons on antiretroviral medication will be considered only if the medication is

approved by the U.S. Food and Drug Administration and is used in accordance with an
acceptable drug therapy protocol. Acceptable protocols are cited in Guidelines for the
Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents developed by the
Department of Health and Human Services Panel on Clinical Practices for Treatment of
HIV Infection.

For persons taking HIV medication for long-term prevention or Pre-Exposure

Prophylaxis (PrEP), see Item 48. General Systemic - Human Immunodeficiency Virus
(HIV).

Application for special issuance must include reports of examination by a physician

knowledgeable in the treatment of HIV-infected persons and a medical history
emphasizing symptoms and treatment referable to the immune and neurologic
system. In addition, these reports must include a "viral load" determination by
polymerase chain reaction (PCR), CD4+ lymphocyte count, a complete blood count,
and the results of liver function tests. An assessment of cognitive function (preferably
by Cogscreen or other test battery acceptable to the Federal Air Surgeon) must be
submitted. Additional cognitive function tests may be required as indicated by results of
the cognitive tests. At the time of initial application, viral load must not exceed 1,000
copies per milliliter of plasma, and cognitive testing must show no significant deficit(s)
that would preclude the safe performance of airman duties.

Application for special issuance must include reports of examination by a physician

knowledgeable in the treatment of HIV-infected persons and a medical history
emphasizing symptoms and treatment referable to the immune and neurologic system.
For initial consideration, see the following Human Immunodeficiency Virus (HIV)
Specification Sheet for the required clinical reports and documentation (including
cognitive testing).

If granted Authorization for Special Issuance, follow-up requirements will be specified in

the Authorization letter. However, the usual requirements will be:

 First 2 years of surveillance: see the Under 2 Year Surveillance HIV

Specification Sheet

 After the first 2 years of surveillance: see the After 2 Years Surveillance HIV
Specification Sheet

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HUMAN IMMUNODEFICIENCY VIRUS (HIV) SPECIFICATION

(Updated 06/30/2021)

Persons who are infected with the HIV and who do not have a diagnosis of Acquired
Immunodeficiency Syndrome (AIDS) may be considered for any class medical
certificate, if otherwise qualified. Persons on an antiretroviral medication will be
considered only if the medication is approved by the U.S. Food and Drug Administration
and is used in accordance with an acceptable drug therapy protocol. Current studies
should be submitted no later than 30-days from test date. In order to be considered for
a medical certificate the following data must be provided:
1. A current report from a physician knowledgeable in the treatment of HIV-infected
persons and a medical history emphasizing symptoms and treatment referable to the
immune system;*

2. Current viral load determination by polymerase chain reaction (PCR) – (for persons
who have had an AIDS defining illness 2 determinations, 1 month apart);

3. Current CD4 (for persons who have had an AIDS defining illness, 2 determinations, 1
month apart) and lymphocyte count;

4. Current complete blood count (CBC) with differential;

5. Results of current liver function tests;

6. BUN and creatine;

7. A current assessment of cognitive function must be provided with the Initial

application. Follow-up neuropsychological evaluations are required annually for first
and second-class pilots and every other year for third-class pilots. Follow the testing
specifications as described in the FAA Neuropsychology Testing Specifications site.
To promote test security, itemized lists of tests comprising
psychological/neuropsychological test batteries have been moved to this secure site.
Authorized professionals should use the secure portal. For access, email a request to
[email protected].

All of the above should be submitted together in one mailing to:

Using US Postal Service: or Using special mail (UPS, FedEx, etc.)

Federal Aviation Administration Federal Aviation Administration
Aeromedical Certification Branch-AAM-300 Aeromedical Certification Branch-AAM-300
Mike Monroney Aeronautical Center Mike Monroney Aeronautical Center
PO Box 25082 6700 S. MacArthur Blvd, Room B-59
Oklahoma City, OK 73125 Oklahoma City, OK 73169

*For applicants with a history of cytomegalovirus (CMR) retinitis, a current ophthalmological evaluation
with visual fields must be provided with the initial application and at 6 month-intervals thereafter.

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UNDER 2 YEAR SURVEILLANCE HIV SPECIFICATION

(Updated 06/30/2021)

Please provide our office with a current status report from a treating physician
knowledgeable and experienced in the treatment of HIV-infected persons. This report
should include the information outlined below, along with any separate additional
testing.

The results should be sent to the Aerospace Medical Certification Division (AMCD) After
review, if the airman is determined qualified, AMCD/Regional Flight Surgeon (RFS) will
send a letter to the airman authorizing the Aviation Medical Examiner (AME) to issue a
new time-limited medical certificate, as applicable.
Both the initial and subsequent medical determinations may only be made by the RFS
or AMCD.

The current status report should include:

 Every 3 months: determinations of viral load, CD4 cell count, a clinical

assessment of cognitive function, and any other laboratory and clinical tests
deemed necessary by the treating physician. These results may be aggregated
and included in the written current status report every 6 months unless there is
an adverse change;

 Every 6 months a written current status report from the treating physician
knowledgeable and experienced in the treatment of HIV-infected persons. To
include the following: a medical history emphasizing symptoms and treatment
referable to the immune system, any signs or symptoms of atherosclerotic
cardiovascular disease, and diabetes mellitus or insulin resistance and a clinical
assessment of cognitive function;

 A current assessment of cognitive function must be provided with the Initial

application. Follow-up neuropsychological evaluations are required annually for
first and second-class pilots and every other year for third-class pilots. Follow the
testing specifications as described in the FAA Neuropsychology Testing
Specifications site. To promote test security, itemized lists of tests comprising
psychological/neuropsychological test batteries have been moved to this secure
site. Authorized professionals should use the secure portal. For access, email a
request to [email protected]; and

 Any other tests advised by the treating physician.

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AFTER 2 YEARS SURVEILLANCE HIV SPECIFICATION

(Updated 06/30/2021)

Please provide our office with a current status report from a treating physician
knowledgeable and experienced in the treatment of HIV-infected persons. This report
should include the information outlined below, along with any separate additional
testing.

The results should be sent to the Aerospace Medical Certification Division (AMCD) After
review, if the airman is determined qualified, AMCD/Regional Flight Surgeon (RFS) will
send a letter to the airman authorizing the Aviation Medical Examiner (AME) to issue a
new time-limited medical certificate, as applicable.
Both the initial and subsequent medical determinations may only be made by the RFS
or AMCD.

The current status report should include:

 Every 6 months: determinations of viral load, CD4 cell count, a clinical

assessment of cognitive function and any other laboratory and clinical tests
deemed necessary by the treating physician. These results may be aggregated
and included in a written current status report every 12 months unless there is an
adverse change;

 Every 12 months a written current status report from the treating physician
knowledgeable and experienced in the treatment of HIV-infected persons. To
include the following: a medical history emphasizing symptoms and treatment
referable to the immune system, any signs or symptoms of atherosclerotic
cardiovascular disease, and diabetes mellitus or insulin resistance and a clinical
assessment of cognitive function;

 A current assessment of cognitive function must be provided with the Initial

application. Follow-up neuropsychological evaluations are required annually for
first and second-class pilots and every other year for third-class pilots. Follow the
testing specifications as described in the FAA Neuropsychology Testing
Specifications site. To promote test security, itemized lists of tests comprising
psychological/neuropsychological test batteries have been moved to this secure
site. Authorized professionals should use the secure portal. For access, email a
request to [email protected]; and

 Any other tests advised by the treating physician.

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Protocol for Initial Evaluation of

Implanted Pacemaker
(Updated 08/25/2021)
A 2-month recovery period is required after pacemaker implantation to allow for recovery and stabilization. After the
2-month recovery period, submit the following:

1. Hospital records. Copies of hospital admission summary medical records pertaining to pacemaker. This
includes history and physical, operative report, discharge summary, coronary catheterization or ischemia work up (if
performed), and all ECG tracings. Pacemaker information must include the make of the generator and leads, model,
and serial number.

2. Cardiology narrative. A typed narrative or clinical note from your cardiologist detailing your interim and current
cardiac condition, functional capacity, medical history, and medications. It must also include:

a. Evaluation of pacemaker function, programmed pacemaker parameters, exclusion of myopotential

inhibition and pacemaker induced hypotension (pacemaker syndrome), elective replacement indicator/end of
life (ERI/EOL), and battery voltage.

b. Pacemaker Status Summary*

3. Lab. Current fasting blood sugar and a current blood lipid profile to include total cholesterol, HDL, LDL, and
triglycerides.

4. Cardiac monitor. A current Holter monitor or similar evaluation for at least 24-consecutive hours to include
select representative tracings. It must list:
a. Atrial and ventricular ectopic counts/burden;
b. Hourly tabular data to include the longest pause duration and counts of all pauses >2.0 or 2.5 seconds;
c. Heart rate (max and min), other day-by-day histograms, and frequency graphs; and
d. Percentage of time in atrial fibrillation/flutter

5. Echo. A current M-mode, 2-dimensional echocardiogram with Doppler.

6. Stress test. A current Maximal Graded Exercise Stress Test Requirements (GXT). If a radionuclide stress (RS)
or cardiac angiogram (cardiac catheterization) were performed, submit those images and reports. Due to poor image
quality, Xeroxed or faxed images will not be accepted.

Note: Evaluation of Pacemaker Dependency is no longer required for any class as of 08/25/2021.

It is the responsibility of each applicant to provide the medical information required to determine his/her eligibility for
airman medical certification.

To aid in the review process, it is critical that the airman’s full name and date of birth appear all correspondence
and reports. Send all information in one mailing to:

Using regular mail (US postal service) Using special mail (FedEx, UPS, etc.)

Federal Aviation Administration Federal Aviation Administration Medical

Appeals Section, AAM-313
Civil Aerospace Medical Institute, Building 13
Aerospace Medical Certification Division, AAM-313 Aerospace Medical Certification Division
PO Box 25082 6700 S MacArthur Boulevard, Room B-13
Oklahoma City, OK 73125-9914 Oklahoma City, OK 73169

No consideration will be given for special issuance until ALL the required data has been received.

*Note: The Pacemaker Status Summary is not required, however, it will it will help to significantly DECREASE
FAA review time.

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PACEMAKER STATUS SUMMARY

(Updated 08/25/2021)

Name _______________________________ Birthdate ________________

Applicant ID#__________________________ PI# _____________________

Please take the following form to your cardiologist and have them enter the requested information in the
space provided. Submit either this summary* or all supporting documentation addressing each item to your
AME or to the FAA at:
Federal Aviation Administration
Civil Aerospace Medical Institute, Building 13
Aerospace Medical Certification Division, AAM-300, PO Box 25082,
Oklahoma City, OK 73125-9867
/ /
1. Date pacer data below was obtained.……………………………………...
Manufacturer Model
2. Pacer Manufacturer and Model……………………………………………..
/ /
3. Date pacer (or generator) implanted ………………………………………
Yes No
4. Does the pacer have a defibrillator circuit that is ENABLED? (Check one)..
Years Months
5. Estimated battery longevity………………………………………………….

6. Pacer Mode (DDDR, VVIR, etc.)……………………………………………

7. Current atrial output – volts (NOT thresholds)……………………………. volts

8. Current ventricular output – volts (NOT thresholds)……………………… RV LV

9. Current atrial impedance (in ohms)…………………………………………

ohms

10. Previous atrial impedance (in ohms)...…………………………………..… ohms

11. Current ventricular impedance (in ohms)………………………………….. RV LV

12. Previous ventricular impedance (in ohms)………………………………… RV LV

13. In the past 6 months has the pacemaker functioned normally with no Yes No
significant abnormality in cardiac response? If lead(s) or generator
replaced, check No………………………………………………………….
Yes No
14. To your knowledge, any lead(s) or generator recalled? (Check one)………

_________________________________ __________________
Cardiologist signature Date

Note: Evaluation of Pacemaker Dependency is no longer required for any class as of 08/25/2021.

*This Pacemaker Status Summary is NOT required; however, it will help to streamline and significantly
DECREASE FAA review time.

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Protocol for Liver Transplant (Recipient)

(Updated 07/29/2015)

The AME must defer initial issuance. An applicant with a history of liver transplant must
submit the following for consideration of a medical certificate. Applicants found qualified
will be required to provide annual follow up evaluations per their authorization letter.

Requirements for initial consideration:

1. A six (6) month post-transplant recovery period with documented stability for the
last three (3) months;

2. Pre-transplant treatment notes that identify the diagnosis, indication for

transplant, and any sequelae prior to transplant. If alcohol was a contributing
factor (abuse or dependence), submit evidence of treatment and recovery;

3. Hospital reports to include admission note, operative note, and hospital

discharge summary;

4. A current status report from the treating physician that describes:

o The status of the transplant, functional capacity, modifiable risk factors,
and prognosis for incapacitation; and
o Any recent or expected change in treatment plan

5. Complication history such as:

o Rejection or graft versus host disease/GVHD;
o Infection Hepatitis C (HCV) or CMV; and/or
o Malignancy due to hepatocellular carcinoma (HCC) or following transplant
and initiation of immune-suppressants

6. Current medication list to include names and dosage of immunosuppressive

medications, the presence or absence of any side effects, and how long the
airman has been on these medications.

7. Lab and images to include copies of most recent lab performed by the treating
physician (CBC, CMP with LFTs) and any other tests deemed necessary by the
treating physician such as imaging or liver biopsy

Recertification: Applicants found qualified will be required to provide follow up

evaluations. This includes updated items 4-7 above, plus any additional information
specifically requested in the airman's Authorization letter.

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Protocol for Medication Controlled

Metabolic Syndrome
(Glucose Intolerance, Impaired Glucose tolerance, Impaired Fasting Glucose,
Insulin Resistance, and Pre-Diabetes)

This protocol is used for all applicants with Glucose Intolerance, Impaired Glucose
tolerance, Impaired Fasting Glucose, Insulin Resistance, and/or Pre-Diabetes treated with oral
agents or incretin mimetic medications (exenatide), herein referred to as medication(s).

An applicant with a diagnosis of diabetes mellitus controlled by medication may be

considered by the FAA for an Authorization of a Special Issuance of a Medical
Certificate (Authorization). For medications currently allowed, see chart of Acceptable
Combinations of Diabetes Medications.

When medication is started the following time periods must elapse prior to certification
to assure stabilization, adequate control, and the absence of side effects or
complications from the medication.
 Metformin only. A 14 day period must elapse.
 Any other single diabetes medication requires a 60-day period.

The initial Authorization decision is made by the AMCD and may not be made by the
AME. An AME may re-issue a subsequent airman medical certificate under the
provisions of the Authorization.

The initial Authorization determination will be made on the basis of a report from the
treating physician. There must be sufficient information to rule out diabetes mellitus.
For favorable consideration, the report must contain a statement regarding the
medication used, dosage, the absence or presence of side effects and clinically
significant hypoglycemic episodes, and an indication of satisfactory control of the
metabolic syndrome. The results of an A1C hemoglobin determination within the past
30 days must be included. Note must also be made of the presence of cardiovascular,
neurological, renal, and/or ophthalmological disease. The presence of one or more of
these associated diseases will not be, per se, disqualifying but the disease(s) must be
carefully evaluated to determine any added risk to aviation safety.

Re-issuance of a medical certificate under the provisions of an Authorization will also be

made on the basis of reports from the treating physician. The contents of the report
must contain the same information required for initial issuance and specifically
reference the presence or absence of satisfactory control, any change in the dosage or
type of medication, and the presence or absence of complications or side effects from
the medication. In the event of an adverse change in the applicant's status
(development of diabetes mellitus, poor control or complications or side effects from the
medication), or the appearance of an associated systemic disease, an AME must defer
the case with all documentation to the AMCD for consideration.

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If, upon further review of the deferred case, AMCD decides that re-issuance is
appropriate, the AME may again be given the authority to re-issue the medical
certificate under the provisions of the Authorization based on data provided by the
treating physician, including such information as may be required to assess the status of
associated medical condition(s).

At a minimum, follow-up evaluation by the treating physician of the applicant's metabolic

syndrome status is required annually for all classes of medical certificates.

An applicant with metabolic syndrome should be counseled by his or her AME regarding
the significance of the disease and its possible complications, including the possibility of
developing diabetes mellitus.

The applicant should be informed of the potential for hypoglycemic reactions and
cautioned to remain under close medical surveillance by his or her treating physician.

The applicant should also be advised that should their medication be changed or the
dosage modified, the applicant should not perform airman duties until the applicant and
treating physician has concluded that the condition is:

 Under control;
 Stable;
 Presents no risk to aviation safety; and
 Consults with the AME who issued the certificate, AMCD, or RFS.

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Protocol for Musculoskeletal Evaluation

The AME should defer issuance.

An applicant with a history of musculoskeletal conditions must submit the following if

consideration for medical certification is desired:

 Current status report

 Functional status report

 Degree of impairment as measured by strength, range of motion, pain

NOTE: If the applicant is otherwise qualified, the FAA may issue a limited certificate.
This certificate will permit the applicant to proceed with flight training until ready for a
medical flight test. At that time, and at the applicant's request, the FAA (usually the
AMCD) will authorize the student pilot to take a medical flight test in conjunction with the
regular flight test. The medical flight test and regular private pilot flight test are
conducted by an FAA inspector. This affords the student an opportunity to demonstrate
the ability to control the aircraft despite the handicap. The FAA inspector prepares a
written report and indicates whether there is a safety problem. A medical certificate and
statement of demonstrated ability (SODA) may be provided to the airman from
AMCD/RFS office if the MFT is successful and the airman is otherwise qualified.

When prostheses are used or additional control devices are installed in an aircraft to
assist the amputee, those found qualified by special certification procedures will have
their certificates limited to require that the device(s) (and, if necessary, even the specific
aircraft) must always be used when exercising the privileges of the airman certificate.

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 Specifications for
Neuropsychological Evaluations for Potential
Neurocognitive Impairment
(Updated 04/27/2020)

Why is a neuropsychological evaluation required? Head trauma, stroke,

encephalitis, multiple sclerosis, other suspected acquired or developmental conditions,
and medications used for treatment, may produce cognitive deficits that would make an
airman unsafe to perform pilot duties. This guideline outlines the requirements for a
neuropsychological evaluation.

Who may perform a neuropsychological evaluation? Neuropsychological

evaluations should be conducted by a qualified neuropsychologist with additional
training in aviation-specific topics. The following link contains a list of
neuropsychologists who meet all FAA quality criteria: FAA Neuropsychologist List.

Will I need to provide any of my medical records? You should make records
available to the neuropsychologist prior to the evaluation, to include:
 Copies of all records regarding prior psychiatric/substance-related
hospitalizations, observations or treatment not previously submitted to the FAA.
 A complete copy of your agency medical records. You should request a copy of
your agency records be sent directly to the psychiatrist and psychologist by
submitting a Request for Airman Medical Records (FAA Form 8065-2).

What must the neuropsychological evaluation report include? At a minimum:

 A review of all available records, including academic records, records of prior
psychiatric hospitalizations, and records of periods of observation or treatment
(e.g., psychiatrist, psychologist, or pediatric neuropsychiatrist treatment notes).
Records must be in sufficient detail to permit a clear evaluation of the nature and
extent of any previous mental disorders.
 A thorough clinical interview to include a detailed history regarding: psychosocial
or developmental problems; academic and employment performance; legal
issues; substance use/abuse (including treatment and quality of recovery);
aviation background and experience; medical conditions, and all medication use;
and behavioral observations during the interview and testing.
 A mental status examination.
 Interpretation of a full battery of neuropsychological and psychological tests
including, but not limited to, the “core test battery” (specified below).
 An integrated summary of findings with an explicit diagnostic statement, and the
neuropsychologist’s opinion(s) and recommendation(s) regarding clinically or
aeromedically significant findings and the potential impact on aviation safety
consistent with the Federal Aviation Regulations.

What is required in the “core test battery?”

To promote test security, itemized lists of tests comprising

psychological/neuropsychological test batteries have been moved to a secure
site. Authorized professionals should use the portal at FAA Neuropsychology Testing
Specifications. For access, email a request to [email protected].
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What must be submitted? The neuropsychologist’s report as specified in the portal,
plus:
 Copies of all computer score reports; and
 An appended score summary sheet that includes all scores for all tests
administered. When available, pilot norms must be used. If pilot norms are
not available for a particular test, then the normative comparison group (e.g.,
general population, age/education-corrected) must be specified. Also, when
available, percentile scores must be included.

Recommendations should be strictly limited to the psychologist’s area of expertise. For

questions about testing or requirements, email [email protected].

What else does the neuropsychologist need to know?

 The FAA will not proceed with a review of the test findings without the above
data.
 The data and clinical findings will be carefully safeguarded in accordance with
the APA Ethical Principles of Psychologists and Code of Conduct (2002) as well
as applicable federal law.
 The raw neurocognitive testing data may be required at a future date for expert
review by one of the FAA’s consulting clinical neuropsychologists. In that event,
authorization for release of the data by the airman to the expert reviewer will
need to be provided.

Additional Helpful Information

1. Will additional testing be required in the future? If eligible for unrestricted medical
certification, no additional testing would be required. However, pilots found eligible
for Special Issuance will be required to undergo periodic re-evaluations. The letter
authorizing special issuance will outline required testing, which may be limited to
specific tests or expanded to include a comprehensive test battery.
2. Useful references for the neuropsychologist:
 MOST COMPREHENSIVE SINGLE REFERENCE:
Aeromedical Psychology (2013). C.H. Kennedy & G.G. Kay (Editors). Ashgate.
 Pilot norms on neurocognitive tests: Kay, G.G. (2002). Guidelines for the Psychological
Evaluation of Aircrew Personnel. Occupational Medicine, 17 (2), 227-245.
 Aviation-related psychological evaluations: Jones, D. R. (2008). Aerospace Psychiatry. In J. R.
Davis, R. Johnson, J. Stepanek & J. A. Fogarty (Eds.), Fundamentals of Aerospace Medicine (4th
Ed.), (pp. 406-424). Philadelphia: Lippencott Williams & Wilkins.

3. URLS for links listed in this document:

 FAA Neuropsychologist List:

http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/
AeromedicalNeuropsychologistList.pdf
 Request for Airman Medical Records (FAA Form 8065-2)
https://www.faa.gov/licenses_certificates/medical_certification/media/MedicalRecordsReques
tForm.pdf
 FAA Neuropsychology Testing Specifications (for authorized professionals only)
https://avssp.faa.gov/avs/aam/HQ/AAM200/AAM220/NP/SitePages/Neuropsychology.aspx

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 FAA Specifications for Neurologic Evaluation
(Updated 08/25/2021)

INFORMATION FOR THE AIRMAN: The FAA requires a neurological evaluation to

determine your ability to hold a medical certificate. The evaluation must meet the
following criteria to be considered:

 Current (must be performed within the last 90 days);

 Performed by a board-certified physician (M.D., D.O., or physician degree
equivalent (e.g. MBBS), who also holds a current board certification by the
American Board of Psychiatry and Neurology or equivalent accrediting authority.
(if you are uncertain, consult your AME); and
 Evaluation must meet the Comprehensive Neurological Evaluation criteria
listed in Item A below.

The following will cause a delay in the processing of your medical application:
- Evaluations which do not meet the above criteria;
- Neurologist evaluation which does not address all the requested information
in Item A;
- Missing or incomplete information requested in Items B - D.

To ensure the neurological evaluation meets FAA requirements, we strongly

recommend that you share all pages of this specification sheet with your
neurologist. Your Aviation Medical Examiner (AME) or personal physician may help
you locate a board-certified neurologist.

IMPORTANT:
 !! Please verify that all CDs submitted will open in an UNENCRYPTED DICOM
READABLE FORMAT!!
 *EEG recordings must have proprietary opening software that is compatible with
Windows 10.
 The airman’s name and FAA reference identification (MID, PI, and/or APP ID#)
should be on all correspondence and reports.
 Mail all requested records and tests, including the neurological evaluation, in ONE
complete package to:

Regular First Class Mail OR Special Delivery/Overnight Mail

Federal Aviation Administration Federal Aviation Administration

Aerospace Medical Certification Division Aerospace Medical Certification Division
CAMI Building 13, Room 308 AAM-300 6500 S. Macarthur Boulevard
P.O. Box 25082 CAMI Building 13, Room 308 AAM-300
Oklahoma City, OK 73125 Oklahoma City, OK 73169

INFORMATION FOR THE NEUROLOGIST: Your patient is an airman who must meet
regulatory requirements in order to be issued a medical certificate. Your
comprehensive report should provide a complete neurological picture for the FAA to
review in making a determination for issuance. The information you provide will be
reviewed by a physician with expertise in aerospace medicine, therefore, it is not our
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expectation that you address the aerospace implications in this evaluation, but to
provide the clinical facts, historical and exam findings, and specialist opinion pertaining
to this airman’s neurologic concerns and/or conditions.

A. COMPREHENSIVE NEUROLOGICAL EVALUATION

The neurological evaluation and examination must be done in accordance with the
1997 documentation guidelines published by the Centers for Medicare and Medicaid
Services and must be detailed enough for a clear understanding of the nature and
extent of the neurological disorder and any limitations. The report submitted to the
FAA must include, at a minimum, the following:

1. Name, address, and phone number of the neurologist conducting the

evaluation.
2. Date of the evaluation.
3. A detailed history of the neurological condition in chronological order from the
time of symptom onset, diagnosis, or presentation to present. It must include a
detailed description of any symptoms as well as relevent positive and negative
findings. Keep in mind that for aviation safety, a history of cognitive and
functional limitations is as important as physical symptoms. Please identify
information sources when appropriate, such as history obtained directly from the
patient, history from other persons/witnesses, and/or history obtained from record
review noting the source record(s).
4. Detailed description of past treatments and outcome(s).
5. Past medical, surgical, and psychiatric history.
6. Medications:
a. Include all herbal, over-the-counter, and/or prescription medications;
b. Document the name, dosage, frequency, reason for use, and side effects;
c. If medications were recently started, stopped, or changed, note the date
and reason; and
d. Note any drug allergies
7. Social and family history:
a. Current occupational or educational functioning;
b. Use of alcohol, tobacco, and other substances; and
c. Any pertinent neurologic family history (e.g. seizures, stroke, migraine,
neurodegenerative and/or neuromuscular disease, etc.)
8. Physical exam:
a. A comprehensive neurological exam: Vital signs; ophthalmoscopic
exam; focused cardiovascular exam (e.g. carotid, cardiac auscultation,
peripheral pulses/perfusion); mental status exam (with a standardized
screening instrument [see below]); cranial nerves II-XII, motor examination
to include mention of bulk, tone, strength, and range of motion; sensory
examination; deep tendon reflexes; coordination; praxis; gait and station;
and other specific examination as deemed necessary;
b. Assessment of mental status: The Montreal Cognitive Assessment
(MoCA) is preferred. Similar instruments such as the Kokmen Short Test
of Mental Status or St. Louis University Mental Status (SLUMS) are also
acceptable. (Note: The Folstein Mini Mental Status Examinaiton (MMSE)
is NOT acceptable.) The test should be administered and scored in
accordance with the published instructions for the specific test. You must
include a copy of the testing sheet with your report; and
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 c. Describe all pertinent positive and negative examination findings and all
functional limitations identified.
9. Results of diagnostic imaging, testing, or procedures conducted and their
significance.
10. Primary diagnosis, any secondary diagnosis, and etiology of the condition.
As applicable, include a discussion of any differential diagnosis that were
considered and why they were excluded.
11. Treatment plan to include:
a. Investigations/testing to be performed;
b. New medications, medication changes, or other therapies;
c. Future treatment plan; and
d. Interval for next scheduled follow up
12. Prognosis and risk assessment: While the final aeromedical risk assessment
will be determined by the FAA, we value your opinion on the potential for sudden
incapacitation (stroke, seizure, etc.); subtle incapictation (slow reaction times,
impaired memory, impaired multi-tasking); or other impairment that may
negatively impact aviation safety.
13. Copies of any pertinent medical records reviewed, including tests performed
as part of the the evaluation. Note: When submitting treatment records from other
physicians make sure they include the actual clinical physician notes, NOT
just the patient after care visit summary or patient summary.

PRIOR TESTING, TREATMENT, OR OTHER RECORDS:

In addition to the Comprehensive Neurological Evaluation, the airman should provide the
following (Items B-D below). See the following page for specifications of document submission.

B. PRIOR TREATMENT RECORDS

Prior treatment records from the current or previous treating physician(s) are an
important aspect of the evaluation. When submitting the following treatment records
to the FAA, include all of the following in the format* noted:
1. Doctor’s office visit and/or progress notes to date with the actual clinical
physician notes, NOT the patient after care visit summary, or patient summary;
and
2. Copies of any EEG, CT, MRI, lab, or other tests performed*

C. IMAGES/TESTING*
This may include CT, MRI, Ultrasound, X-Rays, CT Angiogram, MR Angiogram,
EEG, or other testing ordered by the neurologist or other physician. Test records
submitted must include:

1. Interpretive reports (the final radiology report, ALL pages);

2. Actual images on a compact disc (CD); and
3. EEG recordings*: Sleep-deprived EEG: awake, asleep, and with provocation
(hyperventilation, photic/strobe light)

D. HOSPITAL, EMERGENCY ROOM (ER), AND TREATMENT RECORDS

For each hospitalization or ER visit for a neurological condition or concern, you must
submit:

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 1. Emergency Transport reports (e.g. ambulance, first responder, EMS). If
transported by personal conveyance (not emergency transport), please attach a
memorandum attesting to this;
2. ER record, testing, lab results, and drug screens;
3. Admission History and Physical;
4. Discharge summary from hospital (NOT the patient discharge instructions);
5. Consultant reports (e.g., neurology consult, cardiology consult, etc.);
6. Operative and Procedure reports (e.g., surgery report, angiograms, etc.);
7. Laboratory and pathology testing;
8. Blood tests, surgical pathology specimens;
9. Images/testing*; and
10. EEG reports and CDs of actual EEG recordings*

The airman’s name and FAA reference identification (MID, PI, and/or APP ID#) should
be on all correspondence and reports.

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 Protocol for Obstructive Sleep Apnea
Quick Start for AMES

Sleep apnea has significant safety implications due to cognitive impairment secondary
to the lack of restorative sleep and is disqualifying for airman medical certification. The
condition is part of a group of sleep disorders with varied etiologies. Specifically, sleep
apneas are characterized by abnormal respiration during sleep. The etiology may be
obstructive, central or complex in nature. However, no matter the cause, the
manifestations of this disordered breathing present safety risks that include, but are not
limited to, excessive daytime sleepiness (daytime hypersomnolence), cardiac
dysrhythmia, sudden cardiac death, personality disturbances, refractory hypertension
and, as mentioned above, cognitive impairment. Certification may be considered once
effective treatment is shown.

This protocol is designed to evaluate airmen who may be presently at risk for
Obstructive Sleep Apnea (OSA) and to outline the certification requirements for airmen
diagnosed with OSA. While this protocol focuses on OSA, the AME must also be
mindful of other sleep-related disorders such as insomnia, parasomnias, sleep-related
movement disorders (e.g. restless leg syndrome and periodic leg movement), central
sleep apnea and other hypersomnias, circadian rhythm sleep disorders, etc., that may
also interfere with restorative sleep. All sleep disorders are also potentially medically
disqualifying if left untreated. If one of these other sleep-related disorders is initially
identified during the examination, the AME must contact their RFS or AMCD for
guidance.

Risk Information

The American Academy of Sleep Medicine has established the risk criteria (utilizing
Tables 2 and 3) for OSA. When applying Table 2 and 3, the AME is expected to employ
their clinical judgment.

Educational information for airmen can be found in the FAA Pilot Safety Brochure on
Obstructive Sleep Apnea. Supplemental information for AMEs can be found in OSA
Reference Materials, which can be found at end of the Protocols section.

Persons with physical findings such as a retrograde mandible, large tongue or tonsils,
neuromuscular disorders, or connective tissue anomalies are at risk of OSA requiring
treatment despite a normal or low BMI. OSA is also associated with conditions such as
refractory hypertension requiring more than two medications for control, diabetes
mellitus, and atrial fibrillation. Over 90% of individuals with a BMI of 40 or greater have
OSA requiring treatment. Up to 30% of individuals with OSA have a BMI less than 30.

 AME Actions - On every exam, the AME must triage the applicant into one of 6
groups:

 If the applicant is on a Special Issuance Authorization for OSA (Group/Box 1

of OSA flow chart), select Group 1 on the AME Action Tab:
o Follow AASI/SI for OSA
o Notate in Block 60; and
o Issue, if otherwise qualified
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 If the applicant has had a prior sleep assessment (Group/Box 2 of OSA flow
chart), select Group 2 on the AME Action Tab:

o If the airman is under treatment, provide the requirements of the AASI

and advise the airman they must get the Authorization of Special
Issuance;
o Give the applicant Specification Sheet A and advise that a letter will be
sent from the Federal Air Surgeon requesting more information. The
letter will state that the applicant has 90 days to provide the information
to the FAA/AME;
o Notate in Box 60;
o Issue, if otherwise qualified

 If the applicant does not have an AASI/SI or has not had a previous
assessment, the AME must:

o Calculate BMI; and

o Consider AASM risk criteria Table 2 & 3
o If the AME determines the applicant is not currently at risk for OSA
(Group/Box 3 of OSA flow chart), select Group 3 on the AME Action
Tab:
 Notate in Block 60; and
 Issue, if otherwise qualified

o If the applicant is at risk for OSA but in the opinion of the AME the
applicant is at low risk for OSA , the AME must (Group/Box 4 of OSA
flow chart), select Group 4 on the AME Action Tab:
 Discuss OSA risks with applicant;
 Provide resource and educational information, as appropriate;
 Issue, if otherwise qualified; and
 Notate in Block 60

 If the applicant is at high risk for OSA, the AME must (Group/Box 5 of OSA
flow chart), select Group 5 on the AME Action Tab:
o Give the applicant Specification Sheet B and advise that a letter will be
sent from the Federal Air Surgeon requesting more information. The
letter will state that the applicant has 90 days to provide the information
to the FAA/AME
o Notate in Block 60; and
o Issue, if otherwise qualified

 If the AME observes or the applicant reports symptoms which are severe
enough to represent an immediate risk to aviation safety of the national
airspace (Group/Box 6 of OSA flow chart), select Group 6 on the AME
Action Tab.
o Notate in Block 60
o THE AME MUST DEFER
326
327
328
 Obstructive Sleep Apnea Specification Sheet A
Information Request (Updated 08/30/2017)

Your application for airman medical certification submitted this date indicates that you
have been treated or previously assessed for Obstructive Sleep Apnea (OSA).

You must provide the following information to the Aerospace Medical Certification
Division (AMCD) or your Regional Flight Surgeon within 90 days:

 All reports and records regarding your assessment for OSA by your primary care
physician and/or a sleep specialist.
 If you are currently being treated, also include:
o A signed Airman Compliance with Treatment form or equivalent;

o The results and interpretive report of your most recent sleep study; and

o A current status report from your treating physician indicating that OSA
treatment is still effective.

 For CPAP/ BIPAP/ APAP:

A copy of the cumulative annual PAP device report. Target goal
should show use for at least 75% of sleep periods and an average
minimum of 6 hours use per sleep period.
 For Dental Devices or for Positional Devices:
Once Dental Devices with recording / monitoring capability are
available, reports must be submitted.
 To expedite the processing of your application, please submit the
aforementioned information in one mailing using your reference number (PI,
MID, or APP ID).

Using Regular Mail (US Postal Service) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
AAM-300 AAM-300
Civil Aerospace Medical Institute Civil Aerospace Medical Institute, Bldg. 13
PO Box 25082 6700 S. MacArthur Blvd., Room 308
Oklahoma City, OK 73125-9867 Oklahoma City, OK 73169

329
 OBSTRUCTIVE SLEEP APNEA SPECIFICATION SHEET B
ASSESSMENT REQUEST (Updated 08/30/2017)

Due to your risk for Obstructive Sleep Apnea (OSA), and to review your eligibility to have a
medical certificate, you must provide the following information to the Aerospace Medical
Certification Division (AMCD) or your Regional Flight Surgeon’s Office for review within 90 days:

 A current OSA assessment in accordance with the American Academy of Sleep

Medicine (AASM) by your AME, personal physician, or a sleep medicine specialist.

 If it is determined that a sleep study is necessary, it must be either a Type I laboratory

polysomnography or a Type II (7 channel) unattended home sleep test (HST) that
provides comparable data and standards to laboratory diagnostic testing. It must be
interpreted by a sleep medicine specialist and must include diagnosis and
recommendation(s) for treatment, if any.

 In communities where a Level II HST is unavailable, the FAA will accept a level III HST.
If the HST is positive for OSA, no further testing is necessary and treatment in
accordance with the AASI must be followed. However, if the HST is equivocal, a higher
level test such as an in-lab sleep study will be needed unless a sleep medicine specialist
determines no further study is necessary and documents the rationale.

If your sleep study is positive for a sleep-related disorder, you may not exercise the
privileges of your medical certificate until you provide:

 A signed Airman Compliance with Treatment form or equivalent;

 The results and interpretive report of your most recent sleep study; and

 A current status report from your treating physician addressing compliance, tolerance of
treatment, and resolution of OSA symptoms.

If you are not diagnosed with a sleep-related disorder or the study was negative for a
sleep-related disorder, you may continue to exercise the privileges of your medical certificate,
but the evaluation report along with the results of any study, if conducted, must be sent to the
FAA at the address below. All information provided will be reviewed and is subject to further
FAA action.

In order to expedite the processing of your application, please submit the aforementioned
information in one mailing using your reference number (PI, MID, or APP ID).

Using Regular Mail (US Postal Service) Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Civil Aerospace Medical Institute, Bldg. 13 Civil Aerospace Medical Institute, Bldg. 13
Aerospace Medical Certification Division, AAM Aerospace Medical Certification Division, AAM-
300 300
PO Box 25082 6700 S MacArthur Blvd., Room 308
Oklahoma City, OK 73125-9867 Oklahoma City, OK 73169

330
 OSA STATUS REPORT- INITIAL (Page 1 of 2)
(Updated 02/23/2022)

Name ____________________________________ Birthdate ______________

Applicant ID#_______________________________ PI# ___________________
Please have your treating physician complete this report with the requested information. Submit either
this status report or a clinic note from your physician detailing ALL of the information below. Include
initial sleep study report and, if treated with PAP device(s), include a copy of the most recent PAP
download(s). Submit all items to your AME or to the FAA:

Federal Aviation Administration

Civil Aerospace Medical Institute, Building 13
Aerospace Medical Certification Division, AAM-300, PO Box 25082
Oklahoma City, OK 73125-9867

1. Date of Initial or most recent diagnostic sleep study……………………………….

2. Type of study (in-lab type I or home type II, III, or IV)………………………………..
3. Is the PRIMARY diagnosis Obstructive Sleep Apnea (OSA)?........................... Yes No*
If NO, list diagnosis (e.g. central sleep apnea, restless legs syndrome (RLS),
narcolepsy, insomnia, etc.)___________________________________________________________
No Yes*
4. Any evidence of sleep-disruptive RLS…………………………………………………
5. Periodic limb movements per hour (number)…………………….……………………

6. Central apneas or central hypopneas per hour (number)……....……………………

7. Percentage of total apnea and hypopnea episodes that are central……………….. %

8. Initial Apnea Hypopnea Index (AHI).....................................................................

9. Does the airman have other conditions that may be associated w/increased risk No Yes*
for OSA?..................................................................................................................
If YES, circle any applicable conditions below:
a. Atrial Fibrillation or arrhythmia g. Stroke
b. Congestive heart failure f. Other ________________
c. Coronary Artery Disease (CAD) ________________
d. Diabetes
e. Hypertension
(Treatment refractory; incomplete blood pressure control on 3 or more medication components.)
f. Obesity

10. What is the recommended treatment? (Circle all that apply)

a. PAP (CPAP/BiPAP/APAP). (For FAA purposes, PAP device is required for AHI 16 or higher.)
b. Dental device
c. Nerve stimulator device
d. Surgical intervention
e. Weight loss, positional therapy (conservative management)
f. Other
g. No treatment indicated

331
 OSA STATUS REPORT- INITIAL (Page 2 of 2)
(Updated 09/29/2021)

Name ____________________________________ Birthdate______________

Applicant ID#_______________________________ PI# __________________

No Yes*
11. Does the airman use any sleep or sedating medications? ………………………….
(e.g. zolpidem, eszopiclone, trazodone, ropinirole, gabapentin, pramipexole, diphenhydramine.)
If YES, list medication name, dosage, frequency, and reason for use. _________
________________________________________________________________________________________
Type of treatment used
12. If treatment other than PAP used, list type then go to Question 18...................

CURRENT PAP/CPAP/BIPAP/APAP COMPLIANCE REPORT DATA:

From To
13. Date range of use….................................................................................................
14. Device usage report: Based on the PAP device’s current report, enter number of
days the PAP device was actually used and the total number of days the PAP
device report covers.*…………………………………………………………………....
*FAA medical certification is based on treatment for 365 days or 30 days for newly diagnosed/
treated. If less time represented, describe. _________________________________________________ # of days # of days
actually used covered
________________________________________________________________________________________ in report

15. Usage days - total percentage of days used……………........…………………….... Percentage

Note: 75% or more is acceptable. If less than 75%, comment required.* days used

16. Usage hours - average usage (days used)..............................................................

Note: 6 hours or more is acceptable. If less than 6, comment required.* Hours Minutes

17. Therapy - AHI........……………..........……………………………………….………….

Note: 5 or less is acceptable. If 6 or higher, comment required.* AHI
Yes No*
18. Is current treatment effective* with good control of symptoms, good compliance
with therapy, and should be continued?……………………………………………….
*Subjective screen (Epworth or similar), objective data (residual AHI and device leak, if applicable),
and clinical exam reveal NO concern for residual daytime sleepiness.

19. *Explain any required responses and/or add any additional comments here:

_________________________________________________________ __________________
Treating physician signature Date

Note: This OSA INITIAL Status Report is NOT required; however, it will help to significantly DECREASE FAA
review time.

Pilots, when completed, send all items below as one package:

A copy of this OSA Status Report - Initial or a clinical note (with ALL required information) from your
physician;
A copy of your most recent sleep study (used for diagnosis); and
Compliance data from PAP device representing 30 days if new diagnosis (may consider minimum of
2 weeks if data verifies excellent compliance, effective treatment, and resolved symptoms) OR 365
days if previously diagnosed and treated.

332
 OSA STATUS REPORT - RECERTIFICATION
(Updated 09/29/2021)

Name ____________________________________ Birthdate ________________

Applicant ID#_______________________________ PI# _____________________
Please have your treating physician complete this report with the requested information. Submit either this summary
or a clinic note from your physician detailing ALL the information below. If treated with PAP device, include a copy
of the most recent PAP download. Submit all items to your AME or to the FAA:
Federal Aviation Administration
Civil Aerospace Medical Institute, Building 13
Aerospace Medical Certification Division, AAM-300, PO Box 25082
Oklahoma City, OK 73125-9867

1. Date of INITIAL or MOST RECENT sleep study............................................................................

Yes No*
2. Is the PRIMARY diagnosis Obstructive Sleep Apnea (OSA)?......................................
If NO, list diagnosis (central sleep apnea, restless legs syndrome, narcolepsy, insomnia, etc.)
_____________________________________________________________________________________

3. Initial Apnea Hypopnea Index (AHI)..................................................................................... Initial AHI

4. Does the airman use any sleep or sedating medications?.……………............……………. No Yes*
(e.g. zolpidem, eszopiclone, trazodone, ropinirole, gabapentin, pramipexole, diphenhydramine.)
If YES, list medication name, dosage, frequency, and reason for use.*
Type of treatment used
5. If treatment other than PAP used, list type then go to Question 11…..................
CURRENT PAP/CPAP/BIPAP/APAP COMPLIANCE REPORT DATA:
From To
6. Date range of use.......................................................................................................................
Note: If TWO or more machines are used, download data should be supplied for EACH device. Annotate
this information below. Questions 7-9 should reflect combined times. Certification decision is based on the
cumulative use.

7. Device usage report: Based on the PAP device’s current report, enter number of days
the PAP device was actually used and the total number of days the PAP device
# of days # of days
report covers…………………………………………………………………………………………….. actually used covered
Note: FAA medical certification is based on treatment for 365 days or 30 days for newly diagnosed/treated. in report
If less time represented, describe.*___________________________________________________

8. Usage days - total percentage of days used……………........………………...........…………. Percentage

Note: 75% or more is acceptable. If less than 75%, comment required.* days used

9. Usage hours - average usage (days used)............................................................................

Note: 6 hours or more is acceptable. If less than 6, comment required.* Hours Minutes
10. Therapy - AHI........……………..........…………………………………...........…….………………...
Note: 5 or less is acceptable. If 6 or higher, comment required.*
AHI
11. Is current treatment effective* with good control of symptoms, good compliance with Yes No*
therapy, and should be continued?………………………………………………………………...
*Subjective screen (Epworth or similar), objective data (residual AHI and device leak, if
applicable), and clinical exam reveal NO concern for residual daytime sleepiness.

12. *Explain any required responses and/or add any additional comments here:

______________________________________________ _____________________
Treating physician signature Date

Note: This OSA RECERTIFICATION Status Report is NOT required; however, it will help to significantly DECREASE FAA review time.
Pilots: When completed, send all items below as one package:
A copy of this OSA Status Report - Recertification or a clinical note (with ALL required information) from your physician;
A copy of the most recent sleep study, if not previously submitted; and
Compliance data from PAP device representing 30 days if new diagnosis (may consider minimum of 2 weeks if data verifies excellent
compliance, effective treatment, and resolved symptoms) OR 365 days if previously diagnosed and treated.

333
 OSA Treated with PAP and Use of Two Machines (or more)
(Updated 09/29/2021)

Airmen with obstructive sleep apnea (OSA) treated with PAP (CPAP, BiPAP, or APAP)
may use one machine at home and a separate, portable machine while traveling.
Continuation of the Special Issuance is based on the CUMULATIVE time used.

To submit download data from two (or more) machines:

A. If all machines are used during a normal month (a continuous 30-day period):
1. Use the same one-year date range for each machine (if possible).
2. Submit device downloads from all machines used.
3. Clearly annotate on your 8500-8, a letter from you or on the status report from
your treating physician, the number of machines used.

B. If a single machine is used for more than a month (a continuous 30-day period) and
then additional machines are used:
1. Verify the compliance reports identify the date range used.
2. Submit all device downloads for the past year.
3. Clearly annotate on your 8500-8, a letter from you or on the status report from
your treating physician, the number of machines used.

Successful continuation of Special Issuance will rely on combined usage time and the
percentage of time used. Target goals:

Minimum percent days with device usage 75%

Average usage (days used) 6 hours
Residual Apnea-Hypopnea Index (AHI) 5 or less

334
 Protocol for Peptic Ulcer

An applicant with a history of an active ulcer within the past 3-months or a bleeding
ulcer within the past 6-months must provide evidence that the ulcer is healed if
consideration for medical certification is desired.

Evidence of healing must be verified by a report from the attending physician that
includes the following information:

 Confirmation that the applicant is free of symptoms

 Radiographic or endoscopic evidence that the ulcer has healed

 The name and dosage medication(s) used for treatment and/or prevention, along
with a statement describing side effects or removal

This information should be submitted to the AMCD. Under favorable circumstances, the
FAA may issue a certificate with special requirements. For example, an applicant with a
history of bleeding ulcer may be required to have the physician submit follow-up reports
every 6-months for 1 year following initial certification.

The prophylactic use of medications including simple antacids, H-2 inhibitors or

blockers, proton pump inhibitors, and/or sucralfates may not be disqualifying, if free
from side effects.

An applicant with a history of gastric resection for ulcer may be favorably considered if
free of sequela.

335
 Specifications for Psychiatric Evaluations
(Updated 11/28/2018)

Why is a psychiatric evaluation required? Mental disorders, as well as the

medications used for treatment, may produce symptoms or behavior that would make
an airman unsafe to perform pilot duties. This guideline outlines the requirements for
these evaluations.

Will I need to provide any of my medical records? You should make records
available to the psychiatrist prior to their evaluations, to include:
 Copies of all records regarding prior psychiatric/substance-related
hospitalizations, observations or treatment not previously submitted to the FAA.
 A complete copy of your agency medical records. You should request a copy of
your agency records be sent directly to the psychiatrist by submitting a Request
for Airman Medical Records (FAA Form 8065-2).

THE PSYCHIATRIC EVALUATION

Who may perform a psychiatric evaluation? Psychiatric evaluations must be

conducted by a qualified psychiatrist who is board-certified by the American Board of
Psychiatry and Neurology or the American Board of Osteopathic Neurology and
Psychiatry.
 We strongly advise using a psychiatrist with experience in aerospace psychiatry
and/or familiarity with aviation standards. Using a psychiatrist without this
background may limit the usefulness of the report.
 If we have specified that additional qualifications in addiction psychiatry or
forensic psychiatry are required, please ensure that the psychiatrist is aware of
these requirements and has the qualifications and experience to conduct the
evaluation.

What must the psychiatric evaluation report include? At a minimum:

 A review of all available records, including academic records, records of prior
psychiatric hospitalizations, and records of periods of observation or treatment
(e.g., psychiatrist, psychologist, social worker, counselor, or neuropsychologist
treatment notes). Records must be in sufficient detail to permit a clear evaluation
of the nature and extent of any previous mental disorders.
 A thorough clinical interview to include a detailed history regarding: psychosocial
or developmental problems; academic and employment performance; legal
issues; substance use/abuse (including treatment and quality of recovery);
aviation background and experience; medical conditions, and all medication use;
and behavioral observations during the interview.
 A mental status examination.
 An integrated summary of findings with an explicit diagnostic statement, and the
psychiatrist’s opinion(s) and recommendation(s) for treatment, medication,
therapy, counseling, rehabilitation, or monitoring should be explicitly stated.
Opinions regarding clinically or aeromedically significant findings and the

336
 potential impact on aviation safety must be consistent with the Federal Aviation
Regulations.

What must be submitted by the psychiatrist? The psychiatrist’s comprehensive and

detailed report, as noted above, plus copies of supporting documentation.
Recommendations should be strictly limited to the psychiatrist’s area of expertise.
Psychiatrists with questions are encouraged to call Charles Chesanow, D.O., FAA Chief
Psychiatrist, at (202) 267-3767.

337
 Specifications for Psychiatric and
Psychological Evaluations
(Updated 01/27/2021)

Why are both a psychiatric and a psychological evaluation required? Mental

disorders, as well as the medications used for treatment, may produce symptoms or
behavior that would make an airman unsafe to perform pilot duties. Due to the
differences in training and areas of expertise, separate evaluations and reports are
required from both a qualified psychiatrist and a qualified clinical psychologist for
determining an airman’s medical qualifications. This guideline outlines the requirements
for these evaluations.

Will I need to provide any of my medical records? You should make records
available to both the psychiatrist and clinical psychologist prior to their evaluations, to
include:
 Copies of all records regarding prior psychiatric/substance-related
hospitalizations, observations or treatment not previously submitted to the FAA.
 A complete copy of your agency medical records. You should request a copy of
your agency records be sent directly to the psychiatrist and psychologist by
submitting a Request for Airman Medical Records (FAA Form 8065-2).

THE PSYCHIATRIC EVALUATION

Who may perform a psychiatric evaluation? Psychiatric evaluations must be

conducted by a qualified psychiatrist who is board-certified by the American Board of
Psychiatry and Neurology or the American Board of Osteopathic Neurology and
Psychiatry.
 We strongly advise using a psychiatrist with experience in aerospace psychiatry.
Using a psychiatrist without this background may limit the usefulness of the
report.
 If we have specified that additional qualifications in addiction psychiatry or
forensic psychiatry are required, please ensure that the psychiatrist is aware of
these requirements and has the qualifications and experience to conduct the
evaluation.

What must the psychiatric evaluation report include? At a minimum:

 A review of all available records, including academic records, records of prior
psychiatric hospitalizations, and records of periods of observation or treatment
(e.g., psychiatrist, psychologist, social worker, counselor, or neuropsychologist
treatment notes). Records must be in sufficient detail to permit a clear evaluation
of the nature and extent of any previous mental disorders.

 A thorough clinical interview to include a detailed history regarding: psychosocial

or developmental problems; academic and employment performance; legal
issues; substance use/abuse (including treatment and quality of recovery);
aviation background and experience; medical conditions, and all medication use;
and behavioral observations during the interview.

338
  A mental status examination.

 An integrated summary of findings with an explicit diagnostic statement, and the

psychiatrist’s opinion(s) and recommendation(s) for treatment, medication,
therapy, counseling, rehabilitation, or monitoring should be explicitly stated.
Opinions regarding clinically or aeromedically significant findings and the
potential impact on aviation safety must be consistent with the Federal Aviation
Regulations.

What must be submitted by the psychiatrist? The psychiatrist’s comprehensive and

detailed report, as noted above, plus copies of supporting documentation.
Recommendations should be strictly limited to the psychiatrist’s area of expertise.
Psychiatrists with questions are encouraged to call Charles Chesanow, D.O., FAA Chief
Psychiatrist, at (202) 267-3767.

THE PSYCHOLOGICAL EVALUATION

Who may perform a psychological evaluation? Clinical psychological evaluations

must be conducted by a clinical psychologist who possesses a doctoral degree (Ph.D.,
Psy.D., or Ed.D.), has been licensed by the state to practice independently, and has
expertise in psychological assessment. We strongly advise using a psychologist with
experience in aerospace psychology. Using a psychologist without this background
may limit the usefulness of the report.

What must the psychological evaluation include? At a minimum:

 A review of all available records, including academic records, records of prior
psychiatric hospitalizations, and records of periods of observation or treatment
(e.g., psychiatrist, psychologist, social worker, counselor, or neuropsychologist
treatment notes). Records must be in sufficient detail to permit a clear evaluation
of the nature and extent of any previous mental disorders.
 A thorough clinical interview to include a detailed history regarding: psychosocial
or developmental problems; academic and employment performance; legal
issues; substance use/abuse (including treatment and quality of recovery);
aviation background and experience; medical conditions, and all medication use;
and behavioral observations during the interview.
 A mental status examination.
 Interpretation of a full battery of psychological tests including, but not limited
to, the “core test battery” (specified below).
 An integrated summary of findings with an explicit diagnostic statement, and the
psychologist’s opinion(s) and recommendation(s) for treatment, medication,
therapy, counseling, rehabilitation, or monitoring should be explicitly stated.
Opinions regarding clinically or aeromedically significant findings and the
potential impact on aviation safety must be consistent with the Federal Aviation
Regulations.

What is required in the “core test battery?”

To promote test security, itemized lists of tests comprising
psychological/neuropsychological test batteries have been moved to a secure

339
site. Authorized professionals should use the portal at FAA Neuropsychology Testing
Specifications. For access, email a request to [email protected].

What must be submitted?

The neuropsychologist’s report as specified in the portal, plus:
 Copies of all computer score reports; and
 An appended score summary sheet that includes all scores for all tests
administered. When available, pilot norms must be used. If pilot norms are
not available for a particular test, then the normative comparison group (e.g.,
general population, age/education-corrected) must be specified. Also, when
available, percentile scores must be included.

Recommendations should be strictly limited to the psychologist’s area of expertise. For

questions about testing or requirements, email [email protected].

What else does the psychologist need to know?

 The FAA will not proceed with a review of the test findings without the above
data.
 The data and clinical findings will be carefully safeguarded in accordance with
the APA Ethical Principles of Psychologists and Code of Conduct (2002) as well
as applicable federal law.
 Raw psychological testing data may be required at a future date for expert review
by one of the FAA’s consulting clinical psychologists. In that event, authorization
for release of the data by the airman to the expert reviewer will need to be
provided.

Additional Helpful Information:

1. Will additional evaluations or testing be required in the future? If eligible for

unrestricted medical certification, no additional evaluations would be required.
However, pilots found eligible for Special Issuance will be required to undergo periodic
re-evaluations. The letter authorizing special issuance will outline the specific
evaluations or testing required.
2. Useful references for the psychologist:
 MOST COMPREHENSIVE SINGLE REFERENCE:
Aeromedical Psychology (2013). C.H. Kennedy & G.G. Kay (Editors). Ashgate.
 Pilot norms on neurocognitive tests: Kay, G.G. (2002). Guidelines for the Psychological
Evaluation of Aircrew Personnel. Occupational Medicine, 17 (2), 227-245.
 Aviation-related psychological evaluations: Jones, D. R. (2008). Aerospace Psychiatry. In J. R.
Davis, R. Johnson, J. Stepanek & J. A. Fogarty (Eds.),
 Fundamentals of Aerospace Medicine (4th Ed.), (pp. 406-424). Philadelphia: Lippencott Williams
& Wilkins.

4. Miscellaneous
 Selecting the MMPI-2 vs MMPI-3

340
ADDENDUM – IF NEUROPSYCHOLOGICAL TESTING IS INDICATED

Who may perform a neuropsychological evaluation? Neuropsychological

evaluations should be conducted by a qualified neuropsychologist with additional
training in aviation-specific topics. The following link contains a list of
neuropsychologists who meet all FAA quality criteria: FAA Neuropsychologist List.

Requirements for the evaluation. Requirements for providing records to the

neuropsychologist, conducting the evaluation, and submitting reports are the same as
noted above for the clinical psychologist.

What is required in the “core test battery?”

To promote test security, itemized lists of tests comprising
psychological/neuropsychological test batteries have been moved to a secure
site. Authorized professionals should use the portal at FAA Neuropsychology Testing
Specifications. For access, email a request to [email protected].

What must be submitted?

The neuropsychologist’s report as specified in the portal, plus:
 Copies of all computer score reports; and
 An appended score summary sheet that includes all scores for all tests
administered. When available, pilot norms must be used. If pilot norms are
not available for a particular test, then the normative comparison group (e.g.,
general population, age/education-corrected) must be specified. Also, when
available, percentile scores must be included.

Recommendations should be strictly limited to the psychologist’s area of expertise. For

questions about testing or requirements, email [email protected].

341
 Protocol for Renal Transplant

An applicant with a history of renal transplant must submit the following if consideration
for medical certification is desired:

1. Hospital admission, operative report and discharge summary

2. Current status report including:

 The etiology of the primary renal disease

 History of hypertension or cardiac dysfunction

 Sequela prior to transplant

 A comment regarding rejection or graft versus host disease (GVHD)

 Immunosuppressive therapy and side effects, if any

 The results of the following laboratory results: CBC, BUN, creatinine, and
electrolytes

342
 Six-Minute Walk Test (6MWT) - FAA Result Sheet
(Updated 08/25/2021)

NAME___________________________________________ DOB__________________________________

APPLICANT ID#___________________________________ PI#___________________________________

Please have the provider who treats your cardiac or pulmonary condition complete this sheet. The test must be
done in accordance with the American Thoracic Society (ATS) Guidelines for the Six-Minute Walk Test. (Note:
Link must be opened in Google Chrome.)

Submit this sheet and any other supporting documentation to your AME or to the FAA:
Federal Aviation Administration
Civil Aerospace Medical Institute, Building 13
Aerospace Medical Certification Division, AAM-300
PO Box 25082
Oklahoma City, OK 73125-9867

1. Treating provider’s printed name: ____________________________ Phone number: ________________

2. List ALL current cardiopulmonary medications:_______________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

TEST RESULTS (For YES or NO questions, please circle answer.)

3. Did the airman complete Six-Minute Walk Test? YES or NO. If YES, total distance walked _____ meters.
4. Did the airman stop or pause before 6 minutes? YES or NO. If YES, reason(s):____________________
______________________________________________________________________________________
5. If stopped or paused, total time walked: _________ (min/sec); total distance walked: _________ meters.

Baseline End of End of End of End of End of End of

1 minute 2 minutes 3 minutes 4 minutes 5 minutes 6 minutes
HEART RATE
SpO2 (%)
DYSPNEA
Scale of 0 to 5 (none to severe)

FATIGUE
Scale of 0 to 5 (none to severe)

6. Supplemental oxygen used during the test: YES or NO. If YES, flow ________ (L/min)
7. Rescue inhaler used shortly before or during test: YES or NO.
8. Other symptoms at end of test (e.g. angina; leg/hip/calf pain; dizziness, etc.)
_______________________________________________________________________________________
_______________________________________________________________________________________
9. Treating provider’s interpretation and comments:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Treating provider’s signature ________________________________ Date of evaluation ________________

343
 Protocol for Substances of
Dependence/abuse (Drugs - Alcohol)

 THE AME MUST DEFER ISSUANCE.

 Follow the guidance in the Substances of Dependence/Abuse (Drugs and

Alcohol) section in this document.

344
 Protocol for Thromboembolic Disease
(Updated 10/28/2020)

An applicant with a history of thromboembolic disease must submit the following if

consideration for medical certification is desired:

1. Hospital admission and discharge summary

2. Current status report including:

 Detailed family history of thromboembolic disease;
 Neoplastic workup, if clinically indicated;
 Blood clotting disorders (e.g. PT/PTT, Protein S & C, Factor V Leiden); AND
 If still anticoagulated with warfarin (Coumadin), submit all (no less than monthly)
INRs from time of hospital discharge to present

Warfarin (Coumadin): For applicants who are just beginning warfarin (Coumadin)
treatment the following is required:
 Minimum observation time of 6 weeks after initiation of warfarin therapy;
 Must also meet any required observation time for the underlying condition; AND
 6 INRs, no more frequently than 1 per week

NOAC/DOACs: For applicants who are just beginning treatment the following is required:
 Minimum observation time of 2 weeks after initiation of therapy; AND
 Must also meet any required observation time for the underlying condition.

345
 Guide for Aviation Medical Examiners
__________________________________________________________________________

REFERENCE MATERIALS FOR

OBSTRUCTIVE SLEEP APNEA (OSA)

Table of Contents

1. Guidance
a. OSA Protocol and Decisions Consideration table
b. Quick-Start for AMEs
c. OSA Flow Chart
d. AASM Tables 2 and 3
e. AME Actions
f. Specification Sheet A
g. Specification Sheet B

2. AASI
a. AASI
b. Airman Compliance with Treatment form (signature document)

3. Supplemental and Educational Information

a. Frequently Asked Questions (FAQs)
b. BMI Calculator and Chart
c. Questionnaires
i. Berlin
ii. Epworth Sleepiness Scale
iii. STOP BANG
d. FAA OSA Brochure

4. For AMEs Who Elect to Perform OSA Assessment

a. AASM Guidelines
b. AME Statement (signature document)
Decision Considerations
Disease Protocols – Obstructive Sleep Apnea

Quick Start for AMES

Sleep apnea has significant safety implications due to cognitive impairment secondary to the
lack of restorative sleep and is disqualifying for airman medical certification. The condition is
part of a group of sleep disorders with varied etiologies. Specifically, sleep apneas are
characterized by abnormal respiration during sleep. The etiology may be obstructive, central
or complex in nature. However, no matter the cause, the manifestations of this disordered
breathing present safety risks that include, but are not limited to, excessive daytime
sleepiness (daytime hypersomnolence), cardiac dysrhythmia, sudden cardiac death,
personality disturbances, refractory hypertension and, as mentioned above, cognitive
impairment. Certification may be considered once effective treatment is shown.

This protocol is designed to evaluate airmen who may be presently at risk for Obstructive
Sleep Apnea (OSA) and to outline the certification requirements for airmen diagnosed with
OSA. While this protocol focuses on OSA, the AME must also be mindful of other sleep-
related disorders such as insomnia, parasomnias, sleep-related movement disorders (e.g.
restless leg syndrome and periodic leg movement), central sleep apnea and other
hypersomnias, circadian rhythm sleep disorders, etc., that may also interfere with restorative
sleep. All sleep disorders are also potentially medically disqualifying if left untreated. If one
of these other sleep-related disorders is initially identified during the examination, the AME
must contact their RFS or AMCD for guidance.

Risk Information

The American Academy of Sleep Medicine has established the risk criteria (utilizing Tables 2
and 3) for OSA. When applying Table 2 and 3, the AME is expected to employ their clinical
judgment.

Educational information for airmen can be found in the FAA Pilot Safety Brochure on
Obstructive Sleep Apnea.

Persons with physical findings such as a retrograde mandible, large tongue or tonsils,
neuromuscular disorders, or connective tissue anomalies are at risk of OSA requiring
treatment despite a normal or low BMI. OSA is also associated with conditions such as
refractory hypertension requiring more than two medications for control, diabetes mellitus,
and atrial fibrillation. Over 90% of individuals with a BMI of 40 or greater have OSA requiring
treatment. Up to 30% of individuals with OSA have a BMI less than 30.

347
DISEASE/CONDITION CLASS EVALUATION DATA DISPOSITION

Sleep Apnea

Obstructive Sleep All Requires risk If meets OSA Criteria –

Apnea evaluation, per OSA Issue, if otherwise
Protocol. Document qualified
history and Findings.
Initial Special Issuance
- Requires FAA Decision

Follow-up
Special Issuance
See AASI
Periodic Limb All Submit all pertinent Requires FAA Decision
Movement, etc. medical information
and current status
report. Include sleep
study with a
polysomnogram, use
of medications and
titration study results,
along with a
statement regarding
Restless Leg
Syndrome

348
 OSA QUICK-START for AMEs

The AME while performing the triage function must conclude one of six possible
determinations. The AME is not required to perform the assessment or to comment on the
presence or absence of OSA. For more information, view this instructional video on the
screening process.

Step 1 - Determine into which group (1-6) the airman falls.

Applicant Previously Assessed:

Group 1: Has OSA diagnosis and is on Special Issuance. Reports to follow.
Group 2: Has OSA diagnosis OR has had previous OSA assessment. NOT on
Special Issuance. Reports to follow.

Applicant Not at Risk:

Group 3: Determined to NOT be at risk for OSA at this examination.

Applicant at Risk/Severity to be assessed:

Group 4: Discuss OSA risk with airman and provide educational materials.
Group 5: At risk for OSA. AASM sleep apnea assessment required.

Applicant Risk/Severity Extremely High:

Group 6: Deferred. Immediate safety risk. AASM sleep apnea assessment required.
Reports to follow.

Step 2 – Document findings in Block 60.

Step 3 – Check appropriate triage box in the AME Action Tab.

Step 4 – Issue, if otherwise qualified.

In assessing airmen for groups 4 and 5, the AME is expected to use their own clinical
judgment, using AASM information, when making the triage decision.
Some AMEs have voiced the desire to perform the OSA assessment. While we do not
recommend it, the AME may perform the OSA assessment provided that it is in accordance
with the clinical practice guidelines established by the American Academy of Sleep
Medicine.*

*If a sleep study is conducted, it must be interpreted by a sleep medicine specialist.

349
350
351
AME Actions - On every exam, the AME must triage the applicant into one of 6 groups:

 If the applicant is on a Special Issuance Authorization for OSA (Group/Box 1 of OSA flow
chart), select Group 1 on the AME Action Tab:
o Follow AASI/SI for OSA
o Notate in Block 60; and
o Issue, if otherwise qualified

 If the applicant has had a prior OSA assessment (Group/Box 2 of OSA flow chart),
select Group 2 on the AME Action Tab:
o If the airman is under treatment, provide the requirements of the AASI and advise
the airman they must get the Authorization of Special Issuance;
o Give the applicant Specification Sheet A and advise that a letter will be sent from
the Federal Air Surgeon requesting more information. The letter will state that the
applicant has 90 days to provide the information to the FAA/AME;
o Notate in Box 60;
o Issue, if otherwise qualified

 If the applicant does not have an AASI/SI or has not had a previous assessment, the AME
must:
o Calculate BMI; and
o Consider AASM risk criteria Table 2 & 3
o If the AME determines the applicant is not currently at risk for OSA (Group/Box 3
of OSA flow chart), select Group 3 on the AME Action Tab:
 Notate in Block 60; and
 Issue, if otherwise qualified
o If the applicant is at risk for OSA but in the opinion of the AME the applicant is at
low risk for OSA , the AME must (Group/Box 4 of OSA flow chart), select Group
4 on the AME Action Tab:

 Discuss OSA risks with applicant;

 Provide resource and educational information, as appropriate;
 Notate in Block 60; and
 Issue, if otherwise qualified

 If the applicant is at high risk for OSA, the AME must (Group/Box 5 of OSA flow chart),
select Group 5 on the AME Action Tab:

o Give the applicant Specification Sheet B and advise that a letter will be sent from
the Federal Air Surgeon requesting more information. The letter will state that the
applicant has 90 days to provide the information to the FAA/AME
o Notate in Block 60; and
o Issue, if otherwise qualified

 If the AME observes or the applicant reports symptoms which are severe enough to
represent an immediate risk to aviation safety of the national airspace (Group/Box 6 of
OSA flow chart), select Group 6 on the AME Action Tab.
o Notate in Block 60
o THE AME MUST DEFER

352
 Obstructive Sleep Apnea Specification Sheet A
Information Request (Updated 08/30/2017)

Your application for airman medical certification submitted this date indicates that you have
been treated or previously assessed for Obstructive Sleep Apnea (OSA).

You must provide the following information to the Aerospace Medical Certification Division
(AMCD) or your Regional Flight Surgeon within 90 days:

 All reports and records regarding your assessment for OSA by your primary care
physician and/or a sleep specialist.
 If you are currently being treated, also include:
o A signed Airman Compliance with Treatment form or equivalent;

o The results and interpretive report of your most recent sleep study; and

o A current status report from your treating physician indicating that OSA
treatment is still effective.

 For CPAP/ BIPAP/ APAP:

A copy of the cumulative annual PAP device report. Target goal should
show use for at least 75% of sleep periods and an average minimum of
6 hours use per sleep period.
 For Dental Devices or for Positional Devices:
Once Dental Devices with recording / monitoring capability are available,
reports must be submitted.
 To expedite the processing of your application, please submit the aforementioned
information in one mailing using your reference number (PI, MID, or APP ID).

Using Regular Mail (US Postal Service) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
AAM-300 AAM-300
Civil Aerospace Medical Institute Civil Aerospace Medical Institute, Bldg. 13
PO Box 25082 6700 S. MacArthur Blvd., Room 308
Oklahoma City, OK 73125-9867 Oklahoma City, OK 73169

353
 OBSTRUCTIVE SLEEP APNEA SPECIFICATION SHEET B
ASSESSMENT REQUEST (Updated 08/30/2017)

Due to your risk for Obstructive Sleep Apnea (OSA), and to review your eligibility to have a
medical certificate, you must provide the following information to the Aerospace Medical
Certification Division (AMCD) or your Regional Flight Surgeon’s Office for review within 90
days:

 A current OSA assessment in accordance with the American Academy of Sleep

Medicine (AASM) by your AME, personal physician, or a sleep medicine specialist.

 If it is determined that a sleep study is necessary, it must be either a Type I laboratory

polysomnography or a Type II (7 channel) unattended home sleep test (HST) that
provides comparable data and standards to laboratory diagnostic testing. It must be
interpreted by a sleep medicine specialist and must include diagnosis and
recommendation(s) for treatment, if any.

If your sleep study is positive for a sleep-related disorder, you may not exercise the
privileges of your medical certificate until you provide:

 A signed Airman Compliance with Treatment form or equivalent;

 The results and interpretive report of your most recent sleep study; and

 A current status report from your treating physician addressing compliance, tolerance
of treatment, and resolution of OSA symptoms.

If you are not diagnosed with a sleep-related disorder or the study was negative for a
sleep-related disorder, you may continue to exercise the privileges of your medical
certificate, but the evaluation report along with the results of any study, if conducted, must be
sent to the FAA at the address below. All information provided will be reviewed and is
subject to further FAA action.

In order to expedite the processing of your application, please submit the aforementioned
information in one mailing using your reference number (PI, MID, or APP ID).

Using Regular Mail (US Postal Service) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
AAM-300 AAM-300
Civil Aerospace Medical Institute Civil Aerospace Medical Institute, Bldg. 13
PO Box 25082 6700 S. MacArthur Blvd., Room 308
Oklahoma City, OK 73125-9867 Oklahoma City, OK 73169

354
AME Assisted - All Classes – Obstructive Sleep Apnea (OSA)

AMEs may re-issue an airman medical certificate to airmen currently on an AASI for OSA if the
airman provides the following:
 An Authorization granted by the FAA;
 Signed Airman Compliance with Treatment form or equivalent from the airman attesting to
absence of OSA symptoms and continued daily use of prescribed therapy; and

 A current status report from the treating physician indicating that OSA treatment is still
effective.

o For CPAP/ BIPAP/ APAP:

 A copy of the cumulative annual PAP device report which shows actual time
used (rather than a report typically generated for insurance providers which
only shows if use is greater or less than 4 hours). Target goal should show use
for at least 75% of sleep periods and an average minimum of 6 hours use per
sleep period.

 For persons with an established diagnosis of OSA who do not have a recording
CPAP, a one year exception will be allowed to provide a personal statement
that they regularly use CPAP and before each shift when performing flight or
safety duties.

o For Dental Devices and/or for Positional Devices:

No conditions known to be co-morbid with OSA (e.g., diabetes mellitus, hypertension
treated with more than two medications, atrial fibrillation, etc.). Once Dental Devices
with recording / monitoring capability are available, reports must be submitted.

o For Surgery:
For successfully treated surgical patients, a statement attesting to the continued
absence of OSA symptoms is required.

Defer to the AMCD or the Region for further review if:

 Concerns about adequacy of therapy or non-compliance;

 Significant weight gain or development of conditions known to be co-morbid with OSA
(e.g., diabetes mellitus, hypertension treated with more than two medications, atrial
fibrillation, etc.).

Note: The AME may request AMCD review to discontinue the AASI if there are indications that the
airman no longer has OSA (e.g., significant weight loss and a negative study or surgical
intervention followed by 3 years of symptom abatement and absence of significant weight gain
or co-morbid conditions). In most cases, a follow-up sleep study will be required to
remove the AASI.

355
 AIRMAN COMPLIANCE WITH TREATMENT
OBSTRUCTIVE SLEEP APNEA (OSA)

I ____________________________ (print name) certify that (check one):

___ I have been using __________________ (CPAP/ Dental / or Positional Device) for OSA
as prescribed. I am tolerating the therapy well and have no symptoms of OSA (e.g. daytime
sleepiness or lack of mental attention or concentration).

___ I have been surgically treated for OSA and I have no symptoms of OSA (e.g. daytime
sleepiness or lack of mental attention or concentration).

I understand and acknowledge that I will receive the new requirements for continuation of my
special issuance of Obstructive Sleep Apnea and I will comply with the requirements at my
next FAA medical certificate renewal or reapplication.

Applicant Name: _________________________________________

Date of Birth: ____________________________________________

Reference Number: (PI, MID, or APP ID): _________________________

Applicant Signature _______________________________________ Date _______

356
 OSA – FREQUENTLY ASKED QUESTIONS (FAQS)
(Updated: 02/24/2021)

GENERAL:

1. Where can I view the video explaining the process?

The instructional video for AMEs is available here or at: http://www.faa.gov/tv/?mediaId=1029

2. Where can I find the specification sheets and educational material?

All OSA reference materials can be found at:
http://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/dec_cons/disease_prot/osa/ref_materials/

3. Does this process involve other sleep disorder conditions? (e.g. Period Limb
Movement Disorder, narcolepsy, central sleep apnea, etc.)
No. This process is for obstructive sleep apnea only. If it is clear that the airman suffers from
a different sleep disorder, DEFER and submit any supporting documentation for FAA decision.

TRIAGE:

4. I am not a sleep specialist. How am I supposed to determine if an airman is high risk

enough to send for a sleep evaluation? How many risk factors must be present before
additional testing is required?
The AME should triage the airman based on the FAA OSA Flow Chart, supporting clinical
guidelines, and good clinical judgment to determine the appropriate category for the airman.

5. The airman was assessed 5 years ago for OSA but did not have a polysomnogram. The
evaluation was negative. Is he required to have an updated sleep evaluation or a sleep
study?
No. If there has been NO CHANGE in his/her risk factors, follow Group/Box 2 of the flow
chart and submit a copy of the previous assessment. However, if there has been a change in
risk factors (e.g. elevated BMI, new atrial fibrillation, refractory hypertension, etc.), triage using
the flow chart to determine if the airman needs a repeat assessment.

6. If I mark the radio button (1-6) and have no concerns, do I still need to put notes in
Block 60 regarding the OSA triage?
Yes. It is only required for Group/Box 4 to document that education was given. However, it
may be useful to document the rationale for triage decisions, especially for Group/Box 2, 5,
and 6.

SLEEP EVALUATION AND SLEEP STUDY:

7. Is a sleep evaluation the same as a sleep study?

No. Please reference the AASM guidelines. A sleep evaluation is needed when the triage
process indicates that the airman is at high risk for OSA. The sleep evaluation is used to
determine if a sleep study is warranted.

8. Do I have to turn in the “AME Assessment Statement” for every airman?

No. This statement page is only used by an AME who PERFORMS the sleep evaluation (in
accordance with AASM guidelines) and finds that the airman does not have evidence of OSA.
This is NOT to be used for the routine triage function.

357
 9. What are the different types of sleep studies?
They are:
 Type I: Attended studies (full polysomnogram [PSG] in a sleep lab.
 Type II: Unattended (home) studies using the same monitoring sensors as full PSGs
(Type I).
 Type III*: Unattended (home) studies using devices that measure limited
cardiopulmonary parameters (two respiratory variables [e.g., effort to
breathe, airflow], oxygen saturation, and a cardiac variable [e.g., heart rate or
electrocardiogram].
 Type IV*: Unattended (home) studies using devices that measure only 1 or 2
parameters (typically oxygen saturation and heart rate, or in some
cases, just air flow).

*Please note, Type III and Type IV are NOT acceptable for FAA purposes.

10. Does the FAA require a specific type of sleep study if one is warranted?
Yes. The FAA requires that the test be either a Type I laboratory polysomnography or a Type
II (7 channel) unattended home sleep test (HST) that provides comparable data and
standards to laboratory diagnostic testing. It does not have to be a chain of custody study.

11. What if the doctor or insurance provider is only willing to do a level III Home Sleep Test
(HST)?
In communities where a Level II HST is unavailable, the FAA will accept a level III HST. If the
HST is positive for OSA, no further testing is necessary and treatment in accordance with the
AASI must be followed. However, if the HST is equivocal, a higher level test such as an in-lab
sleep study will be needed unless a sleep medicine specialist determines no further study is
necessary and documents the rationale.

12. If I do the sleep evaluation and determine the airman needs a sleep study, as the AME,
can I interpret the sleep study?
The AME may only interpret the sleep study if he/she is a sleep medicine specialist.

CERTIFICATE, EXTENSION, AND DENIAL PROCESS:

13. If an airman is in Group/Box 5 (at risk for OSA) they have 90 days to comply with
getting an evaluation. Does the AME issue a time-limited, 90 day certificate?
No. Issue a regular (not time limited) certificate, if the airman is otherwise qualified. The AME
MAY NOT issue a time-limited certificate without an authorization from the FAA.

14. I evaluated the airman and triaged him into Group/ Box 5. He had a sleep study and is
doing well on CPAP treatment. Does he have to wait for a time-limited certificate before
he can return to flight duties?
No. Once the airman is compliant with and doing well on treatment, he has met the
requirements for 14 CFR 61.53. The airman may return to flight status with the current
certificate issued by the AME, PROVIDED that ALL the required information regarding OSA
evaluation and treatment has been submitted to the FAA for review.

15. Once the AME issues a regular certificate, who is responsible for keeping track of the
90 days?
The FAA will keep track of the 90 days.

358
 16. The airman has a prior SI/AASI for OSA that only asks for a current status report. Can I
issue this year if he does not bring in any other information on the OSA?
Yes. The AME may issue this year based on the previous SI/AASI if those requirements were
met.

17. Can the airman continue to submit only a current status report until his current AASI
expires?
No. An airman currently on an SI/AASI for OSA will receive a new SI/AASI letter this year. At
that point, he/she will have to comply with the new documentation requirements.

18. What if the airman cannot get a sleep evaluation in 90 days?

The airman may request a one-time, 30-day extension by phone by calling AMCD at (405)
954-4821 and selecting Option 1 when prompted. They may also mail a request to AMCD
(see Specification Sheet B for address) or by contacting their RFS office.

19. If I give the airman Specification Sheet A or B and he does not submit the required
evaluation within 90 days and after the 30 day extension (if requested), what will
happen?
The airman will receive a failure to provide (FTP) denial.

TREATMENT AND FOLLOW UP:

20. How long does an airman have to be on CPAP with a new diagnosis of OSA before they
can return to flying?
The airman may submit the completed compliance statement and required documents to the
FAA for review as soon as they are tolerating the therapy without difficulty and have no
symptoms of OSA.

21. The airman has mild or moderate sleep apnea. Is he required to use CPAP?
In most cases an AHI of 16 or more will require CPAP.

22. If the airman has a sleep study and is diagnosed with OSA does he/she get a new
certificate?
Yes. Once a diagnosis of OSA is established, a Special Issuance is required. When the
airman submits the required supporting documents to the FAA, he/she will be evaluated for a
Special Issuance.

23. If an airman has a previously unreported history of OSA being treated with CPAP, can
the AME issue?
Yes. Issue a regular certificate (Group/Box 2), if the airman is otherwise qualified, and submit
the required information for FAA decision.

24. What if the airman is high risk and has had a previous sleep study that was positive,
but not one of the approved tests? He is currently on CPAP and doing well. Does he
have to get a new sleep study?
Follow Group/Box 2 and submit the required information for FAA decision.

25. The airman had a sleep study in the past and did not have sleep apnea. It was not an
approved test type. Will he have to get another sleep study?

359
 The AME should follow the triage flow chart. If the airman is determined to be Group/Box 5 or
6, he/she will need a sleep evaluation. If a sleep study is warranted, it will need to be an
approved test type (see FAQ #9). Submit the required information for FAA decision.

26. The airman has OSA and was on CPAP in the past. He has now lost weight and is only
on a dental device. What do I do now?
Follow Group/Box 2 and submit the required information for FAA decision.

Measurement Units BMI Formula and Calculation

Pounds and inches Formula: weight (lb) / [height (in)]2 x 703
Calculate BMI by dividing weight in pounds (lbs) by height in inches
(in) squared and multiplying by a conversion factor of 703.
Example: Weight = 150 lbs, Height = 5'5" (65")
Calculation: [150 ÷ (65)2] x 703 = 24.96
Kilograms and meters (or centimeters) Formula: weight (kg) / [height (m)]2
With the metric system, the formula for BMI is weight in kilograms
divided by height in meters squared. Since height is commonly
measured in centimeters, divide height in centimeters by 100 to
obtain height in meters.

Example: Weight = 68 kg, Height = 165 cm (1.65 m)

Calculation: 68 ÷ (1.65)2 = 24.98

360
 Berlin Questionnaire©

Height (m) Weight (kg) Age

Male / Female

Please choose the correct response to each question.

Category 1 Category 2

1. Do you snore? 6. How often do you feel tired or

□ a. Yes fatigued after your sleep?
□ b. No □ a. Almost every day
□ c. Don’t know □ b. 3-4 times per week
□ c. 1-2 times per week
If you answered ‘yes’: □ d. 1-2 times per month
□ e. Rarely or never

2. You snoring is: 7. During your waking time, do you

□ a. Slightly louder than breathing feel tired, fatigued or not up to
□ b. As loud as talking par?
□ c. Louder than talking □ a. Almost every day
□ b. 3-4 times per week
□ c. 1-2 times per week
□ d. 1-2 times per month
□ e. Rarely or never

3. How often do you snore? 8. Have you ever nodded off or fallen asleep
□ a. Almost every day while driving a vehicle?
□ b. 3-4 times per week □ a. Yes
□ c. 1-2 times per week □ b. No
□ d. 1-2 times per month
□ e. Rarely or never If you answered ‘yes’:

4. Has your snoring ever bothered 9. How often does this occur?
other people? □ a. Almost every day
□ a. Yes □ b. 3-4 times per week
□ b. No □ c. 1-2 times per week
□ c. Don’t know □ d. 1-2 times per month
□ e. Rarely or never

5. Has anyone noticed that you stop breathing Category 3

during your sleep?
□ a. Almost every day 10. Do you have high blood
□ b. 3-4 times per week pressure?
□ c. 1-2 times per week □ Yes
□ d. 1-2 times per month □ No
□ □ e. Rarely or never □ Don’t know
361
Scoring Berlin Questionnaire
The questionnaire consists of 3 categories related to the risk of having sleep apnea.
Patients can be classified into High Risk or Low Risk based on their responses to
the individual items and their overall scores in the symptom categories.

Categories and Scoring:

Category 1: Items 1, 2, 3, 4, and 5;
Item 1: if ‘Yes’, assign 1 point
Item 2: if ‘c’ or ‘d’ is the response, assign 1 point
Item 3: if ‘a’ or ‘b’ is the response, assign 1 point
Item 4: if ‘a’ is the response, assign 1 point
Item 5: if ‘a’ or ‘b’ is the response, assign 2 points
Add points. Category 1 is positive if the total score is 2 or more points.

Category 2: items 6, 7, 8 (item 9 should be noted separately).

Item 6: if ‘a’ or ‘b’ is the response, assign 1 point
Item 7: if ‘a’ or ‘b’ is the response, assign 1 point
Item 8: if ‘a’ is the response, assign 1 point
Add points. Category 2 is positive if the total score is 2 or more points.

Category 3 is positive if the answer to item 10 is ‘Yes’ or if the BMI of the patient is
greater than 30kg/m2.
(BMI is defined as weight (kg) divided by height (m) squared, i.e.., kg/m2).

High Risk: if there are 2 or more categories where the score is positive.
Low Risk: if there is only 1 or no categories where the score is positive.

362
 Epworth Sleepiness Scale

The original version of the ESS was first published in 1991. However, it soon became clear that
some people did not answer all the questions, for whatever reason. They may not have had much
experience in some of the situations described in ESS items, and they may not have been able to
provide an accurate assessment of their dozing behavior in those situations. However, if one
question is not answered, the whole questionnaire is invalid. It is not possible to interpolate answers,
and hence item-scores, for individual items. This meant that up to about 5 % of ESS scores were
invalid in some series.
In 1997, an extra sentence of instructions was added to the ESS, as follows:
‘‘It is important that you answer each question as best you can’.
With this exhortation, nearly everyone was able to give an estimate of their dozing behavior in all
ESS situations. As a result, the frequency of invalid ESS scores because of missed item-
responses was reduced to much less than 1%.

The 1997 version of the ESS is now the standard one for use in English or any other language. It is
available in pdf here.

363
 STOP BANG Questionnaire
Height inches/cm:
Age:
Male/Female
BMI:
Weight lb/kg:
Collar size of shirt: S, M, L, XL, or inches/cm neck circumference:

1. Snoring
Do you snore loudly (louder than talking or loud enough to be heard
through closed doors)?
Yes No
2. Tired
Do you often feel tired, fatigued, or sleepy during daytime? Yes
No
3. Observed - Has anyone observed you stop breathing during your sleep?
Yes No
4. Blood pressure
Do you have or are you being treated for high blood pressure?
Yes No

5. BMI -BMI more than 35 kg/m2?

Yes No

6. Age - Age over 50 years old?

Yes No

7. Neck circumference - Neck circumference greater than 40 cm?

Yes No

8. Gender – Male?
Yes No
* Neck circumference is measured by staff

High risk of OSA: answering yes to three or more items

Low risk of OSA: answering yes to less than three items
Adapted from:
STOP Questionnaire
A Tool to Screen Patients for Obstructive Sleep Apnea
Frances Chung, F.R.C.P.C.,* Balaji Yegneswaran, M.B.B.S.,† Pu Liao, M.D.,‡ Sharon A. Chung, Ph.D.,§
Santhira Vairavanathan, M.B.B.S.,_ Sazzadul Islam, M.Sc.,_ Ali Khajehdehi, M.D.,† Colin M. Shapiro, F.R.C.P.C.#
Anesthesiology 2008; 108:812–21 Copyright © 2008, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc.

364
365
366
 For AMEs Who Elect to Perform the OSA Assessment

Evaluating the risk of Obstructive Sleep Apnea (OSA) requires clinical judgment based on an
integrated assessment of history, symptoms, AND physical/clinical findings. If an AME
elects to perform the assessment for OSA, he/she must follow the American Academy of Sleep
Medicine guidelines.

After completing the assessment, if the diagnosis of OSA is not made, the AME must sign and
submit the AME Assessment Statement - OSA. If the AME confirms the presence of OSA, then
full clinical note with test results, if performed, must be submitted.

History of findings that suggest increased risk of OSA include:

• Hypertension requiring more than 2 medications for control or refractory hypertension
• Type 2 Diabetes
• Atrial fibrillation or nocturnal dysrhythmias
• Congestive heart failure
• Stroke
• Pulmonary hypertension
• Motor vehicle accidents, especially those associated with sleepiness/drowsiness
• Under consideration for bariatric surgery

Symptoms that suggest an increased risk of OSA include:

• Snoring
• Daytime sleepiness
• Witnessed apneas
• Complaints of awakening with sensation of gasping or choking
• Non-refreshing sleep
• Frequent awakening (sleep fragmentation) or difficulty staying asleep (maintenance insomnia)
• Morning headaches
• Decreased concentration
• Problems or difficulty with memory or memory loss
• Irritability

Physical/clinical findings that suggest increased risk of OSA include:

• High score on an OSA screening questionnaire (e.g., Berlin, Epworth)
• Increased neck circumference (>17 inches in men, >16 inches in women)
• A Modified Mallampati score of 3 or 4 (assessment of the oral cavity)
• Retrognathia
• Lateral peritonsilar narrowing
• Macroglossia
• Tonsillar hypertrophy
• Elongated/enlarged uvula
• High arched/narrow hard palate
• Nasal abnormalities such as polyps, deviation and turbinate hypertrophy
• Obesity (AASM guidelines)

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 AME ASSESSMENT STATEMENT – OSA (Updated 08/30/2017)

AMEs who elect to perform an OSA assessment and find that the applicant does not meet
the American Academy of Sleep Medicine (AASM) diagnostic criteria for OSA, must submit
this statement to the FAA.

Airman/ Patient Name __________________ DOB: ____________

Reference Number (PI, MID, or App ID): ______________________

_____ (initial) I have performed an OSA assessment in accordance with AASM guidelines
and have determined that there is no evidence of OSA requiring treatment at this time. (If a
sleep study was performed it must be attached).

____________________________________________________________________

____________________________________________________________________

PHYSICIAN NAME ____________________________________________________

Address: ____________________________________________________________

Office Telephone Number: ______________________________________________

PHYSICIAN
SIGNATURE________________________________________DATE____________

Mail this form to:

Using Regular Mail (US Postal Service) or Using Special Mail (FedEx, UPS, etc.)
Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division Aerospace Medical Certification Division
AAM-300 AAM-300
Civil Aerospace Medical Institute Civil Aerospace Medical Institute, Bldg. 13
PO Box 25082 6700 S. MacArthur Blvd., Room 308
Oklahoma City, OK 73125-9867 Oklahoma City, OK 73169

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PHARMACEUTICALS

369
 PHARMACEUTICAL MEDICATIONS
(Updated 03/30/2022)

As an AME you are required to be aware of the regulations and Agency policy and have a
responsibility to inform airmen of the potential adverse effects of medications and to counsel
airmen regarding their use. There are numerous conditions that require the chronic use of
medications that do not compromise aviation safety and, therefore, are permissible. Airmen
who develop short-term, self-limited illnesses are best advised to avoid performing aviation
duties while medications are used.

Aeromedical decision-making includes an analysis of the underlying disease or condition and

treatment. The underlying disease has an equal and often greater influence upon the
determination of aeromedical certification. It is unlikely that a source document could be
developed and understood by airmen when considering the underlying medical condition(s),
drug interactions, medication dosages, and the sheer volume of medications that need to be
considered.

A list may encourage or facilitate an airmen's self-determination of the risks posed by various
medical conditions especially when combination therapy is used. A list is subject to misuse if
used as the sole factor to determine certification eligibility or compliance with 14 CFR part
61.53, Prohibition of Operations During Medical Deficiencies. Maintaining a published a list of
"acceptable" medications is labor intensive and, in the final analysis, only partially answers
the certification question and does not contribute to aviation safety.

Do Not Issue - Do Not Fly

(Updated 02/24/2021)

The information in this section is provided to advise Aviation Medical Examiners (AMEs) about two
medication issues:
 Medications for which they should not issue (DNI) applicants without clearance from the
Federal Aviation Administration (FAA), AND
 Medications for which they should advise airmen to not fly (DNF) and provide additional safety
information to the applicant.

The lists of medications in this section are not meant to be all-inclusive or comprehensive, but
rather address the most common concerns.

For any medication, the AME should ascertain for what condition the medication is being used, how
long, frequency, and any side effects of the medication. The safety impact of the underlying condition
should also be considered. If there are any questions, please call the Regional Flight Surgeon’s
(RFS) office or the Aerospace Medicine Certification Division (AMCD).

Do Not Issue. AMEs should not issue airmen medical certificates to applicants who are using these
classes of medications or medications:
 Angina medications
o nitrates (nitroglycerin, isosorbide dinitrate, imdur),
o ranolazine (Ranexa).

370
  Anticholinergics (oral)
o e.g: atropine, benztropine (Cogentin)
 Cancer treatments including chemotherapeutics, biologics, radiation therapy, etc.,
whether used for induction, “maintenance,” or suppressive therapy.
 Controlled Substances (Schedules I – V). An open prescription for chronic or
intermittent use of any drug or substance.
o This includes medical marijuana, even if legally allowed or prescribed under state
law.
o Note: for documented temporary use of a drug solely for a medical procedure or for
a medical condition, and the medication has been discontinued, see below.
 Diabetic medications
o NOT listed on the Acceptable Combinations of Diabetes Medications.
o pramlintide (Symlin)
 Dopamine agonists used for Parkinson’s disease or other medical conditions:
o bromocriptine (Cycloset, Parlodel)
o pramipexole (Mirapex), ropinirole (Requip), and
o rotigotine (NeuPro)
 FDA (Food and Drug Administration) approved less than 12 months ago. The FAA
generally requires at least one-year of post-marketing experience with a new drug before
consideration for aeromedical certification purposes. This observation period allows time
for uncommon, but aeromedically significant, adverse effects to manifest themselves.
Contact either your RFS or AMCD for guidance on specific applicants or to request
consideration for a particular medication.
 Hypertensive (centrally acting) including but not limited to
o clonidine
o nitrates
o guanabenz, methyldopa, and reserpine
 Malaria medication - mefloquine (Lariam)
 Over-active bladder (OAB)/Antimuscarinic medications as these carry strong warnings
about potential for sedation and impaired cognition.
o e.g.: tolterodine (Detrol),
o oxybutynin (Ditropan),
o solifenacin (Vesicare).
 Psychiatric or Psychotropic medications, (even when used for something other than a
mental health condition) including but not limited to:
o antidepressants (certain SSRIs may be allowed - see SSRI policy)
o antianxiety drugs – e.g.: alprazolam (Xanax)
o antipsychotics
o attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)
medications
o mood stabilizers
o sedative-hypnotics
o stimulants
o tranquilizers
 Seizure medications, even if used for non-seizure conditions such as migraines
 Smoking cessation aid – e.g.: varenicline (Chantix)
 Steroids, high dose (greater than 20 mg prednisone or prednisone-equivalent per day)
 Weight loss medications – ex: combinations including phentermine or naltrexone.
Do Not Fly. Airmen should not fly while using any of the medications in the Do Not Issue section
above or while using any of the medications or classes/groups of medications listed below without an
acceptable wait time after the last dose. All of these medications may cause sedation (drowsiness)
371
and impair cognitive function, seriously degrading pilot performance. This impairment can occur even
when the individual feels alert and is apparently functioning normally - in other words, the airman can
be “unaware of impair.”

For aviation safety, airmen should not fly following the last dose of any of the medications below until
a period of time has elapsed equal to:
 5-times the maximum pharmacologic half-life of the medication; or
 5-times the maximum hour dose interval if pharmacologic half-life information is not
available. For example, there is a 30-hour wait time for a medication that is taken every 4
to 6 hours (5 times 6)

Label warnings. Airmen should not fly while using any medication, prescription or OTC, that carries
a label precaution or warning that it may cause drowsiness or advises the user “be careful when
driving a motor vehicle or operating machinery.” This applies even if label states “until you know
how the medication affects you” and even if the airman has used the medication before with no
apparent adverse effect. Such medications can cause impairment even when the airman feels alert
and unimpaired (see “unaware of impair” above).

 Allergy medications:
o Sedating Antihistamines. These are found in many allergy and other types of
medications and may NOT be used for flight. This applies to both nasal AND oral
formulations.
o Nonsedating antihistamines. Medications such as loratadine, desloratadine, and
fexofenadine may be used while flying, if symptoms are controlled without adverse side
effects after an adequate initial trial period. See medication chart.
 Muscle relaxants: This includes but is not limited to carisoprodol (Soma) and
cyclobenzaprine (Flexeril).
 Over-the-Counter active dietary supplements such as Kava-Kava and Valerian.
 Pain medication:
o Narcotic pain relievers. This includes but is not limited to morphine, codeine,
oxycodone (Percodan, Oxycontin), and hydrocodone (Lortab, Vicodin, etc.).
o Non-narcotic pain relievers such as tramadol (Ultram).
 “Pre-medication” or “pre-procedure” drugs. This includes all drugs used as an aid to
outpatient surgical or dental procedures.
 Sleep aids. All the currently available sleep aids, both prescription and OTC, can cause
impairment of mental processes and reaction times, even when the individual feels fully
awake.
o See wait times for currently available prescription sleep aids
o Diphenhydramine (Benadryl) - Many OTC sleep aids contain diphenhydramine as the
active ingredient. The wait time after diphenhydramine is 60 hours (based on maximum
pharmacologic half-life).

For airmen seeking more information, see “Medications and Flying” and “What Over The Counter
Medications Can I Take and Still Be Safe to Fly?”
The list of medications referenced below provides aeromedical guidance about specific
medications or classes of pharmaceutical preparations and is applied by using sound
aeromedical clinical judgment. This list is not meant to be totally inclusive or comprehensive.
No independent interpretation of the FAA's position with respect to a medication included or
excluded from the following should be assumed.

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ACNE MEDICATIONS

ALLERGY – ANTIHISTAMINES & IMMUNOTHERAPY MEDICATION

ANTACIDS

ANTICOAGULANTS

ANTIDEPRESSANTS

ANTIHYPERTENSIVE

CHOLESTEROL MEDICATION

CONTRACEPTIVES AND HORMONE REPLACEMENT THERAPY

COVID-19 MEDICATION

DIABETES MELLITUS – INSULIN TREATED

DIABETES MELLITUS – TYPE II MEDICATION CONTROLLED (NOT INSULIN)

DO NOT ISSUE/DO NOT FLY

ERECTILE DYSFUNCTION AND BENIGN PROSTATIC HYPERPLASIA MEDICATIONS

GLAUCOMA MEDICATIONS

HYDROXYCHLOROQUINE (HCQ)/ CHLORIQUINE (CQ) [PLAQUENIL/ARALEN]

STATUS REPORT

MALARIA MEDICATION

OVER-THE-COUNTER (OTC) MEDICATIONS

SEDATIVES

SLEEP AIDS

VACCINES

373
 ACNE MEDICATIONS

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113(c)
Second-Class Airman Medical Certificate: 67.213(c)
Third-Class Airman Medical Certificate: 67.313(c)

II. MEDICAL HISTORY:

Topical acne medications, such as Retin A, and oral antibiotics, such as tetracycline, used for
acne are acceptable if the applicant is otherwise qualified.

For applicants using oral isotretinoin (Accutane), there is a mandatory 2-week waiting period after
starting isotretinoin prior to consideration. This medication can be associated with vision and
psychiatric side effects of aeromedical concern - specifically decreased night vision/ night
blindness and depression. These side-effects can occur even after cessation of isotretinoin. A
report must be provided with detailed, specific comment on presence or absence of psychiatric
and vision side-effects. The AME must document these findings in Block 60, Comments on
History and Findings. Some applicants will have to be deferred. For applicants issued, there
must be a “NOT VALID FOR NIGHT FLYING” restriction on the medical certificate. A waiting
period and detailed information is required to remove this restriction. The restriction cannot be
removed until all the requirements are met. See Pharmaceutical Considerations below.

III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 40, Skin.

IV. PROTOCOL: N/A

V. PHARMACEUTICAL CONSIDERATIONS:

 Use of oral isotretinoin must be permanently discontinued for at least 2 weeks prior to
consideration date (confirmed by the prescribing physician) and;
 Eye evaluation must be done in accordance with specifications in 8500-7 and;
 The airman must provide a signed statement of discontinuation that:
o Confirms the absence of any visual disturbances and psychiatric symptoms, and
o Acknowledges requirement to notify the FAA and obtain clearance prior to
performing any aviation safety-related duties if use of isotretinoin is resumed

374
 ALLERGY – ANTIHISTAMINE & IMMUNOTHERAPY MEDICATION
(Updated 07/28/2021)

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.105(b) & (c); 67.113(c)
Second-Class Airman Medical Certificate: 67.205(b) & (c); 67.213(c)
Third-Class Airman Medical Certificate: 67.305(b) & (c); 67.313(c)
II. MEDICAL HISTORY: Item 18.e. Hay fever or allergy
The applicant must report frequency and duration of symptoms, any incapacitation by the condition,
treatment, and side effects. The AME must inquire whether the applicant has ever experienced any
barotitis (‘ear block’), barosinusitis (‘sinus block’), alternobaric vertigo (‘dizziness’), difficulty breathing,
rashes, or any other localized or systemic symptoms that could interfere with aviation safety.
III. AEROMEDICAL DECISION CONSIDERATIONS:
See Item 26. Nose
See Item 35. Lungs and Chest
IV. PROTOCOL: See Disease Protocols – Allergies, Severe
V. PHARMACEUTICAL CONSIDERATIONS: Airmen who are exhibiting symptoms, regardless of the
treatment used, must not fly. AME must warn that flight/safety-related duties are prohibited until after
any applicable post-dose observation time. In all situations, the AME must notate the evaluation data
in Block 60.
 New medications:
o Symptoms must be controlled without adverse side effects.
o Post-dose observation time: Mandatory 48-hour ground trial required after initial use.
 Acceptable medications:
o Do not instill antihistamine eye drops immediately before or during flight/safety related duties, as it is
common to develop temporary blurred vision each time the drops are applied.
o Post-dose observation time: Not required for acceptable medications (see chart below).
 Conditionally acceptable medications:
o May be used occasionally (1-2 times a week) with the stipulation that the airman not exercise the
privileges of airman certificate while taking the medication.
o Daily use is NOT acceptable.
o Post-dose observation time: Required to mitigate central nervous system risk, either as noted in the
table below or 5x the half-life or maximal dosing interval after the last dose.
AMEs are encouraged to look up the dosing intervals and half-life.
 For more information, see: “What Over-the-Counter (OTC) Medications Can I Take and Still Be Safe to
Fly?”

Immunotherapy: Airman must confirm with their treating physician that no other medication is being
taken which would impair the effectiveness of epinephrine (should it be needed) or increases the risk
of heart rhythm disturbances.
 Allergy injections: Acceptable for conditions controlled by desensitization.
 Sublingual immunotherapy (SLIT): Acceptable for allergic rhinitis, however, prohibited for airmen 65 or
older who have an asthma diagnosis that does not meet CACI criteria (See Lungs and Chest).
 Post-dose observation time: 48-hour no-fly after the first dose AND 4-hour no-fly after each
subsequent dose.

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 ACCEPTABLE* (Non-Sedating) Antihistamine and Allergy Medications
May be used as a single agent or in any combination product, if other certification criteria are met.
Most Second Generation Histamine-H1 receptor antagonist Nasal Decongestants
 desloratadine (Clarinex)  pseudoephedrine (Sudafed)
 loratadine (Claritin)  oxymetazoline (Afrin) nasal
 fexofenadine (Allegra) spray
Histamine-H1 receptor antagonist nasal spray All Nasal Corticosteroid
 azelastine (Astepro; Astelin) nasal spray
 olopatadine nasal spray (requires longer initial ground
trial of 7 days)
All Second Generation Histamine-H1 receptor antagonist montelukast (Singulair)
eye drops
 alcaftadine (Lastacaft)
 azelastine (Optivar)
 bepotastine (Bepreve)
 cetirizine (Zerviate)
 ketotifen (Alaway ; Zaditor)
 olopatadine (Pataday; Patanol; Pazeo)
Immunotherapy (require 4 hours wait after each dose)
 Allergy injections
 Sublingual immunotherapy (SLIT)
* Airman are prohibited from flight/safety-related duties after initial use of a new medication until after a 48-hour ground trial and no side effects are
noted. See Medications & Flying.

CONDITIONALLY ACCEPTABLE (Sedating) Antihistamine Medications

May be used occasionally (1-2 x per week) as a single agent or in any combination product, if other
certification criteria are met. NOT FOR DAILY USE.
Medication Drug Class Post-dose observation
All First Generation Histamine- H1 receptor antagonist
 diphenhydramine (Benadryl)** 60 hours
 doxylamine (Unisom) 60 hours
 chlorpheniramine (Coricidin; ChlorTrimeton) 5 days
clemastine (No brand) 5 days

Some Second Generation Histamine- H1 receptor antagonist

 cetirizine (Zyrtec) 48 hour
 levocetirizine (Xyzal) 48 hour
** Diphenhydramine is the most common medication seen on autopsy in aircraft accidents. It is found in many
over-the-counter products and in some combination prescription medications.

UNACCEPTABLE (Sedating) Antihistamine Medications

Use prohibited as a single agent or in any combination product.
ᴓ Some Second Generation Histamine- H1 receptor antagonist
 astemizole (Hismanal)

376
 ANTACIDS

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113(b)(c)
Second-Class Airman Medical Certificate: 67.213(b)(c)
Third-Class Airman Medical Certificate: 67.313(b)(c)

II. MEDICAL HISTORY: Item 18.i.,Stomach, liver, or intestinal trouble.

The applicant should provide history and treatment, pertinent medical records, current
status report, and medication. If a surgical procedure was done, the applicant must
provide operative and pathology reports.

III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 38, Abdomen and Viscera,
Aerospace Medical Disposition Table.

IV. PROTOCOL: See Peptic Ulcer

V. PHARMACEUTICAL CONSIDERATIONS
The prophylactic use of medications including simple antacids, H-2 inhibitors or blockers,
proton pump inhibitors, and/or sucralfates may not be disqualifying, if free from side
effects.

377
 ANTICOAGULANTS (Updated 08/26/2020)

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113(b)(c)
Second-Class Airman Medical Certificate: 67.213(b)(c)
Third-Class Airman Medical Certificate: 67.313(b)(c)

II. MEDICAL HISTORY: Item 18.g. Heart or vascular trouble.

The applicant should describe the condition to include, dates, symptoms, treatment, and provide
medical reports to assist in the certification decision-making process. These reports should
include, as indicated by the applicable underlying condition(s) and class applied for: 24-hour
Holter monitor, operative reports of any coronary intervention (including the original cardiac
catheterization report), stress tests (including worksheets and original tracings or a legible copy).
For myocardial perfusion imaging, we require the interpretive report and copies of the actual
images in both grey-scale and color (in digital format or hard copy.) Per Part 67, for all classes of
medical certificates, there is cause for denial if there is an established medical history or clinical
diagnosis of myocardial infarction, angina pectoris, cardiac valve replacement, permanent cardiac
pacemaker implantation, heart replacement, or coronary heart disease (CHD) that has required
treatment (or if untreated, that has been symptomatic or clinically significant).

III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 36, Heart, Aerospace Medical
Disposition table
IV. PROTOCOL: As per the specific underlying condition(s), see Disease Protocols
V. PHARMACEUTICAL CONSIDERATIONS
Warfarin (Coumadin):
For applicants who are just beginning warfarin (Coumadin) treatment the following is required:
 Minimum observation time of 6 weeks after initiation of warfarin therapy;
 Must also meet any required observation time for the underlying condition; AND
 6 INRs, no more frequently than 1 per week
For applicants who are on an established use of warfarin (Coumadin), status report from the
treating physician should address and include:
 Drug dose history and schedule;
 Comment regarding side effects; AND
A minimum of monthly International Normalized Ratio (INRs) results for the immediate prior 6
months.
NOAC/DOACs: For applicants who are just beginning treatment with NOAC/DOACs, the
following is required:
 Minimum observation time of 2 weeks after initiation of therapy; AND
 Must also meet any required observation time for the underlying condition

For Non-Valvular Atrial Fibrillation (AFib) – see Emboli Mitigation on the following page.

378
 EMBOLI MITIGATION IN NON-VALVULAR
ATRIAL FIBRILLATION (AFIB)
(Updated 8/26/2020)

The CHA2DS2-VASc score is used to estimate thromboembolic risk in atrial fibrillation and
inform emboli mitigation requirements. Annual stroke risk increases with increasing score.
The following emboli mitigation strategies are acceptable for FAA medical certificate
purposes:

CHA2DS2-VASc Required Emboli Mitigation

Score
Coumadin/warfarin; or
2 or higher NOAC/DOAC or
LAA closure
0-1 Emboli mitigation usually not required for FAA purposes.

CHA2DS2-VASc Score
Congestive heart failure 1
Hypertension 1
Age > 75 2
Diabetes mellitus 1
Previous stroke/TIA/TE 2
Vascular disease (prior MI, PAD, or aortic 1
plaque/atheroma)
Age 65-74 1
Female (Male = 0) 1
Total

Warfarin (Coumadin): For applicants who are just beginning warfarin (Coumadin) treatment
the following is required:
Minimum observation time of 6 weeks after initiation of warfarin therapy;
Must also meet any required observation time for the underlying condition; AND
6 INRs, no more frequently than 1 per week
o 80% or more of INR values should be between 2.0 and 3.0.
o When used for heart valves, INR goal should be in accordance with standard of
care for that type of valve: and
o If INR is outside this target range, the physician should explain.

NOAC/DOACs: For applicants who are just beginning treatment the following is required:
Minimum observation time of 2 weeks after initiation of therapy; AND
Must also meet any required observation time for the underlying condition.

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 ANTIDEPRESSANTS

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.107
Second-Class Airman Medical Certificate: 67.207
Third-Class Airman Medical Certificate: 67.307

II. MEDICAL HISTORY: Item 18.m., Mental disorders of any sort; depression, anxiety, etc.

An affirmative answer to Item 18.m. requires investigation through supplemental history taking.
Dispositions will vary according to the details obtained. An applicant with an established history of
a personality disorder that is severe enough to have repeatedly manifested itself by overt acts, a
psychosis disorder, or a bipolar disorder must be denied or deferred by the AME.

III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 47., Psychiatric, Aerospace

Medical Disposition table.

IV. PROTOCOL: See Aerospace Medical Dispositions, Item 47., Psychiatric Conditions

V. PHARMACEUTICAL CONSIDERATIONS
The use of a psychotropic drug is disqualifying for aeromedical certification purposes – this
includes all antidepressant drugs, including selective serotonin reuptake inhibitors (SSRIs).
However, the FAA has determined that airmen requesting first, second, or third class medical
certificates while being treated with one of four specific SSRIs may be considered (see Item 47.,
Psychiatric Conditions – Use of Antidepressant Medications). The Authorization decision is made
on a case-by-case basis. The AME may not issue.

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 ANTIHYPERTENSIVE
(Updated 10/28/2015)

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113(b)(c)
Second-Class Airman Medical Certificate: 67.213(b)(c)
Third-Class Airman Medical Certificate: 67.313(b)(c)

II. MEDICAL HISTORY: Item 18.h., High or low blood pressure.

III. AEROMEDICAL DECISION CONSIDERATIONS:

See Item 36. Heart, Hypertension
Also see Item 55. Blood Pressure

IV. PROTOCOL: N/A. See Hypertension Disposition table

V. PHARMACEUTICAL CONSIDERATIONS
 Seven-day (7) no-fly/ground trial is required when starting a new hypertension (HTN)
medication to verify no side effects.
 AME should issue (if otherwise qualified) if the airmen is on 3 or fewer medications
 Uses of beta-adrenergic blockers ARE allowed with insulin, meglitinides, or sulfonylureas.

ACCEPTABLE HTN Medications

(when certification criteria are met)
 Alpha adrenergic blockers  Calcium channel blockers
 Angiotensin converting enzyme (ACE)  Direct renin inhibitors
inhibitors
 Angiotensin II receptor antagonists  Direct vasodilators
(ARBs)
 Beta-adrenergic blockers  Diuretics

UNACCEPTABLE HTN Medications

(as a single agent or in any combination product)
DO NOT ISSUE
 Clonidine (ex. Catapres/Clorpres)
 guanabenz
 guanfacine/Tenex
 methyldopa
 Nitrates (ex. nitroglycerin/isosorbide dinitrate/isosorbide mononitrate)
 reserpine

381
 CHOLESTEROL MEDICATION
(Updated 03/30/2022)

I. CODE OF FEDERAL REGULATIONS - 67.113(c); 67.213(c); and 67.313(c)

II. MEDICAL HISTORY: Item 37: Vascular System

The applicant should provide history as to why the medication is used. If taken for a cardiac
condition, see that section. The AME should inquire if the applicant has ever experienced any side
effects that could interfere with aviation safety.

III. AEROMEDICAL DECISION CONSIDERATIONS:

See Item 37: Vascular system

IV. PROTOCOL: N/A

V. PHARMACEUTICAL CONSIDERATIONS
 Cholesterol Medication
o All drug classes require the minimum standard 48-hour initial ground trial.

ACCEPTABLE
(As a single agent or in any combination product.)
 HMG-CoA reductase inhibitor Fibric Acid
 atorvastatin (Lipitor; Sortis [INTL])  fenofibrate (Antara, Tricor, Triglide, Trilipix)
 fluvastatin (Lescol)  gemfibrozil (Lopid)
 lovastatin (Altoprev)
 Bile Acid Sequestrant
 pravastatin (Pravachol)
 cholestyramine (Prevalite; Questran)
 rosuvastatin (Crestor)
 colesevelam (Welchol)
 simvastatin (Zocor)
 colestipol (Colestid)

Omega-3-acid ethyl esters  Adenosine Triphosphate-Citrate Lyase (ACL) Inhibitor

 omega-3-acid ethyl esters (Lovaza)  bempedoic acid (Nexletol)
 icosapent ethyl (Vascepa)

Nicotinic acid 2-Azetidinone

 niacin (Niaspan)  ezetimibe (Zetia)

CONDITIONALLY ACCEPTABLE
Medication Post-dose observation (no-fly time after each dose)
Monoclonal Antibody - PCSK9 Inhibitor 4 hours
 alirocumab (Praluent)
 evolocumab (Repatha)

UNACCEPTABLE
Apolipoprotein B Antisense Oligonucleotide
 mipomersen (Kynamro)

382
 CONTRACEPTIVES AND
HORMONE REPLACEMENT THERAPY

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113(b)(c)
Second-Class Airman Medical Certificate: 67.213(b)(c)
Third-Class Airman Medical Certificate: 67.313(b)(c)

II. MEDICAL HISTORY: Use of Oral or Repository Contraceptives or Hormonal Replacement

Therapy are not disqualifying for medical certification. If the applicant is experiencing no
adverse symptoms or reactions to hormones and is otherwise qualified, the AME may issue
the desired certificate.

III. AEROMEDICAL DECISION CONSIDERATIONS: See Medical History above and Item
48., General Systemic, Gender Dysphoria

IV. PROTOCOL: N/A

V. PHARMACEUTICAL CONSIDERATIONS: See Medical History above.

383
 COVID-19 MEDICATION
(Updated 04/27/2022)

I. CODE OF FEDERAL REGULATIONS - 67.113(b)(c); 67.213(b)(c); 67.313(b)(c)

II. MEDICAL HISTORY: Item 48. General Systemic

The use of medications below may be acceptable if there are no side effects (localized or systemic)
which could interfere with aviation safety and the applicant is otherwise qualified.

III. AEROMEDICAL DECISION CONSIDERATIONS:

See Item 48. General Systemic, COVID-19 Infections

IV. PROTOCOL: None

V. PHARMACEUTICAL CONSIDERATIONS:
 FDA- or EUA-approved COVID-19 medications are acceptable.
 COVID-19 medications require a post-dose observation time due to side effects which may
affect aeromedical safety.
 NO flying or safety-related duties permitted DURING COVID-19 infection.
 Follow the current CDC and FAA guidelines for recovery from COVID-19 before return to
duty or flying.

Q: Which COVID-19 medications can I use and still fly? A: None. You cannot take a medication and
fly or perform safety-related duties. See the chart below for more information.

Conditionally ACCEPTABLE Post-dose Observation* and

Additional Requirements
COVID PRE-EXPOSURE PROPHYLAXIS No pilot or safety-related duties for 4
hours after dose (due to
Used only for individuals who are not currently infected with
hypersensitivity).
the SARS-CoV-2 and who have not recently been exposed.
tixagevimab + cilgavimab (Evusheld)
COVID TREATMENT or POST- EXPOSURE PROPHYLAXIS ALL of the following criteria must
be met BEFORE returning to flight
Any FDA-approved treatments below are acceptable,
status or safety-related duties:
however, the following restrictions apply:
1. Wait 24 hours after the last dose
 DO NOT fly if taking ANY medications listed until ALL
of COVID-19 medication; AND
items (#1-4) in the next column are met; and
 DO NOT fly if symptomatic or infected. 2. Be free of significant side effects
after COVID-19 medication; AND
Currently FDA approved treatment(s)*
3. Meet the current CDC/FAA
bamlanivimab + etesevimab (no brand name)
guidelines for recovery from
bebtelovimab (LY-CoV1404)
COVID disease or exposure; AND
casirivimab + imdevimab (Regen-COV)
molnupiravir (no brand name) 4. Meet the requirements on the
nirmatrelvir + ritonavir (Paxlovid) COVID-19 Disposition Table.
remdesivir (Veklury)
sotrovimab (no brand name) 14 CFR 61.53 applies after any
medication use or illness.
*This list updated as of 04/27/2022. This list may change. Contact your AME if you
have questions regarding newer, FDA-approved medications.

384
 DIABETES MELLITUS - INSULIN TREATED

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113(a)(b)(c)
Second-Class Airman Medical Certificate: 67.213(a)(b)(c)
Third-Class Airman Medical Certificate: 67.313(a)(b)(c)

II. MEDICAL HISTORY: Item 18.k., Diabetes.

III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 48,

General Systemic Aerospace Medical Disposition table.

IV. PROTOCOL: See Diabetes Mellitus Type I or Type II - Insulin-Treated Protocol

V. PHARMACEUTICAL CONSIDERATIONS
 Insulin pumps are an acceptable form of treatment.
 Combinations of anti-diabetes medication (s): The chart of Acceptable Combinations
of Diabetes Medications (pdf) summarizes the acceptable medications for both
monotherapy and combination therapy. The chart organizes medications into groups
based on similarity of mechanisms of actions and/or therapeutic effects.

385
 DIABETES MELLITUS TYPE II -
MEDICATION CONTROLLED (NOT INSULIN)

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113 (a)(b)(c)
Second-Class Airman Medical Certificate: 67.213(a)(b)(c)
Third-Class Airman Medical Certificate: 67.313(a)(b)(c)

II. MEDICAL HISTORY: Item 18.k. Diabetes.

The applicant should describe the condition to include symptoms and treatment. Comment on the
presence or absence of hyperglycemic and/or hypoglycemic episodes. A medical history or clinical
diagnosis of diabetes mellitus requiring insulin or other hypoglycemic drugs for control is
disqualifying. The AME can help expedite the FAA review by assisting the applicant in gathering
medical records and submitting a current specialty report such as the DIABETES or
HYPERGLYCEMIA ON ORAL MEDICATIONS STATUS REPORT. See Item 48, Diabetes

III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 48, Diabetes

IV. DISEASE PROTOCOL: See Diabetes Mellitus Type II - Medication Controlled

V. PHARMACEUTICAL CONSIDERATIONS: Combinations of anti-diabetes medication (s): The

chart of Acceptable Combinations of Diabetes Medications (pdf) summarizes the acceptable
medications for both monotherapy and combination therapy. The chart organizes medications into
groups based on similarity of mechanisms of actions and/or therapeutic effects.

386
 ACCEPTABLE COMBINATIONS OF DIABETES MEDICATIONS
(Updated 01/27/2021)
The chart on the following page outlines acceptable combinations of medications
for treatment of diabetes.

Please note:

 Initial certification of all applicants with diabetes mellitus (DM) requires FAA
decision;
 Use no more than one medication from each group (A-F);
 Fixed-dose combination medications - count each component as an
individual medication. (e.g., Avandamet [rosiglitazone + metformin] is
considered 2-drug components);
 Up to 3 medications total are considered acceptable for routine treatment
according to generally accepted standards of care for diabetes (American
Diabetes Association, American Association of Clinical Endocrinologists);
 For applicants receiving complex care (e.g., 4-drug therapy), refer the case
to AMCD;
 For applicants on AASI for diabetes mellitus, follow the AASI;
 Consult with FAA for any medications not on listed on the chart;
 Observation times:
When initiating NEW diabetes therapy using monotherapy or combination medications:
Adding Medication Observation Time
Group A ONLY 14 days
Group B-D 30 days
Group E1 60 days

When ADDING a new medication to an ESTABLISHED TREATMENT regimen:

Current Medication Adding Medication Observation Time
on Group A-D + new Group A-D 14 days
on Group E1 + new Group A-D 30 days
on Group A-D + new Group E1 60 days
Note: If transitioning between injectable GLP-1 RA and oral GLP-1 RA formulation = 72
hours

When initiating NEW or ADDING therapy for any regimen (new or established therapy):
Adding Medication Observation Time
Group F (SGLT2 inhibitors) 90 days
Group E2 (insulin):
 For agency ATCSs (non-CGM or CGM protocol) 90 days
 For Pilots / Part 67 applicants, class 3 non-CGM 90 days
protocol only: 180 days
 For Pilots / Part 67 applicants, any class CGM protocol:

387
 ACCEPTABLE COMBINATIONS OF DIABETES MEDICATIONS
(Updated 01/27/2021)
Biguanides
A -metformin (e.g. Glucophage, Fortamet,
Glutetza, Riomet)

Thiazolidinediones (TZD)
B - pioglitazone (Actos)
- rosiglitazone (Avandia)

GLP1 mimetics
- albiglutide (Tanzeum)
- dulaglutide (Trulicity)
- exenatide (Byetta)
- exenatide-ED (Bydureon)
- liraglutide (Victoza)

C - lixisenatide (Adlyxin)
- semaglutide (Ozempic, Rybelsus)
Group C not
allowed with
Meglitinides
DDP4
- alogliptin (Nesina)
- linagliptin (Tradjenta)
- saxagliptin (Onglyza)
USE NO MORE - sitagliptin (Januvia)
THAN 1 Alpha-glucosidase inhibitors
MEDICATION D - acarbose (Precose)
FROM ANY - miglitol (Glyset)
GROUP (A-F)
Meglitinides Meglitinides not
- nateglinide (Starlix) allowed with
- repaglinide (Prandin) Group C

Sulfonylureas (SFU)
- chlorpropamide (Diabenase)
E1 - glimepiride (Amaryl)
- glipizide (Glucotrol)
- glyburide (Diabeta)
- tolbutamide (Orinase)
E OR - tolazamide (Tolinase)
- gliclazide (Diamicron) - International

Insulin
E2 - All forms
- Initial certification requires FAA decision
Note: Amylinomimetics e.g., pramlintide
(Symlin) are NOT Considered acceptable
for medical certification.
SGLT2 Inhibitors
- canagliflozin (Invokana) SGLT2 inhibitors
F - dapagliflozin (Farxiga) not allowed with
- empagliflozin (Jardiance) Group E 388
- ertugliflozin (Steglatro)
 ERECTILE DYSFUNCTION AND
BENIGN PROSTATIC HYPERPLASIA MEDICATIONS
(Updated 08/30/2017)

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113(c)
Second-Class Airman Medical Certificate: 67.213(c)
Third-Class Airman Medical Certificate: 67.313(c)
II. MEDICAL HISTORY: Use of medication for erectile dysfunction (ED) and/or benign prostatic
hyperplasia (BPH) may not be disqualifying for medical certification if there are no side effects, the
underlying condition is not aeromedically significant, and the applicant is otherwise qualified. If the
medication is used for any other condition, do not issue – FAA approval is required.
III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 41. G-U System,
IV. PROTOCOL: N/A

V. PHARMACEUTICAL CONSIDERATIONS: The use of medications below for G-U conditions

including ED and BPH may not be disqualifying, if free from side effects. For the required minimum
wait time after use, see the table below.

If the medications below are used for any other non G-U condition (e.g., pulmonary arterial
hypertension [PAH]) the AME must defer issuance of a medical certificate.

 Alpha blockers are allowed for daily use if there no side effects. No minimum wait time is required
after use once the airman has successfully passed the 7-day ground trial period required for all
hypertension medication.
 If alpha blockers are used in combination with PDE5 inhibitors (common examples are listed below),
the airman should not fly until verification that no hypotensive episodes or other side effects are
noted.
 Nitrates are not allowed.

ERECTILE DYSFUNCTION AND BENIGN PROSTATIC HYPERPLASIA

PDE-5 INHIBITOR MEDICATION WAIT TIMES
Trade Name Generic Name Required minimum wait time after last dose before resuming pilot duties
Cialis (daily use) Tadalafil 2.5 or 5 mg daily is allowed if no side effects after 7 days
Cialis (prn use) Tadalafil 24 hours
Levitra Vardenafil 8 hours
Staxyn Vardenafil 8 hours
Stendra Avanafil 8 hours
Viagra Sildenafil 8 hours

389
 EYE MEDICATION
(Updated 04/27/2022)

I. CODE OF FEDERAL REGULATIONS - 14 CFR 67.103(e) and 67.113(b)(c); 67.203(e)

and 67.213 (b)(c); 67.303(e) and 67.313(b)(c)

II. MEDICAL HISTORY: Item 18.d. Medical History, eye or vision trouble except glasses.

III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 32, Ophthalmoscopic

IV. PROTOCOL: N/A

V. PHARMACEUTICAL CONSIDERATIONS

 For applicants using eye drops in the ACCEPTABLE category (below), determination will depend
on whether the underlying condition for use is acceptable or disqualifying.

 In general, do not instill antihistamine eye drops immediately before or during flight/safety
related duties. It is common to develop temporary blurred vision each time the drops are applied.

 Pilocarpine (Vuity) is a prescription eye drop used for presbyopia (age-related, blurry near
vision). It creates a temporary chemical correction of visual acuity by decreasing pupil size. This
can increase depth of focus and give transient improvement to near vision in individuals with
presbyopia. There are overt FDA-required warnings from the manufacturer regarding night vision
and operating machinery. Since medication and the availability of ambient lighting impact visual
acuity, pilocarpine is unacceptable.

Eye Conditions found in a separate section:

a. Allergy – See Allergy – Antihistamine and Immunotherapy Medication
b. Glaucoma – See Glaucoma and Ocular Hypertension Medication

ACCEPTABLE Medications, if the underlying condition is acceptable

(as a single agent or combination product)
 Calcineurin Inhibitor  Pain management; Postoperative
cyclosporine (Restasis) surgery
NSAID (Nonsteroidal Anti-inflammatory
Drug)
Carbonic anhydrase inhibitors Antibiotics
Most Mydriatic 
cyclopentolate (Cyclogyl) – 24 hour no-fly
phenylephrine (Altafrin) – 8 hour no-fly
tropicamide (Mydriacyl) – 8 hour no-fly

UNACCEPTABLE Medications due to the underlying condition

Some Mydriatic Cholinergic Agonist
atropine (Isopto Atropine) e.g. pilocarpine (Isopto Carpine; Vuity)
Recombinant Human Nerve Growth Factor Steroid intravitreal implant
cenegermin (Oxervate) fluocinolone (Iluvien; Retisert; Yutiq)

390
 GLAUCOMA AND OCULAR HYPERTENSION MEDICATIONS
(Updated 04/27/2022)

I. CODE OF FEDERAL REGULATIONS - 67.113(b)(c); 67.213 (b)(c); and 67.313(b)(c)

II. MEDICAL HISTORY: Item 18.d. Medical History, Eye or vision trouble except glasses.
The applicant should provide a current, detailed Clinical Progress Note from the treating
physician generated from a clinic visit no more than 90 days prior to the AME exam. It must
include a summary of the history of the condition; current medications, dosages, and side
effects (if any); clinical exam findings; results of any testing performed; diagnosis;
assessment; plan (prognosis); and follow-up.

III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 32, Ophthalmoscopic

IV. PROTOCOL: N/A

V. PHARMACEUTICAL CONSIDERATIONS

 Rho kinase inhibitors or oral medications for glaucoma do not qualify for the CACI
program. They may be considered for Special Issuance certification following
demonstration of adequate control.

 Cholinergic agonists causes pupillary constriction, which can interfere with visual
acuity and night vision. They are no longer first-line Glaucoma agents
CACI Glaucoma Medications
(as a single agent or in a combination product)
 Beta-Blocker  Carbonic Anhydrase Inhibitor
e.g. timolol (Timoptic) e.g. dorzolamide (Trusopt)
Alpha2 Agonist  Prostaglandin
e.g. brimonidine (Alphagan P) e.g. Latanoprost (Xalatan)

CONDITIONALLY ACCEPTABLE Glaucoma Medications (Requires SI)

(as a single agent or in a combination product)
Rho Kinase Inhibitor Oral medications
e.g. netarsudil (Rhopressa) e.g. acetazolamide (Diamox)

UNACCEPTABLE Glaucoma Medications

Cycloplegics Cholinergic Agonist
e.g. atropine e.g. pilocarpine (Isopto Carpine, Vuity)

391
 HYDROXYCHLOROQUINE (HCQ)/ CHLOROQUINE (CQ) STATUS REPORT
[Plaquenil/Aralen] (Updated 09/29/2021)
Name __________________________________________ Date of Birth _________________________
MID#___________________ Applicant ID# _____________________ PI#______________________

The treating ophthalmologist or optometrist must complete this status report. The Airman must provide this
document and copies of all required tests (see below) to AME or directly to the FAA:

Using US Postal Service: OR Using special mail (UPS, FedEx, etc.):

Federal Aviation Administration Federal Aviation Administration
Aerospace Medical Certification Division AAM-300 AMCD-AAM-300
Mike Monroney Aeronautical Center Civil Aerospace Medical Institute, Building 13
PO BOX 25082 6700 S. MacArthur Boulevard, Room 308
Oklahoma City, OK 73125 Oklahoma City, OK 73169

1. Provider printed name/title: ___________________________ Phone number ___________________

2. Date hydroxychloroquine (HCQ) or chloroquine (CQ) treatment initiated________________________
3. Date of most recent HCQ/CQ screening _________________
4. Type of screening: 󠇯 Baseline or 󠇯 Follow-up

Does the airman take or have ANY of the following: 5.

BASELINE Group: FOLLOW-UP

NO A. HCQ/CQ medication for 5 or more years YES

B. Tamoxifen or other drugs affecting the macula
C. Renal Disease (GFR less than 60 mL/min)
D. Glaucoma
E. Maculopathy and/or
F. Higher than average renal weight dosing:
 HCQ > 5 mg/kg
 CQ > 2.3 mg/kg

Baseline evaluation includes: Baseline and annual evaluation includes:

Eye evaluation with dilated fundus exam A. Eye evaluation with dilated fundus exam
B. Threshold visual field*
C. Spectral-domain optical coherence
tomography (SD-OCT)

LOW-RISK
LONG-TERM HIGH-RISK
(Group A only)
May Consider CACI
Not CACI eligible
(NOTE: Will not require another exam unless
May Consider CACI if all testing Will need SI/SC and
or until airman meets any of the criteria in the
shows no abnormal pathology annual evaluation
gray box above.)

*Threshold visual field: 10-2 or 12-2. Per AAO guidelines, for individuals of Asian descent, we will accept 24-2 or 30-2 threshold when perimacular
area is at risk (as determined by the treating eye provider).
Note: CACI/SI/SC is for Aviation Medical Examiner use only.

Evidence of bull’s-eye lesion or other macular/extra-macular retinopathy: Yes No

If yes, explain: _______________________________________________________
6. Abnormality on automated threshold visual field testing: Yes No
If yes, explain: _______________________________________________________
7. Abnormality on Spectral-domain optical coherence tomography (SD-OCT): Yes No
If yes, explain: _______________________________________________________
8. Any other eye pathology, symptoms, color vision loss, or clinical concerns? Yes No
If yes, explain: _____________________________________________________________
Treating Provider Signature ______________________________ Date ____________
Modified from 2016 American Academy of Ophthalmology (AAO) guideline recommendations

392
 MALARIA MEDICATIONS
(Updated 04/27/2016)

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113(c)
Second-Class Airman Medical Certificate: 67.213(c)
Third-Class Airman Medical Certificate: 67.313(c)

II. MEDICAL HISTORY: This medication is absolutely disqualifying for pilots. Mefloquine
(Lariam) is associated with adverse neuropsychiatric side-effects, even weeks after the drug
is discontinued. Because of the association with adverse neuropsychiatric side-effects, even
weeks after discontinuation, a pilot who elects to use mefloquine for malaria prophylaxis or
who contracts malaria and is treated with mefloquine will be disqualified for pilot duties for the
duration of use of mefloquine and for 4 weeks after the last dose. In this instance, the pilot
must contact the FAA or his/her Aviation Medical Examiner prior to returning to flight duties
after use.

III. AEROMEDICAL DECISION CONSIDERATIONS: For return to pilot duties there must be
no history of neurologic or psychiatric symptoms during and or after mefloquine use.
Examples of symptoms related to mefloquine use include: dizziness or vertigo, tinnitus, and
loss of balance; anxiety, paranoia, depression, restlessness or confusion, hallucinations and
psychotic behavior.

IV. PROTOCOL: N/A

V. PHARMACEUTICAL CONSIDERATIONS:
 Use of mefloquine must be discontinued for at least 4 weeks prior to consideration
and:
 The airman must contact the FAA agency flight surgeon or their AME before resuming
pilot duties
 For return to pilot duties there must be no history of neurologic or psychiatric
symptoms during and or after mefloquine use

393
 SEDATIVES
(Updated 06/24/2020)

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.107
Second-Class Airman Medical Certificate: 67.207
Third-Class Airman Medical Certificate: 67.307

II. MEDICAL HISTORY and CONVICTIONS OR ADMINISTRATIVE ACTIONS.

Medical History: Item 18.n., Substance Dependence; or failed a drug test ever; or substance
abuse or use of illegal substance in the last 2 years.

"Substance" includes alcohol and other drugs (e.g., PCP, sedatives and hypnotics,
anxiolytics, marijuana, cocaine, opioids, amphetamines, hallucinogens, and other
psychoactive drugs or chemicals). For a "yes" answer to Item 18.n., the AME should obtain
a detailed description of the history. A history of substance dependence or abuse is
disqualifying. The AME must defer issuance of a certificate if there is doubt concerning an
applicant's substance use.

Convictions or Administrative Actions: Item 18.v. Medical History v. History of Arrest(s),

Conviction(s) and/or Administrative Action(s)

Arrest(s), conviction(s), and/or administrative action(s) affecting driving privileges may raise
questions about the applicant's qualifications for airman medical certification. All incidents
must be reported (even if reported on a previous application), to include even a single driving
while intoxicated (DWI) arrest, conviction and/or administrative action. Incidents reported
under 18.v. are just part of many factors considered in the overall process of medical
certification. See Substances of Dependence/Abuse

NOTE: Checking yes does not relieve the airman of responsibility to report each motor
vehicle action to Security. Also, remind the airman that once he/she has checked yes to any
item in #18, especially items 18 n., 18 o. or 18 v., they must ALWAYS mark yes to these
numbers, even if the condition has been reviewed and granted an eligibility letter from the
FAA

III. AEROMEDICAL DECISION CONSIDERATIONS: See Item 47., Psychiatric, Aerospace

Medical Disposition table.

IV. PROTOCOL: See Substances of Dependence/Abuse

V. PHARMACEUTICAL CONSIDERATIONS

A. Aerospace Medical Dispositions, Item 47. Psychiatric Conditions

394
 SLEEP AIDS
(Updated 07/29/2020)

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113(c)
Second-Class Airman Medical Certificate: 67.213(c)
Third-Class Airman Medical Certificate: 67.313(c)

II. MEDICAL HISTORY: Use of sleep aids is a potential risk to aviation safety due to effects
of the sleep aid itself or the underlying reason/condition for using the sleep aid.

All the currently available sleep aids, both prescription and over the counter, can cause
impairment of mental processes and reaction times, even when the individual feels fully
awake. (As examples, see the Food and Drug Administration drug safety communications on
zolpidem and eszopiclone)

Medical conditions that chronically interfere with sleep are disqualifying regardless of whether
a sleep aid is used or not. Examples may include primary sleep disorders (e.g., insomnia,
sleep apnea) or psychological disorders (e.g., anxiety, depression). While sleep aids may be
appropriate and effective for short term symptomatic relief, the primary concern should be the
diagnosis, treatment, and resolution of the underlying condition before clearance for aviation
duties.

Occasional or limited use of sleep aids, such as for circadian rhythm disruption in commercial
air operations, is allowable for pilots. Daily/nightly use of sleep aids is not allowed regardless
of the underlying cause or reason. See Pharmaceutical Considerations below.

III. AEROMEDICAL DECISION CONSIDERATIONS: N/A

IV. PROTOCOL: N/A

V. PHARMACEUTICAL CONSIDERATIONS:

Because of the potential for impairment, we require a minimum wait time between the last
dose of a sleep aid and performing pilot duties. This wait time is based on the pharmacologic
elimination half-life of the drug (half-life is the time it takes to clear half of the absorbed dose
from the body). The minimum required wait time after the last dose of a sleep aid is 5-times
the maximum elimination half-life.

The table on the following page lists several commonly prescribed sleep aids along with the
required minimum wait times for each.

395
 SLEEP AID WAIT TIMES

Required minimum waiting time after last

Trade Name Generic Name
dose before resuming pilot duties
Ambien zolpidem* 24 hours
Ambien CR zolpidem (extended release) 24 hours
Edluar zolpidem (dissolves under the
36 hours
tongue)
Intermezzo zolpidem (for middle of the
36 hours
night awakening)
Lunesta eszopiclone 30 hours
Restoril temazepam 72 hours
Rozerem ramelteon 24 hours
Sonata zaleplon 12 hours
Zolpimist zolpidem (as oral spray) 48 hours

* NOTE: The different formulations of zolpidem have different half-lives, thus different wait times.

396
 VACCINES
(Updated 09/29/2021)

I. CODE OF FEDERAL REGULATIONS

First-Class Airman Medical Certificate: 67.113(b)(c)
Second-Class Airman Medical Certificate: 67.213(b)(c)
Third-Class Airman Medical Certificate: 67.313(b)(c)

II. MEDICAL HISTORY: Item 48. General Systemic

The use of vaccines below may be acceptable if there are no side effects (localized or systemic),
which could interfere with aviation safety and the applicant is otherwise qualified.

III. AEROMEDICAL DECISION CONSIDERATIONS:

See Item 48. General Systemic

IV. PROTOCOL: None

V. PHARMACEUTICAL CONSIDERATIONS
 Some vaccines will require a post-dose observation time due to either immediate or delayed
side effects that will affect aeromedical safety. See table below.
 FDA approved vaccines are acceptable.
o If vaccine is FDA approved and not listed on the table below, contact AMCD/RFS for
further guidance.

Vaccine Post-dose observation1

 Bacillus Calmette-Guérin [intradermal] (BCG vaccine)
 Diphtheria, tetanus and pertussis (Boostrix)
 Hepatitis A
 Hepatitis B
 Influenza Not required
 Meningococcal (Menactra; MenQuadfi; Menveo)
 Pneumonia
 Shingles
 Yellow Fever
 YF-VAX
 Stamaril (when YF-VAX is depleted in US)

 COVID-19 Vaccines
 Johnson & Johnson/Janssen2 48 hour
 Moderna
 Pfizer-BioNTech/ Comirnaty
 Typhoid vaccine (Typhim Vi; Vivotif) 72 hours
 Rabies
1. After any vaccine, follow 14 CFR 61.53. Airmen should not fly if experiencing significant side effects.
2. If symptoms of thrombosis or thrombocytopenia, contact AMCD/RFS for guidance.

397
AME ASSISTED SPECIAL ISSUANCES (AASI)

AASIs for ALL CLASSES

AASI COVERSHEET

398
 Authorization for Special Issuance of a Medical Certificate and
AME Assisted Special Issuance (AASI)

A. Special Issuance.
At his discretion, the Federal Air Surgeon may grant an Authorization for Special
Issuance of a Medical Certificate (Authorization), with a specified validity period, to an
applicant who does not meet the established medical standards. The applicant must
demonstrate to the satisfaction of the Federal Air Surgeon that the duties authorized by
the class of medical certificate applied for can be performed without endangering public
safety for the validity period of the Authorization. The Federal Air Surgeon may
authorize a special medical flight test, practical test, or medical evaluation for this
purpose. An airman medical certificate issued under the provisions of an Authorization
expires no later than the Authorization expiration date or upon its withdrawal. An
airman must again show to the satisfaction of the Federal Air Surgeon that the duties
authorized by the class of medical certificate applied for can be performed without
endangering public safety in order to obtain a new airman medical
certificate/Authorization under Title 14 of the Code of Federal Regulations (14 CFR)
§67.401.

See Title 14 of the Code of Federal Regulations (14 CFR) §67.401.

B. AME Assisted Special Issuance (AASI).

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an
Authorization to an applicant who has a medical condition that is disqualifying under 14
CFR Part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. AMEs may re-issue an airman medical certificate under the
provisions of an Authorization, if the applicant provides the requisite medical
information required for determination. AMEs may not issue initial Authorizations. An
AME's decision or determination is subject to review by the FAA

399
 AME Assisted Special Issuance (AASI)
(Updated 01/27/2021)

The following pages of the Guide for Aviation Medical Examiners introduce the AME Assisted
Special Issuance (AASI) process.

The Guide refers to a number of selected medical conditions that are initially disqualifying (if
the applicant does not meet the issue criteria in the Aerospace Medicine Dispositions Tables or
the Certification Worksheets) and must be deferred to the AMCD or RFS. If this is a first-time
application for an AASI for a disqualifying disease/condition, and the applicant has all of the
requisite medical information necessary for a determination, the AME must defer, and submit
all of the documentation to the AMCD or your RFS.

Following the granting of an Authorization for Special Issuance of a Medical Certificate

(Authorization) by the AMCD or RFS, an AME may reissue a medical certificate to an applicant
with a medical history of an initially disqualifying condition once the AASI's specialized criteria
is met and the applicant is otherwise qualified.

DIABETES MELLITUS – TYPE II Medication

ARTHRITIS and/ or PSORIASIS Controlled (Not Insulin)

ASTHMA GLAUCOMA
ATRIAL FIBRILLATION HEPATITIS C
BLADDER CANCER HYPERTENSION (HTN)
BREAST CANCER HYPERTHYROIDISM
CARDIAC – SINGLE VALVE HYPOTHYROIDISM
REPLACEMENT OR REPAIR
LYMPHOMA and HODGKIN’S DISEASE
CHRONIC KIDNEY DISEASE (CKD)
MELANOMA
CHRONIC LYMPHOCYTIC LEUKEMIA
(CLL) MIGRAINE HEADACHES

CHRONIC OBSTRUCTIVE MITRAL and AORTIC INSUFFICIENCY

PULMONARY DISEASE (COPD)
PAROXYSMAL ATRIAL TACHYCARDIA
COLITIS (PAT)
(Ulcerative or Crohn’s Disease) or Irritable
Bowel Syndrome (IBS) PROSTATE CANCER

COLON CANCER/COLORECTAL CANCER RENAL CALCULI

CORONARY HEART DISEASE (CHD) RENAL CANCER

VENOUS THROMBOEMBOLISM (VTE) - SLEEP APNEA/ OBSTRUCTIVE SLEEP

DEEP VENOUS THROMBOSIS (DVT), APNEA (OSA)
PULMONARY EMBOLISM (PE), and/ or
HYPERCOAGULOPATHIES TESTICULAR CANCER

THROMBOCYTOPENIA

400
 AASI for Arthritis and/or Psoriasis

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments which specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 The type of arthritis or psoriasis;
 A general assessment of the condition and its effect on daily activities;
 The name and dosage of medication(s) used for treatment and/or prevention with
comment regarding side effects; and
 For arthritis - comments regarding range of motion of neck, upper and lower
extremities, hands, etc.

The AME must defer to the AMCD or Region if:

 The applicant has developed any associated systemic manifestations;

 For arthritis - new joints have become involved;
 The applicant required change in medication used for control of the disease; or
 The applicant is taking steroid doses equivalent to more than 20 mg of prednisone per
day (steroid conversion calculator)

401
 AASI for Asthma

Note: If the applicant has mild symptoms that are infrequent, have not required hospitalization,
or use of steroid medication, and no symptoms in flight, the AME may issue an airman medical
certificate. See Item 35., Lungs and Chest Aerospace Medical Disposition.

If the applicant does not meet the above criteria, the AME must follow the AASI process.

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue
an airman medical certificate under the provisions of an Authorization for Special Issuance of a
Medical Certificate (Authorization) to an applicant who has a medical condition that is
disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments
that specify the information that treating physician(s) must provide for the re-issuance
determination. If this is a first-time application for an AASI for the above disease/condition, and
the applicant has all the requisite medical information necessary for a determination, the AME
must defer and submit all of the documentation to the AMCD or RFS for the initial
determination.

AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if
the applicant provides the following:

 An Authorization granted by the FAA;

 The applicant’s current medical status that addresses frequency of attacks and whether
the attacks have resulted in emergency room visits or hospitalizations;
 The AME should caution the applicant to cease flying with any exacerbation as warned
in § 61.53;
 The name and dosage of medication(s) used for treatment and/or prevention with
comment regarding side effects; and
 Results of pulmonary function testing, if deemed necessary, performed within the last
90 days

The AME must defer to the AMCD or Region if:

 The symptoms worsen;

 There has been an increase in frequency of emergency room, hospital, or outpatient
visits;
 The FEV1 is less than 70% predicted value;
 The applicant requires 3 or more medications for stabilization; or
 The applicant is taking steroid doses equivalent to more than 20 mg of prednisone per
day (steroid conversion calculator)

402
 AASI for Atrial Fibrillation
(Updated 08/26/2020)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an
airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical
Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under
Title 14 of the Code of Federal Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that
specify the information that treating physician(s) must provide for the re-issuance determination. If
this is a first-time application for an AASI for the above disease/condition, and the applicant has all
the requisite medical information necessary for a determination, the AME must defer and submit all
of the documentation to the AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the
applicant provides the following:

 An Authorization granted by the FAA;

 A report of a minimum 24-hour cardiac monitor performed within last 90 days. (Cardiac monitor
report must be submitted, even if findings are normal, and should include 1-page computerized
summary and the representative full-scale multi-lead ECG tracings);
 A completed FAA Atrial Fibrillation (AFib)/A-Flutter Recertification Status Report OR a
cardiologist evaluation that addresses all items on the recertification status report; and
 The above data verifies:
o No interval evidence or suspicion of stroke, TIA, or other thromboembolic event.
o Heart rate is well controlled on cardiac monitor by cardiologist interpretation.
o If symptom, rate, or rhythm control is indicated and, if so, a description of how it this is
managed.
o When CHA2DS2-VASc score ≥ 2, verify emboli mitigation is in place without side
effects. See Pharmaceuticals – Anticoagulants - Emboli Mitigation.

The AME must defer to the AMCD or Region if:

 Applicant had left atrial appendage (LAA) occlusion (Watchman)/excision or developed a new
cardiac condition;
 There has been an interval definitive or suspicious thromboembolic event;
 Cardiology interpretation indicates questionable or poor rate control. Average heart rate is
> 100, maximum (non-exercise) is >120, or a single pause is > 3 seconds;
 Evidence that symptoms, rate, or rhythms are not well controlled;
 CHA2DS2-VASc is ≥ 2 and emboli not mitigated; (Acceptable emboli mitigation under AASI
authorization is anti-coagulation with either NOAC/DOAC/warfarin. When using
warfarin/Coumadin, if more than 20% of INR values are less than 2.0 or greater than 3.); and/or
 Interval bleeding that required medical intervention.

403
 AASI for Bladder Cancer

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA; and

 A current status report performed within 90 days that must include all the
required follow-up items and studies as listed in the Authorization letter and that
confirms absence of recurrent disease

The AME must defer to the AMCD or Region if:

 There has been any recurrence of the cancer; or

 Any new treatment is initiated

404
 AASI for Breast Cancer

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA; and

 A current status report performed within the last 90 days that must include all the
required follow-up items and studies as listed in the Authorization letter and that
confirms absence of recurrent disease.

The AME must defer to the AMCD or Region if:

 There has been any recurrence of the cancer; or

 Any new treatment is initiated.

405
 AASI for Cardiac - Single Valve Replacement or Repair
All Classes
(Updated 01/27/2021)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an airman medical
certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an
applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR §
67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s)
must provide for the re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME
must defer and submit all of the documentation to the AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the
applicant provides the following:

Authorization granted by the FAA

ECG - Required annually.
Echo - Current 2D echocardiogram performed within 90 days
INRs for Mechanical Heart Values - A minimum of monthly International
Normalized Ratio (INR) results for the immediate prior six months
Status report - performed within the past 90 days in accordance with the CHD Protocol

The AME must defer medical certification if the applicant has:

 Additional valve procedure performed;

 Any other disqualifying medical conditions or therapy not previously reported;
 Any other reason for not renewing an AASI;
 Arrhythmia, new onset, such as of atrial fibrillation/flutter, ventricular bigeminy,
ventricular tachycardia, Mobitz Type II or greater AV block, complete heart block, RBBB,
LBBB, or LVH
 Bleeding that required medical intervention or other;
 Echo reveals:

IF ANY OF THE FOLLOWING ARE NOTED ON ECHO, THE AME MAY NOT ISSUE.
Any valve Perivalvular leaking
Area post procedure is less than 1.0 cm2
Aortic Valve
Peak gradient level is 60 mmHg or more
Mean gradient is 40 mmHg or more
Mitral Valve Any evidence of worsening of mitral valve regurgitation or stenosis in narrative

 Emboli or thrombosis develop

 INR - More than 20% of INR values are less than 2.5 or greater than 3.5.
o In select cases of a Bileaflet (St. Jude) valve in the aortic position, INR values
between 2.0 and 3.0 may be accepted (check with FAA)
 New Event - Has another event, develops a new condition or identification of an
additional cardiac condition not previously reported

406
 AASI for Chronic Kidney Disease (CKD)
(Updated 11/25/2015)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR)
part 67.

An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:
 An Authorization granted by the FAA;
 A current status report from the treating physician detailing:
o How long the condition has been stable and asymptomatic;
o If there has been any significant change in eGFR or renal function;
o Any interval development of other complications or abnormal physical
exam findings (such as diabetes, uncontrolled HTN, or clinically significant
proteinuria);
o Most recent lab results including eGFR, creatinine, hemoglobin, hematocrit
and urine albumin or ACR;
o The name and dosage of medication(s) and presence or absence of any
side effects; and
o Statement from the treating physician if there is any evidence of
cardiovascular disease

The AME must defer to the AMCD or Region if:

 The condition is no longer stable (per the treating physician note);
 Dialysis has been started or transplant has occurred;
 The airman is taking a medication that is not acceptable (See Pharmaceuticals –
Antihypertensive) or has aeromedically significant side effects from the
medication;
 Anemia with hemoglobin less than 10 gm/dL or hematocrit less than 30% is
present; or
 The eGFR is 29 or less; (if this occurs, the airman will need to submit additional
testing to show stability [such as inulin clearance testing, creatinine clearance
testing, or a 24-hour urine creatinine result] and the nephrologist’s clinical
interpretation of results, prognosis, and plan for follow up).

407
 AASI for Chronic Lymphocytic Leukemia (CLL)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 A clinical follow-up report from the treating physician that includes an update of
the condition of the applicant since the last examination; and
 The results of any applicable laboratory results, including a complete blood count
performed within the last 90 days.

The AME must defer to the AMCD or Region if:

 The condition currently requires treatment with a chemotherapeutic agent; or

 The white blood cell count has risen above 80,000; or
 Any new treatment is initiated

408
 AASI for Chronic Obstructive Pulmonary Disease (COPD)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 A statement regarding symptomatology of the condition;
 A statement addressing any associated illnesses, such as heart failure;
 The name and dosage of medication(s) used for treatment and/or prevention
with comment regarding side effects; and
 A pulmonary specialist evaluation that includes the results of a current
pulmonary function test, performed within the last 90 days

The AME must defer to the AMCD or Region if:

 The FEV1 or FEV1/FVC is less than 70%;

 The applicant has developed an associated cardiac condition, or
 The applicant is taking steroid doses equivalent to more than 20 mg of
prednisone per day (steroid conversion calculator)

409
 AASI for Colitis (Ulcerative or Crohn’s Disease)
or Irritable Bowel Syndrome (IBS)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 A statement regarding the extent of disease;
 A statement regarding the frequency of exacerbation (the applicant should
cease flying with any exacerbation as warned in § 61.53); and
 The name and dosage of medication(s) used for treatment and/or prevention
with comment regarding side effects.

The AME must defer to the AMCD or Region if:

 There is a current exacerbation of the illness;

 The applicant is taking medications such as Lomotil, steroid doses equivalent to
more than 20 mg of prednisone per day (steroid conversion calculator),
antispasmodics, and anticholinergics; or
 The pattern of exacerbations is increasing in frequency or severity; or applicant
underwent surgical intervention.

410
 AASI for Colon Cancer/Colorectal Cancer
(Updated 10/27/2021)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA; and

 An update of the status of the malignancy since the last FAA medical
examination, to include the results of a current (performed within the last 90
days) carcinoembryonic antigen (CEA), if a baseline value is available

The AME must defer to the AMCD or Region if:

 There has been any progression of the disease or an increase in CEA or

 Any new treatment is initiated

411
 AASI for Coronary Heart Disease (CHD)
All Classes
(Updated 01/27/2021)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to reissue an airman medical
certificate to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations, (14 CFR) part 67. This AASI is for an applicant with a history of Angina Pectoris; Atherectomy;
Brachytherapy; Coronary Bypass Grafting; Myocardial Infarction; Percutaneous Transluminal Angioplasty (PTCA);
Rotoblation; or Stent Insertion for any class.

The FAA physicians provide the initial certification decision and grant the Authorization for Special Issuance of a
Medical Certificate (Authorization) in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the issuance determination. If this is
first-time application for an AASI for the above disease/condition, and the airman has all the requisite medical
information necessary for a determination, you must defer and submit all of the documentation to the AMCD or your
RFS for the initial determination.

AMEs may reissue an airman medical certificate if the applicant provides the following:
Authorization granted by the FAA;
Status report - Performed within the past 90 days in accordance with the CHD Protocol; and
Current maximal stress test GXT – See GXT Protocol
The AME must defer medical certification if the applicant has:

 Any other disqualifying medical conditions or therapy not previously reported;

 Any other reason for not renewing an AASI
 Bleeding that required medical intervention or other;
 Chest pain - Complains of chest pain at any time (exclude chest pain with a firm diagnosis of
non-cardiac causes of chest pain);
 New Event - Has another event, develops a new condition or identification of an additional
cardiac condition not previously reported (such as myocardial infarction, or restenosis
requiring CABG, atherectomy, brachytherapy, PTCA, stent or other procedure);
 Nitrate - Is placed on a long acting nitrate for any reason
 Risk factors - Inadequately controlled; or
 Unacceptable exercise stress test (GXT) results include:
TEST IF ANY OF THE FOLLOWING ARE NOTED, THE AME MAY NOT
ISSUE.
PMHR (predicted maximal heart rate) less than 85%;
All Exercise
classes stress test Time less than 9 minutes--under age 70;
(EST) Time less than 6 minutes --age 70 or greater

1 mm ST depression or greater at any time during stress testing -

UNLESS the applicant has additional medical evidence such as a nuclear
imaging study or a stress echocardiogram showing the absence of
reversible ischemia or wall motion abnormalities reviewed and reported by
a qualified cardiologist.

NOTE: If ANY of the items from the regular Bruce EST are not acceptable, the AME MUST
DEFER.

An AME is NOT authorized to recertify a CHD AASI for any class if a nuclear stress
test or stress echo is required.

412
 AASI for Venous Thromboembolism (VTE) - Deep Venous Thrombosis
(DVT), Pulmonary Embolism (PE), and/or Hypercoagulopathies
(Updated 09/29/2021)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an
airman medical certificate under the provisions of an Authorization for Special Issuance of a
Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying
under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that
specify the information that treating physician(s) must provide for the re-issuance determination.
If this is a first time issuance of an Authorization for the above disease/condition, and the
applicant has requisite medical information necessary for a determination, the AME must defer
and submit all of the documentation to the AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance, if the applicant provides the following:

 A valid Authorization for Special Issuance granted by the FAA;

 A summary of the applicant’s medical condition since the last FAA medical examination,
including a statement regarding any further episodes of VTE (DVT, PE) or other
complication of hypercoagulopathy (see below*), future treatment plan, and prognosis;
 The name and dosage of all medication(s) used for treatment and/or prevention with
comment regarding side effects, if any; and
 If using Coumadin (Warfarin), obtain a minimum of monthly International Normalized Ratio
(INR) results for the immediate prior 6 months (see below*); and
 If using other types of anticoagulants such as NOAC/DOAC (i.e. Xarelto, Eliquis, Pradaxa,
Savaysa, etc.), the airman should obtain a statement from their treating/prescribing
physician with details of the underlying condition, tolerance of the medication to include
the presence or absence of side effects, any bleeding episodes requiring medical
attention, and any occurrence/recurrence of deep vein thrombosis or pulmonary embolism.

*The AME must defer to the AMCD or Region if:

 If using Coumadin (Warfarin) and more than 20% of INR values are <2.0 or >3.0; or
 If applicant experienced any side effects or bleeding episodes requiring medical attention;
or
 The applicant develops emboli, thrombosis, bleeding, or any other cardiac or neurologic
condition previously not diagnosed or reported.

413
 AASI for Diabetes Mellitus - Type II
Medication Controlled (Not Insulin)
AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-issue an
airman medical certificate under the provisions of an Authorization for Special Issuance of a
Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying
under Title 14 of the Code of Federal Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by attachments that
specify the information that treating physician(s) must provide for the re-issuance determination. If
this is a first-time application for an AASI for the above disease/condition, and the applicant has
all the requisite medical information necessary for a determination, the AME must defer and
submit all of the documentation to the AMCD or RFS for the initial determination. The information
can be submitted using the DIABETES or HYPERGLYCEMIA ON ORAL MEDICATIONS
STATUS REPORT.

AMEs may re-issue an airman medical certificate under the provisions of an Authorization,
provided that the applicant does not require insulin, remains on an acceptable oral
medication therapy according to the chart Acceptable Combinations of Diabetes
Medications, and if the applicant provides the following:
 An Authorization granted by the FAA AND either
 A DIABETES or HYPERGLYCEMIA ON ORAL MEDICATIONS STATUS REPORT
OR
 A current status report from the physician treating the airman’s diabetes, including:
o A statement attesting that the airman is maintaining his or her diabetic diet;
o A statement regarding any diabetic symptomatology; including any history of
hypoglycemic events and any cardiovascular, renal, neurologic, or
ophthalmologic complications; and
o The results of a current HgA1c level performed within last 30 days.

The AME must defer to the AMCD or Region if, since the applicant’s last exam:
 The applicant has been placed on insulin;
 The HgA1c level is greater than 9.0 mg%
 The applicant has experienced:
o Severe Hypoglycemia event(s) - requiring assistance of another person to
actively administer carbohydrates, glucagon, or take other corrective actions
(plasma glucose concentrations may not be available)*;
o Documented Symptomatic Hypoglycemia event(s) - typical symptoms of
hypoglycemia accompanied by a measured plasma glucose concentration
≤70 mg/dL (≤3.9 mmol/L)*;
o Asymptomatic Hypoglycemia – no reported symptoms but a measured
plasma glucose concentration ≤54 mg/dL (≤3.0 mmol/L)
 The applicant has developed evidence of any of the following:
o Cardiovascular disease,
o Neurologic disease, including any change in degree of peripheral
neuropathy,
o Ophthalmologic disease,
o Renal disease (including a Creatinine over 2.0)
414
 The airman has been placed on any amlynomimetics, such as pramlintide (Symlin)
 The applicant is using any medication (single or in combination) that falls outside
the framework of Acceptable Combinations of Diabetes Medications
 The applicant has required treatment other than routine outpatient follow-up (e.g.
emergency department, inpatient admission) for diabetes (e.g. hypoglycemia,
ketoacidosis, non-ketotic hyperglycemia) or diabetes-related conditions.
 The applicant has experienced any event suggesting hypoglycemia unawareness
or hypoglycemia-associated autonomic failure.

* Reference: Hypoglycemia Workgroup of the ADA & The Endocrine Society

415
 AASI for Glaucoma

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR)
part 67.

An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the re-
issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 Certification only granted for open-angle-glaucoma and ocular hypertension;
 The FAA Form 8500-14, Glaucoma Eye Evaluation Form is filled out by the
treating eye specialist; and
 A set of visual fields measurements is provided.

The AME must defer to the AMCD or Region if:

 The FAA Form 8500-14 Glaucoma Eye Evaluation Form demonstrates visual
acuity incompatible with the medical standards; or
 There is a change in visual fields or adverse change in ocular pressure.

416
 AASI for Hepatitis C

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 Any symptoms the applicant has developed;
 The name and dosage of medication(s) used for treatment and/or prevention
with comment regarding side effects; and
 A current liver function profile performed within the last 90 days.

The AME must defer to the AMCD or Region if:

 The applicant has developed symptoms;

 There has been a change in treatment regimen or the applicant has been placed
on alpha-interferon;
 Any side effects from required medication; or
 An adverse change in liver function studies.

417
 AASI for Hypertension (HTN)
(Updated 10/28/2015)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR)
part 67.

An FAA physician provides the initial certification decision and grants the Authorization in
accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 A current status report from the treating physician detailing:
o If the is condition stable and, if so, for how long;
o Any secondary cause for the HTN;
o Any co-morbid condition (such as diabetes, obstructive sleep apnea); and
o Any history of end organ damage (such as heart failure, myocardial
infarction, cerebrovascular accident, kidney disease, eye disease); and
o The name and dosage of medication(s) and presence or absence of any
side effects.

The AME must defer to the AMCD or Region if:

 The condition is not stable or has become uncontrolled (per the treating physician
note);
 The airman is taking a medication that is not acceptable (See Pharmaceuticals –
Antihypertensive);
 The airman has aeromedically significant side effects from the medication;
 There is a new co-morbid condition, complication, or end organ damage; or
 The end organ damage condition(s) do not meet FAA requirements. (See the
applicable section for the specific condition(s) in the AME guide)

418
 AASI for Hyperthyroidism

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA current statement of the condition since last
FAA medical examination;
 The name and dosage of medication(s) used for treatment and/or prevention with
comment regarding side effects; and
 Current thyroid function studies performed within last 90 days.

The AME must defer to the AMCD or Region if:

 The applicant has developed hypothyroidism; or

 The thyroid function studies are elevated, suggesting inadequate treatment; or
 The applicant developed an associated illness, such as dysrhythmia.

419
 AASI for Hypothyroidism

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 The name and dosage of medication(s) used for treatment and/or prevention
with comment regarding side effects;
 A statement regarding any other associated problems, such as cardiac or visual;
and
 A statement regarding the current thyroid stimulating hormone (TSH) level
performed within the last 90 days.

The AME should defer to the AMCD or Region if:

 The applicant develops a related problem in another system, such as cardiac; or

 The TSH level is elevated.

420
 AASI for Lymphoma and Hodgkin’s Disease

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA; and

 An update of the status of the disease from the last FAA medical examination
and any testing deemed necessary by the treating physician.

The AME must defer to the AMCD or Region if:

 There has been any recurrence or disease progression

 Any new treatment is initiated

421
 AASI for Melanoma
(Updated 08/26/2015)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA, and

 A current status report performed within the last 90 days that must include all
the required follow-up items and studies as listed in the Authorization letter and
that confirms absence of recurrent disease

The AME must defer to the AMCD or Region if:

 There has been any recurrence of the cancer, or

 Any new treatment is initiated

Note:

 A Special Issuance or AASI is required for any metastatic melanoma regardless of Breslow
level.

 A Special Issuance or AASI is required for any melanoma which exhibits Breslow Level equal to
or deeper than 0.75 mm with or without metastasis.

 A melanoma that exhibits a Breslow Level of less than 0.75 mm and no evidence of metastasis
may be regular issued.

422
 AASI for Migraines

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 A statement regarding the frequency of headaches and/or other associated
symptoms since last follow-up report;
 A statement regarding if the characteristics of the headaches changed; and
 The name and dosage of medication(s) used for treatment and/or prevention with
comment regarding side effects.

The AME must defer to the AMCD or Region if:

 The frequency of headaches and/or other symptoms increase since the last
follow-up report; or
 The applicant is placed on medication(s), such as isometheptene mucate,
narcotic analgesic, tramadol, tricyclic-antidepressant medication, etc.

423
 AASI for Mitral or Aortic Insufficiency

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 A summary of the applicant’s medical condition since the last FAA medical
examination, including a statement regarding any further episodes of atrial
fibrillation; and
 A current 2-D echocardiogram with Doppler performed within the last 90 days.

The AME must defer to the AMCD or Region if:

 The mean gradient across the valve reaches 40 mm Hg;

 New symptoms occur;
 An arrhythmia develops; or
 The treating physician or AME reports the murmur is now moderate to severe
(Grade III or IV).

424
 AASI for Paroxysmal Atrial Tachycardia (PAT)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 A statement regarding any recurrences since the last FAA medical examination;
and
 The name and dosage of medication(s) used for treatment and/or prevention
with comment regarding side effects.

The AME must defer to the AMCD or Region if:

 There have been one or more recurrences; or

 The applicant has received some treatment that was not reported in the past,
such as radiofrequency ablation

425
 AASI for Prostate Cancer

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 A current status of the medical condition to include any testing deemed
necessary; and
 A current PSA level performed within the last 90 days.

The AME must defer to the AMCD or Region if:

 The PSA rises at a rate above 0.75 ng/ml per year;

 A new treatment is initiated; or
 Any metastasis has occurred.

426
 AASI for Renal Calculi

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to
re-issue an airman medical certificate under the provisions of an Authorization for
Special Issuance of a Medical Certificate (Authorization) to an applicant who has a
medical condition that is disqualifying under Title 14 of the Code of Federal
Regulations (14 CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA;

 A statement from your treating physician regarding the location of the retained
stone(s), estimation as to size of stone, and likelihood of becoming
symptomatic; and
 A current report of appropriate imaging study (IVP, KUB, Ultrasound, or Spiral
CT Scan) and provide a metabolic work-up, both performed within the last 90
days.

The AME must defer to the AMCD or Region if:

 If the treating physician comments that the current stone has a likelihood of
becoming symptomatic;
 If the retained stone(s) has moved when compared to previous evaluations; or
 If the stone(s) has become larger when compared to previous evaluations.

427
 AASI for Renal Cancer
(Updated 04/25/2018)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA; and

 A current status report performed within the last 90 days that must include all the
required follow-up items and studies as listed in the Authorization letter and that
confirms absence of recurrent disease.

The AME must defer to the AMCD or Region if:

 There has been any recurrence of the cancer; or

 Any new treatment is initiated.

428
 AASI for Sleep Apnea/Obstructive Sleep Apnea (OSA)
(Updated 01/27/2021)

AME Assisted - All Classes – Sleep Apnea/Obstructive Sleep Apnea (OSA)

AMEs may re-issue an airman medical certificate to airmen currently on an AASI for OSA if the
airman provides the following:

 An Authorization granted by the FAA;

 Signed Airman Compliance with Treatment form or equivalent from the airman attesting
to absence of OSA symptoms and continued daily use of prescribed therapy; and
 A current status report from the treating physician indicating that OSA treatment is still
effective.

o For CPAP/ BIPAP/ APAP:

 A copy of the cumulative annual PAP device report which shows actual
time used (rather than a report typically generated for insurance
providers which only shows if use is greater or less than 4 hours). Target
goal should show use for at least 75% of sleep periods and an average
minimum of 6 hours use per sleep period.

 For persons with an established diagnosis of OSA who do not have a

recording CPAP, a one-year exception will be allowed to provide a
personal statement that they regularly use CPAP and before each shift
when performing flight or safety duties.

o For Dental Devices and/or for Positional Devices:

No conditions known to be co-morbid with OSA (e.g., diabetes mellitus,
hypertension treated with more than two medications, atrial fibrillation, etc).
Once Dental Devices with recording / monitoring capability are available, reports
must be submitted.

o For Surgery:
For successfully treated surgical patients, a statement attesting to the continued
absence of OSA symptoms is required.

Defer to the AMCD or the Region for further review if:

 Concerns about adequacy of therapy or non-compliance;

 Significant weight gain or development of conditions known to be co-morbid with
OSA (e.g., diabetes mellitus, hypertension treated with more than two medications,
atrial fibrillation, etc).

Note: The AME may request AMCD review to discontinue the AASI if there are indications that
the airman no longer has OSA (e.g., significant weight loss and a negative study or
surgical intervention followed by 3 years of symptom abatement and absence of
significant weight gain or co-morbid conditions). In most cases, a follow-up sleep
study will be required to remove the AASI.

429
 AASI for Testicular Cancer
(Updated 04/25/2018)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:

 An Authorization granted by the FAA; and

 A current status report performed within the last 90 days that must include all the
required follow-up items and studies as listed in the Authorization letter and that
confirms absence of recurrent disease.

The AME must defer to the AMCD or Region if:

 There has been any recurrence of the cancer; or

 Any new treatment is initiated.

430
 AASI for Thrombocytopenia
(Updated 10/27/2021)

AME Assisted Special Issuance (AASI) is a process that provides AMEs the ability to re-
issue an airman medical certificate under the provisions of an Authorization for Special
Issuance of a Medical Certificate (Authorization) to an applicant who has a medical
condition that is disqualifying under Title 14 of the Code of Federal Regulations (14
CFR) part 67.

An FAA physician provides the initial certification decision and grants the Authorization
in accordance with 14 CFR § 67.401. The Authorization letter is accompanied by
attachments that specify the information that treating physician(s) must provide for the
re-issuance determination. If this is a first-time application for an AASI for the above
disease/condition, and the applicant has all the requisite medical information necessary
for a determination, the AME must defer and submit all of the documentation to the
AMCD or RFS for the initial determination.

AMEs may re-issue an airman medical certificate under the provisions of an

Authorization, if the applicant provides the following:
 An Authorization granted by the FAA;
 An update of the status of the disease from the last FAA medical examination
and any testing deemed necessary by the treating physician; and
 CBC within the past 90 days.

The AME must defer to the AMCD or Region if:

 There has been any recurrence or disease progression; or
 There has been any bleeding that required treatment; or
 Any new treatment is initiated such as IVIG, high dose steroids, platelet
transfusion, splenectomy (as treatment, not traumatic), or others; and/or
 Platelet count falls below 50,000/microL.

431
 Aviation Medical Examiner
Assisted Special Issuance (AASI)
Certificate Issuance (Updated 10/27/2021)
I have reviewed the enclosed medical report(s) and have determined that the report(s) is in accordance with this applicant’s Authorization for
Special Issuance of a Medical Certificate and the AASI Protocol established for certificate issuance.

I have issued a -class medical certificate to the airman named below with all other limitations listed on the original certificate. The
certificate issued is timed limited by the restriction “NOT VALID FOR ANY CLASS AFTER ____________”
Date
Check all that apply:
Interim certificate issued for disease(s)/condition(s) below – No examination performed.
AASI CONDITION AASI CONDITION AASI CONDITION
Arthritis Colon Cancer/ Colorectal Cancer Paroxysmal Atrial
Tachycardia (PAT)
Asthma Diabetes Mellitus – Type II Prostate Cancer
Medication Controlled
Atrial Fibrillation Glaucoma Renal Calculi

Bladder Cancer Hepatitis C Renal Cancer

Breast Cancer Hypertension (HTN) Sleep Apnea/Obstructive Sleep
Apnea (OSA)
Cardiac – Single Valve Hyperthyroidism Testicular Cancer
Replacement or Repair
Coronary Heart Disease (CHD) Hypothyroidism Thrombocytopenia
Chronic Kidney Disease (CKD) Lymphoma and Hodgkins Warfarin (Coumadin) Therapy
for Venous Thromboembolism -
Deep Venous Thrombosis,
Pulmonary Embolism, and/ or
Hypercoagulopathies

Chronic Lymphocytic Melanoma

Leukemia (CLL)
Chronic Obstructive Migraine Headaches .
Pulmonary (COPD)
Colitis Mitral and Aortic
(Ulcerative or Crohn’s) or Insufficiency
Irritable Bowel Syndrome (IBS)

AASI CONDITION

Certificate issued - New application and examination performed.

AIRMAN INFORMATION:

Name:

PI: DOB:

AVIATION MEDICAL EXAMINER (AME) INFORMATION:

AME Name (Print):

AME Signature:

AME Number: Date:

 Guide for Aviation Medical Examiners
__________________________________________________________________________

SUBSTANCES OF DEPENDENCE/ABUSE
 Guide for Aviation Medical Examiners
____________________________________________________________________________

SUBSTANCES OF DEPENDENCE/ABUSE
(Updated 09/27/2017)

General Information for All AMEs

 DUI/DWI/Alcohol Incidents - Disposition Table

 Alcohol Event Status Report for the AME
 Drug Use - Past or Present - Disposition Table
 Drug and Alcohol Event - FAA Certification Aid - Required Information
 Security Notification/ Reporting Events
 Substances of Dependence/Abuse FAQs

FAA Drug and/or Alcohol Monitoring Program and the HIMS Program:

Airmen who have a regulatory diagnosis of alcohol dependence or abuse may require
evaluation and monitoring before they can obtain a medical certificate. If an airman requires
monitoring they should establish with a HIMS (Human Intervention Motivation Study) trained
AME (HIMS AME) to help them work through the FAA process.

 Drug and/or Alcohol monitoring - Initial Certification

o HIMS AME – Huddle Electronic Case Submission and FAQs
o HIMS-Trained AME Checklist – Drug and Alcohol INITIAL
o HIMS-Trained AME Data Sheet
o FAA Certification Aid – HIMS Drug and Alcohol – INITIAL
o Specifications for Psychiatric and Neuropsychological Evaluations for Substance
Abuse/Dependence

 Drug and/or Alcohol monitoring – Recertification

o HIMS AME Information – HIMS Step Down Plan
o Airman Information – HIMS Step Down Plan
o HIMS-Trained AME Checklist Drug and Alcohol Monitoring Recertification
o FAA Certification Aid - Drug and Alcohol Monitoring Recertification

 Monitoring/HIMS FAQs

For information on the Industry Drug and Alcohol Testing Program see:
Aviation Industry Antidrug and Alcohol Misuse Prevention Programs

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General Information for ALL AMES

DUI/DWI/Alcohol or Drug Use/Abuse (Updated 09/27/2017)

Drug and alcohol use, abuse or dependence can be of significant concern to the flying
public. Arrest(s), conviction(s) and/or administrative action(s) affecting driving privileges may
raise questions about the applicant's fitness for certification and may be cause for
disqualification. When an airman checks yes to items 18.n. 18.o., or 18.v., or AME notes
Item 47 concerns, additional history should be obtained by the AME regarding these events.
The AME should then follow the instructions in the corresponding disposition table(s).

Some of the most common Substances of Dependence/Abuse are listed below. This list is not
totally inclusive or comprehensive. No independent interpretation of the FAA's position with
respect to a medication included or excluded from the list should be assumed.

Medications
Alcohol Marijuana
Amphetamines Narcotics
Anxiolytics Phencyclidine (PCP)
Cocaine Psychotropics
Hallucinogens Stimulants
Hypnotics Tranquilizers

I. All Classes: 14 CFR 67.107(a)(b), 67.207(a)(b), and 67.307(a)(b)

First-Class Airman Medical Certificate: 67.107

Second-Class Airman Medical Certificate: 67.207
Third-Class Airman Medical Certificate: 67.307

(a) No established medical history or clinical diagnosis of any of the following:

(4) Substance dependence, except where there is established clinical evidence,

satisfactory to the Federal Air Surgeon, of recovery, including sustained total
abstinence from the substance(s) for not less than the preceding 2 years. As used
in this section -

(i) "Substance" includes: alcohol; other sedatives and hypnotics; anxiolytics;

opioids; central nervous system stimulants such as cocaine, amphetamines,
and similarly acting sympathomimetics; hallucinogens; phencyclidine or
similarly acting arylcyclohexylamines; cannabis; inhalants; and other
psychoactive drugs and chemicals; and

(ii) "Substance dependence" means a condition in which a person is

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dependent on a substance, other than tobacco or ordinary xanthine-containing
(e.g., caffeine) beverages, as evidenced by-
(A) Increased tolerance
(B) Manifestation of withdrawal symptoms;
(C) Impaired control of use; or
(D) Continued use despite damage to physical health or impairment of
social, personal, or occupational functioning.
(b) No substance abuse within the preceding 2 years defined as:
1. Use of a substance in a situation in which that use was physically
hazardous, if there has been at any other time an instance of the use of a
substance also in a situation in which that use was physically hazardous;
2. A verified positive drug test result, an alcohol test result of 0.04 or greater
alcohol concentration, or a refusal to submit to a drug or alcohol test
required by the U.S. Department of Transportation or an agency of the U.S.
Department of Transportation; or
3. Misuse of a substance that the Federal Air Surgeon, based on case history
and appropriate, qualified medical judgment relating to the substance
involved, finds-
(i) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or
(ii) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.
II. Exam Techniques

The FAA has concluded that certain conditions are such that their presence or a past history
of their presence is sufficient to suggest a significant potential threat to aviation safety. It is,
therefore, incumbent upon the AME to be aware of any indications of these conditions currently
or in the past, and to deny or defer issuance of the medical certificate to an applicant who has
a history of these conditions. An applicant who has a current diagnosis or history of these
conditions may request the FAA to grant an Authorization under the special issuance section
of part 67 (14 CFR 67.401) and, based upon individual considerations, the FAA may grant
such an issuance.
III. Aerospace Medical Disposition

The following items list the most common conditions of aeromedical significance, and course of
action that should be taken by the AME as defined by the protocol and disposition in the table.
Medical certificates must not be issued to an applicant with medical conditions that require
deferral, or for any condition not listed in the table that may result in sudden or subtle
incapacitation without consulting the AMCD or the RFS. Medical documentation must be
submitted for any condition in order to support an issuance of an airman medical certificate.

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DUI/DWI
DUI/ DWI /Alcohol Incidents
All Classes
(Updated 09/27/2017)

CONDITION EVALUATION DATA DISPOSITION

ISSUE
A. The airman should bring his/her letter(s) from the
History of alcohol related event(s) FAA (for this condition) for the AME to review. Annotate Block 60 with
the mm/yyyy of the most
OR 1. The AME should review the letter and obtain recent event and that
alcohol dependence any additional history necessary from the there have been no
airman to verify no subsequent events have further events or
Previously reported to FAA and occurred.
changes in condition.
written proof from the FAA that 2.
monitoring is not required. 3. If the airman is required to remain abstinent,
the AME, based on their clinical assessment, If changes, consult with
should note in Block 60 if the airman is adhering AMCD/RFS or Defer
to this requirement.
ISSUE
B. The AME should gather information regarding
Single event the incident including date, events surrounding Summarize this history,
5 or more years ago the incident, history of other events, or any prior annotate Block 60
treatment programs (it is highly recommended including date (mm/yyyy)
with Blood Alcohol Content (BAC) that the AME obtain all items on the Airman of the offense.
less than 0.15 Drugs and Alcohol Personal Statement.
Submit Airman Drugs and
If AME determines, through exam and interview, Alcohol Personal
there is no current or historical evidence of a Statement and copy of
substance abuse or dependence problem. BAC (if available) to the
FAA for retention in the file.

C. The AME must complete the Alcohol Event Follow the instructions on
Single event Status Report for the AME OR write a summary
less than 5 years ago the Alcohol Event Status
report that includes all of the items on the Alcohol Report for the AME.
OR Event Status Report.
Single event at any time with Submit the information to
Unknown BAC, If the single event was 10 or more years ago, the FAA for review.
Refused BAC/breathalyzer or the BAC or court records are unavailable, and
BAC .15 or above the AME has no concerns, call AMCD at 405- Follow up Issuance will
954-4821 or the RFS to discuss. be per the airman’s
authorization letter.
D. DEFER
Two or more events in the Submit the following for FAA review:
airman’s lifetime
 Airman’s personal statement Submit the information to
Or the FAA for review.
History of dependence or  The Alcohol Event Status Report for the
substance use disorder AME along with the supporting information Follow up Issuance will be
used to review. per the airman’s
Additional information may be required after
authorization letter.437
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 Note: If FAA letter(s) are not available or if the AME has questions, call AMCD at 405-954-4821 or their RFS
and request a copy or to discuss with AMCD or their RFS.

 If unable to obtain and review the required reports within 14 days of the exam; the AME must defer and should
inform the airman what reports will be needed.

 If the airman does not qualify based on the results from the DUI/DWI/Alcohol Event History, all of that
supporting information MUST be submitted for consideration of Medical Certification. See FAA Certification
Aid -Drug and Alcohol INITIAL for details. Upon review, additional information may be required.

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Alcohol Event Status Report for the AME
(Updated 09/27/2017)
Name _______________________________________________ Birthdate _______________________________

Applicant ID# _________________________________________ PI# ____________________________________

Airmen - See the FAA Certification Aid - Drug and Alcohol INITIAL to identify what information you should give the AME.

AME Instructions:
• Address the following items based on your in-office exam and documentation review;
• Submit this Checklist (it must be signed and dated by the AME); and
• Submit the supporting documentation reviewed to complete this checklist within 14 days to:

Federal Aviation Administration

Civil Aerospace Medical Institute, Bldg. 13
Aerospace Medical Certification Division, AAM-313
PO Box 25082, Oklahoma City, OK 73125-9867

1. List DATE(s) of any arrest, conviction or administrative action here: _____________

2. Number of alcohol related events in the airman’s lifetime? ......................................... One Two or more

3. AIRMAN’s STATEMENT Do you find any evidence of current or previous alcohol

No Yes
abuse, dependence or other concerning behaviors?.......................................................

4. BLOOD/BREATH ALCOHOL CONTENT (BAC) from all offenses:

Did the airman ever REFUSE TO TEST..................................................................... No Yes
Missing records of test performed (per the airman)? ....……………............................ No Yes
Any BAC in the records of 0.15 g/dl or HIGHER ………………………………………. No Yes (.15 or
List the highest BAC found on report(s) here: _________ higher)

5. COURT RECORD(s) AND ARREST RECORD(s): (including military records)

Did the airman fail to provide a copy of the narrative police/investigative report from all
offenses and complete copies of all court records associated with the offense(s)
including court-ordered education?.................................................................................. No Yes

6. DRIVING RECORD: AME must review a complete Department of Motor Vehicles

(DMV) record. List all states the airman held a driver’s license for the past 10 years.
1. 3.
2. 4.

Any additional driving offenses involving alcohol or other concerns not listed in #1?................... No Yes

7. EVIDENCE OF TREATMENT: Did the airman attend any inpatient or outpatient rehabilitation or
treatment? (Do not include court-ordered education programs.) ..................................................... No Yes

8. Is there any history or evidence of any DRUG (illicit, Rx, etc.) offense at any time?............. No Yes

9. Do you have ANY concerns regarding this airman? If yes, notate in Block 60……………... No Yes

AME Signature Date of evaluation

If ALL items fall into the clear column, the AME may issue with notes in Block 60 but must submit all documents to the FAA.

If ANY SINGLE ITEM falls into the SHADED COLUMN, or the actual records are not available to review, the AME MUST
DEFER. The AME report should note what aspect caused the deferral and explain any answers in the shaded column.

Remind the airman to report any new event to Security.

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Drug Use
Drug Use -
Past or Present
All Classes
(Updated 09/27/2017)

CONDITION EVALUATION DATA DISPOSITION

A. ISSUE
History of drug use, drug- The airman should bring his/her letter(s) from the
FAA (for this condition) for the AME to review.
related event(s), or drug Annotate Block 60
dependence (illicit or 4. The AME should review the letter and obtain any with the date
prescription). additional history necessary from the airman to (mm/yyyy) of the most
verify no subsequent events have occurred. recent event and if
5. there have been no
Previously reported to FAA
6. If the airman is required to remain abstinent, the
and written proof from the further events or
AME, based on their clinical assessment, should
FAA that monitoring is not note in Block 60 if the airman is adhering to this changes in condition.
required requirement.

B. DEFER
Any event in the airman’s Submit the following for FAA review:
lifetime that has not yet been Airman statement that describes all of the following: Submit the
cleared by the FAA and given 1. Primary drug used. information to the FAA
an eligibility letter. 2. Any additional drugs/substances used in for review.
the airman’s lifetime (This includes marijuana
even if allowed in some states, illicit drugs, Follow-up Issuance
prescription medications, or others). will be per the
3. Describe for each: airman’s
a) Frequency of use;
authorization letter.
b) Amount used;
c) Setting in which used; and
d) Dates use started and stopped.
4. Did you attend any treatment program(s)?
If yes, provide beginning and end dates.
If no, this should be stated.
5. Any economic, legal problems, or
other adverse consequences from use?

 Note: If FAA letter(s) are not available or if the AME has questions, call AMCD at 405-954-4821 or their RFS
to request a copy or to discuss with AMCD or their RFS.

 If unable to obtain and review the required reports within 14 days of the exam; the AME must defer and should
inform the airman what reports will be needed.

 Upon receipt and review of the above information, additional information may be required.

 If the airman sees a substance abuse professional for alcohol use, they should also describe and comment on
the drug use history in their report.

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DRUG AND ALCOHOL EVENT - FAA CERTIFICATION AID - REQUIRED INFORMATION

(Page 1 of 2)
(Updated 01/27/2021)
AMEs should use this tool to help collect information needed for the Alcohol Event Status Report for
the AME.

The following information is to assist you and your treating physician/provider who may be unfamiliar with
FAA medical certification requirements. It lists the ABSOLUTE MINIMUM information required by the FAA
to make a determination on an airman medical certificate. You should strongly consider taking a copy to
each evaluator so they understand what specific information is needed in their report to the FAA. If
the corresponding provider does not address each item, there may be a delay in the processing of your
medical certification until that information is submitted. Additional information, such as clinic notes or
explanations, should also be submitted as needed.

REPORT FROM MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING (Drug and Alcohol)

A. 3. Detailed typed personal statement from you that describes the offense(s):
AIRMAN a. What type of offense occurred;
DRUG AND b. What substance(s) were involved;
ALCOHOL c. State or locality or jurisdiction where the incident occurred;
(D&A) d. Date of the arrest, conviction, and/or administrative action;
PERSONAL e. Description of circumstances surrounding the offense; and
STATEMENT f. Describe the above for each alcohol incident. If no other incidents, this should be stated.
4. Your past, present, and future plans for alcohol or drug use.
a. When did you start drinking? How much? How often?
b. How much, how often were you drinking at the time of the incident(s);
c. How much, how often do you drink now? If abstinent, state date abstinence started;
d. Any negative consequences (legal complications or medical complications such as blackouts,
pancreatitis, or ER visits); and
e. Include any other alcohol or drug offenses (arrests, convictions, or administrative actions), even if they
were later reduced to a lower sentence.
5. Treatment programs you attended ever in your life. If none attended, this should be stated
a. Dates of treatment;
b. Inpatient, outpatient, other; and
c. Name of treatment facility
6. Current recovery program (if any). If AA or another program, list name of program and frequency attended.
If not in a recovery program, this should be stated.

B. 1. Blood Alcohol Concentration (BAC) from any alcohol offense. BAC may be listed in a hospital report, a police
BLOOD ALCOHOL report, or investigative report.
CONTENT (BAC) a. This will be either a breathalyzer test or a blood test.
b. Attach copies of any additional drug testing performed.

C. 1. Police/investigative report from dates of incident(s). It should describe the circumstances surrounding the offense
COURT RECORDS and any field sobriety tests performed.
2. Court records, if applicable.
3. Military records if events occurred while the applicant was a member of the U.S. armed forces. It should include
military court records, records of non-judicial punishment, and military substance abuse records.

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DRUG AND ALCOHOL EVENT - FAA CERTIFICATION AID - REQUIRED INFORMATION

(Page 2 of 2)
D. 1. List every state/principality/location and dates you have held a driver’s license in the past 10 years.
DRIVING RECORD, 2. Submit a complete copy of your driving records from each of these for the past 10 years.
DEPARTMENT OF
MOTOR VEHICLES
(DMV) RECORDS
E. 1. Treatment records and copy of certificate, if any.
EVIDENCE OF 2. If no program was recommended or if treatment was started but not completed, that should be stated.
TREATMENT

F. The report must include at a minimum:

SUBSTANCE
ABUSE 9. List of the items/documents reviewed.
EVALUATION* a. Verify if you were provided with and reviewed a complete copy of the airman’s FAA medical file sent to
you by the FAA; and
b. Include list of collateral contact(s) used to verify history, if any.
*May not be required 10. Summary of the above records. Were the records clear and in sufficient detail to permit a satisfactory evaluation
for all airmen. of the nature and extent of any previous mental disorders?

If required, the type of Clinical interview that covers the following:

provider to perform the
evaluation will be in the 11. Family history of drug and alcohol or mental health issues.
letter sent to the 12. Developmental history.
airman from the FAA. 13. Past medical history and medical problems such as blackouts; memory problems; stomach, liver, cardiovascular
This will be either a problems; or sexual dysfunction.
Substance Abuse 14. Psychiatric history, if any. Include diagnosis, treatment, and hospitalizations.
Professional (SAP), a. Personal history of anxiety, depression, insomnia; and/or
HIMS AME, b. Suicidal thoughts or attempts.
Psychiatrist, 15. Alcohol and/or drug use history:
Addictionologist or a a. Include any treatment or hospitalizations; and
HIMS psychiatrist b. The current status of drug or alcohol use (what used, how often, start/stop dates).
16. Other concerns such as:
If all of the items are a. Personality changes (argumentative, combative) or loss of self-esteem or isolation;
not covered or contain b. Social family problems such as marital separation or divorce;
insufficient detail to c. Irresponsibility or child/spousal abuse;
make a decision, d. Legal problems such as alcohol-related traffic offenses or public intoxication, assault and battery, etc.;
additional testing or e. Occupational problems such as absenteeism or tardiness at work, reduced productivity, demotions,
review may be frequent job changes, or loss of job;
required. f. Economic problems such as frequent financial crises, bankruptcy, loss of home, or lack of credit; and
g. Interpersonal adverse effects such as separation from family, friends, associates, etc.
If the evaluation 17. Any other concerns per the evaluator.
submitted is not 18. Results of any testing that was performed (SASSI, etc.).
adequate or does not 19. Mental status examination results.
meet the specified 20. Summary of your findings. Include if you agree or disagree with previous diagnosis or findings from the records
parameters, a higher- you reviewed and why.
level evaluation may be 21. DSM diagnosis for Axis I-V (if none, that should be stated).
required. 22. Any evidence of drug or alcohol abuse or dependence (if not mentioned above).
23. Any additional concerns or comments.

Note: if the above evaluation is not adequate, an additional evaluation from a psychiatrist or other provider may
be required.

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Security Notification/ Reporting Events

(Updated 06/27/2018)

Security Notification for a Conviction or Administrative Action

Note: Under 14 CFR 61.15, all pilots must send a Notification Letter (MS Word) to
FAA's Security and Investigations Division, within 60 calendar days of the effective
date of an alcohol and/or drug related conviction or administrative action.

Federal Aviation Administration

Security and Investigations Division AXE-700;
P.O. Box 25810
Oklahoma City, OK 73125-0810

For additional information including a copy of the required Notification Letter, see:
Security

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Substances of Dependence/Abuse FAQs

(Updated 09/27/2017)

1. Is there a difference in a regulatory requirement vs a clinical diagnosis? Which

one must an airman meet?
Yes. Airmen must meet the regulatory requirements of 14 CFR Part 67, which are not
the same criteria used for a clinical (DSM) diagnosis.

2. What is the FAA regulatory definition of Substance Dependence?

“Substance dependence” means a condition in which a person is dependent on a
substance other than tobacco or ordinary xanthine containing (e.g., caffeine) beverages,
as evidence by:
A. Increased tolerance;
B. Manifestation of withdrawal symptoms;
C. Impaired control of use; or
D. Continued use despite damage to physical health or impairment of social,
personal, or occupational functioning.

3. What is the FAA regulatory definition of Substance abuse?

1) Use of a substance in a situation in which that use was physically hazardous, if
there has been at any other time an instance of the use of a substance also in
a situation in which that use was physically hazardous;

2) A verified positive drug test result, an alcohol test result of 0.04 or greater
alcohol concentration, or a refusal to submit to a drug or alcohol test required
by the U.S. Department of Transportation or an agency of the U.S. Department
of Transportation; or

3) Misuse of a substance that the Federal Air Surgeon, based on case history
and appropriate, qualified medical judgment relating to the substance involved,
finds:

(i) Makes the person unable to safely perform the duties or exercise the
privileges of the airman certificate applied for or held; or

(ii) May reasonably be expected, for the maximum duration of the airman
medical certificate applied for or held, to make the person unable to
perform those duties or exercise those privileges.

4. What type of drug or alcohol related events are asked for on the 8500-8?
A. Arrests;
B. Convictions; or
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C. Administrative actions - such as if the airman attended an educational or

rehabilitation program in lieu of conviction or was given a lesser charge after
being arrested (ex: an arrest for DUI that was reduced to reckless driving after
court proceedings).

5. Does an airman need to report a DUI from years ago?

Yes. The 8500-8 specifically asks the airman to report if they “ever in their life have
been diagnosed with, had, or presently have...”

The AME should inquire about each event, no matter how long ago, and follow the
appropriate disposition table instructions.

6. What should the AME do when an airman has a positive answer to 18.n. 18.o., or
18.v.?

The AME should obtain additional history and follow the correct disposition table. In
some cases, additional information will be required before a medical certificate may be
issued.

7. Must the airman continue to mark “yes” on all subsequent exams?

Yes. If the airman has reported the event to the FAA, they must continue to report it on
ALL subsequent 8500-8 applications. This applies even when the FAA has reviewed
documentation and sent the airman a letter saying no further monitoring or information is
needed for that event.

If the applicant/airman documented the information on previous exams AND there are no
new arrest(s), conviction(s), and/or administrative action(s) since the last application, the
Applicant may enter PREVIOUSLY REPORTED, NO CHANGE.

The AME should verify there have been no additional drug or alcohol
events/offense(s). If none have occurred, that should be noted in Block 60 per the
disposition table. If any additional events have occurred, the AME should refer to the
instructions on the correct disposition table.

8. How does an airman report a Drug and/or Alcohol event to the FAA? (Updated
06/27/2018)

Airmen must report alcohol and drug events under both Part 67 and Part 61.
This requires two separate actions by the airman:

1. Notify the FAA Medical Division (Part 67).

2. Notify the FAA Security Division (Part 61).
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1. The airman should notify the FAA Medical department regarding any new arrest,
convictions or administrative actions as soon as possible after the event.

a. If a new exam is performed, the AME should follow the disposition table.
b. If the airman is on a Special Issuance for drug or alcohol condition(s) and they
have a new event, they should not fly under 61.53 until their case is reviewed.

2. Under 14 CFR 61.15, all pilots must send a Notification Letter (MS Word) to FAA's
Security and Investigations Division, within 60 calendar days of the effective date of
an alcohol- and/or drug-related conviction or administrative action.

Federal Aviation Administration

Security and Investigations Division, AXE-700
P.O. Box 25810
Oklahoma City, OK 73125-0810

For additional information see Security.

9. If the airman reports his/her DUI or any alcohol or drug offense (i.e., motor vehicle
violation) to the AME or on an 8500-8/MedXPress, will that take the place of
reporting it to legal/security?

No. The airman must take a separate action to report a conviction or administrative
action to security.

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Drug/Alcohol Monitoring Programs and HIMS

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HIMS AME - HUDDLE ELECTRONIC CASE SUBMISSION

(Updated 01/27/2021)

At this time, only HIMS AMES may submit cases electronically via Huddle.
To do so, HIMS AMES must first complete initial Huddle training. If you do not have a Huddle
account or have not completed training, send requests to [email protected].
 Submit only first- and second-class HIMS cases.
 Do NOT send third-class cases via huddle.

Steps for Electronic Submission

A. Log into your Huddle account

B. Create a folder for the airman. Use PI# if available, type of case (HIMS, HIMS+SSRI).
Each airman case must have a separate folder.
C. Upload all relevant files in the designated order with correct naming conventions as
indicated on the HIMS AME Checklist.
D. Share completed folder with HIMS Analyst Team.
E. Follow any instructions you receive from your assigned HIMS Analyst.*

*When the HIMS Analyst determines the file is complete, they will move the folder from
the Huddle workspace for FAA review.

For detailed instructions, log into your Huddle account and go to the “Huddle Training and
Updates” page.

FREQENTLY ASKED QUESTIONS (FAQs)

1. What is the preferred format for uploaded documents?

Use PDF or Microsoft Word format.

2. Is there a limit to the number of folders or limit on size of the files?

There is no limit on the number of folders. File size is limited to 20 GB.

3. How do I identify different reports from the same consultant? I might have a
Neuropsychologist initial report, followed by a second report or a follow up report,
etc.

Place the naming conventions at the beginning of the document. If you have
additional documents as described above, place a dash after the naming convention
then add the description. (EX: Neuropsychologist Report – follow up.)

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4. Should I wait until the airman’s folder has all the required files before sharing
them or should I share them as they come in?

Do not share the folder with the HIMS Analyst Team until ALL the required
documents are present.

5. How do I provide missing or additionally requested information after I have

already shared the folder?

If you need to submit a document after you have already shared a folder, simply create
another folder with the airman’s identifying information, label it “additional documents,”
add the additional files, and then share the new folder with the HIMS Analyst Team.

6. Once I share the files in Huddle, do I also have to mail them to the FAA?

No, once you share the file electronically, do NOT mail the same file. Duplicate
copies will slow down the review process.

7. What happens to the folders once they are shared with the HIMS Analyst Team?

Once an entire folder is shared, the analyst checks for any missing information. If the
folder is complete, it moves into the process for FAA review.

8. Will the Aerospace Medical Certification Division (AMCD) staff have access to the
Huddle space as well?

Yes, they will have as-needed access to the files in your Huddle workspace.

9. What about third-class Drug and Alcohol cases?

Third class cases are processed at the Aerospace Medical Certification

Division in Oklahoma City and should be mailed to the address indicated on the
HIMS Checklist.

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HIMS trained AME Checklist – Drug and Alcohol MONITORING INITIAL Certification
(Updated 03/31/2021)
Airman Name _____________________________________ MID or PI#________________________

Submit this MANDATORY checklist and ALL supporting information outlined below within 14 days of deferred
exam. Use only ONE method to submit. Sending by multiple modes (or duplicates) will delay the review process.

Check one of the boxes below to indicate the method of the submission.

 Electronic submission:  All others, mail to:

First and second class HIMS cases ONLY
Using regular mail US Postal Service: Using FedEx, UPS, etc.:
USE HUDDLE Federal Aviation Administration Federal Aviation Administration
Civil Aerospace Medical Institute, Building 13 Medical Appeals Section, AAM-313
Aerospace Medical Certification Division AAM-313 Aerospace Medical Certification Division
PO Box 25082 6700 S. MacArthur Boulevard, Room B-13
Oklahoma City, OK 73125-9914 Oklahoma City, OK 73169

The specific information required for each report type is detailed in the corresponding numbered (#) items on the
FAA Certification Aid – HIMS Drug and Alcohol – INITIAL.

0.* HIMS-Trained AME Checklist - Drug and Alcohol MONITORING INITIAL Certification. *Use this checklist as a
coversheet and submit the rest of the information, numbered and ordered as shown below:

1. HIMS AME Report FACE-TO-FACE, IN-OFFICE EVALUATION (narrative): NA Yes No

 Signed and dated………………………………………………………………………………………

2. HIMS AME Data Sheet N/A Yes No

(N/A for third class airmen)…..…………………………………………………………….………………..........

3. Drug and /or alcohol TREATMENT RECORDS: N/A Yes No

 Include any applicable psychotherapy notes and pre-treatment psychiatrist reports…………..
4. PSYCHIATRIST EVALUATION:
N/A Yes No
 HIMS-trained psychiatrist for most first and second class airmen.........................……………..
 Most third class will require a board-certified psychiatrist.
N/A Yes No
5. NEUROPSYCHOLOGIST EVALUATION and RAW TESTING DATA…………………………………
 CogScreen results

6. ADDITIONAL RECORDS: N/A Yes No

 Aftercare Report (Group)…………………………………………………………………………………...
 Airline Reports: Chief Pilot Report and Peer Pilot Letter (for commercial pilots 1st or 2nd-class; 3rd class N/A)……
 Airman’s Personal Statement…………………………………………………………..........................
 Drug or Alcohol Testing…………………………………………………………………………………...
 DUI Records (BAC, court records, driving/DMV records)...........................................................................
Medical Records (List any other conditions relevant to this case)…………..……………………………...........
 SI Additional Reports (Only when specified by the Authorization Letter)…………………..……………...

________________________________________________ ____________________
HIMS-trained AME Signature Date

MISSING OR INCOMPLETE ITEMS WILL CAUSE CERTIFICATION REVIEW DELAYS.

 Send all of the above information AND this Checklist in ONE PACKAGE, via electronic submission or
mailed to the appropriate address listed above.
 Upon receipt and review of all of the above information, additional information or action may be
requested.
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FAA CERTIFICATION AID - HIMS Drug and Alcohol - INITIAL (Page 1 of 5)

(Updated 01/27/2021)

The following information is to assist your treating physician/provider who may be unfamiliar with FAA
medical certification requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to
make a determination on an airman medical certificate. You should strongly consider taking a copy to each
evaluator so they understand what specific information is needed in their report to the FAA. If each item is
not addressed by the corresponding provider there may be a delay in the processing of your medical
certification until that information is submitted. Additional information such as clinic notes or explanations
should also be submitted, as needed.

ALL REPORTS MUST BE CURRENT (WITHIN THE LAST 90 DAYS) FOR FAA PURPOSES.

REPORT FROM MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING

HIMS AME CHECKLIST 1. Using the HIMS-Trained AME Checklist – Drug and Alcohol Monitoring INITIAL Certification, comment on
any items that fall into the shaded category on the Checklist.

#1 HIMS AME REPORT 1. Must be a face-to-face, in-person evaluation performed by the HIMS-trained AME.
(narrative) 2. List of the items/documents reviewed:
a. Prior SI authorizations, if issued by the FAA;
The airman must b. Verify if you were provided with and reviewed a complete copy of the airman’s FAA Medical file sent to you
establish with a HIMS- by the FAA; and
c. Include list of collateral contact(s) used to verify history, if any.
trained AME if monitoring
3. Describe
is required. a. How the case was initially identified. Circumstances regarding the pilot’s entry into the HIMS program;
b. Description of the history of the addiction problem;
c. Participation in aftercare groups, if any;
d. Participation in support groups (AA, BOAF, other);
e. History of ER visits;
f. Previous psychiatric hospitalizations, treatments, or suicide attempts; and
g. Hospital/treatment discharge summary.
4. Compliance History
a. Any evidence (such as a positive test) or concern the airman has not remained abstinent;
b. Any evidence or concern the airman has not been compliant with the recovery program;
c. If you do not agree with the supporting documents or if you have additional concerns not noted in the
documentation, please discuss your observations or concerns; and
d. Describe how the airman is doing in the program and if he/she is engaged in recovery.
5. Summarize your aeromedical impression and evaluation as a HIMS AME based on the face-to-face
evaluation AND review of the supporting documents.
a. Do you recommend a Special Issuance for this airman;
b. Do you agree to serve as the airman’s HIMS AME and follow this airman per FAA policy; and
c. Do you agree to immediately notify the FAA (at 405-954-4821) of any change in condition, deterioration, or
stability and/or if there is any positive drug or alcohol testing?
6. Any NEW condition(s) that would require Special Issuance? (Do not include any new CACI qualified
conditions.)
If using Huddle, submit the following as INDIVIDUAL PDFs:
 HIMS AME Checklist;
 HIMS trained AME written report (narrative)
 HIMS AME Data Sheet
 Drug and/or Alcohol Treatment Records
 Psychiatrist Evaluation
 Neuropsychologist Evaluation and Raw Test Data
 Additional Records - all other supporting documentation that you reviewed

Submit all the information as ONE PACKAGE (via Huddle or mailed to the appropriate address on the HIMS-Trained AME
Checklist.) Review for certification WILL BE DELAYED if package is incomplete.

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FAA CERTIFICATION AID - HIMS Drug and Alcohol - INITIAL (Page 2 of 5)

#2 HIMS AME 1. A copy of the sheet printed after entering information via www.himsdatasheet.com. (*only for first and
DATASHEET* second class airmen.)

#3 DRUG AND/OR 1. Include any applicable psychotherapy notes, therapist follow-up reports, social worker reports, AA
ALCOHOL TREATMENT sponsor contact, etc.
RECORDS 2. Include all the original records summarized in the HIMS AME Report above.

#4 PSYCHIATRIST The report must include at a minimum:

EVALUATION
1. List of the items/documents reviewed.
1st and 2nd
class a. Verify if you were provided with and reviewed a complete copy of the airman’s FAA medical file sent
to you by the FAA; and
commercial airmen will b. Include list of collateral contact(s) used to verify history, if any.
require a HIMS trained 2. Summary of the above records. Were the records clear and in sufficient detail to permit a satisfactory evaluation of
psychiatrist* to perform the nature and extent of any previous mental disorders?
this evaluation in most
cases. Clinical interview that covers the following:
3. Family history of drug and alcohol or mental health issues.
Most others will require a 4. Developmental history.
board certified psychiatrist 5. Past medical history and medical problems such as blackouts, memory problems; stomach, liver, cardiovascular
problems, or sexual dysfunction.
6. Psychiatric history, if any. Include diagnosis, treatment, and hospitalizations.
a. Personal history of anxiety, depression, insomnia; and/or
b. Suicidal thoughts or attempts.
* To find a HIMS psychiatrist, the 7. Alcohol and/or Drug use history:
airman should FIRST establish a. Include any treatment or hospitalizations; and
with a HIMS-trained AME and b. The current status of drug or alcohol use (what used, how often, start/stop dates).
should refer to their letter to 8. Other concerns such as:
determine what level of a. Personality changes (argumentative, combative) or Loss of self-esteem or Isolation;
evaluation is required. b. Social family problems such as marital separation or divorce;
c. Irresponsibility or child/spousal abuse;
.
d. Legal problems such as alcohol-related traffic offenses or public intoxication, assault and battery, etc.;
e. Occupational problems such as absenteeism or tardiness at work; reduced productivity, demotions,
frequent job changes, or loss of job;
f. Economic problems such as frequent financial crises, bankruptcy, loss of home, or lack of credit; and
g. Interpersonal adverse effects such as separation from family, friends, associates, etc.
9. Any other items per the evaluator.
10. Results of any testing that was performed (SASSI, etc.).
11. Mental status examination results.
12. Summary of your findings. Include if you agree or disagree with previous diagnosis or findings from the records
you reviewed and why.
13. Any evidence of drug or alcohol abuse or dependence (if not mentioned above).
14. Summarize clinical findings and status of the airman.
When appropriate, provide specific information about the quality of recovery, including the period of total
abstinence.
15. List the DSM diagnosis, if any. (if none, that should be stated).
16. Specifically mention if any of the following regulatory components are present or not:
a. Increased tolerance;
b. Manifestation of withdrawal symptoms;
c. Impaired control of use;
d. Continued use despite damage to physical health or impairment of social, personal, or occupational
functioning;
e. Any evidence of any other personality disorder, neurosis, or mental health condition; and/or
f. Use of a substance in a situation in which that use was physically hazardous.
17. Give recommendations for any additional treatment or monitoring, if applicable.
18. Any additional concerns or comments.

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FAA CERTIFICATION AID - HIMS Drug and Alcohol - INITIAL (Page 3 of 5)

#5 For complete details, see the Neuropsychological Evaluation section of the

NEUROPSYCHOLOGIST
EVALUATION AND
Specifications for Psychiatric and Neuropsychological Evaluations for
RAW TEST DATA* Substance Dependence/Abuse.

*CogScreen-AE results The neuropsychologist report MUST address:

and 1. Qualifications: State your certifications and pertinent qualifications.
neurocognitive
evaluation
2. Records review: What documents were reviewed, if any?
a. Specify clinic notes and/or notes from other providers or
hospitals; and
b. Verify if you were provided with and reviewed a complete copy of
the airman’s FAA medical file.
3. Results of clinical interview: Detailed history regarding psychosocial or
developmental problems; academic and employment performance; family or
legal issues; substance use/abuse (including treatment and quality of
recovery); aviation background and experience; medical conditions and all
medication use; and behavioral observations during the interview and testing.
Include any other history pertinent to the context of the neuropsychological
testing and interpretation.
4. Mental status examination
5. Testing results:
a. CogScreen-Aeromedical Edition (CogScreen-AE); and
b. Remainder of the core test battery.
6. Interpretation:
a. The overall neurocognitive status of the airman;
b. Clinical diagnosis(es) suggested or established based on testing, if any;
c. Discuss any weaknesses or concerning deficiencies that
may potentially affect safe performance of pilot or aviation-
related duties, if any;
d. Discuss rationale and interpretation of any additional testing
that was performed; and include
e. Any other concerns.
7. Recommendations: Additional testing, follow-up testing, referral for
medical evaluation (e.g., neurology evaluation and/or imaging),
rehabilitation, etc.

Submit report along with the CogScreen-AE computerized summary report

(approximately 13 pages) and summary score sheet for ALL additional testing performed.

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FAA CERTIFICATION AID - HIMS Drug and Alcohol - INITIAL (Page 4 of 5)

#6 ADDITIONAL RECORDS

AFTERCARE REPORT Progress report should include:

(Group) 5. If the airman is continuing to participate in abstinence-based sobriety;
6. How often the airman attends (weekly or per Authorization Letter); and
7. Agreement to immediately notify the HIMS AME if there are any changes or deterioration in the airman’s
condition.

AIRLINE REPORTS Must attest, to the best of their knowledge, the airman’s continued total abstinence from drugs or alcohol.

Peer Pilot (from employer, Monthly reports must address:

ALPA, etc.) 1. The airman’s performance and competence;
Chief Pilot, Flight Operation 2. Crew interaction;
Supervisor, or Airline 3. Mood (if available); and
Management Designee* 4. Presence or absence of any other concerns.

* If the airman is 1st or 2nd class and Combine all monthly reports into ONE PDF if submitting via Huddle.
employed by an air carrier.

AIRMAN 1. Detailed typed personal statement from you that describes the offense(s):
PERSONAL a. What type of offense occurred;
STATEMENT DRUG AND b. What substance(s) were involved;
ALCOHOL c. State or locality or jurisdiction where the incident occurred;
(D&A) d. Date of the arrest, conviction and/or administrative action;
e. Description of circumstances surrounding the offense; and
f. Describe the above for each alcohol incident. If no other incidents, this should be stated.
2. Your past, present, and future plans for alcohol or drug use:
a. When did you start drinking? How much? How often?;
b. How much, how often were you drinking at the time of the incident(s);
c. How much, how often do you drink now? If abstinent, state date abstinence started;
d. Any negative consequences (legal complications or medical complications such as blackouts,
pancreatitis, or ER visits); and
e. Include any other alcohol or drug offenses (arrests, convictions, or administrative actions), even if
they were later reduced to a lower sentence.
3. Treatment programs you attended ever in your life (if none, this should be stated).
a. Dates of treatment;
b. Inpatient, outpatient, other; and
c. Name of treatment facility
7. Current recovery program (if any). If AA or another program, list name of program and frequency
attended.
If not in a recovery program, this should be stated.

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FAA CERTIFICATION AID - HIMS Drug and Alcohol - INITIAL (Page 5 of 5)

DRUG OR ALCOHOL 1. Must be random, unannounced drug/alcohol testing. (Urine EtG/EtS, PEth testing or a mobile alcohol
TESTING monitoring system are preferred.)
2. Must state if the testing is performed by:
 HIMS AME;
 Air Carrier testing program/office. Air Carrier must immediately notify the HIMS AME of any positive
test HIMS AME may require additional testing to supplement the testing conducted by the Air Carrier; or
 Other, such as return to duty testing from a substance abuse professional or a DOT/FAA Drug
Abatement Program.
3. Drug and/or alcohol testing results summarized, how often tested, how many tests performed to date.
a. Positive test results – submit the actual report.
b. Negative test results should be reported in the HIMS AME Report.

DUI RECORDS Court Records

1. Police/investigative report from dates of incident(s). It should describe the circumstances surrounding
the offense and any field sobriety tests that were performed;
2. Court records, if applicable; and
3. Military records if event(s) occurred while the applicant was a member of the U.S. armed forces. It should
include military court records, records of non-judicial punishment, and military substance abuse records.

Driving record/Department of Motor Vehicles (DMV) Records

4. List every state/principality/location and dates you have held a driver’s license in the past 10 years;
5. Submit a complete copy of your driving records from each of these for the past 10 years; and
6. Blood Alcohol Concentration (BAC) from any alcohol offense. It may be listed in a hospital report, a police
report or investigative report.
a. This will be either a breathalyzer test or a blood test.
b. Attach copies of any additional drug testing that performed.

MEDICAL RECORDS List any other medical records relevant to this case.

SI ADDITIONAL 1. Submit any reports required by a current Authorization for Special Issuance (SI); and/or
REPORTS 2. Any reports for a new condition that may require SI (or AME is instructed to defer).

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SPECIFICATIONS FOR PSYCHIATRIC AND

NEUROPSYCHOLOGICAL EVALUATIONS FOR
SUBSTANCE ABUSE/DEPENDENCE
(Updated 01/29/2020)

Why are both a psychiatric and a neuropsychological evaluation required? Substance

use disorders, including abuse and dependence, not in satisfactory recovery make an airman
unsafe to perform pilot duties. These evaluations are required to assess the disorder, quality of
recovery, and potential other psychiatric conditions or neurocognitive deficits. Due to the
differences in training and areas of expertise, separate evaluations and reports are required
from both a qualified psychiatrist and a qualified clinical psychologist for determining an
airman’s medical qualifications. This guideline outlines the requirements for these evaluations.

Will I need to provide any of my medical records? You should make records available to
both the psychiatrist and clinical neuropsychologist prior to their evaluations, to include:
 Copies of all records regarding prior psychiatric/substance-related hospitalizations,
observations or treatment not previously submitted to the FAA.
 A complete copy of your agency medical records. You should request a copy of your
agency records be sent directly to the psychiatrist and psychologist submitting a
Request for Airman Medical Records (FAA Form 8065-2).

THE PSYCHIATRIC EVALUATION

Who may perform a psychiatric evaluation? Psychiatric evaluations must be conducted by a

qualified psychiatrist who is board-certified by the American Board of Psychiatry and Neurology
or the American Board of Osteopathic Neurology and Psychiatry, and must either be board
certified in Addiction Psychiatry or have received training in the Human Intervention Motivation
Study (HIMS) program. Preference is given for those who have completed HIMS training.
Using a psychiatrist without this background may limit the usefulness of the report.

What must the psychiatric evaluation report include? At a minimum:

 A review of all available records, including academic records, records of prior psychiatric
hospitalizations, and records of periods of observation or treatment (e.g., psychiatrist,
psychologist, social worker, counselor, or neuropsychologist treatment notes). Records
must be in sufficient detail to permit a clear evaluation of the nature and extent of any
previous mental disorders.
 A thorough clinical interview to include a detailed history regarding: psychosocial or
developmental problems; academic and employment performance; legal issues;
substance use/abuse (including treatment and quality of recovery); aviation background
and experience; medical conditions, and all medication use; and behavioral observations
during the interview.
 A mental status examination.

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 An integrated summary of findings with an explicit diagnostic statement, and the
psychiatrist’s opinion(s) and recommendation(s) for treatment, medication, therapy,
counseling, rehabilitation, or monitoring should be explicitly stated. Opinions regarding
clinically or aeromedically significant findings and the potential impact on aviation safety
must be consistent with the Federal Aviation Regulations.

What must be submitted by the psychiatrist? The psychiatrist’s comprehensive and

detailed report, as noted above, plus copies of supporting documentation. Recommendations
should be strictly limited to the psychiatrist’s area of expertise. Psychiatrists with questions are
encouraged to call Charles Chesanow, D.O., FAA Chief Psychiatrist, at (202) 267-3767.

THE NEUROPSYCHOLOGICAL EVALUATION

Who may perform a neuropsychological evaluation? Neuropsychological evaluations must

be conducted by a neuropsychologist who is included on the provider list, accessed through the
following link: FAA Neuropsychologist List.

What must the neuropsychological evaluation report include? At a minimum:

 A review of all available records, including academic records, records of prior psychiatric
hospitalizations, and records of periods of observation or treatment (e.g., psychiatrist,
psychologist, or pediatric neuropsychiatrist treatment notes). Records must be in
sufficient detail to permit a clear evaluation of the nature and extent of any previous
mental disorders.
 A thorough clinical interview to include a detailed history regarding: psychosocial or
developmental problems; academic and employment performance; legal issues;
substance use/abuse (including treatment and quality of recovery); aviation background
and experience; medical conditions, and all medication use; and behavioral observations
during the interview and testing.
 A mental status examination.
 Interpretation of a full battery of neuropsychological and psychological tests including
but not limited to the “core test battery” (specified below).
 An integrated summary of findings with an explicit diagnostic statement, and the
neuropsychologist’s opinion(s) and recommendation(s) regarding clinically or
aeromedically significant findings and the potential impact on aviation safety consistent
with the Federal Aviation Regulations.

What is required in the “core test battery?”

To promote test security, itemized lists of tests comprising psychological/neuropsychological
test batteries have been moved to a secure site. Authorized professionals should use the portal
at FAA Neuropsychology Testing Specifications. For access, email a request to:
[email protected].

What must be submitted?

The neuropsychologist’s report as specified in the portal, plus:
 Copies of all computer score reports; and

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 An appended score summary sheet that includes all scores for all tests administered.
When available, pilot norms must be used. If pilot norms are not available for a
particular test, then the normative comparison group (e.g., general population,
age/education-corrected) must be specified. Also, when available, percentile scores
must be included.

Recommendations should be strictly limited to the psychologist’s area of expertise. For

questions about testing or requirements, email [email protected].

What else does the psychologist need to know?

 The FAA will not proceed with a review of the test findings without the above data.
 The data and clinical findings will be carefully safeguarded in accordance with the APA
Ethical Principles of Psychologists and Code of Conduct (2002) as well as applicable
federal law.
 Raw psychological testing data may be required at a future date for expert review by one
of the FAA’s consulting clinical psychologists. In that event, authorization for release of
the data by the airman to the expert reviewer will need to be provided.

Additional Helpful Information

1. Will additional evaluations or testing be required in the future? If eligible for unrestricted
medical certification, no additional evaluations would be required. However, pilots found
eligible for Special Issuance will be required to undergo periodic re-evaluations. The letter
authorizing special issuance will outline the specific evaluations or testing required.
2. Useful references for the psychologist:
 MOST COMPREHENSIVE SINGLE REFERENCE:
Aeromedical Psychology (2013). C.H. Kennedy & G.G. Kay (Editors). Ashgate.
 Pilot norms on neurocognitive tests: Kay, G.G. (2002). Guidelines for the Psychological
Evaluation of Aircrew Personnel. Occupational Medicine, 17 (2), 227-245.
 Aviation-related psychological evaluations: Jones, D. R. (2008). Aerospace Psychiatry.
In J. R. Davis, R. Johnson, J. Stepanek & J. A. Fogarty (Eds.), Fundamentals of
Aerospace Medicine (4th Ed.), (pp. 406-424). Philadelphia: Lippencott Williams &
Wilkins.

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DRUG AND ALCOHOL MONITORING AND HIMS

RECERTIFICATION REQUIREMENTS
HIMS AMES should use the following section once the airman has a valid Special Issuance
Authorization for a Drug or Alcohol condition.

In response to NTSB Safety Recommendation A-07-43, the FAA has extended follow up for
airmen with a diagnosis of substance dependence on a HIMS Step Down Plan.

HIMS AMES should use the following pages to guide them in recommending testing frequency
and general milestones.

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HIMS AME INFORMATION – HIMS STEP DOWN PLAN (Updated 09/29/2021)

Note that the time course listed is nominal and indicates usual, uncomplicated progression of
recovery but may be modified on a case-by-case basis.
 Not all airmen will progress at the same rate.
 Progression is NOT guaranteed.
 An airman’s progression is based on compliance, his or her individual evaluation by
HIMS professionals, and FAA review.
Permanent abstinence from mind and mood altering substances is required for the duration of
the flying career.
The testing frequencies listed are minimums and may be increased at the discretion of the
HIMS AME. AMEs should recommend a change in testing/evaluations when clinically
appropriate and after the minimum time has passed in each stage.

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AIRMAN INFORMATION – HIMS STEP DOWN (Updated 01-27-2021)

IF YOU ARE AN AIRMAN:

(a) Continue to work with your sponsor/physician/therapist/support group and get/stay
healthy.
(b) Do not fly in accordance with 14 CFR 61.53 if you relapse.
(c) Permanent abstinence from mind and mood altering substances is required for the
duration of the flying career.
(d) Work with your HIMS AME to obtain any necessary evaluations and
documentation.
(e) When submitting information: Coordinate with your AME to ensure ALL ITEMS are
COMPLETE. Incomplete packages will cause a DELAY IN CERTIFICATION.
When you have passed the required minimum time AND your HIMS AME recommends
you are ready to have a decrease in monitoring requirements, they will submit a report
verifying this information. The FAA makes the determination if you meet requirements to
reduce monitoring requirements.
• Examples of MINIMUM required items and testing are listed in the HIMS Step Down
Plan illustration.
• You may require additional monitoring or testing based on your recovery.

• You may need to repeat a phase based on your recovery.

• Your HIMS AME is NOT Authorized to make changes.

If and when appropriate, you will receive an updated Special Issuance letter with updated
Special Issuance requirements.

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AME Checklist - Drug and Alcohol Monitoring Recertification

(Updated 08/30/2017)

Airman Name ______________________________ PI#____________________________

Instructions to the HIMS AME:

 Address the following items based on your in-office exam and documentation review;
 Submit this Checklist (it must be signed and dated by the HIMS AME); AND
 Include supporting documentation reviewed to complete this checklist (including your HIMS AME report) within 14
days to: Federal Aviation Administration, Civil Aerospace Medical Institute, Bldg. 13
Aerospace Medical Certification Division, AAM-313
PO Box 25082, Oklahoma City, OK 73125-9867

I reviewed the airman’s HIMS Authorization Letter dated: (Date of Authorization letter)

1. HIMS AME FACE-TO-FACE, IN OFFICE EVALUATION: Required EVERY 6 months for ALL CLASSES
Any concerns that the airman is not successfully engaged in a continued abstinence-based recovery program No Yes
or is not working a good program based on your clinical interview/evaluation and review of reports?...........…..
Interval evaluations (every 3 months or as required by Authorization Letter) were unfavorable? ………………..
 Any evidence or concern the airman has not remained abstinent?……………………………………..
 Any positive drug or alcohol tests since last HIMS evaluation? …………………………………………
 Any evidence of noncompliance or concern the airman is not working a good recovery program?...
 Any NEW condition(s) that would require Special Issuance? (Do not include any new CACI
qualified condition.).…………………………………………………………………………………….……..

2. TREATING PSYCHIATRIST REPORT or HIMS PSYCHIATRIST REPORT: Required EVERY 12 months

for ALL CLASSES unless a different time interval is specifically stated in the Authorization Letter. Not Yes No
Due
 Report(s) is/are favorable (no anticipated or interim treatment changes) ...………………........
 The psychiatrist recommends no additional treatment or monitoring.……................................

Items 3 - 5: The AME should review. Do not submit these items (3-5) to the FAA unless concerns are noted.
3. AFTERCARE COUNSELOR REPORTS: For 1st and 2nd class: Required every 3 months; 3rd class: Per
Authorization Letter. N/A Yes No
 Show continued participation and abstinence-based sobriety? ……………………………......

4. CHIEF PILOT REPORT(S): Required monthly for commercial pilots holding first- or second-class
certificates (N/A for third-class): N/A Yes No
 Report(s) is/are favorable? ………………………………………………………………………......

5. PEER PILOT REPORTS: Required monthly for commercial pilots holding first- or second-class certificates
(N/A for third-class): N/A Yes No
 Report(s) is/are favorable with continued total abstinence? ……………………………………..

6. ADDITIONAL REPORTS: Required ONLY when specified by the Authorization letter

N/A Yes No
 HIMS related (AA attendance, therapy reports, etc.) are favorable and meet authorization
requirements…………………………………………………………………………………………....
 Reports required for other non-HIMS conditions all meet Authorization requirements…….......

Yes No
7. I have no other concerns about this airman and recommend re-certification for Special Issuance. ……………….

______________________________________________ ________________________________
HIMS AME Signature Date of Evaluation

If ALL items fall into the clear column, the AME may issue with the time limitation specified in the Authorization letter.
If ANY SINGLE ITEM falls into the SHADED COLUMN, the AME MUST DEFER or contact the FAA for guidance AND
EXPLAIN in the HIMS evaluation report.

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FAA CERTIFICATION AID – Drug and Alcohol Monitoring Recertification (Page 1 of 2)

(Updated 05/25/2016)

The following information is to assist your treating physician/provider who may be unfamiliar with FAA medical
certification requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a
determination on an airman medical certificate. You should strongly consider taking a copy to each evaluator so
they understand what specific information is needed in their report to the FAA. If each item is not addressed
by the corresponding provider there may be a delay in the processing of your medical certification until that
information is submitted. Additional information such as clinic notes or explanations should also be submitted as
needed. All reports must be CURRENT (within the last 90 days) for FAA purposes.

REPORT REQUIRED INTERVAL MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING

FROM (Drug and Alcohol Monitoring Recertification)

HIMS AME Every 6 months or per 1. Must be a face-to-face, in-person evaluation.

Authorization Letter for all 2. Must be performed by the HIMS AME listed on the Authorization Letter.
classes 3. Summarize findings from additional interim evaluations that were performed by any other venue
(phone/video/email), either at the AME’s discretion or as required by the Authorization Letter (every 1-3
months).
4. Summarize your aeromedical impression and evaluation as a HIMS AME based on the face-to-face
evaluation AND review of the supporting documents.
a. Any evidence (such as a positive test) or concern the airman has not remained abstinent?
b. Any evidence or concern the airman has not been compliant with the recovery program?
c. If you do not agree with the supporting documents or if you have additional concerns not
noted in the documentation, please discuss your observations or concerns.
5. State if the airman meets all the requirements of the Authorization Letter or describe why they do not.
6. Do you recommend continued Special Issuance in this airman?
7. Agreement to continue to serve as the airman’s HIMS AME and follow this airman per FAA policy.
8. Agreement to immediately notify the FAA (at 405-954-4821) of any change in condition, deterioration or
stability, or if there is any positive drug or alcohol testing.
9. Using the HIMS AME Checklist - Drug and Alcohol Monitoring Recertification, comment on any items that fall
into the shaded category on the Checklist.
10. Submit the HIMS AME Checklist, your HIMS AME written report, and all required supporting documentation
that you reviewed with your package.

DRUG OR Every 6 months or per 1. Must be random, unannounced drug/alcohol testing. (Urine EtG/EtS, PEth testing or a mobile alcohol
ALCOHOL Authorization Letter monitoring system are preferred.)
TESTING 2. At a minimum, frequency must be 14 tests over a 12-month period (can be more frequent at AME
discretion).
3. Must state if the testing is performed by:
 HIMS AME
 Air Carrier testing program/office. Air Carrier must immediately notify the HIMS AME of any
positive test
HIMS AME may require additional testing to supplement the testing conducted by the Air
Carrier.
 Other, such as return to duty testing from a substance abuse professional or a DOT/FAA drug
abatement program.
4. HIMS AME must immediately report any positive test to the FAA.

PSYCHIATRIST Every 12 months or per 1. Summarize clinical findings and status of how the airman is doing.
HISTORY Authorization Letter 2. Note any clinical concerns or changes in treatment plan.
REPORT 3. Recommendations for any additional treatment or monitoring, if applicable.
4. Agreement to immediately notify the FAA or AME (at 405-954-4821) if there are any changes in the
airman’s condition.
5. Interval treatment records if any, such as clinic or hospital notes, should also be submitted.

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FAA CERTIFICATION AID – Drug and Alcohol Monitoring Recertification (Page 2 of 2)

(Updated 05/25/2016)

The following information is to assist your treating physician/provider who may be unfamiliar with FAA medical
certification requirements. It lists the ABSOLUTE MINIMUM information required by the FAA to make a
determination on an airman medical certificate. You should strongly consider taking a copy to each evaluator so
they understand what specific information is needed in their report to the FAA. If each item is not addressed
by the corresponding provider there may be a delay in the processing of your medical certification until that
information is submitted. Additional information such as clinic notes or explanations should also be submitted as
needed. All reports must be CURRENT (within the last 90 days) for FAA purposes.

REPORT FROM REQUIRED MUST SPECIFICALLY ADDRESS OR STATE THE FOLLOWING

INTERVAL (Drug and Alcohol Monitoring Recertification)
Pro
GROUP 1st and 2nd class: EveryPro Progress report should include:
AFTERCARE 3 months or per 1. If the airman is continuing to participate in abstinence-based sobriety.
COUNSELOR Authorization Letter 2. How often the airman attends (weekly or per Authorization Letter).
3. Agreement to immediately notify the HIMS AME if there are any changes or deterioration in the airman’s
3rd class: As required condition.
per Authorization Letter

CHIEF PILOT, 1st and 2nd class: Every Monthly reports must address:
FLIGHT month (bring cumulative d. The airman’s performance and competence.
OPERATION reports to HIMS AME e. Crew interaction.
evaluation every 6 f. Mood (if available).
SUPERVISOR,
months.) g. Presence or absence of any other concerns.
OR AIRLINE
MANAGEMENT 3rd class: Not applicable
DESIGNEE

If the airman is
1st or 2nd class
and employed
by an air carrier

PEER PILOT 1st and 2nd class: Every Must attest to the best of their knowledge, the airman’s continued total abstinence from drugs or alcohol.
month (bring cumulative
(Ex: from reports to HIMS AME
evaluation every 6
employer, ALPA, months.)
etc.)
3rd class: Not applicable

ADDITIONAL Every 6 months or per Varies. See the airman’s Authorization Letter. Include any applicable psychotherapy notes, therapist follow up
PROVIDERS Authorization Letter reports, social worker reports, AA sponsor contact, etc.

If the airman has other non-SSRI conditions that require a special issuance, those reports should also be
Additional submitted according to the Authorization Letter.
reports for HIMS
or any other
condition noted
in Authorization
Letter

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Drug/Alcohol Monitoring Programs and HIMS FAQS (Updated 09/27/2017)

1. What is a HIMS AME or HIMS-Trained AME?

 An AME who has successfully completed and passed additional training in evaluating
airmen for substance- or alcohol-related conditions or other conditions (such as the
SSRI program).

 HIMS AMEs can provide sponsorship and monitoring when required by the FAA for
medical certification purposes. A HIMS AME can sponsor:
o Airmen in an industry HIMS program; and
o Airmen who do not work for an HIMS industry airline but are in an FAA-
monitoring program.

2. Where do I find a HIMS AME?

You can find an HIMS AME using the FAA AME Locator.

3. What is a HIMS psychiatrist?

A psychiatrist who has successfully completed additional training in evaluating airmen for
substance- or alcohol-related conditions or other conditions (such as the SSRI program).

4. How do I find a HIMS psychiatrist?

Consult with a HIMS AME.

5. Is the HIMS program the same as a HIMS AME?

No. The HIMS program in an industry program. The airmen in this program are followed
for FAA purposes by a HIMS AME. For more information, see the HIMS program Website.

6. Do all commercial pilots use the HIMS program?

No. The HIMS program is not used by all airlines. The list of current carriers with a HIMS
program can be found on the HIMS program Website.

7. What if the airman flies recreationally or for an airline that does not have a HIMS
program but they require monitoring for their FAA medical certificate?

Airmen who do not work for a carrier with a HIMS program can still be monitored by a HIMS-
trained AME to fulfill the requirements of their medical certificate as outlined by the FAA.

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SYNOPSIS OF MEDICAL STANDARDS

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SYNOPSIS OF MEDICAL STANDARDS (Updated 03/31/2021)

Medical
Certificate First-Class Second-Class Third-Class
Pilot Type Airline Transport Pilot Commercial Pilot Private Pilot

20/40 or better in each

20/20 or better in each eye separately, with or
DISTANT VISION eye separately, with or
without correction.
without correction.
20/40 or better in each eye separately (Snellen equivalent), with or
NEAR VISION
without correction, as measured at 16 inches.
20/40 or better in each eye separately (Snellen
INTERMEDIATE
equivalent), with or without correction at age 50 No requirement.
VISION
and over, as measured at 32 inches.
Ability to perceive those colors necessary for safe performance of airman
COLOR VISION
duties.
Demonstrate hearing of an average conversational voice in a quiet room,
HEARING using both ears at 6 feet, with the back turned to the AME OR pass one of
the audiometric tests below.
Audiometric speech discrimination test: Score at least 70% reception in
AUDIOLOGY one ear at an intensity of no greater than 65 dB. Pure tone audiometric
test. Unaided, with thresholds no worse than:

500 Hz 1,000 Hz 2,000 Hz 3,000 Hz

Better Ear 35 Db 30 dB 30 dB 40 dB
Worst Ear 35 dB 50 dB 50 dB 60 dB

No ear disease or condition manifested by, or that may reasonably be expected to

ENT
maintained by, vertigo or a disturbance of speech or equilibrium.
PULSE Not disqualifying per se. Used to determine cardiac system status and responsiveness.
No specified values stated in the standards. The current guideline maximum value is
BLOOD PRESSURE
155/95.
ELECTRO- At age 35 and
Not routinely required.
CARDIOGRAM (ECG) annually after age 40
MENTAL No diagnosis of psychosis, or bipolar disorder, or severe personality disorders.
A diagnosis or medical history of "substance dependence" is disqualifying unless there is
established clinical evidence, satisfactory to the Federal Air Surgeon, of recovery,
SUBSTANCE including sustained total abstinence from the substance(s) for not less than the preceding
DEPENDENCE AND 2 years. A history of "substance abuse" within the preceding 2 years is disqualifying.
SUBSTANCE ABUSE "Substance" includes alcohol and other drugs (i.e., PCP, sedatives and hypnotics,
anxiolytics, marijuana, cocaine, opioids, amphetamines, hallucinogens, and other
psychoactive drugs or chemicals).
Unless otherwise directed by the FAA, the AME must deny or defer if the applicant has a
history of: (1) Diabetes mellitus requiring hypoglycemic medication; (2) Angina pectoris;
(3) Coronary heart disease (CHD) that has been treated or, if untreated, that has been
symptomatic or clinically significant; (4) Myocardial infarction; (5) Cardiac valve
DISQUALIFYING replacement; (6) Permanent cardiac pacemaker; (7) Heart replacement; (8) Psychosis;
CONDITIONS (9) Bipolar disorder; (10) Personality disorder that is severe enough to have repeatedly
manifested itself by overt acts; (11) Substance dependence; (12) Substance abuse; (13)
Epilepsy; (14) Disturbance of consciousness and without satisfactory explanation of
cause, and (15) Transient loss of control of nervous system function(s) without
satisfactory explanation of cause.

NOTE: For further information, contact your Regional Flight Surgeon.

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STUDENT PILOT RULE CHANGE

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Student Pilot Rule Change

(Updated 09/28/2016)

As of April 1, 2016, AMEs are no longer able to issue the combined FAA Medical Certificate and
Student Pilot Certificate. Student Pilots must have a separate Student Pilot Certificate and a
separate FAA Medical Certificate.

This change is due to a new Final Rule published on 01/12/16 [81 FR 1292]. It is in response to
section 4012 of the Intelligence Reform and Terrorism Prevention Act and facilitates security vetting by
the Transportation Security Administration (TSA) of student pilot applicants prior to certificate
issuance.

The airman, student pilot airman, and non-FAA Air Traffic Control Specialist will continue to require a
medical exam issued by an AME.

The student pilot will need a valid medical certificate prior to solo flight.

What has changed for the AME regarding the MEDICAL CERTIFICATE?

 Medical Flight Test:

If the AME determines a MFT is needed (such as for a vision defect, amputation or orthopedic
condition), the AME must DEFER the exam.

 Age Requirement:
There is no age requirement for a medical certificate. The exam should be timed so that the
medical certificate is valid at the time of solo flight.

 Restrictions are no longer used by the AME:

“Valid for flight test only”; “Valid for student pilot purposes only”; “Not valid until (date of 16 th
birthday).”

 English Proficiency:
There is no language requirement for medical certification.

 Transmittal time:
The AME has 14 days to transmit exams. The previous requirement to transmit student
exams within 7 days no longer applies.

Helpful Resources regarding the Student Pilot Certificate:

The student pilot certificate will now be issued by a Flight Standards District Office (FSDO), an FAA-
designated pilot examiner, an airman certification representative associated with a part 141 flight
school, or a certificated flight instructor (CFI).

The minimum age for the student pilot certificate is 16.

 See FAQs for AMEs. A description of the changes can be found in the Advisory Circular/AC 61-65F.
 Resident and US citizen student pilots follow Student Pilot’s Certificate Requirements.
 Foreign student pilots (non-resident) follow the Alien Flight Student Program.

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GLOSSARY

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GLOSSARY/ACRONYMS
(Updated 02/24/2021)

AAM - Office of Aerospace Medicine

AASI - AME Assisted Special Issuance - Criteria under which an AME may reissue a medical
certificate for a third-class applicant with a medical history of a disqualifying condition, who has
already received a Special Issuance Authorization from the FAA, and criteria to defer issuance
to AMCD or RFS for these situations.

AMCD - Aerospace Medical Certification Division - located at the Civil Aerospace Medical
Institute in Oklahoma City, Oklahoma

AMCS - Airman Medical Certification System - allows the AME to electronically submit FAA
Form 8500-8, Application for Airman Medical Certificate to AMCD.

AME - Aviation Medical Examiner - a physician designated by the FAA and given the
authority to perform airman physical examinations for issuance of second- and third-
class medical certificates. (NOTE: Senior AMEs perform first-class airman
examinations).

ATCS - Air Traffic Control Specialist

AV - Atrioventricular

BUN - Blood Urea Nitrogen Test

CACI - Condition AME Can Issue

CAD - Coronary Artery Disease

CAMI - Civil Aerospace Medical Institute

CAT - Computerized Axial Tomography Scan

CBC - Complete Blood Count

CEA - Carcinoembryonic Antigen

CFR - Code of Federal Regulations

CHD - Coronary Heart Disease

CT - Computed Tomography Scan

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CVE - Cardiovascular Evaluation

DOT - Department of Transportation

DUI/DWI - Driving Under the Influence/Driving While Intoxicated

ECG - Electrocardiogram

ECHO - Echocardiographic images

ENT - Ear, Nose, and Throat

FAA - Federal Aviation Administration

FAR - Federal Aviation Regulations

FAS – Federal Air Surgeon

FSDO - Flight Standards District Office

GXT - Graded Exercise Test

HgbA1C - Hemoglobin A1C

INR- International Normalized Ratio

IVP - Intravenous Pyelography Test

KUB - Kidneys, Ureters and Bladder

MFO - Medical Field Office

MFT - Medical Flight Test

MRI - Magnetic Resonance Imaging

MVP - Mitral Valve Prolapse

NTSB - National Transportation Safety Board

OSA - Obstructive Sleep Apnea

PAC - Premature Atrial Contraction

PET - Positron Emission Tomography

PFT - Pulmonary Function Test

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PSA - Prostate Specific Antigen

PT - Prothrombin Time

PTT - Partial Thromboplastin Time

PVC - Premature Ventricular Contraction

RF - Radio Frequency Ablation

RFS - Regional Flight Surgeon

SI - Special Issuance

SODA - Statement of Demonstrated Ability

TFT -Thyroid Function Test

US -Ultrasound

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ARCHIVES AND UPDATES

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Guide Official Revision Description Reason For Update

Version Date Number Of Change
2022 04/27/2022 1. Medical Policy In Pharmaceuticals, added
COVID-19 Medication page.
2. Medical Policy In Item 48. General Systemic,
updated COVID-19 Infections
Disposition Table to include links
to COVID-19 Medications
guidance.
3. Medical Policy In Pharmaceuticals, renamed
Glaucoma Medications to
Glaucoma and Ocular
Hypertension Medications.
Revised to include chart of CACI
acceptable, conditionally
acceptable, and unacceptable
glaucoma medications.
4. Medical Policy In Pharmaceuticals, added new
Eye Medication page.
5. Medical Policy In Item 38. Abdomen, Viscera,
and Anus Conditions, added
disposition table for Barrett’s
Esophagus.
6. Medical Policy In Item 36. Heart, added
disposition table for Premature
Atrial Contraction.
7. Medical Policy Item 62. Has Been Issued,
deferral instructions clarified and
visual reference updated.
8. Medical Policy Pharmaceuticals section revised
to include links to guidance on
Do No Issue/Do Not Fly and
Over-the-counter (OTC)
Medications.
9. Medical Policy Revised all CACI condition
worksheets to remove usage of
“current status report” term.
10. Administrative New shortcut URLS added for
HIMS:
https://www.faa.gov/go/hims and
for Medications:
https://www.faa.gov/go/meds.
11. Administrative Letter of Denial Issued by AME
revised to add “AME Name” and
“Date Signed” lines.
12. Administrative In PDF version of the Guide, title
of Items 25-48 revised to include
disposition tables: “AME Physical
Examination Information and
Disposition Tables.”

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13. Administrative In Specifications for

Neuropsychological Evaluations
for Potential
Neurocognitive Impairment (in
PDF version of the AME Guide
only), added actual URL
addresses for Web links
contained in the document.
2022 04/13/2022 1. Administrative Revised all CACI condition
worksheets to add “current,
detailed Clinical Progress Note”
language and link to introductory
paragraph.
2022 03/30/2022 1. Medical Policy In Item 25-30. Nose, and Throat,
revised to remove anosmia note.
Added link to the Anosmia
Disposition Table.
2. Medical Policy In Item 52. Color Vision, revised
to add Farnsworth D-15 as
UNACCEPTABLE.
3. Medical Policy In Pharmaceuticals, Cholesterol
Medication, expanded chart to
add additional acceptable
medications: iovastatin
(Altoprev), rosuvastatin (Crestor),
gemfibrozil (Lopid),
cholestyramine (Prevalite;
Questran), colesevelam
(Welchol), and niacin (Niaspan.
4. Medical Policy In General Information, added
Item #23. Pilot Information –
Detailed Current Clinical
Progress Note. Item explains
what must be included in the
current detailed Clinical Progress
Note. The information was also
added under the Resources
section in the Web version of the
AME Guide.
5. Medical Policy In Disease Protocols, Diabetes
Mellitus Type I or Type II –
Insulin Treated - CGM Option,
removed requirement to send
finger stick blood glucose data.
Deleted “Blood Glucose
Monitoring Sheet” and “Finger
Stick Blood Glucose Information”
worksheets.
6. Medical Policy In Disease Protocols, Diabetes
Mellitus Type I or Type II –

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Insulin Treated - CGM Option,

Initial Certification –
Airman Information, added
requirement that CGM data be
sent in 30-day increments.
Changed and expanded ranges
to report.
7. Medical Policy In Disease Protocols, Diabetes
Mellitus Type I or Type II –
Insulin Treated - CGM Option,
Initial Certification Consideration
Requirements, revised to remove
requirement for FSBS data;
remove optional information for
flight hours; add monthly
reporting requirement; expand
CGM levels to report; and add
chart of target range values.
8. Medical Policy In Disease Protocols, Diabetes
Mellitus Type I or Type II –
Insulin Treated - CGM Option,
Renewal Certificate
Requirements, revised to clarify
what information is required
within each timeframe.
9. Medical Policy In Disease Protocols, Diabetes
Mellitus Type I or Type II –
Insulin Treated - CGM Option,
Insulin Treated Diabetes
Information Submission
Requirements, revised to clarify
what is due when; removed
FSBS readings and flight time;
and changed A1C to annual
reporting.
10. Medical Policy In Disease Protocols, Diabetes
Mellitus Type I or Type II –
Insulin Treated - CGM Option,
Overlay Report and Alert
Sample, revised to add samples
from CGM devices that currently
meet FAA requirements.
11. Medical Policy In Disease Protocols, Diabetes
Mellitus Type I or Type II –
Insulin Treated - CGM Option,
Frequently Asked Questions
(FAQs), revised #9 to indicate
that while the FAA does not
recommend specific brands of
CGM devices, a section was

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added to include devices that

currently meet FAA
requirements.
12. Administrative Added shortcut link for Bundle
Branch Block (BBB) at
https://www.faa.gov/go/bbb
2022 02/23/2022 1. Medical Policy In Item 26. Nose, added new
Anosmia Disposition Table.
2. Medical Policy In Item 48. General Systemic,
Covid-19 Infections Disposition
Table, added information on
Anosmia.
3. Medical Policy In Pharmaceuticals, added new
section for Cholesterol
Medications.
4. Medical Policy Revised all CACI Worksheets to
add that a detailed Clinical
Progress Note (within 90 days of
the exam) is required from the
treating physician.
5. Medical Policy In Item 36. Heart, Mitral Valve
Repair Disposition Table, added
note for pilots: “Take the CACI
worksheet to your cardiologist so
they can fully address the FAA
requirements.”
6. Medical Policy Revised CACI – Mitral Valve
Repair Worksheet to clarify and
add “Aortic
regurgitation/insufficiency (any
severity)” as disqualifying criteria.
7. Medical Policy In Item 35. Lungs and Chest,
Chronic Obstructive Pulmonary
Disease, revised evaluation data
to state detailed Clinical Progress
Note and FEV1, FVC, and
FEV1/FVC are required.
8. Medical Policy In Item 46. Neurologic,
Cerebrovascular Disease,
revised note at end of page
which previously referenced
benign supratentorial tumors.
9. Administrative In Disease Protocols, Protocol for
Attention Deficit Disorder/
Hyperactivity Disorder, updated
FAA HIMS Neuropsychologist
List.
2022 01/01/2022 1. Administrative Changed coversheet to 2022 and
added monthly update schedule
for the calendar year.

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2021 11/24/2021 1. Medical Policy Revised all CACI Worksheets to

add an option to indicate if the
airman “Has current OR previous
SI/AASI but now CACI qualified.”
2. Administrative On the home page of both the
PDF and HTML versions of the
AME Guide, added an “AME
Alert” box for important
notifications.
2021 10/25/2021 1. Medical Policy In CACI – Arthritis Worksheet,
revised to change no-fly time for
adalimumab (Humira) from 24
hours to 4 hours.
2. Medical Policy In Item 48. General Systemic,
Primary Hemochromatosis
Disposition Table, revised to add
myeloproliferative disorders as a
co-morbid condition.
3. Medical Policy In Item 48. General Systemic,
CACI – Primary
Hemochromatosis Worksheet,
revised to add myeloproliferative
disorders as a co-morbid
condition.
4. Medical Policy In Item 48. General Systemic,
COVID-19 Disposition Table,
revised to add cognitive
symptoms to “ongoing residual
signs and symptoms.” Also
added neuropsychology to the
examples of “specialty
consultations performed.”
5. Medical Policy In Item 52. Color Vision, added
instructive note: “If the airman
fails acceptable color vision tests,
then obtains an LOE or SODA -
check fail and add airman has
LOE.
If they pass any acceptable color
vision test- mark pass.”
6. Administrative To improve ability to search in
PDF Guide document, changed
title of AASI for Colon Cancer to
AASI for Colon Cancer/
Colorectal Cancer. Title change
also made on Colon Cancer
Disposition Table and CACI
worksheet.

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7. Administrative In AASI for Thrombocytopenia,

revised to add “or” to list of defer
criteria.
2021 10/14/2021 1. Medical Policy In Item 47. Psychiatric, added
new Post-Traumatic Stress
Disorder (PTSD) Disposition
Table.
2. Medical Policy In Item 47. Psychiatric, added
new Post-Traumatic Stress
Disorder (PTSD) Decision Tool
for the AME.
2021 09/29/2021 1. Medical Policy In Protocols, Obstructive Sleep
Apnea, added OSA Status
Summary – Initial.
2. Medical Policy In Protocols, Obstructive Sleep
Apnea, added OSA Status
Summary – Recertification.
3. Medical Policy In Protocols, Obstructive Sleep
Apnea, added guidance for OSA
Treated with PAP and Use of
Two Machines (or more).
4. Medical Policy In Pharmaceuticals, revised
Hydroxychloroquine (HCQ)/
Chloroquine (CQ) Status Report
to clarify groups and to add “color
vision loss” to question #8 on the
report.
5. Medical Policy In AASI, revised title of Deep
Venous Thrombosis, Pulmonary
Embolism, and/or
Hypercoagulopathies to “Venous
Thromboembolism (VTE) – Deep
Venous Thrombosis (DVT),
Pulmonary Embolism (PE),
and/or Hypercoagulopathies.”
Change was also made on AASI
main listings and on AASI
Coversheet.
6. Medical Policy In HIMS AME Information –
HIMS Step Down Plan, revised
chart to show parameter of
Maintenance Phase-4 is “Year
8+.”
7. Medical Policy In Pharmaceuticals, Vaccines,
added tradename Comirnaty to
FDA-approved Pfizer-BioNTech
COVID-19 vaccine.
8. Administrative In General Information, added
AMCS Technical Support
information for help with

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transmitting exams, resetting

passwords, etc. Also includes
link to AMCS Access Form.
9. Administrative In Item 36. Heart, Arrhythmias,
added link for Implanted
Pacemaker Disposition Table.
10. Medical Policy In Item 47. Psychiatric Conditions
Disposition Table, added a
placeholder for Post-Traumatic
Stress Disorder. Policy due to be
finalized and posted mid-October
2021.
2021 08/25/2021 1. Medical Policy In Item 48. General Systemic,
added Primary Hemochromatosis
Disposition Table.
2. Medical Policy In Item 48. General Systemic,
added CACI – Primary
Hemochromatosis Worksheet.
3. Medical Policy In Protocols, added 6-Minute
Walk Test (6MWT) – FAA
Results Sheet.
4. Medical Policy In Item 48. General Systemic,
added link to 6MWT in COVID-19
Disposition Table.
5. Medical Policy In Item 35. Lungs and Chest,
added link to 6MWT in Chronic
Obstructive Pulmonary Disease
(COPD) Disposition Table.
6. Medical Policy In Disease Protocols, added
Specifications for Neurologic
Evaluation.
7. Medical Policy In Disease Protocols, revised
Protocol for Implanted
Pacemaker. (Evaluation of
Pacemaker Dependency is no longer
required for any class.)
8. Medical Policy In Disease Protocols, revised
Pacemaker Status Summary
sheet.
9. Medical Policy In Item 36. Heart, added
Pacemaker Disposition Table.
10. Medical Policy In Pharmaceuticals, Therapeutic
Medications, added
Hydroxychloroquine (HCQ)/
Chloroquine (CQ) Status Report
[Plaquenil/Aralen].
11. Medical Policy Revised Arthritis – CACI
Worksheet to include links to
Hydroxychloroquine (HCQ)/

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Chloroquine (CQ) Status Report

[Plaquenil/Aralen].
12. Medical Policy In Special Issuances, AASI for
All Classes, changed Cardiac
– Single Valve Replacement
to “Cardiac – Single Valve
Replacement or Repair.”
13. Medical Policy On Special Issuance Coversheet,
changed Cardiac – Single
Valve Replacement to
“Cardiac – Single Valve
Replacement or Repair.”
14. Medical Policy In Protocols Graded Exercise
Stress Test Requirements,
revised note to state “Single
Valve Replacement or Repair.”
15. Administrative Revised shading in blocks for
HIMS AME Checklist – SSRI
Initial Certification-Clearance.
16. Administrative Changed mailing address (from
Washington DC to Oklahoma
City) on Airman Information –
SSRI Initial Certification sheet
and HIMS AME Checklist – SSRI
Initial Certification-Clearance.
2021 07/28/2021 1. Medical Policy In Pharmaceuticals, Allergy –
Antihistamines & Immunotherapy
Medications, revised to include
prohibition of antihistamine eye
drops immediately before or
during flight or safety-related
duties. Also added list of
acceptable Second Generation
Histamine-H1 receptor
antagonist eye drops.
2. Medical Policy In Pharmaceuticals, Therapeutic
Medications, revised Vaccines
page. No post-dose observation
time is required for Bacillus
Calmette-Guérin [intradermal]
(BCG) vaccine.
3. Medical Policy In Item 38. Abdomen and Viscera
and Anus Conditions, revised
CACI - Colitis Worksheet, to add
additional acceptable
medications and applicable no-fly
times.
4. Medical Policy In Item 35. Lungs and Chest,
revised CACI – Asthma

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Worksheet to add that

Monoclonal antibodies are NOT
acceptable for CACI.
5. Medical Policy In Item 43. Spine and Other
Musculoskeletal, revised CACI -
Arthritis Worksheet to identify
additional acceptable
medications (biologics) and
applicable no- fly times. No labs
needed for NSAIDS or steroids
only.
6. Medical Policy In Item 43. Spine and Other
Musculoskeletal, revised Arthritis
Disposition Table.
2021 06/30/2021 1. Medical Policy In Item 36. Heart, Atrial
Fibrillation, revised disposition
table to include recovery periods
for atrial fibrillation treated with
ablation (3 months) or
cardioversion (1 month).
2. Medical Policy In Disease Protocols, Human
Immunodeficiency Virus (HIV),
revised specification sheet to
clarify instructions and include
directions for authorized
professionals to use secure FAA
Neuropsychology Testing
Specification Site.
3. Medical Policy In Disease Protocols, Human
Immunodeficiency Virus (HIV),
revised Under 2 Year Surveillance
HIV Specification Sheet to clarify
instructions and include
directions for authorized
professionals to use secure FAA
Neuropsychology Testing
Specification Site.
4. Medical Policy In Disease Protocols, Human
Immunodeficiency Virus (HIV),
revised After 2 Years Surveillance
HIV Specification Sheet to clarify
instructions and include
directions for authorized
professionals to use secure FAA
Neuropsychology Testing
Specification Site.
2021 05/26/2021 1. Medical Policy In Pharmaceuticals, Therapeutic
Medications, added new
Vaccines page.

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2. Medical Policy In Examination Techniques, Item

36. Heart, revised and expanded
Atrial Fibrillation disposition table.
2021 04/28/2021 1. Medical Policy Revised Protocol for Insulin-
Treated Diabetes Mellitus - Type
I & Type II Non CGM - Third-
Class Option to include link to
and preference for Initial
Comprehensive Report.
2. Medical Policy In Disease Protocols, changed
name of Graded Exercise Stress
Test Requirements (Bundle
Branch Block) to Protocol for
Bundle Branch Block (BBB).
Page content revised and
reorganized.
3. Medical Policy In Item 36. Heart, Arrhythmias,
revised disposition table entry for
Bundle Branch Block.
2021 03/31/2021 1. Medical Policy In Item 48. General Systemic,
added disposition table for
guidance on COVID-19
Infections.
2. Medical Policy In General Information,
Equipment Requirements, added
equipment checklist and
signature document: AME
Equipment and Confidentiality.
3. Medical Policy In Substances of
Dependence/Abuse, revised
HIMS-Trained AME Checklist -
Drug and Alcohol Monitoring -
Initial Certification to clarify that
checklist must be submitted. Also
clarified First and second class
HIMS cases should be sent via
Huddle electronic submission. All
others should be mailed to
AMCD.
4. Medical Policy In Synopsis of Medical
Standards, revised Audiology
entry to clarify intensity
parameters for audiometric
speech discrimination test.
2021 02/24/2021 1. Medical Policy In Protocols, Implanted
Pacemaker, revised guidance
and changed title to Initial
Evaluation for Implanted
Pacemaker.

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2. Medical Policy In Protocols, Initial Evaluation for

Implanted Pacemaker, added
Pacemaker Status Summary
Sheet.
3. Medical Policy In Pharmaceuticals, merged
Allergy pages to create Allergy-
Antihistamine & Immunotherapy
Medication page with tables for
acceptable, conditionally
acceptable, and unacceptable
medicatons.
4. Medical Policy In Item 36. Heart, Atrial
Fibrillation (Afib)/A-Flutter),
updated disposition table to
include specific sleep study
criteria.
5. Medical Policy In Disease Protocols, revised
Cardiac Valve Replacement,
Follow up Certification section:
TAVR or other SINGLE valve
replacement may be eligible for
AASI Cardiac – Single Valve
Replacement.
6. Medical Policy In Pharmaceuticals, Do Not
Issue/Do Not Fly, revised
information on FDA approval.
7. Medical Policy In Reference Materials for
Obstructive Apnea, Frequently
Asked Questions, added
information on the four types of
sleep studies.
8. Administrative Added Conditions AMEs Can
Issue (CACI) and Special
Issuance (SI) to the
Glossary/Acronyms.
2021 01/27/2021 1. Medical Policy In Specifications for Psychiatric
and Psychological Evaluations,
added link for information on
Selecting MMPI-2 vs MMPI-3.
2. Medical Policy In Pharmaceuticals, Do Not
Issue/ Do Not Fly, Diabetic
Medications, removed
prohibitions on SGLT2 inhibitors.
Added pramlintide (Symlin) as
not allowed.
3. Medical Policy In Disease Protocols, Diabetes
Mellitus Type II - Medication
Controlled, revised Acceptable
Combinations of Diabetes
Medication guidance and

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redesigned chart to include

SGLT2 inhibitors.
4. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), General Information for
All AMEs, reorganized guidance
with new Drug and Alcohol Event
– FAA Certification Aid –
Required Information sheet.
5. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), Drug/Alcohol Monitoring
Programs and HIMS section,
added guidance for HIMS AME –
Huddle Electronic Case
Submission and FAQs.
6. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), Drug/Alcohol Monitoring
Programs and HIMS section,
revised HIMS-Trained AME
Checklist – Drug and Alcohol
Monitoring – Initial Certification to
align with Huddle naming
conventions and order of
submissions.
7. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), Drug/Alcohol Monitoring
Programs and HIMS section,
revised and renamed FAA
Certification Aid - HIMS Drug and
Alcohol – INITIAL.
8. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), Recertification, added
Introductory page in PDF Version
and blurb in HTML version.
9. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), Recertification - added
HIMS AME Information – HIMS
Step Down Plan.
10. In Substances of
Dependence/Abuse (Drugs and
Alcohol), Recertification - added
Airman Information – HIMS Step
Down Plan.
11. Medical Policy In Item 36. Heart, revised
Coronary Heart Disease

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Disposition Table to include all

classes considered.
12. Medical Policy In Item 36 Heart, Valvular
Disease Disposition Table,
revised row for Single Valve
Replacement to indicate all
classes may be considered for
initial special issuance.
13. Medical Policy In Protocol for Cardiac Valve
Replacement, revised note in
Follow-up Certification Section to
indicate all classes may be
considered for an AASI Cardiac
Valve Replacement.
`14. Medical Policy In Special Issuance, removed
page for third class AASI. All
previously listed cardiac
condition categories are now
considered for all classes.
Revised AASI All Classes listings
to include Coronary Heart
Disease and Cardiac-Single
Valve Replacement.
15. Medical Policy Revised AASI Certificate
Issuance Sheet to mirror
changes made in Special
Issuance section for cardiac
conditions and single valve
replacement.
. 16. Medical Policy In Special Issuances, revised
AASI for Single Valve
Replacement. All classes eligible
for consideration.
.17. Medical Policy In Special Issuances, revised
AASI for Coronary Heart
Disease. All classes eligible for
consideration.
18. Medical Policy In Disease Protocols, revised
Graded Exercise Stress Test
Requirements (Maximal).
. 19. Administrative In Special Issuances, expanded
title of Sleep Apnea to Sleep
Apnea/Obstructive Sleep Apnea
(OSA) on cover page and on the
individual AASI page.
2021 01/01/2021 1. Administrative Changed coversheet to 2021 and
added monthly update schedule
for the calendar year.
2020 12/30/2020 1. Administrative In Disease Protocols, added
word “Protocol” to Coronary

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Heart Disease (CHD) listing to

improve search function.
2. Administrative In Pharmaceuticals, Do Not
Issue/ Do Not Fly, added note
and hyperlinks:
“For airmen seeking more
information, see ‘Medications
and Flying’ and ‘What Over The
Counter Medications Can I Take
and Still Be Safe to Fly?’
2020 11/25/2020 1. Medical Policy In Diabetes Mellitus - Type II,
Medication Controlled (Not
Insulin), in Acceptable
combination of Diabetes
Medication Chart, revised
observation times when initiating
new diabetes therapy using
monotherapy or new combination
medications.
2. Administrative In General Information, added
link to Aerospace Medical
Disposition Tables.
2020 10/28/2020 1. Medical Policy In Disease Protocols, Coronary
Heart Disease and
Thromboembolic Disease were
revised to group blood clotting
disorders.
2020 09/30/2020 1. Medical Policy In Diabetes Mellitus Type I or
Type II Insulin Treated - CGM
Option, revised required glucose
parameters time–in-range to 80-
180 mg/dL.
2. Medical Policy In Diabetes Mellitus Type I or
Type II Insulin Treated - CGM
Option, revised Airman
Information sheet.
3. Medical Policy In Diabetes Mellitus Type I or
Type II Insulin Treated - CGM
Option, revised Initial Certificate
Consideration Requirements,
(Changes made to Item #1 Initial
Comprehensive Report, Item #3
FSBS Glucose Monitoring Diary,
Item #4 Continuous Glucose
Monitoring CGM Data, and Item
#7 Cardiac Evaluation.)
4. Medical Policy In Diabetes Mellitus Type I or
Type II Insulin Treated - CGM
Option, revised Blood Glucose
Worksheet for CGM Use.

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5. Medical Policy In Diabetes Mellitus Type I or

Type II Insulin Treated - CGM
Option, revised Frequently Asked
Questions to address change in
glucose parameters.
2020 08/26/2020 1. Medical Policy In Exam Techniques, Item 36.
Heart, added new Non-Valvular
Atrial Fibrillation (AFib)/A-Flutter
Disposition Table. This replaces
the old “Atrial Fibrillation” table.
2. Medical Policy In Exam Techniques, Item 36.
Heart, added new Non-Valvular
Atrial Fibrillation (AFib)/A-Flutter
INITIAL Status Report.
3. Medical Policy In Exam Techniques, Item 36.
Heart, added new Non-Valvular
Atrial Fibrillation (AFib)/A-Flutter
RECERTIFICATION Status
Report.
4. Medical Policy In Special Issuances, Atrial
Fibrillation, revised content to
match updated guidance.
5. Medical Policy In Pharmaceuticals,
Anticoagulants, added guidance
for Non-Valvular Atrial Fibrillation
(AFib)/A-Flutter Emboli
Mitigation.
6. Medical Policy In Item 36. Heart, Arrhythmias
Disposition Table, updated Radio
Frequency Ablation section to
include note: *If performed for
atrial fibrillation AFib/A-Flutter,
see that section first.
7. Medical Policy In CACI Conditions, updated
CACI - Mitral Valve Worksheet to
remove notation regarding atrial
fibrillation treated with ablation.
2020 07/29/2020 1. Medical Policy In Examination Techniques, Item
41. G-U Systems, added a
Polycystic Kidney Disease (PKD)
disposition table. Nephritis
disposition table was revised to
remove reference to PKD.
2. Medical Policy In General Information, added
guidance on Medical Certificates
Requested for any Situation or
Job Other than a Pilot or Air
Traffic Controller.

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3. Medical Policy In Pharmaceuticals, Sleep Aids,

revised wait time for Sonata
(zaleplon) from 6 to 12 hours.
4. Medical Policy In protocol for Diabetes Mellitus
Type I or type II
Insulin Treated - CGM Option,
revised multiple pages to state that
eye evaluation must be done by a
board-certified ophthalmologist
(M.D. or D.O.) and eye evaluation
by an optometrist (O.D.) is NOT
acceptable.
5. Medical Policy In Pharmaceuticals, Acceptable
Combinations of Diabetes
Medications, revised to add
observation wait times and
additional notes to combinations
chart.
6. Administrative Updated the FAA
Neuropsychologist List.
2020 06/24/2020 1. Medical Policy In Item 38. Abdomen and
Viscera, added Pancreatitis
Disposition table.
2. Medical Policy In 18.v. Medical History v. History
of Arrest(s), Conviction(s) and/or
Administrative Action(s), revised
to clarify language.
2020 02/26/2020 1. Medical Policy In Disease Protocols, Diabetes
Mellitus Type I and Type II –
Insulin Treated – Continuous
Glucose Monitoring (CGM)
Option (ITDM CGM Option
Protocol) for all classes – revised
multiple sections to clarify that
only airmen with flight hours are
required to “Note on an Excel
spreadsheet any flights, glucose
levels during flight, and any
actions needed to correct
glucose.” Sections changed:
Airman Information;
Initial Certificate Consideration
Requirements; Renewal
Certificate Requirements; and
Insulin Treated Diabetes
Information Submission
Requirements
2. Medical Policy In Disease Protocols, Diabetes
Mellitus Type I and Type II –
Insulin Treated – Continuous

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Glucose Monitoring (CGM)

Option (ITDM CGM Option
Protocol) for all classes – revised
Blood Glucose Worksheet to
changed language to include any
recalls to the “CGM
device/insulin pump or parts.”
2020 01/29/2020 1. Medical Policy In Disease Protocols, Attention
Deficit/Hyperactivity Disorder, in
sections for Testing
Requirements, Report
Requirements, and Reference
Information for the
Neuropsychologists, revised to
remove description of specific
neuropsychological testing and to
provide a link directing
authorized users to the FAA
Neuropsychological Testing
Specifications site.
2. Medical Policy In Disease Protocols, Human
Immunodeficiency Virus (HIV),
Human Immunodeficiency Virus
(HIV) Specification Sheet,
revised to remove description of
specific neuropsychological
testing and to provide a link
directing authorized users to the
FAA Neuropsychological Testing
Specifications site.
3. Medical Policy In Item 47. Psychiatric
Conditions, Use of
Antidepressant Medications,
Specifications for
Neuropsychological Evaluations
for Treatment with SSRI
Medications, revised to remove
description of specific
neuropsychological testing and to
provide a link directing
authorized users to the FAA
Neuropsychological Testing
Specifications site.
4. Medical Policy In Disease Protocols,
Specifications for Psychiatric and
Neuropsychological Evaluations
for Substance
Abuse/Dependence, revised to
remove description of specific
neuropsychological testing and to

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provide a link directing

authorized users to the FAA
Neuropsychological Testing
Specifications site.
5. Medical Policy In Disease Protocols,
Neurocognitive Impairment,
Specifications for
Neuropsychological Evaluations
for Potential Neurocognitive
Impairment, revised to remove
description of specific
neuropsychological testing and to
provide a link directing
authorized users to the FAA
Neuropsychological Testing
Specifications site.
6. Medical Policy In Disease Protocols, Psychiatric
and Psychological Evaluations,
Specification for Psychiatric and
Psychological Evaluations,
revised to remove description of
specific neuropsychological
testing and to provide a link
directing authorized users to the
FAA Neuropsychological Testing
Specifications site.
2020 01/01/2020 1. Administrative Changed coversheet to 2020 and
added monthly update schedule
for the calendar year.
2019 11/07/2019 1. Medical Policy In Disease Protocols, added new
protocol for Diabetes Mellitus
Type I and Type II – Insulin
Treated – Continuous Glucose
Monitoring (CGM) Option (ITDM
CGM Option Protocol) for all
classes. Includes Initial
Certificate Consideration
Requirements and Renewal
Certificate Requirements.

2. Medical Policy In Disease Protocols, added

Airman Information Sheet to the
ITDM CGM Option Protocol.
3. Medical Policy In Disease Protocols, added
Insulin Treated Diabetes
Information Submission
Requirements Worksheet to the
ITDM CGM Option Protocol.

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4. Medical Policy In Disease Protocols, added

Blood Glucose Worksheet for
Continuous Glucose Monitoring
(CGM) Use to the ITDM CGM
Option Protocol.
5. Medical Policy In Disease Protocols, added
Overlay Report and Alert Sample
sheets to the ITDM CGM
Protocol.
6. Medical Policy In Disease Protocols, added
ITDM Frequently Asked
Questions (FAQs) section to the
ITDM CGM Option Protocol.
7. Medical Policy In Disease Protocols, changed
the name for the former Diabetes
Mellitus Type I and Type II –
Insulin Treated Protocol to
include “NON CGM Option –
Third Class” in the title.

8. Medical Policy Revised Pharmaceuticals

(Therapeutic Medications)
Diabetes Mellitus - Insulin
Treated to include link to ITDM
CGM Option Protocol.
9. Medical Policy In Exam Techniques, Item 48.
General Systemic - Diabetes,
Pre-Diabetes, Metabolic
Syndrome, and/or Insulin
Resistance revised disposition
table to include link to ITDM
CGM Option Protocol.
2019 10/30/2019 1. Medical Policy In Item 48. General Systemic,
Human Immunodeficiency Virus
(HIV) disposition table was
updated to include Descovy
(emtricitabine and tenofovir
alafenamide).
2. Administrative Updated AASI Certificate
Issuance Coversheet to match
guidance. Removed block for
“Metabolic Syndrome, Glucose
Intolerance, Impaired Glucose
Tolerance, Impaired Fasting
Glucose, Insulin Resistance, and
Pre-Diabetes.”

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2019 10/21/2019 1. Administrative Change links for the HIMS-

Trained AME Data Sheet to an
online portal at
https://www.himsdatasheet.com
2. Medical Policy Revised HIMS-Trained AME
Checklist – Drug and Alcohol
Monitoring Initial Certification to
clarify when HIMS Data Sheet is
required.
2019 09/25/2019 1. Medical Policy In Item 48. General Systemic,
added Disposition Table for
Thrombocytopenia.
2. Medical Policy In Item 48. General Systemic,
added CACI Worksheet for
Chronic Immune
Thrombocytopenia (C-ITP).
3. Medical Policy In AME Assisted Special
Issuances, All Classes, added
AASI for Thrombocytopenia.
4. Medical Policy Updated AASI Certificate
Issuance Coversheet to include
Thrombocytopenia.
5. Administrative In Item 48. General Systemic,
Gender Dysphoria, updated the
FAA Gender Dysphoria Mental
Health Status Report to remove
use of the word “form.”
2019 08/28/2019 1. Medical Policy In Disease Protocols, updated
and reorganized Protocol for
Cardiac Valve Replacement.
2. Administrative Updated address (Room 8W-
100) for Medical Certification
Appeals – AAM-240 on pages for
Airman Information – SSRI Initial
Certification, HIMS AME
Checklist – SSRI Initial
Certification, and HIMS-Trained
AME Checklist – Drug and
Alcohol Monitoring – Initial
Certification.
2019 07/31/2019 1. Medical Policy In Disease Protocols, Cardiac
Valve Replacement, updated to
show TAVR procedure may be
considered.
2019 07/09/2019 1. Administrative In Item Exam Techniques, Item
48. General Systemic, Gender
Dysphoria, updated link to World
Professional Association for
Transgender Health (WPATH)

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guidelines. (Note: Link must be

opened in Google Chrome.)
2019 06/26/2019 1. Medical Policy In Pharmaceuticals, updated
chart of Acceptable
Combinations of Diabetes
Medications. Added lixisenatide
(Adlyxin) to GLP-1 mimetics.
2. Administrative Standardized references to
Visual Acuity Standards.
2019 05/29/2019 1. Medical Policy In Examination Techniques,
Items 50 - 54., added Visual
Acuity Standards table.
2. Medical Policy In Examination Techniques, Item
51.a Near Vision and Item 51.b.
Intermediate Vision, updated
Visual Acuity Standards table.
3. Medical Policy In Protocol for Binocular
Multifocal and Accommodating
Devices, added a new Visual
Acuity Standards table.
2019 04/24/2019 1. Medical Policy In Substances of
Dependence/Abuse, added a
revised HIMS-Trained AME
DATA Sheet.
2. Medical Policy In Substances of
Dependence/Abuse, added a
hyperlink to HIMS-Trained AME
DATA Sheet Instruction Page,
which provides directions on how
to complete the new HIMS-
Trained AME DATA Sheet.
2019 03/27/2019 1. Medical Policy Revised Chronic Kidney Disease
(CKD) Disposition Table to clarify
guidance concerning single
kidney.
2. Medical Policy Revised CACI Chronic Kidney
Disease (CKD) Worksheet to
add, that for CACI consideration,
airman must have two
functioning kidneys.
3. Medical Policy In AASI Atrial Fibrillation and in
AASI Deep Venous Thrombosis
(DVT), Pulmonary Embolism
(PE), and/ or
Hypercoagulopathies, added
Savaysa to the list of other types
of anticoagulants.
2019 02/27/2019 1. Medical Policy In Pharmaceutical Medications,
Do Not Issue/ Do Not Fly, added
Xigduo,

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Invokamet, and Qtern as NOT

allowed.
2. Medical Policy In Acceptable Combinations of
Diabetes Medications, In Group
C, added semaglutide (Ozempic)
under GLP-1 mimetics. Also, in
Group E, added gliclazide
(Diamicron) - International under
Sulfonylureas (SFU).
2019 01/28/2019 1. Administrative Changed coversheet to 2019 and
added monthly schedule of when
updates will take place.
2018 12/13/2018 1. Medical Policy Revised language regarding
“Who may perform a
neuropsychological examination”
and added link to FAA HIMS
Neuropsychologist List to the
following specification sheets:
 Specifications for ations for
ADHD/ADD

 Airman Information –
ADHD/ADD

 Specifications for
Neuropsychological
Evaluations for Treatment
with SSRI Medications

 Specifications for
Neuropsychological
Evaluations for Potential
Neurocognitive Impairment

 Specifications for Psychiatric

and Psychological Evaluations

 Specifications for Psychiatric

and Neuropsychological
evaluations for Substance
Abuse/Dependence.

2018 11/28/2018 2. Medical Policy In Item 48. General Systemic,

Blood and Blood-Forming Tissue
Disease, revised the disposition
table to provide guidance for
Chronic Lymphocytic Leukemia.
3. Administrative In Disease Protocols, Attention
Deficit/Hyperactivity Disorder,

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Airman Information – ADHD/ADD

Evaluation, changed title of the
“Aeromedical Neuropsychologist
List” to “FAA HIMS
Neuropsychologist List.”
4. Errata In Item 47. Psychiatric Conditions
- Use of Antidepressant
Medications, HIMS AME
Checklist - SSRI
Recertification/Follow Up
Clearance, corrected PO Box in
the mailing address.
2018 10/31/2018 1. Medical Policy In AASI for Deep Venous
Thrombosis (DVT), Pulmonary
Embolism (PE), and/ or
Hypercoagulopathies, guidance
added for use of NOAC/DOACs.
2. Medical Policy In AASI for Atrial Fibrillation,
guidance added for use of
NOAC/DOACs.
3. Medical Policy In Pharmaceuticals –
Anticoagulants, guidance added
for use of NOAC/DOACs.
4. Medical Policy In Protocol for Thromboembolic
Disease, guidance added for use
of NOAC/DOACs.
2018 09/26/2018 1. Medical Policy In Disease Protocols,
Specifications for
Neuropsychological Evaluations
for ADHD/ADD – add language
to Airman Information and
Testing Requirements to clarify
that if the airman has stopped
taking ADHD/ADD medication(s),
they must be off the
medication(s) for 90 days before
testing and evaluation.
2018 08/29/2018 1. Administrative Throughout the AME Guide -
revised instructions to airmen on
how to request copies of their
medical records. Requests
should now be made by
submitting FAA Form 8065-2.
2018 07/25/2018 1. Medical Policy In Item 47. Psychiatric Conditions
- Use of Antidepressant
Medications,
Recertification/Follow-up
Clearance, added a new page,
HIMS AME Change Request.

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2. Administrative In Specifications for

Neuropsychological Evaluations
for ADHD/ADD, updated the
Aeromedical Neuropsychologist
List.
2018 06/27/2018 1. Medical Policy In Specifications for Psychiatric
and Psychological Evaluations,
updated testing information. For
cases in which the clinical history
or presentation indicates a
possible personality disorder, the
Millon Clinical Multiaxial
Inventory, 4th Edition (MCMI-IV)
should be used (updated from
MCMI-III).
2. Administrative In General Information, added
link to new FAA Form
8065-2 06/18 – Request for
Airman Information.
3. Administrative References to the Security and
Investigations Division AMC-700
were updated to show
organization’s new name, AXE-
700.
2018 05/30/2018 1. Medical Policy In Item 29. Ear, added new
Acoustic Neuroma Disposition
Table.
2018 04/25/2018 1. Medical Policy In AASI, changed the title of
Renal Carcinoma to Renal
Cancer. Also Changed title of
Testicular Carcinoma to
Testicular Cancer. Titles were
also changed on the main AASI
listing page.
2. Medical Policy In the PDF version of the Guide,
revised Specifications for
Neuropsychological Evaluation
for ADHD/ADD, Reference
Information for
Neuropsychologists (Specific
Tests, Item F.) to match the Web
version.
3. Medical Policy In Specifications for
Neuropsychological Evaluation
for ADHD/ADD – Testing
Requirements, revised guidance
to state that urine drug screening
for ADHD must include testing for
amphetamine and
methylphenidate. Also clarified

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that Tower of London (TOL),

Drexler Edition (TOL-DX) is the
version to be used.
4. Medical Policy In Specifications for
Neuropsychological Evaluation
for ADHD/ADD – Airman
Information, revised guidance to
state that urine drug screening
for ADHD must include testing for
amphetamine and
methylphenidate.
2018 03/28/2018 1. Medical Policy In Substance of
Dependence/Abuse, FAA
Certification Aid – Drug and
Alcohol Initial, removed
requirement for a “blue ribbon”
copy of the airman’s FAA
medical file.
2. Medical Policy In Disease Protocols – Attention
Deficit/Hyperactivity Disorder,
Report Requirements, removed
requirement for a “blue ribbon”
copy of the airman’s FAA
medical file.
2018 02/28/2018 1. Medical Policy In Disease Protocols - Attention
Deficit/Hyperactivity Disorder,
revised section to include links to
new information pages.
2. Medical Policy In Disease Protocols - Attention
Deficit/Hyperactivity Disorder,
added Airman Information for
ADHD/ADD page.
3. Medical Policy In Disease Protocols - Attention
Deficit/Hyperactivity Disorder,
Airman Information for
ADHD/ADD page, added link to
Aeromedical Neuropsychologist
List.
4. Medical Policy In Disease Protocols - Attention
Deficit/Hyperactivity Disorder,
added Neuropsychologist
ADHD/ADD Information - Testing
Requirements.
5. Medical Policy In Disease Protocols - Attention
Deficit/Hyperactivity Disorder,
added Neuropsychologist
ADHD/ADD Information – Report
Requirements.
6. Medical Policy In Disease Protocols - Attention
Deficit/Hyperactivity Disorder,

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added Neuropsychologist
ADHD/ADD Information –
Reference Information for the
Neuropsychologist.
7. Medical Policy In Applicant History – II Prior to
Exam, removed guidance that
applicant needs to bring
summary sheet to the exam.
8. Administrative In Item 47. Psychiatric Conditions
– Use of Antidepressant
Medications, added a link at the
top of the page directing ATCS
on SSRI to see the FAA ATCS
How to Guide.
2018 01/31/2018 1. Administrative On the 2018 AME Guide Cover
Page, added monthly schedule of
when updates will take place.
2017 12/27/2017 1. Administrative In Security Notification/ Reporting
Events, reworded link
information.
2. Administrative In Pharmaceuticals, Sedatives -
Convictions or Administrative
Actions: revised wording in the
PDF version to match Web
version of the AME Guide.
2017 11/29/2017 1. Medical Policy Revised CACI – Renal Cancer
Worksheet to address
chemotherapy and surgery.
2017 10/25/2017 1. Medical Policy Item 36. Heart - revised guidance
for Other Cardiac Conditions,
including that anticoagulants may
be allowed, if the condition is
allowed.
2. Medical Policy HIMS AME Checklist – SSRI
Initial Certification/Clearance:
clarified that the checklist and
ALL supporting information must
be submitted.
3. Medical Policy In Item 47. Psychiatric – Use of
Antidepressant Medications:
added box at the top of the page
to direct airmen to information for
SSRI initial certification.
2017 09/27/2017 1. Medical Policy In Item 48., General Systemic,
added new Breast Cancer
Disposition Table and CACI -
Breast Cancer Worksheet.
Breast Cancer added to the main
CACI Conditions index.

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2. Medical Policy Substances of

Dependence/Abuse (Drugs and
Alcohol) main page was revised
to add index of new documents.
3. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), added new General
Information for All AMEs section.
4. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), added new DUI/DWI/
Alcohol Incidents Disposition
Table.
5. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), added new Alcohol
Status Report for the AME.
6. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), added new Drug Use –
Past or Present Disposition
Table.
7. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), added new FAA
Certification Aid – Drug and
Alcohol INITIAL.
8. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), added Security
Notification/Reporting Events
information.
9. Medical Policy In Substances of
Dependence/Abuse (Drugs and
Alcohol), added new Substances
of Dependence/Abuse FAQs.
10. Medical Policy In Substance of Dependences of
Abuse (Drugs and Alcohol),
added new section FAA Drug
and/or Alcohol Monitoring
Programs and the HIMS with
information for initial certification
criteria.
11. Medical Policy In FAA Drug and/or Alcohol
Monitoring Programs and the
HIMS Program, added new
HIMS-Trained AME Checklist –
Drug and Alcohol INITIAL.
12. Medical Policy In FAA Drug and/or Alcohol
Monitoring Programs and the

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HIMS Program, added new

HIMS-Trained AME Data Sheet.
13. Medical Policy In FAA Drug and/or Alcohol
Monitoring Programs and the
HIMS Program, added links to
FAA Certification Aid – Drug and
Alcohol INITIAL and to
Specifications for
Neuropsychological Evaluations
for Substance
Abuse/Dependence.
14. Medical Policy Moved HIMS-Trained AME
Checklist Drug and Alcohol
Monitoring Recertification and
FAA Certification Aid – Drug and
Alcohol Monitoring Recertification
sheets into the section for FAA
Drug and/or Alcohol Monitoring
Programs and the HIMS
Program.
15. Medical Policy In FAA Drug and/or Alcohol
Monitoring Programs and the
HIMS Program section, added
new Monitoring Programs and
HIMS FAQs.
16. Medical Policy In Item 47. Psychiatric, revised
language in disposition table
notes which referenced
substances of abuse.
17. Medical Policy Moved language from
Substances of
Dependence/Abuse into the
Pharmaceuticals section to clarify
reasons as to why there is no list
of “acceptable” medications.

2017 09/27/2017 1. Medical Policy In Applicant History, revised

Items 18.n., 18.o, and 18.v to
reflect changes in Substances of
Dependence/Abuse section.
2017 08/30/2017 1. Medical Policy In Pharmaceuticals, Erectile
Dysfunction and Benign Prostatic
Hyperplasia Medications, added
daily Cialis (Tadalafil) use as
allowed with limitations.
Decreased required wait time
after last dose of PRN Cialis from
36 to 24 hours.

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2. Administrative Throughout the AME Guide,

updated mailing address for the
Aerospace Medical Certification
Division to PO Box 25082.

(Previous address with PO Box

26080 or PO Box 26200 are no
longer to be used.)
3. Administrative In Substances of
Dependence/Abuse (Drugs and
Alcohol), HIMS AME Checklist –
Drug and Alcohol Monitoring
Recertification Worksheet,
updated checkboxes for item #2
on the worksheet.
2017 07/26/2017 1. Medical Policy In Disease Protocols, Disease
Protocols - Diabetes Mellitus
Type I and Type II - Insulin
Treated, added Diabetes on
Insulin Re-Certification Status
Report.
2. Medical Policy In Student Pilot Rule Change
FAQs, clarified Item E. Paper
8500-8 forms are no longer valid;
any remaining paper 8500-8
forms must be destroyed by the
AME.
3. Medical Policy In General Information, 12.
Medical Certificates – AME
Completion Requirements,
clarified instructions to the AME
regarding the completion,
signing, distribution, etc., of an
airman medical certificate.
4. Administrative In General information, 13.
Validity of Medical Certificates,
removed redundant note
regarding typing or hand-writing
medical certificates.

2017 06/28/2017 1. Administrative In Item 55. Blood Pressure,

added a link to Hypertension
FAQs.
2. Medical Policy In the chart of Acceptable
Combinations of Diabetes
Medications, added albiglutide
(Tanzeum) to GLP-1 mimetics,
Group C (not allowed with
Meglitinides).

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3. Medical Policy In Item 50. Distant Vision and

Item 51. Near and Immediate
Vision, revised to remove
requirement to test both
corrected and uncorrected visual
acuity. Added “Note: If correction
is required to meet standards,
only the corrected visual acuity
needs to be tested and
recorded.”
4. Administrative Reformatted Table of Contents to
include all vision testing items
and sections titled “AME Physical
Exam Information” and “AME
Office-Required Ancillary
Testing.”
2017 05/31/2017 1. Medical Policy In Pharmaceuticals, updated the
Do Not Issue – Do Not Fly list to
provide examples within classes
of medications.
2017 04/26/2017 1. Medical Policy In Disease Protocols - Coronary
Heart Disease (CHD), Disease
Protocols - Valve Replacement,
and Disease Protocols - Cardiac
Transplant, revised to remove
reference to mandatory wait time
for third class, per Public Law
114-190, Sec. 2307. Note: 49
USC 44703 note. Medical
Certification of Certain Small
Aircraft Pilots.
2. Medical Policy Revised language In
Pharmaceuticals – Glaucoma
Medications, Item 31. Eye, and
CACI – Glaucoma Worksheet.
Applicants using miotic or
mydriatic eye drops or taking an
oral medication for glaucoma
may be considered for Special
Issuance certification following
their demonstration of adequate
control. These medications do
not qualify for the CACI program.
2017 04/07/2017 1. Administrative In Item 47. Psychiatric
Conditions, Use of
Antidepressant Medications,
revised Airman Information –
SSRI INITIAL Certification sheet
to clarify information regarding
submitting package to the FAA.

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2. Administrative In Item 47. Psychiatric

Conditions, Use of
Antidepressant Medications,
revised HIMS AME Checklist –
SSRI Recertification/Follow Up
Clearance to correct address.
2017 03/29/2017 1. Administrative In the Protocol for History of
Diabetes Mellitus Type II
Medication-Controlled (Non-
Insulin), added a note to the
Diabetes or Hyperglycemia on
Oral Medications
Status Report:

“Note: Acceptable Combinations

of Diabetes Medications and
copies of this form for future
follow-ups can be found at
www.faa.gov/go/diabetic.”

2. Medical Policy Item 47. Psychiatric Conditions,

Use of Antidepressant
Medications, revised to include
information regarding FAA ATCS
and added hyperlinks to new
documents.
3. Medical Policy In Item 47. Psychiatric
Conditions, Use of
Antidepressant Medications,
revised SSRI Decision Path-I
flow chart to include FAA ATCS.
4. Medical Policy In Item 47. Psychiatric
Conditions, Use of
Antidepressant Medications,
revised SSRI Decision Path-II
flow chart to include FAA ATCS.
Renamed it SSRI Decision Path-
II – INITIAL Certification/
Clearance.
5. Medical Policy In Item 47. Psychiatric
Conditions, Use of
Antidepressant Medications,
deleted Airman Information and
HIMS AME Checklist - SSRI
Initial Certification sheet.
Replaced it with Airman
Information – SSRI INITIAL
Certification sheet.
6. Medical Policy In Item 47. Psychiatric
Conditions, Use of
Antidepressant Medications,

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added FAA ATCS How To Guide

- SSRI.

7. Medical Policy In Item 47. Psychiatric

Conditions, Use of
Antidepressant Medications,
Revised HIMS AME Checklist –
SRRI Initial Certification sheet to
include FAA ATCS. Sheet
renamed HIMS AME Checklist –
SSRI INITIAL
Certification/Clearance.
2017 03/29/2017 8. Medical Policy In Item 47. Psychiatric
Conditions, Use of
Antidepressant Medications,
revised FAA Certification Aid –
SSRI Initial Certification to
include information regarding
FAA ATCS. Sheet renamed FAA
Certification Aid – SSRI INITIAL
Certification/Clearance.
9. Medical Policy In Item 47. Psychiatric
Conditions, Use of
Antidepressant Medications,
added flow chart FAA ATCS
SSRI Follow Up Path for the
HIMS AME.
1. Medical Policy In Item 47. Psychiatric
Conditions, Use of
Antidepressant Medications,
revised HIMS AME Checklist –
SSRI Recertification to include
information regarding FAA
ATCS. Renamed HIMS AME
Checklist – SSRI
Recertification/Follow Up
Clearance.
2. Medical Policy In Item 47. Psychiatric
Conditions, Use of
Antidepressant Medications,
revised FAA Certification Aid –
SSRI Recertification. Renamed
FAA Certification Aid – SSRI
Recertification/Follow Up
Clearance.
3. Medical Policy In Disease Protocols, revised
Specifications for
Neuropsychological Evaluations
for Treatment with SSRI
Medications to include

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information regarding FAA

ATCS.

2017 02/22/2017 1. Medical Policy In Item 38. Abdomen and

Viscera, added new CACI –
Colon Cancer Worksheet.
2. Medical Policy In Item 38. Abdomen and
Viscera, updated Malignancies
Disposition Table with
information on colon cancer.
3. Medical Policy On main CACI page, added
listing for colon cancer.
4. Medical Policy In Pharmaceuticals, Allergies –
Immunotherapy, updated
information for sublingual
immunotherapy (SLIT).
5. Medical Policy In Item 26. Nose, added note on
desensitization treatment
(injection or SLIT).
6. Medical Policy In Item 35. Lungs and Chest -
Allergies, expanded information
on hay fever requiring
antihistamines and added note
on desensitization treatment
(injection or SLIT).
2017 01/25/2017 1. Medical Policy In Item 48. General Systemic,
added guidance blood donation.
2016 12/28/2016 1. Medical Policy Revised General Information,
Authority of Aviation Medical
Examiners to further clarify that
an AME may not perform self-
examinations for issuance of a
medical certificate or issue to
themselves or an immediate
family member. Status reports
must be done by the treating
provider. Reports done by the
airman will NOT be accepted,
even if that airman is a physician.
2016 11/30/2016 1. Medical Policy Revised Item 58. ECG to further
clarify when an ECG is required,
currency criteria, equipment
requirements, AME review and
interpretation, transmitting, and
FAA support information.
2. Medical Policy In Substances of
Dependence/Abuse, in the FAA
CERTIFICATION AID – Drug and
Alcohol Monitoring Recertification
sheet, revise page 2 to remove

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“AA Meeting” as a valid example

in the “Group, Aftercare or
Counselor” category.
3. Medical Policy Revised Item 47. Psychiatric
Conditions – Use of
Antidepressant Medications - “4.)
The applicant DOES NOT have
symptoms or history of.” Also
reorganized listing of
informational hyperlinks
associated with the “Initial
Certification” and “Recertification”
categories.
4. Administrative On the main Disease Protocol
page, update the link for
Depression Treated with SSRI
Medications so it directs the user
to Item 47. Psychiatric Conditions
- Use of Antidepressant
Medications.
2016 10/26/2016 1. Medical Policy Revised Item 47. Psychiatric to
add Airman Information and
HIMS AME Checklist – SSRI
INITIAL Certification guidance.
2. Medical Policy Revised Item 47. Psychiatric to
add FAA Certification Aid – SSRI
Initial Certification guidance.
3. Medical Policy In Item 47. Psychiatric, revised
SSRI Decision Path II – (HIMS
AME) flow chart. Renamed and
added verbiage to reflect update
in SSRI INITIAL Certification
policy.
4. Medical Policy In Disease Protocols –
Depression Treated with SSRI
Medications, reorganized
Specifications for
Neuropsychological Evaluations
for Treatment with SSRI
Medications. Moved notes from
the bottom to the top of the page.
2016 09/28/2016 1. Medical Policy In General Information, Who May
Be Certified, and in Student Pilot
Rule Change, revise information
on language requirements.
Remove references to ICAO
standards on English proficiency.
2016 08/31/2016 1. Medical Policy Revised HIMS AME Checklist -
Drug and Alcohol Monitoring

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Recertification to add “N/A”

column to item 2.
2. Errata In Item 62. Has Been Issued,
added hyperlink for Letter of
Denial.
2016 07/27/2016 1. Medical Policy Revised CACI – Renal Cancer
Worksheet to specify that if it has
been 5 or more years since the
airman had any treatment for
renal cancer, with no history of
metastatic disease and no
reoccurrence, CACI is not
required and AME must note in
Box 60.
2016 06/29/2016 1. Medical Policy In Item 46. Neurologic, added
new FAA Airman Seizure
Questionnaire.
2. Medical Policy In Item 47. Psychiatric, changed
the title of the SSRI Specification
Sheet to SSRI Specification
Sheet – for Initial Consideration.
Appropriate hyperlinks were also
renamed in the Web version of
the AME Guide.
3. Medical Policy In Item 47. Psychiatric, changed
title of Depression Treated with
SSRI Medications to
Specifications for
Neuropsychological Evaluations
for Treatment with SSRI
Medications. Appropriate
hyperlinks were also renamed in
the Web version of the AME
Guide.
2016 05/25/2016 1. Medical Policy In Item 47. Psychiatric, added
new SSRI Follow Up Path for the
HIMS AME. Chart has new title
and content. This replaces the
previously titled “SSRI Follow Up
Path.”
2. Medical Policy In Item 47. Psychiatric, added
HIMS AME Checklist – SSRI
Recertification.
3. Medical Policy In Item 47. Psychiatric, added
FAA Certification AID – SSRI
Recertification.
4. Medical Policy In Substances of
Dependence/Abuse, added
HIMS AME Checklist – Drug and

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Alcohol Monitoring
Recertification.
5. Medical Policy In Substances of
Dependence/Abuse, added FAA
Certification AID – Drug and
Alcohol Monitoring
Recertification.
6. Errata Removed duplicated punctuation
on CACI - Pre Diabetes Mellitus
Worksheet.
2016 04/27/2016 1. Medical Policy References to ATCS removed
from the AME Guide with the
exception of use in General
Information - Classes of Medical
Certificate and in Item 52. Color
Vision – ATCS testing criteria.
2. Medical Policy In Item 41. GU- Kidney Stone(s) -
(Nephrolithiasis, Renal Calculi) or
Renal Colic - All Classes, revised
Disposition Table to clarify
criteria.
3. Medical Policy Revised title of CACI – Kidney
Stone(s) Worksheet to CACI –
Retained Kidney Stone(s)
Worksheet.
4. Medical Policy In the Acceptable Combinations
of Diabetes Medications Chart,
add dulaglutide (Trulicity) to the
GLP-1 section.
5. Errata In the Glossary, revise entries for
PAC, PET, and PVC.
2016 04/08/2016 1. Medical Policy Update information on the
Student Pilot Rule Change page.
AMEs have 14 days to transmit
the exams.
2016 03/08/2016 1. Medical Policy As of April 1, 2016 (per Final
Rule [81 FR 1292]), AMEs will no
longer be able to issue the
combined FAA Medical
Certificate and Student Pilot
Certificate. Student Pilots will
have a separate Student Pilot
Certificate and a separate FAA
Medical Certificate. As such, all
AME instructions regarding the
issuance of a combined
certificate have been removed
from the AME Guide. In addition,
a section explaining the policy

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change has been added. See

Student Pilot Rule Change.
2. Administrative In Application Process for
Medical Certification, Applicant
History, II. Prior to the
Examination, revise to change
any “MedX” references to
MedXpress.
4. Administrative In Item 31. Eyes, General –
revise language in disposition
table for Amblyopia.
5. Administrative In Item 42. Upper and Lower
Extremities, Item 49. Hearing,
and Disease Protocol for
Musculoskeletal, revise language
to clarify process.
6. Administrative In Glossary, revise entries for
AMCS and AME to clarify
definition.
2016 03/08/2016 1. Administrative In all dispositions tables for
conditions with CACIs, where
applicable, revise language in
Evaluation Data column to “See
CACI” and revise language in
Disposition column to “Follow
CACI.”
2016 02/24/2016 1. Medical Policy In Item 36. Heart, Valvular
Disease Disposition Table,
reorganize and add entry for
Mitral Valve Repair.

2. Medical Policy In Item 36. Heart, add Mitral

Valve Repair Disposition Table.
3. Medical Policy In Item 36. Heart, add CACI –
Mitral Valve Repair Worksheet.
4. Medical Policy In the PDF version of The Guide,
Item 26. Nose, revise information
on severe allergic rhinitis and hay
fever requiring antihistamines so
information is consistent with the
Web version.
5. Errata In Special Issuances, AASI for
Mitral or Aortic Insufficiency,
correct typographical error.
2016 01/27/2016 1. Medical Policy In Item, 41. G-U System, Gender
Identity Disorder, rename to
Gender Dysphoria, update
information, and relocate entry to
Item 48, General Systemic,
Gender Dysphoria.

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2. Medical Policy In Item 48. General Systemic,

Gender Dysphoria, add Gender
Dysphoria Mental Health Status
Report form.
3. Medical Policy In Item 41. G-U System,
Pregnancy, remove and relocate
entry to Item 48., General
Systemic, Pregnancy.
4. Medical Policy In Pharmaceuticals,
Contraceptive and Hormone
Replacement Therapy, III
Aeromedical Considerations,
change reference from Item 41.
Gender Identity Disorder to Item
48. General Systemic, Gender
Dysphoria.
5. Errata In Synopsis of Medical
Standards, correct typographical
error.
2016 01/01/2016 1. Administrative Revise cover page to reflect the
current calendar year.

2015 11/25/2015 1. Medical Policy In Item 41. G-U Systems,

General Disorders, add Chronic
Kidney Disease Disposition
Table.

2. Medical Policy In Item 41. G-U Systems,

General Disorders, add CACI –
Chronic Kidney Disease
Worksheet.
3. Administrative On main CACI Certification
Worksheets page, add entry for
Chronic Kidney Disease.
4. Medical Policy In Special Issuances, add AASI
for Chronic Kidney Disease.
5. Administrative On main AASI page, add entry
for Chronic Kidney Disease.
6. Medical Policy In AME Assisted Special
Issuances (AASI), revise AASI
Coversheet to include box for
Chronic Kidney Disease.
2015 11/06/2015 1. Errata In Item 48. General Systemic –
CACI – Pre Diabetes Worksheet,
corrected typographical errror in
Accebtable Certification Criteria:
Oral glucose test, if performed,

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should be less than 200 mg/dl at

2 hours.
2015 10/28/2015 1. Medical Policy In Item 36. Heart, revise
Hypertension Dispositions Table
to clarify certification
requirements.
2. Medical Policy In Item 36. Heart, revise CACI –
Hypertension Worksheet to
provide example of clonidine as a
centrally acting
antihypertensive(s), which is not
acceptable.
3. Medical Policy In Item 36. Heart, add
Hypertension – Frequently Asked
Questions ( FAQs).
4. Medical Policy In Pharmaceuticals (Therapeutic
Medications) - Antihypertensives,
revise to include table with
examples of medications that are
acceptable and not acceptable
for treatment of hypertension.

5. Medical Policy In AME Assisted Special

Issuances (AASI), add AASI for
Hypertension.

6. Medical Policy In AME Assisted Special

Issuances (AASI), revised AASI
Coversheet to include box for
Hypertension.
7. Medical Policy In Item 55. Blood Pressure,
Decision Considerations, revise
to include more information on
AME options if airman’s blood
pressure is higher than 155/95
during the exam.
2015 09/30/2015 1. Medical Policy In Item 41. G-U Systems, add
Kidney Stone(s) Dispositions
Table.
2. Medical Policy In Item 41. G-U Systems, add
CACI – Kidney Stone(s)
Worksheet.
3. Medical Policy In Item 41. G-U Systems,
Neoplastic
Disorders,Dispositions Table,
revise information for Renal
Cancer.

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4. Medical Policy In Item 41. G-U Systems,

Neoplastic Disorder, revise the
CACI – Renal Cancer Worksheet
to include “disease recurrence
and stage 4 disease” as part of
criteria AME must review.
5. Medical Policy In Item 41. G-U Systems, Urinary
System, revise Disposition Table
to include information on
Hematuria, Proteinuria, and
Glycosuria. Removed
information on renal calculi,
which is now captured in Kidney
Stone (s) Disposition Table.
6. Administrative In Item 41. G-U Systems, revised
the list of conditions to appear in
the following order:
-General Disorders
-Gender Identity Disorders
-Inflamatory Conditions
-Kidney Stone(s)
-Neoplastic Disorders
 Bladder Cancer
 Prostate Cancer
 Renal Cancer
 Testicular Cancer
 Other G-U
Cancers/Neoplastic
Disorders
-Nephritis
-Pregnancy
-Urinary System
2015 08/26/2015 1. Medical Policy In Item 41. G-U Systems,
Neoplastic Disorders,
Dispositions Table, revise
information for Prostate Cancer.
2. Medical Policy In Item 41. G-U System,
Neoplastic Disorders, add CACI
– Prostate Cancer Worksheet.
3. Medical Policy In Item 42. G-U System,
Neoplastic Disorders, add
Prostate Conditions Dispositions
Table to include information on
BPH and elevated PSA.
4. Medical Policy On CACI Conditions main page,
revise guidance to clarify that if
all the CACI criteria are met and
the applicant is otherwise

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qualified, the AME may issue on

the first exam or the first time the
condition is reported to the AME
without contacting AMCD/RFS.
AMEs should document the
appropriate notes in Block 60
and keep the supporting
documents in their files; they do
not need to be submitted to the
FAA at this time.
5. Administrative In Special Issuance, AASI for
Melanoma and in Item 40. Skin,
Disposition Table for Skin Cancer
– All Classes, revise to clarify
expression of Breslow level.
(Removed < > signs.) EX:
“Melanoma less than 0.75 mm in
depth or Melanoma in Situ” and
"Melanoma equal to 0.75mm or
greater in depth.”

6. Administrative In Item 41. G-U System –

Neoplastic Disorders, Disposition
Table – Testicular Cancer – All
Classes and in Disposition Table
– Bladder Cancer – All Classes,
revise to clarify - “Non metastatic
and treatment completed 5 or
more years ago.”
7. Administrative In CACI – Bladder Cancer
Worksheet and CACI –
Testicular Cancer Worksheet,
revise information in notes to
clarify: “If it has been 5 or more
years since…”
2015 07/29/2015 1. Medical Policy In Item 41. G-U System,
Neoplastic Disorders,
Dispositions Table, revise
information for Bladder Cancer.
2. Medical Policy In Item 41. G-U System,
Neoplastic Disorders, add
CACI – Bladder Cancer
Worksheet.
7. Medical Policy In Item 48. General Systemic -
Endocrine Disorders, revised
CACI – Hypothyroidism

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Worksheet. Changed normal

TSH from 90 days to one year.
8. Medical Policy In Item 38. Abdomen and
Viscera, Dispositions, revise to
include criteria for Liver
Transplant - Recipient, Liver
Transplant - Donor, and
Combined Transplants (Liver in
combination with kidney, heart,
or other organ.)
9. Medical Policy In Protocols, add protocol for
Liver Transplant – (Recipient).
2015 06/24/2015 1. Medical Policy In Item 41. G-U System,
Neoplastic Disorders,
Dispositions Table, revise
information for Testicular Cancer.

2. Medical Policy In Item 41. G-U System,

Neoplastic Disorders, add CACI
– Testicular Cancer Worksheet.
3. Medical Policy In Pharmaceuticals (Therapeutic
Medications), add guidance for
use of Erectile Dysfunction
and/or Benign Prostatic
Hyperplasia Medications,
including table of wait times.
4. Medical Policy In CACI – Hypertension
Worksheet, revise to change
medication wait time from
2 weeks to 7 days.
5. Medical Policy In PDF version of the Guide,
create a page listing all CACI
worksheets. In both PDF and
Web versions of the Guide,
include instructions for the AME
to review the disposition table
first to verify that a CACI is
required.
2015 06/17/2015 1. Administrative In Protocols, Diabetes Mellitus
Type I and Type II – Insulin
Treated, clarify diabetes
requirements by class.
2. Administrative In Pharmaceuticals, Diabetes
Mellitus Type I and Type II –
Insulin Treated, remove
redundant language. Retain links
to applicable Diabetes

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information elsewhere in the

AME Guide.
2015 05/27/2015 1. Medical Policy In Item 48. General Systemic,
Dispositions Table for Human
Immunodeficiency Virus (HIV),
add issuance criteria for HIV
negative airmen taking long-term
prevention or Pre-Exposure
Prophylaxis (PrEP). Also added
link to the information in Protocol
for Human Immunodeficiency
Virus (HIV).

2. Medical Policy In Protocols, Diabetes Mellitus

Type II – Medication Controlled,
added PDF form “DIABETES or
HYPERGLYCEMIA ON ORAL
MEDICATIONS STATUS
REPORT.”
Links to the form also added in
Pharmaceuticals, Diabetes
Mellitus Type II – Medication
Controlled (Not Insulin) and in
Special Issuances AME Assisted
- All Classes - Diabetes Mellitus -
Type II, Medication Controlled
(Not Insulin).
2015 04/29/2015 1. Medical Policy In Item 40. Skin, replace
dispositions table for Malignant
Melanoma with an expanded
table named “Skin Cancers – All
classes.”
2. Administrative In all CACI worksheets, revise
note in Block 60 language to
read:
 CACI qualified (condition).
 Not CACI qualified
(condition). Issued per
valid SI/AASI. (Submit
supporting documents.)
 NOT CACI qualified
(condition). I have
deferred.
3. Medical Policy In Disease Protocols, Obstructive
Sleep Apnea, Reference
Materials, revise Specification

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Sheet B to include bullet: “In

communities where a Level II
HST is unavailable, the FAA will
accept a level III HST. If the HST
is positive for OSA, no further
testing is necessary and
treatment in accordance with the
AASI must be followed. However,
if the HST is equivocal, a higher
level test such as an in-lab sleep
study will be needed unless a
sleep medicine specialist
determines no further study is
necessary and documents the
rationale.”
4. Medical Policy In Disease Protocols, Protocol for
History of Diabetes Mellitus Type
II Medication – Controlled (Non
Insulin), Protocol for Metabolic
Syndrome, and CACI – Pre
Diabetes, revise to add 14 day
wait period for use of Metformin
only. (Any other single diabetes
medication requires a 60-day
wait period.)

5. Medical Policy In Item 43. Spine and other

Musculoskeletal, add a
disposition table for Gout and
Pseudogout.
2015 04/21/2015 1. Medical Policy In Disease Protocols, Protocol for
Diabetes Mellitus, Type I and
Type II – Insulin Treated, revise
language to remove reference to
class of certification.
2. Medical Policy In Pharmaceuticals (Therapeutic
Medications) Diabetes Mellitus –
Insulin Treated, revise language
under III. Aeromedical Decision
Considerations. Remove
reference to class of certification.
2015 04/16/2015 1. Medical Policy In Disease Protocols, Protocol for
History Diabetes Mellitus Type II
Medication-Controlled (Non-
Insulin) and in Protocol for
Medication Controlled Metabolic
Syndrome, remove: “An
applicant who uses insulin for the
treatment of his or her metabolic
syndrome may only be

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considered for an Authorization

for a third-class airman medical
certificate.”
2. Administrative To bring the PDF version of the
Guide up-to-date with the online
version: In Item 36. Heart, C.
Medication, NOT ACCEPTABLE
- Remove "A combination of
beta-adrenergic blocking agents
used with insulin, meglitinides, or
sulfonylureas.”
2015 04/03/2015 1. Medical Policy In Disease Protocols, Obstructive
Sleep Apnea, Reference
Materials, Frequently Asked
Questions (FAQs), add new
FAQ: “What if the doctor or
insurance provider is only
willing to do a level III Home
Sleep Test (HST).”
2015 03/19/2015 1. Medical Policy In Disease Protocols, Obstructive
Sleep Apnea, add new section
within the Reference Materials
for Frequently Asked Questions
(FAQs).
2. Administrative In Disease Protocols, Obstructive
Sleep Apnea, add a link for the
FAA OSA screening video.
2015 03/10/2015 1. Administrative In Disease Protocols, Obstructive
Sleep Apnea, create additional
hyperlinks within the material.
2015 03/02/2015 1. Medical Policy In Disease Protocols, revise
guidance to introduce “Protocol
for Obstructive Sleep Apnea
(OSA).”
2. Medical Policy In Disease Protocols, add new
section, “Reference Materials for
Obstructive Sleep Apnea (OSA),”
to the end of the Protocols.
3. Medical Policy In AME Assisted – All Classes -
Sleep Apnea, revise guidance on
certification criteria. Change title
to “AME Assisted – All Classes –
Obstructive Sleep Apnea (OSA).”
4. Medical Policy In Item. 35, Lungs and Chest,
Revise guidance in Decisions
Considerations Table regarding
Obstructive Sleep Apnea.
5. Medical Policy In Item. 25-30, Ear, Nose and
Throat, add link to Protocol for
Obstructive Sleep Apnea.

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6. Medical Policy In Item. 28, Mouth and Throat

Decision Considerations Table,
add link to Protocol for
Obstructive Sleep Apnea.

7. Administrative In Protocols, revise table of

contents page to show entry for
Obstructive Sleep Apnea (OSA).
In the PDF version of the AME
Guide, add note to indicate
location of the “Obstructive Sleep
Apnea (OSA) – Reference
Materials.”
2015 02/11/2015 1 Administrative In Item. 52, Color vision, revise
format to emphasize existing
policy – “Color vision tests
approved for airmen ARE NOT
all acceptable for air traffic
controllers.”
2. Medical Policy In Protocol for History of Human
Immunodeficiency Virus (HIV)
Related Conditions, revise
language and insert links to
specification sheets to clarify
criteria for Special Issuance and
follow-up.
2014 12/17/2014 1. Medical Policy In Pharmaceuticals, Anti-
hypertensives, revise to state
that the combination use of beta-
blockers and insulin,
meglitinides, or sulfonylurea is
now allowed.
2014 12/01/2014 1. Medical Policy In Pharmaceuticals, Do Not Issue
– Do Not Fly, remove
“Concurrent use of a beta-
blocker plus a sulfonylurea or
insulin or a meglitinide” from the
Do Not Issue listing.
2014 12/01/2014 1. Administrative Review Guide and remove any
erroneous references to Titmus II
Vision (TII, TIIs) Testers. Tester
was previously removed
(09/27/13) as acceptable for
airmen.
2014 11/24/2014 1. Administrative In Disease Protocols, review and
adjust table of contents order.
2014 10/22/2014 1. Medical Policy In Pharmaceuticals, Diabetes
Mellitus Type II – Medication
Controlled (Not Insulin), revise
chart of Acceptable

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Combinations of Diabetes
Medications to include alogliptin
(Nesina) and trade names for
metformin (Glucophage,
Fortament, Glutetza, Riomet.)
2014 10/20/2014 1. Medical Policy In Pharmaceuticals, Diabetes
Mellitus – Insulin Treated and in
Diabetes Mellitus – Diabetes
Mellitus Type II – Medication
Controlled (Not Insulin), revise
guidance under V.
Pharmaceutical Considerations
regarding chart of Acceptable
Combinations of Diabetes
Medications.
2. Medical Policy In Pharmaceuticals, revise chart
of Acceptable Combinations of
Diabetes Medications regarding
Bydureon and Beta-Blockers.
3. Medical Policy In AASI, Diabetes Mellitus –
Type II Medication Controlled
(not insulin), revise guidance
regarding deferral criteria.
2014 09/10/2014 1. Medical Policy In General Information,
Equipment Requirements and in
Item. 52, Color Vision, revise to
indicate that the OPTEC 2000
vision tester (Models 2000 PM,
2000 PAME, 2000 PI) MUST
contain the 2000-010 FAR color
perception PIP plate to be
approved.
2014 08/6/2014 1. Medical Policy In General Information, Classes
of Medical Certificates and also
in Validity of Medical Certificates,
revise to include language
regarding digital signatures of
authorized FAA physicians on
certificates.
2014 07/25/2014 1. Medical Policy In General Information, Classes
of Medical Certificates and also
in Validity of Medical Certificates,
revise to include language
regarding necessity for original
AME or FAA physician signature
on certificates.
2014 07/23/2014 1. Medical Policy In AASI, Diabetes Mellitus,
Medication Controlled (Not
Insulin), revise to include that
applicant must be deferred if

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taking more than 3 Diabetes

medications or is using a
combination prohibited in the
Acceptable Combinations of
Diabetes Medical Chart.
2014 05/16/2014 1. Administrative In Pharmaceuticals (Therapeutic
Medications), Malaria, reorder
category content.
2. Medical Policy In Pharmaceuticals, (Therapeutic
Medications), Sleep Aids, revise
to include warning on
eszopiclone.
3. Medical Policy In Item 46. Neurologic, In the
dispositions table, change
“Dystonia musculorum
deformans" to "Dystonia -
primary or secondary.”
2014 05/12/2014 1. Medical Policy In Acceptable Combinations of
Diabetes Medications Chart,
revise to add alogliptin (Nesina).
2014 05/05/2014 1. Medical Policy In Decision Considerations,
Disease Protocols - Graded
Exercise Stress Test
Requirements, revise to remove
hyperventilation requirement
from testing.
2014 04/22/2014 1. Administrative In Pharmaceuticals (Therapeutic
Medications) revise Acceptable
Combinations of Diabetes
Medications to include link to the
Pre-Diabetes CACI Worksheet.
2014 04/17/2014 1. Medical Policy In Pharmaceuticals (Therapeutic
Medications) revise to include
chart of Acceptable
Combinations of Diabetes
Medications.
2. Administrative In Applicant History, Item 3.,
(Last Name; First Name; Middle
Name.), revise to clarify
instructions if applicant has no
middle name.
2014 03/28/2014 1. Administrative In Disease Protocols, add
acronyms to Protocol for
Cardiovascular Evaluation (CVE)
and Protocol for Evaluation of
Coronary Heart Disease (CHD).

2014 03/20/2014 1. Medical Policy In CACI Certification

Worksheets, add worksheet for

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Colitis. Revise Colitis

Dispositions Table and Colitis
Special Issuance criteria to
reflect the change.
2014 03/14/2014 1. Medical Policy In Disease Protocols,
Cardiovascular Evaluation, revise
to clarify criteria.
2. Medical Policy In Disease Protocols, Coronary
Heart Disease, revise to clarify
criteria.
3. Medical Policy In Disease Protocols, Graded
Exercise Stress Test
Requirements, revise to clarify
criteria.
2014 03/14/2014 1. Medical Policy In Exam Techniques,
III. Aerospace Medical
Disposition, revise to clarify the
definition of Conditions AMEs
Can Issue (CACI).
2014 03/10/2014 1. Medical Policy In Item 47. Psychiatric, Use of
Antidepressant Medications,
revise policy to change the
required time applicant must be
on a stable dose of the SSRI
from 12 months to 6 months.
2014 02/05/2014 1. Medical Policy In Pharmaceuticals (Therapeutic
Medications) – Anticoagulants
and in Disease Protocols –
Thromboembolic Disease, revise
to policy include required wait
time after initial start of warfarin
(Coumadin) treatment.
2014 01/16/2014 1. Medical Policy In Equipment Requirements and
Item 52. Color Vision, remove
APT-5 Color Vision Tester.
2 Medical Policy In Pharmaceuticals (Therapeutic
Medications), add new “Do Not
Issue-Do Not Fly” section.
2014 01/01/2014 1. Administrative Revise cover page to reflect the
current calendar year.
2013 12/23/2013 1. Administrative In Pharmaceutical (Therapeutic
Medications), Sleep Aids, add a
link for FDA studies.

2013 12/12/2013 1. Medical Policy In Pharmaceutical (Therapeutic

Medications), Acne Medications,
revise policy to include language
on use of topical acne
medications, such as Retin A,

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and oral antibiotics, such as

tretracycline.
2013 12/06/2013 1. Administrative In AASI, change title of Deep
Venous Thrombosis/Pulmonary
Embolism - Warfarin (Coumadin)
Therapy to “Deep Venous
Thrombosis (DVT), Pulmonary
Embolism (PE), and/ or
Hypercoagulopathies”. Title of
block on the Certificate Issuance
sheet also changed.
2013 11/06/2013 1. Medical Policy In Item 46. Neurologic, revise the
Cerebrovascular Disease
dispositions table to expand on
criteria for Transient Ischemic
Attack, Completed Stroke
(ischemic or hemorrhagic), and
Subdural, Epidural or
Subarachnoid Hemorrhage.
2013 09/27/2013 1. Medical Policy In General Information,
Equipment Requirements – Color
Vision Test Apparatus, remove
Titmus II Vision Tester (Model
Nos. TII and TIIS) from the list of
approved testers.
2013 09/27/2013 1. Medical Policy In Disease Protocols, revise
Hypertension Worksheet to
clarify criteria whereby AME can
assess current status.
2013 09/17/2013 1. Medical Policy In Disease Protocols, add new
test (Gordon Diagnostic System
[GDS]) to evaluation sheets for
Attention Deficit/Hyperactivity
Disorder; Depression Treated
with SSRI Medications;
Neurocognitive Impairment; and
Psychiatric and
Neuropsychological Evaluations
for Substance
Abuse/Dependence.
2. Medical Policy In Disease Protocols listing,
rename “Substances of
Dependence/Abuse (Drugs and
Alcohol)” to “Psychiatric –
Substances of
Dependence/Abuse (Drugs and
Alcohol.”
3. Administrative Add updated link for the
International Standards on
Personnel Licensing.

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2013 08/16/2013 1. Medical Policy In Pharmaceuticals, Malaria

Medications, update policy
information regarding the use of
mefloquine.
2. Medical Policy In Special Issuances, update
policy for prednisone usage for
treatment of Asthma, Arthritis,
Colitis, and/ or Chronic
Obstructive Pulmonary Disease.
3. Medical Policy In Special Issuances, revise
introductory language to clarify
requirements for deferral.
Specifically if “the applicant does
not meet the issue criteria in the
Aerospace Medicine Dispositions
Tables or the Certification
Worksheets.”
2013 08/14/2013 1, Medical Policy In Item 41. G-U System –
Neoplastic Disorders, revise
dispositions table language from
“Any other G-U Neoplastic
Disorder” to “All G-U cancers
when treatment was completed
less than 5 years ago or for
which there is a history of
metastatic disease.” Also, direct
AMEs to reference the specific
cancers in this category for
requirements and dispositions.
2013 07/30/2013 1. Medical Policy In Pharmaceuticals, add
information page on Sleep Aids,
including wait times.
2. Errata In Examination Techniques, Item
36. Heart – Syncope, correct
typographical error: bilatcarotid
Ultrasound to bilateral carotid
Ultrasound.
2013 06/19/2013 1. Medical Policy In Item 41. G-U System –
Neoplastic Disorders, revise
dispositions table to include
criteria for “All G-U Cancers
when treatment was completed
more than 5 years ago and there
is no history of metastatic
disease.”
2013 06/13/2013 1. Medical Policy Revise language in all
Certification Worksheets:
(Arthritis, Asthma, Renal Cancer,
Glaucoma, Hepatitis C,
Hypertension, Hypothyroidism,

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Migraine – Chronic Headaches,

and Pre Diabetes) to add
“Applicants for first- or second-
class must provide this
information annually; applicants
for third-class must provide the
information with each required
exam.”
2. Medical Policy In Item 35. Lungs and Chest,
revise Asthma Worksheet to
include “FEV1, FVC, and
FEV1/FVC are all equal to or
greater than 80% predicted
before bronchodilators” and
Pulmonary Function Test “is not
required if the only treatment is
PRN use on one or two days a
week of a short-acting beta
agonist (e.g. albuterol).”
3. Administrative In Item 43. Spine and Other
Musculoskeletal, revise Arthritis
Worksheet to include link to
steroid conversion calculator.
4. Medical policy In Item 41. G-U System –
and Neoplastic Disorders, revise
Administrative Renal Cancer Worksheet to state
“ECOG performance status or
equivalent is 0.” Include link to
ECOG Performance Status
definitions.
5. Medical Policy In Item 48. General Systemic –
Pre-Diabetes, Diabetes,
Metabolic Syndrome, and/or
Insulin Resistance, revise
dispositions table to include
Polycystic Ovary Syndrome.
6. Medical Policy In Item 48. General Systemic -
Pre-Diabetes, Diabetes,
Metabolic Syndrome, and/or
Insulin Resistance, revise Pre-
Diabetes Worksheet to include
Polycystic Ovary Syndrome.

2013 06/11/2013 1. Medical Policy In Dispositions Table, Item 46.

Neurologic, revise language to
reflect that “Any loss of
consciousness, alteration of
consciousness, or amnesia,
regardless of duration” requires
FAA Decision.

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2013 06/04/2013 1. Medical Policy In Dispositions Table, Item 38.

Abdomen and Viscera, Hepatitis
C, revise to show that if disease
is resolved without sequela and
need for medications, the AME
can issue.
2013 05/15/2013 1. Medical Policy In Dispositions Table, Item 43.
Arthritis – add row for certification
criteria for Osteoarthritis and
variants on PRN NSAIDS only.
2. Medical Policy In Dispositions Table, Item 55.
Blood Pressure, Hypertension
Worksheet, revise to “treating
physician or AME finds…etc.”
2013 05/08/2013 1. Administrative In Archives and Modifications,
change title to “Archives and
Updates.”
2. Administrative In AME Assisted Special
Issuances (AASI), revise
language on the introductory
page and all 25 AASI pages from
"If this is a first time issuance of
an Authorization for the above
disease/condition…” to “If this is
a first-time application for an
AASI for the above
disease/condition …”
2013 04/09/13 1. Medical Policy In Examination Techniques, Item
35. Lungs and Chest, revise
dispositions table for Asthma.
Introduce Asthma Worksheet
with certification criteria under
which the AME can regular issue.

2. In Examination Techniques, Item

43. Spine and Other
Musculoskeletal, revise
dispositions table for Arthritis.
Introduce Arthritis Worksheet
with certification criteria under
which the AME can regular issue.
3. In Examination Techniques, Item
41. G-U System – Neoplastic
Disorders, revise dispositions

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table for Prostatic, Renal, and

Testicular Carcinomas.
Introduce Renal Cancer
Worksheet with certification
criteria under which the AME can
regular issue.
4. In Examination Techniques,
Items 31 - 34. Eye, revise
Examination techniques and
dispositions table for Glaucoma.
Introduce Glaucoma Worksheet
with certification criteria under
which the AME can regular issue.
5. In Examination Techniques,
Items 38. Abdomen and Viscera,
revise dispositions table for
Hepatitis C - Chronic. Introduce
Hepatitis C – Chronic Worksheet
with certification criteria under
which the AME can regular issue.
6. In Examination Techniques,
Items 55. Blood Pressure, revise
dispositions table for
Hypertension. Introduce
Hypertension Worksheet with
certification criteria under which
the AME can regular issue.
7. In Disease Protocols, delete
Hypertension Protocol.
8. In Examination Techniques,
Items 48. General Systemic –
Endocrine Disorders, revise
dispositions table for
Hypothyroidism. Introduce
Hypothyroidism Worksheet with
certification criteria under which
the AME can regular issue.
9. In Examination Techniques,
Items 46. Neurologic –
Headaches, revise dispositions
table for Migraine and Chronic
Headache. Introduce Migraine
and Chronic Headache
Worksheet with certification
criteria under which the AME can
regular issue.
10. In Examination Techniques,
Items 48. General Systemic –
Diabetes, Metabolic Syndrome,
and/or Insulin Resistance, revise

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dispositions table to add Pre-

Diabetes. Introduce Pre-Diabetes
Worksheet with certification
criteria under which the AME can
regular issue.
11. In Disease Protocols, delete
protocol for Medication
Controlled Metabolic Syndrome
(Glucose Intolerance, Impaired
Glucose Tolerance, Impaired
Fasting Glucose, Insulin
Resistance, and Pre-Diabetes)
12. In Disease Protocols, revise Diet
Controlled Diabetes Mellitus and
Metabolic Syndrome. Change
title to Diabetes Mellitus – Diet
Controlled.
13. In Disease Protocols, revise title
of Medication Controlled
Diabetes Mellitus - Type II.
Change name to Diabetes
Mellitus Type II – Medication
Controlled (Non Insulin). Also, in
Pharmaceuticals section, revise
name of protocol link to reflect
title change.
14. In Disease Protocols, revise title
of Insulin Treated Diabetes
Mellitus - Type I or Type II.
Change title to Diabetes Mellitus
Type I or Type II – Insulin
Treated. Also, in
Pharmaceuticals section, revise
name of protocol link to reflect
title change.

15. In Pharmaceuticals,
Antihypertensives, change name
of protocol link from
Hypertension Protocol to
Hypertension Worksheet.
16. In AME Assisted Special
Issuance (AASI), delete AASI for
Metabolic Syndrome, Glucose
Intolerance, Impaired Glucose
Tolerance, Impaired Fasting
Glucose, Insulin Resistance, and
Pre-Diabetes.

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2013 03/05/13 1. Medical Policy In Disease Protocols, add

Specifications for
Neuropsychological Evaluations
for ADHD/ADD.
2. Medical Policy In Disease Protocols, add
Specifications for
Neuropsychological Evaluations
for Treatment with SSRI
Medications.
3. Medical Policy In Disease Protocols, add
Specifications for
Neuropsychological Evaluations
for Potential Neurocognitive
Impairment.
4. Medical Policy In Disease Protocols, add
Specifications for Psychiatric
Evaluations.
5. Medical Policy In Disease Protocols, add
Specifications for Psychiatric and
Psychological Evaluations.
6. Medical Policy In Disease Protocols, add
Specifications for Psychiatric and
Neuropsychiatric Evaluations for
Substance Abuse/Dependence.
7. Medical Policy In Item 47. Psychiatric
Conditions, revise table to
include reference to new
Psychiatric Specification Sheets.
8. Medical Policy In Item 47. Psychiatric
Conditions, revise SSRI
Specifications Sheet to remove
Federal Register link and include
link to Specifications for
Neuropsychological Evaluations
for Treatment with SSRI
Medications.
2013 02/15/13 1. Medical Policy In Item 47. Psychiatric
Conditions, revise Table of
Medical Dispositions to include
additional evaluation guidance.
2. Medical Policy In Item 52. Color Vision, revise to
state that use of computer
applications, downloaded
versions, or printed versions of
color vision tests are prohibited
for evaluation.
3. Medical Policy In Disease Protocols, Disease
Protocols - Human
Immunodeficiency Virus (HIV),
revise to include statement on

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status report requirements after

the first two years of SI/SC.
2013 01/03/13 1. Administrative Revise cover page to reflect the
current calendar year.
2012 12/14/12 1. Medical Policy In Item 47. Psychiatric
Conditions, revise SSRI
Specifications sheet to change
“neurocognitive testing” to
“CogScreen-AE testing.”
2012 12/06/12 1. Medical Policy In Item 47. Psychiatric
Conditions, revise SSRI Decision
Path I chart to change application
wait time from 90 days to 60
days. Also, revise SSRI Follow
Up Path chart to change
“neurocognitive testing” to
“CogScreen-AE testing.”
2012 10/24/12 1. Medical Policy In Disease Protocols – Coronary
Heart Disease, remove reference
to FAA Form 8500-20 Medical
Exemption Petition. Form 8500-
20 is cancelled.
2012 10/01/12 1. Administrative Revise language throughout the
AME Guide to reflect procedural
changes as dictated by
MedXPress, the mandatory
electronic application system for
airmen. (Effective October 1,
2012)

2. Medical Policy In Special Issuances, Atrial

Fibrillation, revise to specify INR
requirement for airmen being
treated with warfarin (Coumadin).
2012 08/09/12 1. Errata In Examination Techniques, Item
52. Color Vision; revise title of
chart for Acceptable Test
Instruments for Color Vision
Screening of ATCS (FAA
Employee 2151 Series and
Contract) to “Acceptable Test
Instruments for Color Vision
Screening of ATCS (FAA
Employee 2151 Series and
Contract Tower ATCSs.)”
2012 07/20/12 1. Medical Policy In accordance with the direct final
rule (14 CFR Part 67 [Docket No.
FAA-2012-0056; Amdt. No 67-
21] ),“Removal of the
Requirement for Individuals

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Granted the Special Issuance

of a Medical Certificate To
Carry Their Letter of
Authorization While Exercising
Pilot Privileges,” references to
the requirement to carry an LOA
were removed from the General
Information and Special
Issuances sections of the Guide.
2012 07/03/12 1. Medical Policy In Item 41. G-U System, remove
information on “Contraceptives
and Hormone Replacement
Therapy.” Move this information
to a new page of the same title
within the Pharmaceuticals
section.
2012 06/30/12 1. Medical Policy In Item 41. G-U System, create
new section for pregnancy.
2012 06/07/12 1. Medical Policy In Item 41. G-U System, revise
guidance on Gender Identity
Disorder to specify requirements
for current status report,
psychiatric and/or psychological
evaluations, and surgery follow-
up reports.
2012 05/25/12 1. Medical Policy In Item 52. Color Vision, add
chart for criteria and acceptable
tests for Air Traffic Controllers
(FAA employee 2152 series and
Contract Tower ATCS).
2012 01/31/12 1. Medical Policy In Decision Considerations.
Aerospace Medical Dispositions,
Item 45. Lymphatics, revise title
from ‘Hodgkin’s Disease –
Lymphoma” to “Lymphoma and
Hodgkin’s Disease.”
2012 01/26/12 1. Medical Policy In Examination Techniques. Item
48. Hypothyroidism, add note
that AMES may call FAA for
verbal clearance if airman
presents current lab reports.
2. Medical Policy In Pharmaceuticals, Allergy –
Desensitization Injections,
Change the title and references
to Allergy – Immunotherapy. Add
note stating that sublingual
immunotherapy (SLIT) is not
acceptable.
3. Medical Policy In Examination Techniques, Item
36. Heart, remove requirement

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for reporting serum potassium

values if the airman is taking
diuretics.
4. Medical Policy In Protocol for Evaluation of
Hypertension, remove
requirement for reporting serum
potassium if the airman is taking
diuretics.
5. Medical Policy In Item 36. Heart – Dispositions
Table, Coronary Artery Disease,
revise table to clarify evaluation
data required for third class.
2012 01/03/12 1. Administrative Revise cover page to reflect the
current calendar year.
2. Medical Policy In General Information, Medical
Certificates – AME Completion,
revise language to clarify
signature requirements.
2011 12/13/11 1. Medical Policy In Examination Techniques, Item
52. Color Vision, revise to include
Color Vision Testing Flowchart.
2011 12/01/11 1. Medical Policy In Pharmaceuticals (Therapeutic
Medications) section, change title
of Antihistaminic and
Desensitization Injections to
include the word “Allergy.” Also,
change title of Diabetes Mellitus
– Type II Medication Controlled
to include “(Non Insulin).” This
title was also changed in the
AASI.
2. Medical Policy In Pharmaceuticals (Therapeutic
Medications) Acne Medications,
revise page format to clarify
policy.
2011 11/16/11 1. Medical Policy In General Information,
Disposition of Applications and
Medical Examinations, Clarify to
indicate that Student Pilot
Applications and Examinations
must be transmitted to AMCD
within 7 days.
2011 11/01/11 1. Medical Policy In Pharmaceuticals – Insulin,
revise to clarify guidance on
medication combinations.
2011 10/24/11 1. Administrative In Aerospace Medical
Dispositions, Item 49. Hearing,
clarify guidance on hearing aids.

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2011 09/15/11 1. Medical Policy In Examination Techniques, Item

31 – 34. Eye - Orthokeratology,
revise to clarify policy.
2. Medical Policy In Aerospace Medical
Dispositions, Item 31. Eyes –
General, revise to include
information on Keratoconus.
3. Medical Policy In General Information,
Equipment Requirements, revise
to include equipment to measure
height and weight.
2011 09/12/11 1. Medical Policy In Aerospace Medical
Dispositions, Item 47.,
Psychiatric Conditions – Use of
Antidepressants, include SSRI
Specification Sheet for guidance.
2. Medical Policy In Pharmaceuticals,
Antidepressants, revise to clarify
medical history, protocol, and
pharmaceutical considerations.
3. Administrative In Table of Contents, renumber
entries listed on pages iii and iv.
2011 08/12/11 1. Medical Policy In Special Issuances, Third-Class
AME Assisted – Valve
Replacement, revise to include
additional criteria for deferral
(“the applicant develops emboli,
thrombosis, etc.”).
2. Medical Policy In Special Issuances, AME
Assisted – All Classes – Atrial
Fibrillation, revise to include
additional criteria for deferral
(“bleeding that required medical
intervention”).
3. Medical Policy In Special Issuances, AME
Assisted – All Classes – Warfarin
(Coumadin) Therapy for Deep
Venous Thrombosis (DVT),
Pulmonary Embolism (PE), and/
or Hypercouagulopathies, revise
to include additional criteria for
deferral (“bleeding that required
medical intervention”).
4. Medical Policy In Special Issuances, Third-Class
AME Assisted – Coronary Heart
Disease, revise to include
additional criteria for deferral
(“bleeding that required medical
intervention”).

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2011 08/09/11 1. Medical Policy In Disease Protocols, Coronary

Heart Disease, correct in item
A.1.b., “replacement” to “repair.”
2. Administrative In Pharmaceuticals –
Antihypertensive, revise to clarify
unacceptable medications.
3. Administrative In Examination Techniques, Item
36., Heart, revise to clarify
unacceptable medications.
4. Administrative In Aerospace Medical
Dispositions, Item 55., revise to
clarify blood pressure limits.
5. Administrative In Aerospace Medical
Dispositions, Item 47.,
Psychiatric Conditions, revise
table to include information on
depression requiring the use of
antidepressant medications.
6. Administrative In Disease Protocols,
Hypertension, revise to clarify
unacceptable medications.
2011 05/25/11 1. Administrative In Examination Techniques, Item
47., Psychiatric, revise SSRI
Follow Up Chart to clarify
procedure.
2011 05/08/11 1. Administrative In Pharmaceuticals, reorganize
and clarify the page content for
Acne Medications, Antacids,
Anticoagulants, Antihistaminic,
Antihypertensive, Desensitization
Injections, Diabetes – Type II
Medication Controlled, Glaucoma
Medications, and Insulin.
2011 03/11/11 1. Medical Policy In Aerospace Medical
Dispositions, Item 47.,
Psychiatric Conditions, clarify
policy verbiage on Bipolar
Disorder and Psychosis.
2011 03/02/11 1. Medical Policy In Aerospace Medical
Dispositions, Item 47.,
Psychiatric Conditions, add
section titled “Use of
Antidepressant Medication,” to
state revised policy on use of
SSRIs.
2011 02/23/11 1. Medical Policy In Aerospace Medical
Dispositions, Item 52., Color
Vision, clarify pass criterion for
OPTEC 900 Vision Tester.

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2011 02/03/11 1. Medical Policy In Medical History, Item 18. v.,

History of Arrest(s),
Conviction(s), and/ or
Administrative Action(s), reorder,
revise, and clarify deferral and
issuance criteria.
2011 01/31/11 1. Errata Revise to correct transposed
words in title: Decision
Considerations, Disease
Protocols – “Graded Exercise
Stress Test – Bundle Branch
Block Requirements.”
2011 01/07/11 1. Administrative Revise cover page to reflect
current calendar year.
2010 11/23/10 1. Medical Policy In Exam Techniques, Item 26.
Nose and Item 35. Lungs and
Chest, revise and clarify criteria
for hay fever medications.
2. Medical Policy In Pharmaceuticals (Therapeutic
Medications) - Desensitization
Injections, revise and clarify
criteria for hay fever medications.
2010 10/29/10 1. Medical Policy In Aerospace Medical
Dispositions, Item 52. Color
Vision, remove Titmus II Vision
Tester (Model Nos. TII and TIIS)
as an acceptable substitute for
color vision testing.
2010 09/20/10 1. Medical Policy In AASI Protocol for Arthritis,
change title to “Arthritis and/ or
Psoriasis.” Clarify authorization
and deferral criteria.
2010 09/03/10 1. Medical Policy In Exam Techniques, Item 21-22
Height and Weight, add Body
Mass Index Chart and Formula
Table.
2010 06/15/10 1. Medical Policy In Aerospace Medical
Dispositions, Item 48, General
Systemic, clarify disposition for
Hyperthroydism and
Hypothyrodism. First Special
Issuance requires FAA decision.
Guidance for Follow-up Special
Issuance is found in AASI
Protocol.
2. Administrative In AASI Protocol for
Hyperthyroidism and Protocol for
Hypothyroidism, clarify criteria for
deferring and issuing.

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2010 05/20/10 1. Administrative In Aerospace Medical

Dispositions, Item 47, Psychiatric
Conditions Table of Medical
Dispositions, clarify “see below”
information in Evaluation Data
column.
2010 03/17/10 1. Medical Policy In Disease Protocols, Binocular
Multifocal and Accommodating
Devices, clarify criteria for
adaptation period before
certification.
2. Medical Policy In Applicant History, Item 17b,
revise and clarify criteria
regarding use of types of contact
lenses.
3. Medical Policy In Exam Techniques, Items 31-
34 Eye – Contact Lenses, revise
and clarify criteria.
2010 01/20/10 1. Administrative Revise cover page to reflect
current calendar year.
2. Medical Policy In Applicant History, Item 18
Medical History, v. History of
Arrest(s), Conviction(s), and/or
Administrative Action(s), revise
and clarify deferral and issuance
criteria.
2009 12/08/09 1. Medical Policy In Examination Techniques, Item
52. Color Vision, remove APT-5
as an acceptable color vision
tester.
2009 10/22/09 1. Medical Policy In Examination Techniques, Item
52. Color Vision, add note to
Agency-Designated AMEs: “Not
all tests approved for pilots are
acceptable for FAA ATCSs.
Contact RFS for current list.”
2009 10/16/09 1. Medical Policy In Special Issuance, Diabetes
Mellitus – Type II, Medication
Controlled, revise to reflect
further criteria required for AME
re-issuance: current status report
from physician treating diabetes
to include any history of
hypoglycemic events and any
cardiovascular, renal, neurologic
or opththalmologic complications;
and HgA1c level performed
within the last 30 days.

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2009 09/30/2009 1. Medical Policy In Disease Protocols, Diabetes

Mellitus – Type I or Type II,
Insulin Treated, add note to
indicate that insulin pumps are
acceptable.
2. Medical Policy In Disease Protocols, revise main
listing to reflect addition of
“Diabetes Mellitus and Metabolic
Syndrome – Diet Controlled” and
“Metabolic Syndrome (Glucose
Intolerance, Impaired Glucose
tolerance, Impaired Fasting
Glucose, Insulin Resistance, and
Pre-Diabetes) - Medication
Controlled.”
3. Medical Policy In Aerospace Medical
Dispositions, Item 48. General
Systemic – Diabetes, Metabolic
Syndrome, and/or Insulin
Resistance, revise table to reflect
addition of “Diabetes Mellitus and
Metabolic Syndrome – Diet
Controlled” and “Metabolic
Syndrome (Glucose Intolerance,
Impaired Glucose tolerance,
Impaired Fasting Glucose, Insulin
Resistance, and Pre-Diabetes) -
Medication Controlled.”
4. Medical Policy In Disease Protocols, add new
protocol outlining Metabolic
Syndrome, Medication
Controlled.
5. Medical Policy In Disease Protocols, Diabetes
Mellitus – Diet Controlled, revise
to reflect Diabetes Mellitus and
Metabolic Syndrome (Glucose
Intolerance, Impaired Glucose
tolerance, Impaired Fasting
Glucose, Insulin Resistance, and
Pre-Diabetes) - Diet Controlled

2009 09/21/2009 1. Errata In Disease Protocols,

Substances of

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Dependence/Abuse (Drugs and

Alcohol), change “personnel
statement” to “personal
statement.”
2. Medical Policy In Special Issuance, Colon
Cancer; Chronic Lymphocytic
Leukemia; Diabetes Mellitus –
Type II, Medication Controlled;
and Lymphoma and Hodgkin’s
Disease, add if “Any new
treatment is initiated” – to criteria
for deferment to AMCD or
Region.
3. Medical Policy In Aerospace Medical
Dispositions, Item 48. General
Systemic, Diabetes – change title
to “Diabetes, Metabolic
Syndrome, and/or Insulin
Resistance.” Also add new table
entry to reflect criteria for
“Metabolic Syndrome or Insulin
Resistance.”
4. Medical Policy In AME Assisted Special
Issuance, All Classes – added
entry and criteria for Metabolic
Syndrome (Glucose Intolerance,
Impaired Glucose Tolerance,
Impaired Fasting Glucose, Insulin
Resistance, and Pre-Diabetes).
Also added entry on AASI
Certificate Issuance sheet.
5. Administrative In General Information, Who May
Be Certified, b. Language
Requirements – added
information to clarify guidance on
certification and reporting
process.
2009 07/30/2009 1. Medical Policy In Pharmaceuticals, Acne
Medications, add language to
further clarify instructions for
deferral and restrictions.

2009 07/09/2009 1. Medical Policy In Pharmaceuticals, Diabetes

Mellitus – Type II, Medication
Controlled, revise to remove

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amlynomimetics from allowable

combinations.
2. Medical Policy In AASI, Diabetes Mellitus –
Type II, Medication Controlled,
revise criteria for deferring to
AMCD or region.
2009 05/13/2009 1. Medical Policy In General Information,
Equipment Requirements and
Examination Equipment and
Techniques, Item 52. Color
Vision, add OPTEC 2500 as
acceptable vision testing
substitute.
2009 04/30/2009 1. Errata In Examination Techniques, Item
31-34. Eye, correct typographical
error in form number. Revised to
reflect “8500-7.”
2009 04/24/2009 1. Medical Policy In AASI, Diabetes Mellitus –
Type II, Medication Controlled;
and Pharmaceuticals, Diabetes
Mellitus - Type II, Medication
Controlled - revise to clarify
criteria for deferring to AMCD or
region also to clarify allowable
medication combinations.
2009 02/04/2009 1. Administrative Revise cover page to reflect
current calendar year.
2008 12/11/2008 1. Medical Policy In Examination Techniques, Item
52. Color Vision, revise language
to specify that AME-
administered aviation Signal
Light Gun test is prohibited.
2008 10/30/2008 1. Errata In Examination Techniques and
Aerospace Medical Dispositions,
Item 52. Color vision, revise to
list correct testing plates for
Richmond HRR, 4th Edition.

2008 10/10/2008 1. Administrative In General Information, create

new section 12. “Medical
Certificates – AME Completion.”
2. Administrative In Table Of Contents, General
Information, adjust and renumber
listings to reflect inclusion of

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Medical Certificates – AME

Completion.
3. Medical Policy In Examination Techniques, Item
52., Color Vision, add new vision
tester.
4. Medical Policy In Aerospace Medical
Disposition, Item 52. Color
Vision, revise section A., All
Classes, to include standard for
new vision tester.
2008 09/17/2008 1. Medical Policy Change Applicant History, 18. v.
Conviction and/or Administrative
Action History to “History of
Arrest(s), Conviction(s), and/or
Administrative Action(s). Revise
language within 18. v. to include
reference to arrests.
2. Medical Policy Revise Applicant History to
create a new section, 18.y.
Medical Disability Benefits.
3. Medical Policy Revise Entire Guide to replace
any usage of term “Urinalysis”
with “Urine Test(s).”
2008 09/05/2008 1. Administrative Change cover page to remove
“Version V” title. Change title to
reflect current calendar year.
2. Medical Policy In General Information,
Equipment Requirements, and in
Examination Techniques Items
50, 51, and 54, revise acceptable
vision testing equipment
requirements.
3. Medical Policy In Aerospace Medical
Dispositions, Item 52., Color
Vision, revise to provide
guidance on Specialized
Operational Medical Tests: the
Operational Color Vision Test
and the Medical Flight Test.
Also, update list of acceptable
and unacceptable color vision
testing equipment.
V. 07/31/2008 1. Medical Policy In General Information,
Equipment Requirements, and in
Examination Techniques (Items
50-52 and 54), revise acceptable
vision testing equipment.
V. 07/16/2008 1. Medical Policy In General Information, Validity of
Medical Certificates, revise third-

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class duration standards for

airmen under age 40.
2. Medical Policy In General Information, Requests
for Assistance, revise to remove
references to international and
military AMEs.
3. Administrative In General Information, Classes
of Medical Certificates, revise to
clarify “flying activities” to
“privileges.”
4. Medical Policy In Special Issuances, revise to
include language requiring
airman to carry Authorization
when exercising pilot privileges.
5 Medical Policy In Applicant History, Guidance
for Positive Identification of
Airmen, revise to include link to
14 CFR §67.4. Applicants must
show proof of age and identity.
V. 04/1/2008 1. Administrative In General Information, Who May
Be Certified, add guidance on
ICAO standard for English
Proficiency, Operational Level 4.
2. Medical Policy In General information,
Equipment Requirements, revise
list of acceptable equipment,
particularly acceptable substitute
equipment for vision testing.
3. Medical Policy In Exam Techniques, Item 50,
Distant Vision, revise equipment
list of acceptable substitutes.
4. Medical Policy In Exam Techniques, Item 51.
Near and Intermediate Vision,
revise equipment table of
acceptable substitutes.
5. Medical Policy In Exam Techniques, Item 54.
Heterophoria, revise equipment
table of acceptable substitutes.
V. 02/01/2008 1. Medical Policy In Exam Techniques, Item. 52.
Color Vision, revise Section E.,
which clarifies unacceptable
tests.
V. 01/11/2008 1. Medical Policy In AME Assisted Special
Issuance (AASI), add section on
Warfarin (Coumadin) Therapy for
Deep Venous Thrombosis,
Pulmonary Embolism, and/ or
Hypercoagulopathies.
2. Medical Policy Revise AASI coversheet to
include box for Warfarin

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(Coumadin) Therapy for Deep

Venous Thrombosis, Pulmonary
Embolism, and/ or
Hypercoagulopathies.
V. 11/26/2007 1. Administrative In General Information, Validity of
Medical Certificates, delete note
for “Flight outside the airspace
of the United States of America.”
2. Administrative In Disease Protocols, Conductive
Keratoplasty (CK), revise
description of CK procedure.
3. Errata In Aerospace Medical
Dispositions, Item 31. Eye,
correct typographical error.
4. Medical Policy In Pharmaceuticals, add “Malaria
Medications.”
5. Medical Policy In Exam Techniques, Item
51. Near and Intermediate vision,
add Keystone Orthoscope and
Keystone Telebinocular.
6. Administrative In Airman Certification Forms,
add note regarding International
Standards on Personnel
Licensing.
7. Administrative In General Information,
Equipment Requirements, add
note regarding the possession
and maintenance of equipment.
8. Administrative In General Information, Privacy
of Medical Information, add note
on the protection of privacy
information.

9. Administrative In General Information,

V. 11/26/2007 Disposition of Applications, add
note to include electronic
submission by international
AME’s.
10. Medical Policy In Exam Techniques and
Criteria, 31-34 Eye, Refractive
Procedures, revise to include
Wavefront-guided LASIK.
V. 09/01/2007 1. Administrative Revise title of Disease
Protocols, “Antihistamines” to
“Allergies, Severe.”
2. Administrative In Pharmaceuticals, add “Acne
Medications” and “Glaucoma
Medications.”

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3. Medical Policy Add policy regarding use of

isotretinoin (Accutane) in
Pharmaceuticals; Aerospace
Medical Dispositions, Item 40.
Skin; and Examination
Techniques and Criteria for
Qualification, Item. 40 Skin
4. Errata Revise Protocol for Maximal
Graded Exercise Stress Test
Requirements to change “8
minutes” to “9 minutes.”
5. Errata In Aerospace Medical
Dispositions, Item. 36. Heart –
Atrial Fibrillation - change “CHD
Protocol with ECHO and 24-
hour Holter” to read “See CVE
Protocol with EST, Echo, and
24-hour Holter.”
6. Medical Policy Revise Aerospace Medical
Dispositions, Item 36. Heart -
Syncope.
7. Medical Policy Revise Examination Techniques
and Criteria for Qualification,
Item. 36 Heart – Auscultation.

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Guide Official Revision Description Reason For Update

Version Date Number Of Change
V. 09/01/2007 8. Administrative In Pharmaceuticals,
Antihypertensive, V.
Pharmaceutical
Considerations – remove “D.
AME Assisted – All Classes,
Atrial Fibrillation.”
9. Administrative In Pharmaceuticals,
Antihistaminic, V.
Pharmaceutical
Considerations – add
“C. Aerospace Medical
Dispositions, Item 35. Lungs
and Chest.”
10. Medical Policy Revise Disease Protocols,
Coronary Heart Disease to
clarify requirements for
consideration for any class of
airman medical certification.
11. Errata Revise Disease Protocols,
Coronary Heart Disease to
remove “Limited to Flight
Engineer Duties.”
V. 04/25/2007 1. Administrative Move Leukemia, Acute and
Chronic from Aerospace
Medical Dispositions Item 48.
General Systemic to Item 48.
General Systemic, Blood and
Blood-Forming Tissue
Disease.

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Guide Official Revision Description Reason For Update

Version Date Number Of Change
V. 04/25/2007 2. Administrative Revise Aerospace Medical
Dispositions Item 48. General
Systemic to include disposition
table titled “Neoplasms.”

3. Administrative Move Breast Cancer from

Aerospace Medical
Dispositions Item 38.
Abdomen and Viscera -
Malignancies to Item 48.
General Systemic, Neoplasms.
Also, move Colitis (Ulcerative,
Regional Enteritis or Crohn's
disease) and Peptic Ulcer from
Aerospace Medical
Dispositions Item 38.
Abdomen and Viscera –
Malignancies to Item 38.
Abdomen and Viscera and
Anus Conditions.
4. Administrative Update individual
Pharmaceutical pages to
include “Pharmaceutical
Considerations.”
V. 11/20/2006 1. Medical Policy Insert into Disease Protocols a
new section on Cardiac
Transplant for Class III
certificates only.
2. Errata Corrected AASI on Mitral or
Aortic Insufficiency to read
“mean gradient.”

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Guide Official Revision Description Reason For Update

Version Date Number Of Change
V. 08/23/2006 1. Errata INR values for mechanical
valves should have read
between 2.5 and 3.5, except
for certain types of bileaflet
valves in the aortic position.
2. Administrative Clarified the Hypertension
Protocol regarding initiation
and change of medication and
the suspension of pilot duties.
3. Errata Maximal graded exercise
stress test requirement for
under age 60 corrected to 9
minutes.
4. Medical Policy Remove prohibition on bifocal
contact lenses or lenses that
correct for near and/or
intermediate vision in Items
31-34, Eyes; Section 5,
Contact Lenses.
5. Medical Policy Update Neurological
Conditions Disposition Table
and Footnote #21 with
guidance on Rolandic Seizure.
6. Administrative Clarified language in General
Information, Item 9. Who May
Be Certified;
a. Age Requirements.
V. 04/03/2006 1. Administrative Redesign the appearance and
navigable format of the Guide
for Aviation Medical Examiners
2. Administrative Install a Search Engine
located in the Navigation Bar
3. Administrative Revise Heading Titles for
Chapters 2, 3, and 4
4. Administrative Insert a Special Issuances
section located in the
Navigation Bar and into the
General Information section
5. Administrative Insert a Policy Updates section
to post new and revised
Administrative and Medical
Policies

V. 04/03/2006 6. Medical Policy

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Insert into the AME Assisted

Special Issuance (AASI)
section a Testicular Carcinoma
AASI
7. Medical Policy Revise Atrial Fibrillation AASI
8. Medical Policy Revise Asthma AASI
9. Medical Policy Revise Hyperthyroidism and
Hypothyroidism AASIs
10. Medical Policy Insert a new AASI subsection
containing Coronary Heart
Disease and Single Valve
Replacement applicable for
Third-Class only

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Guide Official Revision Description Reason For Update

Version Date Number Of Change
V. 04/03/2006 11. Medical Policy Insert into the Disease
Protocols section a new
Coronary Heart Disease and
Graded Exercise Stress Test
Protocol, and revise the Valve
Replacement Protocol
12. Administrative Insert Items 49 – 58 into the
Examination Techniques
section
13. Medical Policy Revise Item 35. Lungs and
Chest, Asthma, Aerospace
Medical Disposition Table
14. Medical Policy Revise Item 36. Heart, Atrial
Fibrillation, Aerospace Medical
Disposition Table
15. Medical Policy Revise Item 36. Heart,
Coronary Heart Disease,
Aerospace Medical Disposition
Table
16. Medical Policy Revise Item 36. Heart,
Valvular Disease, Aerospace
Medical Disposition Table
17. Medical Policy Revise Item 48. General
Systemic, Hyperthyroidism
and Hypothyroidism,
Aerospace Medical Disposition
Table
18. Medical Policy Revise all Oral Medications -
Diabetes Mellitus, Type II
references
19. Medical Policy Revise FAA Form 8500-7,
Report of Eye Evaluation
IV. 07/31/2005 1. Administrative Redesign the appearance and
navigable format of the Guide
for Aviation Medical
Examiners
2. Administrative Revise Section 9., Refractive
Surgery heading in Items 31-
34. Eyes, to Refractive
Procedures
3. Medical Policy Insert Conductive Keratoplasty
into Section 9, Items 31-34,
Eyes, and into Item 31’s
Aerospace Medical Disposition
Table

IV. 07/31/2005 4. Administrative

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Replace optometrist or
ophthmologist reference(s) to
“eye specialist”
5. Medical Policy Insert Pulmonary Embolism
into Item 35, Lungs and Chest,
Aerospace Medical Disposition
Table
6. Medical Policy Insert Deep Vein Thrombosis
and Pulmonary Embolism into
Item 37, Vascular System,
Aerospace Medical Disposition
Table
7. Medical Policy Insert Deep Vein Thrombosis
and Pulmonary Embolism into
the Thromboembolic Protocol.
IV. 01/16/2006 8. Medical Policy Insert into the Disease
Protocol section a Conductive
Keratoplasty Protocol
9. Medical Policy Delete a paragraph located in
Item 31-34. EYE,
Section 4. Monocular vision
10. Medical Policy Insert into the Disease
Protocol section a Binocular
Multifocal and Accommodating
Devices Protocol
11. Medical Policy Insert into the AME Assisted
Special Issuance (AASI)
section the new Bladder,
Breast, Melanoma, and Renal
Carcinoma AASI’s
III. 11/01/2004 1. Medical Policy Revise AASI Process to
include First- and Second-
class Airman Medical
Certification
2. Administrative Insert into General
Information, a new Section 10
that provides Sport Pilot
Provisions
3. Administrative Update revised Title 14, Code
of Federal Regulations, §61.53
4. Administrative Insert a link to download a
revised AME Letter of Denial
5. Administrative Insert a link to download a
printable AASI Certificate
Coversheet

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Guide Official Revision Description Reason For Update

Version Date Number Of Change
II. 02/13/2004 1. Administrative Install Search Engine located
in the Navigation Bar
2. Administrative Insert a WHAT’S NEW link
located in the Navigation Bar
3. Administrative The “Instructions” site of the
2003 Guide is deleted and
incorporated into the
“Introduction” and “Available
Downloads” located in the
Navigation Bar
4. Administrative Insert an “Available
Downloads” site located in the
Navigation Bar
5. Administrative Insert a Table of Contents and
an Index into the pdf version of
the 2004 Guide
6. Administrative Insert a one-page synopsis of
the Medical Standards located
in the Navigation Bar
7. Medical Policy Insert Section 6.
Orthokeratology into Items 31-
34. Eye
8. Administrative Relocate Item 46. Footnote #
21 from Head Trauma to
Footnote #19, Headaches
9. Administrative Insert Attention Deficit
Disorder into Item 47’s,
Aerospace Medical Disposition
Table
10. Medical Policy Revise Item 60; Comments on
History and Findings
11. Medical Policy Revise Item 63; Disqualifying
Defects
12. Medical Policy Delete from AASI’s a History
of Monocularity
13. Administrative Insert an Archives located in
the Navigation Bar
09/16/2004 14. Administrative Insert CAD Ultrasound into
Item 37’s, Aerospace Medical
Disposition Table
I. 09/24/2003 Introduction of the
2003 Guide for Aviation Medical Examiners Website

551