CHAPTER 2, PAGE 17 – APPLICATION FOR MEDICAL CERTIFICATION

 

General Information

 

Chapter 2 contains guidance for items on the Medical History and General Information page of FAA Form 8500-8, Application for Airman Medical Certificate or Airman Medical and Student Pilot Certificate. All application forms prior to the current FF series are obsolete and can no longer be used.

Both the yellow and white certificates/instructions must be removed before the application is given to the applicant. The Information for Applicant Sheet must also be given to the applicant.

On the general information and medical history page of the application, the applicant is to fill in Items 1-20 in his or her handwriting using a ballpoint pen, exerting sufficient pressure to make legible imprints upon the Examiner’s copy of the form.

The Examiner should verify with the applicant all of the information reported by the applicant in Items 1-9.

On occasion, individuals have attempted to be examined in the name of another person. If the applicant is new to the Examiner, the Examiner should request some evidence of positive identification. If an airman objects to providing identification, the Examiner should not withhold certification for this reason alone, but should report details of the incident promptly to the Aeromedical Certification Division, AAM-300, or the appropriate Regional Flight Surgeon.

The Examiner should also note the refusal to show identification on the application form in Item 60 and forward the form to the Aeromedical Certification Division, AAM-300.

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.

The Examiner should ensure completeness and review all items 1 through 20. A medical certificate should never be issued to an applicant who refuses to answer Items 13, 16, 17, 18, and 19, or to an applicant who refuses to sign the form (Item 20). Items 1-9 are necessary for identification and for the issuance of properly completed medical certificates to applicants who qualify. The date for Item 16 may be estimated if the applicant does not recall the actual date of the last examination. (See Item 16.)

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The applicant must personally enter all data and make all corrections on the application form. The applicant should initial all corrections. The application constitutes a legal document and must be completed in the applicant’s handwriting. If for any reason someone other than the applicant enters information in Items 1-20, the person should initial beside that item (including any check marks), and the Examiner should add a note explaining in Item 60 the person’s inability to enter the data.

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

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

The applicant indicates whether the application is for an Airman Medical Certificate (white) or an Airman Medical and Student Pilot Certificate (yellow), and 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, a student pilot may ask for a first-class medical certificate to see if he or she qualifies medically before entry into an aviation career.

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

 

ITEMS 3-10.  Identification

 

The following information is required for identification of the individual who is applying for medical certification:

 

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3.  Last Name; First Name; Middle Name

The applicant’s last, first, and middle name (or initial if appropriate) should be printed. All applicants without a middle name should enter “NMN” or “NONE”. Nicknames and abbreviated names should not be used. 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.

4.  Social Security Number (SSN)

Although applicants are asked to complete all questions on the application, FAA Form 8500-8, they are not legally required to complete Item 4. The FAA requests the SSN for identification purposes and record control. Its use as a unique identifier may eliminate a mistake in identification.

5.  Address and Telephone Number

The applicant should print a permanent mailing address, including country, and the zip code (full nine digits if known). The person should also provide a current daytime area code and telephone number.

6.  Date of Birth

The applicant should enter the numbers for the month, day, and year of birth in order (e.g., 04 29 2000 for April 29, 2000). Name, date of birth, and SSN are the basic identifiers of airmen. When an Examiner wishes to communicate with the FAA concerning an applicant, the Examiner should 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.

If the applicant wishes to be issued an Airman Medical and Student Pilot Certificate (FAA Form 8420-2), the Examiner should check the date of birth to ensure that the applicant is at least 16 years old. Unless the applicant is at least 16 years old, a combined Airman Medical and Student Pilot Certificate may not be issued, even if the applicant will become 16 before the certificate expires (except as noted below).

The FAA will recall a certificate issued by an Examiner to a person who is less than 16 years old. The applicant must be at least 16 to be eligible for a student pilot certificate for flight of powered aircraft. This minimum age requirement applies only to the issuance of the yellow FAA Form 8420-2, and never to the issuance of the white medical certificate (FAA Form 8500-9).

If the applicant is not yet 16 and wishes to solo on or after his or her 16th birthday, the Examiner should issue a white FAA Form 8500-9. (if

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the applicant is fully qualified medically). On or after his or her 16th birthday, the applicant may obtain a student pilot certificate for the flight from a Flight Standards District Office (FSDO) or designated Flight Examiner upon presentation of the FAA Form 8500-9 (white medical certificate).

An alternative procedure for this situation is for the Examiner to issue the Airman Medical and Student Pilot Certificate, FAA Form 8420-2 (yellow), with the following statement in the limitations block of the student pilot certificate:

Not valid until (month, day, and year of 16th birthday)

This procedure should not be used if the applicant’s 16th birthday will occur more than 30 days from the date of application.

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 makes them unable to pilot a glider or balloon.

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

7.  Color of Hair

Color of hair should be entered as “brown,” “black,” “blonde,” “gray,” or “red”. Lack of hair should be entered as “bald”. No abbreviations or other colors should be used. This information is for identification only.

8.  Color of Eyes

Color of eyes should be entered as “brown,” “black,” “blue,” “hazel,” “gray,” or “green”. No abbreviations or other colors should be used. This information is for identification only.

9.  Sex

The applicant should enter either male or female.

10.  Type of Airman Certificate(s) You Hold

Applicant checks appropriate block(s).

 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.

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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 Examiner 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 Examiner is authorized to issue a renewal medical certificate to the person if medically qualified; or

• The Examiner obtains oral or written authorization to issue a medical certificate from an FAA medical office.

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

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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 NONprescription)?

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. Guidelines for the certification of airmen who use antihypertensive medication may be found in Item 55.III., page 95

For example, any airman who is undergoing continuous treatment

with anticoagulants, antiviral agents, anxiolytics, barbiturates, chemotheraputic 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.

During periods in which the foregoing medications are being used for treatment of acute illnesses, the airman is under obligation not to perform the duties of an airman unless cleared by the FAA.

Further information concerning an applicant’s use of medication may be found under the items pertaining to the condition(s) for which the medication is used.

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 should counsel the applicant that the use of contact lens(es) (bifocal or unifocal) specifically for the correction of near vision is/are inappropriate. The AME should

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note in Item 60 that this counseling has been given.

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 the use of contact lens(es) specifically to correct near vision is/are inappropriate for flying.

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 certificate 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.

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Of particular importance are conditions that have developed since the last FAA medical examination. If more space is needed, a plain sheet of paper bearing the applicant’s full printed name, date of birth, signature, and the date should be used.

 

The Examiner must take the time to review the applicant’s responses on FAA Form 8500-8 before starting the applicant’s medical examination.

 

The Examiner should ensure that the applicant has checked all of the boxes in Item 18 as either “yes” or “no”. The Examiner 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 Examiner should provide in Item 60 an explanation of the nature of items checked “yes” in Items 18.a. through 18.x. An additional sheet may be added if necessary.

Supplementary reports from the applicant’s physician(s) should be obtained and forwarded to the Aeromedical Certification Division, AAM-300, 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 Examiner’s Regional Flight Surgeon 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 Examiner should attempt to establish rapport with the applicant and to develop a complete medical history. Further, the Examiner should be familiar with FA certification policies and procedures in order to provide the applicant with sound advice.

 

18.a.  Frequent or severe A history of simple headaches without sequelae 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 Examiner and require special evaluation and consideration (e.g., migraine and cluster headaches). Also see Item 46 for a discussion of headaches).

 

18.b.  Dizziness or fainting spells. 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.

Episodic disorders of dizziness or disequilibrium, however, are another matter and require careful evaluation

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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 for a discussion of syncope and vertigo).

 

18.c.  Unconsciousness for any reason. 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 Examiner. If the cause of the disturbance is explained and a loss of consciousness is not likely to recur, then medical certification may be possible.

If surgical treatment was necessary to correct the precipitating cause, the Examiner should defer issuance, transmit the application electronically as usual, and forward any available medical records and specialty reports to the Aeromedical Certification Division, AAM-300. (Also see Items 18.b., 18.l., and 46).

 

18.d.  Eye or vision trouble except glasses. The Examiner 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? (Also see Items 31 through 34, 53, and 54).

 

18.e.  Hay fever or allergy. Hay fever controlled solely by desensitization without requiring antihistamines or other medications is not disqualifying. Individuals who have hay fever that requires only occasional seasonal therapy may be certified by the Examiner with the stipulation that they not fly during the time when symptoms occur and treatment is required. However, nonsedating antihistamines including loratadine, astemizole, or fexofenadine may be used while flying, after adequate individual experience has determined that the medication is well tolerated without significant side effects.

Airmen with seasonal allergies requiring antihistamines may be certified by the Examiner with the stipulation that they not exercise privileges of airman certification within 24 hours of experiencing symptoms requiring treatment or within 24 hours after taking an antihistamine. The Examiner should document this in Item 60.

In the case of severe allergies, the Examiner should deny or defer certification and provide a report to the Aeromedical 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. (Also see Items 25 through 30).

A history of acute or chronic urticarial eruptions is not necessarily disqualifying. However, the Examiner should explore any relationship to

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cold exposure and trauma or to abdominal pain and/or diarrhea. Familial angioneurotic edema and acquired angioedema are disqualifying.

 

18.f.  Asthma or lung disease. A history of mild or seasonal asthmatic symptoms is not disqualifying if the applicant otherwise meets the medical standards and currently requires no treatment. A history of frequent severe attacks is disqualifying. Certificate issuance may be possible in other cases. If additional information is obtained, it must be submitted to the FAA. (Also see Item 35).

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.

On the other hand, an individual who has sustained a repeat pneumothorax normally is not eligible for certification until surgical intervention is carried out to correct the underlying problem. A person who has such a history is usually able to resume airman duties 3 months after the surgery. No special limitations on flying at altitude are applied.

Chronic bronchitis, emphysema, and/or chronic obstructive pulmonary disease (COPD) are often disqualifying. Certification may be considered in some cases, however, when the condition is mild without significant impairment of pulmonary functions. (See Item 35). If the applicant has frequent exacerbations or any degree of exertional dyspnea, certification should be deferred.

 

18.g.  Heart or vascular trouble. Because of the possibility of sudden and severe incapacitation, certain heart conditions are disqualifying based upon history alone, regardless of how remote that history may be. 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.

The Examiner may not issue a certificate to a person with such a history unless specifically authorized to do so by the FAA. The Examiner may issue a letter of denial or defer issuance and transmit the application to the Manager of the Aeromedical Certification Division. The Examiner should report any available information concerning this history in Item 60 of the application form.

The Examiner should deny or defer issuance to any applicant with a history of arrhythmia, except when the disturbance is sinus arrhythmia or occasional ventricular ectopic beats not due to organic heart disease.

An airman who has had an episode of acute rhythm disturbance may be considered by the Federal Air Surgeon for medical certification

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under the special issuance section of Part 67 (14 CFR 67.401) after an acceptable interval without recurrence. A history of

cardioversion or drug treatment, per se, does not rule out certification. A current, complete cardiovascular evaluation will be required. (See Item 36). An individual with chronic rhythm disturbance may apply for medical certification and would require a similar evaluation.

With the possible exceptions of aspirin and dipyridamole taken for their effect on blood platelets the use of anticoagulants, or other drugs for treatment or prophylaxis of fibrillation, may preclude medical certification.

Also potentially disqualifying is a history of cardiac decompensation, congenital heart disease with associated abnormalities such as cardiac enlargement, and significant valvular heart disease. The Examiner should assist in collecting data the FAA will need if the applicant wishes further consideration for certification. Documentation needed may include hospital and other medical records, a specialty evaluation, and certain laboratory tests and special procedures. Specifications for Cardiovascular Evaluation (FAA Form 8500-19) are included in Appendix B. (Also see Items 36 and 37).

 

18.h.  High or low blood pressure. 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 antihypertensive medication. The Examiner should also determine if the applicant has a history of complications, adverse reactions to therapy, hospitalization, etc. (Details are given in Item 55).

A history of low blood pressure requires elaboration. If the Examiner is in doubt, it is usually better to defer issuance rather than to deny certification for such a history.

 

18.i.  Stomach, liver, or intestinal trouble. A history of acute gastrointestinal disorders is usually not disqualifying once recovery is achieved.  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 Examiner should not issue a medical certificate if the applicant has a recent history of bleeding ulcers. Otherwise, ulcers must not have been active within the past 3 months. (Item 38 outlines the special studies needed for consideration of persons with an ulcer history).

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.

 

18.j.  Kidney stone or blood in urine. An Examiner may not issue a medical certificate to an applicant with a history of recent or recurring renal stones unless there is documentation that there is no residual stone or significant likelihood

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of recurrence. If the applicant has a remote history of a single episode of a kidney stone and is free of signs or symptoms, the Examiner may issue a medical certificate. The documentation obtained must be submitted to the FAA. Other significant renal history is discussed in Item 41. A history of recent or significant hematuria requires further elaboration or evaluation.

 

18.k.  Diabetes. A medical history or clinical diagnosis of diabetes mellitus requiring insulin or other hypoglycemic drugs for control are disqualifying. The application of persons with a history of diabetes currently treated by hypoglycemic medication should be deferred and transmitted to the Aeromedical Certification Division for further evaluation. (See Item 48).

The Examiner can help expedite the FAA review by assisting the applicant in gathering medical records and submitting a current specialty report. The application of persons with a history of diabetes controlled by diet and exercise may be issued a medical certificate by the Examiner in accordance with the guidelines in Item 48.

 

18.l.  Neurological disorders; epilepsy, seizures, stroke, paralysis, etc. An established diagnosis of epilepsy, a transient loss of control of nervous system function(s) without satisfactory medical explanation of the cause, or a disturbance of consciousness without a satisfactory medical explanation of the cause is a basis for denial no matter how remote the history. A medical certificate should be denied or deferred if the applicant has a history of or an existing neurological condition or disease that may be incapacitating. This includes a history of seizures or a single seizure.

The Examiner should obtain details about such a history and report the results of this inquiry in Item 60. Although the likelihood for certification is poor, the Examiner can assist the applicant who wishes further consideration by helping to acquire all past records.

 

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 Examiner. (See Items 46 and 47).

 

18.n.  Substance dependence; or failed a drug test ever; or substance abuse or use of illegal substance in the last 2years. “Substance” includes alcohol and other drugs (i.e., 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 Examiner should obtain a detailed description of the history. A history of substance dependence or abuse is disqualifying. The Examiner must defer issuance of a certificate if there

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is doubt concerning an applicant’s substance use. (See Item 47).

 

18.o.  Alcohol dependence or abuse. See Item 18.n.

 

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 Examiner 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).

 

18.q.  Motion sickness requiring medication. A careful supplemental history 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. If in doubt or if medication is repeatedly required, the Examiner should deny or defer issuance.

Supplemental history concerning the nature of the sickness, frequency, and need for medication should be reported in Item 60.

 

18.r.  Military medical discharge. If the person has received a military medical discharge, the Examiner 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 Examiner should inquire about the place, cause, and date of rejection and enter the information in Item 60. It is of great assistance to the applicant and the FAA if the Examiner can help obtain copies of military documents for attachment to the FAA Form 8500-8. If a delay of more than 2 weeks is expected, the Examiner should transmit FAA Form 8500-8 to the FAA with a note specifying what documents will be forwarded later under separate cover.

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 Examiner 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

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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.  Conviction and/or Administrative Action History. The events to be reported are specifically identified in Item 18.v. of FAA Form 8500-8. If “yes” is checked, the applicant must describe the conviction(s) and/or administrative action(s) in the EXPLANATIONS box. The description must include:

• The alcohol or drug offense for which the applicant was convicted or the type of administrative action involved (e.g., attendance at an educational or rehabilitation program in lieu of conviction; license denial, suspension, cancellation, or revocation for refusal to be tested; educational safe driving program for multiple speeding convictions; etc.);

• The name of the state or other jurisdiction involved; and

• The date of the conviction and/or administrative action.

If there have been no new convictions or administrative actions since the last application, the applicant may enter “PREVIOUSLY REPORTED, NO CHANGE.” Convictions and/or administrative actions affecting driving privileges may raise questions about the applicant’s fitness for certification and may be cause for disqualification. (See Items 18.n. and 47).

A single driving while intoxicated (DWI) conviction or administrative action usually is not cause for denial if there are no other instances or indications of substance dependence or abuse. The Examiner should inquire regarding the applicant’s alcohol use history, the circumstances surrounding the incident, and document those findings in Item 60. (See Item 47).

 

NOTE: The Examiner should advise the applicant that the reporting of alcohol or drug offenses (i.e., motor vehicle violation) on the history part of the medical application does not relieve the airman of responsibility to report each motor vehicle action to the FAA within 60 days of the occurrence to the Civil Aviation Security Division, AAC-700; P.O. Box 25810; Oklahoma City, OK  73125-0810.

 

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) in the EXPLANATIONS box. (See Item 47).

 

18.x.  Other illness, disability, or surgery. The applicant should describe the nature of these illnesses in the EXPLANATIONS box. If

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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 Examiner, the Examiner should defer issuance.

If the applicant wishes to have the FAA review the application and decide what ancillary documentation is needed, the Examiner should defer issuance of the medical certificate and forward the completed FAA Form 8500-8 to the Aeromedical Certification Division, AAM-300. If the Examiner 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 Aeromedical Certification Division with a note that additional documents will be forwarded later under separate cover.

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 Examiner should review the matter with the applicant. The Examiner will record in Item 60 only that information needed to document the review and provide the basis for a certification decision. If the Examiner finds the

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information to be of a personal or sensitive nature with no relevancy to flying safety, it should be recorded in Item 60 as follows:

“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 Examiner.

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 Examiner 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 Declarations

 

 

 

 

 

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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. The applicant should be instructed to sign Item 20 after reading the declaration. The signature should be in ink. If an applicant does not sign the declaration for any reason, the Examiner shall not issue a medical certificate but forward the incomplete application to the Aeromedical Certification Division, AAM-300.

END OF CHAPTER 2 | AME GUIDE

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