Aviation Medical Certificate Renewal History

This aviation medical certificate renewal history form is tailored for aviators undergoing periodic medical examinations required by the Federal Aviation Administration for first, second, or third class medical certificates. The form systematically documents all health changes, new medical conditions, hospitalizations, surgeries, and medication changes that have occurred since the applicant's previous FAA medical examination. It includes aviation-specific questions about in-flight medical events, loss of consciousness, vertigo episodes, and other conditions that could affect flight safety. Aviation Medical Examiners rely on this detailed interval history to determine continued medical fitness for flight duties.

The form includes sections for cardiovascular changes, neurological symptoms, psychiatric treatment, substance use, vision changes, hearing loss, and all new prescription medications. It also captures any FAA medical certificate denials, suspensions, or special issuance requirements from previous examinations. Special attention is given to conditions requiring FAA special issuance authorization such as diabetes, cardiac disease, mental health conditions, and sleep apnea. This template is essential for Aviation Medical Examiners, aerospace medicine clinics, flight surgeons, and occupational health providers serving commercial pilots, private pilots, air traffic controllers, and other aviation personnel.