Aviation Medical Recertification History
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Aviation Medical Recertification History
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This specialized medical history form is designed for pilots and aviation medical examiners (AMEs) conducting recertification examinations for FAA airman medical certificates. It focuses on capturing changes in health status since the previous medical certificate, including new diagnoses, hospitalizations, surgeries, medication changes, vision changes, and reportable incidents. The form streamlines the renewal process by documenting only interval changes rather than complete medical history.
Essential for aviation medical examiners, flight schools, corporate flight departments, and pilots maintaining first, second, or third class medical certificates. The form includes FAA-specific questions about disqualifying conditions, substance use, mental health changes, cardiovascular events, and neurological symptoms. It ensures compliance with FAR Part 67 medical standards and helps identify conditions requiring special issuance or deferral to the FAA Aerospace Medical Certification Division.
What's included
- Previous medical certificate details
- Interval health changes documentation
- New medications and dosage changes
- Surgeries and hospitalizations since last exam
- Vision and hearing changes
- Cardiovascular event screening
- Mental health and substance use updates
- Reportable incidents or accidents
- FAA disqualifying condition checklist
- Special issuance status updates
Who uses this template
- Aviation medical examiner offices
- Flight school medical programs
- Corporate aviation departments
- Military to civilian pilot transitions
- Commercial airline pilot health monitoring
All form fields
10 fields across 3 pages. Customize any field after signing up.
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