Aviation Medical Certificate Renewal History Form

This aviation medical certificate renewal history form is tailored for Aviation Medical Examiners (AMEs), flight surgeons, and pilots seeking to renew their first-class, second-class, or third-class FAA medical certificates. The form focuses specifically on interval changes since the previous medical examination, streamlining the renewal process by documenting new health conditions, medication changes, surgical procedures, emergency room visits, and any reportable events that may affect flight safety or require additional FAA review and special issuance consideration.

The template includes targeted questions about cardiovascular changes, vision deterioration, neurological symptoms, psychiatric medication additions, diabetes progression, sleep apnea diagnosis, loss of consciousness events, and substance use patterns that are critical for FAA medical certification decisions. It helps AMEs efficiently identify conditions requiring deferral to the FAA Aerospace Medical Certification Division, document compliance with special issuance requirements, and ensure pilots meet the medical standards outlined in 14 CFR Part 67. The form supports BasicMed conversions and helps maintain complete longitudinal health records essential for aviation safety.