Aviation Physical Examination Medical History
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Aviation Physical Examination Medical History
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This aviation physical examination medical history form is specifically designed to meet Federal Aviation Administration (FAA) requirements for airman medical certificates. The form systematically collects detailed health information relevant to flight safety, including cardiovascular disease, diabetes, seizures, psychiatric conditions, substance use, and medications that may affect pilot performance or require special issuance authorization.
Tailored for Aviation Medical Examiners (AMEs) and aerospace medicine clinics, this comprehensive form streamlines the medical certification process by capturing all information needed for Class 1, 2, and 3 medical certificates. It includes questions about previous FAA denials or deferrals, special issuance authorizations, and aviation-specific concerns like spatial disorientation, color vision deficiencies, and hearing loss. The form helps identify conditions requiring additional documentation or FAA review before certificate issuance, reducing examination delays and ensuring regulatory compliance.
What's included
- Complete cardiovascular disease history
- Neurological conditions and seizure history
- Psychiatric and mental health treatment history
- Substance use and DUI/DWI history
- Diabetes and metabolic disorder screening
- Vision and hearing deficit documentation
- Current prescription and OTC medications
- Previous FAA medical certificate denials or deferrals
- Special issuance authorization status
- Sleep apnea and sleep disorder screening
- Recent hospitalizations and surgeries
- Family history of sudden cardiac death
Who uses this template
- Aviation Medical Examiner (AME) offices
- Aerospace medicine clinics
- Occupational medicine practices serving pilots
- Military aviation medicine facilities
- Flight school medical screening programs
All form fields
10 fields across 3 pages. Customize any field after signing up.
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