ITEM 48. General Systemic

CHECK EACH ITEM IN APPROPRIATE COLUMN Normal Abnormal

I. Code of Federal Regulations

All Classes: 14 CFR 67.113(a)(b)(c), 67.213(a)(b)(c), and 67.313(a)(b)(c)

II. Examination Techniques

A protocol for examinations applicable to Item 48 is not provided because the necessary historytaking, observation, and other examination techniques used in examining other systems have already revealed much of what can be known about the status of the applicant's endocrine and other systems. For example, the examination of the skin alone can reveal important signs of thyroid dysfunction, Addison's disease, Cushing's disease, and several other endocrine disorders. The eye may reflect a thyroid disorder (exophthalmos) or diabetes (retinopathy).

When the AME reaches Item 48 in the course of the examination of an applicant, it is recommended that the AME take a moment to review and determine if key procedures have been performed in conjunction with examinations made under other items, and to determine the relevance of any positive or abnormal findings.

III. Aerospace Medical Disposition

The following is a table that lists the most common conditions of aeromedical significance, and course of action that should be taken by the AME as defined by the protocol and disposition in the table. Medical certificates must not be issued to an applicant with medical conditions that require deferral, or for any condition not listed in the table that may result in sudden or subtle incapacitation without consulting the AMCD or the RFS. Medical documentation must be submitted for any condition in order to support an issuance of an airman medical certificate.

Conditions:

(Updated 07/29/2026)

The following list of hyperlinks will take the user to the Web version of the AME Guide where the conditions are grouped together with any applicable, related documents.

Endocrinology Conditions

BLOOD DONATION

All Classes

(Updated 01/25/2017)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. One unit (less than or equal to 500 ml)	After a 24-hour recovery period and the airman has no symptoms:	ISSUE Summarize this history in Block 60.
B. Two or more units (more than 500 ml) This includes Power Red (double red cell donation)	After a 72-hour recovery period and the airman has no symptoms:	ISSUE Summarize this history in Block 60.
C. Platelet OR Plasma donation	After a 4-hour recovery period and the airman has no symptoms:	ISSUE Summarize this history in Block 60.

BLOOD AND BLOOD-FORMING TISSUE DISEASE

All Classes

(Updated 11/28/2018)

ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

All Classes

(Updated 04/26/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Treatment completed ten (10) or more years ago	The AME must review an oncology evaluation performed within the previous 12 months.If the oncology evaluation verifies the individual is cured, with no follow up treatment required:	ISSUESummarize this history in Block 60 and submit the evaluation to the FAA for retention in the pilot’s file.
B. All others	Submit the following to the FAA for review:☐ A current, detailed Clinical Progress Note generated from a clinic visit with the treating oncologist no more than 90 days before the AME exam. It must include a detailed summary of the history of the condition, physical exam findings, results of any testing performed, diagnosis, assessment and plan (prognosis), and followup. ☐ It must specifically include o Initial staging; o Treatments used; o How long the condition has been stable or in remission; o Any term follow-up (surveillance) requirements; o Recurrence(s); o Risk of recurrence; and o If recurrence were to occur, how would it present ☐ Medication list: Dates started and stopped. Description of side effects, if any; ☐ Operative notes and discharge summary (if applicable); ☐ Copies of lab including pathology reports, tumor markers (if already performed by treating physician); ☐ Copies of imaging reports from testing already performed (such as MRI/CT or PET scan); and ☐ Copies of any other testing already performed for this condition.	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter.

THROMBOCYTOPENIA

(Platelet count < 150,000) All Classes (Updated 09/25/2019)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. 5 or more years ago Most recent event/diagnosis	No symptoms or current problems. No ongoing treatment OR surveillance needed.	ISSUE Summarize this history in Block 60.
B. Less than 5 years ago Due to:Drugs (including HIT*), Infection (now resolved), Pregnancy, etc.*Heparin induced thrombocytopenia	• Treating physician report verifies condition has resolved or, if due to a medication, it has been stopped with no plan to re-start.• No symptoms or current problems.• No ongoing treatment OR surveillance needed.Note: If an underlying condition is identified, see that section. Example: Thrombocytopenia due to chemotherapy, malignancy, autoimmune disorders, or alcohol use.	ISSUE Summarize this history in Block 60
C. Less than 5 years ago Immune thrombocytopenia (ITP)	See CACI worksheetNote: CACI is for Chronic ITP only. All other causes of thrombocytopenia, See item “D. All Others” below.	Follow the CACI – Chronic Immune Thrombocytopenia (cITP) WorksheetAnnotate Block 60.
D. All others	Submit the following to the FAA for review: ☐ Current status report from the treating Hematologist with diagnosis, treatment plan and prognosis; ☐ If an underlying cause is identified, the status report should include diagnosis, treatment plan, prognosis, and adherence to treatment for this condition; ☐ List of medications and side effects, if any; ☐ Operative notes and discharge summary (if applicable); ☐ Copies of imaging reports or other lab (if already performed by treating hematologist); and ☐ CBC within the past 90 days.	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance will be per the airman’s authorization letter.

CACI – Chronic Immune Thrombocytopenia (cITP) Worksheet

(Also known as idiopathic thrombocytopenic purpura, immune thrombocytopenic purpura, or autoimmune thrombocytopenic purpura (AITP).

(Updated 04/27/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

*Notes: Chronic ITP defined as more than 12 months from diagnosis.

Any recurrence, bleeding that requires treatment, or platelet count drops below 50,000/microL OR if any surgery or invasive procedures are performed, the airman should not fly in accordance with 61.53.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified cITP.

[ ] Has current OR previous SI/AASI but now CACI qualified cITP.

[ ] NOT CACI qualified cITP. I have deferred. (Submit supporting documents.)

COVID-19 INFECTIONS

All Classes

(Updated 10/30/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Asymptomatic or mild infection;ORProlonged outpatient course;ORHospitalization, NOT requiring intensive (ICU) care	Fully recovered. No residual symptoms or clinical findings.*See COVID-19 MedicationSee Anosmia Disposition Table - Item 26. Nose.	ISSUE, if otherwise qualified
B. Hospitalization, requiring ICU care with or without ventilator	Submit the following to the FAA for review:A current, detailed Clinical Progress Note from the treating physician no more than 90 days before the AME exam to include: ☐ Current functional status, treatment plan and prognosis; ☐ Specialty consultations already performed (ex: neurology, cardiology, pulmonology, neuropsychology, etc.); ☐ List of current medications and side effects, if any; ☐ Hospital discharge summary; and ☐ Copies of imaging reports and lab (if already performed).	DEFER* Note in Block 60:“Intensive care COVID-19 infection with full recovery.”Submit the information to the FAA for review.
C. All othersLong COVID	Submit the following to the FAA for review:	DEFER** Note in Block 60:
Post-COVID Ongoing residual Signs and/or Symptoms* of confirmed COVID-19 such as:• Cardiovascular dysfunction;• Cognitive symptoms or concerns;• Kidney injury;• Neurological dysfunction;• Psychiatric conditions (depression, anxiety, moodiness);• Respiratory abnormalities; and/or• Symptoms such as fatigue, shortness of breath, cough, arthralgia, or chest pain.	A current, detailed Clinical Progress Note from the treating physician no more than 90 days before the AME exam to include:☐ Description the sequelae and current functional status; ☐ Treatment plan, and prognosis;☐ Specialty consultations performed (ex: neurology, cardiology, pulmonology, neuropsychology, etc.); ☐ List of medications and side effects, if any; ☐ Hospital discharge summary; (if applicable); and ☐ Copies of imaging reports and lab (if already performed by treating physician). ☐ 6MWT (in some cases)	“Currently experiencing sequelae from COVID-19 infection to include… (List the pathology or symptoms).”Submit the information to the FAA for review.

* See Anosmia Disposition Table for evaluation criteria

**DEFER - If the AME defers the exam, the FAA will request additional information, including hospitalization and treating physician records. After review, the FAA will determine eligibility for airman medical certificate or if special issuance or denial is indicated.

PREDIABETES

(Metabolic Syndrome, Impaired Fasting Glucose, Insulin Resistance, or Glucose Elevation/Intolerance)

All Classes

(09/27/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.Treated with lifestyle intervention	If the AME can determine the condition is:• Under control;• Current medications are acceptable; and• The individual has no symptoms that would interfere with flight duties:	ISSUEAnnotate this information in Block 60.
B. Treated with ONE diabetic medication (non-insulin) component	See the CACI – Prediabetes Worksheet and the Weight Loss Management or Prediabetes Status ReportThis requires a current, detailed Clinical Progress Note from the treating physician and Hemoglobin A1C lab performed no more than 90 days before the AME exam.If the pilot meets all CACI worksheet criteria and is otherwise qualified:	ISSUEAnnotate the correct CACI statement in Block 60 and keep the required supporting information on file.
C. Treated with TWO (2) or more diabetic medication (non-insulin) componentsNote: If the medication is taken for weight loss, and the individual has a diagnosis of diabetes, seewww.faa.gov/go/diabetic	Submit either:1. Diabetes or Hyperglycemia on Oral Medications Status Report (The treating physician must clearly indicate the reason for the medication and if there is any history of diabetes.)OR2. A current, detailed Clinical Progress Note from the treating physician which contains all the required information listed in the above status report.• It must include the indication for the medication and if there is any history of diabetes or not;• Hemoglobin A1c lab performed no more than 90 days before the AME exam.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

Note: For Polycystic Ovarian Syndrome (PCOS), see that page.

CACI – Prediabetes Worksheet

(Metabolic Syndrome, Impaired Fasting Glucose, Insulin Resistance, Glucose Elevation/Intolerance) (Updated 08/26/2026)* To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam. NOTE: CACI expanded to include diabetic medication taken for weight loss.

If the applicant has EVER had an A1C OF 6.5% OR GREATER, DO NOT USE THIS CACI.

AME MUST NOTE in Block 60 either of the following options:

[ ] CACI qualified prediabetes.

[ ] Has current OR previous SI/AASI but now CACI qualified prediabetes. [ ] NOT CACI qualified prediabetes. I have deferred. (Submit supporting documents.)

DIABETES MELLITUS

All Classes

(Updated 09/27/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Diet Controlled/In Remission or treated with lifestyle intervention	See Diabetes Mellitus – Diet Controlled Protocol	ISSUE Summarize this history, annotate Block 60
B. Treated with one or more (non-insulin) diabetic medications	See: Protocol for Diabetes Mellitus Treated with Any Medication Other Than InsulinFor acceptable medication and wait times, see Acceptable Combinations of Diabetes Medications.	DEFERSubmit the information to the FAA.Initial Special Issuance – Requires FAA DecisionFollow up Special Issuances - See Diabetes Mellitus - Type II, Medication Controlled (Not Insulin)
C. Treated with ANY type of insulin	1st and 2nd class must use:Diabetes Mellitus Type I or Type II - Insulin Treated - CGM Option Protocol3rd class may use the CGM protocol above OR theInsulin-Treated Diabetes Mellitus Non CGM – Third Class Option Protocol	DEFERSubmit the information to the FAA.Initial Special Issuance – Requires FAA Decision

DIABETES INSIPIDUS OR POLYURIA

(Arginine vasopressin deficiency; central diabetes insipidus or Arginine vasopressin resistance; nephrogenic diabetes insipidus)

All Classes

(Updated 09/27/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. 5 or more years agoDue to a temporary condition which has fully resolved (ex. pregnancy)ANDDid not require surgery	The AME should review a detailed Clinical Progress Note from a board-certified endocrinologist, nephrologist, or treating physician.If the documentation verifies that:• The individual has no sequela; and• The condition was due to a temporary condition which has resolved with no expectation to recur:	ISSUEAnnotate Block 60 and submit the evaluation to the FAA for retention in the file.
B. Arginine vasopressin deficiency (central diabetes insipidus)ORArginine vasopressin resistance (nephrogenic diabetes insipidus)ORUnknown causeIf due to a neurologic condition such as a tumor, infection, stroke, neurosurgery, or head injury, see that condition page.	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified endocrinologist, nephrologist, or treating physician no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition including etiology;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan;• Prognosis; and• Follow-up.2. Copies of any lab performed for evaluation of this condition.3. Copies of any imaging (CT/MRI, etc.) already performed.	DEFERSubmit the information to the FAA.
C.	Submit the following for FAA review:
Primary polydipsia (dipsogenic or psychogenic)If due to a neurologic condition such as a tumor, infection, stroke, neurosurgery, or head injury, see that condition page.	1. A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified endocrinologist, nephrologist or treating physician no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition; including etiology;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and plan;• Prognosis; and• Follow-up.2. Copies of any lab performed for evaluation of this condition.3. Copies of any imaging (CT/MRI, etc.) already performed.Note: Psychiatric evaluation will be requested if the documents show the condition is psychogenic polydipsia.	DEFER Submit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

ENDOCRINE DISORDERS

ACROMEGALY

All Classes

(Updated 07/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Due to pituitary tumorNOTE: Must submit this informationANDAny required pituitary tumor information.	Submit the following for FAA review:1. Sleep Study that meets current AASM or CMS Guidelines for a Type I or Type II sleep study (Type III or Type IV NOT allowed) performed no more than 12 months before the AME exam. (If currently treated for OSA, see that page.)2. A current, detailed Clinical Progress Note generated from a clinic visit with a cardiologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.3. Labs to include lipids and hemoglobin A1c performed no more than 90 days before the AME exam.4. Echocardiogram (Echo). Copies of a 2-D and Doppler flow study report performed no more than 90 days prior to the AME exam.5. 24-hour cardiac monitor performed no more than 90 days prior to the AME exam.≥ 24-hour cardiac monitor (such as a Holter, Zio Patch, etc.). It should have atrial and ventricular ectopic counts; hourly tabular data to include the longest pause duration and counts of all pauses > 2.0 or 2.5 seconds; heart rate (max, min, and average); other histograms and frequency graphs; and percentage of atrial fibrillation/flutter.	DEFERSubmit the information to the FAA for a possible Special Issuance
	6. A Neuropsychological evaluation that meets **FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment** from a clinic visit with the treating neuropsychologist no more than 90 days before the AME exam.7. Other records and testing: Copies of prior records and any testing already performed by the treating physician.8. All items listed on the correct row of the PITUITARY ADENOMA page.
B. Due to any other causeor tumor in any location other than pituitary gland.	Submit the following to the FAA for review:1. All items in Row A AND2. A current, detailed Clinical Progress Note generated from a clinic visit with the treating Endocrinologist no more than 90 days before the AME exam. It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and followup.3. It must specifically include the cause of acromegaly, if known.4. Copies of all imaging per location of tumor if present (pancreas, hypothalamus, etc.).5. Other records and testing already performed by the treating physician.	DEFERSubmit the information to the FAA for a possible Special Issuance

ADRENAL INSUFFICIENCY (Addison’s Disease)

All Classes

(Updated 07/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Any history of	Submit the following to the FAA for review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating Endocrinologist no more than 90 days before the AME exam.It must include a detailed summary of the history of the condition; current medications, dosages, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and followup.2. Copies of any testing already performed by the treating physician (e.g., labs, imaging).	DEFERSubmit the information to the FAA for a possible Special Issuance

CUSHING SYNDROME

All Classes

(Updated 07/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Any historyIf due to pituitary adenoma or other cause, see that page.	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating Endocrinologist no more than 90 days before the AME exam.It must include a detailed summary of the history of the condition; current medications, dosages, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.It must specifically include:• Cardiovascular risk factors;• Functional capacity;• Any concern for OSA; and• Any neuropsychological or psychiatric concerns.2. Labs. Hemoglobin A1c no more than 90 days prior to exam. Any other labs already performed or clinically indicated.3. Operative and pathology report(s), if applicable.4. Reports of imaging studies (CT/MRI/ultrasound) already performed.After reviewing the above, some cases will require a Neuropsychological Evaluation in accordance with the Potential Neurocognitive Impairment specification sheet.	DEFERSubmit the information to the FAA for a possible Special Issuance.Annotate (elements or findings) in Item 60.

• HYPOGLYCEMIA
• All Classes
• (Updated 07/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Associated with diabetes mellitus or diabetes medication	See corresponding diabetes page.
B. Asymptomatic and incidental findings on labs ONLYORA single episode due to a specific cause which is unlikely to recur.Examples: decreased intake in setting of extreme exercise (marathon), critical illness	The AME should review any applicable records:• Hospital History & Physical (H&P);• Hospital discharge summary;• Emergency Department notes;• Office visit notes; and• Lab or other testing results.If the AME can determine that the condition has fully resolved without sequelae, with no evidence of or concern for recurrence or problems that would interfere with flight duties:	ISSUEAnnotate this information in Block 60.
C.Single episode WITHOUT specific causeORMultiple episodes (recurrent)ORHypoglycemia related to metabolic disorderNote: If a secondary cause is identified (e.g. adrenal insufficiency, hypothyroidism, or tumor), see that page.	Submit the following to the FAA for review:1. A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified endocrinologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include frequency of episodes, symptoms, all testing performed, diagnosis, treatment, and likelihood of recurrent hypoglycemia.3. Results of all testing (e.g. lab work, imaging) performed for this	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

HYPERPARATHYROIDISM

All Classes

(07/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Treated with parathyroidectomy• Fully recovered,• Normal calcium and PTH levels, and• Symptoms resolvedIf history of kidney stones, see that page.	If the AME can determine there are no symptoms or current problems that would interfere with flight duties and no ongoing treatment or surveillance needed:	ISSUESummarize this information in Block 60.
B. All others• Treated nonoperatively• Symptomatic• Abnormal calcium or PTH levels• Cause unknownIf history of kidney stones, see that page.	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating Endocrinologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Lab. Serum calcium, PTH, and urinary calcium performed no more than 90 days prior to the AME exam.3. Imaging (X-ray or CT). Report from imaging study to evaluate for the presence of kidney stones no more than 90 days prior to the AME exam.4. Results of any other testing already performed.	DEFERSubmit the information to the FAA for a possible Special Issuance.
C. Secondary hyperparathyroidismIf no cause identified, see Row B	See corresponding underlying cause (e.g., chronic kidney disease) page.

HYPOPARATHYROIDISM

All Classes

(08/28/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.Post-surgical hypoPARAthyroidismhypoPARAthyroidism treated with surgery six (6) or more months agoAND• Condition resolved• Asymptomatic• No longer requires treatment.	If the AME is able to determine through history and physical exam, the condition has resolved with surgery 6 or more months ago, is asymptomatic, and no longer requires treatment	ISSUEAnnotate (elements or findings) in Item 60.
B.Post-surgical hypoPARAthyroidism treated with surgery less than six (6) months agoORTreated at any time and remains symptomaticAND/ORCurrently requires treatment with medications and/or supplements (e.g., calcium carbonate or calcium citrate)	Submit the following:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating SURGEON no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include the indication for surgery and clinical interpretation of lab results below.3. Lab performed no more than 90 days before the AME exam to include:• Basic metabolic panel• Intact PTH• Magnesium• Phosphorus• Total serum or ionized calcium• 25-hydroxy vitamin D	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Item 60.
	4. Any other testing already performed or deemed clinically necessary by the treating physician.
C.Chronic hypoPARAthyroidism due to autoimmune or other cause (treated or untreated)	Submit the following:1. A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified ENDOCRINOLOGIST no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. It must specifically include if any history (or not) of cardiac, renal (including nephrolithiasis) ,or skeletal manifestations; clinical interpretation of lab results below; and a detailed neurological exam.3. Lab performed no more than 90 days before the AME exam to include:• Basic metabolic panel• Intact PTH• Magnesium• Phosphorus• Total serum or ionized calcium• 25-hydroxy vitamin D• 24-hour urine calcium and creatinine excretion4. Report from renal stone imaging of clinician’s choice (to identify presence of stones).5. A current, detailed Clinical Progress Note generated from a clinic visit with a board-certified OPHTHALMOLOGIST no more than 90 days before the AME exam.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Item 60.
	It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.6. Any other testing already performed or deemed clinically necessary by the treating physician.Note: Neuropsychological evaluation that meets FAA Specifications for Neuropsychological Evaluations for Potential Neurocognitive Impairment may be required after review of the submitted information.

HYPERPROLACTINEMIA

All Classes

Updated 07/29/2026

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Due to pituitary tumor	See Pituitary Adenoma page.
B. Due to any other cause(e.g., adrenal insufficiency, hypothyroidism, medication, chronic kidney disease, or tumor in any location other than pituitary)	Submit the following for FAA review:2. A current, detailed Clinical Progress Note generated from a clinic visit with their treating endocrinologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.It must specifically include a discussion of the cause of the hyperprolactinemia, including any concern of a pituitary tumor.3. Results of any other testing (e.g., labs or imaging) already performed.4. Medical records from any visit associated with this condition.5. If any concern for pituitary tumor, MRI pituitary must be submitted. See Pituitary Adenoma page for requirements.	DEFERSubmit the information to the FAA for a possible Special Issuance.

HYPERTHYROIDISM

All Classes

(Updated 07/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Any history	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating physician (family medicine, internal medicine, endocrinology) no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.2. Lab: Performed no more than 90 days before the AME exam to include• Thyroid Stimulating Hormone (TSH), and• Any other lab already performed (e.g. T3, Free T4) by the treating physician.3. Imaging: Copies of any imaging reports (MRI, CT, ultrasound, X-ray) already performed.4. Any other testing deemed clinically necessary by the treating physician.5. If previous thyroidectomy, submit operative report, History and Physical, and Discharge summary.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

HYPOTHYROID or HYPOTHYROIDISM

(Including Hashimoto's Disease) All Classes (Updated 01/25/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Resolved No treatment required	If the AME is able to determine through history and exam no treatment necessary, no symptoms, and no clinical concern:	ISSUEAnnotate this information in Block 60.
B. Primary Hypothyroidism	See the CACI - Hypothyroidism Worksheet.This will require a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days before the AME exam AND TSH.Note: As of 1/25/2023, TSH up to 9.9 can be considered for CACI if other criteria are met.	If the pilot meets all CACI worksheet criteria and is otherwise qualified,ISSUE with no time limitation Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
C. Primary HypothyroidismSymptomaticTSH 10 mIU/L or higherCentral Hypothyroidism(Due to pituitary or hypothalamic disease)	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician performed no more than 90 days before the AME exam. (Diagnosis of Central Hypothyroidism should be evaluated by an endocrinologist.) It must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment; plan (prognosis); and follow-up.2. Lab: Performed within 90 days of the AME exam to include:• Thyroid Stimulating Hormone (TSH), and• Any other lab already performed (Ex. T3, Free T4) by the treating physician. 3. Imaging: Copies of any imaging reports (MRI, CT, ultrasound, Xray) already performed.	DEFERSubmit the information to the FAA for a possible Special Issuance.
	• Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.4. Any other testing deemed clinically necessary by the treating physician.

CACI - Hypothyroidism Worksheet

(Updated 06/28/2023) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified hypothyroidism. (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified hypothyroidism.

[ ] NOT CACI qualified hypothyroidism. I have deferred. (Submit supporting documents.)

PITUITARY ADENOMA

(Microadenoma or Macroadenoma) All Classes

Updated 07/29/2026

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Microadenoma (Tumor size < 1cm)Not treated with surgery or radiation	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating endocrinologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.It must specifically include whether surgical intervention is recommended.2. MRI of the pituitary gland with and without contrast within the last 12 months confirming tumor size.3. Copies of all prior clinical records, laboratory testing, and imaging for this condition.Note: If functional tumor (secreting), please also refer to appropriate page (Acromegaly, Cushing’s, etc.) for additional requirements	DEFERSubmit the information to the FAA for a possible Special Issuance.
B. Macroadenoma (Tumor size 1cm or larger)Not treated with surgery or radiation	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with their treating endocrinologist no more than 90 days before the AME exam.It should include a summary of the history of the condition or diagnosis; current medications, dosages, and side effects (if any); clinical exam findings; results of any testing performed; diagnosis; assessment and plan (prognosis); and follow-up.It must specifically include whether surgical intervention is recommended.2. MRI of the pituitary gland with and without contrast within the last 12 months confirming tumor size.3. Copies of all prior clinical records, laboratory testing, and imaging for this condition.4. A current, detailed Clinical Progress Note generated from a clinic visit with an ophthalmologist no more than 90 days before the AME exam.It should include an explanation of the visual fields (normal, abnormal, or field loss) and if there is any evidence of optic nerve disease.5. Visual field graphs (24-2 or 30-2) with clinical interpretation by the treating eye specialist performed no more than 90 days prior to the AME exam.6. Any other testing/studies accomplished for the diagnosis or treatment.7. If evaluated by surgeon (neurosurgery or ENT), submit a copy of the progress note from the office visit including discussion of surgical recommendation.Note: If functional tumor (secreting), also refer to the appropriate page (Acromegaly, Cushing’s, etc.) for additional requirements.	DEFERSubmit the information to the FAA for a possible Special Issuance.
C. Pituitary Adenoma (micro or macro)Treated with surgery or radiation	After completion of all treatment (including radiation therapy, if applicable), allow a 6-month recovery period before submitting the following to the FAA for review:1. All items in Row B 2. Hospital records pertaining to surgical resection: a. History and Physical b. Discharge Summary c. Operative Reports d. Pathology reportsNote: If functional tumor (secreting), also refer to the appropriate page (Acromegaly, Cushing’s, etc.) for additional requirements.	DEFERSubmit the information to the FAA for a possible Special Issuance.

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

All Classes

(Updated 04/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
HIV medication taken for long-term prevention or Pre-Exposure Prophylaxis (PrEP) in an HIV negative airman*Note: This does NOT include use for short-term Post-Exposure Prophylaxis (PEP) - (ex: healthcare exposure.)	Review a current status report from the prescribing physician that verifies:☐ HIV status is negative; ☐ Appropriate lab studies are being monitored; ☐ Medication is Truvada (tenofovir-emtricitabine), Descovy (emtricitabine and tenofovir alafenamide), or Apretude (cabotegravir); or Yeztugo (lenacapavir) ☐ No side effects from the medication.	ISSUENote this in Block 60 and submit the initial current status and lab report to FAA for retention in the airman’s file.Inform the airman that if they develop any problems with the medication, change in prophylactic medications, or seroconvert to HIV+ status they must report this to the FAA.For continued certification: If no change in medication and HIV status remains negative, the AME may issue and note this in Block 60.
Human Immunodeficiency Virus (HIV)Use this disposition if the airman has a history of HIV only.	See HIV Protocol	DEFERRequires FAA Decision
Acquired Immunodeficiency Syndrome (AIDS)Use this disposition if the airman has EVER had a history of AIDS.	See HIV Protocol	DEFER Requires FAA Decision

NEOPLASMS

All Classes

(Updated 02/25/2026) DISEASE/CONDITION EVALUATION DATA DISPOSITION Also see:

• G-U System Cancers
• Kaposi’s Sarcoma
• Leukemias and
• Lymphomas
• Malignant Melanomas
• Eye Tumors

BREAST CANCER

All Classes

(Updated 09/27/2021)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Non metastatic – treatment completed 5 or more years ago	If no recurrence, current problems, or ongoing treatment:Continued hormone treatment is allowed (tamoxifen, aromatase inhibitor)	ISSUE Summarize this history in Block 60.
B. Non metastatic – treatment completed Less than 5 years ago	See CACI worksheet	Follow the CACI – Breast Cancer Worksheet. Annotate Block 60.
C. All others Chemotherapy used Lymph node spread Metastatic disease Stage IA or higher	Submit the following to the FAA for review: ☐ Status report or treatment records from treating oncologist that provides the following information: o Initial staging, o Disease course including recurrence(s), o Location(s) of metastatic disease (if any), o Treatments used, o How long the condition has been stable, o If any upcoming treatment change is planned or expected and prognosis;☐ Medication list. Dates started and stopped.	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance Will be per the airman’s authorization letter.
	Description of side effects, if any; ☐ Operative notes and discharge summary (if applicable); ☐ Copies of lab including pathology reports, tumor markers (if already performed by treating physician); Copies of imaging such as mammogram, MRI/CT or PET scan reports that have already been performed.(In some cases, the actual CDs will be required in DICOM format for FAA review).

CACI – Breast Cancer Worksheet (Updated 04/27/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

Notes: If it has been 5 or more years since the airman has had any treatment (surgery or radiation) for this condition, has no history of metastatic disease, and no reoccurrence, CACI is not required. Note this in Block 60.

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified breast cancer (Documents do not need to be submitted to the FAA.)

[ ] Has current OR previous SI/AASI but now CACI qualified breast cancer.

[ ] NOT CACI qualified breast cancer. I have deferred. (Submit supporting documents.)

• HORMONE REPLACEMENT THERAPY (HRT) - Female
• All Classes
• (Updated 04/29/2026)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.Hormone replacement(e.g. estrogen, progesterone, or testosterone)near physiologic levels	If the AME can determine there are• no side effects which would interfere with flight duties,• no history of VTE (PE/DVT)• no history or increased risk of stroke, severe migraine, or uncontrolled HTNNote: if the AME determines the individual is at increased risk for VTE (e.g. hypercoagulable condition), go to row B.	ISSUESummarize in Item 60.
B. All othersIf history of VTE or stroke, see that page	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician no more than 90 days prior to the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any);• Physical exam findings;• Results of any testing performed;• Diagnosis;• Assessment and Plan;• Prognosis and Follow-up.2. It must specifically include if any history of: o Hypercoagulable condition o VTE (PE/DVT) or stroke.3. Labs or imaging already performed or determined necessary by the treating provider.	DEFERSubmit the information to the FAA for a possible Special Issuance.Summarize elements or findings in Item 60.

• POLYCYSTIC OVARIAN SYNDROME (PCOS)
• All Classes
• (Updated 09/27/2023)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A.Not requiring medication; treated with lifestyle intervention only	If the AME can determine:• Condition is under control;• No medications used; and• No symptoms that would interfere with flight or safety related duties	ISSUEAnnotate this information in Block 60.
B. Treated with acceptable medication(s).	See the CACI - Polycystic Ovarian Syndrome (PCOS) Worksheet.This will require a current, detailed Clinical Progress Note.If the pilot meets all CACI worksheet criteria and is otherwise qualified:	ISSUE with no time limitationAnnotate the correct CACI statement in Block 60 and keep the required supporting information on file.
C. All others	Submit the following for FAA review:1. A current, detailed Clinical Progress Note generated from a clinic visit with the treating endocrinologist, OB/GYN, or treating physician no more than 90 days before the AME exam. It must include:• A detailed summary of the history of the condition;• Current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan; prognosis; and follow-up.2. The Clinical Progress Note must specifically include if there is any:• History of obstructive sleep apnea;• Evidence of depression or anxiety as indicated; by current PHQ-9/GAD-7 score); and/or• Evidence of diabetes.3. Any other testing already completed or deemed necessary by the treating physician.	DEFER Submit the information to the FAA for a possible Special Issuance

CACI – Polycystic Ovarian Syndrome (PCOS) Worksheet

(Updated 03/25/2026) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the Examiner can issue. Applicants for first or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

• AME MUST REVIEW ACCEPTABLE CERTIFICATION
• CRITERIA

Treating physician finds the condition:

☐ Stable on current regimen;

☐ No side effects from medication;

☐ Cardiovascular risk factors are controlled; and ☐ No changes recommended.

• [ ] Yes
• History of obstructive sleep apnea [ ] No
• OR
• [ ] OSA adequately treated

(Applicant has Special Issuance.)

Any Evidence of depression or anxiety

(as indicated by current PHQ-9/GAD-7 score)?

[ ] No

Any evidence of diabetes or prolactinoma? [ ] No

Treated with the acceptable medication(s) listed:

(May be used in combination) [ ] YES

Indicate medication(s) used:

☐ anti-androgen (e.g., finasteride, dutasteride) ☐ letrozole ☐ metformin ☐ oral contraceptive ☐ spironolactone (7-day wait)

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Polycystic Ovary Syndrome [PCOS].

[ ] Has current OR previous SI/AASI but now CACI qualified Polycystic Ovary Syndrome [PCOS].

[ ] NOT CACI qualified Polycystic Ovary Syndrome [PCOS]. I have deferred. (Submit supporting documents.)

PREGNANCY

Pregnancy under normal circumstances is not disqualifying. It is recommended that the applicant's obstetrician be made aware of all aviation activities so that the obstetrician can properly advise the applicant. The AME may wish to counsel applicants concerning piloting aircraft during the third trimester. The proper use of lap belt and shoulder harness warrants discussion.

• PRIMARY HEMOCHROMATOSIS
• All Classes
• (Updated 10/27/2021)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Tested and found not to have the disease.Carrier status in the Absence of disease is not disqualifying.	No evaluations or follow up needed.	ISSUE Summarize this history in Block 60.
B. Asymptomatic	See CACI worksheet	Follow the CACI-Primary Hemochromatosis Worksheet. Annotate Block 60.
C. SymptomaticOREvidence of End Organ DamageOR Co-morbid conditions*• Unacceptable medications are used;• Side effects are present;• Phlebotomy performed more than monthly; and/or• Iron overload caused by other mechanisms or diseases (e.g. secondary hemochromatosis	Submit the following to the FAA for review:☐ Current evaluation from a board-certified gastroenterologist, hepatologist, or hematologist which documents course of disease from diagnosis to present; severity of the condition; presence or absence of joint, liver, CNS, endocrine, renal or hematologic disease; pertinent historical lab summary; and evidence of any cognitive changes. Evaluation should document stability, treatment plan, and prognosis. ☐ List of medications and side effects, if any ☐ Current Lab (within the past 90 days) ☐ CBC, serum iron, ferritin level, and transferrin saturation ☐ Comprehensive metabolic panel	DEFER Submit the information to the FAA for a possible Special Issuance.Follow up Issuance will be per the airman’s authorization letter.
	☐ Hemoglobin A1c ☐ TSH ☐ Resting EKG ☐ Echocardiogram ☐ Liver/cardiac imaging and biopsies (only if clinically indicated) ☐ Any other testing clinically indicated

*Note:

Co-morbid conditions for FAA purposes include:

CACI – Primary Hemochromatosis Worksheet

(Updated 04/13/2022) To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.

• AME MUST REVIEW ACCEPTABLE CERTIFICATION
• CRITERIA

Treating physician finds the condition is:

and

Treating physician documents NO evidence of:

hypopituitarism, hypogonadism, or hypothyroidism;

Labs (within past 90 days):

Current treatment:

Note: Maintain hydration following phlebotomy and no fly for 24 hours. If more than one unit of blood is removed (greater than 500mL), no fly time is 72 hours.

[ ] None or dietary changes

OR [ ] Phlebotomy no more frequently than monthly

AME MUST NOTE in Block 60 one of the following:

[ ] CACI qualified Primary Hemochromatosis

[ ] Has current OR previous SI/AASI but now CACI qualified Primary Hemochromatosis.

[ ] NOT CACI qualified Primary Hemochromatosis. I have deferred. (Submit supporting documents.)

WEIGHT LOSS MANAGEMENT

(Use of Medication for Obesity or Overweight) All Classes (Updated 03/27/2024)

DISEASE/CONDITION	EVALUATION DATA	DISPOSITION
A. Treated with lifestyle intervention or acceptable over the counter (OTC) medicationsSee Weight Loss Medications	If the AME can determine the condition is:• Under control;• Current medications are acceptable; and• The individual has no symptoms that would interfere with flight duties:	ISSUEAnnotate this information in Block 60.
B. Treated with ONE diabetic medication (non-insulin) component	See the CACI – Weight Loss Management Worksheet.This requires a current, detailed Clinical Progress Note from the treating physician and Hemoglobin A1c lab performed no more than 90 days before the AME exam. OR Weight Loss Management Status Report If the pilot meets all CACI worksheet criteria and is otherwise qualified:	ISSUEAnnotate the correct CACI statement in Block 60 and keep the required supporting information on file.
C. Treated with TWO (2) or more diabetic medication (non-insulin) componentsNote: If the medication is taken for weight loss, and the individual has a diagnosis of diabetes, seewww.faa.gov/go/diabetic	Submit either:1. Weight Loss Management Status Report (The treating physician must clearly indicate the reason for the medication and if there is any history of diabetes.)OR2. A current, detailed Clinical Progress Note from the treating physician which contains all the required information listed in the above status report.• It must include the indication for the medication and if there is any history of diabetes or not;• Hemoglobin A1c lab performed no more than 90 days before the AME exam.	DEFERSubmit the information to the FAA for a possible Special IssuanceAnnotate (elements or findings) in Block 60.

Note: For Polycystic Ovarian Syndrome (PCOS), see that page.

CACI – Weight Loss Management Worksheet

(Use of Medication for Obesity or Overweight)

(Updated 09/30/2026)* To determine the applicant’s eligibility for certification, the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam. If the applicant meets ALL the acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam. NOTE: CACI expanded to include diabetic medication taken for weight loss.

If the applicant has EVER had an A1C OF 6.5% OR GREATER, DO NOT USE THIS CACI.

AME MUST NOTE in Block 60 one of the following options:

[ ] CACI qualified weight loss management.

[ ] Has current OR previous SI/AASI but now CACI qualified weight loss management. [ ] NOT CACI qualified weight loss management. I have deferred. (Submit supporting documents.)

WEIGHT LOSS MANAGEMENT or PREDIABETES STATUS REPORT

(Updated 04/29/2026) Name ________________________________ Birthdate ______________________

Applicant ID# __________________________ PI#___________________________

Please have the provider who prescribes your medication for weight loss or prediabetes enter the information in the space below. Return the completed status report to your AME to upload into your FAA file.

Reason for taking this medication:

• [ ] Prediabetes/hyperglycemia [ ] Weight loss management
• Date of last clinical encounter____________
• Date of most recent MEDICATION change ____________

A1C required only for prediabetes (dated within 90 days of the AME exam); enter n/a if medication is for weight loss only

(If taking GLP-1, verify no psychiatric side effects.)

________________________________________________________________________________

______________________________________________________________________ *If any YES answers, please attach narrative, tests, etc.

__________________________________ ________________ Treating Provider Signature Date

_______________________________________________ _______________________ Name or Office Stamp Phone Number

Note: If diagnosed with diabetes, see www.faa.gov/go/diabetic.

If taking insulin, see www.faa.gov/go/ITDM