APPLICATION FOR MEDICAL CERTIFICATION

Items 1-20 of FAA Form 8500-8

ITEMS 1- 20 of FAA Form 8500-8

This section contains guidance for items on the Medical History and General Information page of FAA Form 8500-8, Application for Airman Medical Certificate.

I. AME Guidance for Positive Identification of Airmen and Application Procedures

All applicants must show proof of age and identity under 14 CFR §67.4. On occasion, individuals have attempted to be examined under a false name. If the applicant is unknown to the AME, the AME should request evidence of positive identification. A Government-issued photo identification (e.g., driver’s license, identification card issued by a driver’s license authority, military identification, or passport) provides age and identity and is preferred. Applicants may use other government-issued identification for age (e.g., certified copy of a birth certificate); however, the AME must request separate photo identification for identity (such as a work badge). Verify that the address provided is the same as that given under Item 5. Record the type of identification(s) provided and identifying number(s) under Item 60. Make a copy of the identification and keep it on file for 3 years with the AME work copy.

An applicant who does not have government-issued photo identification may use nonphoto government-issued identification (e.g. pilot certificate, birth certificate, voter registration card) in conjunction with a photo identification (e.g. work identification card, student identification card).

If an airman fails to provide identification, the AME must report this immediately to the AMCD, or the appropriate RFS for guidance.

II. Prior to the Examination

(Updated 02/28/2018)

AMEs should call AMCS Support if the confirmation number cannot be retrieved.

III. After the Applicant Completes the Medical History of the FAA Form 8500-8

The AME must review all Items 1 through 20 for accuracy. The applicant must answer all questions. The date for Item 16 may be estimated if the applicant does not recall the actual date of the last examination. However, for the sake of electronic transmission, it must be placed in the mm/dd/yyyy format.

Verify that the name on the applicant's identification media matches the name on the FAA Form 8500-8. If it does not, question the applicant for an explanation. If the explanation is not reasonable (legal name change, subsequent marriage, etc.), do not continue the medical examination or issue a medical certificate. Contact your RFS for guidance.

The applicant's Social Security Number (SSN) is not mandatory. Failure to provide is not grounds for refusal to issue a medical certificate. (See Item 4). All other items on the form must be completed.

Applicants must provide their home address on the FAA Form 8500-8. Applicants may use a private mailing address (e.g., a P.O. Box number or a mail drop) if that is their preferred mailing address; however, under Item 18 (in the "Explanations" box) of the FAA Form 8500-8, they must provide their home address.

An applicant cannot make updates to their application once they have certified and submitted it. If the AME discovers the need for corrections to the application during the review, the AME is required to discuss these changes with the applicant and obtain their approval. The AME must make any changes to the application in AMCS.

Strict compliance with this procedure is essential in case it becomes necessary for the FAA to take legal action for falsification of the application.

ITEMS 1-2. Application for; Class of Medical Certificate Applied For

The applicant indicates the class of medical certificate desired. The class of medical certificate sought by the applicant is needed so that the appropriate medical standards may be applied. The class of certificate issued must correspond with that for which the applicant has applied.

The applicant may ask for a medical certificate of a higher class than needed for the type of flying or duties currently performed. For example, an aviation student may ask for a first-class medical certificate to see if he or she qualifies medically before entry into an aviation career. A recreational pilot may ask for a first- or second-class medical certificate if they desire.

The AME applies the standards appropriate to the class sought, not to the airman's duties - either performed or anticipated. The AME should never issue more than one certificate based on the same examination.

ITEMS 3-10. Identification

Items 3-10 on the FAA Form 8500-8 must be entered as identification. While most of the items are self-explanatory (as indicated in the MedXPress drop-down menu next to individual items) specific instructions include:

*If an applicant has no middle name, leave the middle name box blank. Do not use nomenclature which indicates no middle name (i.e. NMN, NMI, etc.). If the applicant has used such a nomenclature on their MedXPress application, delete it and leave the middle name box blank.

Note: If the applicant's name changed for any reason, the current name is listed on the application and any former name(s) in the EXPLANATIONS box of Item 18 on the application.

The applicant should indicate citizenship (e.g., USA).

*Providing an SSN is not mandatory. See instructions for applicants who do not wish to use their SSN (Item 4).

The applicant should enter either male or female.

Applicant checks appropriate block(s).

ITEMS 11-12. Occupation; Employer

Occupational data are principally used for statistical purposes. This information, along with information obtained from Items 10, 14 and 15 may be important in determining whether a SODA may be issued, if applicable.

This should reflect the applicant's major employment. "Pilot" should only be reported when the applicant earns a livelihood from flying.

The employer's name should be entered by the applicant.

ITEM 13. Has Your FAA Airman Medical Certificate Ever Been Denied, Suspended, or Revoked?

The applicant shall check "yes" or "no." If "yes" is checked, the applicant should enter the date of action and should report details in the EXPLANATIONS box of Item 18.

The AME may not issue a medical certificate to an applicant who has checked "yes." The only exceptions to this prohibition are:

ITEMS 14-15. Total Pilot Time

The applicant should indicate the total number of civilian flight hours and whether those hours are logged (LOG) or estimated (EST).

The applicant should provide the number of civilian flight hours in the 6-month period immediately preceding the date of this application. The applicant should indicate whether those hours are logged (LOG) or estimated (EST).

ITEM 16. Date of Last FAA Medical Application

If a prior application was made, the applicant should indicate the date of the last application, even if it is only an estimate of the year. This item should be completed even if the application was made many years ago or the previous application did not result in the issuance of a medical certificate. If no prior application was made, the applicant should check the appropriate block in Item 16.

ITEM 17.a. Do You Currently Use Any Medication (Prescription or NON prescription)?

If the applicant checks yes, give name of medication(s) and indicate if the medication was listed in a previous FAA medical examination.

This includes both prescription and nonprescription medication. (Additional guidelines for the certification of airmen who use medication may be found throughout the Guide).

For example, any airman who is undergoing continuous treatment with anticoagulants, antiviral agents, anxiolytics, barbiturates, chemotherapeutic agents, experimental hypoglycemic, investigational, mood-ameliorating, motion sickness, narcotic, sedating antihistaminic, sedative, steroid drugs, or tranquilizers must be deferred certification unless the treatment has previously been cleared by FAA medical authority. In such an instance, the applicant should provide the AME with a copy of any FAA correspondence that supports the clearance.

During periods in which the foregoing medications are being used for treatment of acute illnesses, the airman is under obligation to refrain from exercising the privileges of his/her airman medical certificate unless cleared by the FAA.

Further information concerning an applicant's use of medication may be found under the items pertaining to specific medical condition(s) for which the medication is used, or you may contact your RFS.

ITEM 17.b. Do You Ever Use Near Vision Contact Lens(es) While Flying?

The applicant should indicate whether near vision contact lens(es) is/are used while flying. If the applicant answers "yes," the AME must counsel the applicant that use of contact lens(es) for monovision correction is not allowed. The AME must note in Item 60 that this counseling has been given. Examples of unacceptable use include:

If the applicant checks "yes" and no further comment is noted on FAA Form 8500-8 by either the applicant or the AME, a letter will automatically be sent to the applicant informing him or her that such use is inappropriate for flying.

Please note: the use of binocular contact lenses for distance-correction-only is acceptable. In this instance, no special evaluation or SODA is routinely required for a distance-vision-only contact lens wearer who meets the standard and has no complications. Binocular bifocal or binocular multifocal contact lenses are also acceptable under the Protocol for Binocular Multifocal and Accommodating Devices. If the applicant checks “yes” in Item 17.b but actually is using binocular bifocal or binocular multifocal contact lenses then the AME should note this in Item 60.

ITEM 18. Medical History

Each item under this heading must be checked either "yes" or "no." For all items checked "yes," a description and approximate date of every condition the applicant has ever been diagnosed with, had, or presently has, must be given in the EXPLANATIONS box. If information has been reported on a previous application for airman medical certification and there has been no change in the condition, the applicant may note "PREVIOUSLY REPORTED, NO CHANGE" in the EXPLANATIONS box, but the applicant must still check "yes" to the condition.

Of particular importance are conditions that have developed since the last FAA medical examination. The AME must take the time to review the applicant's responses on FAA Form 8500-8 before starting the applicant's medical examination.

The AME should ensure that the applicant has checked all of the boxes in Item 18 as either "yes" or "no." The AME should use information obtained from this review in asking the applicant pertinent questions during the course of the examination.

Certain aspects of the individual’s history may need to be elaborated upon. The AME should provide in Item 60 an explanation of the nature of items checked “yes” in items 18.a. through 18.y. Please be aware there is a character count limit in Item 60. If all comments cannot fit in Item 60, the AME may submit additional information on a plain sheet of paper and include the applicant’s full name, date of birth, signature, any appropriate identifying numbers (PI, MID or SSN), and the date of the exam.

Supplementary reports from the applicant's physician(s) should be obtained and forwarded to the AMCD, when necessary, to clarify the significance of an item of history. The responsibility for providing such supplementary reports rests with the applicant. A discussion with the AME's RFS may clarify and expedite the certification process at that time.

Affirmative answers alone in Item 18 do not constitute a basis for denial of a medical certificate. A decision concerning issuance or denial should be made by applying the medical standards pertinent to the conditions uncovered by the history.

Experience has shown that, when asked direct questions by a physician, applicants are likely to be candid and willing to discuss medical problems.

The AME should attempt to establish rapport with the applicant and to develop a complete medical history. Further, the AME should be familiar with the FAA certification policies and procedures in order to provide the applicant with sound advice.

18.a. Frequent or severe headaches. The applicant should report frequency, duration, characteristics, severity of symptoms, neurologic manifestations, whether they have been incapacitating, treatment, and side effects, if any. (See Item 46)

18.b. Dizziness or fainting spells. The applicant should describe characteristics of the episode; e.g., spinning or lightheadedness, frequency, factors leading up to and surrounding the episode, associated neurologic symptoms; e.g., headache, nausea, LOC, or paresthesias. Include diagnostic workup and treatment if any.

(See Items 25-30 and Item 46)

18.c. Unconsciousness for any reason. The applicant should describe the event(s) to determine the primary organ system responsible for the episode, witness statements, initial treatment, and evidence of recurrence or prior episode. Although the regulation states, “an unexplained disturbance of consciousness is disqualifying,” it does not mean to imply that the applicant can be certificated if the etiology is identified, because the etiology may also be disqualifying in and of itself. (See Item 46).

18.d. Eye or vision trouble except glasses. The AME should personally explore the applicant's history by asking questions, concerning any changes in vision, unusual visual experiences (halos, scintillations, etc.), sensitivity to light, injuries, surgery, or current use of medication. Does the applicant report inordinate difficulties with eye fatigue or strain? Is there a history of serious eye disease such as glaucoma or other disease commonly associated with secondary eye changes, such as diabetes?

For glaucoma or ocular hypertension, obtain a FAA Form 8500-14, Report of Eye Evaluation for Glaucoma. For any other medical condition, obtain a FAA Form 8500-7, Report of Eye Evaluation. Under all circumstances, please advise the examining eye specialist to explain why the airman is unable to correct to Snellen visual acuity of 20/20. (See Items 31-34, Item 53, and Item 54)

18.e. Hay fever or allergy. The applicant should report frequency and duration of symptoms, any incapacitation by the condition, treatment, and side effects. The AME should inquire whether the applicant has ever experienced any barotitis (“ear block”), barosinusitis, alternobaric vertigo, or any other symptoms that could interfere with aviation safety. (See Item 26)

18.f. Asthma or lung disease. The applicant should provide frequency and severity of asthma attacks, medications, and number of visits to the hospital and/or emergency room. For other lung conditions, a detailed description of symptoms/diagnosis, surgical intervention, and medications should be provided. (See Item 35)

18.g. Heart or vascular trouble. The applicant should describe the condition to include, dates, symptoms, and treatment, and provide medical reports to assist in the certification decision-making process. These reports should include operative reports of coronary intervention to include the original cardiac catheterization report, stress tests, worksheets, and original tracings (or a legible copy). When stress tests are provided, forward the reports, worksheets, and original tracings (or a legible copy) to the FAA. Part 67 provides that, for all classes of medical certificates, an established medical history or clinical diagnosis of myocardial infarction, angina pectoris, cardiac valve replacement, permanent cardiac pacemaker implantation, heart replacement, or coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant, is cause for denial. (See Item 36)

18.h. High or low blood pressure. The applicant should provide history and treatment. Issuance of a medical certificate to an applicant with high blood pressure may depend on the current blood pressure levels and whether the applicant is taking anti-hypertensive medication. The AME should also determine if the applicant has a history of complications, adverse reactions to therapy, hospitalization, etc.

(Details are given in Item 36 and Item 55)

18.i. Stomach, liver, or intestinal trouble. The applicant should provide history and treatment, pertinent medical records, current status report, and medication. If a surgical procedure was done, the applicant must provide operative and pathology reports. (See Item 38)

18.j. Kidney stone or blood in urine. The applicant should provide history and treatment, pertinent medical records, current status report and medication. If a procedure was done, the applicant must provide the report and pathology reports.

(See Item 41)

18.k. Diabetes. The applicant should describe the condition to include symptoms and treatment. Comment on the presence or absence of hyperglycemic and/or hypoglycemic episodes. A medical history or clinical diagnosis of diabetes mellitus requiring insulin or other hypoglycemic drugs for control are disqualifying. The AME can help expedite the FAA review by assisting the applicant in gathering medical records and submitting a current specialty report. (See Item 48)

18.l. Neurological disorders; epilepsy, seizures, stroke, paralysis, etc. The applicant should provide history and treatment, pertinent medical records, current status report and medication. The AME should obtain details about such a history and report the results. An established diagnosis of epilepsy, a transient loss of control of nervous system function(s), or a disturbance of consciousness is a basis for denial no matter how remote the history. Like all other conditions of aeromedical concern, the history surrounding the event is crucial. Certification is possible if a satisfactory explanation can be established. (See Item 46)

18.m. Mental disorders of any sort; depression, anxiety, etc. An affirmative answer to Item 18.m. requires investigation through supplemental history taking. Dispositions will vary according to the details obtained. An applicant with an established history of a personality disorder that is severe enough to have repeatedly manifested itself by overt acts, a psychosis disorder, or a bipolar disorder must be denied or deferred by the AME. (See Item 47)

18.n. Substance dependence; or failed a drug test ever; or substance abuse or use of illegal substance in the last 2 years. "Substance" includes alcohol and other drugs (e.g., PCP, sedatives and hypnotics, anxiolytics, marijuana, cocaine, opioids, amphetamines, hallucinogens, and other psychoactive drugs or chemicals). For a "yes" answer to Item 18.n., the AME should obtain a detailed description of the history. See disposition tables. A history of substance dependence or abuse is disqualifying. The AME must defer issuance of a certificate if there is doubt concerning an applicant's substance use.

See: Pharmaceuticals and Substances of Dependence/Abuse.

18.o. Alcohol dependence or abuse. See DUI/ DWI /Alcohol Incidents Disposition Table.

18.p. Suicide attempt. A history of suicidal attempts or suicidal gestures requires further evaluation. The ultimate decision of whether an applicant with such a history is eligible for medical certification rests with the FAA. The AME should take a supplemental history as indicated, assist in the gathering of medical records related to the incident(s), and, if the applicant agrees, assist in obtaining psychiatric and/or psychological examinations. (See Item 47)

18.q. Motion sickness requiring medication. A careful history concerning the nature of the sickness, frequency and need for medication is indicated when the applicant responds affirmatively to this item. Because motion sickness varies with the nature of the stimulus, it is most helpful to know if the problem has occurred in flight or under similar circumstances. (See Item 29)

18.r. Military medical discharge. If the person has received a military medical discharge, the AME should take additional history and record it in Item 60. It is helpful to know the circumstances surrounding the discharge, including dates, and whether the individual is receiving disability compensation. If the applicant is receiving veteran's disability benefits, the claim number and service number are helpful in obtaining copies of pertinent medical records. The fact that the applicant is receiving disability benefits does not necessarily mean that the application should be denied.

18.s. Medical rejection by military service. The AME should inquire about the place, cause, and date of rejection and enter the information in Item 60. It is helpful if the AME can assist the applicant with obtaining relevant military documents. If a delay of more than 14-calendar days is expected, the AME should transmit FAA Form 8500-8 to the FAA with a note specifying what documents will be forwarded later.

Disposition will depend upon whether the medical condition still exists or whether a history of such a condition requires denial or deferral under the FAA medical standards.

18.t. Rejection for life or health insurance. The AME should inquire regarding the circumstances of rejection. The supplemental history should be recorded in Item 60. Disposition will depend upon whether the medical condition still exists or whether a history of such a condition requires denial or deferral under the FAA medical standards.

18.u. Admission to hospital. For each admission, the applicant should list the dates, diagnoses, duration, treatment, name of the attending physician, and complete address of the hospital or clinic. If previously reported, the applicant may enter "PREVIOUSLY REPORTED, NO CHANGE." A history of hospitalization does not disqualify an applicant, although the medical condition that resulted in hospitalization may.

18.v. History of Arrest(s), Conviction(s), and/or Administrative Action(s).

(Updated 06/24/2020) Arrest(s), conviction(s), and/or administrative action(s) affecting driving privileges may raise questions about the applicant's qualifications for airman medical certification. All incidents must be reported (even if reported on a previous application), to include even a single driving while intoxicated (DWI) arrest, conviction and/or administrative action. Incidents reported under 18.v. are just part of many factors considered in the overall process of medical certification. See Substances of Dependence/Abuse.

NOTE: Remind your airman that once he/she has checked yes to any item in #18, especially items 18 n., 18 o. or 18 v., they must ALWAYS mark yes to these numbers, even if the condition has been reviewed and granted an eligibility letter from the FAA. 18.w. History of nontraffic convictions. The applicant must report any other (nontraffic) convictions (e.g., assault, battery, public intoxication, robbery, etc.). The applicant must name the charge for which convicted and the date of the conviction(s), and copies of court documents (if available). (See Item 47)

18.x. Other illness, disability, or surgery. The applicant should describe the nature of these illnesses in the EXPLANATIONS box. If additional records, tests, or specialty reports are necessary in order to make a certification decision, the applicant should so be advised. If the applicant does not wish to provide the information requested by the AME, the AME should defer issuance.

If the applicant wishes to have the FAA review the application and decide what ancillary documentation is needed, the AME should defer issuance of the medical certificate and forward the completed FAA Form 8500-8 to the AMCD. If the AME proceeds to obtain documentation, but all data will not be received with the 2 weeks, FAA Form 8500-8 should be transmitted immediately to the AMCD with a note that additional documents will be forwarded later under separate cover.

ITEM 19. Visits to Health Professional within Last 3 Years

The applicant should list all visits in the last 3 years to a physician, physician assistant, nurse practitioner, psychologist, clinical social worker, or substance abuse specialist for treatment, examination, or medical/mental evaluation. The applicant should list visits for counseling only if related to a personal substance abuse or psychiatric condition. The applicant should give the name, date, address, and type of health professional consulted and briefly state the reason for the consultation. Multiple visits to one health professional for the same condition may be aggregated on one line.

Routine dental, eye, and FAA periodic medical examinations and consultations with an employer-sponsored employee assistance program (EAP) may be excluded unless the consultations were for the applicant's substance abuse or unless the consultations resulted in referral for psychiatric evaluation or treatment.

When an applicant does provide history in Item 19, the AME should review the matter with the applicant. The AME will record in Item 60 only that information needed to document the review and provide the basis for a certification decision. If the AME finds the information to be of a personal or sensitive nature with no relevancy to flying safety, it should be recorded in Item 60 as follows:

"Item 19. Reviewed with applicant. History not significant or relevant to application."

If the applicant is otherwise qualified, a medical certificate may be issued by the AME.

FAA medical authorities, upon review of the application, will ask for further information regarding visits to health care providers only where the physical findings, report of examination, applicant disclosure, or other evidence suggests the possible presence of a disqualifying medical history or condition.

If an explanation has been given on a previous report(s) and there has been no change in the condition, the applicant may enter "PREVIOUSLY REPORTED, NO CHANGE."

Of particular importance is the reporting of conditions that have developed since the applicant's last FAA medical examination. The AME is asked to comment on all entries, including those "PREVIOUSLY REPORTED, NO CHANGE." These comments may be entered under Item 60.

ITEM 20. Applicant's National Driver Register and Certifying Declaration

In addition to making a declaration of the completeness and truthfulness of the applicant's responses on the medical application, the applicant's declaration authorizes the National Driver Register to release the applicant's adverse driving history information, if any, to the FAA. The FAA uses such information to verify information provided in the application. Applicant must certify the declaration outlined in Item 20. If the applicant does not certify the declaration for any reason, AME shall not issue a medical certificate but forward the incomplete application to the AMCD.