Guide for Aviation Medical ExaminersVersion 09/30/2026
Front Matter
10 pagesPages 2–10
- 2026
- GUIDE FOR AVIATION MEDICAL EXAMINERS
(Updated 09/30/2026) Welcome to the Guide for Aviation Medical Examiners. The format of this version of the Guide provides instant access to information regarding regulations, medical history, examination procedures, dispositions, and protocols necessary for completion of the FAA Form 8500-8, Application for Airman Medical Certificate.
To navigate through the Guide PDF by Item number or subject matter, simply click on the “BOOKMARK” tab in the left column to search specific certification decision-making criteria. To expand any “BOOKMARK” files, click on the corresponding + button located in the front of the text. To collapse any of the expanded files, click on the + button again.
AME ALERT
New disposition tables:
GI
GI Procedures (EGD or Esophagogastroduodenoscopy; Colonoscopy or C-scope)
Hernia (Abdominal; Incisional; Inguinal; Femoral; Perineal; Ventral; Congenital Diaphragmatic Hernia)
Hernia - Hiatal (Sliding or Paraesophageal)
Liver Function Test Elevation
Splenomegaly
Pulmonology
Cystic Fibrosis
Pulmonary Hypertension
Pulmonary Nodule (Lung Nodule)
Drug & Alcohol
DUI/DWI Disposition table - updated
DUI/DWI Personal Statement – new
DUI/DWI Event Status Report for the AME - updated
Drug Use Disposition table - updated
Drug Use Personal Statement -new
Substance Use Disorders (DSM);Substance Abuse or Substance Dependence (DSM or CFR) - new
Neurology
Reduced recovery for Severe Brain Injury (TBI) from 5 to 4 years.
(continued)
Endocrinology
Diabetes. If no retinopathy, annual diabetic eye evaluation from an optometrist (OD) may be acceptable.
ITDM-CGM, a subset of may be considered for a 12-month certificate instead of 6 months on a case by case (recert only)
Medication
Added orforglipron (Foundayo) to Weight Loss Management CACI.
Allergy & Antihistamine Immunotherapy Medication added brompheniramine with no fly 5 days.
HTN medication new class Endothelin Receptor Antagonist (aprocitentan (Tryvio)
See the Archives and Updates section for more information.
NOTE: Updates to the 2026 AME Guide are scheduled for the last Wednesday of each month, as indicated below. Please refer to the Archives and Updates section for a description of changes that are made.
| JANUARY 28 | MAY 27 | SEPTEMBER 30 |
|---|---|---|
| FEBRUARY 25 | JUNE 24 | OCTOBER 28 |
| MARCH 25 | JULY 29 | NOVEMBER - No scheduled updates |
| APRIL 29 | AUGUST 26 | DECEMBER - No scheduled updates |
TABLE OF CONTENTS
GENERAL INFORMATION ................................................................................... 11
Legal Responsibilities of Designated Aviation Medical Examiners................. 12
Authority of Aviation Medical Examiners ........................................................ 13
Equipment Requirements ............................................................................... 14
Medical Certification Decision Making ............................................................ 17
Authorization for Special Issuance and AME Assisted Special Issuance (AASI) ........................................................................................................................... 18
Privacy of Medical Information ....................................................................... 21
Release of Information ................................................................................... 22
No "Alternate" Examiners Designated ............................................................ 22
Who May Be Certified .................................................................................... 23
Classes of Medical Certificates .................................................................... 24
Operations Not Requiring a Medical Certificate ........................................... 25
Medical Certificates – AME Completion ....................................................... 26
Validity of Medical Certificates ..................................................................... 28
Title 14 CFR § 61.53, Prohibition on Operations During Medical Deficiency 29
Reexamination of an Airman ........................................................................ 29
Examination Fees......................................................................................... 30
Replacement of Medical Certificates ............................................................ 30
Disposition of Applications and Medical Examinations ................................. 30
Protection and Destruction of Forms ............................................................ 31
Questions, Requests for Assistance, and Technical Support ....................... 31
Airman Appeals ............................................................................................ 32
Medical Certificates Requested for any Situation or Job Other than a Pilot or Air Traffic Controller. .......................................................................................... 35
Pilot Information – Current Detailed Clinical Progress Note ......................... 36
English Proficiency and Pilot Medical Certification ...................................... 39
Aeromedical Summary (AMS) ..................................................................... 40
Subpoena for Medical Records or Testimony: AME Guidance ................... 42
APPLICATION FOR MEDICAL CERTIFICATION ................................................ 43
I. AME Guidance for Positive Identification of Airmen and Application Procedures ........................................................................................................................... 44
II. Prior to the Examination ................................................................................. 44
III. After the Applicant Completes the Medical History of the FAA Form 8500-8 45 ITEMS 1-2. Application for; Class of Medical Certificate Applied For ................ 46
ITEMS 3-10. Identification ................................................................................. 46
ITEMS 11-12. Occupation; Employer ................................................................ 47
ITEM 13. Has Your FAA Airman Medical Certificate Ever Been Denied, Suspended, or Revoked? ................................................................................... 47
ITEMS 14-15. Total Pilot Time .......................................................................... 48
ITEM 16. Date of Last FAA Medical Application................................................ 48
ITEM 17.a. Do You Currently Use Any Medication (Prescription or NON prescription)? ..................................................................................................... 48
ITEM 17.b. Do You Ever Use Near Vision Contact Lens(es) While Flying? ...... 49
ITEM 18. Medical History .................................................................................. 49
ITEM 19. Visits to Health Professional within Last 3 Years ................................ 54
ITEM 20. Applicant's National Driver Register and Certifying Declaration ......... 55
EXAMINATION TECHNIQUES ............................................................................. 56
ITEMS 21-22. Height and Weight ...................................................................... 57
ITEMS 23-24. Statement of Demonstrated Ability (SODA); SODA Serial Number ....................................................................................................................... 58
AME PHYSICAL EXAMINATION INFORMATION AND DISPOSITION TABLES 60
Condition Not Listed ................................................................................................... 62
ITEM 27. Sinuses .......................................................................................... 70
ITEM 28. Mouth and Throat ........................................................................... 71
ITEM 29. Ears, General ................................................................................. 73
ITEMS 31-34. Eye ......................................................................................... 90
AMBLYOPIA .................................................................................................. 97
Amblyopia (Lazy Eye) Status Summary (Developmental adaptation to unilateral visual impairment*) ......................................................................... 98
BLEPHARITIS and CONJUNCTIVITIS .......................................................... 99
CATARACT(S) ............................................................................................. 101
DIPLOPIA (DOUBLE VISION) ..................................................................... 102
OCULAR HISTOPLASMOSIS ..................................................................... 103
EYES – GENERAL, OTHER CONDITIONS ................................................ 104
EYES – PROCEDURES .............................................................................. 105
LENS IMPLANT ........................................................................................... 106
Crystalline Lens Replacement (Cataract or Refractive). .............................. 106
(Use for VISION surgery such as Lens Implantation, Intraocular Lens [IOL], ..................................................................................................................... 106
or cataract surgery with Lens Implant.) ........................................................ 106
EYES - LENS IMPLANT STATUS SUMMARY ............................................ 108
CATARACTS AND INTRAOCULAR LENSES (IOL) .................................... 110
FREQUENTLY ASKED QUESTIONS (FAQS) ............................................. 110
EYES - REFRACTIVE SURGERY ............................................................... 112
(Use for elective vision surgery such as Excimer Laser Corneal Refractive Surgery [LASIK, PRK, SMILE]) .................................................................... 112
EYES – REFRACTIVE SURGERY STATUS SUMMARY ............................ 114
ITEM 32. Ophthalmoscopic .......................................................................... 116
CHORIORETINITIS ..................................................................................... 117
COLOBOMA ................................................................................................ 119
CACI - Glaucoma Worksheet ....................................................................... 121
(Updated 04/13/2022) .................................................................................. 121
LATTICE DEGENERATION ......................................................................... 122
OPTIC NEURITIS ........................................................................................ 123
RETINOSCHISIS ......................................................................................... 126
ITEM 33. Pupils ............................................................................................ 127
ITEM 34. Ocular Motility ............................................................................... 127
ITEM 35. Lungs and Chest ........................................................................... 128
PULMONARY HYPERTENSION (Pulmonary HTN) .................................... 142
ITEM 36. Heart ............................................................................................. 153
WOLFF PARKINSON WHITE (WPW) and other pre-excitation conditions . 170 CORONARY HEART DISEASE ................................................................... 173
HEART MURMUR ........................................................................................ 186
ENDOCARDITIS .......................................................................................... 188
CONGENITAL HEART CONDITIONS .......................................................... 193
FIBROMUSCULAR DYSPLASIA .................................................................. 196
HEART TRANSPLANT (cardiac transplant, heart replacement) .................. 197
Hypertrophic Cardiomyopathy (HCM), Hypertrophic Obstructive
Cardiomyopathy (HOCM), or Idiopathic Hypertrophic Subaortic Stenosis (IHSS) ..................................................................................................................... 199
ITEM 37. Vascular System ........................................................................... 203
ARTERIOVENOUS MALFORMATION (AVM) - Peripheral (lungs, liver, bone)206 Buerger Disease or Thromboangiitis Obliterans (TAO) ................................ 207
POSTURAL TACHYCARDIA SYNDROME (POTS) ..................................... 208
ITEM 38. Abdomen and Viscera ................................................................... 210
Congenital Sucrase-Isomaltase Deficiency (CSID) ...................................... 222
Eosinophilic Esophagitis ............................................................................... 223
ITEM 39. Anus .............................................................................................. 242
ITEM 40. Skin ............................................................................................... 244
ITEM 41. G-U System................................................................................... 251
ITEMS 42-43. Musculoskeletal ..................................................................... 276
OSTEOMYELITIS (BONE INFECTION) ....................................................... 280
ITEM 44. Identifying Body Marks, Scars, Tattoos ......................................... 289
ITEM 45. Lymphatics .................................................................................... 290
ITEM 46. Neurologic ..................................................................................... 297
ARTERIOVENOUS MALFORMATION (AVM) – Neurological (Brain or Spinal Cord)............................................................................................................. 303
ITEM 47. Psychiatric ..................................................................................... 385
Therapy, Psychotherapy and Counseling Information: Pilots / ATCS .......... 389
Therapy, Psychotherapy, and Counseling FAQs for Pilots and ATCS ......... 390
Information for Psychotherapists Treating Pilots and ATCS ......................... 392
USE OF ANTIDEPRESSANT MEDICATIONS ............................................. 393
AIRMAN INFORMATION - SSRI INITIAL CERTIFICATION......................... 397
PATH Status Summary Anxiety, Depression, and Related Conditions ......... 420
POST-TRAUMATIC STRESS DISORDER (PTSD) ...................................... 421
SITUATIONAL DEPRESSION...................................................................... 423
SITUATIONAL DEPRESSION DECISION TOOL FOR THE AME ............... 425
PSYCHIATRIC CONDITIONS ...................................................................... 426
ITEM 48. General Systemic .......................................................................... 428
BLOOD DONATION ..................................................................................... 430
BLOOD AND BLOOD-FORMING TISSUE DISEASE................................... 431
ACUTE LYMPHOCYTIC LEUKEMIA (ALL) .................................................. 432
THROMBOCYTOPENIA............................................................................... 433
CACI – Chronic Immune Thrombocytopenia (cITP) Worksheet.................... 434
PREDIABETES ............................................................................................ 437
CACI – Prediabetes Worksheet .................................................................... 438
DIABETES MELLITUS ................................................................................. 439
DIABETES INSIPIDUS OR POLYURIA........................................................ 440
ACROMEGALY ............................................................................................ 443
ADRENAL INSUFFICIENCY (Addison’s Disease) ...................................... 445
CUSHING SYNDROME ............................................................................... 446
HYPERPARATHYROIDISM ......................................................................... 449
HYPOPARATHYROIDISM ........................................................................... 450
HYPERPROLACTINEMIA ............................................................................ 453
HYPERTHYROIDISM ................................................................................... 454
HYPOTHYROID or HYPOTHYROIDISM...................................................... 455
CACI - Hypothyroidism Worksheet ............................................................... 457
PITUITARY ADENOMA ................................................................................ 458
HUMAN IMMUNODEFICIENCY VIRUS (HIV).............................................. 461
NEOPLASMS ............................................................................................... 462
BREAST CANCER ....................................................................................... 463
CACI – Weight Loss Management Worksheet ............................................. 474
AME OFFICE-REQUIRED ANCILLARY TESTING ............................................ 476
ITEM 49. Hearing......................................................................................... 477
ITEM 50. Distant Vision ................................................................................ 481
ITEM 51.a. Near Vision................................................................................ 484
ITEM 51.b. Intermediate Vision ................................................................... 484
ITEM 52. Color Vision ................................................................................... 486
ITEM 53. Field of Vision................................................................................ 496
ITEM 54. Heterophoria ................................................................................ 499
ITEM 55. Blood Pressure.............................................................................. 501
ITEM 56. Pulse ............................................................................................. 503
ITEM 57. Urine Test/Urinalysis ..................................................................... 504
ITEM 58. ECG .............................................................................................. 505
AMCS SUPPORT DESK ..................................................................................... 509
APPLICATION REVIEW ..................................................................................... 510
ITEM 61. Applicant's Name ......................................................................... 512
ITEM 62. Has Been Issued .......................................................................... 512
ITEM 63. Disqualifying Defects.................................................................... 513
ITEM 64. Medical Examiner's Declaration ................................................... 514
CACI CONDITIONS ............................................................................................ 515
DISEASE PROTOCOLS ..................................................................................... 516
DISEASE PROTOCOLS............................................................................... 517
Protocol for Binocular Multifocal and Accommodating Devices .................... 535
Protocol for Bundle Branch Block (BBB)....................................................... 536
Protocol for Cardiac Testing ......................................................................... 536
Coronary Artery Calcification (CAC) Scoring; Calcium Score; ...................... 537
Coronary Computed Tomography Angiography (CCTA) .............................. 537
Protocol for Cardiac Valve Replacement ...................................................... 539
Protocol for Conductive Keratoplasty............................................................ 542
Protocol for Coronary Heart Disease – 1st and 2nd Class and ATCS ............ 544
Protocol for Coronary Heart Disease – 3rd Class ......................................... 547
Specifications for Neuropsychological Evaluations for Treatment with SSRI Medications .................................................................................................. 550
Protocol for Diabetes Mellitus - Diet Controlled ............................................ 552
Protocol for Diabetes Mellitus ....................................................................... 553
Treated with Any Medication Other Than Insulin .......................................... 553
Protocol for Diabetes Mellitus Type I or Type II ............................................ 556
Insulin Treated - CGM Option ....................................................................... 556
Protocol for Insulin Treated Diabetes Mellitus NON-CGM Protocol - Third Class Option ........................................................................................................... 580
Protocol for Insulin-Treated Diabetes Mellitus .............................................. 581
Non-CGM - Third-Class Option .................................................................... 581
Protocol for Maximal Graded Exercise ......................................................... 586
Stress Test Requirements ............................................................................ 586
Protocol for History of Human ....................................................................... 587
Immunodeficiency Virus (HIV) Related Conditions ....................................... 587
Protocol for Initial Evaluation of .................................................................... 591
Implanted Pacemaker ................................................................................... 591
Protocol for Medication Controlled ................................................................ 593
Metabolic Syndrome ..................................................................................... 593
Protocol for Musculoskeletal Evaluation ....................................................... 595
Specifications for Neuropsychological Evaluations for.................................. 597
Potential Neurocognitive Impairment ............................................................ 597
FAA Specifications for Neurologic Evaluation............................................... 599
Protocol for Obstructive Sleep Apnea ........................................................... 603
Specifications for Psychiatric Evaluations..................................................... 626
Specifications for Psychiatric and ................................................................. 627
Psychological Evaluations ............................................................................ 627
Protocol for Renal Transplant ....................................................................... 631
Six-Minute Walk Test (6MWT) - FAA Result Sheet ...................................... 632
Protocol for Substances of............................................................................ 633
Dependence/abuse (Drugs - Alcohol) ........................................................... 633
Protocol for Thromboembolic Disease .......................................................... 634
PHARMACEUTICALS......................................................................................... 635
Pharmaceuticals (Therapeutic Medications) ................................................. 641
ALLERGY – ANTIHISTAMINE & IMMUNOTHERAPY MEDICATION .......... 644
ANTACIDS ................................................................................................... 646
ANTICOAGULANTS ..................................................................................... 647
EMBOLI MITIGATION IN NON-VALVULAR ................................................. 648
ATRIAL FIBRILLATION (AFIB) ..................................................................... 648
ANTIDEPRESSANTS ................................................................................... 649
ANTIHYPERTENSIVE (HTN, blood pressure medication) .......................... 651
BIOLOGICS, BIOSIMILARS, NON-BIOLOGICS .......................................... 652
CONTRACEPTIVES AND ............................................................................ 656
HORMONE REPLACEMENT THERAPY ..................................................... 656
CONTROLLED SUBSTANCES AND CBD PRODUCTS .............................. 657
COVID-19 MEDICATION.............................................................................. 658
DIABETES MELLITUS - INSULIN TREATED .............................................. 659
DIABETES MELLITUS TYPE II - MEDICATION CONTROLLED (NOT INSULIN)
..................................................................................................................... 660
ACCEPTABLE COMBINATIONS OF DIABETES MEDICATIONS ............... 661
ERECTILE DYSFUNCTION AND ................................................................. 664
BENIGN PROSTATIC HYPERPLASIA MEDICATIONS ............................... 664
EYE MEDICATION ....................................................................................... 665
GLAUCOMA AND OCULAR HYPERTENSION MEDICATIONS .................. 666
PLAQUENIL STATUS REPORT .................................................................. 667
MALARIA MEDICATIONS ............................................................................ 668
MIGRAINE MEDICATION ............................................................................ 669
OSTEOPOROSIS MEDICATION ................................................................. 672
OVER-THE-COUNTER MEDICATIONS ...................................................... 673
OVER-THE-COUNTER (OTC) MEDICATIONS REFERENCE GUIDE ........ 675
SMOKING CESSATION MEDICATIONS ..................................................... 683
SEDATIVES ................................................................................................. 684
SLEEP AIDS................................................................................................. 685
VACCINES ................................................................................................... 687
WEIGHT LOSS MEDICATION ..................................................................... 688
AME ASSISTED SPECIAL ISSUANCES (AASI)................................................ 689
AASI for Anxiety, Depression, and Related Conditions PATH ...................... 693
AASI for Aortic Insufficiency ......................................................................... 694
AASI for Arthritis and/or Psoriasis ................................................................ 695
AASI for Asthma ......................................................................................... 696
AASI for Atrial Fibrillation .............................................................................. 697
AASI for Bladder Cancer .............................................................................. 698
AASI for Breast Cancer ................................................................................ 699
AASI for Cardiac - Single Valve Replacement or Repair .............................. 700
AASI for Cerebrovascular Disease (CVA/Stroke/TIA)................................... 701
AASI for Chronic Kidney Disease (CKD) ...................................................... 702
AASI for Chronic Lymphocytic Leukemia (CLL) ............................................ 703
Small Lymphocytic Lymphoma (SLL) ........................................................... 703
AASI for Chronic Obstructive Pulmonary Disease (COPD) .......................... 704
AASI for Colitis (Ulcerative or Crohn’s Disease) ........................................... 705
or Irritable Bowel Syndrome (IBS) ................................................................ 705
AASI for Colon Cancer/Colorectal Cancer .................................................... 706
AASI for Coronary Heart Disease (CHD) ...................................................... 707
AASI for Venous Thromboembolism (VTE) - Deep Venous Thrombosis (DVT), Pulmonary Embolism (PE), and/or Hypercoagulopathies ............................. 708
AASI for Diabetes Mellitus - Type II Medication Controlled (Not Insulin) ...... 709
AASI for Glaucoma ....................................................................................... 711
AASI for Hepatitis C ...................................................................................... 712
AASI for Hypertension (HTN) ....................................................................... 713
AASI for Hyperthyroidism ............................................................................. 714
AASI for Hypothyroidism............................................................................... 715
AASI for Low Testosterone (Low T) Hypogonadism ..................................... 716
AASI for Lymphoma and Hodgkin’s Disease ................................................ 717
AASI for Melanoma....................................................................................... 718
AASI for Migraines ........................................................................................ 719
AASI for Mitral Valve Disease....................................................................... 720
AASI for Neurofibromatosis Type 1 (NF1) .................................................... 721
AASI for Paroxysmal Atrial Tachycardia (PAT)............................................. 722
AASI for Prediabetes or Overweight/Obesity Treated with Medication ......... 723
AASI for Prostate Cancer ............................................................................. 724
AASI for Psoriasis ......................................................................................... 725
AASI for Renal Calculi .................................................................................. 726
AASI for Renal Cancer ................................................................................. 727
AASI for Sleep Apnea/Obstructive Sleep Apnea (OSA) ............................... 728
AASI for Testicular Cancer ........................................................................... 729
AASI for Thrombocytopenia.......................................................................... 730
SUBSTANCES OF DEPENDENCE/ABUSE ....................................................... 732
DUI/DWI/Alcohol Incidents (18 v.) ................................................................ 736
DRUG USE - PAST OR PRESENT .............................................................. 741
Substance Use Disorders (DSM);Substance Abuse or Substance Dependence (DSM or CFR) ............................................................................................... 744
Drug/Alcohol Monitoring Programs and HIMS ................................................ 753
Drug/Alcohol Monitoring Programs and HIMS ................................................ 754
SYNOPSIS OF MEDICAL STANDARDS ............................................................ 777
Student Pilot Rule Change ................................................................................ 779
GLOSSARY......................................................................................................... 780
ARCHIVES AND UPDATES ............................................................................... 784
Forms
Federal Aviation Administration Regional and Center Medical Office Addresses
Title 14 Code of Federal Regulations Part 67 — Medical Standards and Certification
Convention on International Civil Aviation International Standards on Personnel Licensing:
The international Standards on Personnel Licensing are contained in Annex 1 – Personnel Licensing to the Convention on International Civil Aviation. The FAA maintains an updated, hard copy of all the ICAO Annexes and also an on-line subscription. The FAA makes copies of Annex 1 available at seminars and can provide AMEs access upon request.
FREQUENTLY USED PAGES
(Updated 06/28/2023) GENERAL
| PAGE | HYPERLINK |
|---|---|
| AME Guide | www.faa.gov/go/ameguide |
| AME Home | www.faa.gov/go/ame |
| AME Training Information | www.faa.gov/go/ametraining |
| AME Seminar Schedule | www.faa.gov/go/ameseminars |
| AMCS Support | www.faa.gov/go/amcssupport |
| CAMI Library | www.faa.gov/go/aeromedlibrary |
| FAA Home | http://www.faa.gov/go/ |
| FAA Neuropsychologists | https://www.faa.gov/ame_guide/media/FAA_ Neuropsychologists.pdf |
| Federal Air Surgeon's Medical Bulletin | www.faa.gov/go/fasmb |
| FSDO | www.faa.gov/go/fsdo |
| HIMS AMEs | https://www.faa.gov/pilots/amelocator |
| Pilot Safety Brochures | www.faa.gov/go/pilotsafetybrochures |
| Regional Flight Surgeons | www.faa.gov/go/rfs |
| Student Pilot Certificate Requirements | www.faa.gov/go/student_cert |
AME GUIDE
| PAGE | HYPERLINK |
|---|---|
| Attention-Deficit/Hyperactivity Disorder (ADHD) | www.faa.gov/go/ADHD |
| Bundle Branch Block | www.faa.gov/go/BBB |
| CACI Worksheets | www.faa.gov/go/caci |
| Color Vision | www.faa.gov/go/colorvision |
| Detailed Clinical Progress Note explained | www.faa.gov/ame_guide/dcpn |
| Diabetes on Medication (not insulin) | www.faa.gov/go/diabetic |
| Diabetes – ITDM CGM and 3rd Class Option (insulin treated) | www.faa.gov/go/ITDM |
| Do Not Issue – Do Not Fly Medications | www.faa.gov/go/dni |
| HIMS Drug and Alcohol Monitoring Program | www.faa.gov/go/hims-da |
| Insulin | http://www.faa.gov/go/insulin |
| Obstructive Sleep Apnea | www.faa.gov/go/osa |
| Over-the-Counter (OTC) Medications Reference Table – What OTC Medications Can I Take and Still Be Safe to Fly? | https://www.faa.gov/pilots/medical_certificat ion/media/OTCMedicationsforPilots.pdf |
| Pharmacy Home | www.faa.gov/go/meds |
| Psychiatric Conditions – Use of Antidepressant Medications | www.faa.gov/go/ssri |
| Weight Loss Management | https://www.faa.gov/ame_guide/media/Wei ght_loss_management_dispo_table.pdf |