Information for Passengers Requiring Medical Clearance MEDIF

Information for Passengers Requiring ​
Medical Clearance MEDIF

Note for the Attending Physician:​

The details requested in here will be treated confidentially; they should enable the Medical Services of the airline(s), as it is their obligation, to judge by their specific air medical knowledge and experience if and under what conditions the patient can be permitted to travel by aircraft as requested. These details will also help the Medical Service in issuing appropriate instructions for the patient’s care which duely consider both his/her diagnosis and the special circumstances of the requested air journey. Kindly answer all questions by cross or in block letters, as necessary.

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Will a 25% to 30% reduction in the ambient partial pressure of oxygen (relative hypoxia) affect the passenger’s medical condition?

(Cabin pressure to be the equivalent of a fast trip to a mountain elevation of 2.400 meters (8.000 feet) above sea level

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Additional clinical information
a. Anemia
b. Psychiatric conditions
If yes see Part 2
c. Cardiac disorder
If yes see Part 2
d. Normal bladder control
e. Normal bowel control
f. Respiratory disorder
If yes see part 2
g. Does the patient require oxygen at home?
h. Oxygen needed during flight
If yes, specify
i. Seizure disorder
If yes see Part 2
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Escort
a. Is the patient fit to travel unaccompanied?
b. Is the patient able to sit in a usual aircraft seat?
c. Is the patient able to embark/disembark independently?
d. If no, will the patient have a private escort to take care of his/her needs onboard?
e. If yes, who should escort the passenger?
f. If other, is the escort fully capable to attend to all above needs?
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Mobility
a. Able to walk without assistance
b. Wheelchair required for boarding
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ATTACHMENT B (To be Completed by Attending Physician)
Information for Passengers Requiring
Medical Clearance MEDIF / Part2

1
Cardiac condition
a. Angina
Is the condition stable
Functional classes of patient
Can the patient walk 100 metres at a normal pace or climb 10-12 stairs without symptoms?
b. Myocardial infarction
Complications?
Stress EKG done?
If angioplasty or coronary bypass, can the patient walk 100 metres at a normal pace or climb 10-12 stairs without symptoms?
c. Cardiac Failure
Is the patient controlled with medication
Functional classes of the patient
d. Syncope
Investigation
2
Chronic pulmonary condition
a. Has the patient had recent arterial blood gases?
b. Blood gases where taken on
If yes, what were the results
c. Does the patient retain CO2?
d. Has his/her condition deteriorated recently?
e. Can patient walk 100 metres at a normal pace or climb 10-12 stairs without symptoms?
f. Has the patient ever taken a commercial aircraft in his/her current medical status?
3
Psychiatric conditions
Is there a possibility that the patient will become agitated during flight?
b. Has he/she taken a commercial aircraft before?
Did the patient travel
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Seizure
d. Are the seizure controlled by medication?
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Prognosis for the trip
Fit to travel

Note : Cabin attendants are not authorized to give special assistance (e.g. lifting, feeding aid) to particular passengers, to the detriment of their service to other passengers. Additionally, they are trained only in first aid and are not permitted to administer any injection, or give medication.

Important: Fees, if any, relevant to the provision of the above information and for carrier-provided special equipment are to be paid by the passenger concerned. ​​​​