Item 19 - Visits to Health Professional Within Last 3 Years

My Flight Surgeon

Sr. Aviation Medical Examiner
There is a requirement for the pilot to provide medical records and physician documentation regarding the medical condition being reported. I would suggest that if you are unsure of how to answer these questions in Item 19, you discuss them with your AME before you complete the form. Some things may not be significant while others will require explanation.


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. 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.

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.

The Examiner is asked to comment on all entries, including those PREVIOUSLY REPORTED, NO CHANGE. Don’t get mad at the AME when you are asked why you were hospitalized if you wrote previously reported, no change. He/She is just doing their job. If the applicant is otherwise qualified, a medical certificate may be issued by the Examiner. If the Examiner 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. 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.

* Italicized text from FAA documents.
 
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