A fillable 8500-8 FAA Form is available for download below. Use additional sheets if necessary and attach to this form. The description must include: cable block(s). The FAA may check state. NOTE: If more space is required to respond to "yes" answers for numbers 17, 18, or 19, use a plain sheet of paper. Visits to Health Professional Within Last 3 Years. 18. The first authorizes the National Driver Register, If information has been reported on a previous application for airman, to release adverse driver history information, if any, about the. At the top half of this page will be a comprehensive examination of each part of the applicant's body. Each ear and eye will be tested separately and any abnormalities will be described. Medical Examiner's Declaration -- I hereby certify that I have personally reviewed the medical history and personally examined the applicant named. Information entered into MedXPress is available to your FAA-designated Aviation Medical Examiner (AME) for review at the time of your medical examination. Statement of Demonstrated Ability (SODA), (Pulse, amplitude and character; arms, legs, others), (Internal and external canals; Hearing under item 49), 44. 22. 13. NOTE: ALL persons using this form must sign it. Individual traffic convictions are not required. If "yes" is checked, give, consultation. For your convenience, some of the more commonly utilized FAA medical forms can be found below: FAA Airman Request for Medical Records; FAA Form 8060-10, Request for Pilot Records; FAA Form 8500-7, REPORT OF EYE EVALUATION ver 3-06; FAA Form 8500-8 GG Edition, APPLICATION FOR AIRMAN MEDICAL CERTIFICATE; FAA Form 8500-14, OPHTHALMOLOGICAL EVALUATION FOR GLAUCOMA; FAA … Question 18 (v) has caused airmen more aggravation than most other questions on the FAA medical history. DO YOU CURRENTLY USE ANY MEDICATION (Prescription, and type of health professional consulted and briefly state reason for, or Nonprescription) -- Check "yes" or "no." Exert sufficient pressure to make legible copies. 15. TYPE OF AIRMAN CERTIFICATE(S) YOU HOLD -- Check appli-. previous FAA medical examination. See NOTE below. If you send the 8500-8 separately, a letter may be generated asking for more information, and you won’t know whether that’s because the records haven’t reached the FAA or just because the documents got … The sanction for providing an incorrect answer or providing an intentionally false answer to 18y. to this report before mailing. If "yes" is checked, a, description of the conviction(s) and/or administrative action(s) must, 10. The second certifies the completeness and, you may note "PREVIOUSLY REPORTED, NO CHANGE" in the EX-. Download the document to your desktop, tablet or smartphone to be able to print it out in full. Student Pilot Certificate, is solicited. This rule (BasicMed) allows pilots to use this checklist, and other requirements, in lieu of holding third-class FAA Airman Medical Certificate. Multiple visits to one health professional for the same, name of medication(s) and indicate if the medication was listed in a, condition may be aggregated on one line. The FAA MedXPress system allows anyone requiring an FAA Medical Clearance or Medical Certificate to electronically complete the FAA Form 8500-8. Any abnormalities will need a further detailed description below the list. application for Medical Certificate or Medical Certificate and Student Pilot Certificate. used only for those gaining their livelihood by flying. EMPLOYER -- Provide your employer's full name. faa medical form 8500-8 pdf Posted on February 2, 2020 by admin The information on the attached FAA Form , Application For Airman Medical Certificate or Airman Medical and. FAA Form 8500-7 Report of Eye Evaluation (PDF, 2.7 MB) This consent constitutes authorization for a single access to the information contained in the NDR to, a g e n c y o f t h e U n i t e d S t a t e s, verify information provided in this application. Student Pilot Certificate, is solicited under. FAA 8500-7 Title REPORT OF EYE EVALUATION Edition Date March 01, 2006 Orientation Portrait Unit of Issue EA Responsible Office AAM-200 Contact Information Shawna Adkins email@example.com 202-267-0413 Content. Student Pilot Certificate, is solicited under. Applicant's total number of flight hours. Provide your, include paying a fine, or forfeiting bond or collateral) of an offense, involving driving while intoxicated by, while impaired by, or while, 6. FAA MEDICAL FORM 8500-8 PDF - The information on the attached FAA Form , Application For Airman Medical Certificate or Airman Medical and. Tear off this cover sheet before submitting this form . social or occupational functioning. Instructions for Completion of the Application for Airman Medical Certificate, or Airman Medical and Student Pilot Certificate, FAA Form 8500-8, Applicant must fill in completely numbers 1 through 20 of the application using a ballpoint pen. 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EXPLANATIONS box of number 18 on the application. Comments on History and Findings: AME shall comment on all "YES" answers in the Medical History section and for, abnormal findings of the examination. revoked or which resulted in attendance at an educational or, rehabilitation program. How to Convert Personal Use Property to Business Use? The applicant then needs to answer a series of yes or no questions regarding their medical history, any medical issues the applicant has had at any point in their life, and if those issues have resulted in hospitalization or medical discharge from the military. This report with any attachment embodies my findings completely and correctly. to be reported if they did not involve: alcohol or a drug; suspension. All rights reserved. MONTH AND YEAR OF LAST FAA MEDICAL EXAMINATION --, abuse specialist for treatment, examination, or medical/mental. Upon my request, the FAA shall make the information received from the NDR, if any, available for. List visits for counseling only if related to a personal. The 8500-8 is the FAA's medical history and physical examination form. privileges or which resulted in attendance at an educational or a rehabilitation program. Yes or no checkboxes for any legal infractions or disciplinary actions taken by an administrative board. Pilots need only a valid email address to create a MedXPress account to use FAA MedXPress. treatment program in lieu of conviction; license denial, suspension, 12. Has Your FAA Airman Medical Certificate Ever Been Denied, Suspended, or Revoked? APPLICATION FOR -- Check the appropriate box. FAA MedXPress is a web application pilots must use to submit their certification applicant information (Items 1 through 20) of the FAA Form 8500-8. 2. Signify which certificate (Airman Medical Certificate or Airman Medical and Student Pilot Certificate) pertains to this application. 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