Medical Information Form (Medif Form)
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5CONFIDENTIAL
MEDIF # _________________
MEDICAL INFORMATION FORM (MEDIF FORM)
APPLICATION FOR THE CARRIAGE OF AN INCAPACITATED PASSENGER
(MEDA CASES)
(Sitting case / Wheelchair / Stretcher / Incubator / Ventilator / Oxygen)
‘VISTARA’ (TATA SIA AIRLINES LIMITED)
MEDIF # _______________
APPLICATION DATE: _________________
DATE OF TRAVEL:____________________
CAREFULLY READ FOLLOWING INSTRUCTIONS
All questions must be answered in full and in legible handwriting.
Use BLOCK letters while completing this form.
Use a cross (X) in ‘Yes’ or ‘No’ boxes to indicate appropriate preference.
INFORMATION IN -
MEDIF-PART-1 - To be completed by an authorized travel agent or by ‘VISTARA’ Sales/Reservations employee.
MEDIF-PART-2 and PART-3 – To be completed by passenger’s attending/treating doctor.
MEDIF-PART-4 - To be completed by medical officer at ‘VISTARA’ Medical Department.
Notes for the guidance of passenger’s treating doctor are mentioned in MEDIF-PART-4.
Cabin attendants are not authorized to give special sanitary assistance to particular passengers, to the detriment of their
services to other passengers. Additionally they are trained only in First Aid and are not permitted to administer any
injections, or to give medication from medical kit.
On completion, this form should be returned to any of ‘VISTARA’ Sales/Reservations office or Travel agent for onward
submission or send scanned copy of completed MEDIF form by email on . MEDIF form,
completed and signed by passenger’s treating doctor, should be submitted not more than 10 days before actual travel date.
Minimum of 48 hours are required to complete ‘MEDA’ formalities.
Minimum of 72 hours are required to complete ‘MEDA – Stretcher case’, formalities.
Oxygen cylinders which are available in the aircraft are for use only during emergencies and is available in very limited quantity.
If passenger requires therapeutic oxygen on aircraft due to certain pre-existing medical conditions, then same will need to be
approved and extra oxygen cylinders will need to be arranged by filling this MEDIF form and getting MEDA approval.
Attendant shall ensure that all items/medical equipment brought inside the aircraft for the MEDA passenger, are removed at the
time the passenger is disembarked from the aircraft.
Particular attention is drawn to the fact that the medical details required to be filled in this form must be accurately
completed. If at time of embarkation/boarding the condition of the passenger becomes worse than the details given in
this form, then the carriage may have to be refused depending on the severity of the situation.
Decision of ‘‘VISTARA’’ Medical Department will be final in all cases of medical clearances/approvals.
Contact:
Email:
Phone: +91 (0)11 49293817 (1000am-0500pm)
PASSENGER MEDICAL INFORMATION FORM (MEDIF) – PART 1
TSA/MED/011
EDITION 3
DATE: 10 OCT 2015
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