Federal Aviation Administration Medical Certificate Form

Federal Aviation Administration Medical Certificate Form - Avianca

MEDICAL CERTIFICATE

Dear Attending Physician:

Please mark an X in the medical case that the traveler presents:

Need for supplemental oxygen on board: Oxygen Concentrator POC.

The Federal Aviation Administration (FAA) prohibits the use of personal oxygen units during flight

because they contain compressed gas or liquid oxygen and are considered hazardous materials.

However, the FAA recently issued guidelines permitting the onboard use of certain portable

oxygen concentrators.

Personal oxygen concentrator Transport, Concentrator

Brand:

_______________________________________________________________________________

Confirmation of Pregnant Traveler over 30 weeks for international and domestic flights.

Other Medical Condition

Which? __________________________________________________

1. To follow up on this requirement, it is necessary for the treating physician to fill out this form or

send a medical certificate with the information required herein. This document must be sent to

the email at least 24 hours before the scheduled

flight departure for routes in Colombia and 48 hours for international routes. This email is required

to continue processing the application for the special service.

2. See the list of equipment approved by the FAA: (Oxygen link)

Especiales.htm

3. See the Medical Guide for authorization for the transport of passengers issued by the Civil

Aviation Administration on 23 July 2008. (Special medical conditions link) or directly from the page

of the FAA: https://

GENERAL INFORMATION

Traveler's full name

_______________________________________________________________________________

Identity document number: Type of document:

_____________________________ ______________

Federal Aviation Administration Medical Certificate Form - Avianca