Guide for Aviation Medical Examiners
________________________________________________________________
ITEM 18. MEDICAL HISTORY
18. Medical History - HAVE YOU EVER IN YOUR LIFE BEEN DIAGNOSED WITH, HAD, OR DO YOU PRESENTLY HAVE ANY OF THE FOLLOWING? Answer “yes” or “no”
for every condition listed below. In the EXPLANATIONS box below, you may note ‘PREVIOUSLY REPORTED, NO CHANGE” only if the explanation of the condition
was reported on a previous application for an airman medical certificate and there has been no change in your condition.
See Instructions Page
a.
b.
c.
d.
Yes No
Frequent or severe headaches
Dizziness or fainting spell
Unconsciousness for any reason
Eye or vision trouble except glasses
Hay fever or allergy
Asthma or lung disease
Condition
Yes No Condition
Heart or vascular trouble
High or low blood pressure
Stomach, liver, or intestinal
trouble
Kidney stone or blood in urine
Diabetes
Yes No Condition
g.
h.
j.
k.
l.
m.
n.
o.
p.
q.
Mental disorders of any sort;
depression, anxiety, etc.
Substance dependence or failed a drug
test ever; or substance abuse or use
of illegal substance in the last 2 years
Alcohol dependence or abuse
Suicide attempt
Motion sickness requiring medication
Military medical discharge
Medical rejection by military service
Rejection for life or health insurance
Admission to hospital
Other illness, disability, or surgery
Yes No Condition
t.
u.
x.
Conviction and/or Administrative Action History - See Instructions Page
Yes No
v.
History of (1) any
conviction(s) involving driving while intoxicated by, while impaired by, or while under the influence
of alcohol or a drug; or (2) history of any conviction(s) or administrative action(s) involving an offense(s) which
resulted in the denial, suspension, cancellation, or revocation of driving privileges or which resulted in attendance
at an educational or a rehabilitation program.
w.
Yes No
History of nontraffic
conviction(s)(misdemeanors
or felonies).
EXPLANATIONS: See Instructions Page
Neurological disorders; epilepsy,
seizures, stroke, paralysis,. etc.
e.
r.
For FAA Use
Review Action Codes
s.
i.
f.
Each item under this heading must be checked either "yes" or "no." For all items
checked "yes," a description and approximate date of every condition the applicant has
ever been diagnosed with, had, or presently has, must be given in the EXPLANATIONS
box. If information has been reported on a previous application for airman medical
certification and there has been no change in the condition, the applicant may note
"PREVIOUSLY REPORTED, NO CHANGE" in the EXPLANATIONS box, but the
applicant must still check "yes" to the condition.
Of particular importance are conditions that have developed since the last FAA medical
examination. If more space is needed, a plain sheet of paper bearing the applicant's full
printed name, date of birth, signature, and the date should be used.
The Examiner must take the time to review the applicant's responses on FAA
Form 8500-8 before starting the applicant's medical examination.
The Examiner should ensure that the applicant has checked all of the boxes in Item 18
as either "yes" or "no." The Examiner should use information obtained from this review
in asking the applicant pertinent questions during the course of the examination.
Certain aspects of the individual's history may need to be elaborated upon. The
Examiner should provide in Item 60, page 153 an explanation of the nature of items
checked "yes" in Items 18.a. through 18.x. An additional sheet may be added if
necessary.
LAST UPDATE: April 3, 2006
29