1. Complete an application in MedXPress:
   • The first step toward getting a medical certificate is to create an account in MedXPress.
   • Once you have created an account, you will answer a series of medical questions and submit your application through MedXPress.
   • After submission, print or save a copy of your application for your Aviation Medical Examiner (AME) who will need the confirmation number from the application.  We recommend you also retain a copy for future reference.
   • You need to complete the AME exam within 60 days of submitting the application, so contact a local AME for an appointment as soon as possible. 
      
2. Find a local AME:
   • An AME is a physician with specific training in how to perform FAA exams.
   • AMEs can be found at https://designee.faa.gov/designeeLocator. You can also ask one of the many pilot advocacy groups or your local flight schools for recommendations. 
   • Remember your MedXPress application will remain active for 60 days; it will disappear from the system if your AME does not upload it within 60 days. 
      
3. Before your AME exam appointment gather necessary documents!
   • It is highly recommended that if you have any current or past medical condition(s) or take medication(s), you research the requirements for medical certification in the Guide for Aviation Medical Examiners (www.faa.gov/go/ameguide). For some conditions, your AME may be able to issue a medical certificate immediately if you have the correct documentation at the time of your exam.  Without the correct documentation, your medical certification may be delayed.
   • The Guide is written for physicians (AMEs) but contains valuable information to help you and your care providers collect information the FAA and AME will need.  Pilot advocates and your AME can also help.
   • Important! For some conditions, the FAA may require medical information in the form of a current, detailed Clinical Progress Note generated from a clinic visit with your treating physician or specialist no more than 90 days prior to your AME exam.  If you ask your physician's office for a copy of your progress note, they may direct you to your patient portal to print out “notes” or an “After Visit Summary (AVS).”  The patient After Visit Summary or notes you can download/print is not sufficient as it may only contain SOME of the necessary information but not ALL the information the FAA needs.  In most cases, the FAA does not require your physician to write a letter, but we do require a copy of the actual Clinical Progress Note.  (All physicians are familiar with progress notes; it is how physicians keep track of you and your condition[s].  It is used for communicating with other physicians and billing).  It is used for communicating with other physicians and billing).  To learn the difference between an AVS and a Clinical Progress Note, see https://www.faa.gov/ame_guide/media/PilotInformation_DetailedClinicalProgressNote.pdf. (PDF).
4. The day of the exam:
   • Bring your MedXPress confirmation number and copies of any medical records (#3 above).
   • As an applicant for a Medical Certificate, you have many rights as described in the Medical Examination Bill of Rights.  You will have acknowledged this and the Pilot’s Bill of Rights as part of the MedXPress application process.
   • Upon arrival, your AME or AME office staff will ask for your MedXPress confirmation number to import your application.  They will need to see a government issued identification card to verify who you are. Your AME and/or their staff will collect your vitals (height, weight, pulse, blood pressure, etc.); test your eyes (visual acuity/depth perception/color vision); perform an audiogram (hearing test) and EKG if required; and collect and test a urine sample.  An EKG tracing will require exposing your chest for lead placement.
      
5. The Examination: Your AME must personally review your medical history with you, review the tasks performed by office staff, and perform the actual physical examination.  When performing a physical examination, your AME will focus on findings which could indicate an aeromedical concern including, but not limited to:
   • Eye evaluation- Your AME should examine your eyes including an ophthalmoscope exam to aeromedical standards necessary for aviation safety.
   • Ear/Nose/Throat (ENT) evaluation may include using an otoscope (ear), pushing/palpation*, and direct observation.
   • Heart and Lungs via a stethoscope, palpation*, and observation.  The AME should ask you to open your shirt to allow skin contact with the stethoscope.
   • Abdomen with palpation* and stethoscope.
   • Anus examinations should only be done if there is a history indicating it needs to be done or at the discretion of the AME and applicant.  The applicant can elect to have their personal physician provide a report in lieu of an anus examination.
   • Genitourinary G-U system and breast exams should only be performed if there is a history indicating it needs to be done or at the discretion of the AME and applicant.  The exam does not include a pelvic exam.  You can elect to have your personal physician provide a report in lieu of a genitourinary (G-U system) or breast exam.
   • Musculoskeletal system will include evaluation of upper and lower extremities, spine, and general musculoskeletal system.  These will be examined with observation and palpation*/reflex/strength testing.
   • Skin and identifying marks such as tattoos and scars will be measured and described.  This may require exposing the skin.
   • Neurologic system will require an AME to check the cranial nerves and reflexes.
   • Psychiatric exam requires an AME to develop a general impression of cognition and mental wellness through observation and general questioning.
   • Hearing will be tested with either a spoken voice test or audiometry.

*During palpation, the AME will press the surface of the body to examine the size, consistency, texture, location, and tenderness of an organ or underlying tissue. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/palpation

A full description of examination techniques is available in the Guide for Aviation Medical Examiners at www.faa.gov/go/ameguide.  As you select each body system, you will find the Code of Federal Regulations applicable requirements, examination techniques, and links to the aeromedical disposition tables which contain more detailed information for most diagnoses.

6. When do I get my medical certificate?
   • If required documentation is present, has been positively reviewed by the AME, and everything in the examination meets the FAA medical standards set forth in 14 C.F.R. part 67, the AME will issue you a medical certificate.
   • For some conditions, or if missing required documentation, the AME must defer the examination to the FAA for review and/or further investigation.
   • In very rare cases, an AME can deny for a specifically disqualifying condition as delineated in 14 C.F.R. part 67.
      
7. What happens if my AME defers my exam?
   • If the AME defers your examination, you will receive a letter from the FAA.  Most letters will list items you need to provide to the FAA (most will be medical records) regarding your condition(s) or medication(s).
   • If medical records are required, make sure you obtain the actual current (no more than 90 days), detailed, Clinical Progress Notes (PDF) from your physician/provider.  Patient Portal notes or an After Visit Summary that do not meet the criteria are NOT sufficient for FAA purposes (refer to item #3 above).
   • Documents received may be reviewed by an FAA physician with expertise in aerospace medicine, occupational medicine, family medicine, internal medicine, or a variety of specialties such as ENT, cardiology, ophthalmology, rheumatology, and/or others.
     • When you obtain these documents, take them to your AME so they can electronically add them to your record.  This is the fastest way to get documents to the FAA.
     • The FAA will send you written notification about the results of its review of your medical application.  A failure to provide all required or requested medical information will result in a delay of your medical certificate issuance or a denial of your medical application.
        
8. What if I receive a denial letter?
   • A denied medical certificate means that you did not meet the unrestricted medical standards set forth in 14 C.F.R. part 67.  If you disagree with that determination, you have the opportunity to appeal that determination and will be provided instructions on how to do that.
   • Don’t panic!  In many cases, an airman who is denied may still be eligible to receive medical certification through the Special Issuance provisions contained in 14 C.F.R. § 67.401. If eligible, you will receive information from the FAA and/or your AME on how to obtain certification through this process.  A medical certificate issues under a Special Issuance authorization requires more rigorous medical information and/or testing documentation to ensure aviation safety.  Additionally, its duration is usually more restrictive. However, an airman with a Special Issuance medical certificate may usually operate an aircraft in the same manner as an airman with an unrestricted medical certificate.