What is the exact title of the form provided in AMC1 ARA.GEN.360(a)(2) for the transfer of medical records?

The exact title of the form is 'SUMMARY OF MEDICAL HISTORY -- FORM FOR THE TRANSFER OF MEDICAL RECORDS'.

In the form for the transfer of medical records, what specific details must be provided under Item 2?

Under Item 2, the title of the licence(s)/certificate(s) and the corresponding serial number of the licence(s) held (or national medical reference number) must be provided, with examples such as 'PPL(A) -- UN country code.FCL.xxx' or 'SPL -- UN country code.FCL.xxx'.

According to the form, what reports must be enclosed at least, and what additional reports should be enclosed where applicable for the class of medical certification?

At least the latest examination report and electrocardiogram (ECG) must be enclosed. In addition, where applicable for the class of medical certification, the latest ophthalmological, ear-nose-throat (ENT), and mental health assessment reports should be enclosed.

What is the certification statement at the end of the form, and who must sign it?

The certification statement reads: 'I, Dr [name], as medical assessor of the (NAA name), certify that the details given above and on any additional pages included are true, complete, and correct.' It must be signed by the medical assessor of the National Aviation Authority (NAA), with date, signature, and licensing authority and stamp/seal.

Under Item 9 of the form, what information about the initial medical certificate must be recorded?

Under Item 9, the date of issue, date of examination, type of certificate (Joint Aviation Authorities (JAR), Part-Med or national), and class must be recorded.

What are the required contact details to be provided under Item 6 of the form?

Under Item 6, the contact details required are email and phone number, with examples such as '(a) example@example.eu' and '(b) +(country code) xxxxxxxxxx'.

What does the form specify should be done if there is insufficient space for any information?

The form specifies that if there is insufficient space for any information, additional pages should be used.

What is the purpose of the form provided in AMC1 ARA.GEN.360(a)(2)?

The purpose of the form is for the transfer of medical records, as indicated by its title 'SUMMARY OF MEDICAL HISTORY -- FORM FOR THE TRANSFER OF MEDICAL RECORDS'.

Under Item 12, what comments are to be included, and what is the instruction regarding enclosing reports?

Under Item 12, comments on any relevant aspect of the applicant's medical history or examination should be included, and if applicable, reports should be enclosed. The instruction is to enclose at least the latest examination report and ECG, and where applicable, the latest ophthalmological, ENT, and mental health assessment reports.

AMC1 ARA.GEN.360(a)(2) Change of competent authority

Q: What does Item 13 of the form require the applicant to specify if they answer 'Yes'?

Item 13 requires the applicant to specify if there is a current investigation into the medical certificate and licence, or suspension or revocation thereof, and to give details on a separate page if 'Yes' is indicated.

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AMC1 ARA.GEN.360(a)(2) Change of competent authority

ED Decision 2020/005/R

SUMMARY OF MEDICAL HISTORY — FORM FOR THE TRANSFER OF MEDICAL RECORDS

SUMMARY OF MEDICAL HISTORY — FORM FOR THE TRANSFER OF MEDICAL RECORDS MEDICAL DETAILS IN CONFIDENCE
Item	Description
1	State of licence(s) issue	Country
2	Title of licence(s)/certificate(s) and corresponding serial number of licence(s) held (or national medical reference number)	e. g. PPL(A) — UN country code.FCL.xxx or SPL — UN country code.FCL.xxx
3	Full name (Last and first names)	LAST NAME 1, LAST NAME 2, etc. First name 1, First name 2, etc.
4	Date of birth (dd/mm/yyyy)	xx/xx/xxxx
5	Address
6	Contact details: email; and phone number.	e.g. (a) [email protected] (b) +(country code) xxxxxxxxxx
7	Nationality	Country
8	Issuing authority	Country and authority
9	Initial medical certificate:	Date of issue	xx/xx/xxxx
		Date of examination	xx/xx/xxxx
		Type of certificate (Joint Aviation Authorities (JAR), Part-Med or national)
		Class
10	Dates of last three revalidation/renewal examinations (if any)


11	Limitations (if any)
12	Comments on any relevant aspect of the applicant’s medical history or examination (if applicable, please enclose reports) Please enclose at least the latest examination report and electrocardiogram (ECG). In addition, where applicable for the class of medical certification, please enclose the latest ophthalmological, ear-nose-throat (ENT), and mental health assessment reports.
13	Past or pending enforcement action[29]	Yes ☐ No ☐ (If yes, please give details on a separate page.)

If there is insufficient space on this form for any information, please use additional pages.

CERTIFICATION
I, Dr ____________________________, as medical assessor of the (NAA name) ________________________________________________________, certify that the details given above and on any additional pages included are true, complete, and correct.
Date	Signature	Licensing authority and stamp/seal

[29] Item 13: specify if there is a current investigation into the medical certificate and licence, or suspension or revocation thereof.

Details

Source-Title: AMC1 ARA.GEN.360(a)(2) Change of competent authority View latest amendments

Erulesid: ERULES-1963177438-16886 Compare versions

Domain: Aircrew

Regulatorysource: ED Decision 2020/005/R Navigate

Regulatorysubject: Part-ARA

Typeofcontent: AMC to IR (Acceptable means of compliance to implementing rule)

Parentir: ARA.GEN.360 Change of competent authority

Origin: EASA

Category: EAR