AMC1 ARA.MED.130 Medical certificate format

STANDARD EASA MEDICAL CERTIFICATE FORMAT

The format of the medical certificate should be as shown below.

I National language(s)/ Authority that issued or is to issue the pilot licence: III National language(s)/Certificate number IV National language(s)/ Last and first name of holder: XIV National language(s)/Date of birth: (dd/mm/yyyy) VI National language(s)/Nationality(ies): VII National language(s)/ Signature of holder:

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XIII National language(s)/Limitations: Code: Operational remark: X National language(s)/* Date of issue: (dd/mm/yyyy) Name and signature of issuing AME/medical assessor /GMP: XI National language(s)/Seal or Stamp:

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IX Nat. lang(s)/ Expiry date of this certificate		Class 1 (dd/mm/yyyy or ‘N/A’)
		Class 1 single-pilot commercial operations carrying passengers (dd/mm/yyyy or ‘N/A’)
		Class 2 (dd/mm/yyyy or ‘N/A’)
		LAPL (dd/mm/yyyy)
Nat. lang(s)./Examination date: (dd/mm/yyyy)
Type of examination	Last	Next
		Class 1	Class 2	LAPD
ECG
Audiogram (For class 1, and for class 2 with IR or en route IR)
Ophthalmological examination
Other information
MED.A.020 Decrease in medical fitness (a) Licence holders shall not exercise the privileges of their licence and related ratings or certificates, and student pilots shall not fly solo, at any time when they: (1) are aware of any decrease in their medical fitness that might render them unable to safely exercise those privileges; (2) take or use any prescribed or non-prescribed medication that is likely to interfere with the safe exercise of the privileges of the applicable licence; or (3) receive any medical, surgical or other treatment that is likely to interfere with the safe exercise of the privileges of the applicable licence. (b) In addition, licence holders shall, without undue delay and before exercising the privileges of their licence, seek aero-medical advice from the AeMC, AME or GMP, as applicable, when they: (1) have undergone a surgical operation or invasive procedure; (2) have commenced the regular use of any medication; (3) have suffered any significant personal injury involving incapacity to function as a member of the flight crew; (4) have been suffering from any significant illness involving incapacity to function as a member of the flight crew; (5) are pregnant; (6) have been admitted to hospital or medical clinic; or (7) first require correcting lenses.
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* Date of issue is the date the certificate is issued and signed