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AMC1 ARA.MED.130 Medical certificate format

Available versions for ERULES-1963177438-10990

ED Decision 2014/020/R found in: Aircrew (No 1178/2011) Part-FCL Part-MED Part-CC Part-ARA Part-ORA Part-DTO (Dec 2024)

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AMC1 ARA.MED.130 Medical certificate format

ED Decision 2014/020/R

STANDARD
EASA MEDICAL CERTIFICATE FORMAT

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

<table border="1" cellpadding="0" cellspacing="0" width="604">
<tr>
<td valign="top" width="302">
Competent
 authority name and logo
(English
 and any language(s) determined by the competent authority)
EUROPEAN
 UNION
(English
 only)
Class
 1/2/LAPL
MEDICAL
 CERTIFICATE
pertaining
 to a Part-FCL licence
(English
 and any language(s) determined by the competent authority)
Issued
 in accordance with Part-MED
This
 medical certificate complies with ICAO standards, except for the LAPL
 medical certificate
(English
 and any language(s) determined by the competent authority)
</td>
<td valign="top" width="28">
</td>
<td valign="top" width="274">
Requirements
"European
 Union” to be deleted for non-EU Member States
Size
 of each page shall be one eighth A4
</td>
</tr>
</table>

<table border="1" cellpadding="0" cellspacing="0">
<tr>
<td valign="top" width="331">
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:
VII         National language(s)/
              Signature of holder:
</td>
</tr>
<tr>
<td valign="top" width="331">
2
</td>
</tr>
</table>

<table border="1" cellpadding="0" cellspacing="0">
<tr>
<td valign="top" width="331">
XIII        National
 language(s)/Limitations: 
              Code.
 
              Description
 : 
X            National
 language(s)/* Date of issue: 
              (dd/mm/yyyy)
              Signature
 of issuing AME/medical assessor /(GMP): 
XI          National
 language(s)/Stamp:
</td>
</tr>
<tr>
<td valign="top" width="331">
3
</td>
</tr>
</table>

<table border="1" cellpadding="0" cellspacing="0">
<tr>
<td rowspan="4" valign="top" width="132">
IX Nat. lang(s)/
Expiry date of this certificate
</td>
<td valign="top" width="198">
Class 1 single pilot commercial operations carrying
 passengers
(dd/mm/yyyy)
</td>
</tr>
<tr>
<td valign="top" width="198">
Class 1 (dd/mm/yyyy)
</td>
</tr>
<tr>
<td valign="top" width="198">
Class 2 (dd/mm/yyyy)
</td>
</tr>
<tr>
<td valign="top" width="198">
LAPL (dd/mm/yyyy)
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="331">
Nat. lang(s)./Examination
date: (dd/mm/yyyy)
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="331">
MED.A.020 Decrease in medical fitness
(a) Licence holders shall not exercise the
 privileges of their licence and related ratings or certificates 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 flight safety.
(b) In addition, licence holders shall, without
 undue delay, seek aero-medical advice 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.
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="331">
4
</td>
</tr>
</table>

\* Date of issue is the date the
certificate is issued and signed

AMC1 ARA.MED.130 Medical certificate format

ED Decision 2014/020/R

STANDARD EASA MEDICAL CERTIFICATE FORMAT

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

<table border="1" cellpadding="0" cellspacing="0" width="604"><tr><td valign="top" width="302">Competent authority name and logo(English and any language(s) determined by the competent authority)EUROPEAN UNION(English only)Class 1/2/LAPLMEDICAL CERTIFICATEpertaining to a Part-FCL licence(English and any language(s) determined by the competent authority)Issued in accordance with Part-MEDThis medical certificate complies with ICAO standards, except for the LAPL medical certificate(English and any language(s) determined by the competent authority)</td><td valign="top" width="28"></td><td valign="top" width="274">Requirements"European Union” to be deleted for non-EU Member StatesSize of each page shall be one eighth A4</td></tr></table>

<table border="1" cellpadding="0" cellspacing="0"><tr><td valign="top" width="331">I National language(s)/ Authority that issued or is to issue the pilot licenceIII National language(s):/Certificate numberIV National language(s):/ Last and first name of holder:XIV National language(s):/Date of birth: (dd/mm/yyyy)VI National language(s)/Nationality:VII National language(s)/ Signature of holder:</td></tr><tr><td valign="top" width="331">2</td></tr></table>

<table border="1" cellpadding="0" cellspacing="0"><tr><td rowspan="4" valign="top" width="132">IX Nat. lang(s)/Expiry date of this certificate</td><td valign="top" width="198">Class 1 single pilot commercial operations carrying passengers(dd/mm/yyyy)</td></tr><tr><td valign="top" width="198">Class 1 (dd/mm/yyyy)</td></tr><tr><td valign="top" width="198">Class 2 (dd/mm/yyyy)</td></tr><tr><td valign="top" width="198">LAPL (dd/mm/yyyy)</td></tr><tr><td colspan="2" valign="top" width="331">Nat. lang(s)./Examinationdate: (dd/mm/yyyy)</td></tr><tr><td colspan="2" valign="top" width="331">MED.A.020 Decrease in medical fitness(a) Licence holders shall not exercise the privileges of their licence and related ratings or certificates 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 flight safety.(b) In addition, licence holders shall, without undue delay, seek aero-medical advice 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.</td></tr><tr><td colspan="2" valign="top" width="331">4</td></tr></table>

\* Date of issue is the date the certificate is issued and signed