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Pior Applications

Pilot Guide - Item 16. Previous FAA Medical Application

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Excerpts from Guide for Aviation Medical Examiners
Application Process for Medical Certification

Applicant History
Item 16. Date of Last FAA Medical Application

If a prior application was made, the applicant should indicate the date of the last application, even if it is only an estimate of the year. This item should be completed even if the application was made many years ago or the previous application did not result in the issuance of a medical certificate. If no prior application was made, the applicant should check the appropriate block in Item 16.

Other Portions of Applicant History:

Item(s) Description
1-2 Application For: Class of Medical Certificate Applied For
3 Last Name; First Name; Middle Name
4 Social Security Number (SSN)
5 Address and Telephone Number
6 Date of Birth
7 Color of Hair
8 Color of Eyes
9 Sex
10 Type of Airman Certificate(s) You Hold
11-12 Occupation, Employer
13 Has Your FAA Airman Medical Certificate Ever Been Denied, Suspended, or Revoked?
14-15 Total Pilot Time
16 Date of Last FAA Medical Application
17 a Do You Currently Use Any Medication (Prescription or Nonprescription)?
17 b Do You Ever Use Near Vision Contact Lens(es) While Flying?
18 Medical History
19 Visits to Health Professional Within Last 3 Years
20 Applicant's National Driver Register and Certifying Declaration
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