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Hepatitis C - Chronic Worksheet
The Examiner must review a current status report by the treating physician and any supporting documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.
|
AME MUST REVIEW |
ACCEPTABLE CERTIFICATION CRITERIA |
|---|---|
|
Treating physician finds the condition stable on current regimen and no changes recommended |
[ ] Yes |
|
Complications or symptoms from Chronic Hepatitis C |
[ ] None |
|
Medications for condition |
[ ] None |
|
Current Labs |
[ ] Within last 90 days [ ] AST (SGOT), ALT (SGPT), Albumin, and PT all within 10% of normal lab scale. |
AME MUST NOTE in Item 60: AME Comments on History and Findings one of the following:
[ ] Airman meets certification criteria for Hepatitis C - Chronic.
[ ] Airman had a previous Special Issuance for this condition and now meets the regular issuance certification criteria for Hepatitis C - Chronic.
[ ] Airman does NOT meet certification criteria for Hepatitis C - Chronic. I have deferred this exam. (Mail the supporting documents to FAA identifying which criteria were not met.)
Last revision date: 06/12/2013
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