Primary hemochromatosis
What the FAA's documents say about primary hemochromatosis, in plain words, with the FAA's own words one press away.
Short version
The FAA's table sorts it into three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row ATested and found not to have the disease | Examiner issues | Examiner can issue |
| Row BAsymptomatic | Worksheet | CACI |
| Row CSymptomatic, end organ damage, or co-morbid conditions | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Primary hemochromatosis
- Row A · Examiner can issue
Tested and found not to have the disease. The table says carrier status in the absence of disease is not disqualifying. The table says no evaluations or follow up are needed, says ISSUE, and has the examiner summarize this history in Block 60.
A. Tested and found not to have the disease. Carrier status in the Absence of disease is not disqualifying. … No evaluations or follow up needed. ISSUE … Summarize this history in Block 60.
- Row B · CACI
Asymptomatic. The table sends the examiner to the CACI worksheet for primary hemochromatosis, and has the examiner annotate Block 60.
B. Asymptomatic See CACI worksheet Follow the CACI-Primary Hemochromatosis Worksheet. Annotate Block 60.
- Row C · Special Issuance
Symptomatic, or evidence of end organ damage, or co-morbid conditions. The row also lists unacceptable medications used, side effects present, phlebotomy performed more than monthly, and/or iron overload caused by other mechanisms or diseases (e.g. secondary hemochromatosis). The examiner submits the listed items to the FAA for review, defers, and submits the information to the FAA for a possible Special Issuance.
C. Symptomatic OR Evidence of End Organ Damage OR Co-morbid conditions* … Unacceptable medications are used; … Side effects are present; … Phlebotomy performed more than monthly; and/or … Iron overload caused by other mechanisms or diseases (e.g. secondary hemochromatosis … Submit the following to the FAA for review: … DEFER Submit the information to the FAA for a possible Special Issuance.
- A note on the table, 1
The table's note lists what co-morbid conditions include for FAA purposes, in its own terms.
*Note: … Co-morbid conditions for FAA purposes include: … Arthropathy; … Cardiomyopathy or other cardiac disease; … Cirrhosis or other documented hepatic disease; … CNS disease (including cognitive deficits); … Endocrine disease including diabetes, hypopituitarism, hypogonadism, or hypothyroidism; … Kidney disease; … Polycythemia; … Myeloproliferative disorders; and/or … Other condition requiring multiple transfusions
The FAA pathways for primary hemochromatosis
Which exam
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: The progress note from the treating doctor or specialist
The note the examiner reviews, and what the treating physician finds.Within 90 days before the examA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.
The treating physician finds the condition
- Stable and asymptomatic
- Not due to a secondary hemochromatosis
- With no treatment changes recommended
No evidence of
- Not: Arthropathy
- Not: Cardiomyopathy or other cardiac disease
- Not: Cirrhosis or other hepatic disease
- Not: CNS disease, including cognitive deficits
- Not: Endocrine disease, including diabetes, hypopituitarism, hypogonadism or hypothyroidism
- Not: Kidney disease
- Not: Polycythemia or other condition requiring multiple transfusions
Show the FAA's words: The progress note from the treating doctor or specialist
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.
FAA source: CACI – Primary Hemochromatosis Worksheet. FAA date 13 April 2022; checked by Crosscheck 14 October 2026.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA
Treating physician finds the condition is:
Stable and asymptomatic;
FAA source: CACI – Primary Hemochromatosis Worksheet. FAA date 13 April 2022; checked by Crosscheck 14 October 2026.
Treating physician finds the condition is:
NOT due to a secondary hemochromatosis;
FAA source: CACI – Primary Hemochromatosis Worksheet. FAA date 13 April 2022; checked by Crosscheck 14 October 2026.
Treating physician finds the condition is:
No treatment changes recommended
FAA source: CACI – Primary Hemochromatosis Worksheet. FAA date 13 April 2022; checked by Crosscheck 14 October 2026.
Treating physician documents NO evidence of:
Arthropathy;
Cardiomyopathy or other cardiac disease;
Cirrhosis or other hepatic disease;
CNS disease (including cognitive deficits);
Endocrine disease including diabetes; hypopituitarism, hypogonadism, or hypothyroidism
Kidney disease; and/or
Polycythemia or other condition requiring multiple transfusions
FAA source: CACI – Primary Hemochromatosis Worksheet. FAA date 13 April 2022; checked by Crosscheck 14 October 2026.
Step 2: Your lab results
The hemoglobin and ferritin figures the worksheet sets.Labs within the past 90 days: hemoglobin of 11 g/dL or higher, and a ferritin level of 150 ng/mL or less.
Show the FAA's words: Your lab results
Labs (within past 90 days):
Hemoglobin 11 g/dL or higher
Ferritin level less than or equal to 150 ng/mL
FAA source: CACI – Primary Hemochromatosis Worksheet. FAA date 13 April 2022; checked by Crosscheck 14 October 2026.
Step 3: Your current treatment
The treatment the worksheet allows, and the no-fly time after a phlebotomy.One question insideNone or dietary changes, or phlebotomy no more frequently than monthly.
After a phlebotomy
The worksheet says to maintain hydration and not fly for 24 hours. If more than one unit of blood (greater than 500mL) is removed, the no-fly time is 72 hours.
Show the FAA's words: Your current treatment
Current treatment:
[ ] None or dietary changes
OR
[ ] Phlebotomy no more frequently than monthly
FAA source: CACI – Primary Hemochromatosis Worksheet. FAA date 13 April 2022; checked by Crosscheck 14 October 2026.
Note: Maintain hydration following phlebotomy and no fly for 24 hours. If more than one unit of blood is removed (greater than 500mL), no fly time is 72 hours.
FAA source: CACI – Primary Hemochromatosis Worksheet. FAA date 13 April 2022; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The table says no evaluations or follow up are needed, says ISSUE, and has the examiner summarize this history in Block 60.
Row BWorksheetCACI
The table sends the examiner to the CACI worksheet for primary hemochromatosis, and has the examiner annotate Block 60.
Row CDefers to the FAASpecial Issuance
The examiner submits the listed items to the FAA for review, defers, and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Tested and found not to have the disease. The table says carrier status in the absence of disease is not disqualifying. The table says no evaluations or follow up are needed, says ISSUE, and has the examiner summarize this history in Block 60.
A. Tested and found not to have the disease. Carrier status in the Absence of disease is not disqualifying. … No evaluations or follow up needed. ISSUE … Summarize this history in Block 60.
- Row B · CACI
Asymptomatic. The table sends the examiner to the CACI worksheet for primary hemochromatosis, and has the examiner annotate Block 60.
B. Asymptomatic See CACI worksheet Follow the CACI-Primary Hemochromatosis Worksheet. Annotate Block 60.
- Row C · Special Issuance
Symptomatic, or evidence of end organ damage, or co-morbid conditions. The row also lists unacceptable medications used, side effects present, phlebotomy performed more than monthly, and/or iron overload caused by other mechanisms or diseases (e.g. secondary hemochromatosis). The examiner submits the listed items to the FAA for review, defers, and submits the information to the FAA for a possible Special Issuance.
C. Symptomatic OR Evidence of End Organ Damage OR Co-morbid conditions* … Unacceptable medications are used; … Side effects are present; … Phlebotomy performed more than monthly; and/or … Iron overload caused by other mechanisms or diseases (e.g. secondary hemochromatosis … Submit the following to the FAA for review: … DEFER Submit the information to the FAA for a possible Special Issuance.
The CACI worksheet's criteria
Progress note
The treating physician finds the condition
- Stable and asymptomatic
- Not due to a secondary hemochromatosis
- With no treatment changes recommended
No evidence of
- Not: Arthropathy
- Not: Cardiomyopathy or other cardiac disease
- Not: Cirrhosis or other hepatic disease
- Not: CNS disease, including cognitive deficits
- Not: Endocrine disease, including diabetes, hypopituitarism, hypogonadism or hypothyroidism
- Not: Kidney disease
- Not: Polycythemia or other condition requiring multiple transfusions
Your current treatment for primary hemochromatosis
The worksheet says to maintain hydration and not fly for 24 hours. If more than one unit of blood (greater than 500mL) is removed, the no-fly time is 72 hours.
Show the FAA's words: the CACI worksheet's criteria for Primary hemochromatosis
- Stable and asymptomatic
FAA criterion: the treating physician finds the condition is stable and asymptomatic.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA … Treating physician finds the condition is: … Stable and asymptomatic;
- Not due to a secondary hemochromatosis
FAA criterion: the treating physician finds the condition is not due to a secondary hemochromatosis.
Treating physician finds the condition is: … NOT due to a secondary hemochromatosis;
- No treatment changes recommended
FAA criterion: the treating physician finds no treatment changes recommended.
Treating physician finds the condition is: … No treatment changes recommended
- No evidence of the conditions the worksheet lists
FAA criterion: the treating physician documents no evidence of the conditions the worksheet lists, in its own terms.
Treating physician documents NO evidence of: … Arthropathy; … Cardiomyopathy or other cardiac disease; … Cirrhosis or other hepatic disease; … CNS disease (including cognitive deficits); … Endocrine disease including diabetes; hypopituitarism, hypogonadism, or hypothyroidism … Kidney disease; and/or … Polycythemia or other condition requiring multiple transfusions
- After a phlebotomy, the worksheet's no-fly time
The worksheet's note under current treatment: maintain hydration following phlebotomy and no fly for 24 hours. If more than one unit of blood is removed (greater than 500mL), the no fly time is 72 hours.
Note: Maintain hydration following phlebotomy and no fly for 24 hours. If more than one unit of blood is removed (greater than 500mL), no fly time is 72 hours.
If the examiner defersSpecial Issuance
The table's row C is symptomatic, or evidence of end organ damage, or co-morbid conditions, with the further lines it lists. The table marks it DEFER.
What the FAA lists to send
- Item 1. A current evaluation from a board-certified gastroenterologist, hepatologist, or hematologist which documents the course of disease from diagnosis to present; the severity of the condition; the presence or absence of joint, liver, CNS, endocrine, renal or hematologic disease; a pertinent historical lab summary; and evidence of any cognitive changes. The table says the evaluation should document stability, treatment plan, and prognosis.
- Item 2. A list of medications and side effects, if any.
- Item 3. Current lab, within the past 90 days: a CBC, serum iron, ferritin level, and transferrin saturation; a comprehensive metabolic panel; a hemoglobin A1c; and a TSH.
- Item 4. A resting EKG and an echocardiogram, and liver/cardiac imaging and biopsies only if clinically indicated.
- Item 5. Any other testing clinically indicated.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's row C is symptomatic, or evidence of end organ damage, or co-morbid conditions, with the further lines it lists. The table marks it DEFER.
C. Symptomatic OR Evidence of End Organ Damage OR Co-morbid conditions* … DEFER Submit the information to the FAA for a possible Special Issuance.
What the FAA lists to send
- Item 1
A current evaluation from a board-certified gastroenterologist, hepatologist, or hematologist which documents the course of disease from diagnosis to present; the severity of the condition; the presence or absence of joint, liver, CNS, endocrine, renal or hematologic disease; a pertinent historical lab summary; and evidence of any cognitive changes. The table says the evaluation should document stability, treatment plan, and prognosis.
Current evaluation from a board-certified gastroenterologist, hepatologist, or hematologist which documents course of disease from diagnosis to present; severity of the condition; presence or absence of joint, liver, CNS, endocrine, renal or hematologic disease; pertinent historical lab summary; and evidence of any cognitive changes. Evaluation should document stability, treatment plan, and prognosis.
- Item 2
A list of medications and side effects, if any.
List of medications and side effects, if any
- Item 3
Current lab, within the past 90 days: a CBC, serum iron, ferritin level, and transferrin saturation; a comprehensive metabolic panel; a hemoglobin A1c; and a TSH.
Current Lab (within the past 90 days) … CBC, serum iron, ferritin level, and transferrin saturation … Comprehensive metabolic panel … Hemoglobin A1c … TSH
- Item 4
A resting EKG and an echocardiogram, and liver/cardiac imaging and biopsies only if clinically indicated.
Resting EKG … Echocardiogram … Liver/cardiac imaging and biopsies (only if clinically indicated)
- Item 5
Any other testing clinically indicated.
Any other testing clinically indicated
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsSpecial Issuance
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.
Under a Special Issuance, the table says follow up issuance will be per the pilot's own authorization letter.
Show the FAA's words: at later exams
Follow up Issuance will be per the airman’s authorization letter.
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workFollow-up issuance per the authorization letter
For row C the table says follow up issuance will be per the airman's authorization letter.
Show the FAA's words: Follow-up issuance per the authorization letter
Follow up Issuance will be per the airman’s authorization letter.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
No-fly time after phlebotomy
The worksheet says to maintain hydration after phlebotomy and no fly for 24 hours. If more than one unit of blood is removed (greater than 500mL), the no-fly time is 72 hours.
Show the FAA's words: good to know, 2
Note: Maintain hydration following phlebotomy and no fly for 24 hours. If more than one unit of blood is removed (greater than 500mL), no fly time is 72 hours.
Phlebotomy no more than monthly
The worksheet allows phlebotomy no more frequently than monthly. Phlebotomy performed more than monthly is a line in row C of the table, which the table marks DEFER.
Show the FAA's words: good to know, 3
Phlebotomy performed more than monthly; and/or … DEFER Submit the information to the FAA for a possible Special Issuance.
[ ] Phlebotomy no more frequently than monthly
Carrier status alone is not disqualifying
The table says carrier status in the absence of disease is not disqualifying. It is in row A, for a pilot tested and found not to have the disease, which the table marks ISSUE.
Show the FAA's words: good to know, 4
A. Tested and found not to have the disease. Carrier status in the Absence of disease is not disqualifying. … No evaluations or follow up needed. ISSUE
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Open to print: CACI – Primary Hemochromatosis Worksheet, a PDF at the FAA, in a new tab
- Primary Hemochromatosis Disposition TableOpen to print: Primary Hemochromatosis Disposition Table, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.