Understanding the FAA medical certification process
From your AME examination to Special Issuance, understand how FAA medical certification works and what to expect.
- From 12 FAA documents
- Checked by Crosscheck 14 October 2026
- Not affiliated with the FAA
The process
How FAA medical certification works
The general shape, not a sequence every applicant follows. Some pilots prepare a good deal of documentation before the exam.
- 01
Prepare for your medical
With a current or past condition or medication, research the Guide's requirements and gather documents before the exam.
- 02
Complete MedXPress
Create an account, answer the medical questions and submit. The examiner needs the confirmation number.
- 03
Visit your AME
Your government-issued ID is checked. The examiner reviews your history with you and performs the exam.
- 04
AME issuance or FAA review
If everything meets the FAA's standards, the examiner issues. For some conditions, or missing documents, the exam is deferred.
- 05
Certification outcome
A certificate at the exam, or, after a deferral, the FAA's written notification of the results of its review.
View detailed process and FAA sources
- 1. Prepare for your medical
The FAA's pilot page recommends that anyone with a current or past medical condition, or who takes medication, research the requirements in the Guide for Aviation Medical Examiners and gather the necessary documents before the exam appointment. For some conditions, the examiner may be able to issue at once when the correct documentation is there at the exam.
Before your AME exam appointment gather necessary documents! It is highly recommended that if you have any current or past medical condition(s) or take medication(s), you research the requirements for medical certification in the Guide for Aviation Medical Examiners . … For some conditions, your AME may be able to issue a medical certificate immediately if you have the correct documentation at the time of your exam.
- 2. Complete MedXPress
Create an account in MedXPress, answer its medical questions and submit the application. The examiner will need the application's confirmation number, so print or save a copy.
is to create an account in MedXPress. … Once you have created an account, you will answer a series of medical questions and submit your application through MedXPress . … After submission, print or save a copy of your application for your Aviation Medical Examiner (AME) who will need the confirmation number from the application.
- 3. Visit your AME
The examiner's office imports the application with its confirmation number and checks a government issued identification card. The examiner must personally review the medical history with the applicant, review the tasks done by office staff, and perform the physical examination.
Upon arrival, your AME or AME office staff will ask for your MedXPress confirmation number to import your application. They will need to see a government issued identification card to verify who you are. … The Examination: Your AME must personally review your medical history with you, review the tasks performed by office staff, and perform the actual physical examination.
- 4. AME issuance or FAA review
When the required documentation is present and positively reviewed by the examiner, and everything in the examination meets the FAA's medical standards, the examiner issues the certificate. For some conditions, or when required documentation is missing, the examiner must defer the exam to the FAA. In very rare cases, an examiner can deny for a specifically disqualifying condition.
If required documentation is present, has been positively reviewed by the AME, and everything in the examination meets the FAA medical standards set forth in 14 C.F.R. part 67, the AME will issue you a medical certificate. … For some conditions, or if missing required documentation, the AME must defer the examination to the FAA for review and/or further investigation. … In very rare cases, an AME can deny for a specifically disqualifying condition as delineated in 14 C.F.R. part 67.
- 5. Certification outcome
The examiner issues the certificate at the exam, or, after a deferral, the FAA sends written notification of the results of its review.
the AME will issue you a medical certificate. … The FAA will send you written notification about the results of its review of your medical application.
The pathways
Understanding the pathways
One ordinary way and three the FAA names. They are not four equal programs: AASI is how an examiner reissues under an existing Special Issuance.
Examiner can issue
Issued at the exam, when the required documents are reviewed and everything meets the FAA's standards.DetailsFor some conditions, or when required documents are missing, the exam is deferred to the FAA.
When the exam is deferredFAA sources: Examiner can issue
- In short
Issued at the exam, when the required documents are reviewed and everything meets the FAA's standards.
If required documentation is present, has been positively reviewed by the AME, and everything in the examination meets the FAA medical standards set forth in 14 C.F.R. part 67, the AME will issue you a medical certificate.
- What sets it apart
For some conditions, or when required documents are missing, the exam is deferred to the FAA.
For some conditions, or if missing required documentation, the AME must defer the examination to the FAA for review and/or further investigation.
CACI
For conditions on the FAA's CACI list, the examiner can issue a regular certificate using the CACI worksheet.DetailsWhen every criterion is met and the pilot is otherwise qualified, the examiner may issue at the first exam, or the first time the condition is reported, without contacting the FAA.
How CACI worksFAA sources: CACI
- In short
For conditions on the FAA's CACI list, the examiner can issue a regular certificate using the CACI worksheet.
Conditions AMEs Can Issue (CACI) is a series of conditions which allow AMEs to regular issue if the applicant meets the parameters of the CACI Condition Worksheet.
- What sets it apart
When every criterion is met and the pilot is otherwise qualified, the examiner may issue at the first exam, or the first time the condition is reported, without contacting the FAA.
If all the CACI criteria are met and the applicant is otherwise qualified, the AME may issue on the first exam or the first time the condition is reported to the AME without contacting AMCD/RFS.
Special Issuance
An FAA Authorization, for a specified period, for a pilot who does not meet a medical standard.DetailsThe FAA grants it. Examiners may not issue an initial Authorization.
How Special Issuance worksFAA sources: Special Issuance
- In short
An FAA Authorization, for a specified period, for a pilot who does not meet a medical standard.
At the discretion of the Federal Air Surgeon, an Authorization for Special Issuance of a Medical Certificate (Authorization), valid for a specified period, may be granted 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 medical certificate applied for can be performed without endangering public safety during the period in which the Authorization would be in force.
- What sets it apart
The FAA grants it. Examiners may not issue an initial Authorization.
At the discretion of the Federal Air Surgeon, an Authorization for Special Issuance of a Medical Certificate (Authorization), valid for a specified period, may be granted 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 medical certificate applied for can be performed without endangering public safety during the period in which the Authorization would be in force.
- What sets it apart
The FAA grants it. Examiners may not issue an initial Authorization.
Examiners may not issue initial Authorizations.
AASI
The examiner may reissue under an Authorization for Special Issuance the FAA has already granted.DetailsAn FAA physician makes the first decision and grants the Authorization. The examiner reissues at later exams.
How AASI worksFAA sources: AASI
- In short
The examiner may reissue under an Authorization for Special Issuance the FAA has already granted.
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations (14 CFR) part 67.
- What sets it apart
An FAA physician makes the first decision and grants the Authorization. The examiner reissues at later exams.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR 67.401.
- What sets it apart
An FAA physician makes the first decision and grants the Authorization. The examiner reissues at later exams.
Following the granting of an Authorization for Special Issuance of a Medical Certificate (Authorization) by the AMCD or RFS, an Examiner may reissue a medical certificate to an applicant with a medical history of an initially disqualifying condition once the AASI's specialized criteria is met and the applicant is otherwise qualified.
If your exam is deferred
What happens if your medical is deferred
A deferral sends the exam to the FAA for review. It is not a decision either way, and what the FAA asks for differs from case to case.
What happens after a deferral
The FAA writes. Most letters list items to provide, mostly medical records.DetailsWhat a deferral is
The examiner sends the exam to the FAA for review, further investigation, or both. The FAA's pilot page says this happens for some conditions, or when required documentation is missing.
FAA source: What a deferral is
For some conditions, or if missing required documentation, the AME must defer the examination to the FAA for review and/or further investigation.
Why an examiner defers
The Guide says some medical conditions are initially disqualifying when the applicant does not meet the issue criteria in its disposition tables or certification worksheets, and must then be deferred to the AMCD or an RFS.
FAA source: Why an examiner defers
The Guide refers to a number of selected medical conditions that are initially disqualifying (if the applicant does not meet the issue criteria in the Aerospace Medicine Dispositions Tables or the Certification Worksheets) and must be deferred to the AMCD or RFS .
The FAA's letter
After a deferral the FAA writes to the applicant. Most letters list items to provide to the FAA, and most of those are medical records about the condition or medication.
FAA source: The FAA's letter
What happens if my AME defers my exam? If the AME defers your examination, you will receive a letter from the FAA. Most letters will list items you need to provide to the FAA (most will be medical records) regarding your condition(s) or medication(s).
Who reviews the documents
The documents may be reviewed by an FAA physician with expertise in aerospace medicine, occupational medicine, family medicine, internal medicine, or a specialty such as ENT, cardiology, ophthalmology or rheumatology. The FAA sends written notification of the results of its review.
FAA source: Who reviews the documents
Documents received may be reviewed by an FAA physician with expertise in aerospace medicine, occupational medicine, family medicine, internal medicine, or a variety of specialties such as ENT, cardiology, ophthalmology, rheumatology, and/or others. … The FAA will send you written notification about the results of its review of your medical application.
What the FAA might ask for
Where records are required: current, detailed Clinical Progress Notes, no more than 90 days old.DetailsMedical records
Where records are required, the FAA's pilot page asks for the actual current, detailed Clinical Progress Notes from the physician or provider, no more than 90 days old; patient portal notes or an After Visit Summary that do not meet the criteria are not sufficient. Taking the documents to the examiner, to add to the record electronically, is in its words the fastest way to get them to the FAA.
FAA source: Medical records
If medical records are required, make sure you obtain the actual current (no more than 90 days), detailed, Clinical Progress Notes (PDF) from your physician/provider. Patient Portal notes or an After Visit Summary that do not meet the criteria are NOT sufficient for FAA purposes … When you obtain these documents, take them to your AME so they can electronically add them to your record. This is the fastest way to get documents to the FAA.
When information is missing
Not providing all required or requested medical information results in a delay of the certificate or a denial of the application.
FAA source: When information is missing
A failure to provide all required or requested medical information will result in a delay of your medical certificate issuance or a denial of your medical application.
Deferral and denial
A denial means the unrestricted medical standards were not met. An applicant who disagrees can appeal.DetailsA denial
A denial means the applicant did not meet the unrestricted medical standards of 14 CFR part 67. An applicant who disagrees can appeal, and is given instructions on how.
FAA source: A denial
What if I receive a denial letter? A denied medical certificate means that you did not meet the unrestricted medical standards set forth in 14 C.F.R. part 67. If you disagree with that determination, you have the opportunity to appeal that determination and will be provided instructions on how to do that.
After a denial
In many cases, the FAA's pilot page says, an applicant who is denied may still be eligible for certification through the Special Issuance provisions of 14 CFR 67.401, and an eligible applicant hears from the FAA, the examiner, or both how to go about it.
FAA source: After a denial
In many cases, an airman who is denied may still be eligible to receive medical certification through the Special Issuance provisions contained in 14 C.F.R. § 67.401. If eligible, you will receive information from the FAA and/or your AME on how to obtain certification through this process.
Timing
How long certification takes
The FAA's documents quoted here give no processing time for an FAA review, so Crosscheck gives none. This is when a certificate can be issued, and who decides.
| Path | When a certificate can be issued | Who decides |
|---|---|---|
| Regular AME issuance | When: At the exam | Who decides: The examiner |
| CACI | When: At the first exam, or the first time the condition is reported, when every criterion is met and the applicant is otherwise qualified | Who decides: The examiner, without contacting the FAA |
| Initial Special Issuance | When: Once the FAA has granted an Authorization | Who decides: The FAA grants the Authorization |
| AASI reissuance | When: At later exams, under the Authorization | Who decides: The examiner, subject to FAA review |
| Deferred applications | When: After the FAA's review | Who decides: The FAA |
Each row in full, with its FAA source
- Regular AME issuance
When the required documentation is present and positively reviewed by the examiner, and everything meets the FAA's standards, the examiner issues at the exam. For some conditions, the examiner may be able to issue at once when the correct documentation is there; without it, certification may be delayed.
If required documentation is present, has been positively reviewed by the AME, and everything in the examination meets the FAA medical standards set forth in 14 C.F.R. part 67, the AME will issue you a medical certificate. … For some conditions, your AME may be able to issue a medical certificate immediately if you have the correct documentation at the time of your exam. Without the correct documentation, your medical certification may be delayed.
- CACI
When all the CACI criteria are met and the applicant is otherwise qualified, the examiner may issue at the first exam, or the first time the condition is reported to the examiner, without contacting the AMCD or an RFS.
If all the CACI criteria are met and the applicant is otherwise qualified, the AME may issue on the first exam or the first time the condition is reported to the AME without contacting AMCD/RFS.
- Initial Special Issuance
A certificate may be issued to a pilot who does not meet one or more of the standards once the pilot holds a valid Authorization from the FAA and is otherwise eligible. The Authorization is valid for a specified period.
A medical certificate of the appropriate class may be issued to a person who fails to meet one or more of the established medical standards if that person possesses a valid agency issued Authorization and is otherwise eligible. … an Authorization for Special Issuance of a Medical Certificate (Authorization), valid for a specified period, may be granted
- AASI reissuance
Once the AMCD or an RFS has granted the Authorization, the examiner may reissue when the AASI's specialized criteria are met and the applicant is otherwise qualified. The examiner's decision is subject to review by the FAA.
Following the granting of an Authorization for Special Issuance of a Medical Certificate (Authorization) by the AMCD or RFS, an Examiner may reissue a medical certificate to an applicant with a medical history of an initially disqualifying condition once the AASI's specialized criteria is met and the applicant is otherwise qualified. … An Examiner's decision or determination is subject to review by the FAA.
- Deferred applications
The FAA sends written notification of the results of its review. Not providing all required or requested medical information results in a delay of the certificate or a denial of the application.
The FAA will send you written notification about the results of its review of your medical application. A failure to provide all required or requested medical information will result in a delay of your medical certificate issuance or a denial of your medical application.
Important deadlines
Limits on how old an application or a document may be, not how long the FAA takes.DetailsMedXPress
An application not submitted within 30 days of being created is removed. Once it is submitted, the examination must take place within 60 days or the application is deleted.
FAA source: MedXPress
If your application is not submitted within 30 days of creation, it will be removed from the system. After your application is submitted, your medical examination must occur within 60 days or your application will be deleted.
Clinical Progress Notes
For some conditions, the FAA may require a current, detailed Clinical Progress Note from a clinic visit with the treating physician or specialist no more than 90 days before the examiner's exam.
FAA source: Clinical Progress Notes
For some conditions, the FAA may require medical information in the form of a current, detailed Clinical Progress Note generated from a clinic visit with your treating physician or specialist no more than 90 days prior to your AME exam.
Certification Assistant
Preparing for your FAA medical certification?
Crosscheck's Certification Assistant helps you identify and organize published FAA requirements for supported medical conditions.
- A step-by-step plan from the FAA's documents
- New cases, renewals and reissues
- Your FAA letters, added to the plan
- One PDF packet for your examiner
It lists what the FAA's documents ask for and what you have gathered. It does not predict what the FAA or an examiner will decide, and it is not medical advice.
High blood pressure
Hypertension
New case · First class
Your certification plan
0 of 2 ready
1 Dec 2026
Things to prepare
- 1Not started
Progress note
Within 90 days before the examEvery year
- 2Not started
Your blood pressure medications
Where this comes from
Official FAA references
Every line in this guide links to the FAA's own words. Where Crosscheck's wording and the FAA's differ, the FAA's document is the one that counts.
- AASI for HypertensionFAA date 27 October 2015
- Authorization for Special Issuance and AME Assisted Special Issuance (AASI)FAA date 28 August 2024
- AASI for Third-ClassFAA date 31 December 2024
- ADHD Fast Track Evaluation – General InformationFAA date 30 October 2024
- Authorization for Special Issuance and AASIFAA date 10 March 2023
- CACI – Hypertension WorksheetFAA date 13 April 2022
- CACI ConditionsFAA date 29 April 2026
- Do Not Issue – Do Not Fly (overview)FAA date 10 July 2023
- How do I get a Medical Certificate and what to expect during the AME examinationFAA date 14 May 2026
- ITDM (CGM) – Submitting Documents for Initial and RenewalFAA date 30 August 2023
- Frequently Asked Questions – MedXPressFAA date not stated
- Special IssuancesFAA date 28 August 2024
Plans
Stay organized for your next FAA medical
Keep your medical information, doctor visits, documents and important dates organized with Crosscheck.
Free
$0The FAA tools and your medical tracker.Crosscheck Plus
$35.99Regular price: $39.99first year, then $39.99 a yearYour FAA medical, doctor visits, medications and reminders.Crosscheck Pro
$62.99Regular price: $69.99first year, then $69.99 a yearEverything in Plus, and the Certification Assistant.
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.
Where Crosscheck's FAA information comes fromOfficial FAA references