Completing the Medical Examination Report
- Part A
- Part B
- Part C
- Part D
- Chart 1 - Body Mass Index (BMI)
- Figure 3 - Vision Standards
- Figure 4 - Medical Certificate
This section deals specifically with the completion of the form.
BLOCK LETTERS OR TYPING SHOULD BE USED
Region and HQ File Number
- These blocks will be completed by the Region.
Type of Licence/Permit Desired
- Indicate any of the types listed in Fig. 2.
Aviation Licence/Permit Held
- Indicate any of the types listed in Fig. 2. Initial applicants should have "NIL" indicated here.
- Enter the applicant's permit/licence number if available.
- Indicate numbers with area codes, Fax, e-mail.
Name, Family Name and Former Surname
- Complete legal names should be indicated here. Initials and nicknames cause confusion.
Address, City\Country, Province, Postal Code
- Full addresses are required. Abbreviations should not be used.
Country of Residence
- Self explanatory.
Date of Birth
- Self explanatory.
Place of Birth (Country)
- Indicate the country only.
- Self explanatory.
- Indicate citizenship.
- Indicate highest level achieved e.g. Grade 12 (or University).
- Self explanatory.
Pilot Flight Time
- This can be very important. A hiatus or sudden change in flying time patterns may indicate an illness/injury which has not been revealed. Grand total is all the flying time since the applicant started flying.
Have you had an aircraft accident...?
- Accident data is not kept on the Department of Transport pilot files. We rely on the information you provide. If the pilot answers yes, note whether there was a medical cause or any medical sequelae in the "Review of Systems" part of the form.
Have you consulted a physician? Reason?
- Self explanatory.
- Indicate the language preferred by the applicant.
Primary Type of Flying Intended
- Recreation includes all non-business related flying. Business includes all business, commercial and military flying.
Date of Last Civil Aviation Medical Examination
- Indicate date and place if known.
Date of Last ECG, Chest X-ray and Audiogram
- Show the complete date if known.
Note: If you are examining the applicant for the first time ask for proof of identity, preferably photo ID!
This section is included to identify people at higher risk for genetic or familial diseases. Any "yes" answers require comment in the blank space provided. There is also a block here in which you can record cardiovascular risk factors.
Review of Systems
The functional inquiry is the basis for any good medical examination. This part should be completed by you. The questions, of course, are simply a guide and are not all inclusive. A positive response should be elaborated in the space below or, if there is insufficient space, on an attached sheet.
Statement of Applicant
This is a legal declaration that the applicant has supplied complete and accurate information. It releases the medical information on the MER and other reports to CAM and Transport Canada. The applicant must read, date and sign the declaration and the signature must be witnessed. The applicant should be aware that it is an offence under the Aeronautics Act to knowingly make a false declaration.
Civil Aviation Medical Examiner's Recommendation
Most of this is self-explanatory. It is possible for a candidate who is an air traffic controller to have two categories such as 2 and 3, as the candidate could be also eligible for private pilot medical certification. The "remarks" area is for any observation or recommendation you wish to make. Part D should be signed at the end of the complete examination and must bear your personal CAME stamp.
General Physical Examination
This section should be completed by you although some portions, such as the height, weight and blood pressure may be completed by your staff. They must be trained and supervised, and appropriately 'delegated' in accordance with the policy of your medical licensing authority. It is preferable that you perform the entire examination.
Height and Weight
- Use metric figures.
- This should be recorded while the applicant is sitting, using a cuff of appropriate size. If a nonstandard cuff is used this should be recorded. The diastolic blood pressure to be recorded is the disappearance of the sound.
- Note any surgical scars, tattoos or other marks. These may be useful for identification in aircraft accidents.
- There are no Transport Canada standards for desirable or maximum weights of individuals. Body Mass Index (BMI) is a useful indicator of a healthy weight. (See Chart 1.)
- BMI = Weight in Kg divided by the height in metres2
- The ideal BMI range is 20-25
Nose and Throat
- The examination should be directed to the presence of any condition which would impair respiratory functions or pressure equalization during flight.
- Examine for any pathology, perforations and for the adequacy of pressure equalization. Pressure equalization should be assessed by observation of the drum during a Valsalva maneuver. Vestibular function should be normal.
- This should include an assessment of the peripheral circulation as well as the heart. A careful note should be made of any murmurs.
Abdomen Including Hernia
- Rectal examination is not mandatory but, in keeping with good medical practice, is recommended for males over age 45. An assessment of the inguinal areas for hernia is necessary, since inguinal hernias are not considered safe in the aviation environment.
- Self explanatory. Pelvic examination is not required.
- Pilot applicants should be assessed for the ability to undertake flight operations in normal and emergency situations. In the case of amputation or paraplegia, special practical tests will be ordered by the RAMO to determine the applicant's suitability for flight.
- A screening examination with assessment of reflexes is required.
- This is an overall assessment of the psychological suitability for the aircrew of air traffic controller licence. A brief comment regarding an applicant's mental stability would be appreciated in the "Remarks" section.
- skin etc.
Note: An excellent outline of an aviation visual examination can be seen on the video, "The Vision Examination for Civil Aviation Medical Examiners" available from CAM Headquarters. This should include examination of the external eye and direct or indirect ophthalmoscopy. Particular attention should be directed to the cornea to detect contact lenses and/or the scars of surgical procedures to correct refractive errors such as PRK and LASIK. Cycloplegic examination is not routinely required.
Chart 1 - Body Mass Index (BMI)
- Assessment by confrontation is adequate.
Distant Vision Testing
The Transport Canada standards for vision are summarized in Fig. 3. Distant vision should be tested using Landolt Rings, a chart of Snellen letters or other similar opotypes situated at an optical distance of 6 meters using either an eye lane or an approved vision testing instrument. Where an eye lane is used, the test chart must be illuminated to a level equivalent to that provided by a 100 watt lightbulb placed 120 centimeters in front of, and slightly above the chart with the light shielded from the applicant. The examination room should be darkened with the exception of the chart.
The uncorrected vision should be tested initially in each eye separately, and then in both eyes. Squinting is not permitted. After the uncorrected vision is tested the corrected vision should be tested in the same manner.
Contact Lens Wearers - It is necessary to test the uncorrected vision in the initial examination without the use of lenses or provide a contact lens report from an eye care professional. They should also be tested with backup glasses prior to putting their lenses in place and the results noted beside the distant vision testing blocks.
If a contact lens wearer cannot remove his/her lenses at the initial examination, he/she should be required to return. It is not necessary to repeat examination to remove the contact lenses.
In initial applicants if the uncorrected vision is 6/60 or less the refractive error must be recorded in the space provided.
Be sure to note whether contact lenses were worn during the examination and whether you recommend an eye specialist's examination.
Figure 3 - Vision Standards
|Distant Vision||In each eye separately, equal or better than|
6/9 (20/30) Corrected or uncorrected in each eye.
6/6 (20/20) both eyes
|Category 2||Same as Category 1.|
6/9 (20/30) or
6/12 (20/40) Corrected or uncorrected.
No less than 6/60 (20/200) uncorrected.
|Category 4||No less than 6/9 (20/30) in the better eye.|
|Categories 1, 2 and 3||N5 at 30 - 50 cm.|
|Category 4||No standard.|
|Ocular Muscle Balance|
|Categories 1, 2 and 3||
Exophoria and Esophoria: maximum 6 prism dioptres.
Hyperphoria: 1 prism dioptre.
|Category 4||No standard.|
|N.B. Vision Testing machines such as the Titmus Vision Tester, Keystone Orthoscope or Telebinocular, Bausch & Lomb Orthorator may be used.|
Near vision should be tested with the Faculty of Ophthalmologists Reading Type 'N' charts or equivalent. Vision in each eye separately should be tested without and then with correction. Use good "over the shoulder" illumination of the card and avoid reflections and glare. Note that the standard does not require the near vision correction to meet TC Standards in each eye separately.
Ocular Muscle Balance
Ocular muscle balance can be tested with the cover test, the Maddox rod or an approved vision tester. Report the results of the cover test in the space provided. The Maddox rod results should be noted in the appropriate spaces. Checking the orthophoria box means that there is no deviation and the other spaces can be left blank. Any deviations should be noted in the esophoria, exophoria and hyper phoria boxes.
Maddox Rod Test - This is described in detail in Appendix 1 and on the aviation vision video. The results should be recorded in the number of dioptres of esophoria, etc. The use of this instrument is demonstrated in the video "The Vision Examination for Aviation Medical Examiners"
Cover Test - The purpose of this test is to determine whether manifest strabismus is present, or whether there is any tendency of the eyes to deviate when the two eyes are dissociated. The examiner stands in front of the candidate who is told to fix his eyes on a small target such as a small examining light. An occluder card is then placed in front of one eye and the other eye checked for movement. If there is none the card is removed and the covered eye examined to see whether it has remained fixed or whether it has moved medially or laterally and has to be re-fixated. The test is then repeated with the other eye covered.
If the candidate is orthophoric no movement of the eyes will take place. If there is esophoria one eye will move in and then re-fixate when the occluder is removed. In exophoria the opposite is true. It should be noted that less than 10% of individuals are orthophoric!
Colour perception should be tested at each aviation medical examination because various eye diseases may cause a change or deterioration. Colour vision may be tested with any of the standard pseudoisochromatic test plate sets noted in Appendix 2. Appropriate lighting must be provided for testing. If a special colour balanced light source is not used, daylight is best for screening. Be wary of fluorescent or incandescent lights which may cause inaccurate readings. The type of plates (Pseudo-isochromatic, Ishihara etc.), the number of plates in the set (versus the number that should be used for testing) and the number of errors should be noted.
An applicant failing colour plate testing may have a colour lantern or a Farnsworth D-15 Hue test performed. These tests are available at a number of locations across the country or CAM regional offices.
Note: The colour lantern test is not acceptable for initial air traffic controller applicants, who must pass the plates or a Farnsworth D-15 Hue test.
This should be tested with the whispered voice. The applicant must be able to hear and understand at a distance greater than 2 metres. Testing with screening audioscope is acceptable. Abnormalities noted on the screening test should prompt testing by pure tone audiometry. Candidates for Category 1 or 2 medical certification will require a pure tone audiogram at the initial examination.
Routine dip-stick testing of the urine for glucose is required at each aviation medical examination. Microscopic examination is only required where clinically indicated.
Renewing a Medical Certificate
If an applicant who has a licence meets all the medical standards in CAR 424 you may renew his/her Medical Certificate (MC) by stamping, signing and dating one of the renewal boxes on the MC. Return the 'renewed' MC to the applicant and mark the FIT box on the MER form. You cannot grant additional privileges. For example, if an applicant with a restriction such as "Valid only when wearing required glasses" presents for medical certification with contact lenses, you can only extend the present privileges, not give authorization for him/her to use contact lenses when flying. This must be done by CAM. In the same way you cannot give authorization for an upgrade from one medical category to another.
Initial applicants do not have a MC so you cannot grant them a medical category and can only mark the DEFERRED box, indicating "initial applicant" under the remarks area.
If an applicant does not present a MC for signature you cannot renew, but only mark DEFER and indicate "no MC available" under the remarks area.
If an applicant wishes to upgrade from a Category 3 to Category 1, complete the examination, arrange for an ECG and audiogram to be submitted with the MER, and renew the existing Cat 3 MC for the full period. If the applicant meets the Category 1 standard then a new multi sign off Category 1 MC will be sent to him\her by Transport Canada.
Figure 4 - Medical Certificate
If renewal has been granted, mark "yes" in the "Was a renewal assigned" block on the MER. If it was not granted mark "no", check the DEFERRED box, and indicate the reason in the space underneath. Also indicate whether further examination is recommended and whether a separate confidential report is being submitted.
If you feel that the applicant is fit, make sure that you put the date of renewal on the renewal box as this relates to the validity period - An undated renewal makes the MC invalid!
Note: If you do not believe an applicant is fit for the category requested, DO NOT RENEW THE MC, mark the DEFERRED box in part "D" of the MER, and add your comments, either in the remarks section or in a confidential report.
The examination form and all additional test results are then forwarded to the RAMO. A copy should be retained in your office for a minimum of six months, but it is wise to retain the copies indefinitely as with any medical record, particularly in the present climate of medico-legal litigation.
A small number of licensed personnel will have been issued with a MC that has been endorsed over the renewal boxes "Not valid for CAME renewal".
In these cases, send in the medical examination report and any other reports/tests that have been requested. Mark the "depressed" box in Part "D". The applicant will be issued with a new MC at each examination.
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