advisory circular · 2018-06-12 · advisory circular ac 67-1 medical standards and certification -...

Advisory Circular AC 67-1

Medical standards and certification - General

Original01 July 2016

General Civil Aviation Authority Advisory Circulars contain information about standards, practices, and procedures that the Director has found to be an Acceptable Means of Compliance with the associated rule.

An acceptable means of compliance is not intended to be the only means of compliance with a rule, and consideration will be given to other methods of compliance that may be presented to the Director. When new standards, practices, or procedures are found to be acceptable they will be added to the appropriate Advisory Circular.

This Advisory Circular also includes guidance material (GM) to facilitate compliance with the rule requirements. Guidance material must not be regarded as an acceptable means of compliance.

Purpose The Advisory Circular provides details on general requirements related to Part 67 Medical standards and certification.

Related Rules This Advisory Circular relates specifically to Civil Aviation Rule Part 67.

Change Notice No change.

Advisory Circular AC 67-1 Original

01 July 2016 CASA PNG 2

Table of Contents

SUBPART B – Medical certification ...................................................................... 3 Rule 67.55 Applications for medical certificates ........................................................... 3

SUBPART D – Designated Aviation Medical Examiners..................................... 3 Rule 67.153 Medical examiner certification requirements ............................................. 3

SUBPART E – Operating Requirements for DAMEs................... ........................ 4 Rule 67.203 Continued Compliance ............................................................................... 4

Appendix 1– DAME Exposition template .................................... ........................ 4

Appendix 2– PNG Medical Manual............................................... ........................ 4

Appendix 3 – CAA Forms.............................................................. ........................ 4


01July 2016 CASA PNG 3

SUBPART B – Medical certification

Rule 67.55 Applications for medical certificates

Rule 67.55(b)(i) provides for an equivalent form of photographic identification.

The equivalent forms of photographic identification that are acceptable to the Director are:

§ A valid and current PNG or foreign passport

§ A valid and current PNG Drivers's Licence

§ A valid and current photographic national identity document issued by a foreign State

SUBPART D – Designated Aviation Medical Examiners

Rule 67.153 Medical examiner certification requirements

Rule 67.153(a)(2) requires a person applying for a medical examiner certificate to have successfully completed aviation medicine training acceptable to the Director.

The aviation medicine training that is acceptable to the Director includes any of the following:

§ Completion of a post-graduate Diploma of Aviation Medicine from either the University of Otago or the Royal College of Physicians (London) ;or

§ Completion of both the aviation physiology and clinical aviation medicine papers offered on a post-graduate basis by the University of Otago; or

§ Completion of MD Aviation Medicine from the University of Medical Sciences, Bangalore, India; or

§ Board Certification in Aviation Medicine (USA); or

§ Australia Certificate of Civil Aviation Medicine (ACCAM), Monash University, Australia; or

§ IAASM- SAA Certification in Aviation Medicine for Medical Examiners and Assessors (ICAO Compliant Training Package), Singapore Aviation Academy(SAA).

Rule 67.153(a)(3) requires a person applying for a medical examiner certificate to demonstrate an awareness of aviation regulatory medicine and the conditions in which applicants for medical certificates are employed. The aviation medicine regulatory awareness training that is acceptable to the Director includes any of the following:

• DAME Workshop conducted by CASA PNG is acceptable for the purpose of this rule.


01 July 2016 CASA PNG 4

SUBPART E – Operating Requirements for Medical examiners

Rule 67.203 Continued Compliance

Rule 67.203(a)(5) requires that a person who holds a medical examiner certificate must attend ongoing training courses in aviation medicine and aviation regulation, as may reasonably be required by the Director.

The ongoing training courses in aviation medicine and aviation regulation, required by the Director are:

For holders of a Medical Examiner 1 certificate:

§ Undertaking training activities which are acceptable under a points system prescribed by the PNG Aviation Medical Society (PAMS), in respect of aviation medical practice during the previous 36 months.

For holders of a Medical Examiner 2 certificate:

§ Undertaking training activities which are acceptable under a points system

prescribed by PAMS in respect of aviation medical practice during the previous 36 months.

(Note: Activities such as attendance of aviation medicine conferences overseas are acceptable for gaining points for this purpose, and the point value will be considered on a case by case basis by the PAMS.

----------ANYBODY’S DAME EXPOSITION----------

Appendix 1

DESIGNATED AVIATION MEDICAL

EXAMINER

PART 67 EXPOSITION

Reference : Specimen / Expo / 1 Issue : Original Date : June 2016

Copy Number : Holder :


THE SPECIMEN EXPOSITION

This specimen Exposition has been prepared to provide policy and procedural guidance to those Aviation Medical Examiners (AMEs) wishing to obtain delegation approval from the Director. The contents relate directly to the requirements of Rule Part 67.161. The text of this guide has been arranged so that each subject is dealt with insofar as the CA Act, CAR Part 67 and advisory circulars defines it. The "Notes" which explain the recommended text and suggest ways in which the DAME might expand it to suit his/her own purposes. It will be appreciated that no single specimen Exposition can meet the needs of all types and sizes of surgery/practices or, indeed, reflect the different organisational structures and corporate policies, which emerge as companies develop. The guidance given has been expanded by including a suitable text or procedure wherever possible. It must be appreciated that this is not the only method of compliance and may, in fact, be unsuitable for some organisations. Its purpose is only to illustrate the nature of the information required.


Anybody’s DAME Exposition Original:June 2016 Page i

LIST OF CONTENTS

List of Contents Page (i) Page Effectivity List (v) Amendment Record (vi) Distribution List (vi)

PART 1 MANAGEMENT

1.1 Statement signed by the Medical Examiner [CAR 67.161(a)(1)] 1/2

1.2 Scope of Aviation Medical Practice [CAR 67.161(a)(2)] 1/4

1.3 Titles and Names of all Medical Personnel in the Surgery [CAR 67.161(a)(3)] 1.3.1 Titles and Names of Doctors working at Surgery 1.3.2 Titles and Names of Nurses working at Surgery 1.3.3 Titles and Names of other personnel

1.4 Duties and Responsibilities of Medical Personnel [CAR 67.161(a)(4)] 1.4.1 Chief Executive /Admin Manager 1.4.2 Doctors working at Surgery 1.4.3 Nurses working at Surgery 1.4.4 Other specialist medical personnel working at Surgery

1.5 Management Organisation Chart(s)

1.6 Facilities [CAR 67.161(a)(5) & (6)] 1.8.1 Location – Main Clinical facilties where aviation medicals conducted 1.8.2 Location – other Facilities where aviation medicals conducted 1.8.3 Administration Facilities 1.8.4 Communication Facilities 1.8.5 Layout of Facilities

1.7 Notifying the Director/Principal Medical Officer (PMO) [CAR 67.161(a)(7)] 1.9.1 Referral of Medical Certificates for Assessments by PMO 1.9.2 Reporting of Changes in a Person’s Medical condition 1.9.3 Prior Notification to Director of changes in sections 1.2, 1.3, 1.4 & 1.6

PART 2 PROCEDURES

2.1 Procedures for: [CAR 67.161(a)(7) – (12)] 2.1.1 Control, Inspection and testing of medical equipment 2.1.2 Control and amendment of Exposition 2.1.3 Identification, collection, indexing, storage, maintenance & disposal of records 2.1.4 Training, Assessment & Authorization to carry out functions/responsibilities in 1.4 2.1.5 Identifying & managing any possible conflict of interest issues 2.1.6 detailes of internal quality audit programme to ensure continued compliance 2.1.7 Distribution of copies of exposition to Director /Other personnel


Anybody’s DAME Exposition Original:June 2016 Page ii

PAGE EFFECTIVITY LIST

Page No. Date Page No. Date Page No. Date i JUN 2016 ii JUN 2016 ii JUN 2016 iv JUN 2016 v JUN 2016 vi JUN 2016 PART 1 1/1 JUN 2016 1/2 JUN 2016 1/3 JUN 2016 1/4 JUN 2016 1/5 JUN 2016 1/6 JUN 2016 1/7 JUN 2016 1/8 JUN 2016 1/9 JUN 2016 1/10 JUN 2016 1/11 JUN 2016

PART 1 (continued) 1/13 JUN 2016 1/14 JUN 2016 1/15 JUN 2016 1/16 JUN 2016 PART 2


Anybody’s DAME Exposition Original:June 2016 Page iii

AMENDMENT RECORD

Amendment Number

Amendment Date

Details Incorporated By

Date Incorporated

DISTRIBUTION LIST

Copy No. 1 Director of Civil Aviation Copy No. 2 Copy No. 3 Copy No. 4 Copy No. 5 Copy No. 6 Copy No. 7 ………… Copy No. 8 ...............


DAME EXPOSITION

PART 1

MANAGEMENT


Anybody’s DAME Exposition Original June 2016 Page

1.1 CORPORATE COMMITMENT BY THE MEDICAL EXAMINER.

DAME EXPOSITION. This Exposition and any associated referenced manuals defines the organisation and procedures upon which the Designated Aviation Medical Examiner delegation is based as required by rule part 67.161. These procedures are approved by the undersigned and must be complied with, as applicable, when work/orders are being progressed under the terms of the DAME delegation. It is accepted that these procedures do not override the necessity of complying with any new or amended rule published by the Director from time to time where these new or amended rules are in conflict with these procedures. It is understood that the Director will approve this Medical Surgery whilst the Director is satisfied that the procedures are being followed and work standards maintained. It is further understood that the Director reserves the right to suspend,limit or revoke the DAME delegation if the Director has evidence that procedures are not followed or standards not upheld Signed.......................................................

Dated……………………… DAME ................... (Signature) ............................... For and on behalf of.........................…. (quote organisation's name) ............. NOTES :- (not for inclusion in the Exposition) 1. This statement satisfies the intent of rule 67.153 & 161(a)(1). 2. Any modification to the statement must not alter its intent. 3. Whenever the DAME is changed it is important that the new DAME signs the statement at

the earliest opportunity as part of his/her acceptance by the Director.



Note: Chapters 1.2 to 1.7 are self-explanatory and each DAME should provide a simple account of the how they manage each subject within the context of their medical surgery practice.



DAME EXPOSITION

PART 2

PROCEDURES NOTES :- (not for inclusion in the Exposition) 1. This specimen exposition is to provide guidance on an acceptable path to compliance with

the CAR Part 67.161 requirements. In each case subject headings in the table of contents are suggested in which the particular nature of the organisation's actual procedures should be defined. Subject headings should be deleted if they do not apply and others may be included if that is the most suitable method of describing the particular organisation.

2. TO REDUCE THE SIZE OF THIS DOCUMENT THE REMAINING SUBJECTS ARE NOT ALLOCATED INDIVIDUAL PAGES AS IN PART 1. IT IS RECOMMENDED, HOWEVER, THAT THE FORMAT OF PART 1 IS ADOPTED FOR THE WHOLE EXPOSITION, IN ORDER TO FACILITATE FUTURE AMENDMENT.

APPENDIX 2 - Medical Examiners’ - Medical Manual

Part 1 – Introduction Approved By: Principal Medical Officer Version: 01 Date:17/06/ 2016

Table of Contents

Subsections to Part 1 are identified as: Page

Medical Examiners’ - Medical Manual ....................................................................................... 1 1.1 About this Manual .................................................................................................... 2 1.2 Who will use this Manual ......................................................................................... 2 1.3 Structure of this Manual ........................................................................................... 2 1.4 Copies of this Medical Manual ................................................................................. 3 1.5 Terminology ............................................................................................................. 3 1.6 Definitions ................................................................................................................ 3 1.7 Abbreviations ........................................................................................................... 3

1.1 About this Manual

This Medical Manual aims, in conjunction with the relevant legislation, to provide information,

guidance, policy, and requirements relating to medical certification under the Civil Aviation

Act 2000(as amended).

This document is to be used in conjunction with:

• The Civil Aviation Act 2000

• The Civil Aviation Rules (CARs) including Rule Part 67;

• The General Directions and Emergency Directives issued by the Director of CivilAviation;

• Civil Aviation Authority (CAA) medical certification forms;

• Advice from the CAA Principal Medical Officer-Dr Robin Sios via e-mail

[email protected]

Whenever an inconsistency occurs between this document and any legislation, the legislation

prevails.

1.2 Who will use this Manual

This Medical Manual is published primarily for Medical Examiners (MEs) to assist them

in discharging their civil aviation regulatory responsibilities. It may also provide a

useful resource to those who hold or are applying for Papua New Guinea medical certificates.

1.3 Structure of this Manual

This Medical Manual is divided into 2 parts:

Part 1: Introduction

Part 2: The medical certification system

In addition each part may contain annexed supportive documents.

Civil Aviation Safety Authority of Papua New Guinea– June 2016 Part 1 – Introduction 2

1.4 Copies of this Medical Manual

This Medical Manual is intended to be accessed via the CASA website. No printed copies

are provided by the CASA. Users who refer to printed copies of this Medical Manual must

ensure that they are using the most up-to-date version.

Medical Examiners will be advised, by e-mail, when updated versions of this Medical

Manual are available on the CASA website.

1.5 Terminology

Terms used in the civil aviation regulatory environment can be found at Section 3 of the Civil

Aviation Act 2000 as well as interpretation sections at the start of some parts and sections of

the Civil Aviation Act 2000 (e.g.PART IVA – Medical Certification), in Civil Aviation Rule Part

1 and Part 67.03, and in section 64G-General Directions and Emergency Directives.

1.6 Definitions

Throughout this document:

• The Act means the Civil Aviation Act 2000(as amended);

• The Director means the Director of Civil Aviation;

• The Delegate means a Medical Examiner with delegation to act on behalf of the

Director, but only in accordance with the terms of the delegated authority;

• Medical standards mean the medical standards contained within Civil Aviation Rule

Part 67;

• Part 67 means Civil Aviation Rule Part 67;

• The Rules mean the Civil Aviation Rules.

1.7 Abbreviations

Throughout this document the abbreviations mean as follows:

AMC Accredited Medical Conclusion

CAA Civil Aviation Authority

CAR Civil Aviation Rule

Civil Aviation Safety Authority of Papua New Guinea– June 2016 Part 1 – Introduction 3

Civil Aviation Authority of PNG– June 2016 Part 1 – Introduction 4

GD General Direction

ME Medical Examiner

ME1 Medical Examiner 1

ME2 Medical Examiner 2

MO CAA Medical Officer

SME Special Medical Examiner

PMO CASA PNG Principal Medical Officer

Table of Contents

Subsections to Part 2 are identified as: Page

Medical Examiners’ - Medical Manual ..................................................................................... 1 2.1 Introduction ............................................................................................................. 2 2.2 Legislation ............................................................................................................... 2 2.3 Application for a Medical Certificate ....................................................................... 3 2.4 Examination by Medical Examiner .......................................................................... 5 2.5 Use of General Directions (GDs) ............................................................................ 7 2.6 Assessment by Medical Examiner ........................................................................ 11 2.7 Extending a Medical Certificate ............................................................................ 19 2.8 Issue of Medical Certificate ................................................................................... 21 2.9 Communication ..................................................................................................... 29 2.10 Review of Assessment by CASA ..........................................................................31 2.11 Change in Medical Condition / Suspension Process ............................................ 32 2.12 Review of Director’s decision by the Convener .................................................... 36 2.13 Replacement Certificate ........................................................................................ 37 2.14 Medical Examiner absence ................................................................................... 38

Medical Examiners’ - Medical Manual

Part 2 – The Medical Certification System Approved By: Principal Medical Officer Version: 01 Date: 17/06/2016

Civil Aviation Safety Authority of PNG-June 2016 Part 2 – The Medical Certification System 2

2.1 Introduction

This part of the Medical Manual describes the administration procedure(s) that may be relevant

when an applicant applies for a medical certificate, or when advising a medical certificate

holder.

2.2 Legislation

On May 2016 an amendment to the Civil Aviation Act 2000 (the Act) established a new

medical certification system. At the core of this system are Medical Examiners (MEs) who are

designated as such by being issued a delegation. This delegation is an Aviation Document,

the privileges of which enable the ME to conduct examinations for a specified class of

aviation medical certificates as described in the Civil Aviation Rules (the rules).

Medical Examiners may also be delegated certain powers and functions of the Director of

Civil Aviation (the Director), such as the power to issue medical certificates. Only the

Director has the power to suspend or revoke a medical certificate under section 64I of the

Act.

The rules are made by the Minister for Civil Aviation under the Act. The medical standards

are prescribed in Civil Aviation Rules (CAR) Part 67.

General Directions (GDs) are issued by the Director under section 64G of the Act. They

are items of legislation and as such are mandatory. They provide direction(s) to MEs in

relation to the conduct of medical examinations, and other requirements. In that regard

they address matters of a clinical nature, refer to subsection 2.5 – Use of General

Directions. Links to the GDs are in Part 4 of this Medical Manual.

http://www.caa.govt.nz/rules/rules.htm�

http://www.caa.govt.nz/rules/Rule_Consolidations/Part_067_Consolidation.pdf�

http://www.caa.govt.nz/medical/General_Directions_home.htm�

Civil Aviation Safety Authority of PNG – June 2016 Part 2 – The Medical Certification System 3

2.3 Application for a Medical Certificate

Primary Legislation: Civil Aviation Act s48,49

Secondary Legislation: CAR Part 67.51 to 67.55 Form:

Application for Medical Certificate (CAA form 67/02)

To be completed by: Applicant

For the purpose of certification an “Application for Medical Certificate” form must be

completed. It is available on the Civil Aviation Authority (CASA) website. The applicant is

responsible for accurately completing the Application for Medical Certificate. This should

include explanations of any positive answers in the space provided under question 31, or

on a separate sheet if necessary. The application is to be signed in front of the ME prior to the commencement of any examination, investigation, or assessment.

The ME must ensure that the form has been completed in full prior to proceeding further with

the examination.

As the application includes a declaration, it is important that the ME does not complete the form

on behalf of the applicant or make any changes to the entries made by the applicant. Given

that the Application for Medical Certificate is the responsibility of the applicant, the ME should sign only in the final section as a witness to the applicant signing the form. The ME should

ensure that the consent on the last page of the application has not been altered by the

applicant.

The ME who first receives the completed Application for Medical Certificate must

forward a copy of the front page to the CASA within five (5) working days of the application

being made (the page may be faxed or emailed to [email protected]). This is

important in order to inform the CASA PEL Branch that an application has been made with a

particular ME.


Key Points:

Applicant to fill in an application with no omissions.

Applicant to expand on “yes” answers in the space provided, or on a separate

sheet as necessary.

Applicant to sign the application in front of the ME.

Medical Examiner to identify the applicant and witness the signature prior to any

questioning or examination.

Medical Examiner must not write on the application form except for signing.

The ME must forward to CASA the front page of the application within 5

working days.

Civil Aviation Safety Authority of PNG– June 2016 Part 2 – The Medical Certification System 5

2.4 Examination by Medical Examiner

Primary Legislation: Civil Aviation Act s64B(1) refers to “the report of the medical examiner”. Secondary Legislation: CAR 67.57

Form: Medical Examination Report

To be completed by: Medical Examiner

Once a properly completed Application for Medical Certificate has been received, the ME can

commence history taking, examination and investigation as necessary.

2.4.1 Medical Examination Report This form is the examining ME’s responsibility and contains the following:

• Confirmation by the ME of the applicant’s identity, refer to subsection 2.4.2 –

Identification of applicant;

• Relevant medical history (including follow-up questioning concerning positive responses

made in the application and any other matter of clinical relevance);

• Details concerning height and weight, blood pressure and pulse, urinalysis,

electrocardiogram and blood lipid evaluations;

• Cardiovascular risk assessment;

• Systems review of the applicant;

• Spirometry;

• Dates of tests conducted;

• Report of any other matters identified;

• Signature, date and stamp of the ME.

If additional space is required the ME should attach additional page(s) to the Medical

Examination form.

If the ME has the appropriate delegation(s), that ME can assess the applicant for the issue of

a Medical Certificate. Refer to subsection 2.6 – Assessment by Medical Examiner.

If not, the necessary report(s) must be forwarded to a ME who holds the appropriate

delegation(s).


2.4.2 Identification of applicant Under rule 67.55(2) an applicant must produce a current PNG Passport, a current PNG

Driver Licence, or an equivalent photographic identification that is acceptable to the Director.

Advisory Circular AC 67-1 Original. Lists equivalent forms of photographic identifications that

are acceptable to the Director.

The ME should attach a photocopy of the photographic identification produced by the applicant

at the time of a first application.

Key Points:

The examining ME is to only write comments on the medical examination report,

not on the application form.

The examining ME must complete the examination in full and attach any other

relevant documentation.

The examining ME must submit the application and the examination reports

without delay to the ME who will be conducting the assessment, if different.


2.5 Use of General Directions (GDs)

Primary Legislation: Civil Aviation Act 64G

Secondary Legislation: CAR 67.57, 67.67, 67.103, 67.105 and 67.107

Form: Not Applicable

Use by: Medical Examiner conducting examination and Medical Examiner conducting the

assessment.

The Act states that the Director may issue General Directions in relation to-

• Conducting examinations of applicants and licence holders and reporting the results of

those examinations to the Director; and

• providing exceptions for temporary medical conditions to the reporting requirements set

in section 64C, refer to subsection 2.11 - Change in Medical Condition / Suspension

process; and

• specifying the requirements of examinations or other clinical matters, which must be

reasonable, including but not limited to:

- the medical content of examinations;

- the interpretation and analysis of results of examinations;

- the significance of results of examinations for the purpose of determining whether

or not an applicant is eligible for a medical certificate under section 64B.

General Directions are items of legislation and as such must be adhered to. A brief

description of some of the GDs is offered below:

2.5.1 Timetable for Routine Examinations GD This GD prescribes the timing of routine examinations. An important feature of this GD is the

series of tables that detail the examination requirements needed to issue a certificate

and includes examples. Here are other examples.

Example 1:

A 43 years old applicant presents for a first examination for issue of a Class 2 certificate.

The requirements are those for an initial general medical examination as demonstrated in the

first line of the table “Class 2 medical certificate”.


Thus the applicant will need, as per the first medical examination requirements:

12 lead ECG, Cardio-vascular risk estimation – only if note 1 applies, blood lipids estimation

and blood sugar estimation, a chest X-ray – only if note 2 applies, Spirometry, Audiometry –

refer to note 3, and Colour vision testing.

Part 2 Class 2 medical certificate

Timing of routine examination

12-lead ECG Cardio-vascular risk estimation

Blood lipids estimation & Blood sugar estimation

Chest X-ray Spirometry Audiometry Colour vision

screening examin-ation

(Ishihara)

First general medical examination

if note 1 applies

if note 2 applies

see note 3

Notes: 1. This examination is required if the applicant is 35 years of age or older.

2. This examination is required only if the applicant’s history indicates a high likelihood of

asymptomatic pulmonary disease. An example of such history is if the applicant has had a

prolonged stay in an area in which infective pulmonary disease is endemic.

3. Routine periodic audiometry is only required for class 2 applicants who undertake Instrument

Flight Rules flights. If audiometry is not undertaken as specified in the schedule then any medical

certificate that is issued must be endorsed “Not valid for IFR flight”.

Example 2:

The same applicant presents again at age 45 for a subsequent examination for re-issue of his

Class 2 medical certificate.

One needs to look at the relevant age. This is the current age of 45 plus the age(s) in between the age of 43 (when he had his last examination) and the current age of 45. In this

instance the ‘in between age’ is 44.



12-lead ECG Cardiovascular risk estimation

Blood liplids estimation & Blood sugar estimation

Spirometry Audiometry

Age 43

Age 44 see note 3

Age 45

Thus the applicant needs: 12-lead ECG, Cardio-vascular risk estimation, blood lipids estimation

and blood sugar estimation and Audiometry – refer to note 3.


Example 3:

An applicant aged 65 presents for a subsequent Class 1 examination. His last examination was

at age 64. The examinations required under the GD “timetable for routine examinations” are:



12-lead ECG Cardiovascular risk estimation

Blood lipids estimation & Blood sugar estimation

Spirometry Audiometry

Age 63

Age 64 Age 65

The examinations required under the current age of 65: Nil.

If the last examination had occurred at age 63, there would be an age in between the current

age of 65 and the age at the time of the last examination. The examinations required at age 64

would have to be completed.

2.5.2 Examination Procedures GD This GD prescribes how to conduct, interpret and report a number of examinations as well

as their validity periods. MEs should become familiar with this GD, which is by and large

self-explanatory.

2.5.3 Clinical GD(s): These GDs prescribe which examination(s) or investigation(s) are to be conducted in relation

to specific medical conditions and how to interpret and analyse tests and reports. The

Impaired Hearing and Hearing Aids GD is the first clinical GD to be available.

Clinical GDs allow MEs to determine if particular conditions are safety relevant and assist

in deciding if an applicant meets the standard prescribed in CAR Part 67.

Medical Examiners having any difficulty with the interpretation of a clinical GD are advised

to contact the CASA PNG Principal Medical Officer.

2.5.4 Conditions that do not need reporting GD (Temporary Medical Conditions): This GD (still under development) describes changes in medical condition that do not need

reporting to the Director.

http://www.caa.govt.nz/medical/GD_Impaired_Hearing.pdf�



Key Points:

The GDs prescribe:

- The timing of routine examinations.

- The content of examinations.

- The interpretation of examination results.

- The reporting of examinations.

The ME:

- Must apply the correct GD to the assessment being performed.

- Must record on the Medical Assessment Report the clinical GD applied to

the assessment, if any.


2.6 Assessment by Medical Examiner

Primary Legislation: Civil Aviation Act s64B

Secondary Legislation: CAR 67.59 – 67.61

Form: Medical Assessment Report (CAA form 24067-003)

Conducted by: Medical Examiner with delegation to issue certificates

The Act [s64B(1)] requires the Director to consider the report of the ME for

certification assessment purposes. This report consists of:

• Completed and signed Application for a Medical Certificate (CAA form 67/02);

• Completed and signed Medical Examination Report ( CAA form 24067-002);

• Completed and signed Medical Assessment Report (CAA form 24067-003)

• All ancillary results and reports whether required by legislation, or likely to be helpful to

the decision.

An ME with delegation to conduct the assessment can require, under section 64B(5), other

tests, examinations, re-examinations, or the provision of further medical information as

reasonably considered necessary. For instance, to routinely require a PSA in a healthy young

male applicant may be unreasonable, but the same requirement in an older male applicant with

symptoms suggestive of prostate problems may be reasonable.

Once the Director or ME has received the report he must assess:

• whether the applicant is eligible for certification, or

• the application can be considered using the flexibility process, or

• the issue of a medical certificate should be declined without considering the application

of flexibility.

This decision-making process must be documented and reported on the Medical

Assessment Report (MAR) (CAA 24067-003).

Completion of the MAR is the assessing ME’s responsibility and contains the following:

• Dates of tests and documents seen;

• Medical conditions that have been considered during the assessment;

• Required surveillance during the validity period of the medical certificate;

• Recommended surveillance at the time of a future application;

Civil Aviation Safety Authority of PNG- June 2016 Part 2 – The Medical Certification System 12

• Expiry dates if certification is an eligible decision;

• Decision concerning any restrictions or endorsements that are applied;

• Decision concerning eligibility. The options provided are eligible (for certification),

ineligible (for certification), and deferred (assessment);

• Any relevant additional information;

• Signature, date and stamp of assessing ME.

Key Points:

Start the assessment as soon as practicable, considering the complete report and

accompanying documentation.

Notify CASA within 5 working days of the commencement of the

assessment unless CASA has already been informed of the application taking

place, or the assessment can be completed and sent to CASA within 5 working

days.

Ensure that any information missing on the Application form or the Medical

Examination report is obtained.

Obtain any other test, examination, re-examination or results as necessary.

Assess eligibility for issue of a medical certificate – refer to subsection 2.6.1.

Complete the MAR inclusive of any restrictions or conditions to be imposed on the

medical certificate.

2.6.1 Applicant meets the Medical Standards prescribed in CAR Part 67



General Directions: As relevant


If an applicant meets the medical standards, having regard to any relevant General

Direction(s), the applicant is eligible under 64B(1)for the issue of a Medical Certificate

(with conditions, restrictions or endorsements as appropriate). This is unless the applicant has

any characteristic that may interfere with the safe exercise of the privileges to which the medical

certificate relates. The MAR must be completed accordingly and an appropriate certificate

issued.

Under s64B of the Act the Medical Certificate must be issued as soon as practicable but no


Civil Aviation Safety Authority of Papua New Guinea – June 2016 Part 2 – The Medical Certification System 13

later than 30 working days after completing or receiving the reports from the ME. If further

reports are needed the time spent waiting for the reports does not form part of the 30 days time

limitation.

Key Points – Applicant meets the medical standards:

Medical Examiner to ensure compliance with any relevant GD.

Medical Examiner to issue certificate ASAP but no later than 30 working days

after receiving the ME’s report.

Medical Examiner to ensure all required medical reports have not expired at the

time of issue.

2.6.2 Applicant does not meet the Medical Standards of CAR Part 67





If, having regard to any relevant General Direction(s), the ME determines that an applicant

fails to meet the standards prescribed in CAR Part 67, consideration can be given to the

exercise of statutory flexibility as provided for by s64B(2) and (3) of the Act.

The ME should carefully consider the rules and the relevant GDs to determine if the

applicant meets the standard. This is to avoid assessing someone as meeting the standards

when this is not the case, or conversely following the flexibility pathway and seeking an

Accredited Medical Conclusion (AMC) unnecessarily.

Example 1:

A Class 1 certificate applicant suffers from well controlled hypertension and the cardiovascular

risk assessment is acceptable according to the GD Examination Procedures. The

applicant does meet the standard according to CAR 67.105(b), unless another section of the

rules or GDs dictates otherwise.

Example 2:

A Class 2 applicant has diabetes controlled with Metformin, it is well controlled and the CV risk

is acceptable according to the Examination Procedures GD. In that case, according to CAR

67.107 the applicant meets the standard with “on-going medical supervision and control”,


http://www.caa.govt.nz/medical/GD_Examination_Procedures.pdf�

http://www.caa.govt.nz/medical/GD_Examination_Procedures.pdf�


unless another section of the rules or GD dictates otherwise. If the applicant was using

a Sulphonylurea he may not meet the standard according to CAR 67.107.

Example 3:

A Class 3 applicant has amblyopia with a visual acuity in one eye of 6/18. He has been

certificated with this impairment for many years and the situation is stable. He does not

meet the standard prescribed in CAR 67.109. Thus this applicant can only be certificated via

the flexibility pathway. Identification of experts must be sought in order to obtain an

Accredited Medical Conclusion (AMC).

If the ME conducting the assessment considers that flexibility should not be exercised, the

alternative is to determine that the applicant is “ineligible” for the issue of a Medical Certificate,

The exercise of flexibility, described in s64B(3) of the Act, requires fulfilment of the

following three conditions:

• An AMC indicates that in special circumstances the applicant's failure to meet any

medical standard prescribed in the rules is such that the exercise of the privileges to

which a medical certificate relates is not likely to jeopardise aviation safety; and

• The relevant ability, skill, and experiences of the applicant and operational conditions

have been given due consideration; and

• The medical certificate is endorsed with any restrictions, conditions, or endorsements

when the safe performance of the applicant's duties is dependent on compliance with

those restrictions, conditions, or endorsements.

When an ME assesses that an applicant does not meet the standards but wishes to apply

flexibility, the ME should document this step on the MAR by specifying that the applicant is

not eligible for a certificate under section 64B(1) and that the ME is considering issuing a

certificate under flexibility. The box “deferred” or “ineligible” may be circled with the

comment that this applies to s64B(1). This is important in order to clarify the legal process

that is being followed. Circling “ineligible” without comment could be confused with ineligible

without flexibility being pursued. For this reason circling the box “deferred” is preferable.


Applicant fails to meet CAR Part 67 medical standards

Or, alternatively if flexibility is not considered.

If the ME considers that the applicant does not meet the standards prescribed in CAR Part

67 but wishes to pursue the flexibility route, the applicant needs to be informed accordingly

(refer to subsection 2.6.2.1 - Accredited Medical Conclusion).

If the certificate is declined the applicant is to be informed in writing without delay of the

ME’s decision. The applicant is also to be informed of the right to seek review of, or appeal

against the ME’s decision, refer to subsection 2.12 - Review of Director’s decision by the

Convener.

Class of Certificate

Class 1 – Single pilot air ops carrying

passengers

Class 1 – For Ops other than single pilot

air ops carrying passengers

Class 2 Class 3

Certificate Expiry Date

Restrictions/ Endorsements

Result of Assessment

Eligible Ineligible

Deferred

Eligible Ineligible

Deferred

Eligible Ineligible

DeferredN/A

Additional Information: Ineligible under section 64B(1).

I elect to consider relying on flexibility under s64B(2) and will seek an Accredited Medical Conclusion.

Class of Certificate

Class 1 – Single pilot air ops carrying passengers

Class 1 – For Ops other than single pilot air ops carrying passengers

Class 2 Class 3

Certificate Expiry Date


Result of Assessment

Eligible Ineligible

Deferred

Eligible Ineligible

Deferred

Eligible Ineligible

DeferredN/A

Additional Information: I do not elect to rely on flexibility, certificate declined


Key Points – Applicant does not meet the medical standards:

Applicant is not eligible under s64B(1) (does not meet the standard) and the

application of flexibility may be considered under s64B(2) and (3), or

Applicant is not eligible under s64B(1) (does not meet the standard) the

application of flexibility is not considered appropriate by the ME.

Medical Examiner to ensure the applicant is informed in writing of the process and

any right of review.

2.6.2.1 Accredited Medical Conclusion

Primary Legislation: Civil Aviation Act s64A(1) - s64B(2)

Secondary Legislation: CAR 67.75

Form: Accredited Medical Conclusion – Request for Identification of Experts (CAA form

24067-300)

Conducted by: Expert(s) identified by the Director for the case concerned.

Action by the ME:

The AMC process provides individual case consideration for applicants who do not meet

the medical standards. If an applicant fails to fulfil the standards prescribed in CAR Part 67

then an AMC may be sought in order to consider issuing a certificate under the flexibility

provisions of the Act. The decision to apply flexibility is entirely discretionary.

To seek an AMC the ME must make an application to the Director for identification of expert(s),

via the Principal Medical Officer. A form is provided for this purpose and is available on the

CASA website. The ME should state on the application if he/she is willing to be identified as

an expert. See below for information that must be provided with the request.

Action by the Director (PMO):

The Director, or delegate, will then identify medical expert(s) acceptable for the purposes of

conducting the AMC for the case concerned.

If the ME does not wish to be identified as an expert, all the information in relation to

the application should be forwarded with the request to the PMO. Otherwise only the

information relating to the specific condition(s) under consideration should be forwarded to the

PMO.

In practice, one or more of the following scenario(s) may occur.

http://www.caa.govt.nz/medical/AMC-forms.htm�

Civil Aviation Safety Authority of Papua New Guiena – May 2011 Part 2 – The Medical Certification System 17

No further information is required by the Director to identify the expert(s):

If the Director is satisfied that he can identify expert(s) on the basis of the information

provided, he will do so. The ME will receive a letter providing the name(s) of the

expert(s).

Further information is required by the Director to identify the expert(s):

If the Director cannot identify the expert(s) on the basis of the information available he

will seek additional information prior to identifying the acceptable expert(s).

Medical Examiner is identified as acceptable expert:

If the ME is identified as the only expert, the ME must conduct and document an AMC.

The expert can ask for advice from the CMU, and consult with flight operations or any

other appropriate expert as may be necessary.

In some cases the Director may identify the ME as expert together with another expert.

Medical Examiner is not identified as an acceptable expert:

The expert(s), who are often Medical Officers employed by the CASA, may need

further information and call upon the ME, acting under delegation, to require further

tests. The expert(s) may also approach the applicant directly, and seek to obtain

the necessary further information.

2.6.2.2 Communication of Accredited Medical Conclusion Medical Examiners named by the Director as acceptable experts for the case concerned should

document their own AMC in writing. This is best done on a separate document from the MAR

unless very short. The AMC should identify the condition(s) considered and express the special

circumstances that have been identified as such that flight safety will not be compromised.

In the case of AMCs conducted by the PMO, once an AMC is reached, a letter detailing the

Accredited Medical Conclusion will be sent to the ME.

Once in possession of an AMC, the ME can continue with the assessment with due

consideration to:

• The relevant ability, skill, and experiences of the applicant and the operational

conditions; and

• The applicable conditions, restrictions, or endorsements when the safe performance of

the applicant's duties is dependent on compliance with those restrictions, conditions, or

endorsements.


The AMC will generally list these as part of the special circumstances identified. The ME can be

more restrictive but cannot be less restrictive than any restrictions or conditions identified by the

AMC as constituting special circumstances.

Key Points – Accredited Medical Conclusion:

The assessing ME:

- Must request identification of experts using the form provided on the

CASA website; include adequate information on the form.

- Should indicate if willing and available to act as expert for the case

concerned.

- Should send to CASA all information relevant to the condition(s)

under consideration.

- Should send complete information relating to the application if not wishing to

be identified as an expert.

- If identified as experts, MEs should document their own AMC.

- Must complete assessment as soon as practicable once in possession of

the AMC.


2.7 Extending a Medical Certificate

Primary Legislation: Civil Aviation Act s64E



Conducted by: Medical Examiner conducting the assessment

Section 64E of the Act states “The Director may, on receiving an application for a

medical certificate from a licence holder before the expiry of his or her existing medical

certificate, grant an extension of no more than 45 days from the expiry date of the licence

holder’s existing medical certificate with any additional conditions, restrictions, or

endorsements as the Director considers necessary.”

This is a useful option for an ME who is not yet able to issue a medical certificate for some valid

and reasonable reason. To legitimately exercise the extension provision an ME must consider

the potential for abuse and must be satisfied that there is no risk to flight safety in exercising this

option.

To consider an extension the following conditions will need to be met:

• An application (completed, signed and witnessed, on CAA form 67/02) must have

been received;

• The existing Medical Certificate for the Class applied for has not expired;

• The ME is satisfied that there is no aviation safety risk in extending the medical

certificate;

• The ME has delegation to extend a medical certificate under s64E of the Act (generally

MEs who have delegation to issue certificates also have delegation to extend).

Any extension issued is to be in one of the formats shown in the following examples. A suitable

electronic form can also be obtained from the CASA PEL Branch or PMO. Alternatively

the third party medical certification software (J. Faris), used by many MEs, also provides a

suitable format.

A copy of the certificate extension must be sent to CASA PEL Branch within 5 working days for

data entry into the CASA register.

Note: Care must be taken to only extend the non expired dates on the certificate.


Example: Reprint of the existing medical certificate and endorse as below.

Conditions, Restrictions, or Endorsements Applicable:

002 Bifocal spectacles must be worn

007 Spare spectacles must be readily available

Certificate Extended until 20 May 2009

Add any additional restriction <XX XX>

29 March 2009

Signed Stamp

Alternatively the medical certificate can be modified to show on the front the extended expiry

date, the date signed, and the usual stamp and signature, with the back endorsed:




Add any additional restriction <XX XX>

This is an extension of the certificate issued on dd/mm/yyyy

Key Points:

Medical Examiner must be satisfied that he or she is working with a valid

application and medical certificate.

Medical Examiner must be satisfied of the absence of any safety issue(s) arising

from the extension.

Medical Examiner must ensure that the reason for extending is reasonable.

Medical Examiner may extend the existing medical certificate for up to 45days from the expiry date; the extension must be clearly recorded and readily

apparent on the certificate.

Medical Examiner to send a copy of the extension certificate and the MAR in

progress to CASA within 5 working days.

The important point is that the medical certificate must clearly indicate which

certificate class was extended, until when, by whom and the date when extended.


2.8 Issue of Medical Certificate




Action by: ME conducting the assessment

2.8.1 Medical Certificate Format The Medical Certificate must be issued in a format acceptable to the Director. A

suitable electronic form can be obtained from the PMO.

Example: Medical Certificate




2.8.2 Effective Start Date A medical certificate issued under the Act commences on the day when the medical

assessment concludes and the certificate is issued. Thus the medical certificate

commencement date is not calculated based on the date of the examination.

Civil Aviation Safety Authority of Papua New Guinea Medical Certificate

Issued pursuant to section 64B of the Civil Aviation Act and in accordance with the Act

Surname Blogg Client No: 12345

Given names: John Date of Birth: 17/09/1950

Expiry Dates

ME Stamp:

Class 1 for single pilot air operations carrying passengers 29/11/2009

Class 1 for operations other than single pilot air operations carrying passengers 29/05/2010

Class 2 29/05/2011

Date signed: 29/05/2009 S i g n a t u r e o f D i r e c t o r o r D e l e g a t e


A medical certificate remains in force until a subsequent or replacement medical certificate is

issued, refer to CAR 67.59(d).

2.8.3 Validity period of a Medical Certificate The duration of the Medical Certificate cannot exceed the maximum duration specified in CAR

Part 67.61. The delegate is able to decide to issue a certificate of a lesser duration if

appropriate for safety considerations.

However, CAR Part 67.61(c) allows for the issue of a slightly longer duration than prescribed in

CAR Part 67.61(a) in some circumstances. The new applicable expiry date may be the date

that would have applied had the certificate been issued on the expiry date of the current medical

certificate if:

• the new certificate is issued during the 30 days prior to the expiry date of the current

certificate; and

• the current / existing certificate has not been extended, and

• the ME determines that the applicant is eligible for the maximum period permitted under

CAR Part 67.61(a).

The purpose of these provisions is to allow an applicant to obtain a certificate that expires on

the same calendar date each year of issue, thus avoiding the so called “creep factor” by which a

few days may be lost at each certification.

Example:

Applicant for a Class 2 certificate is 45 years old and eligible for a certificate of 2 years duration.

Existing Class 2 certificate expiry date: 25 June 2009 Assessment date and issue of certificate: 10 June 2009 New maximum permitted expiry date: 25 June 2011

This option would not be available had the assessment been completed on 22 May 2009, that is

over 30 days prior to the expiry date of the existing certificate.

2.8.3.1 Special case pertaining to a Class 2 certificate when an applicant for a Class 1 and 2 certificate is over the age of 40 and less than 43

When the applicant is over the age of 40, a class 2 certificate can be issued for a maximum

validity period of 2 years. This means that a new Class 2 certificate may well lapse prior to the

date when a previously issued Class 2 certificate, valid for 5 years, would have lapsed.


Example:

A 41 year old pilot was issued with a Class 1 and Class 2 medical certificate just before turning

40. The Class 1 certificate is about to expire and the pilot seeks a new certificate. The Class 2

medical certificate issued a year ago is valid for a maximum of 5 years and will lapse just before

the pilot turns 45. If a new Class 2 certificate is issued now, the expiry date will be at age 43,

which is before the expiry date of the previous Class 2 certificate.

Thus a Class 1 certificate only may be assessed and issued, allowing the existing Class 2 to run

its course, if believed to be safe. This problem cannot arise once the pilot turns the age of 43.

2.8.3.2 Class 1 certificate, at age 40 or over The duration of a class 1 certificate, at the age of 40 or over depends on the type of operations

that are intended. In practice the Class 1 certificate can be treated as two separate certificates.

One with 6 months duration for one scope of operations, and one of 12 months duration for

another scope of operations.

For this reason, under rule 67.61, the certificate can be issued with two expiry dates

pertaining to the two scopes of operations as follows:

6 month expiry date: for single pilot air operations carrying passengers

12 month expiry date: for operations other than single pilot air operations carryingpassengers

Operators and pilots are responsible for knowing which date is applicable to their different

operations.

Example:





Expiry Dates

ME Stamp:

Class 1 for single pilot air operations carrying passengers 28/11/2009


Class 2 28/05/2011


Note: Whenever a pilot is less than 40 years old, both Class 1 expiry dates should still be

completed, using the same 12 month expiry dates. This is important as filling in only the second


expiry may lead licence holders and operators to believe that the applicant can only fly “for

operations other than single pilot air operations carrying passengers”, or alternatively can only

fly “single pilot air operations carrying passengers” depending on which expiry date has been

completed.

2.8.4 Endorsement(s) on a medical certificate

Primary Legislation: Civil Aviation Act s64B(3) & (4) – 64I

Secondary Legislation: Not Applicable

General Directions: Any existing GD relevant to the condition(s) considered

Action by: Medical Examiner conducting the assessment

Under section 64B(4) of the Act “the Director may impose any conditions, restrictions, or

endorsements on a medical certificate issued under this section”.

The purpose of restrictions, conditions, and endorsements is to ensure flight safety. They are a

risk management tool. Such conditions, restrictions and endorsements affect the privileges

related to the Medical Certificate.

Conditions, restrictions and endorsements:

• Should be clear and concise, using either plain English or aviation terminology defined in

legislation;

• Operational restrictions, such as those not allowing the certificate holder to undertake

some types of operations, should be on the medical certificate;

• Other restrictions and conditions, such as medical restrictions and conditions of

surveillance to be carried out during the validity period of the certificate, may be in a

letter referred to on the medical certificate, refer to example 1, 2 and 3.

The use of code numbers is not compulsory. Code numbers assist electronic data acquisition

and improve consistency. Their use is encouraged, and when used, the standard wording

associated with the code number should preferably be used.

A list of common endorsements is available under Part 5 - Annexes and References (still

under development).


Conditions, restrictions and endorsements may:

Example 1: Ensure that the medical standards are met while flying:

Distance spectacles must be worn. Requires that distance vision spectacles of the exact type worn when tested must be worn

at all times when flying. This is to ensure that the prescribed visual acuity standards are

met during flight.


001 Spectacles (distance vision) must be worn.

Example 2: Eliminate or reduce a particular risk to flight safety:

Not valid for night flying or IFR. Will reduce the risk of losing control of the aircraft when it is thought that the distraction

and / or impairment resulting from a medical condition, migraine for instance, is unlikely to

result in loss of control by day under Visual Flight Rules (VFR), but may result in such a

consequence by night; or under Instrument Flight Rules (IFR).


040 Not valid for IFR flights.

085 Not valid for night flying.


Example 3: Mitigate the risk to fight safety:

Not valid for single pilot air operations carrying passengers:

Will mitigate the risk in case of raised, but still acceptable, likelihood of an episode of

incapacitation in these circumstances.


Or


132 NOT VALID FOR – carriage of passengers; glider towing; unpressurised flight above 8000 feet; flight over built-up areas (circuit exempt), IFR flying; international air navigation.





Expiry Dates

ME Stamp:

Class 1 for single pilot air operations carrying passengers

N/A


Class 2 29/05/2011



Example 4: Ensure ongoing stability or control of a particular condition:

Subject to medical surveillance in accordance with a letter dated <date>: Will ensure that a particular condition has not deteriorated and remains acceptable during

the period of validity of the certificate. It must be noted that failure to comply with such

condition of surveillance does render the certificate not current under CAR 61.35.


059 Subject to medical surveillance as specified in Examiner’s letter dated – 08-May-2009.

2.8.5 Class 2 IFR Civil Aviation Rule Part 67 does not make special provisions for Class 2 IFR (Instrument Flight

Rules) as was the case under the previous rule. A Class 2 medical certificate issued in

accordance with CAR CAR Part 67 and the applicable GDs will automatically confer IFR

privileges if satisfactory audiometry testing has been carried out in accordance with the GD

Timetable for Routine Examinations.

If no audiometry has been carried out, the Class 2 certificate must be endorsed in accordance

with this GD with the wording: “Not valid for IFR flights”.


040 Not valid for IFR flights.

http://www.caa.govt.nz/medical/GD_Timetable_for_Routine_Examinations.pdf�


Key Points:

A ME holding delegation should limit restrictions, conditions, and endorsements to

those relevant to operational matters, or conditions that must be fulfilled during

the validity period of the certificate to maintain certificate currency.

Conditions, restrictions and endorsements should be clear and concise, using

either plain English or aviation terminology defined in legislation.

If using code numbers, consider using the standard wording associated with

them.

Operational restrictions should be on the medical certificate.

If imposing non operational restrictions or conditions of use not otherwise listed in

the standard list of endorsements, use preferably the endorsement code and

wording: “020 restricted in accordance with letter dated <date>”, with details

written in a separate letter to the applicant.

If imposing a condition of surveillance use preferably the code 059 and the

wording: “059 subject to medical surveillance in accordance with a letter dated

<date>”.


2.9 Communication

Primary Legislation: Not Applicable

Secondary Legislation: CAR 67.163 – 67.59(2) -


Action by: Medical Examiner conducting the examination

2.9.1 Communication with applicant The following documentation should be forwarded to the applicant immediately once the

assessment has been completed:

• The laminated medical certificate;

• The original of the MAR;

• A letter or information sheet detailing the applicant’s obligations and responsibilities;

• If applicable a letter explaining any conditions, restrictions or endorsements, in particular

those pertaining to new restrictions or surveillance requirements (this can be on the

same letter as above, and should be current).

It is essential to carefully word any letter for maximum clarity. This is particularly important

for letters that are referred to on the certificate detailing restrictions, or conditions of

surveillance imposed on the certificate.

2.9.2 Communication with CASA Medical Examiners are encouraged to liaise closely with the CASA PEL Branch (email:

[email protected] / [email protected]) or PMO (email: [email protected])

during any medical certification activities if unsure of any aspect of the process or any

decision. Within five working days of receiving an Application for a Medical Certificate the

ME should forward a copy of the front page of the application, to the CAA PEL Branch,

unless the assessment can be completed and dispatched within that five working day

period. This is critical to inform the CASA that a medical certificate application has

been made with a particular ME. It also alerts the CASA when multiple applications are

made by an individual. Within five working days of having assessed that an applicant is either

eligible or ineligible for a medical certificate, a ME must forward the following details to the

CASA: • Copy of any certificate(s) issued and any supporting documentation;

• Copy of the MAR;

• Copy of any letter to the applicant;


• Original Application for a Medical Certificate;

• Original Medical History and Examination report;

• Copy of any investigations, results, reports, or consultations undertaken as part of the

examination and assessment processes;

Any AMC, unless issued by CASA, and other consideration, discussion, or documentation felt

to be relevant to the assessment decision.

Any correspondence to the CASA seeking advice should be placed on top of the paperwork

to avoid being overlooked.

The ME should also send a copy of the MAR, certificate and letter to the applicant and to any

SME who undertook the applicant’s medical examination.

The use of a document checklist is recommended to reduce the chance of omission.

Key Points:

Send the assessment and certification documentation within 5 working days (in

practice a weekly mailing will achieve this), in the following order from top to

bottom:

Copy of certificate, stamped, dated and signed, where applicable;

Copy of the MAR, stamped, dated and signed;

Copy of any letter to the applicant;

Original application and examination forms, stamped, dated and signed;

Copy of any documented AMC if conducted by the ME;

Original or good copy or of any ECG tracing;

Original or copy of any other reports;

Note: Any correspondence to CASA should be placed on top of this paper work to avoid

being overlooked by CASA staff.

Civil Aviation Safety Authority of Papua NewGuinea – June 2016 Part 2 – The Medical Certification System 31

2.10 Review of Assessment by CASA

Primary Legislation: Civil Aviation Act s64H(2) and s64I



Action by: PMO

The PMO performs a review of a selection of assessments. This review allows for the detection

of errors and irregularities requiring further action by the delegated ME.

In particular s64H(2) of the Act provides the CASA with a Medical Certificate “claw back” option that can be exercised within 60 working days of certificate issue. Under this clause the

Director may withdraw a medical certificate if he requires further information.

The Director does not need to have reasonable grounds to believe that a licence holder may be

unable to exercise safely the privileges to which the certificate relates to exercise this option. It

is a useful clause that enables the Director to obtain missing information.

One of the reasons for MEs being asked to forward assessments promptly is to allow the

Director to exercise this “claw back” option, if necessary.

The Act (s64I) also provides the Director with a variety of powers for amendment,

suspension, disqualification or even revocation of a Medical Certificate when he has

reasonable grounds to believe that a licence holder may be unable to exercise safely the

privileges to which the certificate relates, refer to subsection 2.11, or the Director has

reasonable grounds to believe that a certificate has been issued other than in accordance

with the legislation or the MEs delegated authority.

Key Points:

Early receipt of report by CASA is vital to enable the assessment review process

by PMO to take place well within 60 days, and allow the Director to exercise

his powers under section 64H of the Act.

Civil Aviation Safety Authority of Papua New Guinea –June 2016 Part 2 – The Medical Certification System 32

2.11 Change in Medical Condition / Suspension Process

Primary Legislation: Civil Aviation Act s64C & s64I


Forms: Suspension Letter

Action by: Licence holder and Medical Examiner who is first informed of the Change in

Medical Condition

2.11.1 Change in Medical Condition Licence holders, MEs, aviation operators and registered medical practitioners all have an

obligation to report to the Director if they are aware of, or have reasonable grounds to suspect,

any change in medical condition of a licence holder that may interfere with the safe exercise of

the privileges to which the licence holder’s medical certificate relate.

2.11.2 Action by Licence Holder Section 64C of the Act stipulates a licence holder’s obligations in the case of a change

in medical condition such as defined above:

• The licence holder must advise the Director as soon as practicable. In practice this will

be by contacting the licence holder’s ME, or the PMO.

• The licence holder may not exercise the privileges to which the licence holder’s medical

certificate relates.

It should be noted that changes in medication may at times constitute a change in medical

condition such as defined above, and may need to be reported.

Temporary Medical Conditions are medical conditions as described in the relevant General

Direction (still under development) that do not need to be reported.

http://www.caa.govt.nz/Forms/24067-406.pdf�

Civil Aviation Safety Authority of Papua New Guinea– June 2016 Part 2 – The Medical Certification System 33

2.11.3 Action by Medical Examiner Medical Examiners need to be familiar with the powers they hold under their delegations, as this

determines how information about changes in medical conditions are to be handled. Medical

Examiner’s usually hold the relevant delegations appropriate to the class of certificate for which

they can examine.

Thus a ME who does not have delegated powers in relation to the class of medical certificate

affected, must report the change of medical condition to the Director who will then take

appropriate action.

Where the Licence Holder IS unable to exercise safely …

“If the Director (or ME acting under delegation) has reasonable grounds to believe that

an licence holder is unable to exercise safely the privileges to which the medical certificate

relate the Director must . . .” - refer to s64I(2) of the Act for action referred to.

Where the Licence Holder MAY be unable to exercise safely …

“If the Director (or ME acting under delegation) has reasonable grounds to believe that

the licence holder may be unable to exercise safely the privileges to which the medical

certificate relates the Director may . . .” - refer to s64I(1) of the Act for action referred to.

Medical Examiners with delegation to issue certificates are generally able to impose conditions,

place restrictions or endorsements on certificates of a class that they are able to issue.

Such actions are limited to 10 working days with the possibility to extend for a further 10

working days. All such action must be notified to PMO as soon as practicable by sending

a copy of all documents or information available. If no action is taken, this must also be

documented.

If in doubt the ME should forward the information to, and seek advice from, PMO.

2.11.4 Process for suspension of certificate or imposition of conditions, restrictions or endorsements

For the suspension or imposition of conditions, restrictions or endorsements of a medical

certificate, the ME should liaise with PMO who will provide a brief report to the Director

recommending enforcement actions. The Director will take the necessary action.


2.11.5 Surrender of the medical certificate Section 64I(9) of the Act requires a licence holder to surrender a suspended,

revoked, withdrawn or disqualified medical certificate to the Director, a person authorised by

the Director, or a member of the police. This is not optional and is not left to the discretion of

the ME. The Director may also require surrender of the certificate under section 24(3)(a) of

the Act. Failure to comply is an offence under section 50A of the Act.

During any period of suspension it is appropriate for the ME, in his/her role as Director’s

delegate, to act as safe keeper of the certificate, particularly if it is likely that the

suspension may be cancelled soon. In such a case the ME should also inform the PMO

that he/she is holding the medical certificate.


If a notice of conditions, restrictions or endorsements has been issued the licence holder may

hold on to the certificate until an amended certificate has been received.

Once an amended certificate has been received the original certificate must be surrendered

to CASA.

Key Points:

In case of a change in medical condition that may interfere with the safe exercise

of the privileges to which the licence holder’s medical certificate relate:

Licence holder may not exercise the privileges to which the medical certificate

relates

Licence holder must advise the ME / Director ASAP, except for those temporary

conditions listed in the GD – temporary medical conditions (still under

development)

Director may or must suspend as appropriate

Suspension is for a maximum of 10 working days

Suspension can be extended for a further 10 working days

Suspension should be cancelled only by the ME who issued suspension, or by the

Director

Director to discuss action taken with PMO ASAP, with any available

documentation

The Director only can take action under s64I(7)(a), (c) or (d).

The Director will then take further action as appropriate.


2.12 Review of Director’s decision by the Convener

Primary Legislation: Civil Aviation Act s64L


Form: Application for Review of Medical Certification Decision

Action by: Applicant and Medical Examiner conducting assessment

The Act (s64L) provides an applicant with the ability to seek a review by the convener of a

decision made in relation to a Medical Certificate. Those decisions which can be reviewed

by the Convener are specified in the Act (s64L).

To initiate a review the applicant must apply directly to the Convener, within 20 working days of

the decision to be reviewed, in writing. For this reason the ME should promptly forward their

decision to the applicant.

A form Application for Review of Medical Certification Decision is available on the

CASA website. This application must be sent to the address below and not to the CASA. PNG

PNG CONVENER - PNG will engage the services of the NZ CONVENER as required

The ME should inform the applicant of this right of review when declining to issue a

Medical Certificate or imposing significant conditions or restrictions. Natural justice

requires this communication to be done promptly to allow the applicant to lodge an application

within the time limitation.

http://www.caa.govt.nz/medical/convenor_application.pdf�

http://www.caa.govt.nz/medical/convenor_application.pdf�


2.13 Replacement Certificate

Primary Legislation: Not Applicable


Form: Letter to the Director Requesting a replacement certificate

Action by: Applicant

The holder of a medical certificate may apply in writing to the Director for a replacement

certificate if the certificate is lost, stolen or destroyed or so damaged that the details on the

certificate are no longer clearly legible.

In order to obtain a replacement certificate the holder must submit to the Director the

appropriate application form with payment of the appropriate fee.

• If the certificate has been lost, stolen or destroyed the statutory declaration must be

completed on the application form.

• If the certificate has been damaged no statutory declaration is required but the damaged

certificate must be enclosed with the application.

A form Application for replacement of Medical Certificate CAA form 24067-407 is

available on the CASA website.

Replacement certificates are issued only by CASA staff because of their access to any

relevant information that may have come to light since the issue of the certificate.


2.14 Medical Examiner absence

Medical Examiner absences of more than 5 working days should be notified to CASA (email is

acceptable), to assist in case of an inquiry to CASA by an applicant.

In all cases of absence of any duration it is the responsibility of the ME to ensure that any

applicant under consideration will not be disadvantaged by any delays resulting from the

absence, for instance an applicant’s inability to work.

If such a situation may occur it is better to pass on the assessment to another ME prior to

departure.

Whenever the CASA is advised of an ME absence and is made aware that an AMC is

expected back by a certain date, CMU tries to provide the AMC in time, if all necessary

information is available to do so.

Key Points: In case of absence by ME of more than 5 working days:

Notify the CASA of the absence

Notify the CASA of the applications being processed

Notify the CASA of the name of the ME(s) assessing the applications during

your absence.

APPENDIX 3 – CAA FORMS FOR AVIATION MEDICALS

The following forms are referred to in Advisory Circular AC 67-1 Appendix 2 - PNG Medical Manual and can be downloaded individually in pdf version from the CASA PNG Website.

1. CAA 67/01: Application to be a PNG Designated Aviation Medical Examiner.

2. CAA 67/02: Application for a Medical Examination 3. CAA 24067-002: Medical Examination Report 4. CAA 24067-003: Medical Assessment Report 5. CAA 24067-300: AMC Request for Identification of Medical Experts 6. CAA 24067-400: Application for Replacement Medical Certificate

CAA 67/01

Page 1 of 8 Rev 1:

07/15

Application for CAR Part 67 CIVIL AVIATION SAFETY AUTHORITY

Designated Aviation Medical Examiner OF PAPUA NEW GUINEA

Grade:

Initial Application Renewal Application (Please tick one of the above only)

Please – Type or print using block letters: retain a copy for your records

Personal Details

Surname Title

Given names Date of Birth

Postal Address (for correspondence with CASA)

Practice Telephone No. + Practice Fax No. +

Mobile Phone No + After hours contact details: +

E-mail Address

Information that you wish to be published on the web site for applicant use:

Address:

Opening Hours Gender:

Telephone: + E-mail:

Criteria for issue of medical examiner certificate

Medical Registration

PNG or Foreign MC No

Country of Practice if not PNG:

Please attach copy of annual certificate

CAA Client No:

Submit an Exposition required under CAR Part 67.161 - see AC 67-1 Appendix 1 .

CAA 67/01

Page 2 of 8 06/16

Medical Examiner Competencies

To be eligible for the issue of a medical examiner certificate, and applicant must, in addition to satisfying other general requirements, demonstrate competency in performing the functions of a medical examiner. There are four generic competence categories: identification, assessment, management, and review/audit.

Please detail how you meet each of the competencies outlined below. Additional documentation should be provided to support any experience, training, or education claims. If further space is needed, please include additional information

The competencies required to be demonstrated for the issue of a Medical examiner Certificate:

• For Medical examiners grade 2 the competencies outlined below relate to personnel who are required tohold a Class 2 Medical Certificate and the aviation environments within which they operate.

• For Medical Examiners grade 1 the competencies outlined below relate to personnel who are required tohold a Class 1, 2, or 3 Medical Certificate and the aviation environments within which they operate.

Identification

1. Apply clinical skills to accurately diagnose and evaluate conditions and situations with the potential tointeract adversely with the aviation environment by utilising:

1.a Clinical history taking;

1.b Physical and mental examination;

1.c Further investigations or consultant reviews (whether performed or arranged by medical examiner);

1.d Diagnostic skills;

1. e Liaison with PMO, colleagues, other health professionals, and other organisations;

2. Identify aspects of the aviation environment with the potential to reduce aviation safety throughinteraction with an applicant’s condition or situation.

CAA 67/01

Page 3 of 8 06/16

3. Identify the competing or conflicting interests inherent in regulatory medical practice.

4. Access additional information, such as journals, scientific research, internet resources, colleagues andspecialist advisors, to support the assessment of an applicant’s suitability and safety to operate in anaviation environment.

Assessment

5. Employ evidence-based medical principles and processes in determining and analysing the suitabilityand safety of an applicant to operate within the aviation environment.

CAA 67/01

Page 4 of 8 06/16

6. Determine and analyse the legislation, regulations, and medico-legal considerations relating to the safetyand suitability of an applicant to operate within the aviation environment.

7. Critically analyse and utilise additional information, such as journals, scientific research, internetresources, colleagues, and specialist advisors, to support the assessment of an applicant’s suitability andsafety to operate in an aviation environment.

Management

8. Manage the risk related an applicant operating in the aviation environment by applying the necessarystandards, methodologies and processes.

9. Manage conflicting or competing interests in a manner that compromises neither aviation safety nor thequality of clinical decision making.

10. Effectively communicate:

10.a Risk assessment determinations and considerations to applicants, the CAA, colleagues and otherorganisations:

10.b information concerning the relevant legislation and regulations to applicants;

10.c With PMO, colleagues, consultants and others as necessary for the purposes of obtaining

additional

CAA 67/01

Page 5 of 8 06/16

information, advice, and guidance concerning regulatory risk management decisions;

11. Manage practice administration and record keeping systems so that:

11.a Regulatory risk assessment and risk management decisions and actions are reliably andthoroughly documented;

11.b Regulatory risk assessment and risk management decisions can be effectively and unambiguouslycommunicated;

11.c Regulatory risk assessment and risk management decisions and actions are easily retrievableovertime;

CAA 67/01

Page 6 of 8 06/16

Review / Audit

12 Be a constructive participant in monitoring, review, and audit activities through:

12.a Taking an active involvement in review processes;

12.b Appreciating and accepting review findings and outcomes;

12.c Implementing review recommendations.

Have you completed a course in Aviation Medicine?

Yes No Date:

Clinical Facilities:

Vision:

Do you have colour vision Plates Yes No

Type: ......................................................................................................................................................

Condition (i.e. colour fading?): .................................................................................................................

Do you have a near vision plates? Yes No

Type of near vision plate: ........................................................................................................................

Do you have distance vision plates? Yes No

Distance used for testing: .......................................................................................................................

Do you have a Maddox Rod? Yes No

Do you have a Maddox Wing? Yes No

Do you have Stereoscopic plates or similar? Yes No

CAA 67/01

Page 7 of 8 Rev 1:

07/15

Hearing:

Do you have an audiometer? Yes No

If yes what type / model? Yes No

Date of Calibration: ................................................................................................................................

Name of Calibration agency: ...................................................................................................................

Cardio-Vascular:

Type of sphygmomanometer used: .........................................................................................................

If Aneroid, date of calibration: .................................................................................................................

Sizes of BP cuffs available: ....................................................................................................................

Cardio-Vascular continued:

ECG, short Description and Model if any: ................................................................................................

Do you have access to the internet and CASA website? Yes No

For designation you are required to undertake a continuing training in aviation medicine:

Do you follow a MOPS programme: Yes No

Does this include an aviation Component: Yes No

Please comment: .......................................................................................................................................

.................................................................................................................................................................

Undertaking to comply with emergency rules issued by the Director under section 73 of the Civil Aviation Act.

I, Undertake to comply with emergency rules issued under section 73 of the Civil Aviation Act.

Applicants Signature.............................................................. Date

Overseas applicants:

CAA 67/01

Page 8 of 8 06/16

Is English your first language Yes No

If no, can you communicate effectively in English /

Written Yes No

Oral Yes No

Applicant’s Checklist: Please ensure you submit the following documents with this application:

(A) –For Local DAME applications

Designated Aviation Medical Examiner (DAME) application fee – K1500.00; AND

Current and Valid Certificate of Registration as a medical practitioner in PNG; AND

Completed Fit and Proper Person application form (CAA FPP); AND

A certificate of successful completion of a course of study in Aviation Medicine; OR

Documents that are evidence of demonstrated competence in aviation medicine.

(B) – For Foreign-Based DAME applications

Designated Aviation Medical Examiner (DAME) application fee paid – K5500.00; AND

Current and valid Certificate of Registration as a medical practitioner in a foreign State; AND

Completed Fit and Proper Person application form (CAA FPP); AND

A certificate of successful completion of a course of study in Aviation Medicine; OR

Documents that are evidence of demonstrated competence in aviation medicine.

Payment of prescribed fees should be made by direct deposit or telegraphic transfer to:

Details of Bank Account: Account Name : CASAPNG Account Number : 13507607 Bank : ANZ (PNG) Ltd BSB Number : 18900 Swift Code: ANZBPGPX Location :Jackson’s Int’l Airport Port Moresby, PNG.

(Note: ANZ Deposit slip or Foreign TT slip should be attached to this application as evidence of payment)

Application for a Medical Certificate

I apply to the Director of Civil Aviation for a medical certificate, and hereby request a Medical Examiner to examine me for that purpose. I understand that I must pay the required Medical Certificate Application Fee before I attend an appointment with a Medical Examiner.

Manual Payment Option Details: Cheque ¨ as attached OR Visa ¨ MasterCard ¨ complete below.

DO NOT SEND CASH AND DO NOT COMPLETE THE FOLLOWING PAYMENT DETAILS IF YOU HAVE PAID THE FEE ONLINE

Name on Card

Card Number Expiry Date (mm/yyyy) /

Signature

Electronic Payment Option Details: (CASA Medical Examiner to complete).

Receipt Number: _________________________ (attach confirmation) Date Payment Made:_____________

My personal, licence, and medical details are as follows: 1. Surname: If changed recently, give previous surname in brackets 2. Title: 3. CAA Client ID:

Mr Mrs Miss Ms ____

4. Given Name: 5. Gender:

M F

6. Known as: 7. Date of Birth: 8. Age:

9. Address for Service:Civil Aviation Act, s48, requires applicants to provide an address for service (ie, a physical PNG address) and to promptly notify the Director of any changes.

10. Postal Address:(If different from Address for Service.)

11. Tel Business: ( ) Work Fax: ( )

Tel Private: ( ) Home Fax: ( )

12. Email: 13. Mobile:

14. Preferred method for urgent written contact:(If we have to contact you urgently about personal medical information, weneed to know your preferred means of communication.)

Email Home Fax Neither

15. Certificate applied for: Class 1 & 2 Class 2 Class 2 – No IFR Class 3

PNG Aviation document currently held: ATPL CPL Private ATC None yet

16. Other or previous licences: Have you ever had a civil aviation licence or medical certificate issued before, either in PNG or from another authority? (Give year, country and licence Type/Number)

17. Employer / Training Facility: Occupation:

18. Aircraft types flown recently: Total Hours: Last 6 months

19. General Practitioner contact details:

Page 1 of 4 CAA 67/02June 2016

http://www.caa.govt.nz/payment

Name________________ Client ID________

20. MEDICAL HISTORY: Have you ever experienced any of the following? (Circle correct answer eg: Y )

20.1 Eye or vision trouble Y N 20.2 Needed new glasses or contact lenses

since last CAA medical Examination Y N

20.3 Eye or corneal surgery Y N 20.4 Hay fever Y N 20.5 Middle ear infection Y N 20.6 Sinusitis Y N 20.7 Hearing trouble Y N 20.8 Problems with balance Y N 20.9 Any other Ears, Nose & Throat problems or

surgery Y N

20.10 Asthma or wheezing Y N 20.11 Chronic Cough Y N 20.12 Any other lung problem Y N 20.13 Any shortness of breath Y N 20.14 Pulmonary embolism or deep vein

thrombosis Y N

20.15 Coughed or vomited blood Y N 20.16 Any severe allergy Y N 20.17 Heart problem Y N 20.18 Vascular problem Y N 20.19 Suffered any chest pain Y N 20.20 Rheumatic fever Y N 20.21 High or low blood pressure Y N 20.22 Severe abdominal pain Y N 20.23 Hernia Y N 20.24 Oesophagus, Stomach, liver gall bladder or

intestinal trouble Y N

20.25 Diagnosed or treated for cancer, tumour, growth or malignancy (including skin cancer)

Y N

20.26 Anaemia or blood disease Y N 20.27 Headaches/migraines which have

interfered in any way with daily living? Y N

20.28 Headaches/migraines requiring medication?

Y N

20.29 Dizziness or fainting spell Y N 20.30 Unconsciousness for any reason Y N 20.31 Head injury Y N 20.32 Seizures/fits Y N 20.33 Stroke Y N 20.34 Paralysis Y N 20.35 Any other neurological disorder Y N 20.36 Diagnosed depression Y N 20.37 Anxiety disorder/panic Disorder Y N

20.38 Learning difficulty Y N 20.39 Attention deficit or hyperactivity Disorder Y N 20.40 Post traumatic stress disorder Y N 20.41 Suicide attempt Y N 20.42 Any other Mental illness Y N 20.43 Substance dependence or substance

abuse Y N

20.44 Use of legal or illegal recreational drugs or substances

Y N

20.45 Alcohol dependence or abuse Y N 20.46 Muscle, bone or joint injury Y N 20.47 Back pain, injury or “back trouble” Y N 20.48 Swollen or painful joints Y N 20.49 Suffered any pain severe enough to be

disabling Y N

20.50 Passed blood with or in urine or faeces Y N 20.51 Kidney, bladder or prostatic disease Y N 20.52 Easy fatigue-ability or sleep in the day Y N 20.53 Investigations for abnormal glucose

tolerance, high blood sugar, or diabetes Y N

20.54 Medical Certificate for absence of 7 or more days from work or school

Y N

20.55 Rejection or premium loading for life or health insurance

Y N

20.56 Rejection or retirement from employment on medical grounds

Y N

20.57 Admission to hospital, psychiatric or in patient facility

Y N

20.58 Taken any type of medicine or alternative medicine for more than 2 weeks

Y N

20.59 Had a positive laboratory test for HIV infection

Y N

20.60 Investigation for any disorder Y N 20.61 Any major medical or surgical procedure Y N 20.62 Day surgery Y N 20.63 Any other illness, disability, debility,

infirmity, treatment or surgery Y N

Females only 20.64 Any troubling menstrual problems Y N 20.65 Other gynaecological problem Y N 20.66 Any obstetric problem Y N 20.67 Breast lump or other breast problem Y N 20.68 PREGNANCY: Are you pregnant? Y N

Page 2 of 4 CAA 67/02Jun 2016

Name________________ Client ID________

21. Has any medical certificate ever been denied, suspended, or revoked within or outside of PNG? ¨ Yes ¨ No

22. Have you ever been convicted of an alcohol or drug-related offence, including a drink-drivingoffence, or is any action pending for such an offence? ¨ Yes ¨ No

23. Have you received any Notice under Section 64I or 64H of the Civil Aviation Act (suspension, restriction, endorsements, etc) during the period of the current or last medical certificate? ¨ Yes ¨ No

24. FAMILY HISTORY: Have any members of your family had vascular disease, hypertension, diabetes, heartdisease, psychiatric disease or neurological disease? (Please mention age) ¨ Yes ¨ No

Mother Father Siblings Grandparents Other

Name of disease and age when discovered

25. SMOKING: Have you ever smoked? Yes No If yes:

26. ALCOHOL: Do you drink alcohol? ¨ Yes ¨ NoIf yes, how much do you drink per week? (be specific)

In total, how many years have you smoked for? ______

Average quantity smoked? ______ (Packs/week)

Are you still smoking or have you smoked within the last 12 months? Yes No

Beer (Cans) Wine (Glasses)

Spirits (Measures)

Total Units Weekly

I usually drink: at weekends most days

27. Have you VISITED a health professional within last 3 years? ¨ Yes (explain below) ¨ No

Date GP/Specialist Reason

28. Have you taken any MEDICATION in past 3 years for 2 weeks or more? ¨ Yes (explain below) ¨ No

Name Dosage Purpose Date started Date finished

29. If you answered “Yes” to any questions from 20 to 28, please provide all details of each instance – useextra pages or attach any documents as required.Question No: Details:

Page 3 of 4 CAA 67/02 June 2016

Name________________ Client ID________

30. Consent

I consent to the disclosure to the Director and, or his delegate, of any medical information relating to me, which is held by a registered medical practitioner, hospital or other organisation. I consent to the disclosure to the Director, of information about convictions for alcohol or substance abuse from the Land Transport Agency or other organisations.

I hereby authorize the Director to use information obtained concerning me for any purpose authorised by law. I authorise such information to be disclosed by the Director to any person who requires such information to carry out any function authorised by law. I understand that the Director may provide relevant medical information to other international jurisdictions for the purpose of aviation medical certification.

31. Acknowledgement

I acknowledge and understand the following:

That I have obligations under the Civil Aviation Act 2000, in relation to -

1. the provision of information, for the purpose of obtaining a medical certificate. I understand that failing to comply with these obligations is an offence, and

2. advising a medical examiner or reporting to the Director if I become aware of, or suspect that there is any change in my medical condition or the existence of a previously undetected medical condition that may interfere with the safe exercise of the privileges to which my medical certificate relates, and

3. the making or causing to be made of any fraudulent, misleading, or intentionally false statement for the purpose of obtaining a medical certificate constitutes an offence under section 283 of the Civil Aviation Act 2000, and is subject, in the case of an individual, to imprisonment for a term not exceeding 12 months or to a fine not exceeding K25,000, and

4. the failure to notify Director of any change in medical condition or the existence of a previously undetected medical condition constitutes an offence under section 283 of the Civil Aviation Act 2000, and is subject, in the case of an individual, to imprisonment for a term not exceeding 12 months or to a fine not exceeding K25,000.

--------------------------------------

I have read this application form, familiarised myself with it and understand its contents, including the consent and acknowledgement in paragraphs 30 and 31. I confirm that all the information that I have entered onto this form is true and accurate in all respects:

Applicant’s Signature Date / /

I have explained this form to the applicant and confirm that he/she has signed it in my presence.

Witnessed by (ME) Date: / /

Page 4 of 4

CAA 67/02June 2016

Medical Examination Report

1. Name 2. Client ID

3. Comments and follow-up on issues raised in the Application for Medical Certificate or history taking:

History:

Medication:

4. CVD Risk Assessment (to be completed as per General Direction following NHF guidelines)

Please detail risk factor(s) in applicable risk group for:

Very high risk (Risk >20%) and Elevated single risk groups (Risk >15%)

OR High Risk Groups (CVD risk as per calculation PLUS additional 5% for any

or all of the special factors ticked below):

FH premature IHD

Ethnicity

DM with Microalbumin

Type 2 DM >10yr

Type 2 DM with HbA1c >8%

Metabolic Syndrome

NB: Fresh lipids and glucose tests not required at every examination. Check GD.

Height (no shoes)cm

Weight (unclothed)kg

BMI

BPmmHg

Pulseper min

Total Cholesterol mmol/l

HDLmmol/l

Triglycerides mmol/l

Tot Chol/HDL ratio

Glucose (if required)mmol/l

5. Eyes Uncorrected Corrected Stand by correction

Visual acuity

Calculated 5yr Risk:

%

Page 1 of 2 CAA 24067/002

June 2016

Right Left Both Right Left Both Right Left Both

DISTANCE VISUAL ACUITY (6m) Std:Classes 1,3 = 6/9 Class 2 = 6/12

6/ 6/ 6/ 6/ 6/ 6/ 6/ 6/ 6/

INTERMEDIATE VISUAL ACUITY (100cm) Std: N14

N: N: N: N: N: N: N: N: N:

NEAR VISUAL ACUITY (33cm) Std: N5

N: N: N: N: N: N: N: N: N:

TYPE OF CORRECTION USED: Write M for main or S for standby correction (below symbol)

NONE Bifocal Trifocal Look-over Progressive focus Contacts Distance Specs

Are the following ALL normal: Lids; Pupils; Lens; Media; Fundi; Visual Fields by confrontation;

Eye movements and Cover tests? (If NO, elaborate) Yes No

(Initial only and as per GD).Standard ISHIHARA 24-plate book Are first 17 plates read with only ONE or fewer errors? Record errors below with an “x”

Yes No

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Name________________ Client ID________

Page 2 of 2 CAA 24067/002

June 2016

Are the following normal, without unusual features? Please tick: Yes No

NOTES: Describe below every abnormality in detail. Use and attach continuation sheets if necessary.

6.1 ENT (inc Eust tube, nasal air entry)

6.2 Speech satisfactory

6.3 Conversational Voice Test at 2m

6.4 Audiogram Normal (if required)

7 Heart (size, rhythm, sounds)

8 Vascular system

9 Lungs & chest

10Abdomen and viscera (including hernia)

11Lymphatic system – spleen, lymph nodes

12 Endocrine system

13 Genito-urinary system

14Skin (indicate identifying marks, scars, tattoos)

15 Locomotor system

16Neurological examination (reflexes, equilibrium senses, co-ordination, etc)

17 Psychiatric examination

18.1 Urinalysis – No Glucose

18.2 Urinalysis – No Protein

19. RoutineSpirometry

Predicted Recorded

FVC (l)

20. Routine Test Dates: Last lipids:

ECG: Spirometry:

Other Info Attached:

Audio Spec. Eye Lipids/BS CXR

FEV1 (l)

FEV1/FVC (%)

PEFR (l/min)

21. Do you know the Applicant? Yes No

If not, indicate below the type & number of ID used:

Driving Licence Passport/Airport Security Other

Type . . . . . . . . . . . . . . Number . . . . . . . . . . . . . . . . . . . .

22. Any other relevant reports, findings, concerns or comments:

Print Examiner’s Name and Address 23. Medical Examiner’s Declaration:

I hereby certify that I personally identified and examined the applicant named on this medical report and that this report with any attached notes embodies my examination completely and correctly.

ME signature Date:

ME

STAMP

of 1 CAA 24067/003

June 16

Medical Assessment Report (MAR)

Name Client ID:

Report Dates

GME: Audio: ECG: Spiro:

Documents Seen

Pilots Licence: Previous Med Cert: Previous MAR:

Medical Conditions Considered (use extra sheets if required)

Condition ReadCode

YearIdentified

GD Used Comments/Certification implication/ Risk reduction by restrictions

CVD Risk (if required) % per 5 years

Surveillance and other requirements (How often? For how long? When next due?)

Mandatory Requirements (as referred to in certificate & letter) Periodicity Duration Next Due

Advisory for Next Assessment (recommendations only)

Duration of Certificate and Restrictions

CLASS 1 – Single pilot

air ops carrying passengersCLASS 1 CLASS 2 CLASS 3

Expiry Date


IFR Yes / No

Assessment EligibleIneligible

Deferred

EligibleIneligible

Deferred

EligibleIneligible

Deferred

EligibleIneligible

Deferred

Additional Information: Certified under s64 B(1) Certified under s64B(2) (ie via AMC process)

Signature of Director/ ________________________ or Delegate:

ME Name/Practice stamp:_____________________

Medical Date Completed: Examiner

ID Stamp: Total number of pages supplied

CAA 24067/300 June 2016

Accredited Medical Conclusion: Request for identification of experts

To: Principal Medical Officer Civil Safety Authority PO Box 1941 BOROKO NCD, PNG Email: [email protected]

Request for the Director to identify experts for Accredited Medical Conclusion In the case of the application for medical certificate:

Applicant name Applicant Client No

Class(es) of medical certificate sought (indicate those that apply)

Class 1 Class 2 Class 3 Date of application for medical certificate Date of this request

The applicant has applied to the Director of Civil Aviation (the Director), under the Civil Aviation Act 2000 (the Act), for the issue of CAA medical certificates.

I have received the report of the medical examiner and considered this application under section 64B(1) of the Act. I am satisfied that the applicant does not meet the medical standards prescribed in Rule Part 67 of the Civil Aviation Rules. The medical conditions and likely aviation medical issues that indicate that the applicant does not meet the medical standards are:

(Attach additional pages if more space is required)

Despite the applicant not meeting the medical standards I wish to consider this application by relying on flexibility in accordance with section 64B(2) of the Act. Accordingly I request the Director to identify expert(s) for the purpose of reaching an Accredited Medical Conclusion in the case of this application.

I have informed the applicant that they do not meet the medical standards and that I am seeking to rely on flexibility under section 64B(2) of the Act.

I am / am not (indicate as appropriate) available and willing to be an expert for this Accredited Medical Conclusion should the Director wish to identify me for that purpose.

Requesting Medical Examiner:

Signature Name and address (Practice stamp preferred)

Medical Examiner stamp

of 1 24067-407June 2016

Application for Replacement of Medical CertificateSection A – Applicant Details

1. Name: 2. CAA Client No:

3. Postal Address: 4. Date of Birth:

5. Certificate Lost or Destroyed:

Class 1 Class 2 Class 3

6. Certificate Holder’s Signature:

Date: / /

Section B – Application

q I apply under CAR 67.77 for replacement of my medical certificate, which has been damagedPlease enclose the damaged certificate and mail with this application, to the CASA PNG PEL Branch.

q I apply under CAR 67.77 for replacement of my medical certificate which has been lost, stolen or destroyed (please delete as appropriate).

Please fill in the statutory declaration below and mail this form and fee to the: CAA PNG PEL Branch PO Box 1941,BOROKO

NCD, PNG

Section C – Declaration (Not if certificate is enclosed)

Form of Declaration

I, ________________________________________________, CAA Client ID ________________ solemnly and sincerely declare that: ______________________________________________________________________________________________________

And I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths, Affirmations and Statutory Declarations Act 1962.

Signed by Applicant: _____________________________ Signature of Authorised Officer: _________________________

Declared at: _____________________________ this ___________ day of ____________ 20_____

Person authorised to take a statutory declaration. (i.e. Justice of the Peace)

Section D – Fee for replacement is K330.00 (incl GST) - PLEASE PAY CASA PNG CASH ON DELIVERY

Signature:

OFFICE USE ONLYReceipt No. Receipt Date W/R No.

MISCMED