Aeromedical · Flying or Special Operational Duty
Medical Recommendation for Flying Duty
Informs the commander of a member's medical fitness to perform flying or special operational duty, and populates the service flight-records system. Do not enter protected health information in the remarks (Item 13).
Items 1–3 · Routing (prepopulated — confirm)
Items 4–10 · Member (prepopulated)
Determination · Item 11 (UP) or Item 12 (DOWN)
11/12Medical authority recommendation
Required
"UP" clears the member for flying duty; "DOWN" places the member on DNIF (Duties Not Including Flying).
The above individual has been found QUALIFIED by medical authority (Item 11).
11aClearance basis
Required
The above individual has been found DISQUALIFIED by medical authority (Item 12) — member is DNIF.
12aDisqualification type
Required
12aTemporary disqualification due to
12aMay participate in (optional)
Item 13 · Remarks / limitations (no protected health information)
Item 14 · Certifying provider
14Certifying provider role
Required
A non-flight-surgeon provider requires a flight surgeon countersignature (Item 14e–h) for Air Force and Navy. Army aeromedical PAs and aviation-medicine NPs do not require a countersignature for Army personnel.
Signature captured at sign-off · CAC / PKI
Item 15 · Member certification
15aI understand the above recommendations and I:
Required
Selecting "May not" does not prohibit simulator or ground-based flight-line duties if those are marked in Item 12.
Item 16 · Action taken by commander (not required for Air Force and Navy)
16Commander action