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Note 2.— Predisposing factors for disease, such as obesity and smoking, may be important for determining
whether further evaluation or investigation is necessary in an individual case.
Note 3.— In cases where the applicant does not fully meet the medical requirements and in complicated and
unusual cases, the evaluation may have to be deferred and the case submitted to the medical assessor of the
Licensing Authority for final evaluation. In such cases due regard must be given to the privileges granted by the
licence applied for or held by the applicant for the Medical Assessment, and the conditions under which the
licence holder is going to exercise those privileges in carrying out assigned duties.
Note 4.— Attention is called to the administrative clause in 1.2.4.8 dealing with accredited medical conclusion.
Note 5.— Guidance material to assist Licensing Authorities and medical examiners is published separately in
the Manual of Civil Aviation Medicine (Doc 8984). This guidance material also contains a discussion of the
terms ‘likely’ and ‘significant’ as used in the context of the medical provisions in Chapter 6.
Note 6.- Basic safety management principles, when applied to the medical assessment process, can help ensure
that aeromedical resources are utilized effectively
While the Standards and Recommended Practices lay down as precisely as possible the minimum levels
considered acceptable, it is understood that a degree of interpretation must often be exercised at the
discretion of the medical examiner or medical assessor. The important non-medical factors which should
be taken into consideration in such cases are the age and experience of the applicant, the privileges of the
ICAO Preliminary Unedited Version — October 2008 I-3-3
particular licence or rating applied for or held, and the environmental conditions in which these are to be
exercised:
6.1.2 The applicant for a Medical Assessment shall provide the medical examiner with a personally certified
statement of medical facts concerning personal, familial and hereditary history. The applicant shall be made
aware of the necessity for giving a statement that is as complete and accurate as the applicant’s knowledge
permits, and any false statement shall be dealt with in accordance with 1.2.4.5.1.
6.1.3 The medical examiner shall report to the Licensing Authority any individual case where, in the
examiner’s judgement, an applicant’s failure to meet any requirement, whether numerical or otherwise, is such
that exercise of the privileges of the licence being applied for or held, is not likely to jeopardize flight safety
(1.2.4.8).
6.1.4 The level of medical fitness to be met for the renewal of a Medical Assessment shall be the same as
that for the initial assessment except where otherwise specifically stated.
Note.— The intervals between routine medical examinations for the purpose of renewing Medical Assessments
are specified in 1.2.5.2.
The purpose of the medical examination is to determine that no physical or mental condition exists which
may reduce the applicant’s medical fitness to a significant degree during the period of validity of the
Medical Assessment. The medical requirements of Annex l are not concerned with social considerations
or medical conditions of importance for employment. Nevertheless, on initial issue of a Medical
Assessment, it would be poor medical practice to encourage an applicant to pursue flight training if the
minimum requirements of Annex 1 are barely met, especially in cases where further deterioration might
be expected or is likely to occur. Likewise, it would be poor practice to disregard the preventive aspects
of the regulatory examination for renewal.
Upon subsequent examination, Licensing Authorities are often able to give consideration to such factors
as skill and experience which are not present on initial application. However, in keeping with the
provisions of Annex 1, continued fitness for flying upon subsequent medical examination is not
guaranteed by success at meeting the medical requirements in the previous examination. Medical
information related to decrease in medical fitness, or any information that would provide clarification
concerning a previously noted condition, must be made a part of the periodic reassessment for renewal of
a Medical Assessment as provided for in Annex 1, Chapter 6. Recently, changes have been made to the
Medical Provisions in Chapter 6 of Annex 1 to increase the emphasis on mental health aspects and
prevention of ill health, especially in the younger age group of Class 1 applicants.
Content of Medical Examinations
6.3.1.2 Except where otherwise stated in this section, holders of commercial pilot licences — aeroplane, airship,
　
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