YOU WILL NEED AN ANNUAL EVALUATION (which will be detailed on your SPECIFICATION SHEET).  YOUR DOCTOR CAN AGAIN FOLLOW THIS OUTLINE NEXT YEAR AND, FOR THEIR CONVENIENCE IN PREPARING THIS REPORT, SIMPLY UPDATE THE INFORMATION .

SUGGESTED LETTER OUTLINE
FOR YOUR CARDIOLOGIST:

For the purposes of the evaluation,  "current"  testing should be 90 days or less old.  Be sure to follow  the instructions for the FAA stress test exactly.


The letter must address the following topics:

    a.  An assessment of personal and family medical history/tendencies, particularly with attention to cardiac and other cardiovascular issues, diabetes

    b.  A report of current clinical cardiac status and general physical examination

    c.  A statement listing the airman's medications, dose, effectiveness, side effects (if any)

    d.  An evaluation of functional capacity or limitations as related to any cardiovascular problem.  Any comments regarding the exercise stress test can be made here but also attach the complete report.

    e.  Comments regarding any modifiable cardiovascular risk factors (e.g., smoking, over weight, etc.)

    f.  Motivation for change of any risk factors, how has the airman taken responsibility to change (e.g., exercise, cessation of smoking, etc.)  Any comments on how the airman has followed medical advice.

    g.  Prognosis for any incapacitation related to cardiovascular issues

    h.  Reports of current  blood chemistries including at least a lipids profile and fasting blood sugar is required.  Any comments regarding the lab studies, example: response to statin medications or diet?  Include a copy of the blood tests.

 

This evaluation should be given to the airman to be included as ONE mailing to the FAA along with their other reports.  It can be sent directly to our office at  P.O. Box 340, Hillsboro, OH  45133 if desired.  Fax is OK also:  937-393-8170