Aviation Blurbs

{patient} presents to aviation medicine clinic for ePHA.

-- Electronic PHA completed and attached to this note

-- MRRS to be updated by corpsman

-- Fit for full duty

-- Worldwide assignable

{patient} presents to aviation medicine clinic for FAA SECOND CLASS MEDICAL CERTIFICATE.

-- FAA-8500 form data entry completed and submitted via Medxpress

-- No special issuances or SODAs (statement of demonstrated ability)

-- FAA medical certificate reviewed, signed, and given to patient

{patient} presents to aviation medicine clinic for COMMERCIAL DRIVERS LICENSE CERTIFICATION.

-- DOT MCSA-5875 completed, reviewed, and signed; expiration {DD}{MMM}{YEAR}

{patient} presents to aviation medicine clinic for FAA SECOND CLASS MEDICAL CERTIFICATE.

-- Medxpress FAA-8500 form website link sent to patient

-- No need for special issuances or SODAs (statement of demonstrated ability)

-- Plan to send FAA medical certificate to patient

{patient} presents to aviation medicine clinic for ORDNANCE PHYSICAL & COMMERCIAL DRIVERS LICENSE CERTIFICATION.

-- No limitations, patient medically clear to handle ordnance

-- OPNAVINST 5100.19 (supervisor's medical surveillance and certification exam referral) completed, reviewed, and signed

-- SF-600 forms (EXPLOSIVES HANDLER AND EXPLOSIVES MATERIAL HANDLING EQUIPMENT OPERATOR; EXPLOSIVES VEHICLE OPERATOR) completed, reviewed, and signed

-- OPNAV 8020/6 (Department of the Navy Medical Examiner Certificate) completed, reviewed, and signed; expiration {DD}{MMM}{YEAR}

-- DOT MCSA-5875 completed, reviewed, and signed; expiration {DD}{MMM}{YEAR}

{patient} presents to aviation medicine clinic for PFA MEDICAL {CLEARANCE}{WAIVER}.

-- Patient waived for the following event(s): {CURL-UPS}, {PUSH-UPS}, {CARDIO}

-- NAVMED 6110/4 (PFA medical clearance/waiver) completed, reviewed, and signed

-- NAVPERS 6110/3 (PARFQ) completed, reviewed, and signed

-- NAVMED 6110/4 and NAVPERS 6110/3 scanned into HAIMS

-- Patient understands that BCA must still be completed

{patient} US ARMY presents to aviation medicine clinic for PHA.

-- PHA paperwork completed

-- Immunizations up to date per corpsman

-- Fit for full duty

-- Worldwide deployable

{patient} presents to aviation medicine clinic for RE-ENLISTMENT PHYSICAL.

-- Patient medically clear to re-enlist

-- Re-enlistment paperwork signed

-- DD FORM 2807-1 completed, reviewed, and signed

{patient} presents to aviation medicine clinic for {RETIREMENT}{SEPARATION} PHYSICAL.

-- Patient clear to separate

-- NPPSC 1900/1 Separation Questionnaire completed, reviewed, and signed

-- DD FORM 2807-1 completed, reviewed, and signed

-- DD FORM 2808 completed, reviewed, and signed

-- DD FORM 2697 completed, reviewed, and signed

-- No referrals placed

{patient} presents to aviation medicine clinic for {SUITABILITY}{OPERATIONAL} DUTY SCREENING.

-- NAVMED 1300/4 (medical/dental/suitability screening) completed, reviewed, and signed

-- DD FORM 2807-1 completed, reviewed, and signed

-- Service member has {no dependents}

-- Service member is not in need of continuing specialized medical care

-- Service member is not going to alcohol or drug abuse rehabilitation

-- The service member may be assigned to an area where medical facilities are limited or non-existent

{patient} presents to aviation medicine clinic for ADMIN UPCHIT.

-- {PQ/AA}{NPQ/AA}{WG for { } {MMM}{YEAR}} {DIACA} {Class I} {SG1}

-- NAVMED 6150-2 (special duty medical abstract) entry completed and signed

-- DD2992 (upchit) completed and provided to patient, expiration {DD}{MMM}{YEAR}

{patient} presents to aviation medicine clinic for BACK SEAT PHYSICAL.

-- Patient cleared to ride in back seat, no concerns for sudden incapacitation

-- {PQ/AA}{NPQ/AA}{WG for { } {MMM}{YEAR}} {DIF} 

-- OPNAV 3710/18 completed, reviewed, and signed

-- DD2992 (upchit) completed and provided to patient, expiration {DD}{MMM}{YEAR}

-- NAVMED 6150-2 (special duty medical abstract) entry completed and signed

{patient} presents to aviation medicine clinic for ePHA.

-- Electronic PHA completed and attached to this note

-- MRRS to be updated by corpsman

-- Fit for full duty

-- Worldwide assignable

HPI

{patient} presents to aviation medicine clinic for { }. No health concerns at this time.

Patient denies sinus problems, vertigo, inability to valsalva, joint pains or confusion during/after flight, seizures, changes is sleep, family/home stressors, substance abuse/addiction, or anything that might degrade safety of flight.

Denies any concerning skin changes.

{patient} presents to aviation medicine clinic for LONG FORM FLIGHT PHYSICAL.

-- {PQ/AA}{NPQ/AA} {WG for { } {MMM}{YEAR}} {DIACA} {Class I} {SG1}

-- DD FORM 2807-1 completed, reviewed, and signed

-- DD FORM 2808 completed, reviewed, and signed

-- NAVMED 6150-2 (special duty medical abstract) entry completed and signed

-- DD2992 (upchit) completed and provided to patient, expiration {DD}{MMM}{YEAR}

-- NAVMED 6120/4 (PHA) completed, reviewed, and signed 

-- Fit for full duty and worldwide deployable

-- MRRS to be updated by corpsman

-- Patient counseled on tobacco, alcohol, safe sex, seat belt use, diet, & exercise

{patient} presents to aviation medicine clinic for MISHAP EVENT.

-- Patient {asymptomatic}

-- Mishap labs {obtained}

-- DD FORM 2807-1 completed, reviewed, and signed

-- DD FORM 2808 completed, reviewed, and signed

-- 72-hour history completed by patient, no concerns

{age} yo {USN} {rank} presents to aviation clinic for NAC/SAR physical.  DD Form

2807-1 reviewed and commented on.  Patient health record reviewed.  {Patient

actively participating in and doing well in most recent PRT.}  Patient

currently has no ongoing medical issues or disqualifying conditions

preventing flight or dive clearance or commissioning such as limited duty or

pending PEB.  Audiogram without significant threshold shifts.  Dental screen

complete, Class {I}.

Please see enclosed or hard copy health record for documentation of medical

history and physical on NAVMED 6410/10 (Abbreviated Aeromedical Exam){, ePHA

completed}.  Patient is healthy, and upon completion of administrative

paperwork will be qualified for Class {II}.

{patient} presents to aviation medicine clinic for PHYSIOLOGICAL EVENT.

-- Patient {asymptomatic}

-- 72-hour history completed by patient, no concerns

-- Part C completed, no concerns, SpCO WNL

-- {Spouse}{sleeping partner} contacted and given precautions to call duty phone number

-- Flight surgeon duty cell phone number given {775-666-7072}

-- NAMI UMO {(850-449-4629)} contacted and agrees with plan

-- Plan to see patient in 24 hours for re-evaluation

{patient} presents to aviation medicine clinic for SHORT FORM FLIGHT PHYSICAL.

-- {PQ/AA}{NPQ/AA}{WG for { } {MMM}{YEAR}} {DIACA} {Class II} {SG1}

-- Test NAVMED 6410/15 (CLEARANCE FOR NONAIRCREW PERSONNEL TO PERFORM MISSION

ESSENTIAL NON‐FLIGHT SAFETY RELATED DUTIES IN USN/USMC AIRCRAFT) completed, reviewed, and signed

-- NAVMED 6150-2 (special duty medical abstract) entry completed and signed

-- DD2992 (upchit) completed and provided to patient, expiration {DD}{MMM}{YEAR}

-- NAVMED 6120/4 (PHA) completed, reviewed, and signed 

-- Fit for full duty and worldwide deployable

-- MRRS to be updated by corpsman

-- Patient counseled on tobacco, alcohol, safe sex, seat belt use, diet, & exercise

{patient} presents to aviation medicine clinic for RAPID DECOMPRESSIVE EVENT.

-- Patient {asymptomatic}

-- 72-hour history completed by patient, no concerns

-- Part C completed, no concerns, SpCO WNL

-- {Spouse}{sleeping partner} contacted and given precautions to call duty phone number

-- Flight surgeon duty cell phone number given {775-666-7072}

-- Plan to see patient in 24 hours for re-evaluation

-- NAMI on call UMO provider {(850-449-4629)} contacted and agrees with plan

-- DCS packet uploaded to HAIMS

{age} y/o {civilian contractor} presents for SelPass clearance to fly

military aircraft as a non-aircrew observer in high performance ejection

seat aircraft capable of sustained high g-force maneuvering for occupation

as a flight test engineer (F-35).  Patient completed OPNAV 3710/18 Medical

Questionnaire (front) and has been cleared by his PCP (outside provider Dr.

{LAST NAME}, {SPECIALTY}) via OPNAV 3710/18 Medical Questionnaire (back) who finds no

contraindication of patient participation in required high risk NASATP

training or in actual flight in high performance or other military aircraft.

He is a systems analyst and will be working in Class I/III/IV aircraft and

will need to complete necessary aviation physiology survival training at a

Navy ASTC.  Please see above or local hard copy health record for

documentation of OPNAV 3710/18 and clearance.  Patient is healthy and upon

completion of administrative paperwork, is Qualified for participation in

High-Risk NASTP Training/Flight in Class I, II, III, or IV aircraft.

{patient} presents to aviation medicine clinic for SHORT FORM FLIGHT PHYSICAL.

-- {PQ/AA}{NPQ/AA} {WG for { } {MMM}{YEAR}} {DIACA} {Class I} {SG1}

-- NAVMED 6410/10 (abbreviated aeromedical examination) completed, reviewed, and signed

-- NAVMED 6150-2 (special duty medical abstract) entry completed and signed

-- DD2992 (upchit) completed and provided to patient, expiration {DD}{MMM}{YEAR}

-- NAVMED 6120/4 (PHA) completed, reviewed, and signed 

-- Fit for full duty and worldwide deployable

-- MRRS to be updated by corpsman

-- Patient counseled on tobacco, alcohol, safe sex, seat belt use, diet, & exercise

{patient} presents to clinic for annual flight physical.  Patient health record reviewed.  Patient completed and passed most recent PRT during {Spring}{Fall} PRT cycle.  Dental screen complete, {Class II}. IMR items verified including HIV, immunizations UTD.

He has had no significant interval history since previous long form flight physical dated {MMM} {YEAR}

Please see above or hard copy health record for documentation of medical history and physical on NAVMED 6410/10, PHA on  NAVMED 6120/4, and tuberculosis exposure risk assessment on NAVMED 6224/8.

{patient} presents to aviation medicine clinic for UPCHIT AFTER GROUNDING.

-- May return to duty involving flight

-- {PQ/AA}{NPQ/AA}{WG for { } {MMM}{YEAR}} {DIACA} {Class I} {SG1}

-- NAVMED 6150-2 (special duty medical abstract) entry completed and signed

-- DD2992 (upchit) completed and provided to patient, expiration {DD}{MMM}{YEAR}