caaf-667-mcc-medical - Civil Aviation Authority

VISUAL ACUITYCOLOUR VISIONFIELD OF VISIONDISTANT VISION/NEAR(ISHIHARA)Uncorrected Corrected VISIONSafe Unsafe Normal AbnormalR L R LPrescription of Glasses / Lenses if any:Hearing Performance: Normal AbnormalClinical Examination Normal Abnormal Clinical Examination Normal Abnormal1. Skin, Lymphatic, Glands 9. Heart, Blood Vessels2. Head, Neck, Face 10. Abdomen3. Ears, Drums 11. Extremities4. Eyes including Funds copy 12. Psychological Disorders5. Nose, Throat & Nasal Passages 13. Neurological Disorders6. Chest / Breasts 14. Genitalia7. Respiratory System 15. Rectal Examination8. Vaginal Examination 16.a) COMMENTS ON CLINICAL EXAMINATIONb) Investigationc) X-ray Chest (if indicated)c) ECG (above 40 years)d) FBS (if indicated, D.M. requiring oral Medication is acceptable)e) Other Tests (if indicated)f) Defects /RestrictionsRECOMMENDATIONS:Medically Fit / Unfit for “MICROLIGHT CERTIFICATE COMPETENCY”DateSignature & Stamp(Authorised Medical Officer)For Official use:Fit / Unfit / Referred to CAM for Accredited Medical Conclusion (AMC)DateSignature & Stamp(Authorised Medical Officer)