Patient Pre-Exam Checklist

71 Rowland Street, Suite 217, Ballston Spa, NY 12020 Phone: (518) 288-3240 Email: trachtmanAME@gmail.comWebsite: www.upstateaviation.com

Patient Pre-Appointment Instructions:

General instructions for all patients

Arrive 15 minutes before your scheduled appointment.
Remain in your vehicle
Call the office

1. FAA PILOT MEDICAL EXAMINATION

For first-, second-, or third-class FAA medical certification.

Bring to every FAA medical examination

Complete the FAA MedXPress application (Form 8500-8) before your appointment.
Bring your MedXPress confirmation number and a copy of your completed application.
Bring valid photo identification.
Bring your prescription glasses or reading glasses, if used. Contact lenses may remain in place. Hearing aids if applicable.
Bring a current list of all medications, including doses and frequency.
Bring relevant medical records if your health, diagnosis, treatment, or medication has changed since your last FAA examination.
Bring all FAA correspondence, including prior deferrals, denials, requests for additional information, and Special Issuance paperwork.
Bring any FAA-required forms or reports relevant to your condition.

Additional documents, if applicable

High blood pressure

Bring the applicable FAA hypertension report and supporting records, if required.

Heart condition or requested EKG

Bring recent cardiology notes and relevant test results.
Bring any FAA-requested cardiac forms.
Avoid applying body lotion to your chest if an EKG may be performed.

Vision or color-vision issues

Bring relevant eye examination reports.
Bring prior FAA color-vision determinations, SODA, or Letter of Authorization (LOE), if applicable.

Previous Special Issuance

Bring your FAA authorization letter.
Bring all required follow-up documentation.

Important: A urine sample is part of the FAA medical examination; it is not a drug test.

If you are unsure which documents are required, contact the office before your appointment.

2. FAA HIMS INITIAL EXAMINATION

Important: New HIMS patients must contact Dr. Trachtman before scheduling at trachtmanAME@gmail.com.

Bring the following documents

Valid photo identification.
MedXPress confirmation number and a copy of the completed Form 8500-8, if required for your appointment. Most do not require.
The FAA letter directing you to a HIMS AME. Should have been sent prior to appointment.
All FAA correspondence, including deadlines and requests for information.
Previous FAA medical certificates, deferral or denial letters, Special Issuance authorizations, and prior HIMS reports, if available.
A complete list of medications, doses, prescribing clinicians, and treatment dates.
Names and contact information for treating physicians, psychiatrists, therapists, addiction-treatment providers, and other clinicians involved in your care, as applicable.
Relevant medical, psychiatric, substance-use treatment, hospitalization, and recovery records requested by the FAA or HIMS AME.
Treatment completion or discharge summaries and current progress reports, if applicable.
Required sobriety documentation, monitoring records, laboratory results, and drug/alcohol testing reports specified in your FAA letter or HIMS plan.
Any employer, airline, union, or HIMS program forms requested for your evaluation.

Before your appointment

Contact the office in advance if you are unsure which records are needed.
Do not assume the office has received records sent by another clinician.
Bring originals or clear copies of records, organized by date when possible.

Important: HIMS requirements vary by individual case. Your specific FAA letter and instructions from your HIMS AME take precedence over this general checklist.

3. FAA HIMS FOLLOW-UP EXAMINATION

Bring the records required by your current FAA authorization and individualized HIMS monitoring plan.

Appointment checklist

Valid photo identification.
MedXPress confirmation number and application copy, if a new FAA medical examination is required.
Current FAA Special Issuance authorization and all relevant FAA correspondence.
Any outstanding FAA requests for information.
Required HIMS progress reports and monitoring forms.
Updated reports from your treating clinicians, including attendance, participation, progress, and current status, as applicable.
Required alcohol or drug testing results, random testing logs, and laboratory reports.
Current medication list and documentation of medication changes.
Records of relapse, recurrence of symptoms, treatment changes, hospitalization, or other significant events since your last visit, if applicable.
Required peer-support, aftercare, continuing-care, or recovery-program documentation, if applicable.
Any FAA, employer, airline, union, or HIMS program forms due for this follow-up.

Before leaving home

Review your FAA letter and last HIMS visit summary to identify the exact reports and testing required.
Make sure reports cover the required dates.
Verify that reports are legible, dated, and identify the reporting clinician or laboratory.
Contact the office if a required report is delayed or missing.

Important: Follow-up requirements differ among HIMS applicants. Contact the office before your appointment if you are uncertain about required documentation.

4. DOT COMMERCIAL TRUCK DRIVER MEDICAL EXAMINATION

For initial or recertification Federal Motor Carrier Safety Administration (FMCSA) medical examinations.

Bring to your appointment

Valid driver's license or other accepted photo identification.
Completed driver portion of the Medical Examination Report, Form MCSA-5875, if available.
Medical Examiner's Certificate form MCSA-5876, if you have been asked to bring it. The office can provide a copy if needed.
Current list of all medications, doses, and prescribing clinicians. Form MCSA-5895 may be helpful.
Prescription glasses or contact lenses, if used.
Hearing aids with working batteries, if used.
Current FMCSA waiver or exemption certificate or Skill Performance Evaluation (SPE) certificate, if applicable.
Relevant medical records for current or past conditions, surgeries, injuries, hospitalizations, or ongoing treatment.
A medical opinion or release letter from your treating clinician when applicable to your condition, recent illness, injury, or surgery.

Additional documents for specific medical conditions

Insulin-treated diabetes

Completed FMCSA Form MCSA-5870 from your treating clinician.
Required blood-glucose records for the preceding three months.
Verify that the treating clinician completed the form within the applicable FMCSA timeframe.

High blood pressure

Current medication list and recent blood pressure readings, if available.
Relevant treating clinician records if requested.

Heart disease or vascular conditions

Recent cardiology notes.
Relevant cardiac testing and reports, if applicable.

Sleep apnea

Sleep study report, if requested.
CPAP/BiPAP adherence or compliance report for the requested period, if applicable.

Seizure, stroke, vision, hearing, or other significant medical conditions

Relevant specialist reports and test results.
Any required FMCSA exemption or supporting documentation.

Important: The urine sample collected during a DOT examination is generally used to screen for sugar, protein, and blood. It is not the DOT drug test. Do not stop or change prescribed medication unless directed by your treating clinician.

5. DOT FOLLOW-UP EXAMINATION FOR A MEDICAL CONDITION

Use this checklist if the office has asked you to return for monitoring, additional documentation, or reassessment of a medical condition.

Bring to every follow-up

Valid driver's license or photo identification.
Current DOT medical certificate, if one was issued.
Prior examination paperwork and written follow-up instructions.
Updated medication list with doses and prescribing clinician contact information.
Requested medical release or opinion letter from your treating clinician, completed and dated.
Recent office notes and relevant test results addressing the condition being followed.

Additional documents based on your condition

Blood pressure

Completed FAA approved HYPERTENSION form

Diabetes

Recent hemoglobin A1c and glucose records, if requested.
For insulin-treated diabetes, the required MCSA-5870 and glucose records
Completed non insulin treated Diabetes form.

Sleep apnea

Sleep study report, if requested, or initial study never sent to FAA.
Current treatment report.
CPAP/BiPAP adherence data covering the requested period.

Recent surgery, injury, or illness

Hospital discharge summary, if applicable.
Follow-up notes from your treating clinician.
Documentation of recovery, restrictions, and return to usual activities.

Neurologic condition, seizure, stroke, or loss of consciousness

Relevant specialist report.
Requested test results.
Information regarding recurrence, treatment, and applicable waiting periods, if relevant.

Medication-related concern

Treating clinician's explanation of the diagnosis, stability, side effects, and any potential effect on safe driving, if requested.

Before the appointment

Read the office's prior instructions carefully.
Bring the exact report or test results requested.
If records are not yet available, call or email the office before your appointment.

Important: A treating clinician's letter is helpful but does not guarantee certification. The certified medical examiner makes the determination under applicable FMCSA standards.

6. FAA EMPLOYEE AND AIR TRAFFIC CONTROL SPECIALIST (ATCS) EXAMINATIONS

For FAA employee examinations and Air Traffic Control Specialist examinations.

Required forms and identification

Valid photo identification.
Signed FAA Form 3930-4, if applicable to your appointment.
FAA Form 3900-7, if applicable to your appointment.
MedXPress confirmation number and a copy of the completed application, when required.
Appointment confirmation and any instructions or forms supplied by FAA Occupational Health, your employing office, or the scheduling team.

Medical information to bring

Current medication list, including doses and prescribing clinician contact information.
Relevant records for new diagnoses, medication changes, recent illness, surgery, or ongoing medical evaluation.
Prior FAA medical correspondence, restrictions, waivers, or requested follow-up reports, if applicable.
Prescription glasses or contact lenses, if used.
Hearing aids, if used.
Any condition-specific forms or reports requested by FAA Occupational Health or the examining office.