Medical Certificate of Fitness for Air Travel （航空旅行医疗健康证明书）.pdfVIP


 Medical Certificate of Fitness for Air Travel (MEDIF form) This form is intended to provide confidential information to enable the airline Medical Doctor to assess the fitness for travel and provide for the passenger’s special needs. It must be dated not more than one month prior to date of flight departure. The physician attending the incapacitated passenger is requested to answer all questions. Put a cross (X) in ‘Yes’ or ‘No’ boxes. Use BLOCK LETTERS or TYPEWRITER when completing this form. ITEM 1 Passenger’s Name: SEX: AGE: Address: Phone(H): Mobile: Email: Itinerary – Flight Details Mandatory Booking Reference: Flight No: Date: From: To: Flight No: Date: From: To: Note: Transfer from one flight to another requires LONGER connecting time. To be completed by Attending Physician/Treating Doctor: Name: Attending ITEM 2 Physician/Treating Address: Doctor Name of Hospital or Clinic (if relevant) Email: Business: HOME: Fax: Medical Clearance required if patient non autonomous. NATURE OF INCAPACITATION: Can patient travel in a sitting position for the duration of flight? ITEM 3