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Additional information

The Medical Information Form (MEDIF) contains information that our medical team will use to assess whether it's safe for a passenger to travel or if we can offer any assistance with the journey. 


Part 2 should be filled in by a doctor and give a professional opinion on whether the passenger is medically fit enough to fly. Please ensure the information is current and accurate, and that all relevant fields are completed. It should be submitted at least 48 hours before the flight. 


Notes for completion:


– Parts of this form have been pre-populated using information already given to us by the passenger or on behalf.. 

– Information on cardiopulmonary cases - as well as for passengers requesting continuous oxygen, a stretcher or an... should be supported by a recentt medical report (such as a copy of a hospital referral). 

– Please note our cabin crew are not authorised to give special assistance to particular passengers, to be detriment... service to other passengers. They are also not permitted to administer injections, give medication, lift passengers or give assistance with bathroom visits. 

– Doctors should refer to part 3 of the MEDIF form for guidance on specific medical conditions.

1. Patient's Details

2. Doctor's Details

Please provide your details

3. Diagnosis

description

Please give a detailed description of the diagnosis (including vital signs)

3000 Characters left

Date of first symptoms
Date of operation/ diagnosis

Some explanation note can go here for the Diagnosis section

4. Prognosis for the flight(s)

Please consider the potential effects of the itinerary and physiological stresses of flight on the patient's state of health and medical terminal case. Please provide more detail if the patient's prognosis is guarded or poor.
prognosis

If Guarded or Poor radio button are selected, please specify

3000 Characters left

Some explanation note can go here

5. Disease details

Does the patient suffer from a contagious and communicable disease?
DISEASE

Please specify:

3000 Characters left

Some explanation note can go here for the Disease section

6. Physical and/or psychological condition

Would the physical and/or psychological condition of the patient be likely to cause distress or discomfort to other passengers?
PHYSICAL

Please specify:

3000 Characters left

Some explanation note can go here for the physical condition section

7. Seat position details

Can the patient use a normal aircraft seat with the seat back placed in an upright position when required?
SEAT

Please specify:

3000 Characters left

Some explanation note can go here for the seat position section

8. Patient unassisted needs

Can the patient take care of their own needs on board, unassisted (including meals, visits to the bathroom etc)?
UNASSISTED

If no, please specify the type of assistance needed:

3000 Characters left

Some explanation note can go here for the patient unassisted section

9. Escort

If the patient has to be accompanied, is the current arrangement described satisfactory to you? If not, please specify how you believe the passenger should be accompanied.
ESCORT

Please specify:

3000 Characters left

Some explanation note can go here for the escort section

10. Oxygen

Does the patient need supplementary oxygen equipment for this flight?

Some explanation note can go here for the oxygen section

11. On the ground medication whilst at the departure airport

Does the patient need any medication that is not self-administered, or do they need to use special equipment as a respiratory nebuliser etc?
GMEDICAL

Please specify:

3000 Characters left

Some explanation note can go here for the ground medication section

12. Medication on board

Does the patient need any medication that is not self-administered, or do they need to use special equipment as a respiratory nebuliser etc?
AMEDICAL

Please specify:

3000 Characters left

Some explanation note can go here for the medication board section

13. Hospitalization during a long layover

In the event of a long layover or overnight stop at a connecting airport, does the patient require hospitalization?
LAYOVERHOSPITAL

Please specify:

3000 Characters left

Please note that the doctor is responsible for all hospitalization arrangements

14. Hospitalization at destination

Does the patient require hospitalization when they arrive at their destination?
DESTHOSPITAL

Please specify:

3000 Characters left

Please note that the doctor is responsible for all hospitalization arrangements

15. Other information or arrangements

Does the patient require any additional arrangements not described above when they arrive at their destination?
OINFO

If yes, please specify and note any other arrangements you have made as the doctor:

3000 Characters left

explanation note for the other information section goes here

16. Attachments

Please upload documents relevant to your request