CACI Conditions Worksheets

What is CACI?

CACI is an acronym for Conditions AMEs Can Issue.  It represents a group of medical conditions that in mild forms, the  FAA requires a minimal amount of medical documentation for medical certification (as opposed to more complex medical conditions that the FAA requires substantial documentation).  If the documentation is presented and demonstrates a qualified conditional status, the AME is able to issue the medical certificate, if the pilot is otherwise qualified during the flight physical.

In all medical cases the FAA wants to know three basic things:

  1. Is the condition stable?

  2. Is the pilot being treated with any medications?  If so, what are they, their doses, the frequency taken, and is the pilot experiencing any side effects

  3. Does the treating provider recommend any changes to the treatment regimen?

The worksheets presented on this page generally include the basic requested information as well as additional condition-specific information.

How to use the worksheets:

Please do this PRIOR TO YOUR FLIGHT PHYSICAL. 

  1. Find the appropriate condition below

  2. Download and print the worksheet

  3. Present the worksheet to your treating provider for completion.  YOUR TREATING PROVIDER IS TO COMPLETE THE WORKSHEET. 

  4. Provide the completed worksheet to Flight Med by:

    • Bringing the completed worksheet to your flight physical or

    • Emailing the completed worksheet to flightmedmd@gmail.com or

    • Having your provider fax the completed worksheet to Flight Med at 210-640-1938.

You can download and/or print the worksheet by clicking on the PDF button to the right of the listed conditions shown below.  If your condition does not meet any criteria listed below, please speak with Dr. Olson at 414-419-3300.

CACI Medical Conditions and Worksheets

Arthritis:

  Osteoarthritis

  Psoriatic

  Rheumatoid

  Ankylosing Spondylitis

Asthma:

  Mild

  Seasonal Asthmatic Symptoms

Bladder Cancer:

  Non-metastatic and treatment completed 

  Less than 5 years ago

Breast Cancer:

  Non-metastatic and treatment completed 

  Less than 5 years ago

Immune Thrombocytopenia (ITP) 

Chronic Immune Thrombocytopenia (C-ITP)

  Less than 5 years ago

Chronic Kidney Disease:

  eGFR 35 to 44

  No CACI form required if eGFR 45 or greater

Colitis:

  Ulcerative Colitis

  Regional Enteritis

  Chron's Disease

Irritable Bowel Syndrome

Colon Cancer:

  Non- metastatic

  No high risk features

  Treatment completed less than 5 years ago

Glaucoma:

  Treated or Untreated

  ** Requires FAA form 8500-14

Hepatitis C - Chronic

Hypertension

Hypothyroidism

Migraine

Chronic Tension or Cluster Headaches

Mitral Valve Repair:

  More than 5 years ago

  No comorbid conditions

Prediabetes

Metabolic Syndrome

Impaired Fasting Glucose

Insulin Resistance

Glucose Elevation/Intolerance

Polycystic Ovary Syndrome

Prostate Cancer:

  Non-metastatic

  Treatment completed less than 5 years ago

Renal Cancer:

  Non-metastatic

  Treatment completed less than 5 years ago

Retained Kidney Stone(s):

  Asymptomatic

  Less than 5 years ago

  No complications

Testicular Cancer:

Non-metastatic

  Treatment completed less than 5 years ago

Primary Hemochromatosis