Dear Passenger:

The information provided during your booking has prompted us to request that a Passenger Medical Clearance
(MEDA) Form be completed by you and your attending doctor.

Some passengers may need special medical consideration when they travel. This may be due to a recent illness,
injury, surgery or hospitalisation; or if you have an existing medical condition where there is reasonable doubt
that you can complete the flight safely without requiring extraordinary medical assistance; or you have requested
the use of medical equipment or oxygen inflight.

The purpose of the MEDA Form is to enable Cathay Pacific, in conjunction with your doctor, to determine your
fitness to travel. Part 1 of the MEDA Form is to be completed by you, the passenger, while Parts 2 and 3 is to be
completed by the attending doctor in English.

Please ensure that the MEDA Form is returned to your local Cathay Pacific Reservation office at least 48
hours prior to your scheduled departure time, to minimise any potential delays. Once Cathay Pacific receives
the completed form and it is assessed by our Aviation Medicine team, a member of Cathay Pacific staff may
contact you to discuss your medical clearance.

Please note that you will have to bear any associated charges made by your doctor for completing this form.

By providing the information requested in the MEDA Form, you are waiving the confidentiality of the information
disclosed by your attending doctor. In order to ensure your requests are conveyed to the relevant connecting
airlines, Cathay Pacific will also disclose the contents of the MEDA Form to all carriers associated with this ticket.

If you have any questions relating to the MEDA Form, please direct it to your local Cathay Pacific Reservation
office. Thank you for your cooperation.

Corporate Medical Department

Cathay Pacific Airways Limited

Attachment: MEDA Form Part 1

Reviewed: 22 August 2014 Page 1

 PASSENGER MEDICAL CLEARANCE FORM (MEDA) – PART 1
- Answer ALL questions
To be completed by
- Put a cross (X) in “YES” or “NO” boxes
PASSENGER
- Use BLOCK LETTERS when completing this form
A Surname ____________________________________ First Name _____________________________ Title ____________
Airline ____ Flight No ________ Class ____ Date __________ Origin _________ Destination ________ Status ___________
B Airline ____ Flight No ________ Class ____ Date __________ Origin _________ Destination ________ Status ___________
* Transfer from one flight to another often requires longer connecting time. If travelling on other airlines please contact them directly for clearance.
C Nature of Medical Condition/Incapacitation ___________________________________________________________________________
D Is stretcher needed on board? No Yes * All stretchers cases MUST be escorted by medical professionals and additional costs apply
Intended Escort Name _____________________________________________________ Sex ________Age ______
Professional qualification Nurse  Medical Doctor  If untrained, indicate “TRAVEL COMPANION / ASSISTANT” 
Is the intended escort capable and prepared to provide all assistance including:
a) assistance in comprehending and responding appropriately to safety instructions from cabin crew and/or assist passenger to evacuate
E the aircraft in the event of an emergency Yes  No 
b) personal care needs e.g. eating/drinking, administration of medications, elimination functions including assistance inside the lavatory
Yes  No 
Segments (if different from passengers) ____________________________________________________________________________
* For blind and/or deaf, state if escorted by trained dog
Wheelchair needed? No Yes To: boarding gate aircraft door seat inflight 
Own Wheelchair? No Yes 
F
Collapsible? No Yes Power driven? No Yes Spillable battery? No Yes 
* Wheelchairs with spillable batteries are "restricted articles" and are permitted on passenger aircraft only under certain conditions which can be
obtained from the airline(s). In addition, certain countries may impose specific restrictions.
Ambulance needed? No Yes (Passenger or attending doctor is responsible for making all ambulance arrangements)
G Ambulance company contact ____________________________________________________________________________________
Destination address __________________________________________________________ Tel: (____)_______________________
Other ground arrangement needed? No Yes 
If Yes, specify below and indicate for each item:
H (a) The ARRANGING airline or other organization
(b) At whose EXPENSE, and
(c) CONTACT addresses/phones where appropriate or whenever specific persons are designated to meet/assist the passenger
Arrangements for drop-off delivery NoYes Details:____________________________________________________________
1
at DEPARTURE airport  __________________________________________________________________

Arrangements for assistance at NoYes Details:____________________________________________________________

2
CONNECTION POINT  __________________________________________________________________

Arrangements for pick-up at NoYes Details:____________________________________________________________

3
ARRIVAL airport  __________________________________________________________________

Other requirements or relevant NoYes Details:____________________________________________________________

4
information  __________________________________________________________________

Special In-flight arrangements needed? No Yes (e.g. special meal, special seating, oxygen or medical equipment*, assistance
with medications, feeding or elimination functions**… etc)
If Yes, DESCRIBE and indicate for each item:
(a) SEGMENT(s) on which required
(b) airline-ARRANGED or arranging third party, and
(c) at whose expense
I * Provision of SPECIAL EQUIPMENT such as oxygen etc. always requires completion of PART 2. See “NOTE” at the end of PART 2.
**While our cabin crew will do everything possible to provide assistance to passengers during the flight, please note that we are unable to
provide passengers with any assistance for personal care needs such as feeding, elimination functions including assistance inside the
lavatory or other personal care needs. Additionally, cabin crew are trained only in FIRST AID and are NOT PERMITTED to administer any
injection or medication.
Details: _______________________________________________________________________________________________________
______________________________________________________________________________________________________________
Does this passenger hold a “Frequent Travellers Medical Card” (FREMEC) valid for this trip? No Yes 
If Yes, add below FREMEC data to your reservation requests
J If No (or if additional data needed by carrying airlines(s)), have attending doctor complete PART 2
FREMEC No. _________________________ Issued by ____________ Valid until _____________
Incapacitation _________________________________ Limitation __________________________________________
PASSENGER’S DECLARATION
I HEREBY AUTHORISE ________________________________________________________________________ (NAME OF NOMINATED DOCTOR)
to provide the airlines with the information required by those airline’s medical departments for the purpose of determining my fitness for carriage by air and in
consideration thereof I hereby relieve that doctor of his/her professional duty of confidentiality in respect of such information, and agree to meet such doctors fees in
connection therewith; I take note that, if accepted for carriage, my journey will be subject to the general conditions of carriage / tariffs of the carrier concerned and that
the carrier does not assume any special liability exceeding those conditions / tariffs. I am prepared, at my own risk to bear any consequences which carriage by air
may have for my state of health and I release the carrier, its employees, servants and agents from any liability for such consequences. I agree to reimburse the carrier
upon demand for any special expenditures or costs in connection with my carriage. (where needed to read by/to the passenger, dated and signed by him/her behalf)
Address: Date: Passenger’s Signature:

Reviewed: 22 August 2014 Page 2