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Application For Carriage of Medical Passengers

This document is an application for carriage of medical passengers on IndiGo flights. It requires a detailed medical certificate and approval from the airline's medical department. IndiGo does not provide oxygen for pre-booked medical passengers. The application collects information about the passenger, their medical details and requirements as assessed by their treating doctor. This includes diagnosis, symptoms, vital signs, mobility, assistance needs and arrangements made at departure and arrival airports. The doctor must declare the passenger fit to fly.

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Manda Reema
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590 views

Application For Carriage of Medical Passengers

This document is an application for carriage of medical passengers on IndiGo flights. It requires a detailed medical certificate and approval from the airline's medical department. IndiGo does not provide oxygen for pre-booked medical passengers. The application collects information about the passenger, their medical details and requirements as assessed by their treating doctor. This includes diagnosis, symptoms, vital signs, mobility, assistance needs and arrangements made at departure and arrival airports. The doctor must declare the passenger fit to fly.

Uploaded by

Manda Reema
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FOR CARRIAGE OF MEDICAL PASSENGERS

Detailed Medical Certificate must accompany this completed form. Medical Passenger
Completed Application to be forwarded to the Medical Department DEL for approval.
IndiGo does not provide any oxygen for pre -booked medical passengers.
Oxygen cannot be carried by medical passengers.
STRETCHER CASE.
(Allowed only on selected flights.)
SITTING CASE

Customer’s last name________________________

Customer’s first name________________________

IndiGo Flight No______ Date______________

Departure city__________________

Arrival city____________________

Permanent Address____________________________________________________

___________________________________________________________

________________________________

Departure contact telephone no___________

Arrival contact telephone no_____________

MEDICAL DETAILS – TO BE COMPLETED BY PASSENGERS’S TREATING DOCTOR:

Level 1 Tower C Global Business Park MG Road Gurgaon,122 002


India T+91 124 406 2500 F+91 124 406 8536 goIndiGo.in
1) Doctor’s Name, Address, Tel / Fax No, Qualifications, Registration No
___________________________________________________________________
___________________________________________________________________

2) Patients’ Name __________________________Sex ______ Age ______

3) Diagnosis & Date of onset of illness _____________________________

4) Is the disease contagious or infectious in any form? Yes / No

5) a) Present Symptoms

___________________________________________________________

b) Prognosis during flight


____________________________________________________________

6) Vital Parameters (Pulse, BP, Temperature, Respiratory rate, Level of Consciousness)

• Normal / Abnormal (Please Specify) _________________________

7) Dyspnoea

Nil / On Accustomed Exertion / At Rest

8) Details of ongoing medical treatment / any special comments regarding treatment on


flight
____________________________________________________________

Level 1 Tower C Global Business Park MG Road Gurgaon,122 002


India T+91 124 406 2500 F+91 124 406 8536 goIndiGo.in
9) Does patient have full control of bowels / bladder? Yes / No

10) Can patient eat / drink unaided? Yes / No

11) Can patient use aircraft toilet unaided? Yes / No

12) Does patient require wheelchair? Yes /

No If yes which of the following

a) To aircraft steps b) To the cabin door c) To seat

13) Does patient require Doctor/Qualified Nurse/Non-Medical Escort? Yes / No

14) Is patient accompanied? Yes/ No

If Yes, by whom___________________

15) Have arrangements for Ambulance / Hospitalization made at


departure/arrival airports?

If yes, give details _____________________________

Have above details been specified to passenger? Yes /

No PASSENGER DECLARED FIT TO FLY

SIGNATURE: _________ STAMP: ____________ DATE:_______

Note: 1) The attendant should ensure that all items / medical equipment brought on to
the aircraft by the patient (needles, syringes, and unused medications) are removed at
the time the patient disembarks from the aircraft

Level 1 Tower C Global Business Park MG Road Gurgaon,122 002


India T+91 124 406 2500 F+91 124 406 8536 goIndiGo.in

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