MEDIF - Medical Information for Fitness to Travel or Special PART 1

To be completed
Assistance by Sales Office /
All sections must be completed clearly. See MEDIF Part 3 for guidance. Use Block letters or a typewriter when completing this form. agent
Yes/No boxes should be completed with a cross in the relevant box

NB. The MEDIF must be completed, at least 48 hours before travel is due to commence
Passengers travelling with any one of the following conditions will be requested to prepare a Medical Information Form (MEDIF) and submit it
when making a reservation.
 Passenger whose medical condition requires oxygen supply, or needs stretcher, medical escort and / or medical treatment onboard the flight.
 Carriage and use of medical equipment or instruments,
 Passenger whose fitness for air travel is in doubt, as evidenced by recent instability, disease, treatment or surgery.
 Passenger who comes under any one of the categories listed as usually unacceptable to travel on MEDIF part 3, or with other serious or unstable sickness / injuries
1. Passenger Details:
1.1 Family name , Initials 1.2 Age 1.3 Title 1.4 Languages spoken 1.5 Origin Tel. No. 1.6 Destination Tel. No.

2. Itinerary: Note: You may need to allow longer for transfer between flights
Date Flight No. From To Class Reserv’n Status Date Flight No. From To Class Reserv’n Status

Booking Reference Number:

3. Nature of Incapacitation / Illness 4. Intended Escort Details: 5. Stretcher needed?

Name, age, languages,  Yes  No
(All stretcher Cases must be escorted)

Medical qualification: If unqualified, state “Travel Companion”. Incubator needed?

 Yes  No

6. Wheelchair needed? Own wheelchair?

 No  No
 Yes 1. Can climb steps and can walk in cabin  (WCHR)  Yes Collapsible? Power driven? Battery type spillable?
2. Unable to climb steps, can walk cabin  (WCHS)  No  No  No
3. Unable to climb steps or walk in cabin  (WCHC)  Yes  Yes  Yes
(Choose one) Note Wheelchairs with “spillable” batteries are considered “dangerous cargo”

7. Have ambulance arrangements been confirmed? 8. Has hospital admission been confirmed at arrival port?  Yes  Not required

At Departure port?  Yes  Not required Hospital details:

(Full name, address, and
 Yes  Not required telephone number)
At Transit port?
*Note: All ambulance and hospital arrangements must be arranged by the
 Yes  Not required treating doctor / hospital. Clearance for travel cannot be given until
At Arrival port? bookings are confirmed.

9. Are any special in-flight arrangements required? 10. Do you have a valid FREMEC card?  Yes  No
Special meals, special seating, extra seat(s), special equipment etc. Provision of special equipment If yes, add below FREMEC data to your reservation requests.
such as oxygen etc. always requires completion of Part 2 overleaf. If no, (or additional data needed by carrying airline(s)), have physician in
attendance complete Part 2 overleaf.
Number : Issued by: Valid until:

Incapacitation Limitation
Passenger's declaration
I hereby authorise (name of nominated physician) to complete Part 2 for the purpose as indicated overleaf and in consideration
thereof, I hereby relieve that physician of his/her professional duty of confidentiality in respect of such information, and agree to meet such physician's 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(s) concerned and that the carrier(s) do 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

Passenger or Agent’s signature

I have read and understood MEDIF Part 3 Signature: Date:
 MEDIF - Medical Information for Fitness to Travel or Special PART 2
To be completed
Assistance by attending
Physician
NB. The MEDIF must be completed, at least 48 hours before travel is due to commence

This form is intended to provide confidential information to enable the airlines' medical departments to aid in assessment of fitness for travel and to provide for the
passenger’s special needs. Please ensure information is accurate and current All sections must be completed clearly using Block letters or a typewriter. Yes/No
boxes should be completed with a cross in the relevant box.

Notes for completion: Cardio-pulmonary cases as well as those requesting continuous oxygen, stretcher or incubator should enclose a recent detailed medical report with the
MEDIF request. (A copy of a specialist or hospital referral would generally be sufficient). Physicians should refer to MEDIF Part 3 for guidance with specific medical conditions.
Cabin attendants are NOT authorised to give special assistance (e.g. lifting) to particular passengers, to the detriment of their service to other passengers, nor are they
permitted to administer any injections, to give medications, to lift passengers or to assist in the toilet.

MEDA 1 PATIENT'S NAME, INITIAL(S) SEX AGE

MEDA 2 ATTENDING PHYSICIAN Telephone Contact Business: Name of Hospital or clinic & speciality:

MEDA 3 MEDICAL DATA: DIAGNOSIS in detail (please include vital signs) Date of operation / diagnosis
Diagnosis:
Blood Pressure:
Day / month / year of first symptoms:
Heart Rate:
Oxygen Saturation on Room Air:
MEDA 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
mention if Terminal case. Narratives required for guarded / poor.
 Good  Guarded  Poor Narrative (e.g. late stage disease, unstable)
(no problems anticipated) (potential problems) (problems likely)

MEDA 5 CONTAGIOUS AND COMMUNICABLE disease?  No  Yes

MEDA 6 Would the physical and / or mental condition of the patient be likely to cause
DISTRESS or DISCOMFORT to other passengers?
 No  Yes, Specify:

MEDA 7 Can patient use normal aircraft seat with seatback placed in the UPRIGHT POSITION
when so required? If "no", patient will need a stretcher on board.
 No  Yes, Specify:

MEDA 8 Can patient take care of his own needs on board UNASSISTED*" (including meals,
visit to toilet, etc.)? If not, specify type of help needed:
 No  Yes, Specify:

MEDA 9 If to be ESCORTED, is the arrangement satisfactory to you? If not, specify type of

escort proposed by you:
 No  Yes, Specify:

MEDA 10 Does the patient need SUPPLEMENTARY OXYGEN ** equipment in flight? Constant flow oxygen (Mask, tracheostomy)

 No  Yes, Specify flow rate:  2L  4L

Can patient go without oxygen for short periods of time? E.g. for toileting.
 No  Yes

GUIDANCE: Patients who can walk 50 metres without dyspnoea generally do not require supplementary Oxygen. Emirates provide flow rates
of 2 or 4 Litres per of constant flow oxygen by mask. Please specify FLOW RATE required.

MEDA 11 Does patient need any medication*

other than self-administered, and/or the (a) on the GROUND while at the airport(s):  No  Yes, Specify:
use of special equipment such as
MEDA 12 respirator, incubator, nebuliser etc.?
(note all equipment on board must be dry cell (b) on board of the AIRCRAFT:  No  Yes, Specify:
battery operated)

MEDA 13 Does patient need (a) during long layover or nightstop at

 No  Yes, Details:
HOSPITALISATION? CONNECTING POINTS en route:
MEDA 14 (If yes, indicate details of arrangements made)
NOTE: The attending physician is responsible (b) upon arrival at DESTINATION:  No  Yes, Details:
for all arrangements.

MEDA 15 Other remarks or information in the interest of your patient's smooth and comfortable transportation (specify if any):

MEDA 16 Other arrangements made by the attending physician:

Attending Physician's Signature. Date:

I have Read and understood Part 3 of the MEDIF form…………………………………………………………………

 MEDIF - Medical Information for Fitness to Travel or Special PART 3
Assistance
Notes for the guidance of medical practitioners and passengers.

The Principal factors to be considered when assessing a patient’s fitness for air travel are:
 Reduced atmospheric pressure (Cabin air pressure changes greatly during 15-30 minutes after takeoff and before landing and gas expansion and contraction can cause pain and pressure effects)
 Reduction in oxygen tension. (The cabin is at a pressure equivalent to an altitude of 6,000 to 8,000 feet and oxygen partial pressure is approximately 20% less than on the ground).

Conditions usually considered unacceptable for air travel (Although these are suggested limiting factors, each individual case must be considered on its merits and is dependent
on whether or not the passenger is accompanied by a professional escort)
 Anaemia of severe degree.
 Severe cases of Otitis Media and Sinusitis.
 Acute, Contagious or Communicable Disease.
 Those suffering from Congestive Cardiac Failure or other cyanotic conditions not fully controlled.
 Uncomplicated Myocardial Infarction within 2 weeks of onset, complicated MI within 6 weeks of onset.
 Those suffering from severe respiratory disease or recent pneumothorax.
 Those with GI lesions which may cause hematemesis, melaena or intestinal obstruction.
 Post operative cases:
a) Within 10 days of simple abdominal operations.
b) Within 21 days of chest or invasive eye surgery (not laser).
 Fractures of the Mandible with fixed wiring of the jaw (unless medically)escorted
 Unstable Mental illness without escort and suitable medication for the journey.
 Uncontrolled seizures unless medically escorted.
 Introduction of air to body cavities for diagnostic or therapeutic purposes within 7 days.

 PREGNANCY: FOR FLIGHT DURATION LESS THAN OR EQUAL TO 8 HOURS.

 No medical certificate or letter is required up to the end of the 28 th week of pregnancy.
 From the beginning of the 29th week, until the end of the 36th week of a single, uncomplicated pregnancy, a medical certificate or letter issued by a qualified doctor or midwife stating fi tness to fly
and confirming expected date of delivery is required. After the end of the 36th week of pregnancy, no travel is permitted.
 From the beginning of the 29th week until the end of the 32nd week of multiple pregnancies such as twins or triplets, Emirates Medical Services approval with be required.

 PREGNANCY: FOR FLIGHT DURATION MORE THAN 8 HOURS.

 No medical certificate or letter is required up to the end of the 28 th week of pregnancy.
 From the beginning of the 29th week until the end of the 32nd week of a single, uncomplicated pregnancy, a medical certificate or letter issued by a qualified doctor or midwife stating fitness to fly
and confirming the expected date of delivery is required. After the beginning of the 33rd week of pregnancy, no travel is permitted.
 From the beginning of the 29th week until the end of the 32nd week of multiple pregnancies such as twins or triplets, Emirates Medical Services approval is required.
 Infants will be accepted within 7 days of birth.

Notes on other Specific items

Allergies: Simple requests for a special meal do not require completion of this form. If your patient has a life threatening food allergy that may require treatment in-flight, particularly if they react to the
presence of traces of food in the air, this form must be completed. Note; we cannot provide peanut free meals.
Asthma: Medication must be carried in cabin baggage. Nebulisers require their own power source. Otherwise, we advise spacer devices with inhalers, which are usually as effective as nebulisers.
Fractures: All new long bone fractures and full leg casts (cast must be at least 48hrs old ) require a MEDIF. Plasters should be split for fresh injuries (48hrs or less), which could swell inside the cast on a
long flight. Extra legroom for leg elevation is not possible in economy class, however an aisle seat can be reserved, please state whether the injury is left or right.
Lung or Heart Disease: Cardiopulmonary disease which causes dyspnoea on walking more than 100m on the flat, or has required oxygen in hospital or at home (or in-flight previously) may require
supplementary oxygen. The aircraft oxygen is for emergency use only. Serious cardiopulmonary cases as well as those requesting continuous oxygen, stretcher, incubator should enclose a recent
detailed medical report with the MEDIF request. (A copy of a specialist or hospital referral would generally be sufficient).
Physical Disabilities: There is no need for this form if you simply require a wheelchair as far as the aircraft door; the travel agent can indicate this on the reservation. Note: Civil Aviation Rules require all
passengers to be able to use the aircraft seat with the seatback in the upright position.
Special Meals: Special diets for religious or other medical reasons can be ordered direct from your travel agent without using this form. If you have a food allergy please see the section on “allergies” above.
Terminal Illness: Passengers in the advanced stages of terminal illness will normally require a medical or nursing escort.
In-flight care: Cabin Crew are trained in First Aid only, and are not expected to pay particular attention to patients to the detriment of service to other passengers. Additionally, they are not permitted to
administer any injections or give any medications. EMIRATES do not provide nursing attendants for invalid passengers.
Escorts: should ensure that they have all appropriate items for the proper care of their patient, and are responsible for att ending to all aspects of their patient’s bodily needs. Cabin Staff
cannot be involved in this, as they also handle food.

Processing MEDIFs
 The MEDIF must be received, at the latest, 2 working days before travel is due to commence
 The MEDIF should be completed based on passenger's (patient's) condition within 14 days from the date of commencement of air travel. EMIRATES must be notified immediately of any change
in the patient’s condition PRIOR to travel.
 In the event of sudden change in the passenger's (patient's) condition during the trip, we will ask the passenger (patient) to obtain another medical information form to confirm the fitness to
continue further air travel.