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*Music*
*Airplane Sound Effect*
Hi, I'm Doctor Judy Frasier.
I'm one of the certification physicians at AMCD, and we're
here to talk about some of the AME guide updates.
This is in response to questions from the AMEs who
are asking for an annual update.
So this is the first, hopefully in a series, for
your information.
Right now for AMEs, conditions are currently followed by...
AMEs have conditions they can issue a regular certificate
based on requirements in the AME guide.
If they don't meet those they can go to an AASI or an SI,
which are all time-limited and require special authorization.
A partial list of current conditions AMEs can issue
after taking a thorough history and determining if the
condition is stable is listed here.
There is a new instructional category in the AME guide and
these are conditions that an AME can issue if they're
within specific parameters as designed on worksheets in the
AME guide.
These are the conditions that are currently allowed that
have worksheets or instructional information that
you, the AME, can issue in your office.
This should speed things up for you because you don't have
to call AMCD or your Regional Flight Surgeon for
authorization if conditions of the worksheet are met.
So what has changed?
In the old AME guide if you went to hypothyroidism for all
classes you would be asked to submit all pertinent records,
a current status, names of meds and
thyroid function testing.
Then it would be worked at AMCD or the regional office,
and your airman would be given a special authorization
that was time-limited.
What's new in the guide is there's this new category, and
we're asking you the AMEs review the information.
If it falls within worksheet parameters, you can issue...
you can issue a regular certificate.
If anything falls outside of the worksheet criteria, you'll
turn in the information as you did in the past,
for a special issuance.
So the conditions AMEs can issue are CACI, Pre-CACI, for
example hypertension required an initial work up, lab, EKG,
a current status and a history.
Now by following the worksheet, that is no longer
required and the AME can determine if the hypertension
is stable.
Regarding thyroid:
You used to have to turn in all the information or call
AMCD or your Regional Flight Surgeon office for
authorization.
Now, if you review all the information, the TSH is
normal, and there's a favorable current status, you
can issue from your office.
And I'll go through each condition at the end of the
program.
So how do you find the information?
You go to the AME guide just as you have in the past.
Remember the most updated version is online, so
specifically with the worksheets we ask that you
don't print them out and use them, to make sure that they
have been updated.
If you go to the AME guide and you use a "Find" bar and type
in the name of the condition and the word "worksheet" you
should be able to get to that page very easily.
There's two pieces of information that you need.
One is the instruction sheet in the AME guide,
and then the worksheet.
The worksheets only have three components.
They have instructions that are very brief and easy.
They have different questions based on the condition.
And then each worksheet has an identical information to put
in box 60 based on what you did with that condition.
So the instructions are easy.
You, the AME, review the information that we ask about.
If it's within the parameters, then you'll be able to issue.
The parameters are listed in horizontal rows.
Make sure that you, the AME, address each
of the horizontal components.
If you leave a horizontal component out the worksheet is
not valid.
The specific comments in box sixty are how you communicate
with AMCD or your Regional Flight Surgeon office this is
how we know the components were met so we do ask that you
put the specific wording in box sixty or the
AME comment box.
So the easy ones if all the criteria are met for example
hypothyroid if all the criteria are met you have the
information in your hand you've reviewed it and it
meets the criteria on the worksheet you can just issue a
regular certificate.
All you have to do is put in box sixty or the AME comment
box airman meets certification criteria for hypothyroidism.
That's the only information we need you don't have to turn
any information in you don't have to turn in worksheets
everything's done you can give your airman a regular
certificate. If your airman has any other condition that still
requires a special issuance such as diabetes or coronary
artery disease you still have to follow the required special
issuance letter for those conditions , turn in that
information as you've always done in the past what we no
longer need is the thyroid information if you put the
specific comment in box sixty.
Important things to remember about CACI everything that is
a CACI condition is not necessarily CACI qualified. So
just because your airman has hypothyroidism does not mean
that in box sixty you can just OK that It has to fall within
worksheet parameters.
So what if the airman does not meet the CACI criteria?
Then you need to put in box sixty or the AME information
box that you deferred because of whatever the condition
outside of the parameters was.
Then the information needs to be turned into AMCD and it
will be worked for special issuance as it was
in the past.
The address to turn in information is what is still
listed in the guide we ask that you turn everything in as
one package.
And please don't mail duplicates as that slows down
our system.
The worksheets are not required but if you turn them
in please make sure you identify who the airman is and
identify what condition was not met.
That speeds everything up from our end.
So what if your airman
had a previous AASI and now they are CACI qualified?
There is no way for you to do that in your office
without a new exam.
So if they currently are in an interim exam phase
you would still issue based on the current AASI give
them a time limited certificate.
That may change in the future but for now that's how you can
address that with your airman.
When the information gets to AMCD we can adjust it to be
CACI qualified at our level. In which case your airman will
get an eligibility letter as he has in the past.
When the exam reaches AMCD it is coded for the CACI
condition this will generate an eligibility letter there's
no instructional letter that will be sent out. The
eligibility letter does tell the airman where to reference
the information that is required for their next exam.
So airman now before you go see your AME's you need to
look at your AME guide print the worksheet bring it to your
treating physician so the treating physician knows what
information we're looking for.
The AME should pull the worksheet at each visit to
make sure there has been no updates identify the
information that is on the worksheet if they can issue
they should issue and put the specific notes in box sixty.
If the airman does not meet criteria for some reason then
they need to note that in box sixty and send in the
information.
Some questions that we've had from AME's already Is there a
physician in clinic looking at an airman who meets all of the
CACI criteria for a specific condition. But they have
called and said there is something wrong with this
person. I know he meets conditions
but there is a problem.
In that case you can defer put something in box sixty that
tells us why you did that and send us the information in.
The next conditions we are going to talk about are
conditions that do not have a worksheet.
There's two of those, testicular cancer and prostate cancer.
There is no worksheet for these conditions. There are new
instructions in the AME guide that will allow you to issue
if conditions are met.
So prostate cancer if treatment is completed, if there
is no evidence of metastatic disease and they aren't having
any current problems you can issue.
If they have turned in any testing CAT scans, PSA's those
still need to be reviewed but if everything appears
clinically stable with no evidence of metastatic disease
you can issue a regular certificate.
For testicular cancer same conditions apply once
treatment is completed if there is no evidence of
metastatic disease if they are back to their daily living
then you can issue a regular certificate.
So for testicular and prostate there are no worksheets.
We are going to go over some of the specific worksheet
questions that we've had so far The first one is.
If someone qualifies for a CACI cancer condition how long
do we have to follow them?
Right now you follow the worksheet if there is a
worksheet such as renal cancer.
At every exam or yearly (we will go over that in just a
minute.) and you're looking for any
changes or reoccurrence.
We also want to know if they have been released back to
their primary care or if thier oncologist is still following
them. And if there has been any reoccurrence.
Worksheet-specific conditions: The first one is arthritis.
Know that daily NSAID use does not require the worksheet or
CACI criteria.
If they are only on daily NSAID use you can go ahead and
issue a regular exam just as you've done in the past.
Remember we are looking for symptom control , range of
motion , flexibility and functional ability and that
there's no side effects .
So your AME guide instructions will look like this. If they're
are on PRN NSAIDS you can issue a regular certificate. If
they have osteo, rheumatoid, or psoriatic-type arthritis
and they follow the worksheet criteria then you can issue a
regular certificate. If they meet all the criteria.
The next condition would be asthma.
If asthma on PRN albuterol is stable they currently require
PFT's, which is a change. But this should be updated
in the near future.
If they are on any type of inhaled steroid or oral
steroid they will require PFT's at least yearly or at
every exam.
For glaucoma, changes that have been made include open
angle glaucoma has been allowed. We currently will
allow closed angle glaucoma that has been
surgically corrected.
There is a specific list for glaucoma on the worksheet of
medications that are allowed.
Any other medications are not necessarily disqualifying but
those have to come through AMCD or a regional flight
surgeon office.
The other big question we get on glaucoma is the visual
fields. If an airman has been on an AASI and they've had
normal visual fields.
That is someone who might qualify for the CACI program.
If they have a visual field defect they do not and will
not qualify for a CACI program.
We have a lot of questions on how to read visual fields.
We like to ask for Humphries. If the visual field looks
something similar to this.
or in the bottom right corner it says it's a normal visual
field. That's fine to go ahead and issue.
Usually we are looking for any defects such as this. If you
see this on your visual field please defer that
and send that in. 00:12:28.400,00:12:32.233 Even if an airman has had a visual field defect that is
stable and we've been following it that does not
qualify for a CACI program.
That still has to be worked with a special issuance.
Everyone's favorite now is hypertension.
Hypertension now has a worksheet There is no longer
an initial hypertension work up. There's no EKG or Lab
required. They do have to be on meds at least two weeks to be
considered for the CACI program. They can be on up to a
combination of three meds.
If a *** doing their regular clinical work does an EKG and
finds that it's abnormal that still needs to be worked up as
we would in clinic.
If you have to do a work up for an abnormal EKG we do want
those results sent into AMCD.
One other question that we've had:
What if the AME transmits the exam?
And the airman's blood pressure is above the 155/95
range in that case the airman will get a letter asking for
three blood pressures and a letter from his physician .
As in the past AME can certify that the hypertension is
stable instead of the primary care physician.
Next category is migraine and chronic headaches. The specific
components to understand on here is what's not allowed
that would be anything that's ocular history of ocular
migraines more than one a month. Anyone who requires
narcotics those do not qualify for the CACI program.
They may qualify for a regular special issuance.
For pre-diabetes, the only medication that is allowed on
pre diabetes is Metformin.
They have to be on Metformin at least 14 days before they
can be authorized on the CACI program their A1C has to be
less than 6.5 and if they are on any other medicines you
have to defer and that will be worked as a special issuance.
We're going to go over some of the frequently asked questions
that we've had to date, and then we will take any
questions from the audience.
Do I have to put a note in box sixty?
Yes, that's how an AME contacts AMCD and the regional flight
surgeon that's how we know whether that have been CACI
qualified or not CACI qualified.
If the airman has a different condition, can I send in the
CACI information also?
We know that some of the information is embedded
especially if someone has hypertension and diabetes
it'll all be on the same letter.
We ask that you do not turn in the CACI information if
everything was qualified if you do turn it in we will look
at that information and it will stay in the file.
What time limit do I put on a certificate if they are CACI
qualified? And the answer is,
There is no time limit this is a regular certificate if
worksheet parameters are met.
So you just give them a regular certificate no time
limitation.
If it requires a time limitation it has to be worked
at the AMCD or a Regional Flight Surgeon level.
Can I Issue a certificate for something almost like CACI?
And we've seen this multiple times.
Well he's pre diabetic but he's on Januvia,
is that close enough?
If it does not follow specific worksheet parameters it is not
a CACI qualified condition.
If the airman currently has an AASI or SI, can he/she elect
to stay on that?
At this time no.
If they are CACI qualified you need to work it as a CACI
condition.
Where do I send the worksheets and the supporting documents?
You don't send any of the CACI worksheets or supporting
documents if they are CACI qualified.
If you had to defer then you'll send the information in
just as you've had in the past.
For exams that were done before April 9th there is
no way for the AME to issue a regular certificate. If they
have an SI or an AASI but if the AMCD or the Regional
flight Surgeon level that can be done so your airman may be
getting eligibility letters for a CACI condition. if your
exam was after April 9th. So be aware that those may be coming.
What if your airman brings in only a completed worksheet?
We've had this question multiple times. If they only
bring in a worksheet treat it as you would a hospital
transfer. If someone brings lab and there's nothing marked on
it. And you can't verify that lab you don't accept it. If it's
been signed and dated and they're using the worksheet as
long as it also has the required information.
PFT's Thyroid testing then you could accept that.
Important Question: How often does the AME have to review
the pertinent clinical information?
If they're a Third Class airman It's every 2 or 5 yrs
Second class will be yearly. Third class under forty will
be yearly. If someone is a first class over the age of 40 they
have to do an exam every six months but we only need the
CACI information just like most of the special issuances
every year.
If you don't know where the year is ways to help decide
that is if they have received an eligibility letter you are
looking to about a year from that date.
If you do not know for sure you can call AMCD. The phone
desk can pull up the last exam and see what was in box sixty
and give you a date. An easy way to remember it is if
you'll do it at the same time as the ECG. That just keeps
everything on target.
Retention of records in your clinic file: You need to do
whatever is required by your state.
Different states have different amounts of time that
they need to hold records.
AME's have asked what if I get a subpoena for my records?
It's the same as the current policy if you get a subpoena
contact our medical records. Kay will be happy to talk to
you. Her number is listed up there.
So in summary, everything that is CACI is not CACI qualified.
They have to make the worksheet parameters.
If they were on a previous SI or An AASI they may or may not
qualify for CACI. Remember if it was an SI instead of an
AASI there was something that needed more evaluation.
Most SI's will not convert to a CACI or a lot of the AASI's,
the six year offs, could potentially convert to a CACI.
If they did not qualify for a regular certificate under CACI
remember you have to turn in the Information.
Please note in box sixty if they are qualified or not.
If they are not qualified let us know why.
Do not send in any worksheets or documents if they
are CACI qualified.
And the final one is remember that you're the physician in
the office looking at this airman.
If something to you looks odd or amiss, even if they've
qualified through the worksheet criteria, since
you're the physician looking at them in the office, put
something in box sixty or the AME comment box.
Let us know what you think was wrong and then we can work it
from the FAA level.
If you have any questions you can always call AMCD or your
Regional Flight Surgeon's office.
Any questions?
Yes, Doctor Frazier.
This CACI program seems like a step in the right direction,
but it also seems like there's a lot more aeromedical
decision making and medical/legal risk that you
put on my shoulders as an AME.
Is that the intent of the program?
No, the intent of the program is to actually speed things up
in your office and at the AMCD level.
The idea of CACI is the decisions have already been
made, which is what the worksheet parameters are.
So if you're the AME and the airman meets the conditions of
the worksheet, there's no additional risk because that
is still worked through the FAA with our requirements.
Dr. Frazier, if I send in all the supporting documentation
and the worksheet.
Do you guys review that to make sure that I made the
right decision?
We don't review your decision-making process.
We do have a QA process that will look at any piece of
paper on certain charts and that may trigger a way to
review it, but we don't review your decision-making process.
We're trusting that you're using the worksheets in the
way that they were designed and issuing appropriately.
If you have any questions you can always call.
Dr. Frazier, what do you do with those supporting
documents that we send in with the worksheet?
The supporting documents all go into the airman's file, and
if that file is chosen for the QA process, the entire file,
or the entire chart is reviewed.
But anything you send in will get put in that
airman's chart.
You have said that the conditions are being changed.
Now, where can I find a copy of these conditions?
Where can I find all of these changes?
The easiest way is to look in the AME guide, and the AME
guide will have an "Updates" section, and that will tell
you the most recent updates.
And it's dated...
There were a whole bunch of changes as of April 9th,
so you'll see that.
Any other questions?
This program is called conditions where an
AME can issue.
What if as an AME I decide I don't want to participate in
this program and I would rather defer those conditions
to the FAA for decision?
Well, remember that the CACI conditions are following
instructions in the AME guide, which is what you're already
doing as an AME.
These are regular issuance conditions.
So if you choose to consistently not use the CACI
program, that decreases how well you function as an AME,
and it may, in turn, affect your future to be able to do
AME exams.
Thank you very much for your participation.
If you have any questions you can always call AMCD or your
Regional Flight Surgeon's office.