Medical Cert Fitness To Fly
Medical Cert Fitness To Fly
Medical Cert Fitness To Fly
This Medical Certificate must be completed in full, and produced at check-in and at each embarkation, by any passenger who has a medical impairment
which may impact on his/her suitability to fly.
Boarding may be denied if this form is not completed in full or at the sole discretion of a Rex agent or crew even when this form is produced.
Oxygen Requirements
The patient requires supplemental oxygen during the flight. Yes No
If yes, the following must be completed:
- The patient may adjust the oxygen flow setting to a maximum of _________________, Yes No
as needed during flight, recognising the possible changes in cabin pressure during flight.
- The patient and/or Carer can appropriately see, hear and respond to any Yes No
applicable alarms.
- The patient requires the use of oxygen at all times, before, during and after flight. Yes No
This includes the use of oxygen while in the airport terminal, during take-off, landing
and while moving throughout the cabin of the aircraft; OR
- The patient requires the use of oxygen only during flight. Yes No
- Other information:
Note: If oxygen is required in flight, only the BOC Oxycare Travel Pack, Supagas Airline Travel Bag or Air Liquide Travel Pack is permitted. Only C size oxygen bottles are permitted. An approved
oxygen concentrator as listed on the Rex website (www.rex.com.au) may also be used. The patient must ensure that they have sufficient oxygen for their ENTIRE journey.
Based on the above, I hereby declare that the patient is fit to travel by air with Regional Express on the date(s) above with
the above conditions fulfilled.
Medical Practitioner Name: ID or Provider No.: