Prepare your documentation before anything else. Submit the MedXPress application, book an Aviation Medical Examiner within the 60-day window, and for any current or past condition bring a detailed Clinical Progress Note dated no more than 90 days before the exam. Then learn the first-class standards — 20/20 distant vision with or without correction, the hearing test options, the 155/95 guideline blood pressure maximum, and the ECG schedule — so you know exactly what the appointment measures.
What this examination is and who it is for
The first-class airman medical examination is a physical performed by an FAA-designated Aviation Medical Examiner (AME) against the standards of 14 CFR Part 67. The first class is the tier required for airline transport pilot operations and carries the strictest thresholds.
An AME is a physician with specific training in how to perform FAA exams. You choose one from the FAA's Designee Locator, or get recommendations from pilot advocacy groups or flight schools.
The FAA's summary of medical standards organizes certificates into three tiers: first class for airline transport pilots, second class for commercial pilots, and third class for private pilots. The examination structure is the same across tiers, but each class applies different thresholds, so a first-class applicant can face a stricter result from the same finding than a private pilot would.
Sources: How do I get a Medical Certificate and what to expect during the AME examination | Federal Aviation Administration — Application, exam-day, and disposition guidance; Guide for Aviation Medical Examiners — Summary of Medical Standards — First-class standards and disqualifying conditions
Apply through MedXPress and book early
You apply before the appointment by creating an account in MedXPress, the FAA's web application, answering its medical questions, and submitting. You then need to complete the AME exam within 60 days of submitting, or the application disappears from the system.
After you submit, print or save the confirmation number. Your AME needs that number to import your application, and keeping your own copy helps if questions come up later.
Contact a local AME for an appointment as soon as you submit. If the 60 days lapse before your exam is uploaded, you would have to start the application again, so treat the window as a scheduling deadline, not a suggestion.
Bring records that meet FAA documentation rules
If you have any current or past condition or take medication, research the requirements in the Guide for Aviation Medical Examiners before your appointment. With the correct documentation, the AME may be able to issue your certificate immediately; without it, certification can be delayed.
For some conditions the FAA requires a current, detailed Clinical Progress Note from a clinic visit with your treating physician no more than 90 days before the AME exam. The FAA explicitly states that notes or an After Visit Summary you print from a patient portal are not sufficient, because they may contain only some of the information the FAA needs.
In most cases you do not need a physician's letter — you need a copy of the actual progress note. Ask the office specifically for that document, since an After Visit Summary looks similar but serves a different purpose.
The same rule applies if your case is deferred: records the FAA requests must again be current within 90 days. Give the documents to your AME so they can be added to your record electronically, which the FAA describes as the fastest route.
What happens during the AME examination
On exam day you bring your MedXPress confirmation number, your records, and a government-issued photo ID. Office staff collect vitals and run the sensory tests; the AME must then personally review your history with you and perform the physical examination.
Staff typically collect height, weight, pulse, and blood pressure; test your eyes for visual acuity, depth perception, and color vision; perform an audiogram and an EKG if one is required; and collect and test a urine sample. An EKG requires exposing your chest for lead placement.
The FAA's exam-technique guidance requires the Examiner to read your history page before the physical, to record any condition found during the exam on the form with facts such as dates, frequency, and severity, and to transmit the completed form electronically to the FAA.
Some parts of the exam are conditional rather than automatic. Anal, genitourinary, and breast examinations are performed only if your history indicates the need or at the discretion of the AME and you, and you can elect to have your personal physician provide a report instead. The exam does not include a pelvic exam.
- Vitals: height, weight, pulse, and blood pressure
- Eyes: acuity, depth perception, and color vision, plus an ophthalmoscopic exam
- Ears, nose, and throat: otoscope, palpation, and direct observation
- Heart and lungs: stethoscope with skin contact, palpation, and observation
- Abdomen: palpation and stethoscope
- Musculoskeletal: extremities and spine, with observation plus reflex and strength testing
- Skin and identifying marks such as tattoos and scars, measured and described
- Neurologic: cranial nerves and reflexes
- Psychiatric: a general impression of cognition and mental wellness from observation and questioning
- Hearing: a spoken voice test or audiometry
- Urine sample: collected and tested
Sources: How do I get a Medical Certificate and what to expect during the AME examination | Federal Aviation Administration — Application, exam-day, and disposition guidance; Guide for Aviation Medical Examiners — Application Process for Medical Certification: Exam Techniques and Criteria for Qualification — FAA Form 8500-8 items and examiner duties
The first-class standards you are tested against
The AME Guide publishes a synopsis of the Part 67 medical standards by class. For the first class, the headline values are 20/20 distant vision in each eye with or without correction, a 155/95 guideline blood pressure maximum, and an ECG at age 35 and annually after age 40.
Two features of this table trip up candidates. Correction is allowed for distant vision, so uncorrected acuity alone never fails you if glasses or contacts bring you to standard. And the intermediate-vision check applies only from age 50, so younger applicants are not measured at 32 inches.
Hearing offers alternatives: demonstrate hearing of an average conversational voice at 6 feet with your back to the examiner, or pass one of the audiometric tests. Pulse is not disqualifying in itself; the FAA uses it to judge cardiac status and responsiveness. Blood pressure has no values stated in the regulation itself — 155/95 is the current guideline maximum.
Practice
An applicant is 32 years old. Distant visual acuity is 20/50 in each eye without correction and 20/20 in each eye with glasses. Near visual acuity is 20/40 in each eye at 16 inches. Assume no other findings. Do the distant and near vision results meet first-class standards?
Show answer
Yes, both meet the standard. Distant vision qualifies because 20/20 or better in each eye is acceptable with or without correction, and the applicant reaches 20/20 with glasses. Near vision meets the 20/40 requirement at 16 inches exactly. The intermediate-vision check does not apply, because the applicant is under 50.
Each standard has its own conditions. The distant-vision standard permits correction, so an uncorrected 20/50 is irrelevant as long as correction achieves 20/20 — it would only fail if no correction reached that level. The near-vision standard fixes both the value (20/40) and the distance (16 inches), both satisfied here. The intermediate-vision standard is age-conditioned and applies at 32 inches only from age 50, so it cannot fail a 32-year-old. Checking the condition attached to each line, rather than reacting to the uncorrected number, is the habit this exercise builds.
| Standard | First-class requirement |
|---|---|
| Distant vision | 20/20 or better in each eye separately, with or without correction |
| Near vision | 20/40 or better in each eye separately, measured at 16 inches |
| Intermediate vision | 20/40 or better in each eye at 32 inches, from age 50 and over |
| Color vision | Ability to perceive the colors necessary for safe performance of airman duties |
| Hearing | Conversational voice at 6 feet with back turned, or a passing audiometric test |
| Blood pressure | No values in the standards; current guideline maximum 155/95 |
| ECG | At age 35 and annually after age 40 (first class only) |
| Mental | No diagnosis of psychosis, bipolar disorder, or severe personality disorders |
Conditions that require denial or deferral
Unless the FAA directs otherwise, the Examiner must deny or defer if the applicant has a history of any of 15 specifically listed conditions. These come directly from the Part 67 framework summarized in the AME Guide.
One entry includes a defined recovery route: a diagnosis or history of substance dependence is disqualifying unless there is clinical evidence satisfactory to the Federal Air Surgeon of recovery, including sustained total abstinence for not less than the preceding 2 years. A history of substance abuse within the preceding 2 years is disqualifying, and substances include alcohol as well as other drugs.
The list explains why your written history matters so much. Several entries hinge on history and explanation — for example, an unexplained disturbance of consciousness — so complete, accurate MedXPress answers and supporting notes are what let the FAA evaluate the condition rather than defaulting to deferral.
- Diabetes mellitus requiring hypoglycemic medication
- Angina pectoris
- Coronary heart disease that is treated, or if untreated is symptomatic or clinically significant
- Myocardial infarction
- Cardiac valve replacement
- Permanent cardiac pacemaker
- Heart replacement
- Psychosis
- Bipolar disorder
- Personality disorder severe enough to have repeatedly manifested itself by overt acts
- Substance dependence
- Substance abuse
- Epilepsy
- Disturbance of consciousness without satisfactory explanation of cause
- Transient loss of control of nervous system function(s) without satisfactory explanation of cause
Issue, deferral, denial, and special issuance
If your documentation is present, reviewed by the AME, and everything meets the Part 67 standards, the AME issues your certificate at the visit. For some conditions or missing documents, the AME must defer the case to the FAA; in rare cases the AME can deny for a specifically disqualifying condition.
A deferral is not a denial. You receive a letter from the FAA listing the items to provide, usually medical records, and FAA physicians with expertise in aerospace medicine and other specialties review them. A failure to provide all requested information results in delay or denial of the application, so respond through your AME with current, detailed notes.
If you are denied and disagree, you have an opportunity to appeal, with instructions provided in the letter. In many cases an applicant who is denied may still be eligible through the Special Issuance provisions of 14 CFR 67.401.
A certificate issued under Special Issuance requires more rigorous medical information or testing documentation, and its duration is usually more restrictive. However, an airman with a Special Issuance certificate may usually operate an aircraft in the same manner as one with an unrestricted certificate.
How long the certificate stays valid
A first-class certificate is valid for the remainder of the month of issue plus 6 calendar months for first-class operations if you are age 40 or over on the examination date, or 12 calendar months if you have not reached age 40. It also serves second- and third-class purposes for longer periods.
The validity counts from the month of issue, not the day, which catches many applicants. The same certificate continues to function at the second-class level for 12 calendar months and at the third-class level for 24 months if you are 40 or over, or 60 months if you are under 40, once first-class validity lapses.
Also note that a medical certificate is valid only with the original signature of the AME or the digital signature of an authorized FAA physician. Copies are not valid, and the FAA — not the AME — issues replacements for lost or destroyed certificates.
Practice
A first-class medical certificate is issued on April 15 to an applicant who is 39 years old on the date of the examination. The certificate carries no limitations. Until what date is it valid for operations requiring a first-class medical certificate?
Show answer
April 30 of the following year.
The rule for an airman under 40 on the examination date is the remainder of the month of issue plus 12 calendar months for first-class operations. April 15 leaves the rest of April, and adding 12 calendar months runs through the end of April the next year — so the certificate expires April 30. If the same applicant had been 40 or older on the exam date, the first-class validity would be 6 months instead, through October 31. Both premises (issue month and age on the examination date) are needed before the rule gives a unique answer, which is why the prompt states them.
Your preparation checklist
Most of what you control happens before the appointment: an accurate MedXPress application, the right records, and a scheduled AME inside the 60-day window.
Work through the following steps in order. If any step involves a medical condition or medication, the AME Guide is written for physicians but the FAA recommends it to applicants and their care providers for collecting what the FAA will need.
Scheduling questions, fees, and anything administrative beyond what the FAA pages state are best confirmed directly with the AME you choose, since individual offices set their own appointments.
- Create your MedXPress account and answer every medical question accurately; you acknowledge the Medical Examination Bill of Rights and the Pilot's Bill of Rights during this process
- Find an AME through the Designee Locator and book within the 60-day window
- For any current or past condition or medication, check the Guide for Aviation Medical Examiners and request detailed Clinical Progress Notes dated within 90 days of the exam
- Bring your confirmation number, records, and government-issued ID on exam day
- Know the first-class standards for your age, especially vision correction, hearing options, and the ECG schedule
- If deferred, obtain the requested current notes and give them to your AME for electronic submission to the FAA
Sources: How do I get a Medical Certificate and what to expect during the AME examination | Federal Aviation Administration — Application, exam-day, and disposition guidance; Guide for Aviation Medical Examiners — Summary of Medical Standards — First-class standards and disqualifying conditions
Sources
Facts checked:
- How do I get a Medical Certificate and what to expect during the AME examination | Federal Aviation Administration
- Guide for Aviation Medical Examiners — Summary of Medical Standards
- Guide for Aviation Medical Examiners — Application Process for Medical Certification: Exam Techniques and Criteria for Qualification
- Guide for Aviation Medical Examiners — Validity of Medical Certificates