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FAA CACI Chronic ITP Worksheet for AMEs

Pilots with chronic immune thrombocytopenia, defined as more than 12 months from diagnosis, can be certified at the AME's office under the FAA's CACI program. This worksheet, updated 04/27/2022, requires stable platelet counts above 50,000/microL, no current treatment, no bleeding ever that needed medical attention, no splenectomy and no antiplatelet or anticoagulant use.

Who completes it

The AME completes the worksheet from a current, detailed Clinical Progress Note written after a clinic visit with the treating physician or specialist, such as a hematologist, no more than 90 days before the AME exam.

Submitting and payment

How to submit it
If all criteria are met, the AME issues, notes 'CACI qualified cITP' in Block 60 and keeps the documents on file without sending them to the FAA; otherwise the AME defers and submits them.
Who pays
The FAA does not set AME examination fees; the pilot pays the examiner, and the FAA recommends the usual and customary local fee for similar services.

Good to know

  • A CBC within 90 days must show platelets of 50,000/microL or higher with no anemia or leukopenia.
  • The note must exclude increased bleeding risk, such as an ulcer or high fall risk, and current antiplatelet agents, including NSAIDs, aspirin or ginkgo biloba.
  • After a recurrence, bleeding needing treatment, a platelet drop below 50,000/microL, or any surgery or invasive procedure, the pilot should not fly under 14 CFR 61.53.
  • The worksheet also covers idiopathic, immune or autoimmune thrombocytopenic purpura; the FAA's thrombocytopenia disposition table applies when CACI criteria are not met.

Get the official form

Download the current version from the source each time; forms change without notice.

CACI – Chronic Immune Thrombocytopenia (cITP) Worksheet

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What platelet count does the FAA require for the ITP CACI?

A CBC within the last 90 days must show a platelet count of 50,000/microL or higher, with no anemia or leukopenia, and the treating physician's note must confirm counts are stable above that level. The pilot must also be on no current treatment for ITP.

Does a pilot with newly diagnosed ITP qualify for the CACI?

No. The worksheet covers chronic ITP only, defined as more than 12 months from diagnosis. Within the first year, or with any history of bleeding that needed medical attention or a splenectomy, the AME defers and sends the documents to the FAA.