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FAA CACI CLL/SLL Worksheet for AMEs

Pilots with early-stage chronic lymphocytic leukemia or small lymphocytic lymphoma under observation can be certified at the AME's office under the FAA's CACI program. This worksheet, dated 05/31/2023, requires diagnosis at age 40 or older, Rai stage 0 to 1 or Binet stage A, at least 5 years of monitoring and an oncologist recommending observation only.

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, typically the oncologist, 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 CLL or SLL' 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

  • Labs within 90 days must show hemoglobin of at least 11, platelets of at least 100,000/microL and a lymphocyte count doubling time longer than 6 months.
  • There must be no evidence of active disease; the worksheet gives unintentional weight loss over 10 pounds or new palpable lymph nodes as examples and suggests considering iwCLL criteria.
  • The treating oncologist must find the condition stable and asymptomatic and recommend observation only.
  • Block 60 has separate CLL and SLL entries. A CLL/SLL Status Summary and a disposition table are related FAA documents.

Get the official form

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

CACI – Chronic Lymphocytic Leukemia (CLL) / Small Lymphocytic Lymphoma (SLL) 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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How this list is checked

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

Can a pilot with CLL get an FAA medical certificate from the AME?

Yes, under the CACI, if the oncologist finds the disease stable and asymptomatic, recommends observation only and has monitored it for 5 or more years, the diagnosis was at 40 or older, the stage is Rai 0 to 1 or Binet A, and recent labs meet the worksheet's limits.

What labs does the FAA CLL/SLL CACI require?

Results from the past 90 days showing hemoglobin of 11 or higher, platelets of 100,000/microL or higher, and a total or absolute lymphocyte count doubling time greater than 6 months. The oncologist's note should report these values with the stage and confirm no evidence of active disease.