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FAA CACI Primary Hemochromatosis Worksheet

Pilots with primary hemochromatosis that is stable and asymptomatic can be certified at the AME's office under the FAA's CACI program. This worksheet, updated 04/13/2022, requires no organ involvement, hemoglobin of 11 g/dL or higher and ferritin of 150 ng/mL or less within 90 days, and treatment limited to diet or phlebotomy no more often than monthly.

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 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 Primary Hemochromatosis' 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

  • The treating physician must document no arthropathy, cardiac, liver, kidney or CNS disease, no endocrine disease such as diabetes, and no polycythemia or condition needing multiple transfusions.
  • Secondary hemochromatosis does not qualify; the physician must state the condition is primary, stable and asymptomatic with no treatment changes recommended.
  • After phlebotomy the pilot should stay hydrated and not fly for 24 hours, or 72 hours if more than one unit (over 500 mL) is removed.
  • When the CACI criteria are not met, the FAA's primary hemochromatosis disposition table guides the AME's next steps.

Get the official form

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

CACI – Primary Hemochromatosis 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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Frequently asked questions

What ferritin level does the FAA hemochromatosis CACI require?

Ferritin of 150 ng/mL or less and hemoglobin of 11 g/dL or higher, both from labs within the past 90 days. The treating physician's progress note should report those values and confirm the condition is primary, stable and asymptomatic with no treatment changes recommended.

How long after phlebotomy can a pilot fly?

The worksheet says the pilot should maintain hydration and not fly for 24 hours after phlebotomy, extended to 72 hours if more than one unit of blood (over 500 mL) is removed. Phlebotomy must be needed no more often than monthly for the CACI to apply.