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FAA CACI Retained Kidney Stones Worksheet

Pilots with one or more stones remaining in the kidney can be certified in the AME's office through this Conditions AMEs Can Issue (CACI) checklist. The AME reviews the treating physician's or urologist's progress note, from a visit within 90 days of the exam, confirming the stones are asymptomatic, stable in number and size, and unlikely to cause sudden incapacitation, with no complications or underlying cause for recurrence.

Who completes it

The AME completes the checklist and marks the Block 60 outcome. The treating physician or urologist writes the current, detailed Clinical Progress Note the AME reviews.

Submitting and payment

How to submit it
A qualifying case is noted as 'CACI qualified Retained Kidney Stone(s)' in Block 60 of FAA Form 8500-8, and the documents do not need to be submitted. Otherwise the AME defers and submits the supporting documents.

Good to know

  • Disqualifying complications include chronic hydronephrosis, a metabolic or underlying condition, 3 or more procedures in the last 5 years, renal failure or obstruction, sepsis and recurrent stone-related UTIs.
  • Supportive treatment such as hydration, thiazides, allopurinol or potassium citrate to reduce recurrence is allowed if there are no side effects.
  • After a single stone event, if follow-up imaging shows no remaining stones, the AME annotates this in Block 60 and no further follow-up is needed unless the condition changes.
  • After surgery, the note must confirm the pilot is off pain medication, fully recovered and has a full release from the surgeon.

Get the official form

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

CACI – Retained Kidney Stone(s) 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 a retained kidney stone be certified by the AME?

Yes, under this CACI, if the treating physician's note from within 90 days shows the stones are asymptomatic, not increasing in number or size, unlikely to cause sudden incapacitation, and without complications or an underlying cause for recurrence. Otherwise the AME defers to the FAA.

Are medications to prevent kidney stones allowed for pilots?

The worksheet allows supportive treatment to decrease recurrence, such as hydration or medications like thiazides, allopurinol or potassium citrate, provided there are no side effects. The treating physician's progress note should list them so the AME can confirm.