Pilots with chronic obstructive pulmonary disease ask the pulmonologist or physician managing it to complete this one-page FAA summary. It covers GOLD stage and exacerbations, resting oxygen saturation, a recent pulmonary function test, a six-minute walk test and medications. With a current progress note and the test reports, it lets the AME or FAA check the pilot against each criterion.
The pulmonologist, primary care physician or other physician managing the COPD completes and signs it, circling their role. The pilot fills in name, birthdate, applicant ID and PI number.
Download the current version from the source each time; forms change without notice.
Chronic Obstructive Pulmonary Disease (COPD) Status Summary
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.
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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Resting oxygen saturation of 96% or higher. During the six-minute walk test, performed within 90 days, saturation may drop no more than 3% from baseline and the pilot must walk at least 400 meters. The test results are attached to the summary.
Three or fewer, not counting a rescue inhaler; the form gives Trelegy plus albuterol as an example. Oral prednisone or a similar steroid must not be needed or used daily. Any NO answer is explained in an attached progress note.