Pilots whose diabetes or hyperglycemia is treated with medications other than insulin have the provider who treats their diabetes complete this one-page FAA report for certification or recertification. It records the last diabetes visit, the most recent medication change, a current A1C, all medications, and yes or no screens for side effects, hypoglycemia, end organ disease and insulin use.
The provider who treats the pilot's diabetes completes, signs and dates it. The pilot fills in name, birthdate, applicant ID and PI number.
Download the current version from the source each time; forms change without notice.
Diabetes or Hyperglycemia on Medications Status Report
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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No. The form tells anyone taking any type of insulin to stop and use the FAA's insulin-treated diabetes documents instead. Item 9 also asks the provider to confirm whether the patient takes any form of insulin.
More than 30 days after the most recent diabetes medication change and within 90 days of certification or recertification. The provider enters the A1C value and date, along with the dates of the last diabetes visit and last medication change.