Pilots on a drug and alcohol monitoring special issuance see their HIMS AME for recertification, and the AME completes this one-page checklist from the in-office exam and the monitoring reports. It covers abstinence, test results, interval evaluations, the psychiatrist's report, aftercare counselor and chief and peer pilot reports, and any reports the Authorization letter adds, ending with the AME's recommendation.
The HIMS-trained AME completes, signs and dates it. Psychiatrists, aftercare counselors, chief pilots and peer pilots supply the reports it reviews.
Download the current version from the source each time; forms change without notice.
HIMS AME Checklist - Drug and Alcohol Monitoring Recertification
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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Every 12 months for all classes, from the treating psychiatrist or a HIMS psychiatrist, unless the Authorization letter sets a different interval. The checklist asks whether the report is favorable with no anticipated treatment changes and no additional treatment or monitoring recommended.
Yes, if every item on the checklist falls in the clear column, the AME may issue with the time limitation in the Authorization letter. If any single item falls in the shaded column, the AME must defer or contact the FAA and explain in the HIMS evaluation report.