When a pilot or FAA air traffic control specialist treated with an antidepressant seeks initial certification or clearance, the HIMS AME completes this one-page checklist to confirm the package is complete. It covers the applicant's statement and records, the HIMS AME face-to-face evaluation, treating physician and board-certified psychiatrist reports, the neuropsychologist report with CogScreen-AE, and additional reports.
The HIMS-trained AME completes and signs it. The applicant, treating physician, board-certified psychiatrist and neuropsychologist provide the statement and reports it checks off.
Download the current version from the source each time; forms change without notice.
HIMS AME Checklist - SSRI INITIAL Certification/Clearance (Antidepressant)
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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The checklist requires verification that the pilot or ATCS has been on the same medication at the same dose for a minimum of 3 months. The HIMS AME, the treating physician (if not a psychiatrist) and the board-certified psychiatrist each confirm this in their reports.
Yes. The neuropsychologist report must address items 1 to 8 of the FAA neuropsychologist requirements and attach the CogScreen-AE computerized report, plus a score summary sheet for any additional neuropsychological testing performed or required.