Pilots and FAA air traffic control specialists with an antidepressant special issuance or special consideration see their HIMS AME for renewal, and the AME completes this one-page checklist from the in-office exam and the reports on file. It covers psychiatric status, medication or dose changes, the psychiatrist's report, any neuropsychological testing, manager reports for ATCS, and the AME's recommendation.
The HIMS-trained AME completes, signs and dates it. The treating psychiatrist, or a HIMS psychiatrist plus the prescribing physician, provides the 6-month report it reviews.
Download the current version from the source each time; forms change without notice.
HIMS AME Checklist - SSRI Recertification/Follow-Up Clearance
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Not routinely. Since 12/15/2022, a neuropsychologist report and CogScreen-AE are needed for renewal only when clinically indicated or specified in the Authorization or Special Consideration Letter. When required, the checklist asks whether the report concludes there are no aeromedically significant cognitive deficits.
For pilots, yes, if every item falls in the clear column, with the time limit in the Authorization or Special Consideration Letter. Any shaded item means the AME defers or contacts the FAA and explains in the HIMS report. For ATCS, the AME contacts the Regional Flight Surgeon with the results.