When a pilot seeks initial special issuance after substance dependence or abuse, the HIMS-trained AME completes this one-page checklist and uses it as the cover sheet for the whole package. It lists, in order, the HIMS AME face-to-face report, data sheet, treatment records, psychiatrist and neuropsychologist evaluations, and additional records such as aftercare and airline reports, DUI records and the pilot's personal statement.
The HIMS-trained AME completes and signs it. Treatment programs, the psychiatrist, the neuropsychologist, aftercare and the airline supply the reports it lists.
Download the current version from the source each time; forms change without notice.
HIMS trained AME Checklist – Drug and Alcohol MONITORING INITIAL Certification
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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As one package with this checklist on top, within 14 days of the deferred exam. First- and second-class HIMS cases can be sent electronically through Huddle; all others are mailed. The FAA asks for only one submission method, since duplicates delay review.
A psychiatrist evaluation (HIMS-trained for most first- and second-class pilots, board-certified for most third-class) and a neuropsychologist evaluation with raw testing data and CogScreen results, plus treatment records, the HIMS AME's face-to-face report and the additional records the checklist lists.