Pilots and air traffic control specialists treated for obstructive sleep apnea use this one-page report, updated 05/27/2026, for their first FAA review and for recertification under a special issuance. The treating provider answers four yes or no questions on diagnosis, medication safety, treatment effectiveness and compliance, and any no answer means the AME must defer or contact the FAA.
The pilot or ATCS completes items 1 and 2 (initial review or recertification, and the therapy in use), signs and takes it to the provider treating the OSA. That physician or provider records the initial untreated AHI, answers questions 1 to 4 and signs, or submits a detailed Clinical Progress Note covering every item.
Download the current version from the source each time; forms change without notice.
Obstructive Sleep Apnea (OSA) Treated 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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Use on 75% or more of nights, an average of 6 or more hours per night and a treated AHI of 5 or less. For a dental device, the standard is daily use with no symptoms. The provider records the current average nightly use, and PAP data can be uploaded with the report.
Any no answer, or any concern about the quality or duration of sleep, means the AME must defer the certificate or contact the FAA's Office of Aerospace Medicine. The provider should explain the answer, for example naming the medication, dose and reason, and attach clinical progress notes or PAP data.
Yes. The treating provider may complete and sign the report or submit a current, detailed Clinical Progress Note that addresses all of its items: the initial untreated AHI, whether the primary diagnosis is uncomplicated OSA, medication safety, treatment effectiveness and compliance.