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FAA Pacemaker Status Summary for Pilots

Pilots with an implanted pacemaker take this one-page summary, updated 12/03/2025, to their cardiologist, who records data from the latest device interrogation. It is optional, but the FAA says it streamlines and significantly shortens review. Certification is annual until less than 12 months remain before the elective replacement interval, then ends the month before the ERI.

Who completes it

The pilot fills in name, birthdate and FAA identifiers. The cardiologist completes items 1 to 14 and signs and dates the form.

Submitting and payment

How to submit it
The pilot gives the summary, or supporting documents that address each item, to the AME for upload into the FAA file as "Cardiac - Pacemaker Info".

Good to know

  • Items cover manufacturer and model, implant date, whether a defibrillator circuit is enabled, ERI, pacing mode, current atrial and ventricular outputs, and current and previous impedances.
  • Record actual output voltages, not thresholds. Item 13 asks whether the device functioned normally over the past 6 months; if a lead or generator was replaced, answer no.
  • Evaluation of pacemaker dependency has not been required for any class since 08/25/2021, so the summary does not ask for it.
  • The initial FAA review requires a 2-month recovery after implantation, plus hospital records, a 24-hour Holter, an echocardiogram and a maximal graded exercise stress test.

Get the official form

Download the current version from the source each time; forms change without notice.

Pacemaker Status Summary

Official pagePDF

Fill it with Vero

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.

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How this list is checked

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.

Frequently asked questions

Is the FAA Pacemaker Status Summary required?

No. The FAA states the summary is not required, but it helps streamline and significantly decrease review time. The alternative is supporting documentation that addresses each of its 14 items, such as a cardiology note with the full interrogation report, uploaded by the AME.

How long can a pilot with a pacemaker hold a medical certificate?

Since 05/29/2024, routine certification is annual until fewer than 12 months remain before the device's elective replacement interval. At that point, aeromedical certification terminates the month before the ERI, which is why the summary asks for the ERI in years and months.

What does the FAA need for the first review after pacemaker implantation?

After a 2-month recovery: hospital records with generator and lead make, model and serial numbers, a cardiology narrative on pacemaker function and battery status, this summary, HbA1c and lipids, a 24-hour Holter, an echocardiogram and a maximal graded exercise stress test.