Pilots taking medication for weight loss or prediabetes, common with GLP-1 receptor agonists, bring this one-page report, updated 04/29/2026, from the prescriber to the AME. It records why the drug is taken, the last visit and medication change, A1C, side effects, hypoglycemia, insulin use and every current medication, so the AME can apply the FAA's CACI or deferral pathway.
The provider who prescribes the weight-loss or prediabetes medication completes and signs the whole report; the pilot adds name, birthdate and FAA identifiers.
Download the current version from the source each time; forms change without notice.
Weight Loss Management or Prediabetes 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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Not if the medication is for weight loss only; the prescriber enters n/a. When it is for prediabetes, the A1C value and date are required and the test must be within 90 days of the AME exam. The prescriber must also confirm there are no psychiatric side effects.
Yes. The FAA accepts a current, detailed Clinical Progress Note from the treating physician covering the same information, including the indication for the medication, whether there is any history of diabetes and, where required, an A1C within 90 days of the AME exam.