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San marino civil aviation

R E P U B L I C O F S A N M A R I N O
C I V I L A V I A T I O N A U T H O R I T Y
SAN MARINO CIVIL AVIATION PROCEDURES
MEDICAL CERTIFICATION
SM-CAP PL 03
INTRODUCTION AND NUMBERING
This Volume dedicated to the Licensing Procedures, is developed by the San Marino CAA for the use of both the Civil Aviation Inspectors and the Civil Aviation users in San Marino and contains all the relevant Forms. Indeed, it gathers all the application forms and licences forms referred to in SM Civil Aviation Regulations Personnel Licensing(SM-CAR PL), relating to all the personnel concerned by a San Marino Civil Aviation Licence as the: The numbering of the forms is built in respect of the following: Example of FL 06-05(Form of Aircraft Maintenance Licence): refers to SM-CAR PL 01 (Personnel Licensing), TABLE OF CONTENT
ELIGIBILITY FOR SPORTING MEDICAL CERTIFICATE…………………………………………10
LIST OF EFFECTIVE PAGES

Revision
Date of issue
Revision
Date of issue
Total number of pages of this document is 16 pages, including cover page and the annexes. RECORD OF AMENDMENT

Revision
Section Revised
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Filled by
1. Purpose

1.1 This order is referred to Licensing Procedures and details the forms associated to the Personnel Licensing Handbook, that an applicant has to fill regarding the issuing, renewing, reissuing of ground licence with the associated rating, flight licence with associated rating class and particular licence and certificate in conformity with the San Marino Civil Aviation Regulations (SM-CAR PL01, 04, 05, 06, 07 and 08).
1.2 All persons having to send any official document by any way must follow the
procedures according the conformity to the San Marino Civil Aviation Regulations. The objective is to insure the tracks and the proper followed of any requirement. 1.3 This procedure, implemented by the CAA-SMR Licensing Department, will be used for any transmission by postal way, electronic device (telefax, telex @mail) and direct manual deposit. Field of application
2.1 All documents contended in the relevant SM-CAR PL must be reported following 2.2 All person wishing to receive a safe, efficient and rapid answer may follow also 3. References
CAA-SMR regulations SM-CAR PL01, 03, 04, 05, 06, 07 and 08. Applicable rules
4.1 The relevant CAA-SMR Regulations are basically the documents to follow. The procedures detailed in Personnel Licensing Handbook are only the explanation of the Personnel Licensing regulations (SM-CAR PL 01,03, 04, 05, 06, 07 and 08). 4.2 Each personal and official of CAA-SMR must be aware that precise delay is committing the responsibility of CAA-SMR and must be respected every time. Any non-complying due to unforeseen reason must be reported without delay and notified to the applicant. Application of the procedures
5.1 All documents must be enclosed with an applicant form (if defined and existing) or a shipping letter annotated with all inside details, 5.2 The shipment must be addressed to the Director of SM.CAA without specifying 5.3 Whatever means of shipment issued (mail, hand, fax, email, etc. ) for a document, it must be taken in charge by the person responsible for the mail register, 5.4 In case of direct delivery to any official CAA-SMR person, this person must transmit without delay all documents concerning entering mail to registering person. If he has no possibility to do it without delay he must refuse to take in charge any document, 5.5 A register is dedicated to the entering mail. It is an official register, where the date, the applicant’s name and subject are written thanks to a registered list of number. The corresponding number is transcribed on the applicant form or shipping letter, 5.6 After this registration, all parts of the total document are transmitted internally to the appropriate personal for application, 5.7 In this case, the date taken into account in the process of delivery of final document is the entering registration date, 5.8 If required, an acknowledgement may be delivered to the applicant, by the person responsible for the mail register, justifying the date and registering number. Replacement of a lost or destroyed pilot licence, flight instructor rating,
knowledge test report or a medical certificate

6.1 A request for the replacement of a lost or destroyed pilot licence, flight instructor rating, or a medical certificate issued under the relevant SM-CAR PL must be made by letter to the San Marino CAA, and must be accompanied by a check or money order for the appropriate fees as prescribed in San Marino regulations. 6.2 A request for the replacement of a lost or destroyed knowledge test report must be made by letter to the San Marino CAA, and must be accompanied by a check or money order for the appropriate fees as prescribed in San Marino regulations. 6.3 The letter requesting replacement must state: (a) the name of the person; (b) the permanent mailing address (including Postal Code), or if the permanent mailing address includes a post office box number, then the person's current residential address; (c) any Personal Identification Document number; (d) the date and place of birth of the licence or certificate holder; and any available information regarding the: (i) number, and date of issuance of the licence, and (ii) date the knowledge test was taken, if applicable. 6.4 A person who has lost a pilot licence, flight instructor rating, knowledge test report or a medical certificate may obtain a facsimile from the San Marino CAA, confirming that it was issued and the: (a) facsimile may be carried as a pilot licence, flight instructor rating, knowledge test report or a medical certificate, as appropriate, for up to 60 days pending the person's receipt of a duplicate under paragraph (1), or (2), of this section, unless the person has been notified that the licence / certificate has been suspended or revoked. Request for such a facsimile must include the date on which a duplicate licence / certificate or knowledge test report was previously requested. Prohibition on operations during medical deficiency
7.1 No person shall act as a pilot or flight instructor, while that person knows or has reason to know or has reason to know of any medical condition that would make the person unable to operate the aircraft in a safe manner. Falsification, reproduction, or alteration of applications, licences, logbooks,
reports, records or certificate

8.1 No person may make or cause to be made: (a) Any fraudulent or intentionally false statement on any application for a licence, rating, authorisation, certificate or duplicate thereof, issued under the relevant SM-CAR PL; (b) Any fraudulent or intentionally false entry in any logbook, record, or report that is required to be kept, made, or used to show compliance with any requirement for the issuance or exercise of the privileges of any licence, rating, or authorisation under the relevant SM-CAR PL; (c) Any reproduction for fraudulent purpose of any licence, rating, authorisation or certificate, under the relevant SM-CAR PL; or (d) Any alteration of any licence, rating, certificate or authorisation under the 8.2 The commission of an act prohibited under paragraph (a) of this section is a basis for suspending or revoking any airman licence, rating, certificate or authorisation held by that person This SM-CAP contains all the necessary forms related to SM-CAR PL 03 concerning
medical certificates.
The following forms are applicable to the procedures described in the volume of the
Personnel Licensing Inspector Handbook:
FL 03-01 APPLICATION FOR THE ISSUING OF MEDICAL CERTIFICATE
FL 03-02 MEDICAL CERTIFICATE MODEL
SUBPART 1
ELIGIBILITY FOR CLASS 1 MEDICAL CERTIFICATE
See JAR FCL 3 Subpart B Class 1 Medical requirements. SUBPART 2
ELIGIBILITY FOR CLASS 2 MEDICAL CERTIFICATE
See JAR FCL 3 Subpart C Class 2 Medical requirements. SUBPART 3
ELIGIBILITY FOR SPORTING MEDICAL CERTIFICATE
Eye

(1) Eye standards for a Sporting medical certificate are:
(a) Distant visual acuity of 20/20 or better in each eye separately, with or without corrective lenses. If corrective lenses (spectacles or contact lenses) are necessary for 20/20 vision, the person may be eligible only on the condition that corrective lenses are worn while exercising the privileges of an medical certificate. (b) Near vision of 20/40 or better, Snellen equivalent, at 16 inches in each eye separately, with or without corrective lenses. If age 50 or older, near vision of 20/40 or better, Snellen equivalent, at both 16 inches and 32 inches in each eye separately, with or without corrective lenses. (c) Ability to perceive those colors necessary for the safe performance of medical (e) No acute or chronic pathological condition of either eye or adnexa that interferes with the proper function of an eye, that may reasonably be expected to progress to that degree, or that may reasonably be expected to be aggravated by flying. (f) Bifoveal fixation and vergence-phoria relationship sufficient to prevent a break in fusion under conditions that may reasonably be expected to occur in performing medical duties. Tests for the factors named in this paragraph are not required except for persons found to have more than 1 prism diopter of hyperphoria, 6 prism diopters of esophoria, or 6 prism diopters of exophoria. If any of these values are exceeded, the designated aviation medical examiner may require the person to be examined by a qualified eye specialist to determine if there is bifoveal fixation and an adequate vergence-phoria relationship. However, if otherwise eligible, the person is issued a medical certificate pending the results of the examination.
Ear, nose, throat, and equilibrium

(1) Ear, nose, throat, and equilibrium standards for a Sorting medical certificate are:
(a) The person shall demonstrate acceptable hearing by at least one of the following (i) Demonstrate an ability to hear an average conversational voice in a quiet room, using both ears, at a distance of 6 feet from the examiner, with the back turned to the examiner. (2) Demonstrate an acceptable understanding of speech as determined by audio-metric speech discrimination testing to a score of at least 70 percent obtained in one ear or in a sound field environment. (3) Provide acceptable results of pure tone audio-metric testing of unaided hearing acuity according to the following table of worst acceptable thresholds, using the following calibration standards. (4) No disease or condition of the middle or internal ear, nose, oral cavity, pharynx, or (a) Interferes with, or is aggravated by, flying or may reasonably be expected to do so; (b) Interferes with, or may reasonably be expected to interfere with, clear and effective (c) No disease or condition manifested by, or that may reasonably be expected to be manifested by, vertigo or a disturbance of equilibrium.
Mental

(1) Mental standards for a Sporting medical certificate are:
(a) No established medical history or clinical diagnosis of any of the following: (2) A personality disorder that is severe enough to have repeatedly manifested itself by (a) A psychosis. As used in this section, "psychosis" refers to a mental disorder in (b) The individual has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition; or (c) The individual may reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition. (e) Substance dependence, except where there is established clinical evidence, satisfactory to the designated aviation medical examiner, of recovery, including sustained total abstinence from the substance(s) for not less than the preceding 2 years. As used in this section (i) "Substance" includes: Alcohol; other sedatives and hypnotics; anxiolytics; opioids; central nervous system stimulants such as cocaine, amphetamines, and similarly acting sympathomimetics; hallucinogens; phencyclidine or similarly acting arylcyclohexylamines; cannabis; inhalants; and other psychoactive drugs and chemicals; and (ii) "Substance dependence" means a condition in which a person is dependent on a substance, other than tobacco or ordinary xanthine containing (e.g., caffeine) beverages, as evidenced by : - Increased Continued use despite damage to physical health or impairment of social, (f) No substance abuse within the preceding 2 years defined as: (i) Use of a substance in a situation in which that use was physically hazardous, if there has been at any other time an instance of the use of a substance also in a situation in which that use was physically hazardous; (g) Misuse of a substance that the designated aviation medical examiner, based on case history and appropriate, qualified medical judgment relating to the substance involved, finds (i) Makes the person unable to safely perform the duties or exercise the privileges of the medical certificate applied for or held; or (ii) May reasonably be expected, for the maximum duration of the medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges. (3) No other personality disorder, neurosis, or other mental condition that the designated aviation medical examiner, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds (a) Makes the person unable to safely perform the duties or exercise the privileges of the medical certificate applied for or held; or (b) May reasonably be expected, for the maximum duration of the medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
Neurological

(1) Neurological standards for a Sporting medical certificate are:
(a) No established medical history or clinical diagnosis of any of the following: (i) Epilepsy; (ii) A disturbance of consciousness without satisfactory medical explanation of (iii) A transient loss of control of nervous system function(s) without satisfactory (b) No other seizure disorder, disturbance of consciousness, or neurological condition that the designated aviation medical examiner, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds (c) Makes the person unable to safely perform the duties or exercise the privileges of the medical certificate applied for or held; or (d) May reasonably be expected, for the maximum duration of the medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.
Cardiovascular

(1) Cardiovascular standards for a Sporting medical certificate are:
(a) No established medical history or clinical diagnosis of any of the following: (i) Myocardial infarction; (ii) Angina pectoris; (iii) Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant; (iv) Cardiac valve replacement; (v) Permanent cardiac pacemaker implantation; or (vi) Heart replacement; (b) A person applying for Sporting medical certification must demonstrate an absence of myocardial infarction and other clinically significant abnormality on electrocardiograph examination: (i) At the first application after reaching the 35th birthday; and (ii) On an annual basis after reaching the 40th birthday. (c) An electrocardiogram will satisfy a requirement of paragraph (b) of this section if it is dated no earlier than 60 days before the date of the application it is to accompany and was performed and transmitted according to acceptable standards and techniques.
General medical condition

(1) The general medical standards for a Sporting medical certificate are:
(a) No established medical history or clinical diagnosis of diabetes mellitus that requires insulin or any other hypoglycemic drug for control. (b) No other organic, functional, or structural disease, defect, or limitation that the designated aviation medical examiner, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds (i) Makes the person unable to safely perform the duties or exercise the privileges of the medical certificate applied for or held; or (ii) May reasonably be expected, for the maximum duration of the medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges. (c) No medication or other treatment that the designated aviation medical examiner, based on the case history and appropriate, qualified medical judgement relating to the medication or other treatment involved, finds (d) Makes the person unable to safely perform the duties or exercise the privileges of the medical certificate applied for or held; or (e) May reasonably be expected, for the maximum duration of the medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges. SAN MARINO CIVIL AVIATION AUTHORITY

APPLICATION FOR THE ISSUING OF MEDICAL CERTIFICATE

1.9 Date of birth: . 1.10 Nationality: . 1.11 The applicant declares hereby that the particulars provided in this application are true in
Notes: An application for the issuing of a medical certificate must comply with the provisions of SM-
CAR PL 03. The applicant should be aware that each false Statement carry out the cancellation of prevailing certificate no withstanding any prosecution. Any falsification, misreproduction or alteration of original certificate should be subject to prosecution as defined in SM-CAR PL 03. SAN MARINO CIVIL AVIATION AUTHORITY
MEDICAL CERTIFICATE MODEL

REPUBLIC OF SAN MARINO
SPORTING
Date of exam: ………………………. CERTIFICATE
The holder of the present medical certificate should not act as a micro light pilot, as the case may be: - condition which could affect the validity of such while he or she is receiving medical treatment, unless otherwise provided for herein; if the holder has entered the thirtieth week of The medical certificate is issued in respect designated aviation medical examiner certify that such holder who has entered the twenty-ninth week of pregnancy, is fit to continue to act as a pilot-in-command, or in any other capacity as a flight crew member or a cabin crew member, for a further period, which period shall not exceed six weeks from the date on which such holder has entered the thirtieth week of pregnancy; if the holder has given birth in the preceding after such medical certificate has expired;

Source: http://www.caa-mna.sm/documents/puen/SM-CAP%20PL%2003%20EN.pdf

Nevada state board of nursing

GUIDELINES FOR PROTOCOLS FOR ADVANCED PRACTITIONER OF NURSING (APN) “Protocol” means written directions for assessment and management of specified medical conditions that the Advanced Practitioner of Nursing (APN) and collaborating physician have agreed upon as a basis for their practice (NAC 632.072). Protocols may be disease-oriented, procedure-oriented and/or process-oriented.

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