Printable Medical Forms
CPAP Airplane Letter Medical Form


{Physician Name}

{address}

{city, state, zip}

{phone}

 

{date}

 

 

RESPIRATORY ASSISTANCE DEVICE COMPLIANCE LETTER

 

To whom it may concern,

 

{Manufacturer name} respiratory assistance devices, including the {ventilator/respirator/CPAP machine} model used by patient and traveler {Name}, are prescribed medical devices.

 

These devices do not contain any materials or parts that could damage an aircraft or interrupt its flight. This specific device model has been tested for electromagnetic compatibility (EMC) in accordance with RTCA/DO-160, Section 21, Category M.

 

{Name} should be allowed to fly with this device per U.S. Department of Transportation Final Rule “Non-Discrimination on the Basis of Disability in Air Travel” (73 FR 27614), which includes respiratory assistance devices.

 

Additionally, under the Americans with Disabilities Act and in keeping with airline industry practice, it’s appropriate that this device count as neither a carryon or personal item in calculating travelers’ allowed baggage.

Sincerely,

 

{Physician Name}











Copyright © 2009-2021 by Savetz Publishing, Inc. Contact us. Privacy Policy.