Doctors Fit To Travel Note
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Business Entreprise Health Santé note Remarque item article travel Voyage doctor note note du médecin Air Passenger Passager
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Can patient travel in a sitting position for the duration of flight ITEM 3 NO YES Whether infectious Note: Non autonomous pax must be accompanied by an able-bodied passenger familiar with his/her needs NO YES Whether patient has full control of bowels bladder NO YES Diagnosis of condition: Present Symptoms: Whether patient displays suicidal tendencies or is subject to fits of violence NO YES Page 1 of 3 Wheelchair Needed ITEM 4 OWN Wheelchair Collapsible Power Driven NO YES WCHC needed, advise if autonomous or non-autonmous on board Battery type (Spillable) NO NO NO NO YES YES YES YES Non-autonomous on board Categories are: Autonomous on board WCHR (wheelchair ramp) WCHS (wheelchair step) WCHC (wheelchair Cabin) Wheelchair category: (If answer is ‘YES’, then you should fill in the next columns)..
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