MEDIF, fit to fly and medical report: the documents for a medical repatriation

Before a patient can fly, an airline or an air ambulance operator must accept the case. Here is what each document is for, who completes it and how to gather everything quickly.

Medical review: [name and qualification of the referring doctor]

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Why the paperwork often sets the departure date

A medical repatriation goes ahead only once a medical team has accepted the patient for the flight: the airline’s medical service on a scheduled flight, the operator’s medical team on an air ambulance. Both decide on written documents.

A report without a recent date, a missing signature or a hospital that has not yet confirmed a bed can delay a transfer even when the patient is ready. The list depends on the patient’s condition and on the means of transport, which our guide air ambulance or stretcher on a scheduled flight explains.

The MEDIF: the airline’s medical information form

MEDIF stands for Medical Information Form. Airlines use it to decide whether a passenger with a medical condition can travel, and on what terms. It follows a model in the IATA Medical Manual, but each airline publishes its own version, contact address and deadline.

One part covers the passenger and the trip: booking reference, flights and the assistance needed (wheelchair, stretcher, escort, ambulance at the airport). The other is completed, signed and stamped by the treating doctor: diagnosis, history, medication, oxygen needs, mobility, infection status and outlook for the journey. Lufthansa’s form is a typical example.

A wheelchair to the gate is an assistance request, not a medical case: IATA’s guidance on assistance codes keeps the two apart. Airlines typically ask for a MEDIF when:

the patient travels on a stretcher or in an incubator;
oxygen is needed during the flight;
the patient has a contagious disease;
a recent illness, operation or hospital stay raises doubt about fitness to fly;
a medical escort or other special arrangements are needed on board.

The airline’s medical service grants or refuses clearance, sometimes with conditions. With some airlines, the ticket is issued only after clearance, and clearance covers only the flights and dates on the form. Deadlines vary, so check the airline’s own pages and send the form early.

FREMEC: for frequent travellers with a stable condition

The FREMEC (Frequent Traveller’s Medical Card) is issued by an airline’s medical service to people who fly regularly with a stable, long-term condition, so they do not need a new MEDIF for every trip. It is rarely relevant after a sudden illness or an accident abroad, when an up-to-date assessment is needed. Validity and acceptance by other airlines vary.

Fit to fly: the doctor’s opinion, the airline’s decision

A fit-to-fly certificate is a short statement, signed by a doctor, saying that the patient can travel by air on a given date, sometimes with conditions such as lying flat, oxygen or an escort. Depending on the airline and the case, it is requested on its own or alongside a MEDIF.

The certificate gives the treating doctor’s opinion; the MEDIF gives the airline’s medical service the facts to reach its own. The final decision always belongs to the airline or, for an air ambulance, to the operator’s medical team. Some MEDIF forms remind doctors that the cabin is pressurised to the equivalent of about 2,400 metres (8,000 feet), which reduces the oxygen available to the patient.

The medical report: the core of the file

Whatever the means of transport, the medical team reads the medical report first. It should come from the treating hospital or doctor, be recent, dated, signed and stamped, and cover:

the diagnosis, when it started and the treatment so far, including any operation;
current medication and known allergies;
recent vital signs and, where relevant, oxygen saturation and oxygen flow;
mobility: can the patient sit upright, walk a few steps, or must they lie flat;
devices in place, such as drips, drains, catheters or casts;
infection status, including isolation or multi-resistant bacteria;
the treating doctor’s direct contact details.

A report in English or French avoids translation delays. Add recent imaging and laboratory results when they help.

Acceptance by the receiving hospital

For a bed-to-bed transfer, the destination hospital should confirm in writing that it accepts the patient, in which department and from which date, ideally with a contact doctor and a ward number. Without it, the patient could land with no bed waiting. For stretcher passengers, some airline forms also ask for the ambulance company at both airports.

Identity and travel documents

Check early:

a valid passport or identity card for the patient and every relative travelling;
visas or residence permits for the destination and any transit country, as a relative of a different nationality may need one when the patient does not;
if the passport is lost or expired, the consulate may, under conditions, issue an emergency travel document;
for a minor without one or both parents, a parental authorisation (France, for example, requires an autorisation de sortie du territoire for a minor living in France who leaves without a parent).

Rules depend on the countries involved, so contact the consulate early. See also our guide on medical repatriation from Africa.

Insurance and payment

If an insurer or assistance company is involved, have the policy number, the case number and the case manager’s name ready. If it is to pay, ask it early for a written guarantee of payment. Our guide on travel insurance and medical repatriation explains what policies usually cover.

Oxygen and medical equipment on a scheduled flight

Some airlines supply medical oxygen on request; others accept a personal portable oxygen concentrator (POC) of an approved model. Advance notice and a doctor’s statement are commonly required. Royal Air Maroc, for example, asks for 72 hours’ notice for airline oxygen, and 48 hours for a personal POC with batteries covering 150% of the maximum flight time.

Other devices, such as a ventilator or infusion pump, need the airline’s technical approval, especially when battery-powered: list each one on the MEDIF. Cabin crew are trained only in first aid and do not give nursing care or medication.

Checklist: what to gather

Medical report: recent, signed, with the doctor’s contact details.
Airline documents: MEDIF and, if requested, a fit-to-fly certificate.
Receiving hospital: written acceptance and a contact.
Identity: passports, visas or residence permits; parental authorisation for a minor.
Insurance: policy number, case number, guarantee of payment.
Equipment: devices, battery types, oxygen flow.

You do not need everything before contacting us. Send what you have through our quote request form: we tell you what is missing, and [documents our team prepares or submits on your behalf]. See also how a medical repatriation works and our page for patients and families.

Important

This guide gives general information. It does not replace the advice of the treating doctor and does not say whether a particular patient can fly: that decision belongs to the doctors in charge and to the airline’s or operator’s medical team. In an emergency, call the local emergency number (112 in the European Union).

Frequently asked questions

Who fills in the MEDIF?

The patient, a relative or the organising team can complete the passenger part. The medical part must be completed, signed and stamped by the treating doctor. The airline’s medical service then decides.

Is a MEDIF needed for an air ambulance flight?

The MEDIF is a form for scheduled airlines. On an air ambulance, the operator’s medical team assesses the patient, mainly from the medical report and exchanges with the treating doctor. Hospital acceptance and identity documents are still needed.

How early should the documents be sent?

IATA’s guidance recommends making assistance requests at least 48 hours before departure. For medical clearance, each airline sets its own deadline, so send everything as early as possible.

Can a family member act as the medical escort?

Not always. Lufthansa and Brussels Airlines, for example, state on their forms that family members are not accepted as medical escorts.

What if the patient’s condition changes after clearance?

Tell the airline or operator and the organising team at once. Clearance was given for the condition described, so a new assessment may be needed.