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Medicina Aeronáutica

Certificación aeromédica

Certificado médico aeronáutico en Colombia

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Examen para certificado médico

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Below we will help you determine if you are in adequate medical condition to dive. At the end of the questionnaire we will tell you if you can dive without problems or require an evaluation with a doctor. In addition, we will send you a report that meets the standards of the "Diver Medical Screen Committee (DMSC)" which is accepted for the practice of diving internationally.

IMPORTANT: For your safety and that of the people who dive with you, it is essential that you answer all the questions in this questionnaire honestly, given that there are some medical conditions that can be dangerous when diving and must be evaluated by a medical professional.

Instructions: Complete this questionnaire as a prerequisite for freediving or scuba diving training. For women: If you are pregnant, or trying to get pregnant, do not dive.

1. I have had problems with my lungs, breathing, heart and/or blood affecting my normal physical or mental performance.

Yes No

1.1. Chest surgery, heart surgery, heart valve surgery, an implantable medical device (eg, stent, pacemaker, neurostimulator), pneumothorax, and/or chronic lung disease.

Yes No

1.2. Asthma, wheezing, severe allergies, hay fever or congested airways within the last 12 months that limits my physical activity/exercise.

Yes No

1.3. A problem or illness involving my heart such as: angina, chest pain on exertion, heart failure, immersion pulmonary edema, heart attack or stroke, OR am taking medication for any heart condition.

Yes No

1.4. Recurrent bronchitis and currently coughing within the past 12 months, OR have been diagnosed with emphysema.

Yes No

1.5. Symptoms affecting my lungs, breathing, heart and/or blood in the last 30 days that impair my physical or mental performance.

Yes No

2. I am over 45 years of age.

Yes No

2.1. I currently smoke or inhale nicotine by other means.

Yes No

2.2. I have a high cholesterol level.

Yes No

2.3. I have high blood pressure.

Yes No

2.4. I have had a close blood relative die suddenly or of cardiac disease or stroke before the age of 50, OR have a family history of heart disease before age 50 (including abnormal heart rhythms, coronary artery disease or cardiomyopathy).

Yes No

3. I struggle to perform moderate exercise (for example, walk 1.6 kilometer/one mile in 14 minutes or swim 200 meters/yards without resting), OR I have been unable to participate in a normal physical activity due to fitness or health reasons within the past 12 months.

Yes No

4. I have had problems with my eyes, ears, or nasal passages/sinuses.

Yes No

4.1. Sinus surgery within the last 6 months.

Yes No

4.2. Ear disease or ear surgery, hearing loss, or problems with balance.

Yes No

4.3. Recurrent sinusitis within the past 12 months.

Yes No

4.4. Eye surgery within the past 3 months.

Yes No

5. I have had surgery within the last 12 months, OR I have ongoing problems related to past surgery.

Yes No

6. I have lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease.

Yes No

6.1. Head injury with loss of consciousness within the past 5 years.

Yes No

6.2. Persistent neurologic injury or disease.

Yes No

6.3. Recurring migraine headaches within the past 12 months, or take medications to prevent them.

Yes No

6.4. Blackouts or fainting (full/partial loss of consciousness) within the last 5 years.

Yes No

6.5. Epilepsy, seizures, or convulsions, OR take medications to prevent them.

Yes No

7. I am currently undergoing treatment (or have required treatment within the last five years) for psychological problems, personality disorder, panic attacks, or an addiction to drugs or alcohol; or, I have been diagnosed with a learning or developmental disability.

Yes No

7.1. Behavioral health, mental or psychological problems requiring medical/psychiatric treatment.

Yes No

7.2. Major depression, suicidal ideation, panic attacks, uncontrolled bipolar disorder requiring medication/psychiatric treatment.

Yes No

7.3. Been diagnosed with a mental health condition or a learning/developmental disorder that requires ongoing care or special accommodation.

Yes No

7.4. An addiction to drugs or alcohol requiring treatment within the last 5 years.

Yes No

8. I have had back problems, hernia, ulcers, or diabetes.

Yes No

8.1. Recurrent back problems in the last 6 months that limit my everyday activity.

Yes No

8.2. Back or spinal surgery within the last 12 months.

Yes No

8.3. Diabetes, either drug or diet controlled, OR gestational diabetes within the last 12 months.

Yes No

8.4. An uncorrected hernia that limits my physical abilities.

Yes No

8.5. Active or untreated ulcers, problem wounds, or ulcer surgery within the last 6 months.

Yes No

9. I have had stomach or intestine problems, including recent diarrhea.

Yes No

9.1. Ostomy surgery and do not have medical clearance to swim or engage in physical activity.

Yes No

9.2. Dehydration requiring medical intervention within the last 7 days.

Yes No

9.3. Active or untreated stomach or intestinal ulcers or ulcer surgery within the last 6 months.

Yes No

9.4. Frequent heartburn, regurgitation, or gastroesophageal reflux disease (GERD).

Yes No

9.5. Active or uncontrolled ulcerative colitis or Crohn’s disease.

Yes No

9.6. Bariatric surgery within the last 12 months.

Yes No

10. I am taking prescription medications (with the exception of birth control or anti-malarial drugs other than mefloquine (Lariam).

Yes No

Birthdate

Day

Month

Year

Participant Name

Instructor Name

Facility Name

Participant Signature (or, if a minor, participant‘s parent/guardian signature required)

Participant statement: I have answered all questions honestly, and understand that I accept responsibility for any consequences resulting from any questions I may have answered inaccurately or for my failure to disclose any existing or past health conditions.

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