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Get FI Finnair MEDIF Standard Medical Information Form For Air Travel 2018-2024

Pdf-instruction Reset Form MEDIF Standard medical information form for air travel Page 1 The Sales office agent or passenger should complete this form. Please answer all of the questions marking an x in the Yes or No boxes and using block letters or typing when completing the form. 1. Passenger s first name Last name Date of birth Gender 2. Proposed itinerary date s flight number s from-to 3. Diagnosis or other reason for special arrangements 4. Is the passenger able to walk 50 meters 55 yards without breathing difficulties Yes No specify 5. Is a wheelchair needed Weight and measurements of the wheelchair No Yes WCHR wheelchair to the gate Passenger s own wheelchair Foldable wheelchair Motorized wheelchair Spillable batteries Non-spillable batteries Permission for transport of a motorized wheelchair must always be obtained from the airline in advance. 6. Is an ambulance needed If yes specify name and telephone number of ambulance company and name of hospital at destination 7. Are other ground arrangements needed Note Finnair does not provide any ground arrangements. If yes specify below contact information of persons and organisations requested to assist Assistance to the aircraft at airport of departure Yes specify Assistance between flights Assistance on arrival at destination Other assistance or valuable information 8. Are any special in-flight arrangements needed such as extra seat or special equipment See Note 2 at the bottom of Page 2. Yes specify at MEDA11-MEDA12 on page 2. 9. Is a stretcher needed onboard Yes. An escort with a medical training is required* 10. Name age and qualifications of medically trained escort. If the escort has no medical training write Travel companion and the person s name. 11. If the passenger is deaf and/or blind is he or she being escorted by a trained dog This text should be read by or to the passenger dated and signed by him or her or on his or her behalf* I hereby authorise all physicians and hospitals to provide the airlines with the information required by these airlines medical departments for the purpose of determining my fitness for carriage by air. I therefore relieve these physicians of their vow of professional secrecy in respect to such information and agree to pay the physicians fees in this matter. I am aware that if accepted for carriage my journey will be subject to the General Conditions of Carriage and the conditions of tariffs of the carriers concerned and that the carriers do not assume any special liability exceeding these conditions. I am prepared at my own risk to bear any consequences which carriage by air may have on my state of health and I release the carriers their employees servants and agents from any liability for such consequences. Finnair 14 10/10 I agree to reimburse the carriers upon demand for any special expenditures or costs in connection with my carriage. Passenger s or guardian s phone number and e-mail address Place and date Next page Confidential medical information form Return page 1 and 2 of this form to Finnair Medical Clearance Services fax 09 818 4825 international call 358 9 818 4825 Page 2 For official use only.

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