Medical Information Form (MEDIF)

This page provides information about cases which require a Medical Information Form (MEDIF).

Customers Who Must Submit a Medical Information Form (MEDIF)

Customers who apply to any of the following are required to submit a medical certificate using ANA’s designated Medical Information Form (MEDIF)

  • Customers using a medical oxygen cylinder
  • Customers using a portable oxygen concentrator (POC) or artificial respirator
  • Customers requiring a stretcher or an incubator
  • Customers whose medical conditions may suddenly change
  • Customers whose recent illness, injury, or surgery may be affected by air travel.
  • Expectant mothers who are within 28 days of their due date
  • Other cases based on the discretion of ANA.
  • * Please see “Information before traveling by air” on the Medical Information Form (MEDIF) below.

How to Complete a Medical Information Form (MEDIF)

Obtain a Medical Information Form (MEDIF)

ANA’s designated Medical Information Form (MEDIF) (PDF file) can be downloaded from the links below. Please contact the ANA Disability Desk if you wish to receive the form by mail or fax.

  • * Please download the form to your PC. You will be able to directly enter the required information into the PDF form after downloading it.

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Fill in the Medical Information Form (MEDIF)

The form needs to be filled in by both the customer and their physician. The form consists of 4 sections (information before traveling by air, guidance for the physician and customers, Medical Information Form (MEDIF), and special assistance request).
Pages 1 and 2 are references for completing the Medical Information Form (MEDIF).  
Page 3 must be completed by your physician.  
Fill out page 4 for details regarding the special assistance you need upon boarding Customers who wish to use medical oxygen cylinders or any other medical equipment on board, please also read the information for Customers with Medical Requirements.

Sample Medical Information Form (MEDIF)

  • Customer (Patient) Information
    Patient's name, age, gender, diagnosis or condition, etc.
  • Detailed Diagnosis
    1. Suitability for flight Must be filled in. In case of a return flight, the fields regarding the return flight must also be filled in
    2. Contagious disease If marked Yes, please specify.
    3. Ability to keep a seated position If marked No and a stretcher is required, please mark as applicable.
    4. Requirement of an escort
    5. Requirement of oxygen inhalation on board If marked Yes, please specify the amount and whether required continuously.
    6. Requirement of medical equipment on board
    7. Requirement of medical treatment on board
    8. Other special notes for boarding
  • Physician Information
    Name (signature), name of medical center or hospital, address and telephone number.

Period of Validity

The Medical Information Form (MEDIF) must be issued by the physician within 14 days of the departure date including the departure date.

Example: If the departure date is December 15, the MEDIF must be issued no earlier than December 2.
It is necessary that your physician certifies that you are fit to travel by air. If your travel includes a return flight, it is necessary to enter the date of the return flight and the physician must certify that you are fit for the return flight as well.
In this case, the MEDIF is valid even if it is issued not within 14 days including the departure date of the return flight.

Advance Confirmation

If you send your Medical Information Form (MEDIF) to the ANA Disability Desk by fax or email in advance, we will be able to arrange smooth boarding for you on your departure day.
Please send it a few days prior to your departure as our staff may contact you in case any information is missing.

If you cannot submit the MEDIF in advance, please bring it with you and show it at the check-in counter on the departure day.