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 expecting delivery in less than 28 days (Japan Domestic Flights/International Flights)
Other cases based on the discretion of ANA.

*

Please refer to "Information on Completing the Medical Certificate" 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.

Medical Information Form (MEDIF) (Japanese)

Medical Information Form (MEDIF) (English)

*

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

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, special assistance request, and Medical Information Form (MEDIF)).
Pages 1 and 2 are references for completing the Medical Information Form (MEDIF).
Fill out page 3 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.
Page 4 must be completed by your physician.

Sample Medical Information Form (MEDIF)

Customer (Patient) Information
Patient's name, age, 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.
6. Please mark if you require constant inhalation of oxygen on board.
7. Requirement of medical equipment on board.
8. Requirement of medical treatment on board.
9. Other special notes for boarding, validity piriod, etc.
Physician Information
Name (Signature), Hospital Name, Phone No., Date, etc.

Sample Medical Information Form (MEDIF)

Notes on Submission

MEDIF must be prepared and issued within 14 days including the departure date.

Passengers whose health condition or symptoms are stable may include a validity piriod on the medical certificate. As long as the boarding date is within the validity period, we will accept the medical certificate even if it is not issued within 14 days.Passengers are requested to keep the medical certificate within the validity period by themselves.

Example: If the departure date is December 15, the MEDIF must be issued no earlier than December 2.

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.

ANA Disability Desk