JAL - Medical Information Form (MEDIF) (JAL PRIORITY GUEST SUPPORT)

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Passengers traveling with any of the following conditions are requested to prepare Medical Information Form (to be hereinafter MEDIF).

Passengers who need a stretcher onboard the aircraft
Passengers who need oxygen supply
Passenger carrying and using medical equipment and having any medical treatment onboard the flight
Passengers with serious illness or injury
Passengers whose fitness for air travel is in doubt, as evidenced by recent instability, disease, treatment or surgery

Please complete Medical Information Form.
(Download and print the certificate in PDF format from the link below or request a certificate from a JAL Group reservation, sales office or JAL Priority Guest Reservations.)
Pages 1 and 2 of the file contain instructions on completing the form and reference information. The Medical Information Form is on page 4 and should be completed by your attending physician.
Page 3 contains the "Necessary Arrangement Request" and "Agreement" sections and should be completed by the passenger.
Upon completion, all documents should be sent in advance with the Medical Information Form by fax to JAL Priority Guest Reservations at 03-5460-5676.
Send your Medical Information Form to:03-5460-5676
JAL will review the Medical Information Form and determine whether or not accommodations can be made for the passenger.
On the day of departure, please bring the original copy of the Medical Information Form to complete the boarding procedures. For further details, contact your nearest JAL sales or reservation office or JAL Priority Guest Reservations.

For details, please contact your nearest reservations, sales office or JAL Priority Guest Reservations.

Notes

* A credible medical certificate for an air travel must be issued within 14 days, including the day of departure, but excluding the cases below.

For use of stretchers : Must be issued within 10 days, including the day of departure
Pregnant woman whose confinement may be expected in less than 28 days : Must be issued within 7 days, including the day of departure
For newborn baby : Must be issued within 2 days, including the day of departure

The Medical Information Form can be downloaded here. (PDF format)

Notes

* Please indicate the need for a wheelchair or arrangements for an attending person in the "Necessary Arrangements" section. "Necessary Arrangement Request" and "Medical Information Form" should be submitted at the airport on the day of departure.
* In order to view PDF documents, you will need to install Adobe Reader on your computer.
Adobe Reader: download Adobe Reader

MEDIF: : should be completed by the attending physician.
MEDA 1: : Applicant
Write the passenger's name, age, and gender.
MEDA 2: : Attending Phisician
Write the name, name of hospital, and telephone contact.
MEDA 3: : Medical Data
Write the details to ensure that we fully understand.
MEDA 4: : Fitness for Air Travel
Write the patient's state of health.
MEDA 5: : Communicable Disease
MEDA 6: : Distress to Other Passengers
MEDA 7: : Sitting Position
"NO": stretcher arrangements are needed.
For details, please see "Passengers Using Stretcher."
MEDA 8: : Taking care of his/her own needs on board
"NO": escort(s) should accompany passenger.
MEDA 9: : Escort(s) Arrangements
MEDA 10: : Oxygen Supply
Write the need for oxygen and the rate of flow per minute required
MEDA 11/12: : Medical equipment to be used.
MEDA 13/14: : Hospitalization at connecting points or upon arrival.
Remarks in Particular: : Write any comments about the patient's condition and any suggestions
Signature and Date: : The statement must be dated and signed by the attending physician.