Download Template Letters | Flying with Medical Equipment

Template Letters | Flying with Medical Equipment
This letter is an example of an appeal to an airline company for a patient to get special permission
to fly with medical equipment. It is intended to be sent by a medical professional on behalf of the
patient. The patient should keep an original signed copy for their records. Please replace all
[bolded] words with the appropriate language.
[PRINT ON MEDICAL CENTER OR INSTITUTION LETTERHEAD]
[DATE]
To Whom It May Concern:
[PATIENT NAME (DOB)] is a patient of mine who suffers from pulmonary hypertension (PH). PH
is a condition characterized by increased blood pressure in the pulmonary artery. PH is grouped
into five clinical classifications as defined by the World Health Organization (WHO) World
Symposium on PH1:
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
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WHO Group 1 PH: Pulmonary Arterial Hypertension (PAH)
WHO Group 2 PH: PH due to Left Heart Disease
WHO Group 3 PH: PH due to Chronic Lung Disease and/or Hypoxia
WHO Group 4 PH: Chronic Thromboembolic Pulmonary Hypertension
WHO Group 5 PH: PH with Unclear, Multifactorial Mechanisms
When PAH occurs in the absence of a known cause, it is referred to as idiopathic pulmonary
arterial hypertension (IPAH). IPAH is extremely rare, occurring in about one person per million
population per year.2,3 PAH can also occur in association with other diseases and exposures,
including historical anorexigen exposure, methamphetamine use, collagen vascular diseases,
HIV infection, portal hypertension, and congenital heart diseases (PAH). PAH affects the vessels
in the lungs, causing narrowing of the vessels and increased pressure within the vessels.
Patients may experience symptoms such as shortness of breath, dyspnea on exertion, and chest
pain. It is a progressive and debilitating disease for which there is no cure. As the disease
progresses, the blood vessels continue to lose elasticity, begin to scar, and the pressure in the
pulmonary artery increases. This makes it extremely difficult for the right side of the heart to
pump, and often results in a dilated and enlarged right heart which may later lead to heart failure.
In order to treat pulmonary hypertension, patients must be on a host of medications. [PATIENT
NAME] is on a continuous intravenous infusion of a medication called [INSERT NAME OF
TREATMENT]. This medication is administered using a portable pump via a central line in [HIS OR
HER] chest. Any interruption in the medication delivery could result in a life threatening pulmonary
hypertension crisis. [PATIENT NAME] must carry all of his medication supplies with him on board
1
Simonneau G, et al. J Am Coll Cardiol. 2013;62(25_S): doi:10.1016/j.jacc.2013.10.029
Humbert M, et al. Am J Respir Crit Care Med. 2006;173(9):1023-1030
3
Escribano-Subias P, et al. Eur Respir J. 2012;40(3):596-603
2
the plane. This includes extra infusion pumps, cassettes, syringes, needles, medication vials,
scissors, clamps, medical dressings and other supplies.
[PATIENT NAME] is in stable condition to fly. [PATIENT NAME] must have all of his medical
supplies for his [INTROVENOUS OR SUBQ] medication as well all of his oral medications with
him on board the plane in the event his luggage is lost. This patient and his family are
responsible for preparing and administrating the medication, programming the pump, and
caring for the central line.
[PATIENT NAME] will require supplemental oxygen at 2 liters/minute via nasal cannula
during the entire duration of the flight.
If you have any questions or need more information, please do not hesitate to contact me.
Sincerely,
[YOUR NAME], [DATE]
[SIGNATURE]
[PRINT NAME]
[ADDRESS]
[PHONE NUMBER]
[FAX NUMBER]