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 arterial hypertension
(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 [FLOLAN OR REMODULIN
SUBQ/IV]. 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 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]