MEDICAL SUPPLEMENT (Migraine)

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OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
MEDICAL STANDARDS LEAFLET (MSL) FOR ROYAL AIR FORCE PRE EMPLOYMENT
HEALTH SCREENING
The Armed Forces require anyone who enters to be medically fit to serve worldwide.
New entrants to the Armed Forces undergo intensive training, which is both physically and
mentally demanding. The Armed Forces medical authorities have to be aware of your medical
history and of any conditions that may affect your performance as a serviceman or
servicewoman. Applicants who do not meet the required medical standards may be rejected.
Your medical history is confidential and will not be given to anyone not authorised to hold this
information.
This leaflet is intended as a guide to some of the medical conditions that may affect your entry
into the RAF. It is not exhaustive and further information is available on the RAF Careers website
and at the Armed Forces Career Office (AFCO). You may also share medical information with
your Armed Forces Careers recruiter voluntarily who will seek advice from the medical staff at the
RAF Recruiting and Selection, Department of Occupational Medicine.
On receipt of the Medical Supplement Leaflets you are requested to complete the sheets which
may apply to a previous or current health condition. To confirm eligibility to proceed with the
candidate journey the sheets will be sent to the Department of Occupational Medicine to assess
your eligibility. For officer candidates this is after the P2 officer presentation (if you have selected
to attend) or via the AFCO once the forms are completed. For non commissioned candidates the
sheets will be sent to the Department of Occupational Medicine after success at the Airman’s
Selection test.
For aircrew candidates only please read the statements below and complete the relevant sheets:
a. Asthma.
Any history of asthma precludes selection for Flying Branches.
b. Hay Fever. If you have a history of hay fever (without wheeze) you may be
considered for selection for aircrew subject to screening of your health declaration.
c. Visual Standards. The entry standards for aircrew selection are higher than
any other Branch choice particularly for pilot duties and you are required to complete
the ophthalmic sheets. All aircrew candidates are to complete the Medical
Supplement (MSL) for eyesight (whether they wear glasses or not) by visiting a local
optician and arranging for the optometry assessment to be completed. The
completed form is to be taken to the AFCO for screening by the Medical Officers at
RAFC Cranwell. Please be aware that non completion of the form will result in a
delay to your recruiting process.
All candidates who currently wear glasses or contact lenses will be required to take a current
prescription (in date within the last year) to any medical assessment for RAF employment. Certain
Ground Branches and Trades have strict eyesight standards where wearing of glasses is not
permitted. If you have undergone laser eye surgery you are required to complete the ophthalmic
sheet and the medical staff will determine your eligibility for military employment.
If you are aware of a colour deficiency or colour blindness you may not be eligible for some
Branch or Trade choices. Advice via the AFCO can be provided where candidates require
confirmation of medical eligibility. They will discuss your case with the Department of
Occupational Medicine.
All completed sheets are to be taken to the AFCO at the initial stage of your recruitment process
and the recruiters will send the medical information to the medical staff for assessment.
The outcome of the pre employment screening will be provided to the AFCO for all candidates Fit
to Proceed with an application.
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
All candidates Unfit to Proceed or permanently medically unfit for recruit entry will be sent a letter
by the Department of Occupational Medicine informing them of the occupational decision.
Any failure to declare your past medical history or any existing medical/health conditions
may result in your application being discontinued. If you are found to have concealed or
not declared a health issue once employed by the RAF then this may result in employment
termination under the terms of Queens Regulations as Services No Longer Required.
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
MEDICAL SUPPLEMENT RECORD
NAME
INITIALS
AFCO
Please tick the boxes below (as appropriate).
I have enclosed the following Medical Supplements:
Asthma Supplement
Hayfever Supplement (Aircrew Applicants Only)
Migraine/Headache Supplement
Neurology Supplement
Head Injury Supplement
Ophthalmic Supplement
Corneal Refractive Surgery Supplement
General Medical Supplement
Musculoskeletal Supplement
Date: …………………………….
Signature: …………………………………..
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
URN
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
INTENTIONALLY BLANK
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
SUPPLEMENT 1
ASTHMA SUPPLEMENT
FOR COMPLETION BY APPLICANT
AFCO/SCLO use
Surname:
First Name:
URN:
Serving member
of HM Forces?
Date of Birth:
Branch/Trade applied
for:
Location:
Yes
No
Age:
For applicants who have suffered or who currently suffer from:
a.
Asthma
b.
Wheeze
c.
Persistent cough
d.
Chest tightness
e.
Bronchitis
1.
Have you ever been diagnosed with asthma or wheeze
Yes
2.
When did you last have symptoms?
Age:
3.
Are you currently taking any treatment for asthma, cough or wheeze
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
4.
5.
6.
7.
8.
9.
Have you had any asthmatic symptoms including nocturnal cough or
exercise induced wheezing in the past five years
Have you had any asthmatic symptoms including nocturnal cough or
exercise induced wheezing since the age of 16 years?
Have you used any inhaler (continuously or intermittently) for the
control of asthma or wheeze for a period longer than 8 weeks in the 5
years prior to this application?
Have you required steroid tablets or syrup for asthma or wheeze since
the age of 5 years?
Have you required admission to an Intensive Care Unit for asthma at
any time in your life?
Have you required hospital admission for longer than 24 hours for
asthma or wheeze since your 5th birthday?
Signed: …………………………..
Date: ……………………………
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
No
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
INTENTIONALLY BLANK
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
SUPPLEMENT 2
HAYFEVER SUPPLEMENT
FOR COMPLETION BY AIRCREW APPLICANTS ONLY
AFCO/SCLO use
Surname:
URN:
Serving member
of HM Forces?
Location:
Yes
First Name:
Date of Birth:
Male
Age:
No
Female
For aircrew applicants who have suffered or currently suffer from hayfever.
1.
What were / are your symptoms?
2.
Did / do you get wheeze or chest tightness with your hayfever?
3.
When did you last have symptoms?
4.
Do you take any Medication for your hayfever?
Month:
Name of medication:
Signed: …………………………..
Date: ……………………………
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
Yes
No
Year:
Yes
No
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
INTENTIONALLY BLANK
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
SUPPLEMENT 3
MIGRAINE SUPPLEMENT
FOR COMPLETION BY APPLICANT
Surname:
AFCO/SCLO use
First Name:
Date of Birth:
URN:
Serving member
of HM Forces?
Location:
Yes
No
Male
Age:
Female
For applicants who have suffered from or currently suffer from Migraine attacks.
1.
When did you first suffer from migraine?
2.
How long did / do your migraines last?
3.
Did / do you get one sided pain?
Yes
No
4.
Was / is the pain throbbing in nature?
Yes
No
5.
Was / is the pain made worse by movement?
Yes
No
6.
Did / do you suffer from associated nausea or vomiting or avoidance of noise
or light?
Yes
No
Over the last 2 years:
7.
How many attacks of migraine have you had?
8.
Approximate date of last migraine.
9.
Did / do you avoid loud noise with your migraine?
Yes
No
10.
Did / do you avoid bright light with your migraine?
Yes
No
11.
Did / do you have any other symptoms associated with your migraine?
Yes
No
Yes
No
Please describe your symptoms:
12.
How would you score your pain on a scale of 1-10? (1 = no pain, 10 = intense
pain)
Have / do you take any preventative medication? (Please give details)
13.
Signed: …………………………..
Date: ……………………………
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
INTENTIONALLY BLANK
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
SUPPLEMENT 4
NEUROLOGY SUPPLEMENT
FOR COMPLETION BY APPLICANT
Surname:
AFCO/SCLO use
First Name:
Date of Birth:
URN:
Serving member
of HM Forces?
Location:
Yes
Male
Age:
No
Female
For applicants who have suffered from any form of:
a.
b.
c.
d.
e.
f.
fit
convulsion
seizure
black-out
loss of consciousness
faint
1.
What is/was the precise diagnosis of your condition?
2.
How old were you when the event first occurred?
How often has the condition occurred?
3.
4.
When did you last have symptoms?
Age:
5.
Was / is there anything which provokes your condition?
What is/was the provoking stimulus?
Signed: …………………………..
Date: ……………………………
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
Year:
Yes
No
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
INTENTIONALLY BLANK
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
SUPPLEMENT 5
HEAD INJURY SUPPLEMENT
FOR COMPLETION BY APPLICANT
Surname:
AFCO/SCLO use
First Name:
Date of Birth:
URN:
Serving member
of HM Forces?
Location:
Yes
Male
Age:
No
Female
For applicants who have suffered a head injury resulting in hospital attendance:
1.
When did your head injury occur
2.
Did you lose consciousness?
3
4.
5.
6.
7.
If you lost consciousness was
it for: (circle correct answer)
Yes
Less than 30
mins
30 mins-24 hrs
Did you have memory loss following the injury?
If you had memory loss was it
for: (circle correct answer)
Less than 30
mins
More than 24 hrs
Yes
30 mins-24 hrs
Did you have a skull fracture?
If you had a skull fracture was it depressed?
No
No
More than 24 hrs
Yes
No
Yes
No
8.
Did you have a brain haemorrhage?
Yes
No
9.
Did you / have you had any other symptoms from your head injury:
Yes
No
10.
What are / were the symptoms?
11.
When did you last have symptoms?
Signed: …………………………..
Date: ……………………………
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
INTENTIONALLY BLANK
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
SUPPLEMENT 6
AIRCREW OPHTHALMIC SUPPLEMENT
FOR COMPLETION BY ALL AIRCREW APPLICANTS
This form is to be taken to your local optician/optometrist for completion. Failure to do so will delay the
recruiting process.
AFCO / SCLO Use
Surname:
First Name:
URN No.
Date of Birth:
AFCO/SCLO
Male
/
Female
Age:
If you have ever had any form of laser eye surgery you are also required to complete the Corneal
Refractive Surgery leaflet
FOR COMPLETION BY OPTOMETRIST / OPHTHALMIC SPECIALIST
Examination Date: …………………
Dist.
vision
Unaided
R
L
Sph
Cyl
Axis
Prism
Dist
Corrected
Inter
Near
6/
6/
N
N
6/
6/
N
N
Adenexae
Normal / abnormal
Accommodation
Motility
Normal / abnormal
Visual fields
(confrontation)
Normal / abnormal
Pupil
reactions
Normal / abnormal
Fundoscopy
Normal / abnormal
Cover test
Normal / abnormal
Slit lamp examination
Normal / abnormal
Heterophoria
(Maddox Rod
& Wing)
Dist:
Stereopsis
TNO test:
of arc
secs
Colour vision
Ishihara :
Pass / fail
Convergence
Near:
cm
cm
Please comment on any abnormal history/ findings:
Signature:
Name:
Practice Stamp
Date:
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
INTENTIONALLY BLANK
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Medical in Confidence (when completed)
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SUPPLEMENT 7
CORNEAL REFRACTIVE SURGERY SUPPLEMENT
FOR COMPLETION BY APPLICANT
Surname:
AFCO / SCLO Use
First Name:
URN:
Date of Birth:
AFCO/SCLO
Male
/
Female
Age:
If you have ever had any form of eye surgery, then an ophthalmic specialist’s report is required
providing the following information:
Please note: Applications can only be considered from a minimum of 12 months after the last
surgical procedure
FOR COMPLETION BY OPTOMETRIST / OPHTHALMIC SPECIALIST
Procedure performed
……………………………………………...
Date(s) of surgery / enhancements:
R eye ………………………………………………
L eye ……………………………………………...
Pre-operative spectacle prescription:
Unaided
6/
Sph
Cyl
Axis
Prism
VA
6/
N
6/
N
6/
Near add
Post-operative refraction results: please give results from examinations AT LEAST 6 months
apart
Date:
Unaided
6/
Sph
Cyl
Axis
Prism
6/
VA
6/
Near add
N
6/
N
Date:
Unaided
Sph
Cyl
Axis
Prism
VA
Near add
6/
6/
N
6/
6/
N
Name:
Practice Stamp
Signature:
Date:
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
INTENTIONALLY BLANK
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Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
SUPPLEMENT 8
GENERAL MEDICAL SUPPLEMENT
FOR COMPLETION BY APPLICANT
AFCO / SCLO Use
Surname:
First Name:
URN:
Serving member
of HM Forces?
Date of Birth:
Branch/Trade applied
for:
Location:
Yes
No
Age:
For applicants who have suffered or who currently suffer from:
a.
Mental health problems
b.
Allergies and sensitivities
1.
Have you ever been given a confirmed diagnosis of Asperger’s
Syndrome?
Yes
No
2.
Have you ever had an eating disorder?
Yes
No
Yes
No
Yes
No
4.
Have you suffered from anxiety within the last year? (Please give
details below)
Have you suffered from depression lasting more than 12 months?
5.
Have you suffered from depression within the last two years?
Yes
No
Have you suffered from an episode of self harm in the last 3 years?
Yes
No
Was the self harm episode/s due to a stressful event?
Yes
No
Yes
No
Yes
No
3.
6.
7.
8.
Date of last episode of self harm.
How many episodes of self harm have you had in total?
Have you had any history of anaphylaxis or other severe allergic
reaction?
Do you carry an adrenaline autoinjector to treat an allergic reaction?
Please provide supporting evidence in the box below for any of the above questions
Further Information
Signed: …………………………..
Date: ……………………………
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
INTENTIONALLY BLANK
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
SUPPLEMENT 9
MUSCULOSKELETAL SUPPLEMENT
FOR COMPLETION BY APPLICANT
Surname:
First Name:
URN:
Serving member of
HM Forces?
Date of Birth:
Branch/Trade applied
for:
Location:
Yes
No
Age:
For applicants who have suffered from or who currently suffer from musculoskeletal problems.
1.
Do you have any current hip symptoms?
Yes
No
2.
Have you had any upper or lower limb fractures within the last year?
Yes
No
Have you had any shoulder dislocations within the last year?
Yes
No
Yes
No
How many in total?
3.
Have you had shoulder stabilisation surgery?
Date of shoulder stabilisation surgery.
How many surgical shoulder stabilisation procedures have you had in the
same shoulder?
4.
Have you had back pain lasting more than 6 weeks?
Yes
No
5.
Have you had any spinal fracture or surgery? (Give details below)
Yes
No
6.
Have you had knee pain within the last year? (Give details below)
Yes
No
7.
Have you had a knee ligament rupture or repair? (Give details below)
Yes
No
8.
Have you had any arthroscopic knee surgery within the last year?
Yes
No
9.
Have you ever had any open knee surgery? (Give details below)
Yes
No
10.
Have you had ankle ligament surgery within the last year?
Yes
No
Please provide supporting evidence in the box below for any of the above questions including dates.
Further Information
Signed: …………………………..
Date: ……………………………
OFFICIAL SENSITIVE PERSONAL
Medical in Confidence (when completed)
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