In brief
A referral means your examiner (AME or aeromedical centre) does not decide alone: your file goes to the medical assessor of the licensing authority, in France the DGAC's Pôle Médical. It is not an unfit assessment. The assessor then decides: fit, fit with limitations, or unfit.
See also: if your initial took place abroad.
Who is writing this guide?
I have been an airline pilot (ATPL) for about twenty years (business jet, Falcon 2000LX) and a former flight instructor. Before aviation, I was a nurse in cardiology, cardiac intermediate care and emergencies at the CHUV in Lausanne. I have never been referred to a medical assessor myself, so this page does not describe a waiting room I have not sat in. It sets out what the European regulation and the authorities write, with the reference for each point.
What "referral" means in the text
The word comes from the European regulation (Part-MED, Annex IV to Regulation (EU) No 1178/2011). When the applicant "does not fully comply with the requirements for the relevant class of medical certificate but is considered to be not likely to jeopardise the safe exercise of the privileges of the applicable licence", the examining doctor does not decide alone. Point MED.B.001(a) sets out three cases:
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01
Class 1: referral. The AME or aeromedical centre (AeMC) shall "refer the decision on fitness of the applicant to the medical assessor of the licensing authority".
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02
Class 2: consultation. The AME or AeMC decides, but "in consultation with the medical assessor of the licensing authority", and issues the certificate with limitations as necessary.
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03
LAPL: one level down. Where national law allows a general medical practitioner (GMP) to issue the LAPL certificate, the GMP refers the applicant to an AME or AeMC, unless only a limitation on corrective lenses or on the period of validity is needed (MED.B.001(b)).
Point MED.A.050, titled "Referral", then deals with the file itself: for class 1 or class 2, "the AeMC or AME shall transfer the relevant medical documentation to the licensing authority". EASA's acceptable means of compliance add that an AME may also refer "in borderline cases or where fitness is in doubt" (AMC1 MED.B.001(a)).
In France, pilots call this service "le pôle médical": the Pôle Médical of the Flight Crew technical directorate at the DSAC. The DGAC vademecum explains that the DSAC applies EASA rules through medical representatives called medical assessors (my translation). In the other countries the function is the same and the address changes (see below).
Situation, decision-maker, certificate: the table
| Your situation | Who decides | What happens to your certificate |
|---|---|---|
| A simple limitation is enough (TML, VDL, VML, VNL, VCL) | The AME or AeMC, no referral (AMC1 MED.B.001(c)(1)) | Issued, with the limitation endorsed on it (MED.B.001(f)). With a TML, validity is shortened, starts on the date of the examination, and any validity left on the previous certificate "is no longer valid" (AMC2 MED.B.001). |
| Class 1, requirement not fully met | Referral: the medical assessor of the licensing authority (ARA.MED.125) | In France, aeromedical fitness is suspended pending the decision (DGAC vademecum). If you are assessed as fit, the assessor issues the certificate or delegates issuance to the AME or AeMC (ARA.MED.125(d)). |
| Class 2, requirement not fully met | Consultation: the AME or AeMC, with the medical assessor | In France, the same suspension applies while waiting: the vademecum covers "referral / consultation". Then a certificate, with or without limitations, or an unfit decision. |
| LAPL with a GMP, requirement not met | Referral to an AME or AeMC (MED.B.001(b)) | The AME or AeMC assesses and issues, with limitations as necessary, and shall always consider an operational passenger limitation (OPL). |
| Revalidation or renewal with the same limitations | The AME or AeMC, without referral or consultation (MED.B.001(a)(2)) | Revalidated or renewed with the same limitations. |
| Assessed as unfit | The AME, the AeMC or the medical assessor | No certificate. You must be informed of your right to have the decision reviewed (MED.A.025(b)(3)). Appeals are covered on the page Pilot medical unfitness and appeals. |
The right-hand column describes what the texts say. It says nothing about the outcome of your own file: the decision rests with the doctor.
The steps of a referral, as the texts describe them
The regulation sets the authority's side of the sequence in point ARA.MED.125 "Referral to the licensing authority":
- The assessor reviews the file, personally or through designated medical staff, and will "request further medical documentation, examinations and tests where necessary".
- The assessor determines your fitness, with one or more limitations if necessary.
- The assessor informs the AME or AeMC of the decision.
- If you are assessed as fit, the assessor issues the certificate or delegates issuance to the AME or AeMC that referred you.
On the examiner's side, EASA's texts ask for two things that concern you directly. In case of denial or referral, the examiner "should inform the applicant in writing regarding the result of the assessment" (AMC1 MED.A.025(f)). And the documents should be sent to the medical assessor "on the same day that the denial or referral decision is reached" (GM1 MED.A.025(d)).
In France, what the DGAC vademecum describes. To start a referral, the AME or AeMC fills in a referral form signed by the examiner and by the pilot, gives the pilot a copy, and sends it the same day to the medical assessor with a copy of the examination. The assessor may ask for an additional specialist examination. You are informed directly by letter, with a copy to your AME. The decision is recorded in a medical report and an administrative report: a certificate if you are fit, with or without limitations, an appeal form if you are assessed as unfit.
What I do not detail here: the step-by-step course of action country by country, what is known of each authority's practice, and the template letter to request your medical file. That is what the pilot medical guide covers.
Which documents you will be asked for
The texts publish no list, which makes sense: it depends on the reason for the referral. What they say is who asks. Your AME transfers "the relevant medical documentation" (MED.A.050). The assessor may then request further documentation, examinations and tests (ARA.MED.125(a)). And point MED.A.040(e) provides that "in the case of referral, the medical assessor" may require additional examinations or investigations when clinically indicated.
In practice, the request reaches you from the authority or from your AME, written for your case. The regulation also provides that a certificate is only issued on a complete medical history, including, when requested, the results of examinations carried out by your own doctor or a specialist (MED.A.040(d)(1)). If a request is unclear, ask for it to be clarified in writing.
While you wait: what you can do, and what you cannot
Flying. In France, the DGAC vademecum is explicit: pending the decision, aeromedical fitness is suspended (my translation). It also asks the AME, when handing you the copy of the form, to explain that you are unfit for your duties until the medical assessor decides. The European regulation does not phrase the rule this way. It sets a broader duty: do not exercise the privileges of your licence when you are aware of any decrease in your medical fitness (MED.A.020(a)).
For Belgium, Switzerland and Luxembourg, I have not found a published text stating what happens to the certificate during a referral. Do not guess: ask your AME, and ask for the answer in writing.
How long it takes. There is no European time limit. EASA's acceptable means of compliance say that each competent authority "should define the time limit for the assessment of referred cases" (AMC1 ARA.MED.125(c)). I have not found that time limit published in the DGAC vademecum, on the FOCA page or in the DAC questions and answers. So I give none.
What stays in your hands. Keep the copy of the referral form or letter. Know what was sent, and why. Answer requests quickly and completely, since the assessor decides on the documents. Write down the date of every exchange.
Referral or unfit: the difference
The regulation separates them as soon as the examination ends. Point MED.A.025(b)(1) requires the AME to "inform the applicant whether he or she is fit, unfit or referred to the medical assessor". Three outcomes, not two. The DGAC vademecum lists four, adding fit with limitations.
- A referral hands the decision to someone with a power the AME does not have in class 1: imposing certain limitations, such as the OML, which only the medical assessor imposes and removes (MED.B.001(d)(1)). Nothing has yet been decided about your fitness.
- An unfit assessment is a decision. The regulation attaches the right to have the decision reviewed to it (MED.A.025(b)(3)), and it starts the appeal deadlines. In France, the vademecum states that after an unfavourable opinion from the medical assessor, the applicant may appeal to the CMAC.
I have not found a text that organises an appeal against the referral itself. Appeals, the bodies that hear them and their deadlines in the four countries are on the page Pilot medical unfitness: what to do, what appeals.
The medical assessor in your country
The mechanism is European. What changes is the office that receives the file, and what it publishes about its procedure.
- 🇫🇷 France. The Pôle Médical of the Flight Crew technical directorate (DSAC, DGAC). Its medical assessors follow up the referrals and consultations sent by AMEs and AeMCs. Of the four authorities, it is the only one whose published referral procedure I have been able to read: the vademecum of 27/11/2025.
- 🇧🇪 Belgium. The licensing authority is the Belgian Civil Aviation Authority (DGTA, FPS Mobility and Transport). I have not been able to read a referral procedure published by it: your AME knows the route, ask them.
- 🇨🇭 Switzerland. The Aviation Medicine Section of the FOCA (AMS). The FOCA writes that the section is in charge of oversight, supervises AeMCs and AMEs, and is the first instance of appeal in conflicts between aviation professionals and doctors (my translation from the French page). Published contact: ams@bazl.admin.ch.
- 🇱🇺 Luxembourg. The Directorate of Civil Aviation (DAC). Its licensing questions and answers page (modified on 22/10/2026) points to the list of Part-MED certified AMEs and does not describe a referral procedure.
Frequently asked questions
Is a referral to the licensing authority an unfit assessment?
Who decides on my fitness after a referral?
Can I fly during a referral?
How long does a referral take?
Which documents do I need to provide?
Does a TML limitation mean my file was referred?
Can I appeal against a referral?
Regulatory references
- Regulation (EU) No 1178/2011, Annex IV (Part-MED): MED.A.020, MED.A.025, MED.A.040, MED.A.050 "Referral", MED.B.001. Annex VI (Part-ARA): ARA.MED.125 "Referral to the licensing authority". Consolidated version on EUR-Lex.
- Implementing Regulation (EU) 2019/27, which replaced Subparts A and B of Part-MED: text published in the Official Journal.
- EASA, Easy Access Rules for Aircrew (November 2025 revision): AMC1 and GM1 MED.A.025, AMC1 and AMC2 MED.B.001, AMC1 ARA.MED.125, on the EASA website.
- DGAC, "Vademecum, guide de pratiques médico-administratives pour la médecine d'expertise de classe 1, 2, LAPL et PNC", created on 27/11/2025, in French: P03 and P07 "Procédure de renvoi", on ecologie.gouv.fr.
Your file is with the authority: what comes next, in order
This page explains what a referral is. The pilot medical guide gives the step-by-step process, what each of the four authorities publishes, and the template letter to request your medical file.
See the guide