Medical Documentation Template - Accessible America

⚠️ Important Privacy Notice

Protect Your Medical Privacy: Only provide the minimum medical information necessary for your accommodation. You are not required to disclose your specific diagnosis - focus on functional limitations and accommodation needs.

TSA Disability Notification Card

Purpose: Discreet communication tool for TSA screening. Optional but helpful for expediting security processes.

Full Name:

Contact Information:

Medical Condition:

Special Assistance Needed:

Medical Equipment:

Note: This card does not exempt you from screening but enables alternative procedures. Present to TSA officer at checkpoint.

Service Animal Documentation Letter

Healthcare Provider Template: This letter should be on official letterhead with provider's licensing information.

[Date]

To Whom It May Concern:

I am a licensed [healthcare provider type] in the state of [state]. I am providing this letter to verify that [patient name] is my patient and is a person with a disability as defined by the Americans with Disabilities Act.

[Patient name] has a disability that substantially limits one or more major life activities. This individual's disability causes functional limitations with:
• [List relevant functional limitations - avoid specific diagnoses]

I have determined that [patient name] requires the use of a service dog to mitigate their disability-related limitations. The service dog has been individually trained to perform specific tasks related to the person's disability.

This letter verifies that [patient name] has a disability-related need for their service dog and that the animal is trained to perform work or tasks related to their disability.

If you have questions regarding this letter, please contact me at [phone number].

Sincerely,

[Provider signature]
[Provider name, credentials]
[License number]
[Contact information]
            

DOT Service Animal Air Transportation Form

Required for Air Travel: Must be submitted to airline 48 hours before flight. Available on airline websites.

Passenger Information:

Service Animal Details:

Training Certification:

Health Attestation:

Relief Attestation (flights >8 hrs):

Medical Equipment Travel Letter

Healthcare Provider Template: For medical devices, medications, and equipment.

[Date]

To Whom It May Concern:

This letter is to certify that [patient name] is under my medical care and requires the following medical equipment/medications for their health condition:

Medical Equipment:
• [List specific equipment - wheelchair, oxygen concentrator, insulin pump, etc.]
• [Include model numbers and specifications if needed for air travel]

Medications:
• [List medications requiring liquid allowances >3.4oz]
• [Specify if refrigeration is required]
• [Note any controlled substances with proper documentation]

This equipment/medication is medically necessary for this patient's health and safety during travel. The patient should not be separated from these items.

Please contact me at [phone number] if you require any additional information.

Sincerely,

[Provider signature]
[Provider name, MD/credentials]
[Medical license number]
[Practice address and phone]
            

✈️ TSA Cares Program

Free assistance for travelers with disabilities:

📞 Phone: (855) 787-2227

⏰ Call: 72 hours before departure

🎯 Helps with: Security screening procedures, medical equipment, service animals, communication assistance

Pre-Travel Medical Checklist

Contact TSA Cares 72+ hours before departure
Confirm airline policies for medical equipment
Prepare service animal documentation (48 hrs before flight)
Pack essential medications in carry-on with extra supply
Print copies of all medical documentation
Verify medical device battery requirements for flights
Research destination medical facilities if needed
Confirm international vaccination/health requirements
Pack medication in original pharmacy bottles with labels
Prepare TSA notification card if using medical devices
Contact airline about wheelchair/mobility device policies
Arrange for accessible seating and accommodations

🌍 International Travel Requirements

CDC Dog Import Requirements: Service animals entering the US need CDC Dog Import Form and rabies vaccination documentation.

Medication Restrictions: Research destination country's medication import laws. Some prescription medications are restricted or require special permits.

Medical Insurance: Consider travel medical insurance that covers pre-existing conditions and medical evacuation.

📞 Emergency & Support Contacts

TSA Cares: (855) 787-2227

DOT Disability Hotline: (800) 778-4838

CDC Traveler's Health: (800) 232-4636

State Dept (Citizens Abroad): (888) 407-4747

Your Healthcare Provider: ________________________

Emergency Contact: ________________________

About This Document

This template compiles official requirements from TSA, DOT, and CDC for medical travel documentation. Always check current requirements on official government websites before travel, as regulations may change.

Provided by AccessibleAmerica.org - Your comprehensive guide to accessible travel resources and destinations.