Airman MedXPress Exam Submittal Process Page: 1 For DIWS Exam (MID) Number: 200004752955 MedXPress Applicant Name: Andreas Guenter Lubitz Applicant DOB: 128987 MedXPress Account Name: andreaslubitz@aol.com WP Address Used: 87.108.171827 Exam Create Date: 6/14/2070 Exam Signee/Submited On o6r4z010 Exam Confiration Number: 39873558 Cannel Var Paseword was weed by a MedXPress spplcan! for submission: — = AMCS Import Date: 6/8/2010 Exam Imported for AME Name/Number JOERG SIEDENBURG / 3015 Exam Imported from MedXPress JORG SIEDENBURG 12010 Peete eee rereneeee ae Ee TreeCrEREERER Exam Submited to FAA On: 6/18/2010 Exem Submitled for AME Name/Number: JOERG SIEDENBURG / 3015 Exam Submitted to FAA by: JORG SIEDENBURG DIWS MID Number: 200004752055 Exam Modification(s) by AME: ‘See Modification Comments below. "Riv carted tak Exarn Wodioatons were [_22010¥e0 by appcant Yes {Btn he maanline tere was «bi paid of reatve dressing sausag subsequent to excessive demanes . The applicant was evaluated by FCL 3 Class 1 Medical finess.; jecompensation jand found fit for JAR-cant t For Shaded Area! Form Approved OMB NO. 2120-0004 Sle porcine De Gi Ra “2 Soci SNOT rer os Bee TNT are concaet EL Fisttattr Reena! 1 Alana tgert rigtegesee El Prete 1 ober 1 concert 1 rionteaalr EF Sent Oye “uRPt Te Tea 7, ETS aaa FA WT GTEC ee ee Prony apr pe oo ayy noo a oo rr Won Cone ane) Whe Fog Tie Ewe ‘evened ans evi oso “rT elon” Have YOU VER W YOUR UFE REN DGHONED NIFH FAD, GR DO VOU PRENEVILY HAVE AN? OF THE FOLLONT ‘rey stn nbn OPA en Ynys PREVIOUSLY Heroes NOCMONGE oi eat Yen me Tae oo esse contton he res The conde ran [te ontion [ia] rar arco nein aor Fi [ay moc cece aleioeaceamwaen foe oie eae Yat [agaee spring tesalce [ mama emt ay oe Je. Binconecousness tox any rewsen ft. CO | Ed Stemsch, Pre or intetinal rouble Tesuintaancsinlnetst2ies Toy [paren bette or neat lsurance [a | Bley or vision rele excaptglanses |), CF | Bley stone cy baw i vine fo-C1 |b Alcobetcserrdence or abuse Js.) [dAdmincion io hospitet He roar i ecm po fama [oe em eo a igang ee ia fnecouocstceome sete [ata [anon scone warinnrmaraion fy cy [itaaci sendin ots Tae Coon Ta FORT Aen stay Sue Poe Tepe Scrum rea ie eae ae ata” ra fe eee SecEerorsuuaeeaeetacin ia eerste Para eee! Tipinwaiions: Seo istvuetions Fags “,Vls to Heath Professional Winn baat mE Yes Capen coh TK" Sor nntctons Page pcan Dale | Tame, Address and Type of Health Professional Consulted =} TNOTICE 20. Applicant National Driver Regjetr and Conlving Dacarations So STE RSET TUE FAA Form 8900-8 (3-02) Supersedes Previous Eiition COPY Confirmation Number: 38873566 HSN: 0052-00-670-6002Form 8500-8 Continuation Sheet ‘aa Medications (From page 1) Neon Prous Roenos 48, Explanations (From pone 1) = 1, Visits to Health Professional Within Last 3 Years. (rom page 1: FAA Form 8300-8 (3.08) Suporsedes Previous Edtion-COPY Confirmation Number: 38873566 NSN: 0052-00-670-6002st For Shaded AreasPLEASE PRINT Form Approved OMB NO, 2120-0034 Reon Se CURT Crmmetedel gy Ammingcimestirt “| rye aM Lom mone cumin See er oa Dare speiit CD Figeinamer 0 Recrestont 1 Ana Tans 1 ragitenseccr Pan Done 1 Comment 1 rin Nistor EY set Oye a Saas oar FER Riggs Daa ie et ee arin sped oF RVR “eit a Te ERAETROT ar ianpreaipani? capone ben) lay Rapa coor Tien tobe ee thie Firat “Gv Ite rave You EVER OURS aMNOS HHO [ne RLY HEPORTED.NG BSANGE: af expinaton fh een ws coal vos wo mae eee [me Sonar ti a i sO|eraicomeebaner (6G [raion pounce = Ed [ions cane 1a encanta fo | erah owt esere ca fon Seb erent E2221. [asta ty arse |< Co] ba Unconcciourness for any reason ft C3 | EStormch, fiver or intestinal rouble eavlawtcaneeie me st 2 yer Dy | eg rajcion for Ie cr he ron |e fatescorassoan cansieces YE tre meted nue [OEY [BT Acontipetenesoton fa [atin ein Ey nro jo eso oC [DAs ave [0 |Baorertom, aan orneaen) rca] era ering cance ra ereason sardonic [pgm acinnsecsenpreseason |p cy [pyieses dosti beet ‘| ole ofatet cage” [sO |a ole Fr, Ca aad Rare Aion Htory— See srueions Page N= Tay yang ares pa orn tin sv ena te es 2 Fe Te aca sige Seales cashes res esa et aya yas a fer Sees Co ee Ste ance fa ets el anges er (edema o heres. SES rca ate caso eaten pr Bee instructions Page sien tonber Fy 750 No sage ese pr Bm Reon recon Nove 200. 209 Tiss Hath Professional witin Lasts Years Tyan Roun bad Te ee [Bate arse Address, and Type of Heath Professional consulta Toor nonce Th Applicants National Diver Register and Goriying Declarations Siureene, wore sytig et cp crt on tn toy ter ke in Taam oat FAA Form 8500-8 (2-08) Supersedos Previous Elion -COPY NSN 9052.00.670-60n2NOTE: FAA/Original Copy of the Report of Medical Examination Must be TYPED. REPORT OF MEDICAL EXANINATION THREE Tana) | WTR BIRT amend of Demanatrated ABMTy {SCOAY i560) Co “80 Yer No Delact Moot [EREGIC EACH TENN APPROPRIATE COLUM oA CHECK EACH TENN APPROPRIATE COUT 25 Fd, ce neck ond oi Fr Waseda ston Paes ol AT 75. Nose 3B, Abdu and visas sony 2 Sse TE. Aras ate cone FE Mow nd ae 70. side 2 Eas, general paced coe ae Fi CU sania ae 30. Ear Dum Patan “FE Uiper and ver tronics Eesha SHER 1 Eyes general fam waa oa 22. Spine, ner mosaulskeletl [ 32. Ophsinoseasie Zeng Body at, sea, aioe Sen 3 Pups Rome aT S_Damphaes 1H Ooulor may nnn aT 6. Newebife Gamay spun soo iron ree [(25: tunga and heal psttsng meta T-Pain pment mat en Bi. est Pemaieati apenas ae 8. Constr SE Bos ay a aa Ear aps Pr lets sah ene Use ana shes acaeEOy 968 HSH FH scrotal ings l tho staminaton (tac a caneiston pos, ECGs, rays, ee tothe apart before mang) acta ee ee ia ates Cece he tc. phen seeing og St Ce a nce ees ieee Core mec Resa Page tas trade aba change fom Wo ‘ct caus aE ea eaten Raat Tanne are OF vu 5, Bist Ver Fix Wear Vison HR. tty ars et [ic wat Sym Conentorm ma 5, FRta of Vston Se a [earha—[einrpperiora| Ta ypephoa GH tomet T snoma t z a a B Blood Pasar ie Tne Test ea) Hee om (siting, mot Laid ocr panera awumn | supe _| ww [eo | yvvy ‘arcu 6 Ls a Neral _[ _Nomnol oar Tone OTT Gr Gorman ony Fntng_ AE ol capa on a VES seve he ea sty econo SETS] Significant Medical Metory as ow Abnormal Physiest Findings ves LN Ti Applicants Name Te Has Been zurd~ Fl yoceal Gutticae __ ClMedioa & Stren! Plot Genieate ANOREAS Guenter LUBITZ Dye crete prod ocmmun rete DPAAATE‘Duaed = scat d Ga. Biequaliying Detects (sty Nem numba TE Wcdica Examines Declaration = Vevey cy al rave pony tevewed oe meio try nd prsonalyormined oe appear med on Fee ccbatn paths poh ey stachmnet sees my fins completa ard rect ate of Examination Fiialon Medleal Exeninor same {ToeRG SIEDENBURG mu [oo|yyyy _ tiaaadrer o5r872010 WEG BEM JAGER 199, E9128 ARES aa TER STEN aR GTS ee [ry Tale “tp Coes ag [ANE Telephone FAA Fars GEO (TH SopTECGG Previous Eaon- COPY SRE PDO STO BZForm 8500-8 Continuation Sheet ANDREAS Guenter LUBITZ 100004752955 Applicant Nami Applicant MID “11. Medications (From page 1: Meceaton Pres Rents 18. Explanations (From page tt 19. Visite to Health Professional Wii at Yeare. (From page 1: Notes (rom pase 2): other Teste ven (From page 2 ‘Comments on History and Findings (From page 2 Co i nti atarone desi cama by aderonpesaton absentia exces deans The soteet wa at ai re Eerie rer eager ier ae ae I ar a a name odteson cere am ANE Ta estes re vor ei ead of acne ‘Agpicont Previously Assessed Tue GGA wiagnocls and is on Special Issuance. Repost flow. HE Has Osa aiagnoste avd is carrey Bet treated OR fas had prov Applicant Wot a Fisk Tia tatermmed to HOT be ‘Applicant at Rauteventy tobe Aaszssat PE Jroeuss OSA da wah aan ano provide educations ates ELE ACS or ona, ASM cloop apnea seaessment required. Reports to folow. Applicant Rikisaverty Nigh Fee Suet immmdite safty risk. AAGM sleep apnea assessment required, Raports to fotow, ISA asserement. HOT on Special Insuance, Reports to fellow. FINA Ferm 8500-8 (299) Supersedes Previous Elon COPY NSW: 9052.00 670-8002Departmont of Transportation 6x.0260689 | Groomer nLoY cEeririexTe MEDICAL CERTIFICATE THIRD CLASS ey AND STUDENT PILOT CERTIFICATE e | [iis at Fae Sa Es “ANDREAS Gussie LUBITZ Germany Dawe weit [Heat | Weak] Hee] iia” a | 1 aod ae Td ‘has mel te medial ands prascobed In pat OT, Federal Avion | Registers, fois cacsof Medeal Cerificate, er SERTIEICATED WSTRUGTOR ENGOREENENT FOR STUBENT POTS ‘ro Here Nislon Node xara ay i 3 ae 4 Witlins aumaun.r0 Heaps |A raison Wh ‘Rests 7001387238 “Gartol WS 790004752955 a5 AEROSPACE MEDICAL CERTIFICATION DIVISION, AAM - 300 FAA Chil Aerospace Modical Institute | Mike Monroney Aeronautical Center } P.0 Box 26080 Oklahoma City, OK 73125-9814 ANDREAS Guenter LUBITZ Germany Dear Aismen: ‘Above is your mew medical cerifeate-Itsupersdes any previous one. you may hae been isued “To validate this centifieate, itis necesemy thet you sign it inthe space provided (Airman's Signature). “This ettfcate must be ia your possesion tal times while exercising your pilot privileges.@ US. Department ic Woeoney Aeon Care F.0. Box 25080 (of Transportation ‘Gh Aerospace Metical institute (CAM) Sktshoma City, OK 73125-0914 ‘ ; Serie Cottcason ONO Federal Aviation ‘Administration guly 08, 2020 ANDREAS GUENTER LUBITZ GERMANY Ref: PI# 2169319 App IDF 2001587238 Dear Mx. Lubitz: Your report of physical examination has been received. Based upon our review xe the information submitted, we are unable te establish your eligibility to hold an airman medical certificate at this time. pue to your history of reactive depression, please submit a cusrent detailed ptatus yeport from your prescribing physician. The report should include the Sete nedicetion(s) were discontinued and confirmation of no recurrence of Geuptoms since discontinuing medication(s). The report shovld also include Glagnosis, prognosis without medication(s), follow-up plan, and copies of treatment records. upon review of the aforementioned information, additional data may be aquired Following our xeview of the requested-data, we will notity you regarding yous pligibility for medical certification. We will appreciate your use of the above reference numbers on any correspondence Please note that your medical certification has not been denied at this time; jouever, if no reply is received within 30 days from the date of this letter, ae aii have no alternative except to deny your application in accordance ween Title 14 of the Code of Federal Regulations (CFRs), Section 67.413 Sincerely, Sedeg Dayne. Warren §. Silberman, D.O., M.P.H. Manager, Aerospace Medical Certification Division civil Aerospace Medical Institute ce: Joerg Siedenburg M.D. oke/tdz@ US. Department ike Monraney Aeronautical Contr P.0. Box 26080 of Transportation (Givi Asrospace Medica istute (CAM) Oklahoma Cy, OK 731254914 ‘Aerospace Mesioal Cortatlon Diision Federal Aviation Administration uly 28, 2010 ANDREAS CUENTER LUBITE GERMANY Ref: PI# 2169329 App Ip# 2001587238 Dear Mr. Lubitz: our review of your medical records hac established that you are eligible for 2 third-clase medical certificate Enclosed is your medical certificate. Tt requires your signature You are cautioned to abide by Title 14 of the Code of Federal Regulations [GERs), Section 61.53, relating to physical deficiency. Because of your history of reactive depression, operation of zircraft is prohibited at any tine new symptons or adverse changes occur or any time medication and/or treatment is required. use of the above reference numbers on future correspondence and/or reports will aid ns in locating your file Warren S. Silberman, D.0., 1.P.it Manager, Aerospace Medical Certification Division Civil Aerospace Medical Institute Enclosure edenburg M.Sine san prose seater meee Scene sos “oan Sais ote i. RRB Se afi AOAARAA MMOD a.2 Us Depatiront vice Yowoney Aaoraual Cast 9.028090 erent aA earn items Sm OK Tar25-044 Federal Aviation foe Aelmiieetion poly 08, 2010 swoneas CUENTER IIT” Ref: Prb 2169319 App 1D8 2001587238 Dear Wr. Lubites Your seport of physical examination has been xeceived. Based vpon our ovis Your, seport ot Enh sumnitted, we are unable to establish your eligibility se a etn aimman Redical cercificate at this tine nue to your history of reactive depression, please submit « current detalted ae te eee toe your prescribing physician. The report should include she dees eee rtonia) were discontigued end confirnation of no recurrence of care ae rete discontinuing nedication(s). The report, should s1s0 include Sree ee RCegnoeia withovt medication(s), followup plan and copies of Ceeatnent records. ‘pon roview of the afoxenentioaed Snfoxmation, additional data aay be varmired. scliowing our review of tue reguested date, ve wilt notify you regarding, yoor Fyne oe ac mesical ‘cortafication. » We-will apprcesate your sse of (he sae eSeetence mambers on any correspondence eiease note that your wedicel certification has act been denied ot, tts, tine: Please note hae oy ta received within 30 days fron tho date of this Letter however SF ne eltarmative except to depy your application in accordanck we a aes (Be the Code of Federal Kegalations {CFRs], Section 67.413 pono cet Joerg Siedenburg #.D- ske/tdeJOERG STEDEREDRG H.0. AIRPORTRING OR 22 reaeruat 69546 CERHANY,(Certified translation from German —— Phone Medical specialist for psychiatry and psychotherapy Fax Clinic ea: SER «= 10° July, 2009 Andreas Lubitz, born on 18” December, 1957, a Dear Colleague, ‘i Anammesis: ‘A-considerable remission has been obtained by medication with Cipralex and Mirtazapin, as ‘well 2s by a psychotherapeutic treatment. Finally, the medication has been tapered. Reychopathologie Lindings: Patient alert and mentally fully oriented, with no retentivty or memory disorders; formal train of thoughts without pathologic findings, no phobias and compulsions; no delusion; no alusia ‘or depezsonalisation; emotionally stable; oscillatory, capeble of exercise; no sleep disorders. Diagno: (ICD+F32.2G) Sovece depressive episode without psychctic symptoms in complete remission Bpierisis ana therapy: Tethe ease of Me, Lubitz, mosifed living conditions caved the onset ofa depresive episode {By a drug therapy anda paychotherapetc weatment, which enabled im to develop the sufficient resources for geting on with sila stuetions inthe fat, the complete remission vas cbisined, The medication could be stopped Mr Lubit completely recovered, there i ot any residuum remained, The treatment hes been finished, Best a “This segort computer generate, ace iis lid witout signatre, ‘a demand, xe sal gladly oad yous cxpy wih slgnatare, c~ gmt Obe 1s VROHYIND.. ovasou? giaatssoThe correctness and completeness of the above translation from German is hereby certified. Grosshaysdorf, 24.740 fourts and public proseci ‘State Schleswig-Holstein. Sy, Hoaeyernepente 1 \ ‘aeteeerman wow ga7r } Teetac On& (Certified translation from German oe Dipl Psyc Psychological psychotherapist Psychotherapist for children and juvenites Me. Andreas Lubitz a) — a 23" February, 2010 Psychological Peychotherapeutic Certificate Mi, Andreas Lubitz, born on 18 December, 1987, resident in "was under my psychotheropentio teatunent from January to October 2009. Mr. Mrabit! high motivation and active participation contsibured tothe sucocssful completion of fhe treatment, after the management of symptoms. pL? beycholopial psychotherapist Signature Peyahotherpist for clildren and joveilesCertified translation from German Phone: ———- fepecalist for psychiatry aud psychotherapy ° Fox: t Clinic F \f IN 2 10 ry, 2009 “Anéreat Labi, born on 18" Decca, 25, TT, DearCollagne, “7 Anamaesis: ‘A-considizable remission hse boon obtained by medication with Cipmalex and Mirtaapia, #8 {yell ashy a psychotherapautic freaboent. Finally, the medication has been tapered. Payshopethologie finding Paljeot ster and mentally flly cated, wi no reteaivty or memory disorders; formal trax Uithoughts witht pedhoFogie Rings 39 phobias and compulsions; no delusen, ne akite ‘or depersonalsitoa, aotionally sable; oscillatory, capable of exercise; no sleep disordes. Diagnosis: (CEF52 2G) Severe depressive episode without psychotic symptoms in complete remission ‘Bpiecsis na therapy: Inthe cose of Mn. Lubitz, modified living conditions caused the ansct of m depressive episode. ‘By a diag therapy and a payehotherepactic treatment, which enabied him to develop the ficient esounces foc geting on with sila sitatioos in the future, the complete emission: ‘was obtained. The medication could be stopp Ir Lubite completely recovered, there is nol any residuum remained, The treatment has bee Sinished. . Bestreguds - “Triste compa goed Sanco tied wit gene ‘Onc, we snl lly nd you xcopy nt gateThe correctness and completeness of the whove translation from German is kereby certified. Ei Grosshapsdorf, 24 #40 iy aultorlsed for the ‘fanstatot for English, offiey iohs authorities of the Federal fourts and public prosect ‘State Schleswig-Holstein. Ee los 217 =Certified translation from German ad Poychological psychotherapist Peychothecapist fr elven and juveniles 2g eebrumy, 2010 ‘Peychological Pesehotherapentic Cortiscate ‘ve, Andceas Labite, bam on 18" December 1987, resident Fry peholieepeti tment fom Jaaary 9 OFabe! 20 RE even cou ave pticipton cone he ssc cxieson of fhe treatment, afer the management of SymDIOmS. Diph-Psychl Psychological psychotherapist Signenoe Peyehotherapis or eldren aa javenitesAirman MedXPress Exam Submittal Process Page: 1 For DIWS Exam (MID) Number: 200003801199 MedXPress Applicant Name: Andreas Guentor Lubitz ‘Applicant DOB: 1218/1987 MedXPress Account Name: ‘andreasiubitz@aol.com IP Address Used: 87.168.118.27 Exam Create 4/04/2008 Exam Signed/Submitted On 4yo4r2008 Exam Confirmation Number: 714135444 | Coneet User Password was used by No | _MeoxPress applicant for submission: it AMCS Import Date: ‘04/09/2008 am inpelted a MATTHIAS JAVON MUELMANN / 15851 Name/Number, ae as Exam imported from MedXPross MATTHIAS J A VON MUELMANN, Exam Date: 419/2608 Exam Submitted fo FAA On: 04/09/2008 Exam Submited for AME NameiNumbor: | MATTHIAS JA VON MUELMANN / 15854 ‘Exam Submitted to FAA by: MATTHIAS J A VON MUELMANN DIWS MID Number: 200003801199 Exam Modification(s) by AME: TRIE ceaiod that Exam Mocifeatons were ‘approved by sppicantcept For Shaded Area: Form Approved OMB NO. 2120-0034 A Sens a Perce Ce oa ae SP oo SSSR EET OR Cicero _Oxmany ao | Swe we [ casas ET Ra ETT TE = i Th nee TE ae Spit CD ptorntr TD Mares! E i | Ti ropeenibeer BD Pr 1 onw le ete es oe a | || 5 comet i rigavemaccoc _ Seset ie gues Desde aren Sa Beg tepeate ceiimitn Fle “a ET TE OT Tea CRATER a Ra a ie senna 8 ie eee “i Ba You Ere sy Healt reason a Woven)? ee Ei Liver Gree bow tno) vod md chccopropinatn. Pry Rept eee He toa a = ise oo | ee ON i oo fo || ee (reed nae stein a FS Sa Meee NO CANES oy Hie suntan of tcenon ws i ice ec tne town noc pn on pee eae fo i finaaracmocnee | [oa] epoeoes a ang ont Iota | earn tow tnoe panne [nt [BISA Src te a esi cory mtg sin a a eg) Ce] CL dL ce [clearness pt [anne Yio man ening or \ caf ettie ig creme [ee ENE | min sn mnt nein atl onvcton anlar RamTTeTAVG Raion History ~ Sew istvetions Page FeO nrc egaamni eteginin om inenety umes tea eta] Pista Shakers os mtny of ny cmon) or aii aos) meted jE | tortion of Se eee | Siindeaaunial Explanations aise to Toth Professional Wiha Last Yeas TW yer omntem So ee Sex netracons Page Ba a Tia, Kisass, and Type of Hesih Protessfoval Consul = Fer Rppieants National Diver Register and Cerifying Deciarations Geeta ye | mmeuicnavanmetmaaetioaate rice peace Ra A sR Enea yn Fema hte oa FAA Form 8500-8 (98) Supersedes Previous Edition COPY ‘NBN: 0052.00 670 €002Form 8500-8 Continuation Sheet 17. Medications (From page 1: 18, Explanations (From page to Heath Profecetonal Watio Lart Years. (From pane fh FAA Form 8800.8 (9-08) Suparsades Previous Extion-COPY Confirmation Number: 71413544841 NW cos2-00.670-e002For Shaded Area: Form Approved OMB NO. 2120-0094 W Rea Sen gy Aan Mee Se poe eee are el permenant Bw Gas Ba ‘ure ANOREAS ‘uses ed tear oo — ee’ _| ey Coe ‘ces Comey aon | ave ne Reps Se ST TST Onore Ty mre specni Cl Fettrtncer C1 Resta Dh siearspot Ch Yitetncer 8 te 1D ote 1 comme 1 rigor St ca nae Caer Re Ban, ae ROTA Dive Bt Hresie ate a cr Ee an ian FAR WET og 2 [= eon [a a You one a eon rein w Napa Tre, ED ves tyes ese tatnnietat) ook echo appoint), Preven igre sea gears eee EC RO 2 Ue ee ee vin tomcionelWifiyng? Oye Dine | SO RUSEE Sen ARERR eon mentee Se ar cnn "Forfeit Tal ieee eee me Sram a fo ESSE fe Joes a epoeaieornng seat fra] eorineriwecmooe [aD ee ata a eacal ton by nian sevice |<. CA] Unconsciousness for any reas mach ter.crinesteat cute |_| — inwetaniz years 1 5 | pyReincion foro or heats naar | ieye owen vette enaet gomene [| Kiyo or Boca in wine fed |B Ache dopencence or see [oC | rission te hosp [ct eremronmay Sac ao Elona ren nity Oo J arrve hra seem poems” [0 SR REM Raion Tony Sotstitons PAGE ale Gees ensesecerana : Vala eaecer Seene en wtiee ein catsetnttoniogan fecrcetenar: orcs SPREE Sas ee Ty aera tee nsictone aa [Wich Hess Pstsainal Wain bass Year [— ox Tame, Aire, wi Type of Heath Profesional Conse jE To. Recents National ver Fglstr and Certying Declarations vom: repeat re Bem™s* RES Sanaa eprae ource FAA Forma 8500.5 (398) Supersedes Previous Eation = COPY ‘WAN; 0952 00-670-8002Not! -ANOriginal Copy of the Report of Medical Examination Must be TYPED. REPORT OF MEDICAL PXATHNATION LRT TRSREST | BE WERT OURTEY TF Sateent of Demonstrated Roy (SCAT Sra RT| er "82 vee of No Nod Hono ee, TRTECOCUT oT] SET CHEE EACH TER TW APPROPRIATE COT si SREERERET TERT AP Sen a Ha or — Fx Sd aie ¥ a oda a Fake z Se 7 Z& Mouth and brrost — x] 20, Stan x Be ae eT aa REO ae es TH. Eyes, general (ker under tame £910 4) saa % 43. Spine, cther musculoskeletal x omen x ed SPs Bene cp Dyess x Se ar naity pean eens [35 Longa and chest quanta ee morta) ¥ “ET, Psych able Pepeorer=n bohwsn, mend, I 9 MIMI ¥ SER Sa ee i We coos aie 3 daa aa Ear SST Ten res aah CoRR i lars Tosca ond arn ETS Tareas EE Tae TRE are OF nese [0 a = 7 S6-Disant sion aie Ti Inteasecitn Viton 32 ches] Be: Coker Vil mt Sanaa Tere Tt 8% cheaatcse mae bom _}er20___Comemato 04 we ioe comemaway pom 20/20 Coracnatoza oon Fea ot Vision a, HELToGHS aT OPT Ceophors Erophari [Rian Fyperona | TERAYperphers Moral C1 Abner ° 7 a ® 35 Blood Pressure ae Tiina Tat toma se ees Ba (ing a of pce Norma ‘een =f Ab | sumer Le Lop | vey ba 6 i a eR [rcnertanarer arson ina Wacoal sory nation and fr fore maliog) Go. Commants on Ristory und Findings: AME sail comment on al “Es Foo erngs of tha examination (ath al coneuaion opt, ECGS, X-rays, et. to BBrepeK Siaiticont Medical History oes ano Abnormal Physical Findings YES Gt. Applicants Name Ties Boontecued— EL yeticalCorscate Dk Model & Stan: Pot Cartcate ANDREAS GuonterLUBIT? jn Ceviicatlsuved Goes FurtetEmuston FAA ATC: Deferred ~ No Carel end Free aren Sena taiorel nati (Oy Ashe isqualiying Defects (sty tam burober) GECMGTaT camino Da HGR Vay Coal perma vie esa i and pnenaly cnn oe ent are on ‘ate of Examination “ation Weal Examiners Warne taarTning J A VON MUELMANRE RTT HT STRAP TSE cum [oo |yyvy __ [Srestasaess eee Uiesaae Pea Pur aE aa aor TST : ‘ity FRANKFURT AM State Fip Code ase [AME Tetophone «06069047601 FAA Form OE00-5 (3-88) Supersedes Previous Eslon COPY NEN: DOEOFOTESOOEForm 8500-8 Continuation Sheet Applicant Name : ANDREAS Guenter LUBITZ ‘Applicant MID: 200003801199 ‘a. Mecications (From page ti: teteon Prony Rpts 418, Explanations (From page 1 49. Visto Heath Professional Within Last 3 Years. (From page MI, Notes (From page 2} ‘otner Tests Given (From page 2} Comments on Hetory are Findings (Frm page 2): Aoplicant Previously Assassed {] 1. Has OSA diogrosis and Is on Speci lesuance. Reports to fellow. 2s Osa dosrcosis and is earnenty bey treated OR has had provious OSA assesement NOT on Special ssuance. Reports f foow. (cant Hot ke 1} 3 Determined fo NOT be lis for OSA at ns examinstion. Applicant st lsuSevery tobe Assessed Ty Dieeues DA ret with man and provide educatlonal mates HE Rieik tor OSA: AASM cleop apne sazerement requited. ports fo follow Applicant RiskiSevsety Nah Phe Dosen mamediate softy rick, AAS rent ciqlad. Reports ‘0 oon FAR Form 8900-8 (3-98) Supersedes Previous Ealion -COPY Nsw 0052.09.670.6002