The DAME should refer an applicant (or arrange referral through the applicant's usual general practitioner) for appropriate specialist review(s) and/or other investigations whenever a significant abnormality in the history or physical examination of an applicant is detected.
The CASA DAME Clinical practice guidelines (The Guidelines) guide DAMEs in conducting aviation medical examinations in accordance with the DAME Handbook. The Guidelines describe how CASA expects DAMEs will approach particular issues and matters during examinations. They may also indicate relevant factors and limitation types CASA may consider when deciding aviation medical certificate applications, noting its decisions are based on each applicant's circumstances. The Guidelines cover specific medical conditions as well as more general topics.
Unless an aeromedical specialist is being consulted, a referral should not to seek an opinion about whether the pilot meets the CASR medical standard. That decision rests in law with CASA, and its delegates.
Note: It is recommended that the headings listed in the Clinical Practice Guidelines are copied into the referral letter (MRS templates may be used, or where applicable, the downloadable report forms, e.g. for migraine).
Once the DAME has collated all relevant investigations and reports concerning the applicant, these should be uploaded and correctly labelled via MRS and sent to CASA. The DAME's own opinion about whether the applicant meets the required standard(s) for medical certification may be attached, and whether medical certification with appropriate conditions is compatible with the safety of air navigation.
Where an applicant fails to return for follow up or completion of the assessment is delayed for more than three months for any reason, the DAME should forward to CASA advice of the situation and upload any reports available. Thereafter, in the event of further delays, or of the applicant failing to return for review, the DAME should advise CASA by secure messaging in MRS. In general, inactive applications are administratively terminated after twelve months of inactivity.