Category 1 Medical Certificate — Complete Guide

Who Needs a Category 1 Medical?

A Category 1 (Cat 1) medical certificate is required for:

• Airline Transport Pilot Licence (ATPL) holders operating as pilot-in-command (PIC) or co-pilot on commercial air transport operations
• Commercial Pilot Licence (CPL) holders exercising privileges under that licence
• Multi-crew Pilot Licence (MPL) holders
• Pilots exercising commercial privileges (e.g. IFR airline, charter, or medevac operations) under a CPL, ATPL, or MPL, including those using an Instrument Rating for those commercial flights
• Flight crew members on aircraft requiring more than one pilot

If you hold a CPL and are flying for hire or reward, you need a Cat 1. If you are flying commercially as a co-pilot on an airliner, you need a Cat 1. This is the most rigorous of the three pilot medical categories.

A valid Category 1 medical also satisfies the requirements of Category 2 and Category 3 for its remaining validity period, unless Transport Canada has imposed a specific limitation. Holders of a Cat 1 do not need a separate Cat 2 or Cat 3 certificate.

Reference: CARs 401.05, 401.15, 404.04; TP 13312

What Does a Cat 1 Medical Involve?

A Cat 1 medical is a comprehensive physical and mental health examination. Your CAME will assess the following:

Vision

• Distant visual acuity: 6/9 or better in each eye separately (corrected or uncorrected), and 6/6 or better with both eyes together
• Near visual acuity: N5 or better at 30-50 cm and N14 at 100 cm with both eyes
• Normal colour vision required (Ishihara plates or equivalent)
• Normal visual fields
• No active pathology of the eye or adnexa that would interfere with safe exercise of licence privileges
• Contact lenses are permitted provided vision standards are met

Hearing

• Able to hear a conversational voice in a quiet room at 2 metres with back turned, in each ear separately
• Audiometric testing may be required if hearing loss is suspected

Cardiovascular

• Resting ECG required (12-lead electrocardiogram)
• ECG schedule follows TP 13312 guidance — see ECG Requirements section below
• Blood pressure must not exceed 160/100 mmHg
• No history of myocardial infarction without satisfactory specialist assessment
• No significant cardiac arrhythmia without satisfactory specialist assessment

Respiratory

• No active tuberculosis
• No significant respiratory disease that would interfere with safe exercise of privileges

Neurological

• No epilepsy or history of epileptic seizure after age 5 (with limited exceptions)
• No significant disturbance of consciousness
• No progressive neurological disease

Psychiatric / Mental Health

• No established diagnosis of psychosis
• No established diagnosis of bipolar disorder without specialist assessment
• Substance dependence is disqualifying; substance abuse requires specialist assessment
• Depression and anxiety are assessed on a case-by-case basis — many pilots with treated mental health conditions maintain Cat 1 certification

Metabolic / Endocrine

• Diabetes mellitus requiring insulin is usually incompatible with a standard Cat 1 certificate; Transport Canada may consider very select cases under special issuance or with restrictions based on detailed endocrinology assessment and current Civil Aviation Medicine policy. Oral medication-treated diabetes is assessed individually.
• Thyroid conditions are assessed on stability and treatment

General

• No established diagnosis of any condition that makes it likely the applicant will become incapacitated
• Body mass index (BMI) is noted but not automatically disqualifying

Reference: CARs 404.04; Transport Canada TP 13312 Medical Fitness Standards

ECG Requirements

The ECG (electrocardiogram) is a unique requirement of the Cat 1 medical — it is not required for Cat 3. Your CAME may perform the ECG in-office if they have the equipment, or refer you to a clinic.

ECG schedule for Cat 1 (minimum Transport Canada standard):

ECG frequency is not hard-coded in CARs 404.04 — it follows TP 13312 standards and your CAME’s assessment:

Note: The exact schedule for your case is determined by your CAME using TP 13312 and current Civil Aviation Medicine guidance. Some operators or individual risk profiles require more frequent ECGs than these minimums. Always confirm with your CAME. See TP 13312 for full standards.

If your CAME does not have ECG equipment on-site, they will refer you to a clinic. This is common — always ask before your appointment whether ECG is available or whether you need to arrange it separately. The ECG fee is often charged separately from the medical examination fee.

Reference: CARs 404.04(3); TP 13312

How Much Does a Cat 1 Medical Cost?

Cat 1 is the most expensive pilot medical. Pricing across Canada varies significantly by province, clinic type, and whether ECG is included.

Typical ranges (2025-2026):
– Examination fee: $250 — $450
– ECG (if not included): $50 — $150 additional
– Specialist referrals (if required): additional cost, varies

Our directory shows human-verified pricing for CAMEs across Canada. Search for a CAME near you to see current pricing.

How Long Is a Cat 1 Medical Valid?

Validity depends on your age at the time of issue:

Note: Employers and operators may require more frequent renewals than these regulatory minimums — check your company operations manual.

This means pilots 40 or older must renew their Cat 1 every 6 months. Many schedule two medicals per year — plan accordingly.

Reference: CARs 404.04(2)

What Happens If You Are Found Unfit?

If your CAME determines you do not meet Cat 1 standards, they will issue a Notice of Assessment. You have the right to:

1. Request a review by Transport Canada’s Civil Aviation Medicine (TCAM) branch
2. Provide additional specialist reports or evidence
3. Apply for a Special Medical Certificate if your condition is stable and managed

Many conditions that initially appear disqualifying can be accommodated with proper specialist documentation. Do not assume a finding at your medical is the end of your flying career — consult with Transport Canada Civil Aviation Medicine directly.

Contact: Transport Canada Civil Aviation Medicine — 1-800-305-2059

Tips for Your Cat 1 Examination

• Book early. Cat 1 medicals can require follow-up testing — don’t leave renewal to the last week before your certificate expires.
• Bring your current certificate and any previous medical history relevant to your examination.
• Disclose everything. Failing to disclose a medical condition is a serious offence under the Aeronautics Act and can result in licence suspension.
• Bring your glasses or contact lenses if you use them for vision correction.
• Ask about ECG before your appointment — whether it’s included and whether there is an additional fee.
• Rested and hydrated. Blood pressure readings can be affected by fatigue, caffeine, and dehydration. Avoid caffeine on the morning of your appointment.
• Bring a list of medications. Your CAME needs a complete medication list including supplements.

Transport Canada Civil Aviation Medicine (TCAM)
– Phone: 1-800-305-2059
– Email: tc.aviationmedicine-medecineaeronautique.tc@tc.gc.ca
– Web: tc.canada.ca/en/aviation/licensing-pilots-crew-members/medical-fitness