Are electronic signatures accepted for this form?

Yes. Electronic signatures are generally legally valid under the ESIGN Act (15 U.S.C. ch. 96, 2000) and UETA where adopted. Acceptance can vary by destination authority; verify carrier and entry requirements before travel.

Does submitting the form share my health data?

Yes. Submitting typically shares relevant fields with the airline and, where required, public-health authorities. When PHI is involved, HIPAA protections apply and a Business Associate Agreement may be required for third-party processors.

What if I develop symptoms after I submit the form?

Report new symptoms to the airline and local health authorities immediately. An updated declaration or additional screening may be required; failure to report can lead to denial of travel or other public-health measures.

How can I correct a mistake after submission?

Contact the airline or submit a corrected declaration if the workflow allows amendments. Maintain copies of both submissions to document changes and the timing of corrections.

Can a parent sign for a minor?

Yes. A parent or legal guardian may complete and sign the declaration on behalf of a minor; carry documentation proving guardianship if requested by authorities.

How long is a submitted form valid?

Validity is set by the airline or destination. Many forms are valid only for a narrow pre-departure window (commonly 24–72 hours). Confirm with the carrier for exact validity rules.

Electronic Signature
Templates
Healthcare
Kenya Airways Health Declaration Form

Kenya Airways Health Declaration Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

MEDICAL INFORMATION – MEDIF CARD

To be completed by KQ APPOINTED PMC DOCTOR or ATTENDING PHYSICIAN

This form is intended to provide CONFIDENTIAL information to enable the airlines’ MEDICAL Department to assess the Fitness of the passenger to travel. If the passenger is acceptable this information will permit the issuance of the necessary directives designed to provide for the passengers’ welfare and comfort. The PHYSICIAN ATTENDING the incapacitated passenger is requested to ANSWER ALL QUESTIONS. Enter a cross “X” or tick “√” in the appropriate ‘Yes or No’ boxes and/or give precise concise answers). PLEASE COMPLETE THIS FORM IN BLOCK LETTERS

This form must be returned to the Head of Medical and Occupational Health

KQ / MEDA01

Patient Title Name Sex Age

Flight Details

From To Date

MEDA02 Relevant Medical History / Other Related Medical Conditions

Compulsory Tests

All Adults – Blood Pressure

Diabetics – Random Blood Sugar

Respiratory / Cardiac Cases – Oxygen Saturation in room air (%)

Pregnant Mothers – Gestational Weeks

Due date

Complications so far

Co-morbidities

CNS Cases – Glasgow Coma Scale Score

Any other additional results

Current Hemoglobin Level (Compulsory) Date Checked

Please note: This document is only valid if tests are completed within 5 days of submission of form

Detailed Diagnosis

Current Clinical Status

MEDA03 Recent Surgical History

Diagnosis / Reason for Surgery

Date Surgery Done

MEDA04 Prognosis under reduced atmospheric and Oxygen pressure at the flight altitude.

MEDA05 Any Contagious AND communicable diseases?

NO YES

MEDA06 Would the physical and /or mental condition of the patient cause distress or discomfort to other passengers?

NO YES

MEDA07 Can patient use normal aircraft seat with seat back placed in upright position when so required?

NO YES

MEDA08 Can patient take care of his own needs on board UNASSISTED* (Including meals, visit to toilet, etc)?

YES NO

Does the passenger require special meals on board?

YES NO

Kenya Airway’s medical clearance process begins with a declaration of illness or incapacitation by a passenger at first point of contact with the company. It involves getting information from your medical doctor or other healthcare provider. KQ will uphold professional ethics and high integrity, and reserves the right and discretion to accept, reject or cancel any medical clearances received. Medical clearance will be done based on PMC conditions as defined by the airline according to IATA guidelines.

MEDICAL INFORMATION – MEDIF CARD

MEDA09

According to your evaluation, does the passenger need an escort?

YES NO IF YES Medical escort (Attach Professional Certificate) Non-Medical escort

MEDA010

Does the patient need OXYGEN? YES Stand-by Oxygen Continuous Flow Oxygen If continuous, what is the rate in liters/Min? NO

Does the patient need medical equipment in flight Yes No

Type of equipment Powered Battery powered?

Manual Electrical power source? DC / AC Volts

MEDA011

Does patient need any MEDICATION during the flight? YES NO

If yes, indicate type of medicine and instructions.

MEDA012

a) Does patient need hospitalization during long layover night stop at CONNECTING POINTS en route? NO YES Have any arrangement been made for that? Yes No

b) Any arrangement made for an ambulance to pick up the passenger? Yes No

MEDA013

Please indicate any other information necessary for the patient’s smooth and comfortable flight.

MEDA014

Other arrangements made by the attending physician:

NOTE.

Cabin attendants are NOT authorized to give extraneous services (e.g. lifting) to particular passengers, to the detriment of service to other passengers. Additionally, they are trained only in FIRST AID and are NOT PERMITTED to administer or give any medication.

IMPORTANT:

Any fees that is payable in respect of the provision of the above information and any special equipment provided by the airline is payable by the passenger concerned.

NOTE: All Stretcher Cases And Patients Requiring Oxygen On Board MUST BE ACCOMPANIED BY A MEDICAL ESCORT

Name of Doctor Date Address Tel GSMTel The name of Hospital / Practice Tel

Official Stamp

PASSENGERS DECLARATION

“I Mr, Mrs, Ms. Dr. Prof. do hereby authorize Dr. to provide the information required by Kenya Airways Medical division for the purpose of determining my fitness for air travel and in consideration thereof, I hereby relieve the above named doctor of his/her professional duty of confidentiality in respect of such information, and agree to meet his/her fee for the service so given.

I take note that, if accepted for carriage, my journey will be subject to the general conditions of carriage/tariffs of the Kenya airways and that the airline does not assume any special liability exceeding those conditions/tariffs.

I agree to reimburse the carrier upon demand for any special expenditures or costs in connection with my carriage”

Name of passenger / guardian Address Tel GSMTel Passport number

Signature

Attending Doctor’s Signature

Official Stamp

What the Kenya Airways Health Declaration Form Is and when it applies

The Kenya Airways Health Declaration Form is a passenger-facing document that records current health status, recent symptoms, recent travel and contact history, and consent to health screening and data sharing required for travel. Airlines, border health authorities, and public-health officials use the form to assess risk, enable contact tracing, and document compliance with destination or transit health entry rules. Many jurisdictions and carriers require completion before check-in or boarding; electronic completion and retention streamline processing while preserving a legal record of the passenger's self-declared health information.

Why completing this form matters for passengers and operators

Submitting a complete, accurate Kenya Airways Health Declaration Form reduces boarding delays, documents consent for required screenings, and helps carriers and health authorities comply with public-health entry requirements while creating an auditable record of the passenger's declarations.

Who completes and relies on the Health Declaration

The form is completed by travelers and used by airline staff, health authorities, and border officials to support safe travel.

Passengers — All travelers, including infants and minors, should complete the form prior to check-in or boarding to certify health status and contact details.
Airline Personnel — Check-in and gate staff verify submission and use responses to apply screening or deny boarding if required by policy.
Public-Health Authorities — Local or national health agencies may receive declarations for contact tracing and entry clearance when required.

Different recipients use the form for boarding decisions, contact tracing, or public-health reporting, depending on the destination and local rules.

Step-by-step: completing the health declaration before travel

Follow these steps in order to finish and submit the form before airline check-in.

01

Prepare documents: Have passport and booking reference handy.
02

Open the form: Use the airline app, website, or provided link.
03

Answer health questions: Respond to symptoms and exposure questions accurately.
04

Sign and submit: Sign electronically and submit before check-in deadline.

How electronic submission and verification typically flow

Electronic forms reduce processing time by routing answers, verifying identity, and storing an auditable record for staff and authorities.

Upload or open: Traveler opens form via airline link or app.
Identity check: System matches name and passport to booking.
Sign: Traveler signs electronically; timestamp captured.
Confirmation: Signed copy and certificate returned to traveler.

Technical considerations for eSubmission and storage

The form is typically accepted as PDF or a secure web form; platforms must support signatures, retention, and audit trails.

Supported Formats: PDF, DOCX, HTML supported
Authentication Options: Email link, SMS code, KBA where required
Integrations: Salesforce, Microsoft 365, Google Workspace

Typical online workflow settings for the form

Configure the form workflow to match airline and destination requirements, including authentication, reminders, and delivery.

Field Mapping	Map passport and booking reference to database
Authentication	Email link plus optional SMS code
Auto-Reminders	Send reminder 24–48 hours before departure
Data Retention	Retain per HIPAA and airline policy
Submission Destination	Airline server and public-health recipient

Essential sections contained in a professional declaration

A complete Kenya Airways Health Declaration Form combines identity, travel, medical, consent, and signature elements to create an auditable public-health record.

Passenger Information

Full legal name, date of birth, passport number, nationality, and contact details for immediate identification and follow-up if contact tracing is needed.

Travel Details

Flight number, seat assignment, departure and arrival airports, and booking reference link the declaration to a specific itinerary for operational checks.

Health Questions

Symptom checkboxes and recent exposure questions that determine whether additional screening or travel restrictions may apply on boarding.

Recent Travel History

Countries visited within a defined lookback period and dates for each trip to assess risk based on jurisdictional entry rules.

Consent and Declarations

Acknowledgement of truthfulness, consent to screening, and permission to share health data with relevant authorities where required by law.

Signature Block

Electronic signature and date plus an audit trail entry (timestamp, IP, email) that supports legal enforceability under ESIGN and UETA.

Security and compliance controls relevant to health declarations

Encryption in Transit: TLS 1.2/1.3

Encryption at Rest: AES-256

HIPAA Capability: BAA available

Audit Trail: Timestamp and IP log

Certifications: SOC 2 Type II

Legal Compliance: ESIGN and UETA

Consequences of an incorrect or incomplete declaration

Denied Boarding: Airline may refuse travel

Fines: Possible civil penalties

Quarantine Orders: Mandatory isolation may follow

Travel Delays: Extra screening and processing

Data Breach Liability: Regulatory fines and notices

Invalid Form: May require re-submission

Common mistakes to avoid when preparing the form

Entering names that do not exactly match passport entries causes verification failures and boarding delays at the gate.
Failing to disclose recent symptoms or exposures can result in denied boarding and potential penalties from health authorities.
Providing contact information you will not have while traveling prevents effective contact tracing and notifications.
Waiting until arrival at the airport to submit the form increases the risk of being unable to board if screening is required.

Timing expectations and common submission windows

Submission timing depends on airline and destination requirements; many carriers ask that passengers complete health declarations before check-in or within a specific pre-departure window.

Pre-Check-in Submission:

Complete before starting online check-in.

Common Time Window:

Often required within 24–72 hours of departure.

Airline Notifications:

Passenger receives confirmation on successful submission.

Health Authority Reporting:

Immediate reporting for positive responses where required.

Retain Signed Copy:

Keep digital copy until travel concludes.

Sample eSignature vendor comparison for submitting health declarations

Compare basic vendor traits relevant to securely collecting and retaining signed health declarations; signNow is listed first per page convention.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	Yes
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

FAQs and troubleshooting for the Kenya Airways Health Declaration Form

Answers to common questions about eSubmission, privacy, legal enforceability, and correcting or revoking a submitted declaration.

Need help? Contact support

Are electronic signatures accepted for this form?
Yes. Electronic signatures are generally legally valid under the ESIGN Act (15 U.S.C. ch. 96, 2000) and UETA where adopted. Acceptance can vary by destination authority; verify carrier and entry requirements before travel.
Does submitting the form share my health data?
Yes. Submitting typically shares relevant fields with the airline and, where required, public-health authorities. When PHI is involved, HIPAA protections apply and a Business Associate Agreement may be required for third-party processors.
What if I develop symptoms after I submit the form?
Report new symptoms to the airline and local health authorities immediately. An updated declaration or additional screening may be required; failure to report can lead to denial of travel or other public-health measures.
How can I correct a mistake after submission?
Contact the airline or submit a corrected declaration if the workflow allows amendments. Maintain copies of both submissions to document changes and the timing of corrections.
Can a parent sign for a minor?
Yes. A parent or legal guardian may complete and sign the declaration on behalf of a minor; carry documentation proving guardianship if requested by authorities.
How long is a submitted form valid?
Validity is set by the airline or destination. Many forms are valid only for a narrow pre-departure window (commonly 24–72 hours). Confirm with the carrier for exact validity rules.

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