Oxygen concentrator form 2025

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The document is a medical authorization form for passengers using Portable Oxygen Concentrators (POCs) on Frontier Airlines. It outlines the requirements for physician approval, passenger responsibilities regarding the POC and battery supply, and instructions for airline personnel. The form must be completed by a physician to confirm the patient's ability to use the device and the necessity of oxygen during travel.

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Click ‘Get Form’ to open the oxygen concentrator form in the editor.
Begin by filling out the 'Passenger Information' section. Ensure you provide accurate details about your Portable Oxygen Concentrator, including its condition and battery supply for the journey.
Next, move to the 'Physician's Statement' section. Here, your physician will need to answer specific questions regarding your ability to use the device and whether oxygen is medically necessary during all phases of travel.
Ensure that your physician completes their information, including their name, telephone number, signature, and date at the bottom of the form.
Review all entries for accuracy before saving or printing the completed form. Retain a copy for your records and be prepared to present it when traveling.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (185 Votes)
2012	4 Satisfied (48 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are the two types of oxygen concentrators?

There are two types of oxygen concentrators: stationary and portable [9, 10]. Stationary (home) concentrators provide an uninterrupted oxygen supply with a flow ranging from 0.5 to 1015 Lmin1.

How to get free oxygen concentrator?

The Medicaid programs in many states cover up to 100% of the cost of a portable oxygen concentrator. The cover is for oxygen therapy. It must be medically necessary and fits the states DME definition. For coverage amount and qualification, contact your state Medicaid agency.

Which form of oxygen therapy is FAA approved?

Portable Oxygen Concentrators. Per the Federal Aviation Administration, certain portable oxygen concentrators are permitted onboard the aircraft, including Inogen One, Sequal Eclipse, Airsep Lifestyle.

How do you take oxygen on a plane?

You can use an FAA-approved portable oxygen concentrator (POC). You cant use compressed gas or liquid oxygen on the plane. When you make your reservation, tell the airline that youll be using oxygen during the flight. Bring extra POC batteries and your own nasal prongs.

Do you need a doctors note to fly with oxygen?

Pursuant to Federal Aviation Regulations, a customer who would like to use a portable oxygen concentrator unit on board an airline must obtain a written statement from his or her physician answering the questions listed below.