【正文】 iring deeply inhaling oxygen, with facial cyanosis, and the health conditions may endanger himself or influence others, or myocardial infarction (The case of myocardial infarction occurred within six weeks before traveling).2. The person suffering from anemia with hematochrome level below 50% (Hb )3. The patient suffering from severe tympanitis with obstruction of eustachian tubes. patient suffering from spontaneous pneumothorax within past two weeks or received pneumoencephalography (PEG) of the nervous system. 5. The patient suffering from mediastinum tumour, serious hernia and intestinal obstruction.6. The patient suffering from head injury, intracranial hypertension and fracture of skull。四、必須提供《診斷證明書》的病患（傷）旅客：1．擔(dān)架旅客；2．需要提供飛機上醫(yī)療氧氣的病患旅客；3．肢體病傷旅客；4．承運人及其代理人懷疑在飛機上需要額外醫(yī)療服務(wù)的情況下，才能夠完成所需航程運輸?shù)穆每停?．懷孕期超過32周在36周以內(nèi)的孕婦。11．年事較高旅客。4．近兩周內(nèi)患自發(fā)性氣胸的病人或者做過氣腦造影的神經(jīng)系統(tǒng)病癥的患者。艙內(nèi)氣壓相當(dāng)于2300公尺（7000英尺）高度的大氣壓力，能引起體腔內(nèi)氣體的膨脹，同時也造成輕度的缺氧狀態(tài)。s and Contact： 旅客或其監(jiān)護人簽名Signature of Passenger /Guardian： 地面服務(wù)經(jīng)辦人簽名Signature of Ground Service Handler： 航空公司代表簽名Signature of HNA Representative：
說明：1．用途：用于特殊旅客自身狀況不穩(wěn)定或者自身原因乘機條件不充分，旅客認識到存在的風(fēng)險，堅持成行下填寫；或者需要旅客證實其旅行及有關(guān)證件或者其他情況符合始發(fā)地、經(jīng)停地、目的地所在國家的法律及其他有關(guān)規(guī)定時填寫。s own health status is unstable, must show county , it is or equivalent to first grade this (such as country two first rate ) whom the above hospital open can be seized the opportunity to prove to be at city level.□ 其他情況Others (3) 并且告知，在旅行開始之前，上述非正規(guī)情況必須加以糾正。the effective backward or continue ticket.□ 不能沒有過境國家所需的所有文件。the effective certificate of the destination country.□ 不能沒有有效的回程或者續(xù)程機票。Ill or because one39。Get off witness it is here, I sign this file on Date Month Year .旅客聯(lián)系地址及聯(lián)系方式Passenger39。 the third sheet is for passenger.136b附表 旅客運輸申明書（背面）參考資料下述內(nèi)容僅供航空旅行時參考：一、機上條件：1．飛機具有密封，增壓客艙的特點。3．嚴重的中耳炎，伴隨有耳咽管堵塞癥的患者。懷孕期在36周以內(nèi)超過32周的孕婦乘機，需具有醫(yī)生在72小時之內(nèi)簽署的診斷證明書。4．旅客不遵守公共民用航空運輸?shù)囊?guī)則，或者不聽從承運人的安排和勸導(dǎo)。ReferencesThe following contents are only for reference in air travel:I. Conditions on board 1. The airplane39。 3. The passenger with sick or wounded limbs。 6. Those passengers may require therapeutic bottled oxygen during flig