If an ATO has an instrument to act on behalf of CASA, test and write out certificates for Licences, Ratings ect. Then surely a Qualified and certified DESIGNATED aviation medical EXAMINER, can write out the certificates on behalf of CASA at the time of Medical. They already have the power to extend it for two months. OK so charge a bit extra for the old A4 paper, but unless you have a problem which may need to be referred to a CASA specialist, there should be no need for them to, wait for it DOUBLE HANDLED(govt Dept's a great for creating work already created). They are effectively, saying your a DAME but we do not trust you so we will just double check your work. BulshUt they are revenue raising.